Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2022-00078
T I t l A l D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/4/2022
Parcel: 1S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: T-Mobile Subdivision: 1993-058 PARTITION PLAT Lot: 1
Project Description: Adding:tower extension,antennas,slab,and(2)support cabinets w/ice bridge.
Contractor: KENNEDY RESTORATION Owner: HA& R LLC
13909 NE AIRPORT WAY ATTN RICHARDS, DALE
PORTLAND,OR 97230 SANDERS,WARREN L& EVA M
332 4TH ST
LAKE OSWEGO, OR 97034
PHONE: 503-234-0509 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Other Permit Fee-Additions,Alterations, 03/31/2022 $917.70
Occupancy Grp: U Occupancy Load: 0 Demolition
12%State Surcharge-Building 03/31/2022 $110.12
Dwelling Units: 0 Plan Review 03/30/2022 $596.51
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 03/31/2022 $274.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 03/31/2022 $62.50
Value: $75.000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,960.83 j
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 throug R 952-001-0090.a ou may o y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: Permittee Signature: �CR>5
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 ApplicationCIII
Commercial RECEIVE
, FOR OFFICE l tit ll\l 1
p�p(y dd 7 yppq Received fy��1 �r��
City of Tigard 1AR 1 COZ2 Date/By: . , '7/z jPermit No.:SVP L-bV...��" 13125 SW Hall Blvd.,Tigard,OR 97223pi rtcvie 1Phone: 503-718-2439 Fax 503-598-196Q;I I Y Uf I I(aNHL DateBY: Zl J ' 1 J 45
Related Permit:
Inspection Line: 503-639-4175 Date R /B r
TIGARD
�I r� l�'/� r1 Ready/By:Y �JJ))J/// �1j.L /' B See Page2for
Internet: www.tigard-orgOV '0.�II<L/IIVL�, L1��I I(��, ti6ed/Metho �L }/ e; Supplemental Information
TYPE OF WORK /�%/E�REQUIRED/ / DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling @ Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
lob site address: 12655-A SW North Dakota St. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 7- Gy/7.. Garage/carport g carport area: square feet
Suite/bldg./apt.#: Project name:'85Odbb Scholls&1Lbtn as 1148 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 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.
Add 20'tower extension onto an existing cell tower and add T-Mobile antennas. Valuation: $ 75,000
On the ground,add a 15'x 10'concrete slab and install(2)support cabinets with Existing building area: square feet
ice-bridge. On proposed H-frame, add ancillary utility equipment. New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name: Crown Castle/Global Signal Acquisitions IV Type of construction: IIB
Address: 2000 Corporate Dr. Occupancy groups: U
City/State/ZIP: Canonsburg, PA 15317 Existing:
Phone:( ) Fax:( )
New:
IX1 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: Crown Castle
(Please refer to feeschedule)
Structural plan review fee(or deposit):
Contact name: Zach Phillips
FLS plan review fee(if applicable):
Address: 1842 SW Lobelia St.
Total fees due upon application:
City/State/ZIP:Portland,OR 97219
Amount received:
Phone:(503 )708-9200 Fax::( )
E-mail: zach.phillipS@crowncaStle.cOm PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Tag_ Kt� l- / ge6 �'7 4_ Submit two(2)sets ofroofplan with connection details
�3�G < and fire department access,along with the 2010 Oregon
Address: / r /c. Solar Installation Specialty Code checklist.
City/State/ZIP: ���y�d� 2,,,, / Permit fee(includes plan review $180.00
Phone: ��-y and administrative fees):
� ',ff"- �U'� O' Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: S 66/ 27.
LL „j Total fee due upon application: $201.60
Authorized signature: , This permit application expires if a permit Is not obtained
within 180 days after it has been accepted as complete.
Print name:Zach Phllh Date: 3/16/22 * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
IN01
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: 0. 42 p Z2- ODD 76
Site Address: 045Y �j(,,) (\1oQ-v O (...oTh Sr Suite/Bldg#:
Project Name: ( O y yci C"TZA- / TM a 61 t-Q
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: AK cf.. a 4?c.*cCL Ap.1-01/15*( I 4rte./1.4.41.tey 01fwar+r
2 tv.tSrinL. u,AVARei.eS S PC-Ce c o-0-00 l C. 41 outs CAte-12 t t3R
Verify site address/suite# exists and active in permit system,,,.-
❑ i er Terrace Neighborhood: ❑ Yes VNo
dUseCase#: VIM 0?,5LZ- CTO'1'j
Plans Matth Approved Land Use:
❑ ite Plan ❑ Landscape Plan ❑ Other:
0 Urban Forestry Plan ❑ Elevation Plan
El ding Height: Maximum Height Actual Height
Conditions Met: ❑ Prior to Submittal 0 Prior to Permit Issuance
lfly,..)siness License:
Exists: 0 Yes 0 No,applicant was provided a business license application
Public Facilities Improvement(PFI)Permit: ��
Required: ❑ Yes, applicant was notified .L�J No Applied For: ❑ Yes 0 No, stop intake
Notes: //
Approved by Planning: - Date: 3 /30 2Z
Revisions(after Building Submittal o ) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 'I i 7 (22-
Site Plans: # a
Building Plans: # '3
Building Permit#: t® Enter building permit#above.
Workflow Routing. Gh Planning 0 Engineering 0 Permit Coordinator t:g. Building
Workflow Sign-off: e. Sign-off for Planning(include notes from planning review)
Route Application Documents: R, Building original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Csbal; 41. Date: 3I30)22_
I:\Building\Fonns\BldgPennitRvw_COM_W ithLandUse_I 11819.docx
Engineering Review
❑ Slope at building pad:
❑ PFI 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: El Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
" P rmit Coordinator Review
❑ Co ' 'ons "Met"prior to issuance of building permit
❑ Approved, T Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applic
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: El Yes N/A
Tigard Trans SDC: ❑ Yes ❑
Parks SDC: ❑ Yes ❑ N/A
LIDA Fee: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:1BuildingWorms\BldgPermitRvw_COM_W ithlandUse_111819.docx