Permit ,, CITY OF TIGARD BUILDING PERMIT
111 COMMUNITY DEVELOPMENT Permit #: BUP2011 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/19/2011
Parcel: 1 S135DA01000
Jurisdiction: Tigard
Site address: 8530 SW PFAFFLE ST
Project: AT & T Mobility Subdivision: METZGER ACRE TRACTS Lot: 20
Project Description: Replacement of (3) antennas. Add (6) remote control units, (1) surge protector and (1) DC converter
Contractor: LEGACY WIRELESS SERVICES INC Owner: DALTON, DAVID L
15580 SE FOR MOR CT 8530 SW PFAFFLE RD
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE 503 - 656 -5300 PHONE
FAX. 503 - 656 -5305
FEES
Specifics:
Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 10/19/2011 $225 80
Class of Work: OTR Demolition
Dwelling Units: 0 12% State Surcharge - Building 08/25/2011 $27.10
Stories: 0 Height: 80 ft Plan Review 08/25/2011 $146.77
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI - Ping 10/19/2011 $64 00
Value: $10,000 DC Provision Review, COM TI - LRP 10/19/2011 $9.00
Info Process /Archiving - Sm Sheet (up to 10/19/2011 $24 00
11x17)
Floor Areas:
Total Area 0
Accessory Struct: 0
Basement 0
Carport 0
Covered Porch: 0
Deck 0
Garage: 0
Mezzanine 0
Total $496 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 .ed subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be do n accordance 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
day- ATTENTION Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 -001 : • • Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503 23 1987 or 1 8 r 33' 2344
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. t i l * CO (15 ( i 5
This permit card shall be kept in a conspicuous place on the job site until completion the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
"`
C®`Illllle aj FOR OFFICE USE ONLY. ,
Cl of Tigard AUG rr 3 Receed
City g (�U U 20 Date /B iv , rE I m Permit No r l., 00 05
5
e q 13125 SW Hall Blvd , Tigard, OR 97223 � , '1 � ���
Phone 503.718 2439 Fax. 503.598.1960 .� 11 Other Permit
CITY OF TIGA _
TI GAIL °D Inspection Line 503.639.4175 tt � : him See Page 2 for
Internet: www.tigard- or.gov PLANNINGIENGIN°=1 , �'1° ethod- 9 9 / .411/Sr Supplemental Information
.1/!£fE 1/,1
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Tl P .Q WORK - `ss'> vEe:,,a ;RE 1J RE f'aJATe1: «:ANb 1i�:r1N�'ie , z-" , E-r ,
„ =,fro...,, ,IV A , „ »HdE7s' �� �,.. =.�:bw.a�'f�,r €_,.r,� >= Ex�; ��3,��.,:�1''; e> ;sr, '` ,, ..,< ., , ,'4, 14 . 440 : 0 1 -# .�„ ,
❑ 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
W2 14.11t: CAS EC' ooifo p115.T.RCJCTiA ,: 3E ? :-�;'; ,;,",,.s�.: ;' work indicated on this application.
�My 3
ES "��:� �: ,..., _ "v' �.�,.,,� .- ,.�r;�E,`��.;,•>.- %'�i� %`,�. �s•ia; €!.�5
El 1- and 2- family dwelling ® Commercial /industrial Valuation: $
El Accessory building ❑ Multi- family Number of bedrooms:
` k ❑ Master builder ❑ Other: Number of bathrooms:
I c y : ,. 3%" ii ,," ,.... Is f Total number of floors:
F n 0 , :- ,SITE•' 71 I, Ot y%AND OC , r , ,
Job site address: 8530 SW Pfaffle Street New dwelling area: square feet
City /State /ZIP: Tigard, OR Garage /carport area: square feet
Suite /bldg. /apt. no.: Project name: PR72 PFAFFLE Covered porch area: square feet
Cross street/directions to job site: see T -1 page of CD's Deck area: square feet
Other structure area: square feet
QIInRED'De TA, COMMERCIAL»U ;GC iEGK0, ,a,
Subdivision: n/a Lot no.: n/a Permit fees* are based on the value of the work performed.
i2: Tax map /parcel no.: 1S135DA01000 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
/ 3
E, , S , CRII'T o OF li : : ;, `` €" "'' work indicated on this application.
'' :0, ,; - T,€ :. , h;, - >: -..:.,�"'" , l,,',0,,,, ,,; `,. ,•' --, 2M e' asE „ "` ;;; ;' ;i `us „ "iEr ,;., d ...; ,; ; ,';Rrrs;' W,,'- ,
Remove (3) p anel antennas from existing 80' AT &T owned monopole. Replace with Valuation: $ ( C1 '
(3) panel antennas on same mounts. Add (6) remote control units, (1) surge Existing building area: square feet
protector unit, and a DC converter. . New building area: square feet
, ,, <i E
3 ' ROPERTY'Q, NEl - ' , , ' ` ,' *- W < ,; T'ENAiiT §;'>,;; ''; '.•.;: Number of stories:
� w; - �ti, / "�_., - l��,;;�'Y °� „fie °m , .,vQ; "'0,Y; §;qi. , T': u,;,' °'?.y,
Name: AT &T Mobility Corporation Type of construction:
Address: 16221 NE 72 Way, RTC 3 Occupancy groups:
City /State /ZIP: Redmond, WA 98052 Existing:
Phone: (206)406 -5117 Fax: ( ) New:
T ; ♦ fir.; ° A'� % �;��r^� r'° `'' % ;'S: €: = -�,.r. ;z,�,<ns•
E ” APP,LI "£l 1 "' a'r J'? F1.} ,d.� ? '!'� R VI OW':'
� .?'� . ,,,:';`��, � ` ;'� � ; "` ®' "�O1V'CACT. PARSON: �`'¢>,,��BC11L1] ER147 ^ �f;N3ES r;
Business name: Ryka Consulting ;h ,:;.:; <r.. :" s=/ ~ %{ :Ple'aserefer."<tofee >selieduk) ;y ,f: i4'
Structural plan review fee (or deposit):
Contact name: George Pierce
FLS plan review fee (if applicable):
Address: 918 S. Horton Street # 1002
Total fees due upon application:
City /State /ZIP: Seattle, WA 98134
Phone: (206) 406 -5117 Fax: (206) 260 -7930 Amount received:
E -mail: gpierce @rykaconsulting.com ;il TOVOLT IIGSOT AR PA L SaTE EEi *
' a `i !i : ibi �` Commercial and residential rescri tive i • lation of
CQNTRACTOR ' -, " gw% roof -top mou PhotoVolt ie Solar ' :nel Sy
, .. , . , � :,,. �,.. ° :.� ;' .,.. ` . wab� ,,_,� - �_, : ; =�.` �«:u �,, ., �z�; • • a stem.
Business name: klavitiray re- t e55 l c Submit two (2) sets • :of plan w', connection details
and fire department access, s - • with the 2010 Oregon
Address: contrac..._ • __ _,, .... Solar Installation Special o. - . • ecklist.
City /State /ZIP: Permit fee (inc - 'es plan revie $180.00
and . iministrative fees):
Phone: ( ) • Fax:( )
State sure. : rge (12% of permit fee): $21.60
CCB lie.: /5 4/5 r a
'otal fee due upon application: $201.60
Authorized signature: ... / This permit application expires if a permit is not obtained
z.____ within 180 days after it has been accepted as complete.
Print name: George J. Pierce Date: 08/12/11 * Fee methodology set by Tri- County Building Industry
Service Board.
I. \Building \Permits \BUP - COM PermitApp doe 02/24/2011 440- 4613T(11/02/COM /WEB)
'I Building Division
Development Code Provision Review
Ti CARD Commercial Projects - No Associated Land Use Case
Building Permit No: 77- DLL P do / I - 6011 ❑ Expedited Review
Plan Submittal Date: / L 3 / I f
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.
Planning Review (contact ` l at 503- 718 -, t 1 or 51 (
Gad Zoning l%� Permitted Use Yes ❑ No ❑ //
❑ Land Use Required: Yes ❑ No (explain below)
Notes:
1:1 A / / .2-6-1 (/
pproved ❑ Not Approved Date: �
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard-or.gov)
Notes:
Routed back to Building Division Date:
L \CURPLN
„?i h ' 8 •� 't, .,- tai ' 4, fi g .. I. °'' �'n-n, �
Supplemental Questionnai
TI'GA Ci7y of Tigard, 13725 SW Hall Blvd, Tigard, OR 97223
. ^ ;; °�r Phone: 503.639.4171 Fax• 503.598.7960 f ; . `‘. °t k=;k;,)
giF r Y1- =t •r-e.,, =.
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: AT &T Mobility
Property Address /Location of Collocation: 8530 SW Pfaffle St
Zone: R -25
Collocating antennas on: Existing tower n 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 #): None on file at AT &T
Height of antenna(s): 81' ft.
Color of antenna(s) and accommodating equipment (i.e. dishes):
Grey
Color of existing tower or structure: Non - reflective metal
Will new accessory equipment be installed? ® Yes I No
Ifyes, please answer the following:
Location of accessory equipment: n Within fenced area previously approved
® Within existing structure
n Other location (Please describe below.)
Existing equipment shelter
Will landscaping be removed to accommodate the accessory equipment?
Ti Yes (Please describe below.) ® No
� Applicant's Signature: -�' Date: 8/19/11
Name Printed: George Pierce Phone: 206 - 523 -1941
FOR OFFICE USE ONLY
', Issue Kermit. n Do not issue permit. Refer to planner.
Planning StafSignature Date
I \CURPLN \Masters \CollocatcAntcnnas doe