Permit n CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2022-00093
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/14/2022
Parcel: 1 S 135DA01100
Jurisdiction: Tigard
Site address: 8540 SW PFAFFLE ST
Project: AT&T Subdivision: METZGER ACRE TRACTS
Lot: 20
Project Description: Add or replace antennas on existing wireless communication facility.
Contractor: D& R COMMUNICATIONS Owner: CROWN CASTLE TOWERS 09 LLC
80 SW CHEHALIS AVE ATTN LEGAL-REAL ESTATE DEPT
CHEHALIS, WA 98532 2000 CORPORATE DR
CANONSBURG, PA 15317
PHONE: 360-996-4513 PHONE:
FAX:
• Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 04/29/2022 $453.95
Occupancy Grp: U Occupancy Load: 0 Demolition
12%State Surcharge-Building 04/29/2022 $54.47
Dwelling Units: 0 Plan Review 04/19/2022 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 04/29/2022 $110.00
Bedrooms: 0 Bathrooms: 0 Info Process/ArchivingSm$0.50(upto 04/29/2022
Value: $25,000 $125.50
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,038.99
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: /G c GG GC
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application RECEIVEC M- 4(i122
Commercial I OR Of l•It l I 'I O\I.1
C
APR 1_ 2022
It ,of Tigard Received Permit Yo.:
IN " Date/B•: 4 I 9 3
13125 SW Hail Blvd.,Tigard,OR 97223 t,i IY OF II(aHPor P1anReriea_,. ��ao a2- o0
® Phone: 503-718-2439 Fax: 503.598-1*.1 Dateit3y: ,1" i 9 -Z) F:elated Permit:
Inspection Line: 503-639-4175 'ILDING DIVISIOAi
9 Date Rendy%13 burn
1'ICi��HI) � is H SeePage24or
Intemet: www.tigard-or.gov Notified/Me trd: .--- Supplemental Information
TYPE OF WORK REQ SIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
— - Indicate the value(rounded to the nearest dollar)of all
(2$Addition/alteration/replacement pi Other: t r A.E 5 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION
i wo k indicated on this application.
— Valuation: S 2 We
CI1-and 2-family dwelling 0 Commercial/industrial i
Number of bedrooms:
❑Accessory building ❑;Multi-family
❑Master builder ,NI Other:L'', ti re-1 t$5 ,., Cc'P t Number of bathrooms:
�lli
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: $$L 0 5 iA1 N.-k c- -� 1-.) r New dwelling area: square feet
City/State/ZIP: `qrit 0 1•-71 3 — Garage/carport area: square feet
Suite/bldg./apt.#: Project name:CRC ut.V1 -fa R... A 1}-1' 9 Covered porch area: square feet
Cross street/directions to job site:i ilk
F'FA.FFTC,— Deck area: square feet
`j�v^ly *7( gi`yVA. / 1 i,i Qr°l _ Other structure area: square feet
coo f 7 rt- k- �4 . _ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdi vision: Lot#: Permit fees*are based on the value of the work performed.
p'P Indicate the value(rounded to the nearest dollar)of all
l ax map/parcel arcel#: 1/1`Q �,� equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
c Wit- Ilk+itt 'mot. Valuation: S
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name: G F2.0v,+A C.4./A Type of construction:
Address: i 5--es' LytLS+ltk,- e- A- t I.) 41-&00 —
Occupancy groups: _.
City/State/ZIP: S ' e. , 0 A 1 010 61
t __ Existing:
Phone:(cost) 2.0 7 — 2-4 e'. t Fax:( ) New: - -
0 APPLICANT El CONTACT PERSON BUILDING PERMIT FEES*
(Pieas
er
duki
Business name..` C9 f',i,I reviewe fee(or epos;ee ):
Structural plan (or deposit):
Contact name: _AAA nj�+-tAJtu V--y� g y/ ,-.5.'
Address: r r Fl..S plan review fee(if applicable):
61 t✓�, .. ( f-- c t)U( �j Total fees due upon application:
City/State/ZIP: 13.
Phone:( 2._, y i L �f - u- 16) Fax: :( ) Amount received:
E-mail: 6 1*n(-`-'v e 64A A-iveif-{A)C`re ,c;(2,^vtt,:es, �yt f,,/1 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaie Solar Panel System.
Ti? 2 Business name: 0 l e.oyike.•e.r Se-u7�a 1f Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 712._ �,_ Ghr t� /S — Solar Installation Specialty Code checklist.
City/State/ZIP: �`�) LS _ ` — Permit fee(includes plan review $13t3 00
and administrative fees):
Phone:(3 Le)? Co. ax:( ) _ State surcharge(12%of pern'n fee): $21.60
CCB Lic.:�i^�
`1 _ Total fee due upon application: S201.60
Authorized Sig , This permit application expires if a permit is not obtained
. 4within 180 days after it has been accepted as complete.
Print name: 2Q? fi , t•-2y,11t tom/?• Date: - f�j,� ._ * Fee methodology by Tri-Count}'Building Industryf Service Board.
L\Building\Permils\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
II " Accessibility; Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
f 1(J A R.1D 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: [21 $
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 $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line[2]of Valuation Computation): $
I:\Building\Permits\BUP COhi PemvtApp.doc Rev.03/05/2019
kte
City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT
1,1
_ Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard•or.Rov
1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with:
A. 0 map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only-).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans,details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit-based on valuation of project.
I:\Building\Permits\BUP_COM_PermitApp,doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Plan Submittal Requirements Matrix
- Commercial & Multi-Family - New, Additions or Alterations
l I G A RD
.. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • vv 4v`ts,.1 oar-i-or. ov
Type of Submittal # of Plans
(Includes new,additions and alterations.) Required at
Submittal
Demolition Permit 9
(site plan is required showing location and square footage
of all buildings to be demolished,erosion control plan and
tree protection,if applicable)
Site Work 3
(must include location of all accessible parking)
Plumbing(site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Solar Photovoltaic 2
(Requires check list for prescriptive installation. If not
prescriptive installation,engineering is required.)
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval,the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor,City of Tigard,Washington
County,and Tualatin Valley Fire&Rescue),if applicable.
1:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
PROPOSED SCOPE OF WORK
PROJECT DESCRIPTION
THE PURPOSE OF THIS PROJECT IS TC PROPOSE AN ANTENNA
MODIFICATION ON AN EXISTING WIRELESS SITE.
TOWER SCOPE OF WORK
Both LTE & NR must be or the same CPRI Rate7. 1st LTE CPRI
should be SFP7 (NE0.20022) on both Radio and ABIA sides for
AirScale RRH (AHLBA, AHLBBA, AHFIB, AHCA, AHNA) and SFP7
(0E0.16446 or NE0.20022) on both Radio and ARIA sides for
ALU radios (UHFA, UHIE). The 2nd 5G CPRI should be SFP7
(NEQ.20022/NEQ.53020) on both Radio and ABIL/ABIO sides for
Airscale and ALU radios. Add 2nd CPRI correction for all
bands/radio that is missing. n77 Band requires (2) CPRI
connections (CEQ.24407) on both Radio and ABC sides.
Contractor to maintain RRH to back of antenna clearance and
B14/R29 & n77 antenna separation per latest AT&T guidelines.
• REMOVE (9) ANTENNAS
• REMOVE (6) TMAs
• INSTALL (9) ANTENNAS
• INSTALL (1) RAYCAP SQUID
• INSTALL (1) 24—PAIR FIBER TRUNK
• INSTALL (2) #6 AWG DC TRUNKS
• MODIFY MOUNT
GROUND SCOPE OF WORK
• INSTALL DC12-48-60-0--RM
• INSTALL (1) —48V RECTIFIER TO THE EXISTING DC PLANT
• EXISTING FSM4 (AMIA) — REMOVE EXISTING (1) ASIK AND (1)
ABIL CARDS ON THE C2 SIDE. ADD (1) ASIL AND (3) ABIO
CARDS TO THE C2 SIDE FOR 5G 850/1900/AWS, 5G C n77
& 5G C n77 dod
City of Tigard
III COMMUNITY DEVELOPMENT DEPARTMENT
a
TIGARCI Building Permit Review — Commercial - No Land Use
Building Permit #: 80192022- 00093
Site Address: ' 1O SW f rE -. . Suite/Bldg#:
Project Name: AT— - c ezt,,* S z-(.
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /\PP oR Re 104 c_ Arvtvv l\1A E 6N C Am n 6 kiiae SS
60111rhuFti C-t11-1 'F,'c' /
Existing Business Activity: �/
Proposed Business Activity: '�1
Verify site address/suite#exists and active in permit system.
❑ River Terrace Neighborhood: ❑ Yes n No
oning. P
liJ Permitted Use: 1J Yes ❑ No ❑ Spec Space
/Confirm no land use required.
,l�J' Business License:
Exists: E Yes ❑ No,applicant was provided a business license application
Notes:
Approved by Planning: lt/'�'U Date: 41(s tz
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: 4 j 1/as
Site Plans: # 3
Building Plans: # 3
Building Permit#: l® Enter building permit#above.
Workflow Routing: a, Planning.. IS 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: tL liJ Date: 4((sjaQ
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
D 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 ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw COM NoLandUse_I11819.docx
"M
t City of Tigard RECEIVEC
ill COMMUNITY DEVELOPMENT DEPARTMENT APR 11012
s .
r,GAR1 Collocation Supplemental Questionnaire CITY OF Il ARLI
... .........9.--,,,d,M3n9.kES,9Y£tflW4t'3 tNflE9fl—, at,..mr,l nt?+l".r RnrosteinsaHRiY42#rer..1E'AMMYki.aanamansmartionrOnanwal rmikt,m�I�41/11 reps efeN
SITE INFORMATION ��_ ��'VVV111
Collocating antenna is on: IiS Existin 1.tower/ 0 Existing non-tower structure
Address: 1ST C 5 IA- Pk 7 de 7- " City/State: t c` Ct,✓�.� (��- Zip: 17 Z 2.?.,�'
PROVIDER INFOMATION
Name of provider: A-14^1 Has this provider previously served Tigard? fir Yes 0 No
Contact name: 61411441 A oY'stt.4/L.1t4'1'`! Phone: Z-C fO —3'4 q—Le Z-
List other providers currently collocating on same tower or structure: Ni 0�?
Approved land use case number: 00 F 2 0 (i o0 I G-3
ANTENNA INFORMATION
Existing: New:
I!eight of antennas: ''' , `f ft. Height of antennas: fig.•`i ft.
Color of antennas: 51I CtA.Dg Color of antennas: 9K I C. 10(Z-
Color of equipment: S( C. t o Color of equipment: S`tk CV lCt6--
Accommodating equipment: ICI Accommod sing equipment:.1.17
Will new accessory equipment be installed? ® Yes 0 No
Location of new accessory equipment:
0 Within previously approved fenced area
311 Within existing structure
0 Other location:
Will landscaping be removed to accommodate the accessory equipment? 0 Yes ei No
'Lye', i bB
` / Y A. A e01.4-0 3/I A Z
Applicants, nature
Print Date
Se-0- /4-f+ C
Pole/structure owner's signature Print name Date
" 1 Ail t ',1' 0\1,1
Zone: L P P Approved 0 Not approved Received by: /J1 Date: 'P 2
Reasons for denial:
City ofTigard • 13t25 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of
•
Ore% CROWN Crown Castle
1505 Westlake Avenue North
,,, 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(2 crowncastle.com
(206) 336-7403
The pathway to possible.
CrownCastle.com
1