Permit Support Document CITY OF TIGARD BUILDING PERMIT
= COMMUNITY DEVELOPMENT Permit#: BUP2022-00064
Date Issued: 10/17/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106AD04900
Jurisdiction:
Site address: 16668 SW AUTUMNVALE LN
Project: Dish Wireless Subdivision: RIVER TERRACE EAST Lot: 156
Project Description: Installation of new collocates and equipment for existing cell tower
Contractor: CAPSTONE SOLUTIONS INC Owner: RALSTON, CHRISTOPHER J
8195 166TH AVE NE,STE 100 RALSTON, SHERI L
REDMOND,WA 98052 2862 SW FAIRVIEW BLVD
PORTLAND, OR 97205
PHONE: 503-707-2656 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VA Permit Fee-Additions,Alterations, 05/12/2022 $453.95
Occupancy Grp: U Occupancy Load: 0 Demolition
12%State Surcharge-Building 05/12/2022 $54.47
Dwelling Units: 0 Plan Review 03/15/2022 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 05/12/2022 $110.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 05/12/2022 $32.50
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 $945.99
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 OAR 952-001-0090. Y copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Pelmittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec' n 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.