9735 SW PEMBROOK ST l
City of Tigard, Oregon
Detailed Damage Assessment Form
BUILDING DESCRIPTION: OVERALL RATING: (Check one) �L
INSPECTED (Green) J�
Name: LIMITED ENTRY (Yellow) / ❑
UNSAFE (Red) ❑
Address: SS- 5' -P �
No. of Stories: 1 DATE 14 1 \3 l ti S TIME 1 am(
Basement: Yes No O Unknown ❑
Approximate Age: years REPORTED BY
Approximate Area: square feet INSPECTION TEAM MEMBERS
Structural System:
Wood Frame Unreinforced masonry O
Reinforced Maso CI ❑
Concrete Frame 0 Concrete Shear Wall ❑
Steel Frame ❑ Other
Primary Occupancy:
Dwelling Other Residential -❑ Commercial ❑ Notified occupants to vacate
Office 0 Industrial ❑ Public Assembly ❑ premises Cl
Occupants indicate temporary housing
School ❑ Government ❑ Emer. Serv. ❑ is required ❑
Hospital ❑ Other
Instructions: Complete building evaluation and checklist on next page and then summarize results below.
Posting Existing Recommended
None O Posted at this Assessment:
Inspected (Green) — El — ]� ❑Yes >No
Limited Entry (Yellow) ❑ ❑ Existing posting by:
Unsafe (Red) O O
Area Unsafe ❑ ❑
Recommendations:
O No further action required
O Engineering Evaluation required (circle one) Structural Geotechnical Other
❑ Barricades needed in the following areas:
Other (falling hazard removal, shoringlbracing required, etc.):
r — �cANeteAa : \
Comments (Why posted Unsafe, etc.): Y ∎ 4c' "'* c-°' 10 e0.�- - , C`(`l`kS ;\\* Co ( ypo f , Nri
\ c ) . — j(3:"r e , re , • cQ.S\i\
��NA Sheet i of
1 4 TOTAL OFFICE PRODUCTS ' 220
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—
ITY OF TIGARD BUILDING INSPECTION NOTICE
Insp do Line (Rec -O- Phone): 639 -4175 Business Phone: 639-4171
Inspection: 1 �� %. q- \ : " : r : 2
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: 17 • 1 `i \, Time: AM PM
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Address: (9 ) - 7 >> e „Nt� VJ---r
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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0 711111MMIEMO
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Date: 1 Z I
Inspector:
• _APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
-Z'c)-?. _Call For Reinsp.
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