Permit •
71 ' ' CITY OF TIGARD BUILDING PERMIT
: COMMUNITY DEVELOPMENT Permit #: BUP2011 -00096
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/26/2011
. Parcel: 2S102BD02600
Jurisdiction: Tigard
Site address: 12925 SW PACIFIC HWY
Project: A T & T Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37
Project Description: Collocation of (3) additional antennas on existing wireless monopole.
Contractor: LEGACY WIRELESS SERVICES INC Owner: KIM, PENNEY
15580 SE FOR MOR CT 395 NW SILVERADO DR
CLACKAMAS, OR 97015 BEAVERTON, OR 97006
PHONE: 503 - 656 -5300 PHONE:
FAX: 503 - 656 -5305
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 08/26/2011 $453.95
Class of Work: ALT Demolition
Dwelling Units: 0 Plan Review 05/12/2011 $295.07
Stories: 0 Height: 76 ft 12% State Surcharge - Building 08/26/2011 $54.47
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Sm Sheet (up to 08/26/2011 $39.00
Value: $25,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $842.49
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 By: rmittee Signature:S l '-- • / '!�
C., 10 3 ' 5 by 7:00 a.m. for the next available inspect n ' ate.
This permit card shall be kept in a conspicuous place on the job site until • • mpletion of the project.
Approved plans are required on the job site at the time of eac inspection.
Building Permit Application
Commer FOR OFFICE USE ONLY
Cl Of Tl and Re ce iv ed
` 1 g , a �, � , Date/BY: 19..1/ u Pao (1-aao r lo
g 1312 SW Hall Bl Tigard, OR 97223 Plan Review r Permit No.: rL 7 Other Permit:
. Phone: 503.718.2439 Fax: ' 503.598.1960 Date/By: f. J
MAY 1 2 2011
T [ G A R D
Internet www tigard -or gov f etho
Inspection Line: 503.639.4175 Date Ready/ c lurk: 63 See Page 2 for
Notified/Method: e 1 Su pplemental Information
• d/Ivt d: �` 7 u � �n
CITY OF TI A; Q om{
m t o E t R° �. , z � � �E
o , 9 TYPE 3 i WOltw t ` 1 ISION aid REQUIRED DATA: -1 A111D 2 FAMILY DWELLING f ' •
❑ 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
V CATEGORY O TRUCTION ,i : work indicated on this application.
dwelling Valuation: $
❑ 1- and 2-family g ® Commercial /industrial
❑ Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
x Total number of floors:
JOB 3,[TEIW014 TION AND LOCATION s
Job site address: 12925 SW Pacific Highway New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: PL77 Tigard West .4;T Covered porch area: square feet
Cross street/directions to job site: Walnut St. Deck area: square feet
Other structure area: square feet
REQUIRED DATA •COMMERCIA US CHECKLISTS
Subdivision: . Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S102BD02600 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
ig e DES OFr WORK •4 r.: work indicated on this application.
Add 3 antennas onto existing wireless facility on a monopole. Valuation: $$25,000.00
Existing building area: square feet
New building area: square feet
PROPERTY OWNER. - 4 j ;`� ®TENAN g a Number of stories:
Name: American Tower Corp. Type of construction:
- i
I
Address: 1101 Perimeter Dr., Ste 225 • Occupancy groups:
City/State /ZIP: Shaumburg, IL 60173 Existing:
Phone: (847)240 -1508 Fax: ( ) New:
a '� . ; ,0 APPLICANT - - I '® CONTA'10 PERSON i!; a . - I BUIEDINGJPERMIT FEE * - "%
(P! a refe to fee schedule) C-
Business name: PTS ( on be half of AT &T)
Structural plan review fee (or deposit):
Contact name: Zach Phillips
FLS plan review fee (if applicable):
Address: 1001 SE Water Ave., ste 180
City/State /ZIP: Portland, OR 97214 Total fees due upon application:
Phone: (503) 708 -9200 Fax: : ( ) Amount received
E -mail: zphillips @ptswa.com c�, PHOTOVOLTAIC S OLAR PANEL S YSTEM`FEES*
3,4 ' C O NTRA C T y, ,.
OR �`
Comme •'.1 and residential prescriptive installa, .n of
, ,. .... � ,,� r.,.�. .�r, ,.�'�� .� _ ,..,.� . ... , �' �.�. �,,.:���� 21 roof -top mo I -d Photovoltaic Solar Panel -stem.
Business name: TRD -464 tf1- S r Submit two (2) s of roof plan with co ection details
and fire department a -ss, along w' . the 2010 Oregon
Address: 7 5 5r-- r ( nor r Solar Installation Specia ad' ecklist.
City /State /ZIP: �� c- t/''�-. Ul2 c -70 is Permit fee (includes -;i eview $180.00
and admi alive =
Phone: ( - ) (9 -s--- .,,,) Fax: (5,3 ) 3.7 State surcharge ( /o of permit fee): Ii ii., $21.60
CCB lie.: 151) Li/'S). Total f due upon application: $201.60
Authorized signature: 4 , - 1/(____ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: '� i S Date: 'Z ' ' * Fee methodology set by Tri -County Building Industry
—0 I / + t Service Board.
I: \Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM/WEB)
r
'PI COLLOCATIOIN REC REC
Supplemental Questionnaire MAR 3 1 2011
TIGARD City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD
Phone: 503.639.4171 Fax: 503.598.1960 1a/ENGINEERING
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: AT &T . S 10 a- 6 61 022 Co 0
Property Address /Location of Collocation: 12925 SW Pacific Highway
Zone: c g /.4.-- l / 70- G,,c ' ( 6 ` , ' -i +•
Collocating antennas on: ® Existing tower ❑ Existing non -tower structure ;=-> r ti-'r ' et ,, t
1
Is this a new provider? ❑ Yes ® No
If yes, list other providers currently collocating on same tower or structure, if any
If no, indicate the previous approval (SDR, MMD or BUP#): 13 (lI r Z d G 5 - 00 109
Height of antenna(s): 62'-4" ft. (' P 6p.r 0060 9
Color of antenna(s) and accommodating equipment (i.e. dishes): 11-4 / �°t tan)
,
Off white, to mach existing antennas.
Color of existing tower or structure: Metal Gray
Will new accessory equipment be installed? ® Yes ❑ No
If yes, please answer the following:
Location of accessory equipment: ® Within fenced area previously approved
❑ Within existing structure
❑ Other location (Please describe below.)
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) ® No
Applicant's Signature: 5' c kr aV-- Date: 3.30.11
Name Printed: Zach Phillips Phone: 503/708 -9200
.A�: , y F R OFFICE�EUSE ONLYs 4 aE, „ :.��,.; l�F�..,,
g . is, 6 . e Ar ❑ Do t 7ue permit. Refer to planner.
Plannin: "taff S . e Date'
I: \CURPLN \Masters \CollocateAntennas.doc