Permit CITY OF TIGARDIN BUILDING PERMIT
a .' COMMUNITY DEVELOPMENT
Permit#: BUP2020-00196
r
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/3/2020
Tf�" jilt ^,2 Parcel: 1S136CCO2100
e
fr— c Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HVVY
Project: T-Mobile Subdivision: None Lot: None
Project Description: Removing RRU;install(3)antennas,(3)RRUs,Hybrid cable.remove(3)cabinets, (2)subracks,baseband,
module,router. Relocate baseband,(7)modules;install(2)cabinets,(13)modules, router,(6)fiber splitters,
voltage booster,junction box;upgrade to 200A amp. 12/1/20-Contractor changed to PAJ TELECOM INC.em
Contractor: PAJ TELECOM INC Owner: GRUNBAUM SURVIVOR'S TRUST
PO BOX 522 BY GRUNBAUM, MARILYN K&ERIC TRS
GLADSTONE, OR 97027 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE:
PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM --
Class of Work: ALT Type of Const: IA Permit Fee-Additions,Alterations, 10/06/2020 $509.05
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 10/06/2020 $61.09
Dwelling Units: 0 Plan Review 09/01/2020 $330.88
Stories: 0 Height: 0 ft DC Provision Review, COM TI-Ping 10/06/2020 $102.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 10/06/2020 $33.50
Value: $30,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,036.52
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 y• 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. Y• • ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
T
Issued By: �- /^J/ Permittee Signature: VfV A'L:/ 4-pdv
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.
Edgardo Maldonado
From: #Building Permit Technicians
Sent: Tuesday, December 1, 2020 3:54 PM
To: Baird, Sarah
Subject: RE: T-mobile Antenna Permits: BUP2020-00196
Attachments: BUP2020-00196.pdf
Sarah,
Attaches is the payment receipt for permit number BUP2020-00196.
Thank you
Eggie Maldonado
Permit Technician Assistant
City of Tigard I Community Development
13125 SW Hall Blvd, Tigard,OR 97223
Ph. (503) 718-2452
From:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Sent:Tuesday, December 1, 2020 7:12 AM
To: Baird, Sarah <Sarah.Baird@crowncastle.com>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Cc: Branden Taggart<brandent@tigard-or.gov>
Subject: RE:T-mobile Antenna Permits: BUP2020-00197
Good morning Sarah,
We have changed the contractor for permit number BUP2020-00197 per your request from MASTEC NETWORK
SOLUTIONS LLC to PAJ TELECOM INC. A$45 admin fee was added,this fee can be paid online at https://aca-
prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number BUP2020-00197 under the Building
tab.
Thank you
Eggie Maldonado
Permit Technician Assistant
City of Tigard I Community Development
13125 SW Hall Blvd,Tigard, OR 97223
Ph. (503) 718-2452
From: Baird, Sarah <Sarah.Baird@crowncastle.com>
Sent: Monday, November 30, 2020 3:36 PM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Cc: Branden Taggart<brandent@tigard-or.gov>
Subject: RE:T-mobile Antenna Permits: BUP2020-00195, 196, 197
1
Caution!This message was sent from outside your organization.
Good afternoon,
I have been informed that T-Mobile would like to change the contractor for permit BUP2020-00197 to PAJ Telecom Inc. I
have attached their CCB info for easy reference. Please let me know if you need anything further from me.
Thank you!
SARAH BAIRD
Site Acquisition Specialist'Seattle
T: 206.336.3204
120
CROWN CASTLE
Westlake Union Center
1505 Westlake Ave N, Ste 800, Seattle, WA 98109
www.crowncastle.com
From: Baird, Sarah
Sent: Monday, November 2, 2020 6:07 PM
To: #Building Permit Technicians<Tigard BuildingPermits@tigard-or.gov>
Cc: Branden Taggart<brandent@tigard-or.gov>
Subject: RE:T-mobile Antenna Permits: BUP2020-00195, 196, 197
Good evening,
My project manager has confirmed the contractor for permit BUP2020-00197 will be Mastec Network Solutions. I have
attached their state license info for easy reference.
Thank you!
Sarah Baird
Site Acquisition Specialist—Seattle I Crown Castle 1206.336.3204
From: Branden Taggart<brandent@tigard-or.gov>
Sent: Monday, October 5, 2020 5:53 PM
To: Baird, Sarah <Sarah.Baird@crowncastle.com>
Cc: Dianna Ornelas <Dianna@tigard-or.gov>; Edgardo Maldonado <edgardom@tigard-or.gov>
Subject:T-mobile Antenna Permits: BUP2020-00195, 196, 197
Importance: High
CAUTION:This email originated from outside of the organization. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
Hello Sarah,
The T-Mobile antenna replacement permits, located at 14020 SW 72"d Avenue, 11744 SW Pacific Highway, and 10185
SW Cascade Avenue, are ready to issue now. I have attached invoices above for you to reference, and the fees due are
as follows:
2
T-Mobile Permits
Permit# Fees Due
BUP2020-00195 $ 473.57
BUP2020-00196 $ 705.64
BUP2020-00197 $ 704.64
Total: $ 1,883.85
The above permit fees can be paid online through our website: https://aca.accela.com/tgard/Default.aspx. From there,
click on the Building tab, enter the permit numbers in the Record Number field,and click Search. Once paid, please
notify us at TigardBuildingPermits(a tgard-or.gov, and I will place these permits in our open Permit Center conference
room for you to pick up between the hours of 8:00 a.m. and 5:00 p.m., Monday through Thursday. We are closed on
Fridays.
Please note that the contractor's CCB license number is required prior to issuance. Please let me know if you have
questions.
Thank you,
Branden Taggart
1111 is City of Tigard
Senior Permit Technician
Community Development
TI Aki)
13125 SW Hall Blvd
Tigard,OR 97223
1503)71B-2449
brandent@tigard-or.gov
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
This email may contain confidential or privileged material. Use or disclosure of it by anyone other than the recipient
is unauthorized. If you are not an intended recipient, please delete this email.
3
BuP2ozs) -oz.) Iq�
111�1y, Sr,/ f;,
C R O A/w( 1505 Westlake Ave N, Phone (206) 336-3204
Y i/ 'V Seattle,WA 98109 Fax
4#4.000CASTLE
www.crowncastle.com
RECEIVED
August 18,2020 AUG 2 4 2020
City of Tigard CITY OF TIGARD
BUILDING DIVISION
131z5 SWWHall Blvd
Tigard,OR 97223
RE: Eligible Facilities Request to modify equipment on a communications tower located at:
11744 SW Pacific Hwy,Tigard,OR,97223
Crown Site Number:824338/Crown Site Name:Greenburg
Customer Site Number:P001373B/Application Number:524390
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.112-96,126 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." Additionally,if"the reviewing State or local government
determines that the application is incomplete"[they]"must provide written notice to the applicant within 3o days of
receipt of the application,clearly and specifically delineating all missing documents or information." Under federal law,
an Eligible Facilities Request is deemed granted with written notification in sixty(6o)days after an application is filed
with a local jurisdiction,excluding tolling.
T-Mobile proposes to modify the"Greenburg Tower"as follows:
Remove(I)RRU;and install(3)antennas,(3)RRUs,and(1)hybrid cable on existing tower. T-Mobile also
proposes to remove(3)cabinets,(2)subracks,(i)baseband unit,(1)module,and(1)router;relocate(1)
baseband unit and(7)modules;and install(2)cabinets,(13)modules,(1)router,(6)fiber splitters,(1)voltage
booster,and(1)junction box;and upgrade to 2ooA amp within existing compound.
Itemized list of submittal documents:
• (1)Cover Letter
• (1)Commercial Building Permit Application
• (1)Collocation Supplemental Questionnaire
• (2)Structural Analysis stamped by Oregon State engineer
• (2)Construction Drawings stamped by Oregon State engineer—11"x17"print
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.
The Foundation for a Wireless World.
CrownCastle.corn
I
ROW 1505 Westlake Ave N, Phone: (206) 336-3204
Seattle,WA 98109Fax:
al.1111:00 CASTLE av,nes,e om
Sincerely,
Sarah Baird
Sarah.Baird@crowncastle.com
(206)336-3204
The Foundation for a Wireless World.
CrownCastle.eorn
�,, CROWN 1505 Westlake Ave N, Phone: (206) 336-3204
i,
Seattle,WA 98109 Fax:
CASTLE wmv.crowncaste.com
September 23,2020
City of Tigard
Community Development
Attn:Eggie Maldonado
13125 SW Hall Blvd.
Tigard,OR 87223
SENT VIA ELECTRONIC MAIL TO: EDGARDOM@TIGARD-OR.GOV
TIGARDBUILDINGPERMITS@TIGARD-ORGOV
****".""NOTICE OF COMPLETE SECTION 6409 APPLICATION*""******
RE: Request for Minor Modification to Existing Wireless Facility—Section 6409
11744 SW Pacific Hwy,Tigard,OR,97223
Crown Site Number:824338/Crown Site Name:Greenburg
Customer Site Number:POo1373B/Application Number:524390
Dear Eggie,
As you are aware,T-Mobile currently has pending before City of Tigard an application for 824338 Greenburg—T-Mobile
Anchor("Application")submitted as an eligible facilities request pursuant to Section 6409.x Section 6409 is a federal law
governing the collocation, replacement, and removal of transmission equipment on existing wireless facilities. Under
Section 6409 and the applicable Federal Communications Commission regulations,'a state or local government must
approve an eligible facilities request(or find the request is not covered by the federal rules)within 6o days or the request
is deemed granted.
The 6o-day time frame for review, or"shot clock,"is only tolled only if a state or local government determines that the
application is incomplete and provides written notice in accordance with the FCC regulations within 3o days of the start
of the shot clock.3
With respect to the Application,our records show that the shot clock started on August 21,2020. It has been more than
thirty days since the start of the shot clock and we have received no notice of incompleteness that tolls the shot clock under
the federal rules.As a result,the application is now complete for purposes of Section 6409.
Middle Class Tax Relief and Job Creation Act of 2012,Pub.L.No.112-96,§6409(2012)(codified at 47 U.S.C.§
1455).
2 Acceleration of Broadband Deployment by Improving Wireless Facility Siting Policies,29 FCC Rcd.12865
(2014)(codified at 47 CFR§ 1.6100);and Implementation of State&LocaI Governments'Obligation to Approve
Certain Wireless Facility Modification Requests Under Section 6409(a)of the Spectrum Act of 2012,WT Docket
No.19-250(June 10,2020).
3 47 CFR§1.61oo(c)(3).
The Foundation for a Wireless World.
CrownCastle.com
CITY OF TIGARD BUILDING PERMIT
1111
• COMMUNITY DEVELOPMENT Permit#: BUP2020-00196
Date Issued: 11/3/2020
T I G A R f3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 136CCO2100
Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HWY
Project: T-Mobile Subdivision: None Lot: None
Project Description: Removing(1)RRU;install(3)antennas,(3)RRUs, (1)Hybrid cable on existing tower, remove(3)cabinets,(2)
subracks,(1)baseband unit, (1)module,(1)router. Relocate(1)baseband unit,(7)modules;install(2)cabinets,
(13)modules,(1)router,(6)fiber splitters,(1)voltage booster, (1)junction box;upgrade to 200A amp w/in existing
Contractor: MASTEC NETWORK SOLUTIONS LLC Owner: GRUNBAUM SURVIVOR'S TRUST
1203 114TH AVE SE BY GRUNBAUM, MARILYN K& ERIC TRS
BELLEVUE, WA 98004 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE: 425-214-9727 PHONE:
FAX: 503-210-1001
FEES
Specifics:
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IA Permit Fee-Additions,Alterations, 10/06/2020 $509.05
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 10/06/2020 $61.09
Dwelling Units: 0 Plan Review 09/01/2020 $330.88
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 10/06/2020 $102.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 10/06/2020 $33.50
Value: $30,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,036.52
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: 111\0\1 \ Q,, �W� — Permittee Signature: O �ppl r c c k d�
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.
r
o
Building Permit Application
Commercial RECEIVED FOR OFFICE USE ONLY
City of Tigard Date/By:
y: 3/-2O2O .gap2o, 0-�X]le��O
114 - Receive Permit\"o.
v 13125 SW Hall Blvd.,Tigard,OR 97223 r 2 A ZO'�O Plan Revict ICI ^�
Phone: 503-718-2439 Fax: 503-598-1960 AU U Y Date/By: / / �C Related Permit:
Inspection Line: 503-639-4175 Date Ready.By: Jarr&: Ef See Page 2 for
TIGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: -1b Tie., Supplemental Information
err� //js7/
BUILDING DIVISION _A
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: Eligible Facilities Request equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building ❑Multi-family
0 Master builder ElOther: 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.#: Project name:824338 Greenburg-T-Mobile Anchor Covered porch area: square feet
Cross street/directions to job site: From the 217 Take exit 6 for Oregon 99W toward Tigard/McMinnville Deck area: square feet
Turn right onto OR-99W N Destination will be on the right. Turn right onto the dutch brothers driveway. Other structure area: square feet
Go past the dutch bros and take the sloped road on the right side REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: R0284105 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
T-Mobile proposes to remove(1)RRU:and install(3)antennas,(3)RRUs,and(1)hybrid cable on existing tower.T-Mobile Valuation: $ 30,000
also proposes to remove(3)cabinets,(2)subracks,(1)baseband unit,(1)module,and(1)router;relocate(1)baseband unit
(6)fiber splitters,(1)voltage booster,and(1)junction box; Compound Area-
and(7)modules;and install(2)cabinets,(13)modules,(1)router, p 9 Existing building area:149e Square feet
and upgrade to 200A amp within existing compound.
New building area: N/A 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
Structural plan review fee(or deposit): �30.
Contact name: Sarah Baird
FLS plan review fee(if applicable):
Address: 1505 Westlake Ave N,Ste 800
Total fees due upon application:
City/State/ZIP: Seattle,WA 98109
Amount received:
Phone:(206 )336-3204 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: sarah.baird@crowncastle.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:—T.BB* A / ,( Submit two(2)sets of roof plan with connection details
4`t!)L�/� and fire department access,along with the 2010 Oregon
Address: 1,20 ,rr../ //4/ JJ43 Solar Installation Specialty Code checklist.
City/State/ZIP: Permit fee(includes plan review $180.00
h ,/4,,d 44 (/1/ 4 idv it and administrative fees):
Phone:( i-jam 01,411— 9')) 7 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.; '41 70 i� Total fee due upon application: $201.60
Authorized signature ot,tgQ 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,on behalf of T-Mobile Date: 8/18/2020 * Fee methodology set by Tri-County Building Industry
Service Board.
I:lBuilding\Permits\BUP_COM_PermitApP doe Rev.04/21/2014 440-4613T(I I/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1 _ " 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: $
(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.doe Rev.03/05/2019
rt. 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# ❑ 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\Permits\BUP_COM_Permittpp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1 - Commercial
° Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
TIGARD 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 Firc& Rescue),if applicable.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
, . .
City of Tigard
•
111 COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: el/402O2O ZV/9c
Site Address: 11744 SW Pacific Hwy Suite/Bldg#:
Project Name: T-Mobile
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Install antennas and accessory equipment
Existing Business Activity: Wireless communication facility
Proposed Business Activity: Wireless communication facility
CIVerify site address/suite#exists and active in permit s stem.
ElRiver Terrace Neighborhood: ❑ Yes ILI No
❑ Zoning: C-G U
ElPermitted Use: L'I Yes No U Spec Space
QConfirm no land use required.
QBusiness License: N/A
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Notes:
Approved by Planning: :,z Date: 8/25/20
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: 08-2V102c7
Site Plans: # Z
Building Plans: # 2-
Building Permit#: Q'Enter building ermit# above.
Workflow Routing: EVPlanning [l Permit Coordinator Er Building
Workflow Sign-off: 13 Sign-off for Planning(include notes from planning review)
Route Application Documents: Q'Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: �J�
By Permit Technician: 4 le;:-� Date: fi .3/:7-OZd
1:1B uiI ding\Forms\B IdgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: deS><
Date:
Notes:
\\
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to :. cant:
Revision Notice 2: Date Se o Applicant:
Revision Notice 3: Da - ent to Applicant:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes 0 N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_N oLandUse_111819.docx
City of Tigard RECEIVED
•1 COMMUNITY DEVELOPMENT DEPARTMENT AUG 2 4 2020
Collocation Supplemental Questionnaire CITY OF TIGARD
TIGARD BUILDING DIVISION
SITE INFORMATION
Collocating antenna is on: ® Existing tower ❑ Existing non-tower structure
Address: 11744 SW Pacific Hwy City/State: Tigard,OR Zip: 97223
PROVIDER INFORMATION
Name of provider: T-Mobile Has this provider previously served Tigard? ®Yes El No
Contact name: Sarah Baird,Crown Castle Phone: 206-336-3204
List other providers currently collocating on same tower or structure: Verizon
Approved land use case number: CUP 96-0006
ANTENNA INFORMATION
Existing: New:
Height of antennas: 131 ft. Height of antennas: 131 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 0 No
Location of new accessory equipment:
® Within previously approved fenced area
0 Within existing structure
El Other location:
Will landscaping he removed to accommodate the accessory equipment? ❑ Yes 2 No
Ifyes, describe here:
_ Sarah Baird,Crown Castle,on behalf of T-Mobile 8/18/2020
Applicant's sign ee Print name Date
a�. Sarah Baird,Crown Castle 8/18/2020
Pole/structur ni ety er's signature Print name Date
STAFF USE ONLY ((��
Zone: Pi' Approved ❑ Not approved Received by: AL-9 Date: B
Reasons for denial:
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of1