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BUP2022-00098 (2) CITY OF TIGARD BUILDING PERMIT 3111 2 COMMUNITY DEVELOPMENT Permit#: BUP2022-00098 Date Issued: 4/20/2023 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00700 Jurisdiction: Tigard Site address: 12655 SW NORTH DAKOTA ST Project: AT&T Subdivision: 1993-058 PARTITION PLAT Lot: 1 Project Description: Modification of existing wireless facility. Contractor: LEGACY WIRELESS SERVICES INC Owner: HA& R LLC 15580 SE FOR MOR CT ATTN RICHARDS, DALE CLACKAMAS, OR 97015 SANDERS, WARREN L& EVA M 332 4TH ST LAKE OSWEGO,OR 97034 PHONE: 503-656-5300 PHONE: FAX: 503-656-5305 Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: Other Info Process/Archiving-Sm$0.50(up to 04/29/2022 $132.50 Occupancy Grp: U Occupancy Load: 0 11x17) Dwelling Units: 0 Permit Fee-Additions,Alterations, 04/29/2022 $453.95 Demolition Stories: 0 Height: 0 ft 12%State Surcharge-Building 04/29/2022 $54.47 Bedrooms: 0 Bathrooms: 0 Plan Review 04/20/2022 $295.07 Value: $25,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $935.99 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 requir y to follow e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 0 95 001-0090. You a btain a c of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.3�j ��Issued By: Permittee Signature: vvy c � e-gv e 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 ApplicationLA- l(1 22 Commercial v' �\�//ED MR OH'It I. 1 5b 1r\I l RDar yJ,y 'n ��' Permit No.: �Zo6 VQQ City of Tigard APR 12022 Date/By:04 Iq 1-0Z�- v 1 2' 9 'i 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev 1= Phone: 503-718-2439 Fax. 503.598-MY OF TIGARD DaeeBy: • 1 elated Permit TIC.;ARD Inspection Line: 503-or.gov75 ;BUILDING y /By. •,/,�� 6 Supplemental Pent 2 lInr Internet: www.tigerd-or.gov DIVISION n6ed/Methed: 5u Iemennl Information TYPE OF WORK REQUIRED , •TA:l-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees'are based on the value of the work performed. n Indicate the value(rounded to the nearest dollar)of all ®Addition/alteration/replacement 4 Other: W s!'C'165 f`i.c.i I i f't+! equipment,materials,labor.overhead,and the profit for the CATEGORY OF CONSTRUCTION J work indicated on this application. Valuation: S L5 000. pp ❑ 1-and 2-family dwelling 0 Commercial/industrial / ❑Accessory building CI Multi-familyNumber of bedrooms: ❑Master builder IN Other:H.p it,' two*fteleSS Number of bathrooms: JOB SITE INFORMATION AND LOCATION a WI Total number of floors: Job site address: I Z ifl 557-A Sa tJ•t 1i.tNe5f- hf o r-FGt ®aKa 41.- S i.. New dwelling area: square feet City/State/ZIP: 1-f Q.d-O WA Cf 1 Z ti Varage/carport area: square feet Suite/bldg./apt.#: Project name:GQAtJf\ CA$444e. eta. Covered porch area: square feet Cross street/dirixtions to job site: %1 tT1 QCI.KO'}A Deck area: square feet c,s. C,IA Ti II S♦�F'e..vv-f'j a 4, r}Lug) a f`I A l Other structure area: square feet )C .G ST„ (%/4 k ai. Qt'G64-, S t'*v ($ On_i l REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 1 [Lot#: Permit tees*are based on the value of the work performed. Tax map/parcel N: 1(2,22)72-7 01 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. s Pr�r O$co Sc12R._ 01r Ww*, Valuation: S r4 (_-1'i s 10 ` A-T t-( 'I it-y Existing building area: square feet J 'G�^t'rvJl Tlr� J New building area: square feet 0 PROPERTY OWNER ir TENANT Number of stories: Name. G(,Zor> C as 442 /SA(ZA- 4 e-3& Y pk Type of construction: Address: ' �� /�-I QV _ Occupancy groups: City/State/ZIP: JO A ,p h 0 C1 Existing: Phone:( b1 'to — 2� pY 1 Far:( ) New: 0 APPLICANT�t ® CONTACT PERSON BUILDING PERMIT FEES* Business name: GMA- /ORA-W -le• S8d^V1ce h f (Name refer balsa seaedael Structural plan review fee(or deposit): Contact name: ?Aia4 MovrikLewri-3 FLS plan review fee(if applicable): Address: QJ O flO City/State/ZIP: ' �kit. IA)A- 1 `a 0 O c"I Total fees due upon application: Z09 .Z;j�f'." a 2 *) Amount received: Phone:( R -'1 Fax: :( ) F,mail: CaI"W 14141.4404N rjd/V 4t 4fiir awl PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: O Submit two(2)sets of roof plan with connection details / /�"" /� and fire department access.along with the 2010 Oregon Address: [.G C Irt/{! r -s te Lrs Solar Installation Specialn Code checklist. City/State/ZIP: J _ e, G'� Permit fee(includes plan review $180.00 v, �,n c r and administrative fees): Phone:�go S a ib/5 State surcharge(12%ofpermit fee): $21.60 CCB Lie.: ` 92 Total fee due upon application: S201.60 Authorized sign • This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Print name:6AI 5 Dater/,j/'/2.2-- * Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Pertnits\BUP_COM_PcrrnitApp.doc Rev.04/21/2014 440-46137111/02/COM/WEB) I p Building Permit Application Nagar Commercial R1C C c f FOR OFFICE USE ONLY City of Tigard Al` ved DatRece/By: Permit No.;(3OI j 1 r • 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review f� ■ . Phone: 503-718-2439 Fax: 503-598-1960 ,..,-. N Date/By: Related Permit: T I G A R D Inspection Line: 503-639-4175 (- I1" )l+?v Date Ready/By: Juria: ® See Page 2 for . Internet: www.tigard-or.gov 71 •.,•ti©i Notified/Method: I Supplemental Information TYPE OF WORK 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 Lv�Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling g Commercial/industrial Valuation: $ ElAccessory building ❑Multi-family Number of bedrooms: 0 Master builder IDOther: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 12655-A SW North Dakota Street New dwelling area: square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.#: Project name:AT&T PR77 Scholls&125th/BU#856366 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: 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. Valuation: $ Request to Add I egacy Wireless Servirec, Inc to BP#BUP2022-00098 and issue permit for construction. Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER 0 TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( 1 New: 0 APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name: FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) Fax: :( ) E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name: Legacy Wireless Services, Inc./Project Coord.Teather Bailey Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon / Address: 15580 SE For Mor Ct. Solar Installation Specialty Code checklist. Permit fee(includes plan review City/State/ZIP: Clackamas, OR 97015 $180.00 and administrative fees): Phone:( 503) 860-2066(m) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lic.: 150432 Total fee due upon application: $201.60 Authorized signature: �„ �,./-1 � �� This permit application expires if a permit is not obtained v.Grc� within 180 days after it has been accepted as complete. Print name: Teather Bailey/Project Coordina Date: 4-13-2023 * Fee methodology set by Tri County Building Industry Service Board. l:lBuildmg\Permits\BUP_COM_PemvtApp.doc Rev.04/21/2014 4404613T(1I/02/COM/WEB) 4 RECEIVED APR O1 2022 CITY OF TIGARD City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENWJILDING DIVISION Ht Accessibility: Barrier Removal Improvement Plan Commercial & Multi-Family - Additions or Alterations TIGARII 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, 5 (g) When possible,additional accessible elements such as storage and alarms: S TOTAL(shall equal line [2] of Valuation Computation): S 1:\Building\Pemuts\BUP_COM_PcmutApp.dne Rcr.0.3/05/2019 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT IN8 " Plan Submittal Requirements Commercial & Multi-Family - New,Additions or Alterations T I<;A K D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439• www.ti Gard-or.gov_ 1. SITE PLAN (3) copies - fully dimensional,drawn to scale and labeled with: A. 0 map&tax lot # ❑ project name ❑ site address 0 suite number 0 zoning ❑ applicant name 0 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\Permits\I 3t1P_COM_PennitApp.duc Rev.03/05/2019 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Plan Submittal Requirements Matrix Commercial & Multi-Family - New, Additions or Alterations iiGAKL? 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. [\Building\Permits\BUP_COM PetmitAppdoc Rev.03/Q5/2O19 • Building Permit application 12655 -A Southwest North Dakota Street, Tigard, OR BU 856366,App ID 569671 PROPOSED SCOPE OF WORK PROJECT DESCRIPTION THE PJR=POSE OF THIS 'RDJECT IS TO PROPOSE AN ANTENNA MODIFICATION ON A'J EXISTING WIRELESS SITE. TOWER SCOPE OF WORK Both LTE & NR must be or the same CPRI Rate7. 1st LIE CPRI should be SFP7 (NEQ.20022) on both Radio and ABIA sides for AirScale RRH (AHLPA, AHLB3A, AHFIB, AHCA, AHNA) and SFP7 (CEO.'6446 or NEC.20022) or both Radio and ABIA sides for ALL radios (UHFA, UHIE). The 2rd 50 CPRI should be SFP7 (NEQ.20022/NEO.53020) on both Radio and ABIL/A3IO sides for Airscale and ALU radios, Add 2nd CPRI correction for all bands/radio that is missing. n77 Band requires (2) CPRI connections (CEQ.24407) or both Radio and ABIO sides. Contractor to maintain RRH to back of antenna clearance and '4/B29 & r7? antenna separation per latest AT&T guidelines. • REMOVE (6) ANTENNAS • INSTALL (9) ANTENNAS • INSTALL (2) #6 AM; DC TRJNKS GROJND SCOPE CF WORK • REMOVE (2) BATTERY CABINETS • REMOVE +24v DC POWER PLANT • REMOVE POWER EQUIPMENT FROM EXISTING CONVERTER SHELF, REMOVE CONVERTER SHELF; TRANSFER LOADS TO NEW' POWER PLANT • INSTALL —48V EMERSON NETSURE 5'2 DC PLANT 'W/ (1 ") RECTIFIERS & (2) CONVERTER MODJLES • INSTALL EMERSON 3ATTERY CABINET • RECONFIGURE (16) +24V STRINGS AS (8) —48V STRINGS • EXISTING FSM4 (AMIA) — REMOVE EXISTING (') ASIK AND (1) ARIL CARDS ON THE C2 SIDE. ADD (1) ASIL AND (3) ABIO CARDS TO THE C2 SIDE FOR 5G 850/1900/AWS, iG C n/i & 5G C r77 dod liCity of Tigard RECEIVED • COMMUNITY DEVELOPMENT DEPARTMENT APR l tOZ TIGARD Collocation Supplemental Questionnaire CITY OFTIGARD SITE INFORMATION Collocating antenna is on: • Existing tower 0 Existing EZ6 non-tower, - structure e� Address: 5S A SO O`Mte- to St City/state: l 5 a''`* Da-- Zip: 17223 Nor-NA 00A449 f'v- S+ree - PROVIDER INFORMATION Name of provider: Al F-i Has this provider previously served Tigard? a Yes 0 No Contact name: Phone: Z �7 I 42 --59 "1 g List other providers currently collocating on same tower or structure: N OE" Approved land use case number: C£L)?i 5-- Oozy ANTENNA INFORMATION Existing: New: cla I'eight of antennas: ft. Height of antennas: 5-42" ft. Color of antennas: S 4"1 C Io02 Color of antennas: CO47 ,� CO - Color of equipment: S ICy CO l Ole- Color of equipment: S K1 C.e ',OR—. Accommodatingequipment: S Accommodating equipment: 5 COto4 Colota---- Will new accessory equipment be installed? ®Yes 0 No Location of new accessory equipment: ® Within previously approved fenced area 0 Within existing structure 0 Other location: Will landscaping be removed to accommodate the accessory equipment? ❑ Yes • No 3fyer, re ibe Z_ C A, , .3 3/. /zv plicant s si ature Print nime Date S'eZr A te '' _ Pole/structure owners signature Print name Date Zone: �, " 0 Approved 0 Not approved Received by: t' Date: 8ZZ Reasons for denial: City ofTigard • 13125 SW Hall Blvd • Tigard,Oregon 97223 • www.thgard-or.gov • 503-718-2421 • Page 1 oft , or CROWN Crown Castle CASTLE 1505 Westlake Avenue Northuit Se 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.Listfjeld@crowncastle.corn (206) 336-7403 CrownCasUe.com