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Permit CITY OF TIGARD BUILDING PERMIT 'q COMMUNITY DEVELOPMENT Permit#: BUP2020-00012 Date Issued: 7/13/2020 T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S136CCO2100 Jurisdiction: Tigard Site address: 11744 SW PACIFIC HWY Project: T-Mobile Subdivision: None Lot: None Project Description: Removing(6)panel antennas, (8)RRU's,and(8)diplexers,and installing (6)panel antennas. Contractor: BLUESTREAM PROFESSIONAL Owner: GRUNBAUM SURVIVOR'S TRUST 3305 HIGHWAY 60 BY GRUNBAUM, MARILYN K& ERIC TRS WEST FARIBAULT, MN 55021 21390 SW EDY RD SHERWOOD, OR 97140 PHONE: 503-334-2268 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 01/30/2020 $377.90 Demolition Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 01/30/2020 $45.35 Dwelling Units: 0 Plan Review 01/23/2020 $245.64 Stories: 0 Height: 0 tt DC Provision Review, COM New-Bldg 01/30/2020 $203.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 01/30/2020 $15.50 Value: $20,000 11x17) Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $887.39 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: /ly7e1j47�/ c Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 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. --ow— -4411111111111111 Building Permit Application Commercial JAN 2 2020 FOR OFFICE. I'SE ONLY City of Tigard CITY OFp� 7T7l�i; j[RD Received / pty Ry 14UILD!NG VI»I IO jateBe (�3 cm Permit No. ��� t.)� `,� 13125 SW Hall Blvd.,Tigard,OR 972 ' `- L tan Revie 4 V��V Phone: 503.718.2439 Fax: 503 598.1960 DateBy: �J��' . - Other Permit: T(GARD Inspection Line: 503.6394175 Date Ready.By: /A LITE: 0 See Page 2 far Internet: www.tigard-orgov tifietLMethod: ! 1 /4 , 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 ❑Addition/alteration/replacement ['Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ID Master builder ['Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11744 SW Pacific Hwy New dwelling area: square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:T-Mobile P001373B Greenburg Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. 1 S136CCO2100 Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. remove(6)panel antennas,(8)RRUs,and(8)diplexers;install(6)panel antennas Valuation: $20,000 Existing building area: N/A square feet New building area: no change square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: N/A Name: SURVIVORS GRUNBAUM TRUST Type of construction: II-B Address: 11744 SW Pacific Hwy Occupancy groups: U City/State/ZIP: Tigard,OR 97223 Existing: U Phone:( ) Fax:( ) New: no change 0 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Crown Castle on behalf of T-Mobile (Please refer to fee schedule) . Structural plan review fee(or deposit): Contact name: Amanda Nations — Address: 1505 Westlake Ave N,Suite 800 FLS plan review fee(if applicable): City/State/ZIP: Seattle,WA 98109 Total fees due upon application: i211 j_y Phone:(206 ) 336-2889 Fax::( ) Amount received: 12 E-mail: amanda.nations.contractor@crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR n roof-top mounted Photo Voltaic Solar Panel System. Business name: TBD rut,. y �^'�j/ya� F of C, f' e- Submit two(2)sets of roof plan with connection details Address: s 3 o S /-[J�5 (4 r v * yr it 6 ��' ,t2 x and fireIInstallation Specialtyt access, Calode cwhecklist. lis. Oregon ( � Solar Installation Code checklist. City/State/ZIP: Fri I_ Ly� 1. {Z�') Permit fee(includes plan review $180.00 9 �/ /� �7 and administrative fees): Phone: (�0'��3 3 L� ZZLG, I Fax ( ) State surcharge(12%of permit fee): $21.60 CCB tic.: '7 n / Total fee due upon application: $201.60 Authorized signature I/'1 ,- ^ :,r_ , This permit application expires if a permit is not obtained III �/W/v"'�" within 180 days after it has been accepted as complete. Print name: Nripq,Q f �'h.1 KC.I0 � Date: 1 J Fee methodology set by Tri-County Building Industry / Service Board. I,\Building\Permits\BUP-COM PermitApp.dac 02/24/2011 440-4613T(11/02/COM/WEB) City of Tigard q COMMUNITY DEVELOPMENT DEPARTMENT i IIIC TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: rJ`A O9.©_ 0, Site Address: //9-//4-/ S'u.) Ac44 /hoq Suite/Bldg#: Project Name: • 7. FYI obis L € (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: 9r..PMD v-Q Atvi Cc 7fhhad' bait/ IVpk /17 Existing Business Activity: A 3/r_Q,bg S (?w j7jm/_m/'et¢ 4"///31 Prop ed Business Activity: // // // V- 'fy site address/suite# exists and active in permit syst 13! ''vet Terrace nNeighborhood: 0 Yes No ni ong: l`0 LI kermitted Use: 0 Yes 0 No 0 Spec Space no land use re aired. Business License: Exists: Yes ❑ No,applicant was provided a business license application Notes: Approved by Planning: ✓ Date: //2S2/ _6 Revisions (after Building Submittal only) Reviewer Date Revision 1: D Approved ❑ Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Building Permit Submittal Original Submittal Date: %A /a.) Site Plans: # 1 Building Plans: # Building Permit#: Can building permit ove. Workflow Routing: j 'ning ermit Coordinator L�YBuilding Workflow Sign-off: 1r 'j off for Planning(include notes from planning review) Route Application Documents: ding. original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: '�� Date: //2.r3/,1z) 1:\Building\Forms\BldgPermitRvw_COM_NolandUse_111819.docx Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: VSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes fiNT/A Tigard Trans SDC: ❑ Yes /A YJ Parks SDC: ❑ Yes N/A U2' OK to Issue Permit AtDate: Approved by Permit Coordinator: //�3/ ° 1:\Building\Forms\BldgPerniltRvw_COM_NotandUse_111819.docx RECEIVED City of Tigard JAN 2 2 2020 COMMUNITY DEVELOPMENT DEPARTMENT % CITY OF TIGARD TIGARD cg16i'f� RING Collocation - Supplemental Qu PROPERTY ADDRESS b it yr •i t.vr: ONi.v Location of collocation: 11744 SW Pacific Hwy T-Mobile Zo Name of provider: Amanda Nations,Crown Castle Approved Contact name: ❑ Not Approved Collocating antennas on: By: Date: d242'0 x❑ Existing tower Reason not approved: ❑ Existing non-tower structure Is this a new provider? 0 Yes © No Other providers currently collocating on same tower or structure: l:\Community Development\land Use Applications\02 Forms and Templates\Land Use Applications\Future Forms Rev.12/14/2017 yes Indicate the previous approval: CUP 96-0006,VAR 96-0010 (SDR,MMD#) ANTENNAINFORMATION Existing: New: I lei ht of antenna(s): 131 131' g (sq. ft.) Height of antenna(s): (sq. ft.) paint to match monopole to match Color of antenna(s): paintmonopole Color of antenna(s): paint to match monopole Color of equipment: Color of equipment: paint to match monopole Accommodating equipment: N/A Accommodating equipment: N/A (i.e.dishes) (i.e.dishes) Will new accessory equipment be installed? 0 Yes ® No Location of new accessory equipment? O Within previously approved fenced area ❑ Within existing structure ❑ Other location: (Please describe) Will landscaping be removed to accommodate the accessory equipment? 0 Yes p No If yes,describe here: 4 e i1/4:ck ) 13-)7-crt-C) Applicant's signature Print name Date City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-ot.gov • 503-718-2421 • Page 1 of 1 CR OWN 1505 Westlake Ave N Phone: (206) 336-2889 Seattle,WA 98109 Fax ro CASTLE www crowncastle corn RECEIVED January 17,2020 JAN 2 ? 2020 CITY OF TIGARD,OR CITY OF (e( AilD 13125 SW Hall Blvd 3UILDING DIVISION Tigard,OR 97223 RE: Eligible Facilities Request to modify equipment on a communications tower located at: ii744 SW Pacific Hwy,Tigard,OR,97223 Crown Site Number:824338/Crown Site Name:Greenburg Customer Site Number: POo1373B/Application Number:484987 Crown Castle USA Inc.("Crown Castle")on behalf of T-Mobile West LLC("T-Mobile")is submitting the attached Eligible Facilities Request application to modify transmission equipment on a telecommunications tower located at 11744 SW Pacific Hwy,Tigard,OR 97223 in CITY OF TIGARD,OR(the"Greenburg Tower"). Section 6409 of the Middle Class Tax Relief and Job Creation Act of 2012,commonly known as the"Spectrum Act" (Pub.Law No.ii2-96,126 Stat 156),mandates that state and local governments"may not deny,and shall approve,any eligible facilities request for a modification of an existing wireless tower or base station that does not substantially change the physical dimensions of such tower or base station." T-Mobile proposes to modify the"Greenburg Tower"as follows:remove(6)panel antennas,(8)RRUs,and(8) diplexers;install(6)panel antennas Itemized list of submittal documents: • Building Permit Application Form • Collocation-supplemental questionnaire • Construction drawings,stamped and signed by Oregon-registered engineer(3) • Structural calculations,stamped and signed by Oregon-registered engineer(2) • Check for plan review fees(S254.64) T-Mobile is committed to working cooperatively with all jurisdictions around the country to secure expeditious approval of requests to modify existing personal wireless service facilities. If you should require more information regarding the Spectrum Act,please do not hesitate to contact me with your questions. Sincerely, Amanda Nations Amanda.Nations.Contractor@crowncastle.com (206)336-2889 The Foundation for a Wireless World. CrownCastle.com