Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT
Permit#: BUP2020-00162
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 • Date Issued: 8/25/2020
Parcel: 2S 102B D 02600
Jurisdiction: Tigard
Site address: 12965 SW PACIFIC HWY
Project: AT&T Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37
Project Description: Remove and replace(3)antennas,remove(3)RRHs,relocate(3)RRHs,add(9)RRHs,(1)surge protector, (1)DC
cable and(1)fiber cable to the existing tower. Within existing ground space/enclosure AT&T will remove all
unused coax.
Contractor: ERICSSON INC Owner: KIM, PENNEY
6300 LEGACY DR 395 NW SILVERADO DR
PLANO, TX 45024 BEAVERTON, OR 97006
PHONE: 972-583-0000 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 08/24/2020 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 08/24/2020 $45.35
Dwelling Units: 0 Plan Review 07/29/2020 $245.64
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 08/24/2020 $102.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Lg$2.00(over 08/24/2020 $90.00
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 $860.89
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: C/ � 7
y
�l7ilnf° t .tG .i7 �fv /
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.
Building Permit Application 7 / ,
Commercial o RECEIVED FOR OFFICE I SI 0vI v p 2-
III
b DateBea / s(.�.f & ./ -00 -
Cityof Tigard Permit No
• 13125 SW Hall Blvd.,Tigard,OR 97223 J U L 1 4 2020 Plan Revie• — -
II, Phone: 503-718-2439 Fax: 503-598-1960 Date/a : 0 Ill Related Permit:
.1.1 t-;tt j1 Inspection Line: 503-639-4175 CITY OF TIGARD Date Ready/By: G. Ions: ®' See Paget for
Internet: www.tigard-orgov BUILDING DIVISION Notified/Method:a .c ..d f r Supplemental Information
'`fr L- C0142—r—ii1 "
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
(I Addition/alteration/replacement 0 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: $
ElAccessory building 0 Multi-family Number of bedrooms:
®Other: Number of bathrooms:
0 Master builder Unmanned Cell Tower
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12965 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP: Portland,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name:PL77-LTE 5C15G/ANT Retrofit Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
1-5 N to Tigard.Take Exit 6 from OR-217 N. Follow OR-99W S/Pacific Hwy to locaton. Other structure area: square feet
Turn right onto OR-99W S/Pacific Hwy N. Pass the B of A site will be on the right. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work petfutmed.
Tax map/parcel#: 2S102BD02600 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. _
Remove and replace(3)antennas, Remove(3)RRHs, Relocate (3)RRHs, Valuation: S 20,000.00
Add(9)RRHs, (1)Surge Protector,(1)DC cable,and(1)Fiber cable to the existing tower Existing building area: square feet
Within the existing ground space/enclosure AT&T will remove all unused coax. New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name: AT&T Mobility Type of construction:
Address: 19801 SW 72nd Ave.,Suite 200 Occupancy groups:
City/State/ZIP:Tualatin, OR 97062 Existing:
Phone:( ) Fax:( ) New:
) APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer Infer schedule)
Business name:Smartlink Group
Structural plan review fee(or deposit): vs,G
Contact name: Courtnee Gomez
Address:11410 NE 122nd Way FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: Kirkland,WA 98034
Phone:(916 ) 527-4157 Fax::( ) Amount received:
E-mail:courtnee.gomez@smartlinkgroup.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: TBD E7-Z iejj"O.\/ /A✓G Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: /40, 7"F...5 Af /'1/f O^/ S7' Si'- -/3 Solar Installation Specialty Code checklist.
City/State/ZIP: Permit fee(includes plan review
pp�L j j/J �/ ()it - - an administrative fees): $180.00
Phone:( ) Fax:( )
State surcharge(12%of permit fee): $21.60
CCB Lie.: 020 9 Total fee due upon application: $201.60
Authorized signature: / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Courtnee Gomez Date:7-13-2020 * Fee methodology set by Tri-County Building Industry
Service Board.
1:1Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
II ® COMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: 2 i&e Z0 20-DO I to 2
Site Address: /.2 q/S" ,,c) ) R e,A hip jj Suite/Bldg#:
Project Name: 4 T� 7 6
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /U'in ve Jt.Qp2 ci Or ierrad c„-n i f-- ,e f tf/)p1nI/2*
Existing Business Activity: /✓49( 1.f Ca get/
Pro.used Business Activity: // // //
raI V: .fy site address/suite#exists and active in permit sys
, i$ ' "ver Terrace Nehborhood: E Yes 6/J No
IQ nmg
minted Use: Yes E No E Spec Space
Confirm no land use required.
usiness License:
Exists: ❑ Yes ❑ No,applicant was provided a business license application
Notes:
Approved by Planning: �— �407(-- Date: —7//c 1.2c7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
IIIiA IV9191 - -
Building Permit Submittal
Original Submittal Date: 7//y/la
Site Plans: # 3
Building Plans: # _..3
Building Permit#: Enter building permit#above.
Workflow Routing: S--Planning 0 Permit Coordinator ceding
Workflow Sign-off: 8- Sign-off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: .......a &e ,R,'-4_ Date: /7='f!/Z�
I:\BuildingWorms\BldgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building pe "t ,
❑ Approved,NOT Released: Date:
Notes: _�r
VW
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Ap. cant:
Revision Notice 2: Date Sent to % plicant:
Revision Notice 3: Date Sent • Applicant:
❑ SDC Fees Entered: Wash 'a Trans Dev Tax: ❑ Yes ❑ N/A
d Trans SDC: ❑ Yes ❑ N/A
'arks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPcrmitRvw_COM_NoLandUse_111819.docx