Permit r °' ilh, CITY OF TIGARD
SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2004 -00023
- ''I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 3/1/2005
SITE ADDRESS: 06830 SW ATLANTA ST PARCEL : 1 S136DD 00900
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING : MUE
BLOCK: LOT: 002 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 57,801.00
EXCV VOLUME: 1,000 cy LANDSCAPING ?:
FILL VOLUME: 525 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: Y IMPERV SURFACE: 12,348 sf
Remarks: Site work for new office building.
Owner: FEES
MALCOLM & SHARON ESLINGER LLC Description Date Amount
11575 SW PACIFIC HWY [BUPPLN] Pln Ck - Valu 8/18/2004 $334.46
PMB 160 [FLS] FLS Pln Rv 8/18/2004 $205.82
TIGARD, OR 97223 [BUILD] Prmt Fee - Valu 3/1/2005 $514.56
Phone: 503-620-9515 [TAX] Valu 8% State Surcharg 3/1/2005 $24.56
[ERPRMT] Erosion Cntl 3/1/2005 $80.00
•
Contractor: [ERPLN] ErsnPlck - CWS 3/1/2005 $26.00
[EROSN] Ersn Plck - COT 3/1/2005 $26.00
OLSON BROTHERS EXCAVATING, INC Total $1,211.40
4515 NW SILVER LEAF DR
PORTLAND, OR 97229
Phone: 503 - 531 -0529
REQUIRED ITEMS AND REPORTS
Reg #: LIC 69865 Special inspection (see plans)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: ,_■:__ z � _ _ , Zre-e:(//
Permittee Signature: 7 •■c.c. s `� ,2 -- -
Call (503) 639 -4175 by 7:00 P.M. for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
A I Bldia�g ]Pert�i$ A ppli�ti ®n . - , T kn• ;�,., _ ` s atereceived: � A t Persrtit no 51' . j
l :�_i City of Tigard � �
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Pr o lect/ app l . n o.: ire date- .
City o rgard ,i 7 a 4 ' ,
4 1�N Phone: (503) 639 - 4171 AU G 1 8 2004 � ` i t� l 3! � � +? Rt ce no.
/ �ry Fax: (503) 598 -1960 Case file no.: Payment 130/1-0//06.- SO, - 24x03 -- OCO c5 type:
Land use approval: VA/2L 2-S6 I &2 family: Simple Complex:
BUILD r i l t
of „...-t„....:2-•'....-,':',.. r . ''.:_ , `,' TYPE OF'PERMIT ,
O 1 & 2 family dwelling or accessory Ill2 Commer.ial/industrial O Multi- family 0 New construction O Demolition
❑ Addition/alteration/replacement O Tenant ii nprovement ❑ Fire sprinkler /alum O Other:
^ JOB SITE INFORIWATION' ; _ .
Job address: , bg 30 ,51.„-..) ,477.-.1 571L►” �- Bldg. no.: Suite no.:
Lot: I Block: Subdivision: I Tax map/tax lot/account no.: 25 ,23(, .0 z) C:11 Co
Project name: /47 4-4-r✓771 nu /4.4/Are-
Description and location of work on premises/special conditions: 5'rfE i.41024 l2 ,4 41/10
/3 v 1 L-00»../6- /I 7 7 S) Ge.Veil/M— o` .472-4741774- C 6&
' OWNER- ` ' - FOR•SPECIAL INFORMATION, USE .CIIECKLIST
Name: H/¢t.CoGiti S/y.4120,„,' N6E/L u_ _ 4.,0 G LL , (Floodplain,septiccapacih ; soiar,etc.)
Mailing address: / j r 7 , S t MciF /t //i,// p/1/3 )60 1 & 2 family dwelling:
City: %/G -4 State:04.. I:.IP: 9 72.23 Valuation of work $
Phone: c& -6 20- 9,5 620 -9 V75 I E -mail: No. of bedrooms/baths
Owner's representative: %f/fy(,ot./' - f /3, S id ev6-17 Total number of floors' •
• Phone: Fax: Email: New dwelling area (sq. ft.)
- APPLICANT'
Garage/carport area (sq. ft.)
Name: sue. f aWvv Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City I State: I : UP; Other structure area (sq. ft.)
Phone: Fax: I E - mail: Commercial/industrial/multi GG
• CONTRACTOR ?. Valuation of work $ ,� Ob I
Business name: T13 '. r t �n� bldg. area (sq. f .)
_ .J i f x(Q.1, t 'sting
area (sq. R)
Address: 40 / / 5 t ()e4^ \ ea U �p Number of stories
City: e•-t( C'IIA.�-0I I State: (4ZIP: J,,2 -- 7 Type of construction
Phone: - I Fax: I E -mail:
CCB no.: / ®�
t._ 1 Occupancy group(s): Existing:
New:
City/metro lit no.: .•• 44 O S Notice: All contractors and subcontractors are required to be
,.•_: _ . . ARCIIITECT/DESIGIER . licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City State: I: >P: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E-mail:
' • ENGINEER . l
Name: Aire F /6 irvcc:g (Contact person: ,4 x /yt) ce Fees due upon application $
Address: /39/o St., 6 42/1.G firioo Date received:
City: S/ /4,,ioo.b State :O . VIP: 97/ yo Amount received $
Phone: 9 25.... 8 799 I Fax: 925 -g fgl E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this applic ttion and the Not ail jurisdictions accept credit muds, pteate calliutssdtaion for MOM hdormadaa
attached checklist. All provisio t , , ,,, fi c i ws and ondinat ices governing this 0 visa ❑ MasterCard
work will be complied . f herein. or not. Credit card number: 1 1
Authorized sit. .. r'°: / . ` ; j -t �" /�. e - �� e Dt:te: , Name of cardholder as drown on acdt card Expires
Print name : / /:t ..40 1 7 J;� $
Cardtiolder atgnattue Amount
Notice: This permit application expires if a permit is not o stained within 180 days after it has been accepted as complete. 4404613 (61XVCOM)
CITY .0F„ IVISION PERMIT #: TIGARD A N
BUILDING D SIT2004-00023
13125 SW Hall Blvd., Tigard, OR 97223 1 .-/4/ f i ' DATE ISSUED: 3/1/2005
Phone: (503) 639-4171 , l
iM\ , •
Inspection Requests (24 Hrs.): (503) 639-4175
t---.
INSPECTION WORKSHEET FOR DATE: 612212006 TIME: 7:01AM PAGE: 75
SITE ADDRESS: 06830 SW ATLANTA ST . CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 002 TYPE OF USE:
PROJECT NAME: ATLANTA COMMERCIAL BUILDING
DESCRIPTION: 1 ,fiorOfor new office building. No sprinkler installed in this building so no inspection will be done
till final building inspection.
OWNER: MALCOLM & SHARON ESLINGER LLC, PHONE #: 503-620-9515
CONTRACTOR: OLSON BROTHERS EXCAVATING, INC PHONE #: 603-531-0629
Inspection Request Scheduled For: Date: 6122/2006 Pour - e: pl,.6.-AS
Code # Inspection Description Confirm # Contact # 'i -ssag:.
499 Final inspection 032147-03 503-516-6980 Y 0/ I r
y 1 -
Corrections/Comments/Instructions:
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'A Z i • g2_ 6 ri'vLA .
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vi PASS
,. 0 PARTIAL APPROVAL n CANCEL fl NO ACCESS
1
I FAIL I I CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: 14 Date: 11)( Phone #: (503) 718- L1/4/zy
, ,