Permit A CITY OF TIGARD SITE WORK PERMIT
PERMIT # : SIT2000 -00032
; DEVELOPMENT HO BME�Ig Tigard, ) 639 -4171 DATE ISSUED : 8/17/00
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 ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE:
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT READ ?: IMPERV SURFACE: 1,792 sf
Remarks: Site permit for modular classroom
Owner:
FEES
Type By Date Amount Receipt
PLCK GWL 7/25/00 $32.50 0003964
PRMT RCP 8/17/00 $50.00 0004540
5PCT RCP 8/17/00 $4.00 0004540
Phone: FIRE RCP 8/17/00 $20.00 0004540
Contractor: QUL% RCP 8/17/00 $210.00 0004540
MODERN BUILDING SYSTEMS INC WQUN RCP 8/17/00 $290.00 0004540
BOX 110 EROS RCP 8/17/00 $80.00 0004540
PO
PO PORTER RD ERPU RCP 8/17/00 $26.00 0004540
9493 AUMSVILLE, OR 97325 ERPC RCP 8/17/00 $26.00 0004540
Total $738.50
Phone: 503 - 749 -4949
Reg #: LIC 00004637
• Required Inspections
Erosion Control
. Grading lnsp
Final Inspection
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 if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the oregfon Ufili Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 -00 !! s Yo may ostain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987. %Oki
Permittee Signature: � �j
Issued By: x/291 _62____
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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\''CITY OF TIGARD , Site Permit Application Plan Checy #-7 0 ve
13125 SW HALL BLVD. Commercial, Residential Recd B` k- ' ''
Date Rec'd 7 2 5"-
J
TIGARD, OR 97223:: and Multi- Family Date to P.E.
(503) 639 -4171 x304 Date to DST
Permit # *4 ti r z ced-00
Print or Type • Related SWR #
Incomplete or illegible applications will not be accepted Called i/A (C .," Ho dcoo
1 1 000 190c/6 8
Project Name Utilities (Complete all that app_ ly)
- Job Metzger Modular Addition #3
Address Address Storm Sewer
10255 SW 90th Ave. Linear Ft.
Name Sanitary Sewer
• Tigard— Tualatin School District 23J Linear Ft.
Owner Mailing Address Fresh Water
13137 SW Pacific ZZ hh Linear Ft.
City/State OR 97223p Catch Catch Basins
. #
General Name . Clean Outs
Contractor Modern Building Systems #
Prior to permit Mailing Address Describe work to be done:
issuance,
copy o all N ew❑ Addition {Alteration❑ Repair
PO Box 110 . ❑
licenses are City/State Zip Phone Additional Description of Work:
required if Aumsville, OR 97325 503/749 -4949- To place a two classroom modular
expired in COT St te39onst. Cont. Board Lic. # En. ,Date 0 structure at Metzger Elementary School
database / /2/
Name Project
Selig / Lee / Rueda Valuation $ '1, 200.00
Architect Mailing Address Plans Required: See Matrix on back page
213 SW Ash St . Suite pp The following, must accompany this application:
Portland, OR 9 ZZ �� 204 50 /�L24 -0173 Site plan with Vicinity Map Parking (including
• Showing ADA compliance ADA) & Lighting Plan
Name Grading Plan and details Landscaping Plan
Modern Building Systems
Engineer Mailing Address . Erosion Control Plan and Retaining Structures
PO Box 1 10 details induding calculations
City/State Zip Phone Site Utility Plan and details Soils Report
Au�sville, ' OR 97325 303/749 -4949 (showing connection to (if required)
approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
information given is correct, that I am the owner or authorized
cu. yds. agent of the owner; and'tha plans submitted are in compliance
- with Oregon St I ws.
Grading Volume • Signature'• •toner /Atient Date
(Soils report required for >5,000 cu. Yds,)
Cu. yds. ' �•" — . 7/25/00
Fill Volume Contact Person Name Phone
(Fill exceeding 12" in depth shall be compacted
To 90% of Maximum Density) Ron Hudson 303/431-4018
cu. yds.
Retaining structure? (check one) ❑Rock . FOR OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
❑Other
•
Total new impervious area including all 1,792 Land Use Case # Map/TL#
buildings, sidewalks, and paving Sq. Ft. k t -lbe9cc, ,c'0 /7
I 3 • 5 v ; LAPPL,i
CITY OF TIGARD
COMMERCIAL SITE WORK PERMIT
is \dsts \forms\site - app.doc 3/17/00