Permit CITY TIGARD SITE WORK PERMIT
DEVELOPMENT SERVICES • PERMIT # : SIT1999 -00067
_,
�`' A - 13125 Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED : 11/02/1999
J W
SITE ADDRESS: 10255 SW 90TH AVE PARCEL : 1S135AB-00100
SUBDIVISION: TOWN OF METZGER ZONING : R -4.5
BLOCK: LOT: 005 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $2,500.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?: Y
ENG ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 2.152 sf
Remarks: Modular classroom
Owner: FEES
TIGARD - TUALATIN SCHOOL DIST 23
13137 SW PACIFIC HWY Type By Date Amount Receipt
TIGARD, OR 97223 PLCK BON 10/21/1999 $38.51 99- 319253
FIRE BON 10/21/1999 $23.70 99- 319253
PRMT GEO 11/02/1999 $59.25 99- 319475
Phone: 503 - 451 -4018 5PCT GEO 11/02/1999 $4.74 99- 319475
Contractor: EROS GEO 11/02/1999 $80.00 99- 319475
MODERN BUILDING SYSTEMS INC ERPU GEO 11/02/1999 $26.00 99- 319475
ERPC GEO 11/02/1999 $26.00 99- 319475
PO 6 PORTER RD QUL% GEO 11/02/1999 $171.18 99- 319475
9493
AUMSVI R E, OR 97325 WQUN GEO 11/02/1999 $236.39 99- 319475
Total $665.77
Phone: 503 - 749 -4949
Reg #: LIC 00004637
Required Inspections
•
Erosion Control Insp 844 -8444
Grading
Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable 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 i "ork is su 'ended 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 -008'. You ay ob'ain copies of these rules or direct questions to OUNC by
" calling (503) 246 -1987. - - –4411 lip.—
Permittee Signature t �=
Issued By: / , ,7' //L__—
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
c
•
CITY OF TIGARD Site Permit Application Plan Check 0 Z•
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Recd By
Date Recd / Z1 1/
TIGARD, OR 97223 Residence: Complete SHADED areas Date to P.E. — ' '
(503) 639 -4171 x304 Date to DST Ad- _ __ ''
Permit # / it deli 1
Related SWR #
Called 1 / 5
Print or Type
.ocomplete or illegible applications will not be accepted
Project Name Utilities (Complete all that apply)
Job / -101)1) LA-2 C 1 --A55 i (Z
Address Address Storm Sewer
p - (]'2 . ti 0/`1 C' Linear Ft.
Name Sanitary Sewer
j) 6.430h- i VAL AI() SCt•b0L- c) is — T N cA% 'linear Ft.
Owner Mailing ddress Fresh Water
("3I3 SiJ �Aei F 4 - k,,a rvoP L. Linear Ft.
City /State Z ,i�pp Phone Catch Basins
1 1 Gki o(L `j7 3 /131- 401e,
p.io,./ #
General Name Clean Outs
Contractor "4 oD enij iS U _3 7S i 5 Ou w, #
Prior to permit Mailing Address Describe work to be done:
issuance, a New❑ Addition Alteration❑ Repair
copy of all P 0 Lp› IIC) ❑
licenses are ity /State ,e t ; Z � ii y p Phone 501 503 Additional Description of Work:
required if AcMSV,Li Or2 ! 1:.32 . 74 ) - 4949 ?t-Ac - m.6� --i 0 i= P--0 v 57n u au/ :1--
expired in COT State Const. Cont. Board Lic. # Exp. M �� � . Y 5 ��
database 4L3 7 /�' t: t'
Name Project -
SL.k Valuation $
Architect Mailing Address Plans Required: See Matrix on back
2-1 5w PIS 1 - 1 - Su cm - 2 - 0 1 The following, must accompany this application:
City /State Zip Phone 5 Site plan with Vicinity Map Parking (including
� c n -uk,, 00.., 97204 224 - 0I73 Showing ADA compliance ADA) & Lighting Plan
Name Grading Plan and details Landscaping Plan
I 5 aL, S _S
Engineer Mailing Address Erosion Control Plan and Retaining Structures
details including-calculations
City /State Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
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 owner or authorized
cu yds agent of the owner, and thaLplans submitted are in compliance
/00 tiJ with Oregon State law :'
Fill Volume (` 3rji t /Agen Date
(Soils report required for >5,000 cu. Yds.) /
A.)0 k; : cu. yds. 1 __ ) f it /! 9 9
Will the fill support a structure Contact Person Name Phone
(Engineer required if answer is yes) YES❑ NO❑
- V o&J of 431 - 'IC ir,
Retaining structure? (check one) ['Rock FOR OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
['Other
Total new impervious area including all Land Use Ca�see# Map/TL#
buildings, sidewalks, and paving 2_15-2- Sq. Ft. t }` t t r q 'Q 1 tQ
i.\dsts \forms\site app.doc 10/30/98 CSp 11) It 1 r 1 QQ� _ 7 °c" �
r
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application; For an electrical submittal, the application must contain the
signature of the supervising electrician before plan review will be conducted.
After plan review approval, Plans Examiner will contact the applicant to request
additional plan sets for distribution purposes. (Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
Total # of
TYPE OF SUBMI I I AL Plans KEY:
Submitted
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, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
*B or B & M (Alt) 1
*B &M &P(Alt) 3
*B &M &P &E(Alt) 3
*B &M &P &E &F(Alt) 3 j
•
NOTES:
*Shaded areas designate ALT submittals only.
I: \dsts \forms \matrxcom.doc 10/8/99 -
CITY OF TIGARD BUILDING INSPECTION DIVISION . MST
24 -Hour Inspection Line: 639 -4175 Business Lin 39-4171 � 1 7
//-2.-- BUP - d0 w
Date Requested / 1 AM PM ` A BU .- 1,q0,01 _ . 30413
Location I 0 - 2_,(5 .- S"
(5 9e Sul MEC
Contact Person (—'°M fr Ph q,) J VO i ' PLM
Contractor Ph .
— ., V a 4 U c 1��i - o 0 1243
UILD Tenant/Owner t.. ` .... - ` - �"
Retaining Wall - erri - ELt l"\ q"i ^ 0 0 (0 (4 )
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SI `-16A - 0 0 G lc, 1
Post & Beam
Ext Sheath /Shear ,
Int Sheath /Shear < q �
Framing - j, 9.6' - l.1 D 4'7 3 (---- --- G_,t-' -t'‘
Insulation
Drywall Nailing 4- e- S -V e_a C/ - ��C
Fire wail � U
Fire Sprinkler ALA 4- 4"..A. �
�-"� n� �"' '^ .
Fire Alarm - Ci,) B L )C1C1 _ O (a � 4 3 c v ,-:- V T / \ S Susp'd Ceiling J 4 � ) (�
Roof /1C1 !�V� Le_ 0-c: �.& _ Sa,► !. •
Misc: - �,
eisi
PASS PART FAI li N ver ( - - - _ II. Y 1i 4. .
s
PLUMBING
Post & Beam g) f Top Out Under Slab 4 1 T t`c� - 0-00 (1 � ( J °e �/V l VC . \/S - —//� 1 `IJ Q
Water Service L �p� rkj
Sanitary Sewer
Rain Drains ,, 5 � " t
Final
PASS PART FAI c ^. ....z.., av / /A), Q �1 -�% _ ck- ,(
MECHANICAL
Post &Beam .& AAA, fL . �-'�`.A� '� " -1,,,,-, v ,,._.;, .
Rough In - ` _ l � I 1 Gas Line �
Smoke Dampers t / ► • 3 � - ✓1 « . J
F inal - - PASS PART FAIL �� �J, �/
ELECTRICAL �" -
Service - s �i� v� \/�" 6( cC-- V
Rough In
UG /Slab 1 A • _ ,at R D � \/ v
Low Voltage
r1 ,� 1 �N d A
Fire Alarm Q } M t\ ��) `, t✓C ,.
Final L
PASS PART FAIL I 4 # r • • Gtf A.
SITE 4 ,
Sanitary Sewer t ( Storm Drain [ ] in pectioee 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
9 .
Approach /Sidewalk
Other Date 0 /2/ / 61 1 Inspector \((; Ext
Final
PASS PART FAIL @D DO NOT R OVEth is inspe tc ion record ro - m en the job i e. SS
N VL ►�w� -e--( , U- -� `- ' S � - .