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„ CITY OF TIGARD BUILDING PERMIT
S • COMMUNITY DEVELOPMENT Permit#: BUP2021-00172
Date Issued: 10/19/2021
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: T-Mobile Subdivision: None Lot: None
Project Description: Modifying antenna equipment and ground structure
Contractor: PAJ TELECOM INC Owner: TIGARD, CITY OF
PO BOX 522 13125 SW HALL BLVD
GLADSTONE,OR 97027 TIGARD,OR 97223
PHONE: PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 08/03/2021 $453.95
Occupancy Grp: U Occupancy Load: 0 Demolition
12%State Surcharge-Building 08/03/2021 $54.47
Dwelling Units: 0 Plan Review 07/15/2021 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 08/03/2021 $110.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 08/03/2021 $43.50
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 $956.99
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: Ho-U,y Va4A.,De-Wege, Permittee Signature: Ow
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.
, —
DESCRIPTION OF WORK
CROWN CASTLE FOR T-MOBILE (BU 879526)
8777 SW Burnham Street, Tigard, OR 97223
PROJECT DESCRIPTION
THE PURPOSE OF THIS PROJECT IS TO ENHANCE
BROADBAND CONNECTIVITY AND CAPACITY TO THE
EXISTING ELIGIBLE WIRELESS FACILITY,
TOWER SCOPE OF WORK:
•REMOVE (6)KMW ANTENNAS
•REMOVE(9)RADIOs
•REMOVE(1)PLATFORM MOUNTS
•REMOVE (6)JUNCTION BOX
•REMOVE(3) HYBRID CABLES
• INSTALL(1)PLATFORM MOUNT W/HANDRAIIS
• INSTALL(6)ANTENNAS
• N STALL(6)RADIOs
• INSTATJ (2)BREAKOUT PENDANTS
• INSTALL(2)HCS 2.0 HYBRID CABLES(1-1/2")
GROUND SCOPE OF WORK: •INSTALL(1)VOLTAGE
•RETAIN (1)INSIBS CABINET BOOSTER
•RETAIN (1)BBU BATTERY •INSTALL(1)EXTRA
CABINET AMPLIFIER
• INSTALL(1) HPL3 CABINET •INSTALL(1)RECTIFIER
• INSTALL(1)LB3 CABINET •INSTALL(1)BREAKERS
•INSTALL(2)ASIB •INSTALL(1)CSR IXRe V2
• INSTALL(2)ASIK (GEN2)
• I NSTAI A.(1)FSMF •INSTALL(2)JUNCTION
•INSTALL(3)ABIA BOXES
• INSTAII.(4) ABII.
• INSTALL(3)ABIC
• INSTALL(2)AMIA
i
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General Property Information
Map&Taxlot ID#: 2S102AD03450
Real Property Account#: R2024501
Site Address: 8777 SW BURNHAM ST.TIGARD OR,97223
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City of Tigard
11111 r COMMUNITY DEVELOPMENT DEPARTMENT
TIcARD Building Permit Review — Commercial - No Land Use
Y,e_rQfcf ._ .,,wr,,,,al ..ft?; .&�3: a ,71`, . . ,,'''' a .L.S..v-i L,Ya_.£k lr.T0. .21M.L p ,t!:), S°;...'s:i..5z.9 t.t,. i•n .va _ t.Y,r_...
Building Permit #: TOP202(-GU17Z
Site Address: 8777 SW Burnham St Suite/Bldg#:
Project Name: T-Mobile
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Plannix -Review Ai&lot MS Us"
Proposal: Modification to existing+-pole and install accessory equipment.
Existing Business Activity: Wireless facility
Proposed Business Activity: Wireless facility
!7 Verify site address/suite # exists and active in permit system.
I River Terrace Neighborhood: ❑ Yes El No
IN Zoning: MU-CBD
® Permitted Use: ® Yes ❑ No ❑ Spec Space
® Confirm no land use required.
f Business License:
Exists: ❑ Yes ❑ No,applicant was provided a business license application
Notes: No land use per 18.450.030.A and C.
Approved by Planning: AVVA it e& Date: 7/7/2021
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: E Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Buildiri Permit Submittal
Original Submittal Date: Q4r/23/202J
Site Plans: # 3
Building Plans: # 3
Building Permit#: P—Enter building permit# above.
Workflow Routing: IR—Planning ❑ Permit Coordinator IR—Building
Workflow Sign-off: ET-Sign-off for Planning(include notes from planning review)
Route Application Documents: Luilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: D 10-02 /
I:\Building\Forms\B1dgPermitRvw_COM_NoLandUse_111819.docx
Coorclinator_Review
❑ Conditio " et"prior to issuance of building permit
❑ Approved,NO •ased: D • _
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Appli .
Revision Notice 3: Date Sent to s .. cant:
❑ SDC Fees Entered: W-: o Trans Dev Tax: ❑ Yes ❑ N
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to •. i e Permit
. .roved by Permit Coordinator: Date:
1:\Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
IN
,, ,:,, Collocation Supplemental Questionnaire
SITE INFORMATION e7 iV6
Collocating antenna is on: ® Existing tower ❑ Existing non-tower structure
Address: 8777 SW Burnham St City/State: Tigard, OR Zip: 97223
PROVIDER INFORMATION
Name of provider: T Moblie Has this provider previously served Tigard? ( 1 Yes 0 No
Contact name: Gary Abrahams Phone: 206-3494279
List other providers currently collocating on same tower or structure: AT&T, Sprint
Approved land use case number: CUP96-0004
ANTENNA INFORMATION
Existing: New:
Height of antennas: of ft Height of antennas: aC> ft.
Color of antennas: Factory Painted Color of antennas: Factory Painted sky color
Color of equipment: Factory Painted _ Color of equipment: Factory Painted
Accommodating equipment: Accommodating equipment:
Will new accessory equipment be installed? ® Yes 0 No
Location of new accessory equipment:
® Within previously approved fenced area
❑ Within existing structure
O Other location:
Will landscaping be removed to accommodate the accessory equipment? ❑ Yes fill No
1 f yes de ' e heir
/
.gyp licant'a, ign ure Print name Date
See Attached ay:Ls U5+• 4 cf� ciii 7( Z.t..1
Pole/structure owner's signature Print name Date
Zone: 1AtA C/C5t) Izi Approved 0 Not approved Received by: f t V Date: �,�✓
Reasons for denial: N1 k
• ::ciiY.'nh3_trie:ceL4�ait-..^.:+aL']Z�.�----t'..xw z: _ .. ..y.�y�L¢i'u,:yd. •. - 'ST.nC.4valEn,.^.Aa�s:SFiRvns4acb*Yz - ._,,...:.-
City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wvwrigard-or.gov • 503-718-2421 • Page 1 ot1
CROWN Crown Castle
1505 Westlake Avenue North
Cf.'
o CASTLE Suite 800
Seattle,WA 98109
September 17,2020
Re: Crown Castle—PNW
Subject: Gary Abrahams—Authorized Consultant for Crown Castle
Dear Reviewing Parties:
This letter serves to notify you that Crown Castle has retained the services of Gary Abrahams, as
approved agent to submit application for and obtain local jurisdiction approvals including but not limited
to zoning and building permits. This includes applicable permitting for any and all customers seeking to
install or modify their equipment on Crown Castle towers.
Please feel free to contact me directly with any questions. Thank you for your expeditious processing of
applications filed by Mr. Abrahams.
Sincerely,
'1 .
Chris Listfjeld
Site Acquisition Project Manager—Seattle
Chris.Listfjeld@crowncastle.com
(206) 336-7403
1'he pathway to possible
CrownCastie.com