Permit �� CITY OF TIGARD BUILDING PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: BUP2010 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 2S101 DD00101
Jurisdiction: Tigard
Site address: 6975 SW SANDBURG ST 100
Project: VERIZON WIRELESS Subdivision: Lot: 0
Project Description: Replacing (6) existing antennas on roof.
Contractor: WESTOWER COMMUNICATIONS INC Owner: WESTON INVESTMENT CO LLC
19500 SW CIPOLE RD 2154 NE BROADWAY, STE 200
TUALATIN, OR 97062 PORTLAND, OR 97232
PHONE: 503 - 210 -1000 PHONE:
FAX: 503 - 210 -1001
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 05/11/2011 $225.80
Class of Work: ALT Demolition
Dwelling Units: 0 Plan Review 06/29/2010 $146.77
Stories: 3 Height: 0 ft 12% State Surcharge - Building 05/11/2011 $27.10
Bedrooms: 0 Bathrooms: 0
Value: $10,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $399.67
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 B • Perruittee Signature: •,
Ca 503.rxT'� by 7:00 a.m. for the next available inspection date. • /j _
This permit card shall be kept in a conspicuous place on the job site until completion of the , ojecX
Approved plans are required on the job site at the time of each inspection.
,
:
Building Permit Application ,:, .
'v. -t z
Commercial -, . A0�0 Received � FOR OFFICE USE O
City of Tigard 4 ' . „ (D4,ti}/B : _ i ?'' Permit No.: - n I a _ U p(S
v 13125 SW Hall Blvd., Tigard, OR 97223 ,� \ �C) . an Review,,` ,l
C ' Phone: 503.639.4171 Fax: 503.598.1960 Oy *� Date /By: ( 1 l� Other Permit:
o
T 1 G A k D Inspe Line: 503.639 rr '� Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov V Notified /Method: cm /b - T Supplemental Information
.� l_ // - - Pa fr, ) 7 nree..61 cal _ &if
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
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling Z Commercial /industrial Valuation: $N /A
❑ Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 6975 SW Sandburg St New dwelling area: square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: VZW - POR Tualatin - LTE Covered porch area: square feet
Cross street/directions to job site: SW 72" Ave (SW corner of Hwy 217 & 1 - 5) Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE.CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 25101 DD00101 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.
Replace six (6) panel antennas on the roof of an existing building Valuation: $$10,000.00
Existing building area: N/A square feet
New building area: N/A square feet
❑ PROPERTY OWNER ® TENANT Number of stories: N/A
Name: Verizon Wireless c/o RealCom Associates Type of construction:
Address: 621 SW Alder St, Suite 300 Occupancy groups:
City/State /ZIP: Portland, OR 97205 Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: RealCom Associates All contractors and subcontractors are required to be
Contact name: Paul Slotemaker, AICP licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 621 SW Alder St, Suite 300 jurisdiction in which work is being performed. If the
- City/State/ZIP: Portland, OR 97205 applicant is exempt from licensing, the following reasons
. apply:
Phone: (503) 241 -0279 ext 23 Fax: : (503) 241 -2204
E -mail:
CONTRACTOR
Business name: TBD t.A.Ar STO « - BUILDING PERMIT FEES*
Address: / 9 c p S - ' 67_, f 4Q /,<- �0 (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State /ZIBe7; 41 4/ C2/t , 7 '7os
Phone: (5d,1) 2/0 — ,'*7 Fax: ( 7� 2/0 — /OO/ FLS plan review fee (if applicable):
CCB lic.: ii1 a11-7 I Total fees due upon application: ¢j )3 d („
r f U .,......_ Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Paul Slotemaker Date: 6/29/10 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building \Permits \BUP -COM PennitApp.doc 10/01/09 440- 4613T(I I /02/COM/WEB)