Permit CITY OF TIGARD BUILDING PERMIT
111
• COMMUNITY DEVELOPMENT Permit #: BUP2011 -00058
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/31/2011
Parcel: 1 S 136AD06300
Jurisdiction: Tigard
Site address: 10955 SW 65TH AVE
Project: AT & T Subdivision: PGE Lot: 0
Project Description: Adding (3) antennas, (1) cabinet, and replacing (1) antenna on existing equipment platform.
Contractor: LEGACY WIRELESS SERVICES INC Owner: PORTLAND GENERAL
15580 SE FOR MOR CT ELECTRIC COMPANY
CLACKAMAS, OR 97015 121 SW SALMON ST
PORTLAND, OR 97204
PHONE: 503 - 656 -5300 PHONE:
FAX: 503 - 656 -5305
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 03/23/2011 $225.80
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 08/31/2011 $27.10
Stories: 0 Height: 0 ft Plan Review 03/23/2011 $146.77
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI - Ping 08/31/2011 $64.00
Value: $10,000 DC Provision Review, COM TI - LRP 08/31/2011 $9.00
Info Process /Archiving - Sm Sheet (up to 08/31/2011 $5.50
11x17)
Floor Areas:
Misc Administration Fee 08/31/2011 $0.50
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $478.67
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
c:43,61 A
Issued By: Permittee Signature: q/02/A..-efea--sory) 9.4175 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.
To: City of Tigard Page 3 of 6 2011 -03 -23 17:46:37 (GMT) From: Ryka Communications
. 03/93/ 72111 019 :Ei7 5035981960 CITY OF TIGARD PA(iF 11
Buf4 aiz Perm i pplie 4ion . - . 1
Coo mercra[ 1''- _
C; of Tigard 112" AR 2, 2 zoli Rc,xival a� i �o ll
r . 13125 $W ball Blvd.. Ti rd,t3R 97;2.23 Detr1E �� �/
t •
. Pure' 503.71$.2439 Fur: 503,5'93.1960 n T C 1 jQAFB � , _
r lnspeetitnt : ir; 50' :3^. -T75 s 21 t ` 1 t � .. �IXtt' _
..• t t "` 1�M -1 yrA
' , , -•�► AS tm;: id ser }P,rga a tar !
Intranet n~ov,v,tiga}d r,r.gnv I''! !°+ � i1 "tAl' � J ' i : A Snirolemezial tataYe eten
. - `•' rr!) 1 :11 ' 1 4 n ` ?i t ,; ".) - --- ,: 7 It: .Ait
. .iiiik' t : l rll
I J j New construction ..,�. 10 Ltettinl `iki[ n 1� � ' ' 5 - � n n 11 ! 1 I i •
Yetatit 1�eee are h tScci o n the value of the work performed. I
} ❑ Other: 2 ! , , � u , , ! } the value (rounded to the ofall
Ad <YifiRnlaitCrA4ivnhEptBCaement
! i ri materials, labcry er3v '.., arid w profit for Chi:
.. t. 00 i1' ' o %. ' P VI 1 ` • Wir* indir d a this appli rtat.
• tU 1- and 2- family dwelliue ■Y "i 1 )1 $ i Valuation: $ _ m
0 Cammerr_ialrsclustriui, i 1 j \ o N) ' I '`4 I
0 Accessory building D multi- mufNtYt- IP' NwnberofImeiroom ;
0 Muter builder ►iZt Other: Wireless I :Number of bathrooms:
} 8 i 0extg if } I Total number of Berme
Job site uddrogt +: 141 SW 65 Ave New dwoffmg area: Square feet
City/Stut,t TP: Tigard, OR 97223 .. G area: g fo# !
i - I
Suite/tt k /VI_ no.: N/A I Pmt ma :.AT&T PTV'Miguel N5.!, I Covered porch area_ _ Y square frxt ...I
Crux a;treetfdir5 to job site: cmynade st 1 tom; Suer,; square feet 1
I I
From OR 99 W turn le cmtn SW Coronado St heat turn right onto SW W 6v4 and i
square feet
beer right onto SW 65 tower is located °inside of the re,h_ ra;ti°tY. I
.
5lttutivisic�t: ! i ' 4*01 'P4t4tik ifixiet }tip j
_ ! 1x72 mo.: c Permit fees' we i,w'u on the 'raiiie of 1121 work Jierfi:rrtt[d,
Tax map/parcel mo.: 1513dAlt i � -� j value ( to the nearest dollar) of all
s l bo.. overhead t h
equipment. rrrateria! , ; and'thc profit for the
`40- '' t* ' WM iatttiurtad °n 41113 upplicaaart, •
1 Removing ing (1) pan's! antenna ; Vaturnirm: SS10,0141.0a
I j
Adding additional (3) antennas and equipment to existing platf!Yrm ! Existing building arm 322 square feet
Adding I cabinet to the existing e$miarocat stinker -• —, I New bttiridirr,g ;c-. .322 square feet
a * ,. ; :' ' t` I 1 Number of stern: i
.„ i�tame: Cruwn C>lYntfe
T of construction: Tekr.onarannlasst
1 Ad3r4ss; *S47 15t Ave NF. 1 i
3 1 City /State/ZIP: Redmond. WA 950.$2 ..
1___-- -•-�-. _ ,_ ___I Occstpaacy groups:
i Phone.: ' I Existing Imam rrY1t
iv Phone.: /412, g _ i ) I --
"� u�> L New: 1lrasaettlAld
`.
W � }
.sot,�,,,,a ram..• 14g� L:ortsul €img (A�Gari tor AT&T i4lofnrrrh'y) -- i
11-
i Structural plan review fee (or deposit):
C+mtact name: Cveor a Nave I
FI S Men review fee (if applicable);
.Address: 9113 South Horton St, STE IBM _
CityfStatsJT•UP: Seattle, WA 95134 i Dial tees Otte upon nppiic alinnt
Monet 4296) 406 .511.7 Fax,:: f 1) 2 -7'938 Amount received: 3 47. ' 71
gt ierce rylacousuliiag.e au � . ! '� � *
&mail:
I . C:a tumet+eial and rmidential prescriptive installation of
. - , ": 0, : -',72° . . _ l `_ i roof -top mounted Photovoltaic Solar Panel System.
Filminess name: TET3 s • Ct � e-ic Sf e r submit two (2) =3 of: sf plea with connection details
Addre�a: _ and fire department =eke., along with the 2010 anon
t �1 ^ �,�r�.� r o f'., ., Zi ,+ ! _ �1 U r tot r r 2� L Sakrr b tssr ,eciu Code theckli .
i.IfJ'f sllt,td 1r �• C C i , e r f oe(ifid- - a 0611 now i
Phone: (50 �/ and ed_imndnitive tees)' S 1 SUM
( T. ' at Fax ; (S ) _ i _ 1 ! Staztesun3Ymlrc (12%alpe+mitfee) : $21,600
C:CB lie.: i 4-13)
Total foe dee upon applkatiar ) $201.60
Authrtri�r i signature: 1 _ ri'hl5 perrntt app1fv,t4es :spars It permit is not u:nte etd
**Jo IRO dare slyer it has been accepted as complete.
Print name :..�........ /� 1 p , ,�/ j ! r Fax mettiodnin{{y set by To-County Rending Industry
Rt < —� Vil 7Di ; n Servitx:l3oard.
1:tl3uitd ln4tvnermits13up r OM PcmiM.pp•doe 02/24/20t'I 446-4411 3T(11102/C ;C 1 )
i
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: In P�) l — usg ❑ Expedited Review
Plan Submittal Date: 3 J ii
To the Applicant:
> If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved.
NO Planning Review (contact g r∎ 41, at 503 -718 or @ ti or.
Zoning _A /C- Permitted Use Yes ❑ No ❑
K Land Use Required: Yes ❑ No } (explain below)
Notes: , ZJI .Erf��
A roved ❑ Not Approved Date: /� `T /ii Pp pp
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN
COLLOCATION '' y -._., ,. :
l - _
0 ,. i"AIR 22201.1
Supplemental Questionnaire
C z o Tigard, 13125 SW Hall Blvd., Tigard, OR 97223 n �'4
t l L; A R D �' .f g , -�' l rY
CIF - D C iN U °
Phone: 503.639.4171 Fax: 503.598.1960 ` ,... f'v's'b' i IL lE {+i i y N E F t:' <j i i G
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: AT &T Mobility
Property Address /Location of Collocation: 10955 SW 65 Ave
Zone: C -G
Collocating antennas on: ® Existing tower ❑ Existing non -tower structure
Is this a new provider? ❑ Yes ® No
Ifyes, list other providers currently collocating on same tower or structure, if any:
N/A
If no, indicate the previous approval (SDR, MMD or B UP #): BUP2001- 00084/BUP2008 -00220
•
Height of antenna(s): 94 ft.
Color of antenna(s) and accommodating equipment (i.e. dishes):
Non - reflective metallic
Color of existing tower or structure: Non - reflective metallic
Will new accessory equipment be installed? ® Yes ❑ No
Ifyes, 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: Date:
Name Printed: Phone:
. F OR OFFICE USE.ONLY .
Iss permit. p ❑ Do not issue permit. Refer to planner.
X3/23 /%
mmng Staff Signature Date
I: \ C U RPLN \ Masters \Collocate Antennas. doc