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Permit
CITY OF TIGARD BUILDING PERMIT �, COMMUNITY DEVELOPMENT Permit#: BU P2021-00058 Date Issued: 8/16/2021 T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 251136000600 Jurisdiction: Tigard Site address: 16580 SW 85TH AVE Project: Verizon Wireless Subdivision: None Lot: None Project Description: install(3)new antennas on existing wireless facility roof Contractor: STRATA INC Owner: CLEAN WATER SERVICES 600 SE MARITIME AVE, BLDG 3, SUITE 330 2550 SW HILLSBORO HWY VANCOUVER, WA 98661 HILLSBORO, OR 97123 PHONE: 425-259-6016 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 08/16/2021 $347.48 Occupancy Grp: U Occupancy Load: 0 Demolition 12%State Surcharge-Building 08/16/2021 $41.70 Dwelling Units: 0 Plan Review 03/03/2021 $225.86 Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 08/16/2021 $103.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 08/16/2021 $37.50 Value: $18,000 11x17) Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $755.54 Required: Required Items and Reports(Conditions) 1 Special Inspection(see plans) 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: , i(. Permlttee Signature: n� ��u�j/j7D,L/ 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 6,1 Commercial FOR OFFICE USE ONLY ill City of Tigard Reeeieea 202(YXb5� g Date/By: `'" -�_2�/ Permit No. = N 13125 SW Hall Blvd.,Tigard,OR 97223 ' '7 C 2 o' Plan Review a] • Phone: 503-718-2439 Fax: 503-598-1960 Date/By. 3-t�� •� Related Permit: Inspection Line: 503-639-4175 Date Read/B rods: TIGARD Cl Y t qqAr, Y Y: A ® See Pagetfor o; Internet www.tlgard-or.goV �t' i1tl!-1fl(� Noti d/Matho J // Supplemental Information Bl.' VG DIVISION) TYPE OF WORK REQUIRED DANND 2-FAMILY.DWELLING . 0 New construction 0 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 _ ' �Et 'TMT3 1 ':= T� = work indicated on this application. a....,aaaaaaaarraaa El1-and 2-family dwelling 0Commercial/industrial Valuation: $ ElAccessory building El Multi-familyNumber of bedrooms: ❑Master builder ❑Other. Number of bathrooms: JOB SFCE INFOF2hIA _�, Total number of floors:a Job site address:16580 SW 85TH AVE New dwelling area: square feet City/State/ZIP:TIGARD, OR 97224 Garage/carport area: square feet Suite/bldg./apt.#: Project namorPt7R-TtiLITSIIS L rt.-i 14,/iyet.,41 Covered porch area: square feet Cross street/directions to job site: Deck area: square feet From SW 69th and SW Pine,Turn left onto SW 85th Ave, destination straight ahead Other structure area: square feet REQUIRED DATA:CO'IMLRCIAL-USE CHECKLIST Subdivision: Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: 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. Install 3 new antennas on existing wireless facility on roof. Valuation: $18,000 Existing building area: square feet New building area: square feet 0 PROPERTY OWNER g TENANT Number of stories: Name:Verizon Wireless Type of construction: Address:5430 NE 122nd Ave Occupancy groups: City/State/ZIP:Portland, OR 97230 Existing: Phone:( ) Fax:( ) New: ❑ AI'PLICANT 0 CONTACT PERSON Bt7ILD1NGPERMITFEE$. 1. 41/00. refer m jeg rnheirdkj -- Business name:Black Rock Structural plan review fee(or deposit): V4. Contact name:Brandon Clower FLS plan review fee(if applicable): Address:PO Box 1744 Total fees due upon application: City/State/ZIP:Tualatin, OR 97062 - Amount received: Phone:( )503-454-6622 Fax: :( ) E-mail.brandon©blk-rock.com PIIOTOVOLT_AIC SOLAR PANEL SYSTEM FEES* s - - Commercial and residential prescriptive installation of CONTRACTOR -r,x f ., roof-top mounted PhotoVoltaic Solar Panel System. Business name:tbd S ! •j A !ix/ Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: G o 0 ,fg.--- /14--/-4 -77in C ny a 6,. 3 f y olar Installation Specialty Code checklist. City/State/ZIP: V�I �Cf�f/� �� 9�6 / 33� Permit fee(includes plan review $180.00 and administrative fees): Phone:(g6,0) 77 f — $ Lo Fax:( ) State surcharge(12%ofpermit fee): $21.60 CCB Lie.: Total fee due upon application: $201.60 , Authorized signature: Z7t/.l,Qyyd - Clgu}gti This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:D Brandon Clover Date:3/2/21 * Fee methodology set by Tri-County Building Industry Service Board, 1:1Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(I I/02/COM/WEB) II City of Tigard iCOMMUNITY DEVELOPMENT DEPARTMENT e TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: 13UP2O21 -OOC)SB Site Address: //e ? S j() OC- Suite/Bldg#: Project Name: Vern (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: /n,c70 hilt) ga-plei Existing Business Activity: 4 ..)r S C,ovm .. 1^i Prop ,ed Business Activity: // // /f V, • 'site address/suite# exists and active in .permit s st •‘31 ,':•ex Terrace Neig orhood: ❑ Yes ►� No ing: l Vprfnitted Use: Yes ❑ No ❑ Spec Space Confirm no land use required. usiness License: Exists: ❑ Yes ❑ No,applicant was provided a business license application Notes: ?) ..____ Approved by Planning: --�— �� Date: s44j Revisions (after Building Submittal only) Reviewer Date Revision 1: E Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved 0 Not Approved Building Permit Submittal Original Submittal Date: D3-,a2"2e2/ Site Plans: # 3 Building Plans: # Building Permit#: a-Enter building permit#above. Workflow Routing: a-Planning 0 Permit Coordinator ErBuilding Workflow Sign-off: a-Sign-off for Planning(include notes from planning review) Route Application Documents: Er-Building: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: 13-43'.2/l 1:\Building\Forms\BldgPennitRvw_COM_No LandUse l 11819.docx Permit Coordinato 'eview ❑ Conditions "Met"prior to issuance of building permit El Approved, NOT Releas• ': Date: Notes: Revisions (after Building Submittal on Revision Notice 1: Date Sent t. •pplicant: Revision Notice 2: Date Sent to • .plicant: Revision Notice 3: Date Sent to Apo c. t: ❑ SDC Fees Entered: Wash Co Trans Dev` ax: ❑ Yes ❑ N/A Tigard Trans : D C: ❑ Yes ❑ N/A Parks SD ❑ Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordin. or: Date: I::\Building\Forms\BIdgPermitRvw_COM_No LandUse_111819.docx Branden Taggart From: Branden Taggart Sent: Tuesday, March 2, 2021 4:36 PM To: Brandon Clower (brandon@blk-rock.com) Subject: Antenna Permit for Verizon Wireless - 16580 SW 85th Ave. Attachments: BUP_COM_PermitApp.pdf Hi Brandon, We received your antenna permit submittal for 16580 SW 85th Avenue. However, we did not receive a completed Commercial Building Permit Application as your cover letter described. I have attached the application above for you. Once we receive the completed application,we will be able to proceed with plan review. Thank you, Branden ofTiTaggart �,q City of Tigard D, ,,, Senior Permit Technician Community Development 13125 SW Hall Blvd Tigard, OR 97223 I5031718-2449 brandentigtigard-or.gov 1 J February 22, 2021 VIA US Post Priority Mail Tracking 9405501206522005833578 City of Tigard Attn: Permit Center Building 13125 SW Hall Blvd Tigard, OR 97223 RE: Verizon Wireless Site at 16580 SW 85th Ave, Portland, OR/POR Tigers HS To whom it may concern: I am making this submittal to obtain a building permit from your jurisdiction for Verizon Wireless' wireless communications facility(antenna on rooftop) located at the address above. All specifics are included in the plans. Building Permit Submittal: 1. Building Permit application. 2. Three (3)sets of 11"x17" drawing set including Site Plan 3. Two (2) sets of structural analysis For review/intake fees due at submittal, please all me at 503-208-5319 for Credit Card info. If you have any questions, I can be reached at 503-454-6622 or Brandon@blk-rock.com. Sincerely, Brandon Clower Representing Verizon Wireless 503-208-5319