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OTTO ROSENAU & ASSOCIATES, INC. Geotechnical Engineering,Construction Inspection&Materials Testing PROPRIETARY ANCHOR ADHESIVE INSPECTION REPORT Job Number: 16-0804b Report Number: 325359 Permit Number: C1602-020 to 02 Project: Eclipse Townhomes-Bldg. 19 Client: Polygon Northwest Address: 3511 31s'Drive,Everett Address: 11624 SE 5'h Street,Bellevue Inspector: Essaw Tesema Date: 12/28/2016 - i Description/Location: Inspected the epoxy grouted installation of(24)#5 bar horizontal reinforcing steel dowels into existing concrete using Simpson Set-XP epoxy adhesive to form a beam at grid lines: 1/A.6-B and 6/A.6-B per sketch from CT Engineering, Inc.dated 12/21/2016 CT-06. Intended Use: Reinforcing steel dowels for beam Building Code&Year: IBC 2012 ®Reinforcing Steel ❑All Thread Bar/Dowel Size&Quantity: #5(24) Anchor Size&Quantity: Rebar Manufacturer: Japan Type of Steel(ASTM): ❑A-36 ❑F-1554 ❑A-307 Rebar Grade: ❑40 ®60 ❑Other: Grade: ❑36 ❑50 ❑75❑Other: Type of Bar: ®A-615 ❑A-706 ❑A-775 ❑Other: Special Ductile Quality(SDQ): ❑Yes ❑ No Anchor Length: 4' Hole Depth: 61/4' Required Embedment: 6" Hole Diameter: '/." Concrete Thickness: - Concrete Strength: 3000 psi Hole Orientation: ❑Vertical Down ❑Vertical Up ® Horizontal Base Material: ® Normal Weight Concrete ❑ Light Weight Concrete ❑CMU ❑ Brick ❑Composite Deck Hole Cleaning: ®Compressed Air ❑ Hand Pump ❑Other: Compressed Air PSI: F Brushed: ®Yes ❑No Hole Condition: ❑Dry ❑Damp ❑Water Saturated ❑Submerged Drill Bit(ANSI B212.15): ❑Yes ® No Approved Diamond Cored Hole: ❑Yes ®No Adhesive Type: Simpson Set-XP Expiration Date: 11/07/2017 ICC ESR#: 2508 Weather: Cloudy Ambient Temperature: 42° Substrate Temperature: 35° Comments Reference Standard(s)Used: Conforms X Does Not Conform Copies to: Client X Engineer Others / _ Owner X Contractor Technical Responsibility: Architect Building Dept. alter Hansen,Project Manager This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau&Associates,Inc. Reproduction of this report, except in full,without written permission from our firm is strictly prohibited. Page 1 of 1 6747 M.L.King Way S.,Seattle,Washington 98118-Phone(206)725-4600 or 1-888-OTTO-4-US-Fax(206)723-2221 Fonn No.:ADMIN-86-02(Rev. 05/13)