Adhesive Anchors Inspection Checklist for Concrete ... - · PDF fileAdhesive Anchors...

Hilti. Outperform. Outlast.

Version 02.2014

Adhesive Anchors Inspection Checklist for Concrete and MasonryPeriodic special must be performed where required in accordance with Section 1705.1.1 and Table 1705.3 of the 2012 IBC, or Section 1704.15 of the 2009 IBC and Table 1704.4 or Section 1704.13 of the 2006 or 2003 IBC, whereby periodic special inspection is defined in Section 1702.1 of the IBC and this report. (See Structural Drawings for Inspection requirements)

Project Name: _______________________________________________________________

Project Location: ____________________________________________________________

Weather: ______________________________ Air Temperature: ______________ (°F / °C)

CODES⃞ IBC 2003⃞ IBC 2006⃞ IBC 2009⃞ IBC 2012

Seismic Zone/Seismic Design Category

Product Name/Manufacturer: _____________________________________________________________________________________Lot No.: ________________________________________________________________________________________________________ICC-ES Report No.: ______________________________________________________________________________________________Adhesive expiration Date: ___/___/___ ⃞ Specified Dispenser ⃞ Specified MixerDiscard Initial Adhesive: _________ (# trigger pulls)Adhesive Tempature: ____________ (°F / °C) Gel Time: __________ Cure Time: __________(per manufacturers installation instructions)

t Type: ⃞ All-Thread ⃞ Internally Threaded ⃞ Torque-Controlled ⃞ Rebar ⃞ Other ______________ (SafesetTM only to be used with Hilti HIT-HY 200)

Material: ⃞ Standard ⃞ Stainless Steel ⃞ High StrengthSteel Grade/Coating: __________________ Length: __________________ (in/mm)Rod Diameter: ⃞ 3/8" ⃞ 1/2" ⃞ 5/8" ⃞ 3/4" ⃞ 7/8" ⃞ 1" ⃞ 1-1/4" ⃞ Other ______________Rebar: ⃞ #3 ⃞ #4 ⃞ #5 ⃞ #6 ⃞ #7 ⃞ #8 ⃞ #9 ⃞ Other ______________

l Base Material Type: ⃞ NW Concrete ⃞ LW Concrete ⃞ Brick ⃞ CMU ⃞ Other ______________Base Material Strength: ⃞ 2000 psi ⃞ 3000 psi ⃞ 4000 psi ⃞ Other ______________Base Material Thickness: ____________ (in/mm)Base Material Temperature: ____________ (°F / °C)

g Drill Bit Diameter: _____________ (in/mm) Hole Depth: ________________ (in/mm)(core bit diameter, if approved)

Drill Bit Type: ⃞ Carbide-Tip Drill Bit ⃞ Diamond Core Bit ⃞ Hollow Drill Bit ⃞ Other ______________ (ANSI B212.15-1994) (if appropriate and allowed) (SafesetTM only to be used with Hilti HIT-HY 200)

Hole Condition: ⃞ Dry ⃞ Water Saturated ⃞ Water Filled ⃞ Under WaterHole Cleaning: ⃞ Compressed Air ⃞ Hand Pump ⃞ Wire Brush ⃞ Other ______________Hole cleaning in accordance with manufacturers’ printed installation instructions: ⃞ Yes ⃞ No

ion Anchor Application: (please check all that apply) ⃞ Tension ⃞ Shear ⃞ Overhead ⃞ Other______________

Anchor insertion: ⃞ Twisting motion ⃞ Annular gap filled with adhesive ⃞ Air Void Free InjectionAnchor Spacing: _____________ (in/mm) Edge Distance: _______________ (in/mm)Embedment (hef): _____________ (in/mm) Installation Torque (if required): ___________ (ft-lb/Nm)

Completed by: __________________________________________________ (Signature) Date:_____/_____/_____

__________________________________________________ (Print) Company:____________________________________

__________________________________________________ (Title)

This form is for consideration for use by the responsible 3rd-party inspector.

Adhesive Anchors Inspection Checklist for Concrete ... - · PDF fileAdhesive Anchors...

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