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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone: 639-4175 Bus,.ie-: Phone: 639-4171
r-Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mach. Rc, i-in Fireplace
PosUBeam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mach. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Meeh.
Underflr. Insul. Shear Wall C Gyp Bd. -Elect.
Gate Requested: ,Z�-2 7 Time: AM ___PM
Address: kAj PL CK
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Data:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
`_Call For Reinsp.
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City of Tigard, Oregon
Rapid Damage Assessment Form
BUILDING DESCRIPTJON: OVERALL RATING: (Check one)
Name: Oo INSPECTED(Green) ❑
(' Exterior only
Address: t � t --� � Exterior &Intenor
LIMITED ENTRY (Yegow) ❑
' No.of Stories: UNSAFE (Red) O
' Basement: Yes 0 No 0 Unknown ❑
INSPECTOR
Primary Occupancy Inspector ID Dwelling 0 Affiliation
Other Residential 0 Commercia`/'-Office O
Industrial ❑ Public Assembly 0 School O INSPECTION DATE: Z � /
Government O Emer.Serv. O Hospital O Mo/day/year \ Z - -- -9 ---
Time _10 l �� 16m, )pm
Other
Instructions: Review structure for the conditions listed below. A "yes" answer to 1, Z 3,or 5 is grounds for
posting entire structure UP ISAFE. If more review is needed, post 1_]AMD ENTRY. A "yes" answer to 4
requires posting AREA UNSAFE and/or barricading around the hamrd.. Hazard., suet 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 U ❑
2 Building or story noticeably leaning ❑ A� 0
3. Severe racking of wall,obvious severe damage and distress 0 ❑
4. ClAmney,parapet or other falling hazard ❑ 0
5. Severe ground or slope movement present ❑ 0
6. Other hazard present: 0 � 0
Reco mendations:
9,-No further action required
0 Detailed Evaluation required (circle one) Structural Geotechnical Other _
O Barricades needed in the fV2u�.1mg areas:
N
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0 Other.
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Posted at this Assessment: Occupants Notified to Vacate Temp Housing Req.
❑Yes 'GNO 0 (Yes 0 Yes p(No ❑ ?
Comments: li-c� ? 3X G ��y--{ --• \
Estimated Damage ❑ % O 25% O 50% ❑ 100%
OFFICE USE ONLY