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Permit st)P 2az -do qZ CROWN I 1505 Westlake Ave N, N Phone: Seattle,WA 98109 CASTLE �.� .�m %aweRECEIVED JUL 2 7 7022 VIA FEDEX CITY OF TIGARD CITY OF TIGARD BUILDING DIVISION March 4,2022 CITY OF TIGARD,OR Community Development 13125 SW HALL BLVD. TIGARD,OR 97223 **********NOTICE OF ELIGIBLE FACILITIES REQUEST********** RE: Request for Minor Modification to Existing Wireless Facility—Section 6409 Site Address: 13680 SW Pacific Highway,Tigard,OR 97223 BUILDING PERMIT APPLICATION Crown Site Number:825028/Crown Site Name:King City Customer Site Number:PRPDXoo342A/Application Number:561493 Dear Building Permit dept., On behalf of DISH Wireless L.L.C. ("Dish Wireless" or "Applicant"), Crown Castle USA Inc. ("Crown Castle")is pleased to submit this request to modify the existing wireless facility noted above through the collocation,replacement and/or removal of the Applicant's equipment as an eligible facilities request for a minor modification under Section 64091 and the rules of the Federal Communications Commission ("FCC")2 Section 6409 mandates that state and local governments must approve any eligible facilities request for the modification of an evicting wireless tower or base station that does not substantially change the physical dimensions of such tower or base station. Under Section 6409,to toll the review period, if the reviewing authority determines that the application is incomplete, it must provide written notice to the applicant within 3o days,which clearly and specifically delineates all missing documents or information reasonably 1 Middle Class Tax Relief and Job Creation Act of 2012,Pub.L.No.112-96,§6409(2012)(codified at 47 U.S.C. §1455). 2 Acceleration of Broadband Deployment by Improving Wireless Facility Siting Policies,29 FCC Rcd.12865 (2014) (codified at 47 CFR§1.6100);and Implementation of State&Local Governments'Obligation to Approve Certain Wireless Facility Modification Requests Under Section 6409(a)of the Spectrum Act of 2012,WT Docket No.19-250(June 10,2020). 3 See 47 CFR§i.61oo(c)(3). 4 See 2020 Upgrade Order at paragraph 16. The Foundation for a Wireless World CrownCastle.com CROWNCROWN1505 Westlake Ave N N t v Seattle,WA 98109 Phone: ,, , CASTLE wow cowncastlecom related to whether the request meets the federal requirements.3 Additionally,if a state or local government, fails to issue any approvals required for this request within 6o days,these approvals are deemed granted. The FCC has clarified that the 3o-day and 6o-day deadlines begins when an applicant: (i)takes the first step required under state or local law;and(2)submits information sufficient to inform the jurisdiction that this modification qualifies under the federal law4. Please note that with the submission of this letter and enclosed items,the thirty and sixty-day review periods have started.Based on this filing,the deadline for written notice of incomplete application is ,2022,and the deadline for issuance of approval islrfcy�- ,$,2022. The proposed scope of work for this project includes: Add or replace antennas,ancillary equipment and ground equipment as per plans for an existing carrier on an existing wireless communication facility. At the end of this letter is a checklist of the applicable substantial change criteria under Section 6409. Additionally,please find enclosed the following information in support of this request: (i) Three (3)copies of Eligible Facilities Request cover letter and narrative(see this document)with Attachment"A,"Section 6409 Substantial Change Checklist,and Attachment"B,"proposed scope of work; (2) Three(3)copies of the City of Tigard Building Permit application; (3) One (1) copy of the Collocation Supplemental Questionnaire with attached Crown Castle authorization; (4) Three(3)copies of the construction drawings prepared PM&A dated , e;71 122- (5) Three(3)copies of Structural Analysis Report prepared by Crown Castle dated 9/25/24 (6) Three(3)copies of Crown Castle Authorization to submit for permits; (7) Section 6409 Substantial Change Checklist. As these documents indicate, (i) the modification involves the collocation, removal or replacement of transmission equipment; and(ii)such modification will not substantially change the physical dimensions of such tower or base station.As such,it is an "eligible facilities request" as defined in the FCC's rules to which the 6o-day deadline for approval applies.Accordingly,Applicant requests all authorization necessary for this proposed minor modification under Section 6409. Our goal is to work with you to obtain approvals earlier than the deadline.We will respond promptly to any request for related information you may have in connection with this request.Please let us know how we can work with you to expedite the approval process.We look forward to working with you on this important The Foundation for a Wireless World CrownCastle.com CROWN1505 Westlake Ave N, N Iv Seattle,WA 98109 Phone: Cf.":•• C A S T L www.crowncaslle.cam project, which will improve wireless telecommunication services in your community using collocation on existing infrastructure. If you have any questions,please do not hesitate to contact me. Regards, Cincife una Gary Abrahams GMA Network Services,LLC Consultant to Crown Castle The Foundation for a Wireless World CrownCastle.com CRO+�A/he 1505 Westlake Ave N, N 1� TV V !y ! Seattle,WA 98109 Phone: CA wnm- a 1 �� ,crownrastle.am Attachment"A" Section 6409 Substantial Change Checklist Towers Outside of the Public Right of Way The Federal Communications Commission has determined that a modification substantially changes the physical dimension of a wireless tower or base station under 47 U.S.C.§ 1455(a)if it meets one of six enumerated criteria under 47 C.F.R. § 1.6100. Criteria for Towers Outside the Public Riehts of Wav YES/NO Does the modification increase the height of the tower by more than the greater of: NO (a) 10% (b) or,the height of an additional antenna array plus separation of up to 20 feet from the top of the nearest existing antenna? YES/NO Does the modification add an appurtenance to the body of the tower that would NO protrude from the edge of the tower more than 20 feet or more than the width of the tower structure at the level of the appurtenance,whichever is greater? YES/NO Does the modification involve the installation of more than the standard number of NO new equipment cabinets for the technology involved or add more than four new equipment cabinets? YES/NO Does the modification entail any excavation or deployment outside the current site NO by more than 30 feet in any direction,not including any access or utility easements? YES/NO Does the modification defeat the concealment elements of the eligible support NO structure? YES/NO Does the modification violate conditions associated with the siting approval with the NO prior approval the tower or base station other than as specified in 47 C.F.R.§ 1.6100(c)(7)(i)—(iv)? If all questions in the above section are answered"NO,"then the modification does gpj constitute a substantial change to the existing tower under 47 C.F.R.§1.6ioo. The Foundation for a Wireless World CrownCastle.com C n O A/N 1505 Westlake Ave N, N R yy [y Seattle,WA 98109 Phonexreew. , �I,,.,, CASTLEco �5,e�m Attachment"B" Proposed Scope of Work SCOPE OF WORK 'MS IS NOT AN ALL INCLJSIVE UST. CONTRACTOR SHALL UTILIZE SPECFED EOtJPMENT PART OR ENGINEER APPROVED EOUNALENT. CONTRACTOR SWILL VERRFY ALL NEEDED EQUPMENT TO PRONOE A FUNCTIONAL SITE THE PROJECT GENETAMLY CONSISTS OF THE FOLLOWING: TOWER SCOPE Of WORK: • INSTALL (3) PROPOSED PANEL ANTENNAS (1 PER SECTOR) • INSTALL (1) PROPOSED ANTENNA PLATFORM MOUNT • INSTALL PROPOSED JUMPERS • INSTALL (6) PROPOSED RRUa (2 PER SECTOR) • INSTALL, (1) PROPOSED OVER VOLTAGE PROTECTION DEVICE (OVP) • INSTALL (1) PROPOSED HYBRID CABLE GROUND SCOPE OF WORK: • UTILIZE EXISTING PLATFORM • INSTALL (1) PROPOSED ICE BRIDGE • INSTALL (1) PROPOSED PPC CABINET • INSTALL (1) PROPOSED EQUIPMENT CABINET • INSTALL (1) PROPOSED POWER CONDUIT • INSTALL (1) PROPOSED ME1.CO CONDUIT • INSTALL (1) PROPOSED TACO—FINER BOX • INSTALL (1) PROPOSED GPS LIMIT • INSTALL. (1) PROPOSED SAFETY SMTDCH (IF REQUIRED) • INSTALL (1) PROPOSED FRIER NID OF REQUIRED) The Foundation for a Wireless World CrownCastle.com rCity of Tigard COMMUNITY DEVELOPMENT DEPARTMENT ,, Collocation Supplemental Questionnaire GA RD .:-.. 9.a.rw a a-. eAl.u..Y a r-.z. w �. +aP.a�u tv .n ..x .t.isJ✓aTY'rfA..W.V43M_.. [hps.g'+:+... ..X.rv-V4fMMmnxumxv SITE INFORMATION Collocating antenna is on: tie Existing tower ❑ Existing non-tower structure Address: (3 68O 5w 1/act, C t411 City/State: 170 a.4O 1 O Cis i 722:3 PROVIDER INFORMATION Name of provider: 12( 5 h IN 1 rei(65 Has this provider previously served Tigard? 0 Yes RI No Contact name: GF{�Z-y AbrOtha/WtS Phone: Jo - 3'(R— ' 279 List other providers currently collocating (on same tower or structure: ' lai tie-I S 11Z.l►'('TL Approved land use case number: 13Uitd zt9r-5, 00I 5-4 ANTENNA INFORMATION Existing: New: p t I ieight of antennas: N/A it. Height of antennas: 0 ft. li Color of antennas: ! (A Color of antennas: SIINNOAlik0 liaki,4 - Color of equipment: 4 A Color of equipment: 61'01 Accommodating equipment: IA Accommodating equipment: 1,11 60'4 Ctatts, R2()`S, 4s4e*w. hot Will new accessory equipment be installed? Cji Yes 0 No Location of new accessory equipment: 'X Within previously approved fenced area 0 Within existing structure 0 Other location: Will landscaping be removed to accommodate the accessory equipment? 0 Yes Sil No i/yes. de e hen-: Atif. A4'ei.14-4"1° 3/Y/2 Applicant's, attire Print name Date cec "WAchel Pole/structure owner's signature Print name Date Zone: C.- 1l tRpproved CI Not Not approved Received by: r` MI Date: (2.1 Reasons for denial: City ofTigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of f S CROWN Crown Castle Cr CASTLE 1505 Westlake Avenue North 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, err- Chris Listfjeld Site Acquisition Project Manager— Seattle Chris.Listfjeld@crowncastle.com (206)336-7403 The paeh%cav to possible. CrownCast$e.com CITY OF TIGARD • BUILDING PERMIT `r1 ' '' COMMUNITY DEVELOPMENT Permit#: BUP2022-00192 Date Issued: 12/19/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CC01100 Jurisdiction: Tigard , Site address: 13680 SW PACIFIC HWY Project: Dish Subdivision: None Lot: None Project Description: Install:(3)panel antennas,(1)antenna platform,jumpers,(6)rru's,(1)over voltage protection device,(1)hybrid cable,(1)each:ice bridge,PPC cabinet,equipment cabinet,power conduit,telco conduit,GPS unit,safety switch if required Contractor: GENERAL DYNAMICS INFORMATION TECHNOLOGY Owner: TIGARD-ORENOMAH LODGE#207 OF AF&AM 77 A STREET PO BOX 230184 NEEDHAM, MD 02494 TIGARD, OR 97281 PHONE: 781-455-3743 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 09/02/2022 $453.95 Occupancy Grp: U Occupancy Load: 0 Demolition 12/o State Surcharge-Building 09/02/2022 $54.47 Dwelling Units: 0 Plan Review 07/27/2022 $295.07 • Stories: 0 Height: 0 ft DC Provision Review, COM TI-Ping 09/02/2022 $110.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 09/02/2022 $77.00 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 $990.49 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 re Tres you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in )5AR 952-001-0010 through OAR 952-001-0090. Y ay obtain copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: 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. ErlCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT " 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: [2] $ 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:\Bullding\Permits\BUP_COM_PertnitApp.doc Rev.03/05/2019 ErCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Plan Submittal Requirements Commercial & Multi-Family - New, Additions or Alterations TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439• www.tiaard-or.gov 1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with: A. ❑ map&tax lot# ❑ project name ❑ site address 0 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\Pemvts\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 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov Type of Submittal # of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (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. I:\Building\Pemilts\BUP_COM_PermitApp.doc Rev.03/05/2019 City of Tigard 7 • COMMUNITY DEVELOPMENT DEPARTMENT T I G A K 111 n Building Permit Review — Commercial - With Land Use Building Permit #: ft,p A6-9,a. - ocl `ice Site Address: 13 kb 61.,0 'PilofiC.. Suite/Bldg#: Project Name: '21S FF t...i t'K SS (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: .' tA,OC4'f►cJ Verify site address/suite# exists and active in permit system. ❑ River Terrace Neighborhood: 0 Yes 0 No nd Use Case #: 11/4/1 MD 2022.—oCCr2-D 0 Plans tch Approved Land Use: Site Plan ❑ Landscape Plan ❑ Other: Urban Forestry Plan 0 Elevation Plan ding Height: Maximum Height Actual Height ir Conditions Met: ❑ Prior to Submittal 0 Prior to Permit Issuance Business License: Exists: 0 Yes ❑ No, applicant was provided a business license application Public Facilities Improvement(PFI)Permit: Required: 0 Yes,applicant was notified 0 No Applied For: 0 Yes 0 No,stop intake Notes: Approved by Planning: Date: 2-2 Ze Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Building Permit Submittal Original Submittal Date: '1 /a 7/A Site Plans: # Building Plans: # Building Permit#: ® Enter building permit#above. Workflow Routing: IN Planning 0 Engineering 0 PeitCoordinator 0 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 1 beam calr„lations and trust details,if applicable,etc. Notes: , / By Permit Technician: / q - Date: q/d7 C z. I:\Building\Fonns\BldgPermitRvw_COM_W ithLandUse_1118 I9.docx Engineering Review ❑ Slope at building pad: ❑ PH Permit#: ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP) ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ❑ No Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date Notes: Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ 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: 0 Yes ❑ N/A Parks SDC: ❑ Yes ❑ N/A LIDA Fee: 0 Yes ❑ N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:1Building\Forms\BldgPermitRvw_COM_WithLandUse_111819.docx 13680 SW Pacific Highway,Tigard, OR 25102CC01100 Crown Castle for Dish Wireless BU 825028, APP ID 561493 Exhibit"A" Proposed Scope of Work SCOPE OF WORK TNMS Is NOT AN ALL, INCLUSNE UST. CONTRACTOR SHALL UTILIZE SPECIFIED EQUIPMENT PART OR ENCMIEER APPROVED EQUIVALENT. CONTRACTOR SWILL VERIFY ALL NEEDED EQUIPMENT TO PROVIDE A FUNCTIONAL SITE. THE PROJECT GENERALLY CONSISTS OF THE FOLLOWING: TOWER SCOPE OF WORK: • INSTALL. (3) PROPOSED PANEL ANTENNAS (1 PER SECTOR) • INSTALL (1) PROPOSED ANTENNA PLATFORM MOUNT • INSTALL PROPOSED JUMPERS • INSTALL (6) PROPOSED RRU! (2 PER SECTOR) • INSTALL (1) PROPOSED OVER VOLTAGE PROTECTION DEVICE (OVP) • INSTALL (1) PROPOSED HYBRID CABLE GROUND SCOPE OF WORK: • UTILIZE EXISTING PLATFORM • INSTALL (1) PROPOSED ICE BRIDGE • INSTALL (1) PROPOSED PPC CABINET • INSTALL (1) PROPOSED EQUIPMENT CABINET • INSTALL (1) PROPOSED POWER CONDUIT • INSTALL (1) PROPOSED TELCO CONDUIT • INSTALL (1) PROPOSED TELCO—FIBER BOX • INSTALL (1) PROPOSED CPS UNIT • INSTALL (1) PROPOSED SAFETY SWITCH (F REQUITED) • INSTALL (1) PROPOSED FIBER NID (IF REQUIRED) If your requested information is not visible, please click here. 9f0_ -N11 Geographic Information Systems Navigation: Washington County. 3. GIS » Reports: A&T Report 25102CC01100 I General Information Assessment &Taxation Report interactive maps map gallery General Property Information contacts Site Address: 13680 SW PACIFIC HWY. TIGARD OR, 97223 Tax Lot ID: 25102CC01100 other gis links Property Account ID: R466604, frequently asked questions Property Classification: 9810 - - See full list of Codes Property Search Neighborhood Code: NAC property/ taxlot Latitude/ Longitude: 45.4206289/ 122.784335 tax maps Tax Statement History: See property tax information for all accounts on this parcel Survey Search Tax Statement History: See property tax information for account R466604 Land Services Sales / Deed Information Sale Date Sale Instrument Deed Type Sale Price Building Services _- Assessed Values for Account R466604 Roll Date: 10/01/2021 Taxcode: 023.74 Market Land Value: $878,870 Market Bldg Value: $156,860 Special Market Value: $0 Market Total Value: $1,035,730 Taxable Assessed Value: $0 Legal: Lot: Lot Size: A&T Acres: 0.91 Bldg Sq Ft: 0 Year Built: N/A Improvement Information Total Improvement Value: $156,860 Plumbing Bedrooms **2022 Information Advisory** All property assessment information presented about the 2022 tax year is unedited and uncertified. This information is subject to change, furnished as reference data only and should not be used to calculate or prorate taxes. **Disclaimer**