Permit CITY OF TIGARD BUILDING PERMIT
■ Permit#: BUP2020-00205
COMMUNITY DEVELOPMENT
T r c-A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/2/2020
Parcel: 2S106AD04900
Jurisdiction: Tigard
Site address: 16668 SW AUTUMNVALE LN
Project: T-Mobile Subdivision: RIVER TERRACE EAST Lot: 156
Project Description: Replace(3)antennas and RRUs;remove(1)RRU and install(1)HCS 2.0 fiber wl pendant on existing tower.
Replace(1)router and install(8)baseband modules,(1)booster,(3)amplifiers,and(1)junction box w/OVP within
existing compound.
Contractor: MASTEC NETWORK SOLUTIONS LLC Owner: RALSTON, CHRISTOPHER J
1203 114TH AVE SE RALSTON, SHERI L
BELLEVUE,WA 98004 21029 SW LEBEAU RD
SHERWOOD, OR 97140
PHONE: 425-214-9727 PHONE:
FAX: 503-210-1001
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IA Permit Fee-Additions,Alterations, 11/02/2020 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 11/02/2020 $45.35
Dwelling Units: 0 Plan Review 09/22/2020 $245.64
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 11/02/2020 $102.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 11/02/2020 $12.00
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 $782.89
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: 11a"Ct^CO2_ •& Permittee Signature: or,‘ 1•Cq l7�
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 OP 3/ z,
Commercial RECEIVED ed ' FOR OFFICE USE ONLY Ny�1 r
1114
� City of Tigard RecelvDate/By: 09+�G'l.(/z0 Permit No.B �Q�zW��r7
13125 SW Hall Blvd.,Tigard,OR 97223 A U G 3 12020 Plan Revie
s Phone: 503-718-2439 Fax: 503-598-1960 °�.3n-2:o �1 Related Permit:
Date/By: ,n7J5e/
i.I U:\R 3 Inspection Line: 503-639-4175 CITY OF I IGARD Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:Wl 171A1 me, Supplemental Information
BUILDING DIVISION _ v t
TYPE OF WORK'..tLcd 5z
REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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: Eligible Facilities Request 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: S
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16668 SW Autumnvale Lane New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: 879602 Barrow Rd-T-Mobile Anchor Covered porch area: square feet
From Newberg OR heading east on OR-99 We t/Pac c NWY W for 6.7 miles
Cross street/directions to job site:then turn left onto SW Elwert Rd.Take the immediate right to stay on SW Elwert Deck area: square feet
Rd.In 2 miles turn right onto SW Schools-Sherwood Rd.In.6 miles turn left onto SW Roy Rodgers Rd.In 3.2 miles Turn right
Ant°SW Friendly lane Sits is straight down road shoat Ii4 mile nn left Armeca road in hating re-built Follow Friendly lane until Other structure area: square feet
the road splits and go left onto SW Autumvale Lane.Follow the road around to the left and up to the site on your left. Site
requires steel plates to support man lift transition from sidewalk to omvel. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: R2201576 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.
T-Mobile proposes to replace(3)antennas and(3)RRUs; remove(1)RRU;and install(1) Valuation: $ 20,000
nGS Z.O Hoer wipenaant on exiting tower.T-Moore also proposes to replace(i)router ana Existing building area: 1800 Area square feet
install(8)baseband modules,(1)booster, (3)amplifiers,and(1)junction box w/OVP within
existing compound. New building area: No change square feet
❑ PROPERTY OWNER ® 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
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Crown Castle on behalf of T-Mobile f`f5 /�
Structural plan review fee(or deposit): &T
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: I
Phone:( 206 )336-3204 Fax::( ) Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Sarah.bai rd @crown ca stle.co m
CONTRACTOR Commercial and residential prescriptive installation of
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
and administrative fees): $t 80.00
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 1'11 05
,.� r/ Total fee due upon application: $201.60
Authorized signature: a This permit application expires if a permit is not obtained
��/ within 180 days after it has been accepted as complete.
Print name: Sarah Baird, Crown Castle, Date: 8/28/2020 * Fee methodology set by Tri-County Building Industry
Service Board.
on behalf of T-Mobile
l:lBuilding\Permits\BUP_COM_PelmitApp.doc Rev.04/21/2014 440-46I3T(11/02/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.tigard-or.gov
REQUIREMENT: OREGON REVISED STATUTE (ORS)447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
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: $
(I) 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\Pemuts\BUP_COM_PcrmitApp.doc Rev.03/05/2019
MICity 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# ❑ 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 requited 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.
1
I:\Buikling\Permits\BUP_COM_PcrnitApp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
T[GARD 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\Pcmuts\BUP_COM_PemitApp.doc Rev.03/05/2019
City of Tigard
11111 COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: t5(/P2020 a 72 2
Site Address: 16668 SW Autumnvale Lane 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
ElVerify site address/suite#exists and active in permit s stem.
ElRiver Terrace Neighborhood: Q Yes No
❑r Zoning: R-7
❑' Permitted Use: CJ Yes U No U Spec Space
ElConfirm no land use required.
❑r Business License: N/A
Exists: ❑ Yes ❑ No,applicant was provided a business license application
Notes:
Approved by Planning: Date: 9/2/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: QS•9/ZOZO
Site Plans: # 2
Building Plans: # Z.
Building Permit#: Er-Enter building ermit# above.
Workflow Routing [n PlanningU--Permit Coordinator R-Building
Workflow Sign-off: R.-Sign-off for Planning(include notes from planning review)
Route Application Documents: t F uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: DIZZ ZOZO
1:1Build ing\Fomis\Bl dgPermitRvw_COM_NoLandUse_l 11819.docx
Pe ' 't Coordinator Review
❑ Co s •on "Met"prior to issuance of building permit
❑
Pp •`•.A roved> ' •leased: Date:
Notes:
Revisions (after Building Submittal only
Revision Notice 1: Date Sent to App,-.
Revision Notice 2: Date Sent to Applicat .
Revision Notice 3: Date Sent to A..:
❑ SDC Fees Entered: W. '% rans Dev Tax: Yew ❑ N/A
igard Trans SDC: ❑ losiL\l/A
Parks SDC: ❑ Yes
❑ 0, Permit •
Approved by Permit Coordinator:
I:\B uil ding\Fors\B I dgPermitRvw_COM_NoLandUse_111819.docx
Pir RECEIVED
AUG 3 1 2020
CITY OF-;;CARD
ELIGIBLE FACILITIES REQUEST CERTIFICATION FOR NON-SUBSTAMMING DIVISION
CHANGES
TO A WIRELESS TOWER NOT LOCATED WITHIN A PUBLIC RIGHT OF WAY
1) Address of the Wireless Tower: 16668 sw Autumnvale Lane,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: too' -
3) What is the height(measured in feet above ground level) at which the modifications to the
Transmission Equipment will occur on the Tower? 86'
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? ioo'
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?
❑ 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?
El 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 2015.3
9) Will the proposed modification in Transmission Equipment defeat the existing concealment
elements of the Tower?
❑ 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 n 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?
El Yes n 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 28th day of August 2020 ,
°1-41:14-C---Tc:1;:s-4:)
tgnature
Sarah Baird, Site Acquisition Specialist
Name & Title
Non-Substantial Change Certificate for Towers Not Within A Public Right of Way
National Development 2015.3
City ofTigard RECEIVED
` COMMUNITY DEVELOPMENT DEPARTMENT AUG 3 1 2020
TIGARD Collocation Supplemental Questionnaire CITY OF i:uARD
RI III mimn D'YI>;IOPJ
SITE INFORMATION
Collocating antenna is on: Existing tower ❑ Existing non-tower structure
Address: City/State: Zip:
PROVIDER INFORMATION
Name of provider: T-Mobile Has this provider previously served Tigard? IR Yes ❑ No
Contact name: Sarah Baird Phone: 206-336-3204
List other providers currently collocating on same tower or structure: Sprint
Approved land use case number: oI-091su/D
ANTENNA INFORMATION
Existing: New:
Height of antennas: 86 ft. Height of antennas: 86 ft.
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? Yes ❑ No
Location of new accessory equipment:
IR Within previously approved fenced area
Si Within existing structure
❑ Other location:
Will landscaping be removed to accommodate the accessory equipment? ❑ Yes ! No
Ifyes, describe here:
Sarah Baird,Crown Castle,on behalf of T-Mobile 8/28/2020
Applicant's si ure Print name Date
Sarah Baird, Crown Castle 8/28/2020
Pole/strut owner's signature Print name Date
STAFF USE ONLY
Zone: ❑ 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 of 1