Michigan Department of Transportation

1451 (02/19)

NON-FRANGIBLE LIGHT STANDARD INSTALLATION INSPECTION REPORT

To be completed in conjunction with Non-Frangible Light Standard Installation Inspection Procedure and submitted to the Structural Fabrication Unit.

File Naming Convention: 1451 SM-CS-JN Date.pdf

PAGE 1 OF 1

GENERAL INFORMATION

STATION MARK CONTROL SECTION JOB NUMBER DATE

REGION COUNTY ROUTE

LOCATION DESCRIPTION

GPS LAT

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GPS LONG

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STRUCTURE INFORMATION

ARM TYPE SINGLE

DOUBLE

NUMBER OF ARMS ARM TO UPRIGHT CONNECTIONS WELDS

BOLTS

UPRIGHT LEAN COATING GALVANIZED PAINTED ALUMINUM

STRUCTURE BASE & FOUNDATION INSPECTION

WELDS

FOUNDATION

ANCHOR BOLT ID# ANCHOR BOLT DIAMETER BOLT CIRCLE DIAMETER (BC)

ANCHOR BOLT INSPECTION

SOUNDING ANCHOR NUTS

1 2 3 4

ANCHOR BOLT PROJECTION (P)

1 2 3 4

STAND-OFF DISTANCE (S)

1 2 3 4

ULTRASONIC TESTING

1 2 3 4

REMARKS

INSPECTOR COMPANY