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OTTO ROSENAU & ASSOCIATES, INC. <br /> Geotechnical Engineering, Construction Inspection & Materials Testing <br /> PROPRIETARY ANCHOR ADHESIVE INSPECTION REPORT <br /> Report Number: PAA468347 Job No.: 24-0053 <br /> Project Name: Waterline Gym Permit: B2306-070 <br /> Project Address: 2900 Grand Avenue, Units 4, 5, Everett <br /> Inspector: John Fraser (WABO#: SI 02055) <br /> Client Name: CH Grand LLC Insp. Date:05/08/2024 <br /> Description / Location / Intended Use J <br /> West Mezzanine: SOMD tie-in dowels <br /> *RFI#004 from Matt Wion— QCE 518124 specified use of grade 40 reinforcing steel <br /> [Building Code &Year: Secure dowels to existing wall <br /> ❑� Reinforcing Steel II Thread <br /> Bar/Dowel Size &Quantity: #4 (23) Anchor Size&Quantity: <br /> Rebar Manufacturer: Nucor Type of Steel (ASTM): ❑ A-36 ❑ F-1554 ❑ A-307 <br /> Rebar Grade 0 40 ❑60 ❑Other: Grade: ❑ 36 ❑ 50 ❑ 75 ❑ Other: <br /> Type of Bar VA-615 ❑A-706 ❑Other: Does Contractor Need to Schedule Torque Verification? ❑ Yes No <br /> Special Ductile Quality(SDQ) Steel: No Reason (If No): <br /> Anchor Length: 8" Hole Depth: 6" Required Embedment: 4.5" <br /> Hole Diameter: 9/16" Concrete Thickness: 12"+ Concrete Strength: Existing <br /> Hole Orientation: ❑Vertical Down ❑ Upwardly Inclined W Horizontal <br /> Base Material: W Normal Weight Concrete ❑ Lightweight Concrete ❑ CMU ❑ Brick ❑ Composite Deck <br /> Hole Cleaning: ❑Compressed Air ❑ Hand Pump Vacuum Drill Bit ❑ Other <br /> Compressed Air PSI: NA Drill Bit (ANSI B212.15): Yes <br /> Brushed: Yes Hole Condition: W Dry ❑ Damp ❑ Water Saturated ❑ Submerged <br /> Adhesive Manufacturer/Type: Simpson Set 3G Expiration Date: 10/2024 ICC ESR#: 4057 <br /> Certified Installers: <br /> Weather: Indoors Ambient Temperature: 64 Substrate Temperature: 65 <br /> Reference Standard(s) Used: IBC 2015 Conforms? 0 Yes ❑ No <br /> Comments: <br /> Copies to: Date: 2024.05.15 <br /> Mac <br /> ❑ <br /> 1 Client Owner ❑d❑4 Engineer Contractor ❑ Others Technical Responsibility: (J `%�"���// 05:14:41 -07'00' <br /> d❑Architect ❑d Building Dept Isaac Ruoff, Project Manager <br /> This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau&Associates, Inc. Reproduction of this <br /> report except in full,without written permission from our firm is strictly prohibited. <br /> 6747 M.L.King Way S.,Seattle,Washington 98118-Phone(206)725-4600--Fax(206)723-2221 <br /> Form No.:ADMIN-86-04(Rev 01124) Page 1 of 1 <br />