Form 851 - Post-Installed Mechanical Anchorage Clearance Report Page 2
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2Use of this form serves as a Quality Assurance Agency Special Inspection Agreement between Building Official, Owner and Quality Assurance
Agency for the purposes of special inspection per Section 22.02.515 of the Building Administrative Code of Clark County.
POST-INSTALLED ADHESIVE ANCHOR CLEARANCE PROCEDURE
SPECIAL CASES: C-E
THIS FORM IS AVAILABLE AT THE CLARK COUNTY BUILDING DEPARTMENT WEB SITE AND LISTED
PRIME AGENCIES
1. The clearance report shall be used for post-installed mechanical anchorage systems as identified in the
approved plans and used as an alternate to the specified cast-in-place anchor.
2. The quality assurance agency special inspector shall complete the report for the work performed and leave
a copy with the general contractor or permit holder.
(At this point an engineer from the special inspection agency will not have sealed the report.)
3. The report shall be given to the Clark County Building Department (CCBD) Inspector as assurance that
mechanical anchorage system installations have been inspected and accepted by the Quality Assurance
Agency (QAA), prior to or at shear wall inspection.
4. The CCBD inspector shall initial the report then place the report into a designated basket in the inspections
office. The designated basket will be located at the public counter.
5. A Building Permit Specialist shall enter the clearance requirement for mechanical anchorage into the
required inspection screen for the permit listed on the form. The clearance shall be established at the hold
point prior to a framing inspection.
6. The structural group will review and disposition the engineer sealed mechanical anchorage report. Both
the field copy and the engineered sealed copy must be received by CCBD staff prior to the removal of the
hold point.
7. The engineer sealed report form shall be sent to CCBD records by the CCBD staff.
Mechanical Anchorage of Rods/Bolts Form
Go to our web site and select forms.
Form 811
10/17/2012
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