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Permit CITY OF TIGARD BUILDING PERMIT II DEVELOPMENT Permit#: BUP2021-00171 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/2/2022 Parcel: 1 S 136CCO2100 Jurisdiction: Tigard Site address: 11744 SW PACIFIC HWY Project: Verizon Wireless Subdivision: None Lot: None Project Description: Modifying antenna equipment and ground structure. Contractor: LEGACY TELECOMMUNICATIONS LLC Owner: GRUNBAUM SURVIVOR'S TRUST PO BOX 360 BY GRUNBAUM, MARILYN K& ERIC TRS BURLEY,WA 98322 21390 SW EDY RD SHERWOOD, OR 97140 PHONE: 253-858-0214 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: VA 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 $49.50 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 $962.99 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: Ea garoi.o-/vj da- Permittee Signature: ye e 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 Z3-4, 2,3 z/ Commercial RECEIVED D i t,iz(I, 1 l( I I .I O\I 1 V a/City of Tigard t DateReceivve d t '/ 1 f"7G 2021 IR PermitNo.��i0Q 17,� 1,1 . 13125 SW Hall Blvd.,Tigard,OR 9Z223 JUN 2 3 2021 PlanRevie 16 Related Permit: Phone: 503-718-2439 Fax: 503-St'960 Date/By: r i c A R l� Inspection Line: 503-639 4175 CITY OF 'iCaAAD Date Ready/By: fr 9/,Z� ji lur s: I (a See Page 2 for Internet: www.tigard-or.gov Notified/Method:',I" Supplemental Information BUILDING DIVISION6-7y�4-i(.,... G- TYPE OF WORK RE IRED DATA:1-AND 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 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder Other: to 02E1 e 7s Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: i l ZT 51M �,�,Ci l Lit9jj {;2)14 % New dwelling area: square feet It City/State/ZIP: -Tt"j�0...T, (g. C 1 V7_3 ,J C' �jd•'r' Garage/carport area: square feet -d ` Suite/bldg./apt.#: roject name:13UE32,4Z3Q �iJ i"t1�o I Covered porch area: square feet Cross street/directions toto job site: 5 Pam ,.lfti h a.0 ,+ Deck area: square feet 112-4-O it)cut ri Ste, p/t t PC{(1 till 47 Other structure area: square feet 4 -&a, a onto Sur t't1 make a..F-b REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: I S 131n cc©Z.LOO ;ReAlitP O i ^f ` 'oc 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. SeE Al-r AC (- C M(tit(;.c . rjC.j jkjyW Valuation: $ ?S CD 000, O li�ecs I A 5-1 .�1 ®a) l Existing building area: Na square feet New building area: WA,. square feet 0 PROPERTY OWNER X'TENANT Number of stories: M,q,,,o pore- Name: C.Ieo.U,A Ca,S,fie., �y Type of construction: �it 0 pi)te Address: t C l e� -tcK� N Ij S"i'e Z7'( Occupancy groups: City/State/ZIP: se.,0'1 4 ./ yl1 P 11€ t 0Ci Existing: !� Phone:(" j 231 4 Fax:( ) New: 3 � 3 �/* 0 APPLICANT IACONTACT PERSON BUILDING PERMIT FEES* Business name: A4 p.- Kt e,,ii.. o�t4 S ,--V-1 j,,ZS ii- (Please refer to fee schedule) � A Structural plan review fee(or deposit): G �`Wd , Contact name: ' �" Address: P� u 47o�/ To?fv FLS plan review fee(if applicable): City/State/ZIP: -g et d1 e (gilt 9$d0 Gj Total fees due upon application: Phone:(25)(o) Sr i ci L.t z 1 I Fax::( ) Amount received: E-mail: GA+ .G M.A Jae4 a, a c _1r1CeS, Co m PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name: `-r Lr° yf Mh(Gt!r(,I,d),/,lit Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: E3(O2, St<tiV$e 6 tJ Solar Installation Specialty Code checklist. City/State/ZIP: G1� u13�12 Loa , ?S33 - Permit fee(includes plan review $180.00 l and administrative fees): Phone:(253) fig—02(II Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained / / within 180 days after it has been accepted as complete. Print name: i �,414p Date:{�'1/j�� * Fee methodology set by Tri-County Building Industry / Service Board. I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(I1/02/COM�>V5B)_C — 6 6 '7, 7� DESCRIPTION OF WORK CROWN CASTLE FOR VERIZON WIRELESS 11744 SW PACIFIC HIGHWAY, TIGARD, OR Proposed Tower scope of work: • Install (6) antennas • Install (3) RRH's • Install (3) Diplexers • Install (1) sector frame T-arm • Install (18) crossover plates • Remove (3) RRH's • Remove (6) Diplexers • Remove (6) coax cables Proposed Ground scope of work: • Remove (3) RRH's • Remove (6) Diplexers 4 City of Tigard s COMMUNITY DEVELOPMENT DEPARTMENT III Q T 1 G A zD Building Permit Review — Commercial - N o Land Use Building Permit #: ZOM121-Od II I Site Address: 11744 SW Pacific Highway Suite/Bldg#: Project Name: Verizon (Name of commercial business occupying the space. If vacant,enter Spec Space.) PPlanlii4 .1eviety Proposal: Modification to antennas on existing pole. Existing Business Activity: Wireless facility Proposed Business Activity: Wireless facility ;i Verify site address/suite # exists and active in permit system. I River Terrace Neighborhood: ❑ Yes 1E1 No LXl Zoning: C-G ® Permitted Use: ® Yes ❑ No ❑ Spec Space ® Confirm no land use required. Fla Business License: Exists: ❑ Yes ❑ No,applicant was provided a business license application Notes: No land use per 18.450.030.A. Approved by Planning: Arall/AOetivtek Date: 7/7/2021 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved .8uildh k Permit Submittal Original Submittal Date: OV.23/10Z/ Site Plans: # .. Building Plans: # Building Permit#: [IL-Enter building permit# above. Workflow Routing: [Planning ❑ Permit Coordinator C9'Building Workflow Sign-off: [i 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: Date: Q L 2/ I:\Building\Forms\BIdgPermitRvw_COM NoLandUse_111819.docx Coordinator_ eviety ❑ 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: ❑ Yes ❑ N Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A El OK to •. .a Permit • . i roved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_COM NoLandUse_I 11819.docx RECEIVED JUN 2 3 2021 111 City of Tigard city OF `IUAFRD " COMMUNITY DEVELOPMENT DEPARTMENT Q►JILDl C DIVISION TIG, p Collocation Supplemental Questionnaire SITE INFORMATION Collocating antenna is on: (XI Existing tower El Existing non-tower structure Address: 11744 SW Pacific HWY Cif,/State: Tigard,OR 97223 PROVIDER INFORMATION Name of provider: Verizon Has this provider previously served Tigard? [[Yes 0 No Contact name: Gary Abrahams Phone: 206'349-4279 List other providers currendy collocating on same tower or structure: Vernon,T-Mobile Approved land use case number: CUP96-0006 ANTENNA INFORMATION Existing: New: Height of antennas: 90 ft Height of antennas: 90 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 ® No Location of new accessory equipment: ® Within previously approved fenced area 0 Within existing structure ❑ Other location: Will scaliing be re roved to accommodate the accessory equipment? ❑ Yes ® No f I ye. de e herr ;.�'� cal;at2S Zylicz/ plicantt, ignature Print name Date See Attached C� Lisrf-jciJ Vi7l7-0 Pole/structure owner's signature Print name Date Zone: " ''f (/Approved 0 Not approved Received by: Date: (2.02_I Reasons for denial: City ofrigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 off CROWN Crown Castle 1505 Westlake Avenue North a.: 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, Chris Listfjeld Site Acquisition Project Manager—Seattle Chris.Listfjeld@crowncastle.com (206) 336-7403 Ihe}lathi%a} 1o1w-0,1101C•. CrownCastle.com CROWN Crown Castle : CASTLE 1505 Westlake Avenue North Suite 800 Seattle,WA 98109 September 17, 2020 RECEIVED JUN232021 Re: Crown Castle—PNW Subject: Gary Abrahams—Authorized Consultant for Crown Castle CITY OF fiGARD BUILDING DIVISION 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, Chris Listfjeld Site Acquisition Project Manager—Seattle Chris.Listfjeld@crowncastle.com (206) 336-7403 The to possible. pathway 1 CrownCastle.com CROWN 1505 Westlake Ave N Phone: (206) 336-2e63 (Y111:1001114 Seattle, WA 98109 Fax ST L E www.crowncastle.com RECEIVED Via FEDEX to City of Tigard JUN 2 3 2021 Tigard,OR CITY OF TIGARD D/VISION June 17,2021 City of Tigard Community Development— Permit Services Attention:Eggie 13125 SW Hall Blvd. Tigard,OR 97223 Phone:503-7i8-2439 RE: Eligible Facilities Request to modify equipment on a communications tower located at: • 11744 SW Pacific Highway,Tigard,OR 97223 • Assessors Tax Parcel ID number: 1S136CCo2100 • Real Property Account No. R2841o5 Jurisdiction:City of Tigard,OR Application for building permit Crown Site Number: 824338 Application ID: 540604 Crown Name: Greenburg Carrier: Verizon Carrier site ID: 171654 Carrier site name: Dartmouth Crown Castle USA Inc.("Crown Castle")on behalf of Verizon is submitting the attached Eligible Facilities Request application for a building permit application to modify transmission equipment on a telecommunications tower located at 11744 SW Pacific Highway,Tigard,OR 97223. Verizon proposes to modify this existing site as follows: Proposed Tower scope of work: • Install(6)antennas The Foundation for a Wireless World. CrownCastle.corn CROWN1505 Westlake Ave N Phone: (206) 336-2863 cywille Seattle,WA 98109 Fax, 1 CASTLEwww.crowncasde.com } 1 • Install(3)RRH's • Install(3)Diplexers • Install(1)sector frame T-arm • Install(18)crossover plates • Remove(3)RRH's • Remove(6)Diplexers • Remove(6)coax cables Proposed Ground scope of work: • Remove(3)RRH's • Remove(6)Diplexers Submittal documents for this Building Permit application: • Cover letter(see this document) • City of Tigard Building Permit Application; • Three(3)copies,construction Drawings,by LAB,dated 6/1/2021; • One(1)copy,Post Mod Antenna Mount Analysis Report and PMI Requirements by TES dated 5/3/21; • Three(3)copies,Modification&Design drawings for Existing Antenna Mounts Existing Monopole Tower by TES dated 5/4/21; • One(1)copy,Structural Analysis Report by Black&Veatch dated 3/26/21; • Crown Castle Authorization to submit for permits,as tower and facility owner 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. Verizon 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. Sincerely, Gary Abrahams for CCI The Foundation for a Wireless World. CrownCastle.com