Permit (65) 71 CITY OF TIGARD BUILDING PERMIT
I COMMUNITY DEVELOPMENT Permit#: BUP2016-00215
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2016
Parcel: 1 S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT&T Subdivision: 1993-058 PARTITION PLAT Lot: 1
Project Description: Replacing(3)panel antennas and installing(6)remote radios,(1)surge suppressor,and equipment inside existing
shelter.
Contractor: VELOCITEL INC Owner: HA&R, LLC
4004 KRUSE WAY PL, SUITE 220 ATTN:TAMMY HOUSE
LAKE OSWEGO, OR 97035 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 503-636-2500 PHONE:
FAX: 503-636-2501
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee-Additions,Alterations, 08/03/2016 $377.90
Occupancy Grp: U Occupancy Load: Demolition
12%State Surcharge-Building 08/03/2016 $45.35
Dwelling Units: 0 Plan Review 06/30/2016 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 08/03/2016 $17.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $20,000 DC Provision Review,COM TI-Ping 08/03/2016 $90.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $776.39
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: e s r Permittee Signature: oA7
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
Commercial FOR OFFICE USE ONLY
City of Tigard Received
�� g ,r-'. 7 DateBy. 6 r -140 PermitNo.: ejipi:2 /v— y,� 1
13125 SW Hall Blvd.,Tigard,OR 9722 ,. Plan Re r �/' t�V r�l"'�
Phone: 503.718.2439 Fax: 503.598. l ,?. Date/By: IP j ��11111
dolltherPermit:
T I GARD Inspection Line: 503.639.4175 q Date Rea �: Juris:
69 Z�1� 7 Z/� S See Pent 2l t
Internet: www.tigard-or.gov �j i3 Notified/Method: / 1�/ InformationSupplemental
r<
f.:✓T.,,�,!.. :rai :
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,�rf�g[ D11�. � i� FGI � % L. (G��s. f'4 y ,f4/:, 41 ,44%,WX , 44/40,440;.�. S u �,..,, f4%r,r ,, � �4,,1 , �fXf� � f0,- rm ,,,
El New construction ,;, t;n' 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: equipment,materials,labor,overhead,and the. r/!!ci` :441:4447.,4„,74744 ��. ,.
profit for thegmtr , r,:f irr , f/ N)gfilU. 1ii , i1f/f` work indicated on this applicaon.
:;,"4:;;, cf.r„l; j! %rff, .friew/4 �r,�ry/%�1✓, r ,� .,r< �r .�l�„
„.N,;:
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
f/dIrNloY frr % r FFOf ri ! r ,Of f%
Total number of floors:r /s ff ! / )r �!7/7,e Arl,/ ,„„idis, , iO,rr.F#}4 l04, r . f..
Job site address:12655-A SW North Dakota St New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:PR77 Scholls/856366 Covered porch area: square feet
Cross street/directions to job site:SW Scholls Ferry Rd&SW North Dakota St Deck area: square feet
Heading S on OR-217 take exit#4B;right on SW Scholls Ferry Rd; Other structure area: square feet
Left on SW North Dakota St fi ll er �ff��! f xlrr l, ,cif,ir i�,i r„ rrr,Ji ref r SfrrT
„Z `�,, � A Ori E� �r CaHI„Cs c
�..�6r;�.ur„�rferirrFi!/!/lJii�f%�L�rJf,.//,�fiirf lJf/Pr?•✓firr.1,�>"�fLirluf��i,'f Fr rdr4.,.,.;'r
Subdivision:N/A Lot no.:1 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:R2032709 Indicate the value(rounded to the nearest dollar)of all
� wire f iir equipment,materials,labor,overhead,and the profit for the
r� fir` ,'`�frrl,fl,`�rf�r/f.f�rr! r ��,�firrr�,f�ri�i rf,;,Flrrr������rfrrf �;:!r�l f%,`,r'r rl�r,,rf,r
/! ilo i r,. f!, ,'f/ .m-"4,r/A,/./0”, ,l iff,, rr "ieviwrr",,%orf.„// . .gol,, fr,'„ , work indicated on this application.
Replace three(3)panel antennas;install six(6)remote radios(RRTls); Valuation: $$20,000.00
install one(1)surge suppressor;and install equipment inside existing shelter Existing building area: 396 square feet
New building area: N/A square feet
/ ! Jf14,4li.irrfe/rVEici ` im firift f,slof7rr,rif y)71
Number of stories: 1r f,,Yo tfr-eete'„4f ilrrie4Paa � rrfie rf eff � !
Name:HA&R LLC Type of construction: Telecom
Address:12655 SW North Dakota St Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing: Unoccupied
Phone:( ) Fax ( )
+.� .. ,
New:
,�? U n.Roc�cupied
rrf%�� ® � P f kfr, r . /frblo Tk t �R � f! / � rf ;%f B ILIDf`' �" U�
er�, r% r' llfli, f % r': �!/Agx.re ,re%,%,r fr.,4fir �m,,✓;„,Oraf��i4,,,,vV✓r/kvJ�1j,r9l>' r „j,,'�� % rfl�Itheuc) f1fi fr
fBusiness name:AT&T submitted by Crown Castle
Structural plan review fee(or deposit): $245.64
Contact name:Aaron Hottell
Address: 1505 Westlake Ave N,Suite 800
FLS plan review fee(if applicable):
City/State/ZIP:Seattle,WA 98109 Total fees due upon application: $245.64
Phone:(206)336-3225 Fax::( ) Amount received: 245.64
rsuv:ozlllfy%f„%rrffl/'!r /P/lif/y/rllffrl�lfv �fr%J/!i f/rfr!fr lifo
E-mail:aaron.hottell@crowncastle.com rOw`OL'TA 4w �E ��
� � �rJ,ffi/J,."•r,'rrrf/Ji r��fJJrf,"!„�I��l>ff//l/,rll,'!f!r/txl:�lrrrr,;,,;,c/�lrll>,� �.�"1�rr”`
ri f !if ff,fly/<r , ff 1
/i f i ,, ,, ORJf ” r rir, , r�f�„ f %r f,,e/ Commercial and residential prescriptive installation of
` � "te r f t' 'rfr1% r' Elf 06,/ %'%f r 1 r fr f� r r roof-top mounted Photovoltaic Solar Panel System.
Business name:Velocitel Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1033 Skokie Blvd,Suite 320 Solar Installation Specialty Code checklist.
City/State/ZIP:Northbrook,IL 60062 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)349-2149 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:200980
Total fee due upon application: $201.60
Authorized signature: .!--^g /' C_______----- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Aaron Hottell,Crown Castle obo AT& Date:6/28/2016 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
_ ti
CITY OF TIGARD FEE AND PAYMENT HISTORY
1111 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
BUP2016-00215 - 12655 SW NORTH DAKOTA ST, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-Additions,Alterations, 230-0000-43104 $377.90 $377.90 $377.90
Demolition
12%State Surcharge-Building 100-0000-24001 $45.35 $45.35 $45.35
Plan Review 230-0000-43106 $245.64 $245.64 $245.64 6/30/16 Check 404768 $0.00
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $17.50 $17.50 $17.50
11x17)
DC Provision Review, COM TI-Ping 100-0000-43112 $90.00 $90.00 $90.00
Totals for Fees $776.39 $776.39 $245.64 $530.75
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
404768 Check 3385 Velocitel, Inc. 06/30/2016 $245.64
Total Payments: ._ , .
245 64
Balance Due: $530.75
CROWNCrown Castle
1505 Westlake Avenue North,Suite 800
: CASTLE RECEIVED Seattle, WA 98109
AUG 3 2016
CITY TIGARD
BUILD/NCI-4 'SION
August 2,2016
Via FedEx Overnight Delivery
Permit Services
City of Tigard
13125 SW Hall Blvd
Tigard,OR 97223
RE: BUP2o16-oo215
Dear Permit Tech,
Please find enclosed check in the amount of$530.74 for outstanding fees.Also,please find enclosed FedEx pack
for the delivery of the issued permit.Thank you for your time.
If you have any questions,please feel free to call me at(206)836-3225 or email me at
aaron.hottell@crowncastle.com.
Sincerely,
� oy fftzeF
Aaron Hottell,Crown Castle
Real Estate Specialist
The Foundation for a Wireless World.
Crown Castle.com
Accela Citizen Access Page 1 of 1
Register for an Account Reports(1)'r Login
�Search.� s'71Home Building Engineering Planning Code Compliance
Apply for Permit Search Permits/Pay Fees Schedule an Inspection
Record BUP2016-00215:
Commercial-Building
Record Status:Ready to Issue
Record Info v Payments e
To schedule an inspection drop down the Record Info menu and select Inspections. Then select
Schedule or Request an Inspection.
Fees
The Building Official may refund up to 80%of the building permit fee for issued permits prior to any inspection request.Refunds will be returned to the
original payor in the same method in which the payment was received.
Please complete a'Request For Permit Action'supplemental form from the following URL in order to process a refund request.
Supplemental Forms
Outstanding:
Date Invoice Number Amount
07/25/2016 192046 $90.00 Pay Fees
07/25/2016 192046 $17.50
06/30/2016 192046 $377.90
06/30/2016 192046 $45.35
Total outstanding fees:$530.75
Paid:
Date Invoice Number Amount
06/30/2016 191538 $245.64 View Details
Total paid fees:$245.64
https://aca.accela.com/TIGARD/Cap/CapDetail.aspx?Module=Building&TabName=Build... 7/29/2016
CROWN 1505 Westlake Avenue North Suite 800 Phone (206) 336-3225
Seattle,WA 98109 Fax:
a: CASTLE www.crowncastle.com
June 28,2016
JUN 2 •9 %016
CiTY 1:'€` Ira ,„.}'�r
City of Tigard PIA NF rN .1 i=
Permit Center
13125 SW Hall Blvd
Tigard,OR 97223
RE: Request for Minor Modification to Existing Wireless Facility-Section 6409/47 CFR§1.40001("6409")
Site Address: 12655-A SOUTHWEST NORTH DAKOTA STREET,TIGARD,OR,97223
AT&T Project No.: PR77 Scholls&125th(BU 856366)
On behalf of New Cingular Wireless PCS, LLC ("AT&T") we are pleased to submit this request to modify AT&T's existing
wireless communication site at the location referenced above, as an Eligible Facilities Request for a minor modification
under Section 6409.
Scope of Work
AT&T proposes the following minor modifications to this site which is not in a Public Right-of-Way.AT&T proposes the following
minor modifications to this site: Replace three (3) panel antennas; install six (6) remote radios (RRHs); install one (1) surge
suppressor;and install equipment inside existing shelter as further described in the construction drawings. (Please note:all
work will be performed wholly within the existing premises and utility easements; this site is free of any concealment
features;and the project otherwise complies with the site's original conditions of approval.)
Section 6409(a)Criteria
Component Federal Section 6409 Limits AT&T's Proposed Modification
Increase height of tower 20 feet or less No increase in height
Antennas extending horizontally Antennas extend less than 20 feet
from edge of tower 20 feet or less horizontally from edge of tower
Additional equipment cabinets 4 or fewer No additional equipment cabinets
Our goal is to work with you to obtain approval of this minor modification. We will respond promptly to any requests for
information you may have for our application. 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 project, which will significantly improve wireless telecommunication
services in your community without requiring an additional site. Should you have any questions or require additional information,
please do not hesitate to contact me with your questions at 206-336-3225 or aaron.hottell@crowncastle.com.
Sincerely,
Aaron 3-fottefC, Crown Castle, on behalf of AT&T'
The Foundation for a Wireless World.
CrownCastle.corn
•
City of Tigard
q COMMUNITY DEVELOPMENT DEPARTMENT
11111 ■
•
r1cARD Building Permit Review — Commercial - No Land Use
Building Permit #: / °2o, - ;is -
Site Address: tato 55 6(Ai Suite/Bldg#:
Project Name: - k T ..t--
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 11odi.P+c.a4;0.45 -fo ods 4-;40) wi+ -(tJ,t -G.cal
b re-i,4 �.,F-d.:o$ r � �-epl a cam- 3 P Mk n n�) ins-t�.(1
o e6�,p,nenf. Id; n 4.1- r4 ni a,Yc.w. . Ke inU.�uot-
i n INAL i,.4.
Existing Business Activity: ..W i itlefs .r„a-(1 11-1
Proposed Business Activity: 14 tett eSi 4 c..L;.(.-,
C"Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ Yes 'No
Zomng: C—G
. Permitted Use: ,V"—Yes ❑ No ❑ Spec Space
.Confirm no land use required.
tJ/2usiness License:
Exists: El Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: CA/24.....L (,-,- Date: 4 "a2 9- / (o
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: /6"Site Plans: #
Building Plans: #
Building Permit#: r building permit#above. ,, --
Workflow Routing: [� Inning rmit Coordinator L�'Sutidtng
Workflow Sign-off: �YSign_off or Planning(include notes from planning review)
Route Application Documents: 1 ding original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
•
By Permit Technician: Date: 4/....76//�
I:\Building\Forms\BldgPermitRvw COM NoLandUse 060116.docx
4.7
ti e
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:
2n'1/4 SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes /A
Tigard Trans SDC: ❑ Yes kbN/A
Parks SDC: ❑ Yes
2:2—
OK to Issue Permit /_ /
Approved by Permit Coordinator: Date: Z./ lL.
IABuilding\Forms\BldgPerniitRvw_COM NoLandUse_070915.docx
RECErt
y ' s
* ` 14.:a
11
City of Tigard `�� . 2016
111
q COMMUNITY DEVELOPMENT DEPARTMENT FLAPi
CITY �. 31
TIGARD I. ,N67,Collocation - Supplemental Questior °na
PROPERTY ADDRESS
loft SlAl tI sr: OI.v
Location of collocation: 12655-A SW North Dakota St C- G
Zone:
Name of provider: AT&T
*Approved
Contact name: Aaron Hottell,Crown Castle 0 Not Approved
Collocating antennas on: ® Existing tower By: .. &ZAP) Date: 6 -G1-4- 1(P
❑ Existing non-tower structure Reason not approved:
Is this a new provider?: 0 Yes
® No
Other providers currently collocating on same tower or structure:
N/A
BUP2011-00056CURPW\Masten\Land Use Applications Rev.09/29/2014
Indicate the previous approval: AMC,lel lvtD Zoo
(SDR,MMD#)
ANTENNA INFORMATION
Existing: New:
Height of antenna(s): 47'&54' (sq.ft.) Height of antenna(s): 47'&58' (sq.ft.)
Color of antenna(s): Grey,Beige Color of antenna(s): Grey,Beige
Color of equipment: Grey,Beige Color of equipment: Grey,Beige
Accommodating equipment: N/A Accommodating equipment: N/A
(i.e.dishes) (i.e. dishes)
Will new accessory equipment be installed?: N Yes
❑ No
Location of new accessory equipment?: El Within previously approved fenced area
® Within existing structure
❑ Other location:
(please describe)
Will landscaping be removed to accommodate the accessory equipment?: ❑ Yes (please describe below)
N No
- Aaron Hottell,Crown Castle obo AT&T 6/28/2016
Applicant's signature Print name Date
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 1
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12655 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Record Type:
Commercial - Building
Inspection Type:
299 Final inspection
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
B U P2016-00215
Inspector:
Jeff Grove
Contractor