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Permit CITY OF TIGARD BUILDING PERMIT Q COMMUNITY DEVELOPMENT Permit #: BUP2010 00194 T 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010 Parcel: 1 S 135CB00200 Jurisdiction: Tigard Site address: 10250 SW NORTH DAKOTA ST Subdivision: Lot: 0 Project: Clear Wire LLC Project Description: 100 ft. monopole with antennas. Owner: FEES PASCUZZI INVESTMENT LLC Description Date Amount 10250 SW NORTH DAKOTA Permit Fee - Additions, Alterations, 10/29/2010 $917.70 TIGARD, OR 97223 Demolition PHONE: Plan Review 08/19/2010 $596.51 12% State Surcharge - Building 10/29/2010 $110.12 Contractor: MONTI ELECTRIC PO BOX 220 TROUTDALE, OR 970660 PHONE: 503 - 491 -4909 FAX: Specifics: Type of Use: COM Class of Work: ALT Dwelling Units: 0 Stories: 0 Height: 100 ft Bedrooms: 0 Bathrooms: 0 Value: $75,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $1,624.33 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 d m accordan 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 s. ATTENTION: Oregon re. • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth ' OAR 52- 001 -0010 through OAR 9 001 -01 r • ou may obtain a copy of the rules or direct questions to OUNC by call' 503.246.6699 or 1.8 .332.2344. � X ssued By: Permittee Signature: , p Call 503.639.4175 by 7:00 a.m. for an inspection that business day. l J ..� 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 ' n � ' � ' "' ` . C I. 1.()R ()1.1. 1. IiSI: O.1.1 ' City of Tigard °i ��© Received e lB ' LfII 1 dill': / Permit No.: 6 Li P , • (D — • 0 10 01 a 13125 SW Hall Blvd., Tigard, OR 9722 r3� , �� Alan Revi ew+ + ' C Phone: 503.639.4171 Fax: 503.598.1960 � .(�� �D ate/B : � �I l Other Permit` Inspection Line: 503.639.4175 P ��t�� \C' Date Ready /: kris ® See Page 2 for i �' �` �� ' N.1 U \� I. Supplemental Information Internet: www.tigard-or.gov (' \� ' G Noti6ed/Method: � � 1 , TYPE OF WORK V 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $N /A ❑ 1- and 2- family dwelling ❑ Comrrtercial/industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: N/A ❑ Master builder ® Other WCF Number of bathrooms: N/A JOB SITE INFORMATION AND LOCATION Total number of floors: N/A Job site address: 10250 SW North Dakota St. New dwelling area: N/A square feet City/State/ZIP: Tigard, OR 97223 Garage/carport area: N/A square feet Suite/bldg. /apt. no.: N/A Project name: ClearWire OR- POR424 Covered porch area: N/A square feet Cross street /directions to job site: SW Tiedeman Avenue Deck area: N/A square feet Hwy 217 to Greenburg Road. West on Greenburg Road to SW Tiedeman Ave. Turn Other structure area: N/A square feet right (north/northwest) on SW Tiedeman, turn right on SW North Dakota St. REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: N/A I Lot no.: N/A Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: 1SI35CB/00200 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Install 100' monopole, with associated antennas, and equipment in ground lease Valuation: $$75,000.00 area. Existing building area: 0 square feet New building area: 392 square feet ® PROPERTY OWNER ❑ TENANT Number of stories: N/A Name: Pascuzzi Investments, LLC Type of construction: 11 -B Address: 10250 SW North Dakota Street Occupancy groups: City/ State/ZIP: Tigard, OR 97223 Existing: Phone: (503)639 -5891 Fax: ( ) New: S-2 ❑ APPLICANT ® CONTACT PERSON NOTICE Business name: on behalf of ClearWire, LLC All contractors and subcontractors are required to be Contact name: Steven W. Topp, AICP licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 12566 SW Bridgeview Ct. jurisdiction in which work is being performed. If the City/ State/ZIP: Tigard, OR 97223 apply: is exempt from licensing, the following reasons PP Y Phone: (503) 708 -7337 I Fax: : (503) 579-4441 E -mail: sw.topp@comcast.net CONTRACTOR Business name: gtt.te -Ma M6 tor I E1 J! ((L1� BUILDING PERMIT FEES* Address: p /� Ago (Please refer to fee schedule) X Structural plan review fee (or deposit): City/ State/ZIP: 2 otAf Lti O( (7 �0 t FLS plan review fee (if applicable): Phone; (66) q�� yQ0 Fax: ( ) Total fees due upon application: CCB lic.: i 363 9 '' p e •311.1/# Amount received: Authorized signature This "'"35:.:er.e7,7".----------- permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Steven W. Topp Date: 08/17/10 • Fee methodology set by Tri-County Building Industry Service Rnard