12010159-SI H,....-....v--v^Or`+�„�Wi+�+:�ro��V1NbG•1JLy�✓� ,_ ..-.....�+u..M^^5+um�.-:+.wlJi.;7::i/}F.A�9S.W'aJa/°MV
L DSA File #
D DSAAppI. #
J 690 SUNOI STREET,BUILDING H•SAN JOSE,CA 9512 _ �
DSA Ap #
1 INSPECTIONS(408) 288-8460•FAx:(408) 271-0902
ANCHOR INSTALLATION INSPECTION REPORT
Cityof: �vPE�T/NU Date: .3 -(o-17__9 3 f
Project Name: 2 / 2 30 /AI/*V--S Tei►-) /0 / —Project# C l - 30
Address: 7,1230 I-16A rSTC-R>) ,Z/) Permit# 17,oI01
Inspectors Name: �J2K h Cf15%�GNGF- ID# y9
———————————————————————————--------------
Installation
-------------Installation Inspection of: ❑Epoxied-Re' clnmfQl� g 5FeeMwels OE-poxied•Alkhread-Anchors P pansion Anchors
❑Witnessed the drilling of the holes and verified proper diameter and depth.
(or)
Yt nspected predrilled holes and verified proper diameter and depth.
�Pobserved the cleaning of the holes and the injection I i se` ' n of 4571A en tJ ST/2yN4/fv t o 13 t i
epoxy-l-epoxyeapsnles-I-grout, ICC ER# /3f(.- Expiration Date NIS{--
f Mitnessed the proper insertion of:
(No.) S/g II diameter allthceedanchars / reinjg[cingsteel.dowels / xpan"slonancho ,
i inches in length,embedded 7 inches,at the following location: /NPO WA-I t r4bTiy456
S
r6/L ROOM 3/ (X/G) Roorh y9 �X/a �/ )POOP, 2/7 4x c) 7 Ray" Ni7 /X t7)
r
(NO.) lamete�llthrea .art hors / rein orcinggsstee dowels/ xpansio anchors
�in"ches i t len t:ddetd _inche tfhe folio g locati�
,(OQM 37- /7%NN4 Aux, N/A!.e X 2, Gl✓/A/L Plxl/N W41.X f l3EMowk AN X3�BFO,ftft A,2 KrI-CAI Z fA&ZI X/
/PIklP1 Y9- C�✓Iiv(� Qd//., X S, I�1N/;W ROM x 7 / flr-h #f X-3 /)Fi)47 X 7
(No.) - dia eter allthread anchors // reinforcinasp dowels xpans on a chors
inc Te: in lel tl, emb0'ddAl_n tcEl +. ;tt t0 a lowing location:
.0,901M 277_ -11Navf Rm„ Yz 46M XS7 Jcwl XS// arvecZ X3 , 6ML* x/
/ QOM 4S -DiV,a� Xy, LiyiNG X ID i 1)El)dI X7 3r&6_0C4U5CFX21Lmo Oz X!�r
-----�---------�7---------- ----- ------------
Notes: / -'am-c, o /O 4- C /NsT�vLc/ 5.9�/S
—————————— ———————————— ————————————— ——————
To the best of my knowledge,work inspected was in accordance with the building department approved design drawings,
specifications and applicable workma hip provisions of the C.B.C.except as noted above:
Inspectors' signature: `f/
I. VINSPECTIONS, Inc. DSA File #
690 SUNOL STREET, BUILDING H • SAN .JOSE, CA 95126 DSA Appl. #
(408) 288-8460 • FAX: (408) 271-0902 OSHPD #
J
PROOFLOAD QNR REPORT' 'f
City of: Ct1PC-W-Tiw0D 3- "l �'' Date: 3 -4 —/ Z—
Project
-d —/ LProject Name: Z 30 lklhe-5nE� tz—o 5 # CG/ —3p
Address: /Z 30 Permit #u12U�0/
Inspectors Name: L� �H ID # / 9
v
............................................................................... ..............
r
Applied tension proof load (lbs.) /Q�(foot-lbs.) of 9!> / S to / diameter
Ej(/�An+Sip� AN�tfai2 located in the ��S O�t-_ RGbMS
r •
e (No.) anchors of a total of installed were tested representing %
-w4h-kw6a_-at�apparent visual distress or failure. (No.) anchors failed to meet proof
c
s load requirements. Identified and reported failed anchors to
at the jobsite for appropriate action.
Notes:
r-
a"
ti•
>. App ied tension proof load (Ibs.)/torque load(foot-lbs.) of to diameter
located in the
s
(No.) anchors of a total of installed were tested re ting %
with/without apparent visual distress or failure. (No.) anchors i1911
to meet proof
load requirements. Identified and reported failed anchors to
at the jobsite for appropriate action.
4
Notes:
t.
Inspectors'signature:
Pul N0:6 499iW5a0 k