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Permit (5) CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: BUP2022-00164 Date Issued: 5/8/2023 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136AD06300 Jurisdiction: Tigard Site address: 11655 SW 65TH AVE Project: AT&T Subdivision: None Lot: None Project Description: An antenna modification on an existing wireless site. Contractor: ELECTRIC TECH CONSTRUCTION INC Owner: PORTLAND GENERAL ELECTRIC COMPANY 1910 MARK COURT 121 SW SALMON ST STE 130 PORTLAND, OR 97204 CONCORD, CA 94520 PHONE: 925-849-5324 PHONE: FAX: FEES Specifics: Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 07/08/2022 $453.95 Occupancy Grp: U Occupancy Load: 0 Demolition 12/o State Surcharge-Building 07/08/2022 $54.47 Dwelling Units: 0 Plan Review 06/23/2022 $295.07 Stories: 0 Height: 0 ft DC Provision Review, COM TI-Ping 07/08/2022 $110.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 07/D8/2022 $150.50 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 $1,063.99 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtai a copy of the les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.Issued By: �� ^ Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application,1 EGEI VE D Commercial �l C FOR OH It l-I 'NI,0AI.N City of Tigard MAY = '7 202Z I kyi Received 'w Permit No.: IN " 13125 S W Hall Blvd.,Tigard,OR 97223 (` Dee/By W ll(9I22 -f "_ w Phone: 503-718-2439 Fax: so3-598-1968'ITY OF TIGARD D� "w Related Permit: b -d$- a 11t,,,,,iti1 Inspection Line: 503-639-4175 BUILDING DIVISiON DateR 'By- � m SuppePage2tor Internet: www.tigardror.gov No' edMi - /!�� G I Supplemental lnearmadon TYPE OF WORK QUiRED 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 •Other: voitea. J 'ABCs N, equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ❑ 1-and 2-family dwelling ❑Commercialindustrial ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder •Other:1,0 i raajy corm it, Number of bathrooms: i 1475-5- JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1,..esS1 S ) 6 sat% Ave. New dwelling area: square feet City/State/ZIP: 1";�q 0.2 Q i 0 9 1 j,Z'3 Garage/carport area: square feet Suite/bldg./apt.#: J Project name: C(QcoN Ait-1 Covered porch area: square feet Cross street/directions to job site: I- da t S�U tm$'R s Deck area: square feet GI 9 M.3 'f-o Su.; CC R c NAc C >'f, t t i44'CJ1 t u ie tA/NS 0 Other structure area: square feet iAJ C L*Ave. A 4- e viA ofC`'1. 4-c e,t oil09 REQUIRED DATA:COMMERCIAL-USE CHECKLIST • Subdivision: I Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: IS 13(p A D p(2 30© it 2.2-19 S4 1 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. 6Er 4-1-' / colz. Dr wear-. Valuation: S Z5; ODO.00 Existing building area: square feet New building area: square feet 0 PROPERTY OWNER �/_ J/ • TENANT Number of stories: Name: C�0.34 ,.!} a�TfjY�/� 45 17 C':t 61i0W Type of construction: Address: (CD S VJ.�/5 r t C ✓ . •` S Co Occupancy groups: City/State/ZIP: c ,e_ liJik 1 Of O 9 Existing: Phone:(3C(p);3(, —7403 Fax:( ) New: ❑ APPLICANT m CONTACT PERSON BUILDING PERMIT FEES* (PBusiness name: &M 3._- t4+t S, ...ei O �,.` reviewase (orer deposit): re) /� ��^ Structural plan review fee(or deposit): Contact name: e S YJ riate4,4444 Address: p ' St S *. 1 O S FLS plan review fee(if applicable): Je1142 `�n Total fees due upon application: City/State/ZIP: (• ikA- p!a I, Phone:(2.0 )51+1 tf a '-f Fax::( ) Amount received: E-mail: a V C ovr r1,=(i-ci2�52 a-eS� (p J( PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES" CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: " e o C (e,-f"i,L L e,...„u� Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: t 110 / Solar Installation Specialty Code checklist. City/State/ZIP: �s 4.1 cb 5-ter Permit fee(includes plan review $180.00 and administrative fees): Phone:(17 511a_el :( ) State surcharge(12%of permit fee): $21.60 CCB Lie.: 02= 7 7 3/2 34.y Total fee due upon application: $201.60 Authorized si This permit application expires if a permit is not obtained J` i within 180 days after it has been accepted as complete. Print name: (,�,i���fllL lr{ Date: 5— f f V - • Fee methodology set by Tri-County Building Industry r "`/y Service Board. I:\Building\Permits\BUP COM_PermitApp.doc Rev.04/21/2014 440-4613T(ll/02/COM/WEB) (1955-5W 65th Ave., Tigard, OR 97223 15136AD06300 Crown Castle Building Permit Application PROPOSED SCOPE OF WORK PROJECT DESCRIPTION THE THIS PRalET IS T AN ANTEN Exr:JI\C• wIELES SITE Roth LTE ‘,R tnLE4 b or the im CI Rate7. 'st• LTE shoild te SFF-'7 -..tiEC,.2:022) or Lot) Rudio and A3IA AirSrAle IH (AHL.3.4, AHLI3A, AHF113, AHLA. AHNA.) and SP/ i.C.E;2, 1644E. NEQ.212C22) Qt Ltt iio drd A13IA AV.! „HIE) The 2tid ::1!..••,F1:1 Le 'OP/ tot Aik/Ale cilld AL. I1Ji . Add 2rd t• '•:-A bdt.dt/tddic 1i.it i . t-h49. t.,•7 L3dt1d !quit . •.' bI idic jicJ AI l'71.'g:%1 to ruirair - kH o back :ariterlra cleArirar mJ (-11'7.111:1 St-.'pArriot• pet latest AT&T :-_iiieht!es. • A\TEM•:1Ali • ':EV:IY'/E '4.147j • IVIlTALL ANTE • I\STALL • IVTALL I:1.. -• -:'1 : • l\ TALL 'J- • IV:TALL 6 : ',, FILER .' .') E FOR' THE ;.:RH * -TELT::TATE T COLLAT,'. AT M ;1PCLE ARCVE LJF CF • ..;;Ek,1::IVE CLiE HA.TTPIES • I\STA.LL FILET L4.:21"; 13CX `,LiELLIW Ex:ISTI\G; • Is..r.q4.1.1.. v1 :.1.1F.TE:-; IN THE F..ACK • 1'..--;T:-LL AH AIIt.fY 5TRIF,I.SS WITHIN THE E:x.1:T.Jr.: • Alen (3:: RE-J1FIERS TO THE EXISTI • EXIST1t:K7 FSA1 — REVCNE EX1f711\1;::, IF: • MIL GN THE SIDE. AD (..•) AIL ••••. : I.: THE 2 SIDE FCR LDG City of Tigard ig 1,11 COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: 20` Z. a)I 01.1 Site Address: lilacs Siiv C-Ctl' Av Suite/Bldg#: Project Name: Gs2cy,"4,1 cAS-N2 —, i-k'r (Name of commercial business occupying the space. If vacant,enter Spec Space) Planning Review Proposal: (ram j Existing Business Activity: �� Business Activity: NA- Proposed +J Vertfy site address/suite#exists and active in permit system. ❑ ice ererrace Neighborhood: ❑ Yes I7 No �Zoning: �1 Pl tted Use: Y Yes ❑ No ❑ Spec Space • ] Confirm no land use required. Vir I Business License: / Exists: ❑ Yes 0 No,applicant was provided a business license application Notes: Approved by Planning: tu,r—`_ Date: C 71/22 Revisions(after Building Submittal onl Reviewer Date Revision 1: 0 Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: ¶4 11,22, Site Plans: # 3 Building Plans: # -- Building Permit#: el*1 Enter building permit#above. Workflow Routing: Planning ❑ Permit Coordinator cg7 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: s2L.0-P Date: (DI t(p 1 2?. 1:113wildinglFornrs1B1dgPennitRvw_COM_NoLandUse 111819.docx Permit Coordin: or Review ❑ Conditions "Met"prio.to issuance of building permit ❑ Approved,NOT Relea.-d: Date: Notes: Revisions(after Building Submittal only) Revision Notice 1: Date Sent to • ,.licant: Revision Notice 2: Date Sent to Ape c.. Revision Notice 3: Date Sent to App .+nt: ❑ SDC Fees Entered: Wash Co T s Dev Ta . ❑ Yes 0 N/A Tigard ans SDC: 0 Yes 0 N/A Par SDC: ❑ Yes 0 N/A ❑ OK to Issue Permit Approved by Permit oordinator: Date: I:\Building\FormslBldgPertnitRvw_COM_NoLandUse 111819.docx City of Tigard COMMMUNITY DEVELOPMENT DEPARTMENT hp Questionnaire TIGARCi Collocation Su lement SITE INFORMATION Collocating antenna is on: U Existing tower 0 Existing non-tower structure Address: S(A) 6 5 411 City/State L t'9 O. , OR Zip: 11��-3 PROVIDER INFORMATION Name of provider: 4�["t1 Has this provider previously sewed Tigard? ®Yes ❑ No Contact name: F -f Phone: �©fo `l- List other providers currently collocatin r on same tower or structure: Vegi 7�/J Approved land use case number: uZo(8` 00 241 ANTENNA INFORMATION Existing: New: Height of antennas: 0 2___ ft. Height of antennas: ( o Z. ft. Color of antennas: Jf W 1 0 a- Color of antennas: 5-161 Co 1'0 i2' Color of equipment: 5kti Co toi0— Color of equipment: SKI CO It.42— Accommodating equipment:Sk-9 Accommodating equipment s 61 Cola- Co I oA+. Will new accessory equipment be installed? ❑ Yes , No Location of new accessory equipment: ❑ Within previously approved fenced area O Within existing structure ❑ Other location: Will landsca• v be removed to accommodate the accessory equipment? 0 Yes ® No Ifyer, .e.-- � AfietaA4444 5-114-1 ire Print namd- Date • S ce A44.0.thJ ck S LiSt fietc( Pole/structure owner's signature Print name Date Zone: [." 0 Approved 0 Not approved Received by: A )1 Date: OS 22 Reasons for denial: City ofTigaul • 13125 SW Hall Blvd. • Tigard,Orcgon 97223 • wwwtigard-or.gov • 503-718-2421 • Page l ofl CROWN Crown Castle 1505 Westlake Avenue North Cr 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.Listfjeldna,crowncastle.com (206) 336-7403 The pathway to pussiiite. CrownCast e.corn