14890 SW 109TH AVENUE ADDRESS:
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CITY OF TIGARD BUILDING INSPECTION DIVISION dZf
cCC„
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested a,M, PIVI BLD —
r
Location C Suite
' MEC
Contact Person Ph PLM _
Contractor i�,� _ SWR
13UILDiNG Tenant/Owner
Retaining Wall ELR
Footing
Access- InC rG FPS
Ftg Grain
Crawl Drain Ir SGN
Slab Not Requested —'
Post&Beam Found During Research SIT _
Ext Sheath/Shear LNo insnection(s) In File
Int Sheath/Shear ---
Framing
:nsulation — -- --
Drywall Nailing —
Firewall --
Fire Sprinkler
Fire Alarm — --
Susp'd Ceiling
Roof
Misc:
Final
PASS PAR-i FAIL - - —_
PLUMBING
Post& Beam
Under Slab
Top Out - -----_. --- _
Water Service
Senitary Sewer ---- --- - --- -�� — --- -- --
Rain Drains
Final ----- -- ----- - - -
PASS PART FAIL
MECHANICAL i-
Post& Bearn ---- - - ---- - - - - -- --
Rough In Gas Line
--- -.
Smoke Dampers ----- ----v�--
Final
PASS PART FAIL
ELECTRICAL - - -- ------ -- -–
Service
Rough In -- --
Lr UG/Slab
Low Voltage -- ---- - __ - -_
~' Fire Alarm
--' Final
PASS PART FAIL
SITE ---------- .__
Backfill/Grading --
Ianitary Sewer
Storm Grain ( ]Rei.rspection fee of$ required before next inspection. Pay at City Hall, 13175 SW Hall Blvd
Catch Base
Fire Supply Line ( ]Please call for reinspection RE: _ ( j Unable to inspect-no access
ADA
Approar,h/Side"alk
Other _ Date Inspector Ext
Final -�--
PASS -PART FAIL DO NOT REMOVE this inspection record from the job site.
17
PERMT
. CITY QF TIGARD PERMIR1#: EI_'C96I0200
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/08/96
13125 SW Hall Blvd.Tigard,Oregon 07223.8190 (503)839-4171 I_')RCGL: I=S 1 10HD-900:x0
SIT'._ 41)DRE-_SS. . . : 14890 3W 109TH AVC
SUB1)I V T S I ON. . . . : CANTERBUU RY WOODS CONDOMINIUM ZONING:R-1;
BLOCK. . . . . . . . . : '_;JT. . . . . . . . . . . . . :30
Pruj-•ct Description: Install one branch circItit dIte to storm r amage. ✓
----RESIDFi\rriAL UNIT-..--- ----TEMPI E-1RVC/FEEDERS------ -----MISCELLANEOUS•-•-----
1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 !-,lJMF'/IRRIC ITION. . . . : 0
EACH ADD' L. 50C SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE= LTD. . : 0
LIMITED ENERGY. . . . . : 0 401 -- 600 amp. . . . . . . : 0 S I GNAI_!FIANEI_. . . . . . . ; 0
MANE. HM/ SVC/FDR. . : 0 601+am.-as-1000 volts. : 0 MINOR LABEL (10) . . . : 0
- --SERVTCE/FE'--DI::R----- - ----BRANCH CIRC:UITS:i_______ _-.-_ADD' L INSPECTIONS-.--.
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER INSPECTION. . . . . : 0
c-01 - 400 yam o. . . . . . : 0 1st W/O SRVC OR F'PR. : 1 PER HOUR. . . . . . . . . . . : 0
401 600 amp. . . . . . 11 0 EA ADD' L BRNCH CIRC: 0 IN PLANT, . . . . . . . . . . ; 0
601 1000 amp. . . . . : 0 -_----- - --- ----FLAN REVIEW SECT ION--_.._.___._._...__.____...._....
1000+ amp/volt. . . . . : 0 ) =4 IBES UNITS. . . . . . . . ) 600 VOLT NOMIIIAL. .
Reconnect only. . . . . : 0 SVC/FDR > = 225 4Mr-'S. . : CLASS AREA/SPIEC OCC. :
biyner: --______._.__.____..._.__-__.____._.______.._-___._.__________.__ FE=ES
CMI PROPERTY MANAGEMENT typk- amol-Int by date recpt
1-:'713 SW ARTHUR PRMT $ 0. 00 CJS 04/08/96 STORM
r'CT $ 0. 00 CJS 04/08/96 STORM
PORTLAND DR 997201.
Phone #: 503--224-2295
I30SE CIT`/ ELECTRIC CO E 0. 00 TOTAL
401 : NE CULLY BLVD
- --- REQUIRED I NSPECT I GNS
1'IGARD OR 17213 Wall Cover Elect' 1 Firal
Phone #: 503--287-6164 Elect' 1 Service
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Flermittee Signati-Ire
apolicable laws. All work will be done in accordance with
approved plans, This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for sore
than 180 days. IsSUed By
.----------------OWNER INSSTALL_ATION
The installation is being made on property I c,wn which is .lot intended for
stale, ].ease, or r-ent.
rL OWNER' S SIGNATURE: DATE:
-
INSTALI-.ATION ONLY-------------
) --
SIGNATURE OF SUF'R_ CLEC' N: DATE: O
;' i ICENSE NO:
Call for inspection 639-4175
• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Pec. ft Stam
Permit # El.Cgj� -0,112o
Phone (503) 639-4171 Date Issued
CITY OF TIGARDFAX (503) 684-7297
TDD No. (503) 684 7. Issued by
Inspection (503) 639-4175
1. Job Address: [Complete Fee Schedule Below:
Name of Development+ '`��" }� _ Number of Inspections per permit allowed
Andress_ � e) �[�CJ_ /�' 5ervica included: Items Cost(ea) Sum
Jl a
City/State/Zip- / ! �__ 4n. Res dential-per unit
1(00 sq it or lona $11000
Name (or name of business)_ E rd,additional 500 sq II or 1
oortionlhaisof $2500
Commercial❑ Residential L 1 Bed Energy —� .25(!0
Eac•Manufd Home or Modular 2
Dwei''ng Serves or Feeder 00 _
.ea. Contractor Ins allstion only: 4b.Services or Feeders
= _- Irrot00a amps
or to ion,or relocation — 2
l lectricai Contractoree lieif 200 amps or le's $60 00 2
djreSS 201 imps to 41 0 amps $8000 2
CIAt� State Zip 401 arnpe'to SL'amps $12000 2
`7 p�C_,L__ 60 ampa Io 1C00 amps $180 00 2
Phone No. ;i-- _ Ove 1000 amps or vont: &34000 2
Contractor's License No. _ Reconnect only $5000
Contractor's Board Reg. No. � jQ 1 4c.Temporary Services or Feeders
Irntallalwn,alteralion,or relocation 2
Signature of Su r. Elec'n 20 imps or Ince W00 2
201 amps to 400 amps $75 00 2
License No. Phone No. 401 amps to 600 amps $10000
Over 600 amps to 1000 volts
2b. For owner installations: see W above
4d. Branch Circuits
Print Owner's Name New,alteration or exionmon per panel
Address a)The fen for branch circuits with
City _ State 7_ip
purchase of service or Nader rata. 2
-'- Each branch CIICU11 _ $5 6t, _
Phone No. b1 The fee for branch crcuts wifhou(_
The installation is tieing made on property I own which is purchase of seryl;•or feeder Ne. t
not intended for sale, lease or rent. First branch lt s 15 00 � 2
Each additional bbranch yrcuit $500
Owner's Signature _ _ 4e. Miscoliensouo
(Service or feeder not inciuded) 2
3. Plan Reviews ,ection (it required): Each pump or irrigation circle $4000 2
Earn sign at outline lighting "0 00
Signal circuits)or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel.allerahon or extension $40 00
4 or more residential units in one structure Minor Labels(10) $10000
Service and feeder 225 amps or more
l System over 600'volts nominal 41. Each additional inspection over
N the allowable to an of the above
Classified area or structure containing special occupancy y
�- —� Pnr irr,ryKnon $3500
as de�aibecf in N E C Chapter 5 —.
hour $5500
In r'IFlM
Submit 2 sale of plans with application where any of the above
apply. Nut required for temporary construction services.
5. Fees:
LLI NOTICE 5a. Enter tole)of above foes $
5%Surcharge(05 X total foes) $ s
PERMITS BECOME VOID IF WORK CR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if roquirpd(Sec 3) $ _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account N
Balance Du s
F �— ELECTRICPL PERMIT
CITY OF TIGARD DfATEIISSUEDI:C96-0198 04/00/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.1.lgard,ohagon 97223.6199 ,503)639.4171 PARCEL: ;='ra 1 10AD-9003:'
�-31TC_ ADDRESS. . . : 14894 SW ? 09TH AVE
SUBDIVISION. . . . .' CA?!TE P�iU RY `MOODS CONDOMINIUM ZONING: R-1
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .
32
Plr^o.ject Description : Install one branch circuit dk.te to storm damage.
----RESIDENTIAL UNIT----- ---'TEMP' SRVC/FE:EDERS---- --•---MISCELI-ANEOUS----•-
1001 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . , : 0
0 C.
- 400 amp. . . . . . . : 0 SIGN/LOUT LINE: LTU. . : 0
EACH ADD' L 5005F. . .
LIMITED FNERGY. . . . . : 0 401 -- 600 amp. . . . . . . : 0 SIGNAL/P'AF.EL. . . . . . . : 0
rIANF. HM/ SVC/FDR. . : 0 601+amps•--1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
-._-SERV ICE/FEEDER------ -----BRANCII CIFRCI.IITS----•- --_ADD' L INSPECTIONS--___.-
QI - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
"_01 - 400 am p. . . . . . : 0 1 st W/O SRVC 7R FDR. : 1 PEP. HOUR. . . . . . . . . . . 0
401 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
G01 - 1000 amp. . . . . : 0 ___-- --- ---__--___._PLAN REVIEW SECT ION- --_..-..__------.--- -__
L000+ e.mp/volt. . . . . : 0 > =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FUR > _ EE5 AMP'S. . : CLASS ARCA/SPEC OCC. :
Owner: __._ __._..______._._._._..__._.___.._._______._.__.._._._---.._.__.__.._.__.__... FEES -•--_-_.--
("MT PROPERTY M(INAGEMEPIT 'ype amount by date recpc
C'78 5e' ARTHUR F'4M"f s 0. 00 CJS 04/08/96 STORM
5P'..T $ 0. 00 CJS 04/08/96 STORM
IDORTLAND OR 9712101
Phone #: 503-224-2295
(_ontract ov-:
ROSE CITY ELECTRIC CO r" 0. 00 TOTAL
4012 NE CULLY BLVD
REQUIRED INSPECTIONS
TiGARD OR 97 :13 Wall Cover F_lect' l Final
V,tione #: 503-287-6164 Elect' l Sei vice
Reg #. . : 3567
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other P'er~mittee SignatUt-e
applicable laws. All work will ba done in accordance with
approved plans. This permit will expire if work is not started a'
within IRO days of issuance, or :f work is suspended for more (,�� <��►�tG
gran 'd0 days. I ssl.ied By
INSTALLATIOhI ONLY-- -______.__.______..._.-•-.----_._.....
TThe installation is being made on proper-ty I own which is not intended far
a sale, lease, or rent.
V; OWNER' S S I GNA•F URE: DATE:
-•-----CONTRACTOR INSTALLATIOIV ONLY----- - -- --- -----______.___
.CO SIGNATURE OF SUPR. ELEC:' N s _Q� a �c�f.!U12.________.—___ DATE: _y 46'
LL:
LICENSE IVO:
Call for inspection - 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
1„125 SVS Hall Blvd.
Tigari, OR 97223 Planck/Rec. # _
Permit # f cQS -010?
Phone (503) 639-4171 Date Issued _-R. 96
CITY OF TIGARD FAX (503) 684-7297 Issued by L"hcz, r
TDD No. (503) 684-2772
Inspection '503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Developmert L 6uox( Number of Inspections per permit alkwed
Address l f/Q QL/ S - _ Service included Items Cost(ea) Sum
Ciy/State/Zip__7'C�� 4QV 4s. Residential-per unit 4
1000 scl It or lose $11000
Name (or name of business) Each additional 500 eq It or
portior thereof $2500 _
Commercial ❑ Residenti 31 ❑ Limited Energy $2500 L
Each Manu1'd dome or Modular
Dwelling Service or Feeder $88 00
2a. Contractor installation only:
I.Services or Feeders
y Irx.tallation,allernbon,or relocation 2
Electricai Contractor_ �+ 200 amps or lens Vo 00 2
PilAddress 0 _ /, l 201 amps to 400 ami u+0 2
401 amps to 800 amps $12000
00 2
city State Gti” Zip Y_ sot amry to 1000 amps $19000 2
Phone No. Over 100 ample or volle $34000 2
�—
Contractor's License No. a2(Qlf�G _ _ Reconnect only $5000
Contractor's Board Reg. No. Y z 4c.Temporary Services or Feeders
Installation,alterat.on,or relocation 2
S ` 200 amps or lees $50 00 2
Signature of Supr. Elec�'� - ?
License No. p 7 Phone No. l 201 amps to 400 ample -- 100$7500
401 amps l0 800 simple 1100 DO
Over 800 snipe to 1000 volts
2b. For owner k1stallations: see•b•above
4d. Branch Circuits
Print 7wner's Name _ New,alteration or extension par panel
Addre'3s a)The fee for branch circuits with
City— State Zip_— purchase of mmke or Moder foo. 2
Each branch circuit S500
Phone N0. b)The lee for branch circior without
The installation is being made on prc,)erty I own which is purche.e of evill or Medi"W. - — 2
not intended for sale, lease or rent. Feat branch —_ E$5 0
Each additional
al bbranch circuitSr5 OU
Owner's Signature 4e. Miscellaneous
(Service(,I feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $4000
Each sign or outline lighting $4000
Signal cimud(s)or a limited energy '-
Please check spr aisle item and enter fee in section 5B. panel,alteration or extension $4000
4 or more reside rtial units in one structure Minor Labels(10) $10000 ^_
_ Service and feeder 225 amps or more
System mer 600 volts nominal 4t. Each additional Inspection over
Classifies'area or structure containing spHcial occupancy the allowable in any of the above
t.s described in N E C Chapter 5 r� ,.IM e,, $3500 _
r��r hrnu $55 00 _
' and $55 00
:vubmil 2 sets of plans with application where any of the above --
apply. Not required for temporary construction services. 5. Fees:
r: 5a. Enter total of above fees
NOTICE 51%Surcharge(05 X total fees) $ s
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25/of line A for
CONSTRUCTION OR WORK IS St1SPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS A"i ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust h count fY $
Balance Due $ 3(�r
.�enarre.wrxom�o -C�7 �"'7v
' MriZTER PERMITPERMITP;:7MIT #h. . . . . . . : MSTr3f) -0067CITY OF
TIGARD
DATU, ISSUED: 1,13/2,7/9E.
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171 PnRCEL.; 2 a 1 10AD- :312► �r11
;UBDIVISION. . . . : CAN"iURBUURY WOODS CUNi,OIv11NIUDI ZONING: R--12
'LUCK. . . . . . . . . . . L01.. . . . . . . . . . . . . .;1701
2earks: Comenn garage re: permits alio for 14888, 14892, and 14894 sw 109th
BUIL')IMG --- -------------------------.------------ -------
ISS;;E; ST3RIES.......: 2 FLOCK AREAS------ --- BASEMENT...: 3 sf REOUIRED SETBACKS---- REOUIRED----------
'LASS OF WORK.:REP ICIGH.........: 0 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: 0 SMOKE DETECTRS:
'YPE OF USE...:MF FLOOR LOAD....: 0 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0
-YPE OF CINJST.:SN DW-LING UNIT": 0 FINBSMENT: 0 J RIGHT.........: 0
:XUPANCY GRP,;R3 BDRM: 0 BATH: 0 TOTAL------: 0 sf VALUE..1: 3950 REAR.,,.......: 0
-.--------------- __ _ _ __ Pi.UMBIM -----------------•-------••---------------
..Iwo.........: 0 WATER CLOSETS. 0 WASHING M�c'0..s 0 IAL1NDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 3
AVATOtIES..... 0 DIG4MC-RS...; 0 FLOOR DRr S..; 0 SEWER LINE ft: 0 Sr RAIN MAIDS; 0 CATCH BASING..: C
'JB/SHOWERS...; 0 GARBAGE LISP—; 0 WATER �'_AXRS.: 0 WATER LINE ft: 2 BCKFLW PREVNTR: 0 GREASE TRAPS..: 2
OTHER FIXTURES: 0
. ----------- __. __- MCD%NICAL ---
-jEL TYPES----------- FURN ! 100K ..: 0 BOIL/CMP ( JHP: 0 VCA? FANS.,.,.: 0 CLOTHES DRYERS: F
FUP.N )=100K ..: 0 UNIT HEATERS..: 0 hConS........... 0 OTHER UNITS...: 0
!IX INP.; 0 BTU FLOOR FURNACES: 0 VENTS.......... u WMr.;TOVES....: 0 GAS OUTLETS...: 0
ELECTRICAL
-RESIDENTIAL L.NNU -- ---SCRVICE/FEEDER•--- --TEMP SRVC/FEEDERS-- •---BRAir1CH CIRCUITS--- ----MISCELLANEOUS-- .--ADD'L INSPECTION:
'3A0 SF OR LESS: 0 0 - 200 nap..: 0 0 - 200 alp-1 0 W/S'X OR FDR..; 0 P7T./IRRIGATION., 0 PER 'WA-CTION: C
'A ADD'L MSF.: 0 201 - 400 0 201 - 400 asp..1 0 1st W/O SVC/FDR: E SIGN/OUT LIN LT: 0 PER NOIIR......i e
'MITED ENERGY.. 0 401 - 600 a.; _: 0 401 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
INF )IM/SVC/FDR: 0 601 - 1000 alp.: 0 601+81ps-1000 v: 0 MINOR LABEL 10: 0
1000+ map/volt.. 0 _..____.._._______..___..____.---__.__-.. PLAN REVIEW SECTION
Reconnect only.1 0 )-4 RES UNITS..: SVC/FDR)=22S A.: > 600 V NOMINIAL: a^ 1'REA/SPC OCC:
__._....__..._..___..___._.______-----..__-- ELECTRICAL - RESTRIC7El) ENERGY -.__ ._.. ..._
A. 5' RESIDENTIAL---.----------------------_ B. CMRCIAL--------------------------------------------------------------------------------
!UDIO 8 STEREO.: VACUUM SYSTEM..: AUDIC & STEREO.: FIRE ALAPM...... INTERCOM/PAGING: OUTDOOI LNGCC LT:
"JRGI.AR ALARM..; 0tH: 1; )OILER.........: HVAC...........: LANDTAPE/IRRIG: PROTECTIVE SIGN.:
IRAGE OPEKR... :LOCK........... INSTRNENTA'ION: MEDICAL........: OTHIR: ::
VAC...........: DATA/TELE CO", NURIT CALLS....: TOTAL M SYSTEMS; 0
--__.-__
..nar; .___._---. ....._._...__..__.. ontractar: .... .... _..._..._... _.._.. __.._. SAL F S:f 0.
11 PROPERTY MANAGEMENT HORIZON RESTORATIONS
'76 SW ARTHUR 16176 SW 72ND AVENUE
3RTL►'.ND GR 11,731 TIGARD OR 97224
-4one It 503-224-205 Phone #: 503-620-2,215
Fl Reg C.: 46081
N lis permit is issuid subject to the regulations ccrtained in the Tigard Municipal Code, State of Ore. Specialty Codes end all other
pplicacle la++s. A,1 work will be done in a cordance with approved plans. This permit will expire if work k not started within log
�~ ays of issuancs, or if work is suspended for mote than 160 days.
REOUIREt INSPECTIONS _..
Lo :ect-ical Pout Buildrg Final _
U '.ectrical F, ..!
J
aaina Insp
-isulaticn Inst
,p Board Insp
CaI ? for ir,spectiat; G:.0 7:;
4
Residential Buildin P41 1 'lir' "
City of T/Sdrd
r,
13125 SW Hail Blvd
Tigatd, OR 97223
(503) 639-4171
I,f ♦ t rr.
TJobsite Address:
6 Oh
Subdivision: Lot#
Y
�Contact )ate f' ! Initials
Valuation: —
:k; Result r, w
New Construction Only: (Square Footac e)
AJ f -�
Planckir;ec#
Perrnit
Ho. se: Garage: `' Reissue of_
Comer Lott Y N Flay Lot? Y N Map &TL#
Zone _
Owner: �,r� PlatC.L #
Address:
�' _ A rovala Req�ulred
c r-rq Planning Setba^ks Solar
I Engineering
Phone: Other _
Contractor. Oncl
Items_R_egu3re�d
r (�C7 b g(,t7 22Subcont-.cors
Address: .��
,1 Truss Oetiils
COther
IG 11 � _
U Notes
Phone:
Contractor's license -
r- attach copy of current Orega; license)
Contact Name:
Contact Phone:
Subcontractors: Architect/Engineer ���___,�
;t Plumbing: Address,-
Mechanical-
(attach
ddress:Mechanical(attach coay of current OR Contractor's License)
phone:
JOB OEXRT :pplican Applicant Prone number
-,-z C3 G
Received by: ___ Date Received:
CITY OF TIGARD BUILDING IMSPECTION NOTICE
75p,3-?;on Linq (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: C-P-4. 'kE SZ SS
Footing Susp. (veiling Sprink. Rough-in Nppr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbu. Top Out Elec. Rough-in FINAL:
Post/Beam Mech San. ;.'ewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ I Time: AM PM
nn
AddresF "( ) �iok (
Builder: Z Zs a r7Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
V� ` ?,C,0 :y. &A- C Ute- ' I.Q s
�-T 4 �� -✓c s —
��
-4e
i
4'0
Inspector. �� Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
�--' __Call For Reinsp.
ti
City of Tigard, Oregon �-j � o
Detailed Damage Assessment Form
BUILDING DESCRIPTION: OVERALL RATING: (Check one)
INSPECTED(Green) ❑
Name: _ LIMITED ENTRY (Yello o) ❑
_ UNSAFE (Red)
Address: S w nck —
No.of`atones: a �, DATE a.�� °IS TIME _ �` _ amen
Basement: Yes ❑ Nom' Unknown ❑
Approximate Age: years REPORTED BY
Approximate Area: square feet INSPECTION TEAM MEMBERS
Structural System: _
Wood Framer Unreinforced masonry ❑
Reinforced N4asonry ❑ Tilt-up ❑
Concrete Frame ❑ Concrete Shear Wall U — -"
Steel Frame ❑ Other
Primary Occupancy:
Dwelling ❑ Other Residential ❑ Commercial J Notified occupants to vacate
Office ❑ Industrial
Ll Assembly O prem►sg- W' ,
Occupants indicate temporary housing
School ❑ Government ❑ Emer.Serv. ❑ is required U
Hospital Ll Other_
Instructions: Complete building evaluation and checklist on next page and then summarize results below.
Posting Existing Recommended
None ❑ Posted at this Assessment:
Inspected(Green) ❑ ❑ Yes O No
Limited Entry(Yellow) ❑ ❑ Existing posting by:
Unsafe(Red) ❑
Area Unsafe ❑ ❑
Recommendations:
❑ No further action required
❑ Engineering Evaluation required Cot le ane) Structural Geotechnical Other —
❑ Barricades ne(-led in the follows ig areas: _
❑ Other(falling hazard removal,shoringlbracing required,etc.): _
Comments(Why posted Unsafe,etc.):
gyp V
Sheet of