Permit 14
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CITY OF TIGARD SITE WORK PEWIT
' ° ' COMMUNITY DEVELOPMENT PERMIT # : SIT2007 -00029
TIGARD DATE ISSUED : 8/28/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL : 1 S135AB -00100
SITE ADDRESS: 10350 SW LINCOLN ST ZONING : R-4.5
• SUBDIVISION: TOWN OF METZGER LOT: 005 JURISDICTION : TIG
PROJECT: METZGER ELEMENTARY PORTABLES
Project Description: Sitework for placement of two portable classrooms.
CLASS OF WORK: ADD PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 0.00
EXCV VOLUME: 10 cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: 4,000 sf
Owner: FEES
TIGARD TUALATIN SCHOOL DISTRICT Description Date Amount
6960 SW SANDBURG ST [BUILD] Prmt Fee -Valu 8/28/2007 $226.95
TIGARD, OR 97223 [TAX] Valu 8% State Surcharg 8/28/2007 $18.16
[BUPPLN] Pln Rv - Valu 8/28/2007 $147.52
Phone: [FLS] FLS Pln Rv 8/28/2007 $90.78
[ERPRMT] Erosion Control 8/28/2007 $80.00
Contractor: [ERPLN] Erosn Pin Rv CWS 8/28/2007 $26.00
[EROSN] Erosn Pln Rv COT 8/28/2007 $26.00
MODERN BUILDING SYSTEMS INC [WQUAL] Water Quality 8/28/2007 $450.00
PO BOX 110 [WQUANT] Water Quantity 8/28/2007 $550.00
9493 PORTER RD
AUMSVILLE, OR 97325 Total $1,615.41
Contact #: PRI 503 - 749 - 4949
FAX 503 - 749 - 4950 REQUIRED ITEMS AND REPORTS
Reg #: LIC 4637
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty C. • es all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started w' hin 180 • - ys of issua , or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by t e Oreg. n Utility Notifica ion Center.
Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of't es or, dire • ques io : to OU NC by
calling 503 • _ _ • •9 or 1.800.332.2344. lr s
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Issue • = i / /,1'A Permittee Signature: i
Call 503.639:4175 by a :m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
a Building Permit Application s O 7 — DO IS
Sit 21 Work FOR OFFICE USE ONLY
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City of Tigard Date/13 : i �Z5 � � Permit No. A fa O, QQe2$
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' II Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R C Inspection Line: 503.639.4175 Date ReadyBy: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ( (..., Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $
❑ I- and 2-family g ❑ Commercial/industrial
Accessory building ❑ Multi- family Number of bedrooms: PA
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i 0 /.5 �(4) L-ii d`U Lam- New dwelling area: square feet
City/State /ZIP: r 't 7 ({ i2�� Garage/carport area: square feet
Suite/bldg. /apt. no.: ` Pro name: „ j�070V-7 4 �
'1( C S Covered porch area: square feet
Cross street/directions to job site: �vA f A�y. ` �T ` ej` Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
� Valuation: $
S IG �Yf 1 „ - � oT 2 a, - i t
itilkA 9 e.lizat -17) 14-.-azirtAr F-...b.o. . cv c-hc rt T Existing building area: 0, 4 00 square feet
New building area: square feet
❑ PROPERTY WNER I ❑ TENANT, Number of stories: I
Name: ; i 2 � 0 y I ( - 1..; Type of construction:
i Address: o t 4 L ` p�}t(�. 'Q_,� Occupancy groups:
City/StateIP: A C j, 7 „.. ` Existing:
Phone: (% iT M )) 4' coo
y Fax: ( ) New:
❑ APPLIC ❑ CONTACT PERSON NOTICE
Business name: pCl wk. . P �. 1 k . E f All contractors and subcontractors are required to be
i J / licensed with the Oregon Construction Contractors Board
Contact name:
�C Wit / D( under ORS 701 and may be required to be licensed in the
Address: (t f jurisdiction in which work is being erformed. If the Li
City/State/ZIP :� ' ''� applicant is exempt from licensing, the following reasons
apply:
Phone: ( t.�3) ZZ4) (., i co Fax: : (t 9) ill 1 / 11,-
E-mail:
CONTRACTOR
Business name: ` f ) _ BUILDING PERMIT FEES*
Address: a Q r , ^ �� � (Please refer to fee schedule) l �? ` Structural plan review fee (or deposit):
City/State /ZIP: U y V ( l ( 71'
`� l FLS plan review fee (if applicable):
Phone: (cb3) 7t1 . i ,\ Fax: I cp') 7 q i f 51
t�3 CCB lic.: l i l / L Total fees due upon application:
.,
Amount received:
Authorized signature: r.
A. � � r This permit application expires if a permit is not obtained
( within 180 days after it has been accepted as complete.
Print name: •(-- (l � G, �- e�lk I Date: •2 G / * Fee methodology set by Tri -County Building Industry
Service Board.
1: \Building\Permits\SIT- PermitApp.doc 12/27/06 440- 4613T(11/02/C M/WEB)
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi- Family and One- and Two - Family Dwellings:
No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will
not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If
fill is in a flood plain, drainage way, or wetland, the applicant must apply for a sensitive lands review
(SLR).
Please complete all items below, unless otherwise noted.
Excavation Volume: r t cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) n 9- cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) --® cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete pcN'e
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: 4-049 o sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attached. The following must accompany this application:
jai Site Plan with Vicinity Map showing ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two- family dwellings.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
1.\Building\Permits \SIT- PermitApp.doc 12/27/06 2
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CITY OF TIGARD _
BUILDING DIVISION PERMIT #: SIT2007 -00029
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2007 x
Phone: (503) 639 -4171 . °01
Inspection Requests (24 Hrs.): (503) 639 -4175 � IL
INSPECTION WORKSHEET FOR DATE: 11/1612007 TIME: 7 :01AM PAGE: 52
SITE ADDRESS: 10350 SW LINCOLN ST CLASS OF WORK:
SUBDIVISION: TOWN OF METZGER LOT #: Q05 TYPE OF USE:
PROJECT NAME: ME ELEMENTARY PORTABLES
DESCRIPTION: Siteworl<for placement of two portable classrooms.
OWNER: PHONE #:
CONTRACTOR: MODERN BUILDING SYSTEMS INC PHONE #: 503-749 -4949
Inspection Request Scheduled For: Date: 11/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
439 Final inspection 059796.01 503 -654 -2336 N
Corrections /Comments/ Instructions:
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IgPASS _ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: !' Date: G l `09( U7 Phone #: (503) 718-
7
CITY OF TIGARD , -
BUILDING DIVISION PERMIT #: SIT2007 -00029
13125 SW Hall Blvd., Tigard, OR 97223 TE ISSUED: 8/28/2007
Phone: (503) 639 -4171 ,1 ygi
Inspection Requests (24 Hrs.): (503) 639 -4175 '!� -_.. / ?I
INSPECTION WORKSHEET FOR DATE: 9/25/2007 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 10350 SW LINCOLN ST CLASS OF WORK:
SUBDIVISION: TOWN OF METZGER LOT #: 005 TYPE OF USE:
PROJECT NAME: METZGER ELEMENTARY PORTABLES
DESCRIPTION: Sitework for placement of two portable classrooms.
OWNER: PHONE #:
CONTRACTOR: MODERN BUILDING SYSTEMS INC PHONE #: 503.749.4949
Inspection Request Scheduled For: Date: 9/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 056260 -01 360- 772 -0231 N
Corre tion /Comments /Instructions:
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❑ PASS _ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t (,t Date: 9 W 1 7 Phone #: (503) 718 - 2"°-. 7
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