Laserfiche WebLink
Adhesive Anchors Inspection Checklist for Concrete & Masonry <br /> Special Inspection shall be in compliance with Section 1701 of the UBC and Section 1704 of the IBC as describerd <br /> below. (See Structural Drawings for Inspection requirements) <br /> CODES <br /> Project Name: 09040 $cwcut_ ?W4sire L i4to, OUBC 1997 BRAUN <br /> O <br /> —-- IBC 2000 <br /> nn-- O IBC 2003 I N T E RT E C <br /> Weather: I� Air Temperature: <br /> 'C) 4kI8C Zoos <br /> Product Name/Manufacturer. 044L" Y JSV M4X <br /> Lot No.: Wo 0(af 767 <br /> ICC-ES Report No.: A—U O 1 3 57 9— 1O0-z4,5,0__ <br /> Adhesive expiration Date:,0_t/0_&/2W ❑ Specified Dispenser a�Specified Mixer <br /> Discard Initial Adhesive: 3 (#trigger pulls) <br /> Adhesive Tempature: f!"O°F (°F/°C) <br /> Gel Time: 5! ill Cure Time: 30Mt� <br /> (per manufacturers unstapation instructions) <br /> Type: ❑All-Thread ❑ Internally Threaded ❑ Torque-Controlled 'Rebar ❑ Other <br /> Material: 4q Standard ❑ Stainless Steel ❑ High Strength <br /> Steel Grade/Coating: (CO <br /> Length: VArt1r-S (irVrtyN <br /> Rod Diameter ❑ 3/8" 111/2* ❑ 5/8" ❑3/4" ❑ 7/8" ❑ 1" ❑ 1 1/4" <br /> Rebar. ❑ #3 :K#4 X#5 ❑ #6 ❑ #7 ❑ #8 ❑ #9 ❑ #10. <br /> ❑ #11 ❑Others <br /> Base Material Type: ;&M Concrete ❑ LW Concrete ❑ Brick ❑ CMU ❑other <br /> Base Material Strength: ❑ 2000psi ❑3000psi ❑ 4000psi ❑Other U49&aw� <br /> Base Material Thickness. WA (in/mm) <br /> Base Material Ternporature: 1o*F (°F/°C) <br /> N / k <br /> Drip Bit Diameter. S 8 (ttthrxrt) Hole Depth: 1Prf (irt/nrn) <br /> (core bit chmneter.if approved) <br /> Drill Bit Type: Carbide-Tip Drip Blt ❑ Diamond Core Bit ❑Other - <br /> (ANSI 8212.15-19" of apipmpdata and ak w 4 <br /> Hole Condition: dR.pry ❑ Water Saturated ❑ Water Filled ❑ Under Water <br /> Hole Cleaning: Wornprossed Air ❑ Hand Pymp Owitre Brush ❑ Nylon Brush ❑ Other <br /> Hole cleaning in accordance with manufacturers' printed installation insUWIons: SKYes ❑ No <br /> Anchor Application: (please dneck as that appy ❑ Tension ❑Shear ❑ova-head ❑ Other <br /> Anchor insertion: 0 Twisting motion ❑Annular gap filled with adhesive ❑Air Void Free Injection <br /> Anchor Spacing: G ' 2a°/_� ) Edge Distance: Qn1mm) <br /> Embedment (hef): r in/mrn) Installation Torque(d requinxQ:_W_(ft-IbMm) <br /> Completed by: (Signature) Date: <br /> VanN0092W7 <br />