Permit I
CITY TI GARD BUILDING PERMIT
PERMIT #: BUP2005 -00336
Al DEVELOPMENT SERVICES DATE ISSUED: 7/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114AA -00300
SITE ADDRESS: 16295 SW 85TH AVE ZONING: I -P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Modify existing wireless communications facility.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 10,000.00
Owner: Contractor:
COMCAST CABLE LEGACY WIRELESS
14200 SW BRIGADOON CT 4252 SE INTERNATIONAL WY # F
BEAVERTON, OR 97006 MILWAUKIE, OR 97222
Phone: 503 - 645 -7365
Phone: 503 - 656 -5300
FEES Reg #: LIC 150432
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 7/15/2005 $139.30
[TAX] 8% State Surcharl 7/15/2005 $11.14
[BUPPLN] Pln Rv 7/15/2005 $90.55
Total $240.99
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
req • you to-$olow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• '2- 001 -0010 throw IkOAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 503 - 246 -6699 0 0- 2 -2344.
Issued By: 4..Mb Permittee Sig nature: a i \--7
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
9 \ -�. W2--
ituilding Permit Appittiti 1 ok ( I 1 I I( F l 11 ( \ l . l
Received ., �, / 2
13125 SW Hall Blvd., Ti
City of Tigard � 3 ,LQ Q� Date/B . 7 �d �, Permit No ij /f� 35
22
Phone: 503.639.4171 Fa 0.98.1 � � GQ• Q "' h'!s' Plan Review ra ,PAM Other Permit:
Line: 503.639.4175 'c� \S .4 '� , Date Ready/13y: �, . L / Ju • ' -� ® See Attached Checklist for
Internet: www.ci.tigard.or.us Q ,00 Notified/Method: /b p 1, Supplemental Information
41k 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
i 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 [�Commercial/industrial
Valuation: $ •
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 (...„..744 3w ..711+ Ave New dwelling area: square feet
City /State/ZIP: .*--n Cr .v) 9 -7 Aa / Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street /directions to job site: c ,S'e%-C "r1 U= ( N3 qN Deck area: square feet
D AN C t; Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 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.: a S 11 44 Ce)300
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ G
"ADD /P`.' erx.(5TIN G W1z SSS �rf/YUM -TIC^ I
o 00)
(-I � i - r b `pf � A'OI� Existing building area: square feet
e v t 0 K Cam elk3 W rr New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 6 hrl * c. e fl.t8ur Type of construction:
Address: ' 4 ,_ co S L - F3 R i � o e N Occupancy groups:
City /State /ZIP: �r .. -rtyv' Existing:
Phone: (j ra 6, , 7( 73c 5 Fax: ( ) New:
R /Q CONTACT PERSON NOTICE
Business name: 42- APSe. k Ass C All contractors and subcontractors are required to be
Contact name: ..-- t T'r.r_721Cd� under ORS 701 and may be required to be licensed in the
Address: q g X8 O a Ud. /V S 10 ) S-r. o 'l I S jurisdiction in which work is being performed. If the
City/State /ZIP: 'lr'O LereklD / 64 9 7 .2 / 6
applicant is exempt from licensing, the following reasons
Phone: ( e265? t'700 Fax:: ( .5- ‘ , 3 ) 4 ,16-7 ?70.0.-
E-mail:
CONTRACTOR
Business name: j�tG,q.d; ki,e_g,es f S(.2Y_a/i c
BUILDING PERMIT FEES*
Address: 4A 4 A Sc.... j"q/ l V•- 1x4411 J('/AL eS i . (`
_
Please refer to fee schedule.
ty
Ci /State /ZIP:
/ 1 L I✓/J C)K t C j OA Q 70� 0'12 Fees due upon application
Phone: (503 ) (,4 ( 3v o Fax: (N ) &C.. 3C
r) 4 3 Amount received
CCB lic.: 1 C,
Date received:
Authorized signature: �� This permit application expires if a permit is not obtained
n , 1 within 180 days after it has been accepted as complete.
Print name: 1 3 Y�l.P <, Date: 7 /( 61‘ * Fee methodology set by Tri -County Building Industry
/ i v Service Board.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP200 &- 00336
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/281:200
Phone: (503) 639 -4171 I�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 103
SITE ADDRESS: 16295 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CINGULAR WRELESS
DESCRIPTION: Modify existing wireless communications facility.
OWNER: COMCAST CABLE, PHONE #: 503 -645 -7365
CONTRACTOR: LEGACY WRELESS PHONE #: 503 - 656
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description / Confirm # Contact # Message ��
299 Final inspection {/ 018938 -02 971 - 998 -2503 Y � - btk 6
Corrections /Comments /Instructions:
'PASS [l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `rI/ I Date: / Phone #: (503) 718-