Permit CITY OF TIGARD BUILDING PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: BUP2020-00201
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2020
TIGARD Parcel: 2S102CC01100
Jurisdiction: Tigard
Site address: 13680 SW PACIFIC HWY
Project: T-Mobile Subdivision: None Lot: None
Project Description: Remove(4)RRU's,relocate(3)antennas;and install(3)RRU's and(1)HCS 2.0 trunck on existing towers.
Remove(3)cabinets and(2)baseband units;relocate(2)baseband units and(5)baeband modules;and install
(10)baseband modules,(1)power supply unit,(2)amplifiers,and(1)router w/n existing compound.
Contractor: LEGACY TELECOMMUNICATIONS LLC Owner: TIGARD-ORENOMAH LODGE#207 OF AF
PO BOX 360 PO BOX 230184
BURLEY,WA 98322 TIGARD, OR 97281
PHONE: 253-858-0214 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IA Permit Fee-Additions,Alterations, 10/19/2020 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 10/19/2020 $54.47
Dwelling Units: 0 Plan Review 09/11/2020 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 10/19/2020 $102.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 10/19/2020 $32.50
Value: $25,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $937.99
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 1.600.332.2344.
Issued By: 1 ' J a Z)cLA3 C Permittee Signature: ar, 1' ( O
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.
t Building Permit Application
Commercial RECEIVE a FOR OFFICE USE ONLY
City of Tigard Received eRve,2020 Permit No jozole ee2d/
- " 13125 SW Hall Blvd.,Tigard,OR 97223 S E P 0 3 2020 y
g Plan Revie
Phone: 503-718-2439 Fax: 503-598-1960 Date/By: ,-1z-Z51 Related Permit:
TIGARD InspecInternet:n www.:god-org v BUILDING DIVISION SIION CITY OF TIGARD Date Ready By: / 1,.... /) arIlGr Supplemental
ePent 2l fnr
a, Internet: www.ti and-oi. ov Notifiedll�fathodi0//.S Su lemental Information
-d-1 t /G-. 72-1"->9
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:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13680 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: 825028 King City-T-Mobile Anchor Covered porch area: square feet
Cross street/directions to job site:From Hwy 217&SW Pacific Highway In Tigard,Oregon Deck area: square feet
Go south on SW Pacific Hwy/OR HWY-99W. In 1.5 miles 13680 SW PACIFIC HWY Other structure area: square feet
is on the left. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot 4: Permit fees*are based on the value of the work performed.
Tax map/parcel 4: R0466604 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 applicattiiioon.
T-Mobile proposes to remove(4)RRUs;relocate(3)antennas;and install(3)RRUs and(1) HCS 2.0 trunk on existing tower. Valuation: $ e 5 tJ QtJ
T-Mobile also proposes to remove(3)cabinets and(2)baseband units;relocate(2)baseband ants and(5)baseband Lease Area-
Existing building area:700 square feet
modules;and install(10)baseband modules,(1)power supply unit,(2)amplifiers,and(1)router within existing compound.
New building area: No change square feet
❑ PROPERTY OWNER 0 TENANT Number of stories: N/A
Name: T-Mobile Type of construction: IIB
Address: 830 NE Holladay St. Occupancy groups:
City/State/ZIP: POrtland,OR 97232 Existing: Unmanned
Phone:( ) Fax:( ) New: No change
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: Crown Castle on behalf of T-Mobile (Mae refer rojee sekednfe
Structural plan review fee(or deposit): 295 Q 7
Contact name: Sarah Baird
FLS plan review fee(if applicable):
Address: 1505 Westlake Ave N,Ste 800
City/State/ZIP: Seattle,WA 98109 Total fees due upon application:
Amount received:
Phone:( 206 )336-3204 Fax: :( )
E-mail: sarah.baird@crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: TBD Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): S21.60
CCB Lie,: {f/} Total fee due upon application: $201.60
Authorized signature: I ,,,, ,„/1 f j This permit application expires if a permit is not obtained
�,,r�""u�"� within 180 days after it has been accepted as complete.
Print name:Sarah Baird,Crown Castle,on alf of T-Mobile Date: g/y2020 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(l1/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Accessibility: Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
TIGARD, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigaQ'}�.t�EIVED
��l SEP 0 3 2020
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. CITY�� f'GARD
(1) Every project for renovation,alteration or modification to affected buildings Bud relate DIVISION
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five percent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering. [1] $
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section,priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
_ Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with:
A. ❑ map &tax lot# 0 project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the"Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit-based on valuation of project.
I:\Building\Pemuts\BUP_COM_PemutApp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
. Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
TIGARD00 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
Type of Submittal # of Plans
(Includes new,additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan is required showing location and square footage
of all buildings to be demolished,erosion control plan and
tree protection,if applicable)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Solar Photovoltaic 2
(Requires check list for prescriptive installation. If not
prescriptive installation,engineering is required.)
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,Washington
County,and Tualatin Valley Fire&Rescue),if applicable.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
r l c n R o Building Permit Review — Commercial - No Land Use
Building Permit #: SUP2076-- 002(f 1
Site Address: 13680 SW Pacific Hwy Suite/Bldg#:
Project Name: T-Mobile
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Remove/replace antennas and equipment
Existing Business Activity: Wireless communication facility
Proposed Business Activity: Wireless communication facility
QVerify site address/suite#exists and active in permit s stem.
0 River Terrace Neighborhood: 0 Yes LI No
QZoning: C-G
❑r Permitted Use: ki Yes U No U Spec Space
❑o Confirm no land use required.
ElBusiness License: N/A
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Notes:
�' �2
Approved by Planning: Date: 9/3/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 09-03.2420
Site Plans: # 2„..._
Building Plans: #n �,Z_-
Building Permit#: a-EEnter building ermit# above.
Workflow Routing: ❑Planning 11 Permit Coordinator E building
Workflow Sign-off: 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:
j
. By Permit Technician: _�% / Ji,',,, Date: Off'-/O '2020
I:1Building\Forms\BldgPermitRvw_COM_NoLandUse_ 11819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: � Date:
Notes: Amp-
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Appli t:
Revision Notice 3: Date Sent to :. 'cant:
❑ SDC Fees Entered: Wash • rans Dev Tax: ❑ Yes ❑ N/A
Ti..rd Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
•
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_l 11819 docx
City ofTigard RECEIVED
DEVELOPMENT DEPARTMENT
l SEP 0 3 2020
`fIGARD Collocation Supplemental Questionnaire CiTY O TIGARD
DUILDIN8 ulmit.iN
SITE INFORMATION
Collocating antenna is on: ® Existing tower L Existing non-tower structure
Address: 13680 SW Pacific Hwy City/State: Tigard, OR Zip: 97223
PROVIDER INFORMATION
Name of provider: T-Mobile Has this provider previously served Tigard? 2 Yes ❑ No
Contact name: Sarah Baird,Crown Castle Phone: 206-336-3204
List other providers currently collocating on samc tower or structure: Sprint
Approved land use case number:
ANTENNA INFORMATION
Existing: New:
Height of antennas: 99 ft Height of antennas: 99 fr.
Color of antennas: Paint to match Color of antennas: Paint to match
Color of equipment: Paint to match Color of equipment: Paint to match
Accommodating equipment: N/A Accommodating equipment: N/A
Will new accessory equipment be installed? 2 Yes 0 No
Location of new accessory equipment:
12 Within previously approved fenced area
i2 Within existing structure
0 Other location:
Will landscaping be removed to accommodate the accessory equipment? ❑ Yes ® No
If yes, describe here:
wrr Applicant's si re P Sarah Baird.Crown Castle on behalf of T-Mobile 9/2/2020
Print name Date
Sarah Baird,Crown Castle 9/2/2020
Pole/structu vner's signature Print name Date
STAFF USE ONLY
Zone: 0 Approved 0 Not approved Received by. Date:
Reasons for denial:
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of1