13965 SW 102ND AVE r s '•,,
City of Tigard, Oregon
Rapid Damage Assessment Form
BUILDING DESCRIPTION: OVERALL RATING: (Check one)
Name: INSPECTED (Green) 0(
//Exterior only
Address: \ -- WoC S \- \ � 2'" N V Exterior & Interior
LIMITED ENTRY (Yellow) ❑
No. of Stories: 1 UNSAFE (Red) U
Basement Yes ❑ No ❑ Unknown ❑
INSPECTOR: -C-
Inspector ■ C�
Primary Occupancy: Dwelling ❑ 1C-
Affiliation
Other Residential ❑ Commercial ❑ Office ❑
Industrial ❑ Public Assembly U School O INSPECTION DATE:
Government O Emer. Serv. O Hospital ❑ Mo /day %year 1 Z/\ ko / c T
Other Time am pm
Instructions: Review structure for the conditions listed below. A "yes" answer to 1, 2, 3, or 5 is grounds for
posting entire structure UNSAFE. If more review is needed, post LIMITED ENTRY. A "yes" answer to 4
requires posting AREA UNSAFE and /or barricading around the hazard. Hazards such as a toxic spill or an
asbestos release are covered by 6 and are to be posted and /or barricaded to indicate AREA UNSAFE.
Condition Yes No More Review
Needed
1. Collapse, partial collapse, or building off foundation ❑ It O
W 2. Building or story noticeably leaning CI
3. Severe racking of wall, obvious severe damage and distress ❑ 0
4. Chimney, parapet or other falling hazard ❑ alk 0
5. Severe ground or slope movement present ❑ 0
6. Other hazard present ❑ g 0
Recommendations:
U No further action required
Detailed Evaluation required (circle one) ' ctura' eotechnical Other
❑ Barricades needed in the following areas:
O Other.
Posted at this Aressment Occupants Notified to Vacate Temp Housing Req. .
❑ Yes OkNo ❑ Yes O Yes &o CI ?
Comments:
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s \--1 6)C A 1 ` ' 6 0 ( 3 9 5 `-,. „..),/
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Estimated Damage ❑ 0% J/U 25% O 50% O 100% $
`'C o, b oe. s ��(aw r\ ,, �\, , JFF� `LL\
•.CgY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection .0 c yv•—QJ
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. - Elect.
/!
Date Requested: ‘r?-1. 6/61 S r Time: AM PM
Address: \ '3S (pc ' ' - -
B u i l d e r : Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: •'2 /((0 f / " T
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
1 & _Call For Reinsp.
January 2, 1997
CITY OF TIGARD
13965 SW 102nd
OREGON
RE: 1995/1996 Storm Damage
We hope that you have recovered from the storm and that you are not experiencing any
difficulties related to storm damage. As you will recall, following the 1995/1996 Storm, a
staff member of the City of Tigard Building Division performed an inspection at the above
noted address, to assess storm damage. At that time you were left a notice regarding the
need for a permit to cover the necessary repairs.
Our records indicate that a Building Permit has not been obtained for the repair. Permits
and inspections required by the Tigard Municipal Code are an important part of your
repair project. Permits help to ensure that work is done in compliance with minimum code
requirements. Inspections are intended to protect the occupants of buildings and building
owners. If the work has already been done, we can still inspect it for compliance with the
code.
ALL FEES WILL BE WAIVED FOR BUILDING PERMITS TO REPAIR STORM
DAMAGE.
Enclosed are the necessary permit applications along with supplemental
information/instructions.
Please submit, in person, the necessary application materials to DEVELOPMENT
SERVICES, 13125 SW Hall Blvd. Or, if you have questions regarding the permit
process, contact DEVELOPMENT SERVICES at 639 -4171 ext. 304.
Thank You,
Jill Aldrich, Customer Service Manager
Development Services
jeannostorm
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
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