Permit CITY OF TIGARD SITE WORK.
DEVELOPMENT SERVICES PERMIT
.4 � I�'� 13125 SW Hall Blvd., Tigard, OR 97223(503) 639 -4171 DATE I ISSUED: 12/ 1 - 7 1 / T 9: 8-0050 /17/98 -0050
PARCEL: 2S113AB -00300
SITE ADDRESS...: 16075 SW UPPER BOONES FERRY RD
SUBDIVISION - FANNO CREEK ACRE TRACTS ZONING: I —L
BLOCK - LOT -036 JURISDICTION: TIG
CLASS OF WORK..:NEW : PAVING? - Y RESO. NO.:
TYPE OF USE -CMS : GRADING? • N VALUE...$: 7000
EXCV VOLUME: 0 cy LANDSCAPING?
FILL VOLUME: 0 cy SITE PREP? -
ENG FILL? STORM DRAINS?...: Y
SOILS RPT REGtD ?: N IMPERV SURFACE: 0 sf
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Remarks : Site work for re locating modular.
Owner: FEES
NORTHWEST LANDSCAPE- INDUSTRIES type amount by date recpt
16075 SW UPPER BOONES FERRY ROAD PRMT $ 37.80 GEO 11/19/98 98- 310955
TIGARD OR 97224 PLCK $ 40.63 GEO 11/19/98 98- 310955
FIRE $ 25.00 GEO 11/19/98 98- 310955
Phone #: EROS $ 80.00 DLH 12/17/98 98- 311623
ERPU $ 26.00 DLH 12/17/98 98- 311623
Contractor: ERPC $ 26.00 DLH 12/17/98 98- 311623
MODERN BUILDING SYSTEMS INC
PO BOX 110
9493 PORTER RD '
AUMSVILLE OR 97325 - - -•
Phone #: 503 - 749 -4949 $ 235.43 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 Paving Insp
applicable laws. All work will be done in accordance with Strm Drain Insp
approved plans. This permit will expire if work is not started San Sewer Insp
within 180 days of issuance, or if work is suspended for more Manhole /C l e an o ut
than 180 days. ATTENTION: Oregon law requires you to follow rules Domestic water 1
adopted by the Oregon Utility Notification Center. Those rules are Misc. Inspection
set forth in OAR 952- 001 -0010 through OAR 952- 001 -0080. Your may Driveway surfaci
obtain'copies of these rules or direct questions to OUNC by calling Final Inspection
(503)246 -9187.
Issued by:' Permittee Signature: 19/97Z-Ed 07
. 45;44j&,_________
/97°, , %/ON
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Call 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 �J / Recd B
ci ___
13125 SW HALL BLVD. Commercial: Complete ENTIRE form `s DateRec'd ql-1C1 -A Date to P.E. / R i7 - q6
TIGARD, OR 97223 Residence: Complete SHADED areas ‘ to DST S / •1- s P. y �/
(503) 639 -4171 x304 Permit*
A Related SWR # 5/ T-/�C 7v
VW" Called Aa' /G - 9 I coLko
P • r • o , S / O6 -Pod. w /-.V c-4A4- Jtr.
Print o Type 6
Incomplete or illegible applications will not be accepted
" • -Pr`oject,Name: F,, ,- t. ten for -modular unit Utilities (Complete all that apply)
'Job =- - and `removal -'of t o- trailers' _ _„ ..
'Address . Address - =- „ - Storm Sewer
.16075 SW'.;Upper`.Boones -Ferry , Road ; , ' . Linear Ft.
Name - Sanitary Sewer
• ' Northwest tandxcape Industries Linear Ft.
• `;,Owner Mailing Address = Fresh Water
" _1'0 S Gi - Lippmr Boris FP iy Roa _ - Linear Ft.
' City" /State - - Zip - Phone :,(503) - Catch Basins
_' ; - _,, _ Tigard, OR 97224 , :, 684 -1450 . -- #
General . Name . ,� , _ _ - ° ° - - Clean Outs
(' Contractor • Modern, Bu - Systems ''' ° ' ' _ ' - #
Prior to permit' • ,'Mailing' Address_ , Describe work to be done:
issuance,.a • P0 Box - 11 0 - , New❑ Addition❑ Alteration® Repair❑
copy of all _ ,
iicensesare City /State -- _ Zip Phone ( 03 ) Additional Description of Work: -. ,'
req uire d if Aumsville, OR 97325 - - , - .749 -4c) 9 - _ expired in COT _ �.;.` - J,ti • .y. .ri __ G t
_ State - Co �ns �:= ont. Board =Lic. # Exp.'Date_ _ _ = e � � - � _ -
database 463 _ = 10/02/00. , -14 < ; i� iG , - = -
Name ' Project , r 7, Odo .00 _ -
/� - Valuation . '$ ' „. ,,,� --
Architect Mailing Address Plans Required:. See 'Matrix on back; - . _
• , The following, must accompany this application:
City /State Zip Phone ' : Site_plan with Vicinity Map . _. Parking (including _ -
- Showing ADA compliance ,_ - ADA)'& Lighting Plan
Name - Grading Plan and details - ; Landscaping_Plan = _
Engineer Mailing Address , Erosion Control Plan,,and ` ,Retaining Structures
' ' details ,•, , v ' „, _ 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 that plans submitted are in compliance • ;with Oregon State laws: „ - • ,
Fill Volume Si" u bf, n r gent„ _ - _ .: '
(Soils report required for >5,000 cu. Yds.)
cu. yds. 4 c iar - Akerman- : ' • , :11/09%98 - -
Will the fill support a structure Contact Person Name F = _ Phone (503}
(Engineer required if answer is yes) YES❑ NOD =. .
- Janette Henman - -- , 684 =1450
Retaining structure? (check one) ❑Rock FOR 0 FICE USE ONL
❑ CMU Notes: " L)
❑Concrete / Zf/
['Other
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving - Sq. Ft. )T ipp, -�/ a S /131 - O°3
siteapp.doc 3/98
•
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan. ReViewAS depenlent upon submittal of BOTHiplans : ANO . a . COMPLETED
application. For an electrical :_submittal the application must:contain the . • • •
signature of : #d a super rising electrician before'pla n review Ott- be conducted,
After plan review ap rov 1 Plans Examineryviiroonta6fitilkeppliCant to request _ -
• -additional plan sets for distribution :purposes.. (copy for Contractor it , .: _ - •
• V as ington "Count', Tualatin Valley .Fare &-=Rescue) -
Total.# of - <, . - _ - -
'TYP E OF SUBMITTAL = ::Plans <:° _:. - - -- KEY: _
, - 7: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
E *or_ B & 1111: (Alt) - • .
*B:. &. M- & i? Oat) < ;-
.:.::, :.:>
*B &'M `& P & E(Alt)
NOTES:
'!Shaded areaS:desigpate At.: • . _
I: \dsts \maxtnxl .doc 07/06/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -417 5/a usiness Line: 639 -4171
BUP
,`:�
Date Requested 'R . ..
� /�_ AM PM BLD
Location 1 &07S 4/1 Suite MEC
Contact Person , . h - 7q3- zq l S PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation • FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: �R - �So
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear c
Framing r ' (I J- !� JD ,
Insulation ° / ` L • Drywall Nailing Cti p / � - 5 d / � - -40
Firewall �, / D
Fire Sprinkler I / - .i_`.A.../ _ .—Ld // m—c/ eJ
Fire Alarm
Susp'd Ceiling i /
Roof
Misc: 1 ' GC A___, / Zd // d.
f_ PART FAIL
PL U BING
Post & Beam 1 ! ,
Under Slab 4
Top Out �� ,
Water Service MillilMirr,i, I- Sanitary Sewer I
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam ..
Rough In
Gas Line
Smoke Dampers
Final _
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
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 / • �
Other Date Inspector ^ A QA_ - Ext
Cap
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.