Permit CITY OF TIGARD BUILDING PERMIT
I COMMUNITY DEVELOPMENT Permit#: BUP2022-00049
Date Issued: 3/15/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135C600200
Jurisdiction: Tigard
Site address: 10250 SW NORTH DAKOTA ST
Project: AT&T Subdivision: None Lot: None
Project Description: Remove(3)antennas. Install(6)antennas, (2)surge protectors, (2)power cables
Contractor: CAPSTONE SOLUTIONS INC Owner: PASCUZZI INVESTMENT LLC
8195 166TH AVE NE, STE 100 10250 SW NORTH DAKOTA ST
REDMOND,WA 98052 TIGARD, OR 97223
PHONE: 503-707-2656 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 03/02/2022 $301.85
Occupancy Grp: U Occupancy Load: 0 Demolition
12%State Surcharge-Building 03/02/2022 $36.22
Dwelling Units: 0
Plan Review 02/15/2022 $196.20
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 03/02/2022 $50.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $15,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $584.77
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 0,' 952-001-0090. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23V.
,,Issued By: Permittee Signature: jf4/ 115-"e— 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.
Building Permit Application a- 2410 /2,2_
Commercial FOR OFFICE I USE ONLY
RECEIVEDReceived � 15\2Z 1 �JF'?OZZ-c o'-4
City of Tigard Permit No..
�� Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
m • Phone: 503-718-2439 Fax: 503-598-1960 FEB 1 n 7c27 Date By: a a� '2 Z Related Permit:
TIGARD Inspection Line: 503-639-4175 Date Ready/Bv• /� Juns: ® See Page 2 for
Internet: NAM tigard-or.gov CITY OF ;r,"'.r+7. tified/Meth / Supplemental Information
— ',i lit 1-);(,i("::; :
TYPE OF WORK' , . ` REQUIRED DATA:1-AND 2-FAMILY DWELLING
O New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
EN 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 dwelling [2Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10250 SW North Dakota St New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 ,t- 7 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: PDB 1 G5 enitbur g-Cbdud"" Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
see plans Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: . Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 13135CB-00200 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.
Remove: (3) Antennas, (2) DC6 surge protectors Valuation: $ 15,000.00
Relocate: (1) Antenna, (8) RRUs Existing building area: square feet
Install: (6) Antennas, (2) DC9 surge protectors, (2) DC Power cables New building area: square feet
0 PROPERTY OWNER a TENANT Number of stories:
Name: AT&T Mobility- Wendy Long Type of construction:
Address: 19801 SW 72nd Ave, Ste 200 Occupancy groups:
City/State/ZIP: Tualatin, OR 97062
Existing:
Phone:(206)321-1116 Fax:( )4 New:
1 (I APPLICANT al CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Smartlink Structural plan review fee(or deposit):
Contact name: Courtnee Gomez
FLS plan review fee(if applicable):
Address: 3612 SE 168th Ave FLS
fees due upon application:
City/State/ZIP: Vancouver,WA 98683
Phone:(916 ) 527-4157 Fax::( )
Amount received:
E-mail: courtnee.gomez@smartlinkgroup.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: TBD ea a5 14 Sa f k- U/7S t Submit two(2)sets of roof plan with connection details
` S N� - and fire department access,along with the 2010 Oregon
I Address: • r. t/ /_ 60 Solar Installation Specialty Code checklist.
City/State/ZIP f� / C ed.
4 , Kos---2_,
Permit fee(includes plan review $180.00
/��vl G2kt f and administrative fees):
Phone: dl/ZS�L �3J� Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: `?G,5 t.'� Total fee due upon application: $201.60
Authorized signature: /1 This permit application expires if a permit is not obtained
l� ,_ within 180 days after it has been accepted as complete.
Print name: Courtnee Gomez Date: 1/26/2022 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(I 1/02/COM/WEB)
f
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Ill3 Accessibility: Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
REQUIREMENT: OREGON REVISED STATUTE (ORS)447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five percent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: 12] $ 0
ELEMENTS: In choosing which accessible elements to provide under this section,priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $ 0
(b) An accessible entrance: $ 0
(c) An accessible route to the altered area: $ 0
(d) At least one accessible restroom for each sex or a single unisex 0
restroom: $
(e) Accessible telephones: $ 0
(f) Accessible drinking fountains:and, $ 0
(g) When possible,additional accessible elements such as storage and 0
alarms: $
TOTAL(shall equal line [2J of Valuation Computation): $ 0
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard
illit
w COMMUNITY DEVELOPMENT DEPARTMENT
l �l� Building Permit Review — Commercial - N o Land Us
Building Permit #: 22_ COO '(cl
Site Address: (61.50 SW N a i k S+: Suite/Bldg#:
Project Name: A-T,1-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review LL � 1Q!-
Proposal: we, 3 a vi k vI nti5 Z P( i kJzJ �,s j It: 6 ifrl 1 tris
2- P C c` Su P lede v s . l per" ioteS `
Existing Business Activity: ,4T Ce /1 J h 'e—
Proposed Business Activity:
C4' Verify site address/suite # exists and active in permit system.
River Terrace Neigh rhood: ❑ Yes K No
Zoning: '— V
p Permitted Use: Z9 Yes ❑ No ❑ Spec Space
[ Confirm no land use required.
pb Business License:
Exists: jo Yes ❑ No,applicant was provided a business license application
Notes: Af, a l J;�t9 lit,(,-eA
Approved by Planning: 'Ate/MA. Date: 7/ , /26 22
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: '6\AV
Site Plans: #
1 Building Plans: #
{ Building Permit#: [ inter building permit#above.
Workflow Routing: ['Planning V Permit Coordinator ["Building
Workflow Sign-off: [}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: ,ter-\J C% O J( Date: a%\\5A22—
G
I:\Building\Forms\B1dgPermitRvw_COM NoLandUse_111819.docx
Permit Coordinator Review
va Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes YJ N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes gf N/A
)2(OK to Issue Permit
Approved by Permit Coordinator: Date: 111112,)2 2--
I:\Building\Forms\B1dgPermitRvw_COM NoLandUse_111819.docx