Report (2) eu► zo-0,20) RECEIVED
SEP 0 3 2020
CITY OF TIGARD
ELIGIBLE FACILITIES REQUEST CERTIFICATION FOR NON-SUBSTANTEM DIVISION
CHANGES
TO A WIRELESS TOWER NOT LOCATED WITHIN A PUBLIC RIGHT OF WAY
1) Address of the Wireless Tower: 13680 SW Pacific Hwy,Tigard,OR 97223
2) The height(measured in feet above ground level) of the existing Tower as originally
approved, including any modifications approved prior to February 22, 2012: 99.
3) What is the height(measured in feet above ground level) at which the modifications to the
Transmission Equipment will occur on the Tower? 96'
4. What will be the height(measured in feet above ground level) of the existing Tower after the
modifications to the Transmission Equipment are installed? 99'
5) Effect of modifications of Transmission Equipment on Tower height:
(A)Will the modifications in Transmission Equipment (addition, removal or replacement of
Transmission Equipment) result in increasing the height above ground level of the
existing Tower?
n Yes ® No
(B) Will the modifications in Transmission Equipment result in increasing the height above
ground level of the existing Tower by more than: (i) 10%of the height of the existing
Tower, as originally approved, including any modifications approved prior to February
22, 2012; or (ii)twenty feet above the height of the existing Tower, as originally
approved, including any modifications approved prior to February 22, 2012, whichever
height increase is greater?
❑ Yes ® No
6) Will the modifications in Transmission Equipment(measured at the height above ground level
where the Transmission Equipment will be attached to the tower)result in any Transmission
Equipment protruding horizontally from the edge of tower by more than twenty (20) feet or by
more than the existing width of the tower at that height, whichever of these dimensions is
greater?
❑ Yes ® No
7) Will the proposed changes in Transmission Equipment involve excavation or placement of
new equipment outside the existing Tower site or outside any access or utility easements
currently related to the site?
❑ Yes ® No
8) Will the proposed modification in Transmission Equipment involve installation of more than
the standard number of new equipment cabinets for the technology involved, but not to exceed
four?
❑ Yes ®No
Non-Substantial Change Certificate for Towers Not Within A Public Right of Way
National Development 20153
V
9) Will the proposed modification in Transmission Equipment defeat the existing concealment
elements of the Tower?
U Yes ® No
(10) Prior Conditions of Approval
(A)Will the proposed modification in Transmission Equipment comply with conditions
of approval imposed on the Tower prior to February 22, 2012?
®Yes ❑ No
(B)If the answer to 10(A) is "No,"is the non-compliance due solely to any of the
conditions addressed in questions 5-9 above?
❑ Yes ❑ No
If the answer to either question 5A or 5B is "No", and the answers to questions 6-9 are
"No", and the answer to either 10A or B is "Yes" then the proposed modifications do not
substantially change the physical dimensions of the existing Tower. Please provide a brief
explanation, if necessary,to clarify any answer.
Explanatory Comments (If Needed):
Question No.
Comment:
This certification is dated this 2nd day of September 2020 .
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Signature
Sarah Baird, Site Acquisition Specialist
Name & Title
Non-Substantial Change Certificate for Towers Not Within A Public Right of Way
National Development 2015.3