Permit CITY OF TIGARD SITE WORK
��p�kj�l�� t' DEVELOPMENT SERVICES PERMIT #PERMIT sIT99 —r�002
DATE ISSUED: 02/18/99
PARCEL: 1S135AB -00100
SITE ADDRESS...: 10255 SW 90TH AVE
SUBDIVISION....: TOWN OF METZGER ZONING: R -4.5
BLOCK • LOT :005 JURISDICTION: TIG
CLASS OF WORK..: NEW PAVING? ° PESO. NO.:
TYPE OF USE . °COM . GRADING ?...... VALUE...$: 3500
EXCV VOLUME: 0 cy LANDSCAPING? °
FILL VOLUME: 0 cy SITE PREP?
i ENG FILL? • STORM DRAINS ?...:
SOILS RPT READ ?: IMPERV SURFACE: 2152 sf
Remarks: Site work for placement of mobile structure at Metzger Elementary
School.
Owner: FEES -•
TIGARD TLN DISTRICT #23J type amount by date recpt
13137 SW PACIFIC HWY PRMT $ 44.50 DEB 02/18/99 99- 313019
TIGARD OR 97223 -0000 PLCK $ 28.93 DEB 02/18/99 99-313019
5PCT $ 2.23 DEB 02/18/99 99- 313019
Phone #: FIRE $ 17.80 DEB 02/18/99 99- 313019
EROS $ 80.00 DEB 02/18/99 99- 313019
Contractor: ERPU $ 26.00 DEB 02/18/99 99- 313019
MODERN BUILDING SYSTEMS INC ERPC $ 26.00 DEB 02/18/99 99- 313019
PO BOX 110 QUL% $ 171.18 DEB 02/18/99 99- 313019
9493 PORTER RD WQUN $ 236.39 DEB 02/18/99 99- 313019
AUMSVILLE OR 97325
Phone #: 503- 749 -4949 $ 633.03 TOTAL
Reg #..: 000046
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more __...
than 180 days. ATTENTION: Oregon law requires you to follow rules .
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952- 001 -0010 through OAR 952-001 -0080. Your may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
. Issue• by: l / #0.■ d v / Permittee Signature':
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Site Permit Application
13125 SW HALL BLVD. Commercial and Multi-Family: Com lete - l'Rforrn"� e
Y p )
Date Recd as -' /
TIGARD, OR 97223 Residence: Complete SHADED re. s' Datb to P.E. 1 - . 1T • o- '
(503) 639 -4171 x304 Date to DST �- 141
L , COT-
Pe' it s/ •'' -°°° ee
elated SWR #
Print or Type Called 0 S"9 - 9.94
\
gAO,C� Ta 40,6.3
Incomplete or illegible applications will not be accepted
• • Project Name Utilities (Complete all that apply)
,Job Metzger Modular. Addition
Address Address Storm Sewer •
10255 SW 90th Ave. ,Portland, OR 97223 Linear Ft.
Name Sanitary Sewer
Tigard - Tualatin School District Linear Ft.
.Owner Mailing Address Fresh Water
•
_ 13137 SW Pacific Hwy. Linear Ft.
City /State Zip ' Phone Catch Basins
Tigard -, OR 9777 1 -m-6 F ?f . ) #
General Name Clean Outs
Contractor Modern Building Systems # •
Prior to permit Mailing Address' Describe work to be done:
„issuance, a PO Box 110 New❑ Addition❑ Alteration❑ Repair
copy of all •
licenses.are City /State Zip . ..Phone Additional Description of Work: ..s,4 &oO ?C e vi l
required it A>>msville, OR 97325 503 -749 -4949 Placement -- off - - mobile struc .e at 1
expired in COT State Const. Cont. Board Lic:- #' 'Exp. Date MetZ,.ger_ Elementa-r_y
database 4637 - 10/2100 .
Name Project "
Selig /Lee /Rueda Valuation $, -: - ,
Architect Mailing Address Plans'Required: See Matrix;.on =back - ' -
.. 213 SW Ash St, , Ste. 201. Tti following, must accompany this application:. • .
City /State Zip Phone Site plan with Map - 7 Parking °(including
. Portland, OR 97204 503 - 224 - 0173 3 Showing ADA.compliance , , ADA) & Lighti'ng Plan
Name Grading Plan.and details _ . • LandscapingPlan
Modern Building Systems .,,
Engineer Mailing Addfess — Erosion Control Plan and `" 'RetairiingStru"ctU [ es
PO Box 110 details inciuding calculations
City /State Zip Phone Site Utility Plan and details 'SoilslReport
Aumsville, OR 97325 503 - 749 - 4949 '(showing connection to (if requi`r'ed)
:•approved system)
Excavation Volume I hereby acknowledge that I have read this. application, that the
(Soils report required for >5,000 cu. Yards) information given is correct, that I am the or authorized
0 Cu . yds. agent of the owner, -that plans submitted are in compliance
with Oregon State( aws.
Fill Volume v f nerlAgent Date
(Soils report required for >5,000 cu. Yds.) 12 ., I /Lz IV
0 cu. yds.
Will the fill support a structure Contact Person Name Phone
(Engineer required if answer is yes) YES❑ NO❑
Ron Hudson 684 - 2235
Retaining structure? (check one) ['Rock FOR OFFICE USE ONLY
❑ CMU Notes:
['Concrete
['Other •
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving 1 ,? Sq. Ft. /.5/33 6 0ID 9
O title,
is \dsts \ forms \com- site.doc 10/29/98 Ub P. / -,92-
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 _�
BUP
Date Requested 3-2-44-9q AM A PM BUp ' - Ode I
Location rAta, - t ,ir f/62,1 (t - (025S qV Ave Suite MEC
Contact Person d1,'7e Ph X1 SB?PS f5Y PLM
Of
Contractor Ph (j -2e-S; SWR
CBUILDIN Tenant/Owner ELC
Reta Wall ELR
Footing ACCeSS:
Foundation FPS
Ftg Drain SGN •
Crawl Drain Inspection Notes:
Slab SIT C P
Post & Beam -
Ext Sheath /Shear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing /
Firewall
Fire Sprinkler 641 FM/Aid
�� J
Fire Alarm G n � � r`
Susp'd Ceiling S • � -
Roof
Misc:
PART FAIL
BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final ( PASS PART FAIL mn(r)
MECHANICAL '
Post & Beam 0, a
Rough In
Gas Line <-60 /
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
P C(fi
UG /Slab
Low Voltage
Fire Alarm
Final
ASS PART FAIL
SIT '
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 3 ~ Inspector i21/N a Ext
• -r V U P
PAS- PART FAIL DO NOT REMOVE this inspection record•from the job site.
COMMERCIAL PLAN SUBMITTAL
•. ; REQUIREMENT MATRIX
appftcation For ,-
001010000011:1006ffiittOlift)01000
otd
• .....
After:::0.1n ;:t4Vid.WitigOitoV:01PIRIOrikE).00000::WiJt k request
iti011111f$1:04:001$1t0f10)00114:
Total # Of
............
KEY:
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, orAitr 2 Add =Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
.................
NOTES:
I:\dsts\forms\rnatrxcom.doc 10/30/98