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Permit CITY OF TIGARD BUILDING PERMIT I a II COMMUNITY DEVELOPMENT Permit#: BUP2021-00193 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/15/2022 Parcel: 1 S136AD06300 Jurisdiction: Tigard Site address: 11611 SW 65TH AVE Project: Verizon Subdivision: None Lot: None Project Description: Tower work:remove:(6)antennas,and(6)RRHS. Install:(5)antennas,(3)HHRS, (1)OVP,(1)hybrid cable, (3) VZWSMART-MSK8 universal angle corner connection bracket,(3)VZWSMART-PLK8 support bracing kit and(1) VZWSMART-MSK10 wire rope routing bracket.Ground work: Install(1)OVP Contractor: M &A CONTRACTING INC Owner: PORTLAND GENERAL ELECTRIC COMPANY 1366 LEE ST SE 121 SW SALMON ST SALEM, OR 97302 PORTLAND, OR 97204 PHONE: 503-581-6125 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 08/25/2021 $453.95 Occupancy Grp: U Occupancy Load: 0 Demolition 12%State Surcharge-Building 08/25/2021 $54.47 Dwelling Units: 0 Plan Review 08/10/2021 $295.07 Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 08/25/2021 $110.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 08/25/2021 $50.50 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 $963.99 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 ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: `r�,�C� - Permittee Signature: !Lt_Gf�// ,�/� i7'Xiii777'XXX Call 503.639.4775 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 Applicatioi. M— 131�,1 Commercial RFCAVFED POR t)l fic 1. 1 tiL OAI.l Received Q ?3 City of Tigard DateBy: OO /O��I � / Permit No.:BU���2I� oU� f 7 • 13125SWHallBlvd.,Tigard,OR 97223 AUG 0 2021 Plan Review CRelated Permit: Phone: 503-718-2439 Fax: 503-598-1960 Date/By: �.�1+ T I G A R D Inspection Line: 503-639-4175 CITY OF-'r I G AR Da Ready/B ) �� ( /, �, ® See Page 2 for Internet: www.tigard-ongov 1I ll , --, ,' ,si. „, oufted/Nethod: g„ (^� Supplemental Information TYPE OF WORK REQUIRE DATA:1-AND 2-FAMILY DWELLING ❑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 CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwellingValuation: $ 0 Commercial/industrial D Accessory building ❑Multi-family Number of bedrooms: ❑Master builder Other: Wire'kSS TZIGI II• J Number of bathrooms: JOB SITE INFORMATION rAND LOCATION Total number of floors: .lob site address: Y I (J' j I SIA) CO Cf." Ate../ --rA etAf'd New dwelling area: square feet City/State/ZIP: � 9 `Q tazet 0(a. i 3 �JJ Garage/carport area: square feet Suite/bldg./apt.#: J Project name:Cifteitsjet. ca clia. VZ Covered porch area: square feet Cross street/directions to job site: yr(t f t p*rtiavk Deck area: square feet qQ W �jtki (.040 00 It)• Ili 1 N �'9 5�f Other structure area: square feet (QL14.1 Ante. Al livdQF 6411 +o��¢. 01-1 (g) REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot#: Permit fees*are based on the value of the work performed. l S t3 b 0 0 6 3 0� * R z-19 S 9 Indicate the value(rounded to the nearest dollar)of all Tax map/parcel#: / equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. S-ks ` it ' Valuation: $ ZSs 040 lee Iola re, 4 w'�ea�es a KW ASS eV«1 Existing building area: square feet c 4 I/irsI rw7^ � New building area: square feet 0 PROPERTY OWNER ((,, I14 TENANT Number of stories: Name: `jAO(� T Ca OS Cloit I t+` ( vIele- Type of construction: Address: 1 sb c V,1e a, A-saL 1.3. - g 00 Occupancy groups: City/State/ZIP: ce L 4 Q, tq e J Q 9 Existing: Phone:( ) 33 S. - )403 Fax:( )z New: 0 APPLICANT WrCONTACT PERSON BUILDING PERMIT FEES* (PleBusiness name: &AAA �e l QQ, S.Q.(/ CAS (__ , vieeterefsrajepschedule) Contact name: ila-►, =WC,. Structural plan review fee(or deposit): ,79.5.07 FLS plan review fee(if applicable): Address: SI/o' .r 'n Q. 5- 1 City/State/ZIP: S A a iJ 101 Total fees due upon application: Amount received: Phone:(yp(p) 3.49 w42,'jq I Fax: :( ) J' E-mail: 6A4.1 6, 6,4A Ih oizAS A I�S,L PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES" Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: /vL �/l1 Its Submit two(2)sets of roof plan with connection details /� and tire department access,along with the 2010 Oregon Address: Ce l_L S-ilty .SE Solar Installation Specialty Code checklist. City/State/ZIP �z '-t c 4- 3 � 2-- Permit fee(includes plan review $180.00 and administrative fees): , Phone:(c ) 3 t_f Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lie.: L 7 aifr 7//b//)—1, Total fee due upon application: $201 60 Authorized sl e: �/ __ /- _ This permit application expires it a permit is not obtained Test ifQ /VLA // within 180 days after it has been accepted as complete. Print name: - / Date: 7 3Q/2/ * Fee methodology set by Tri-County Building Industry Service Board. I:\Buildi ermits\B COM PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT I TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: •1)P20 21- 0019 3 Site Address: 11611 SW 65th Ave Suite/Bldg#: Project Name: Verizon (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planriirik-0eview Proposal: Replace antennas and associated equipment Existing Business Activity: wireless communication facility Proposed Business Activity: wireless communication facility ® Verify site address/suite # exists and active in permit system. © River Terrace Neighborhood: ❑ Yes K No It Zoning: C-G l Permitted Use: ® Yes ❑ No ❑ Spec Space ® Confirm no land use required. DI Business License: Exists: E Yes ❑ No,applicant was provided a business license application Notes: Allowed per 18.450.030.A Approved by Planning: Date: 8/5/2021 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved E Not Approved Revision 2: E Approved ❑ Not Approved Revision 3: ❑ Approved E Not Approved 1Stuildiuk Permit Submittal Original Submittal Date: 60/03/2021 Site Plans: # 3 Building Plans: # 3 Building Permit#: CEnter building permit#above. Workflow Routing: [-Planning ❑ Permit Coordinator Kr-Building Workflow Sign-off: CT Sign-off for Planning(include notes from planning review) Route Application Documents: Building: original permit application,site plans,building plans, engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: ..'i 4/Y�' Date: 0$,40/2OZ-f I:\Buildi ng\Forms\BldgPerrnitRvw_COM_NoLandUse_111819.docx -. 't Coordirlatot Review ❑ Conditio ` et"prior to issuance of building permit ❑ Approved,NO • _ •ased: • 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 > .. cant: ❑ SDC Fees Entered: W o Trans Dev Tax: 0 Yes ❑ N igard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A O OK to •- .ePermit roved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx • RECEWED City of Tigard AUG 05 1021 11 ° COMMUNITY DEVELOPMENT DEPARTMENT CEP(i Y OF f iUaf;U Collocation Supplemental Questionnaire 3U=LDING 0 r?it S! !!� Q,l SITE INFORMATION Collocating antenna is on: X Existing tower ❑ Existing non-tower structure Address: I o9sT7 SW (05'4` A ve City/State: tC� age)/ Ole. `Zip: el 722,3 ►1Io l uu PROVIDER INFORMATIONr Name of provider: \J w.rz_o V\ Has this provider previously served Tigard? III Yes ❑ No Contact name: coo- f"t6,4?..tpk14'11/4%45 Phone: 246 344 -t2"iq List other providers currently collocating on same tower or structure: A 14-'1 Approved land use case number: OfdPZO/S 'd0v7/ ANTENNA INFORMATION Existing: New: Height of antennas: S� ft. Height of antennas: ft. Color of antennas: S { cow_ Color of antennas: Ski CoIOtt Color of equipment: S kj CO(OIL Color of equipment: S 1 Co t eA Accommodating equipment:` Accommodating equipment: V-11440'Nettk C4A21144AS /Vt 444 C Oi 04.4s - Will new accessory equipment be installed? 0 Yes • No Location of new accessory equipment: ❑ Within previously approved fenced area ❑ Within existing structure ❑ Other location: Will landscaping be removed to accommodate the accessory equipment? 0 Yes II No If yes, des' 7e ere: rzrAL4 f 7hOf I e si> ire Print name Date Pole/stnacturc owner's signature Print name Clete C44 Date STAF USE ONLY' / Zone:_G �� Er Approved 0 Not approved Received by: Date: cU � 742-1 Reasons for denial: City ofTigard • 13125 SAY' Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of