Permit Support Document CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT f Permit#: BUP2020-00201
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �23 �a Date Issued: 10/21/2020 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; install(3)RRU's&(1)HCS 2.0 trunk on existing towers;remove(3)
cabinets&(2)baseband units;relocate(2)baseband units&(5)baseband modules;install(10)baseband
modules,(1)power supply unit,(2)amplifiers,&(1)router win existing compound. 12/22/2020:Change contractor.
Contractor: LEGACY WIRELESS SERVICES INC Owner: TIGARD-ORENOMAH LODGE#207 OF AF
15580 SE FOR MOR CT PO BOX 230184
CLACKAMAS, OR 97015 TIGARD, OR 97281
PHONE: 503-656-5300 PHONE:
FAX: 503-656-5305
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)
Misc Administration Fee 12/23/2020 $45.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $982.99
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 DAR
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: 7 f/s;- • /y:,'z_r 4'-'J 7> >t.,'
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.