Permit 4' a CITY OF TIGARD BUILDING PERMIT
111 PERMIT #: BUP2009 - 00017
COMMUNITY DEVELOPMENT DATE ISSUED: 2/4/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102DB - 00200
SITE ADDRESS: 09275 SW HILL ST ZONING: CBD
SUBDIVISION: BURNHAM TRACTS LOT: 007 JURISDICTION: TIG
PROJECT: VERIZON
Project Description: Co- location.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : sf N: S: E: W:
OCCUPANCY GRP: U2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: 95 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 20,000.00
Owner: Contractor:
BURNHAM BUSINESS + STORAGE LLC M & A CONTRACTING INC
9500 SW BARBUR BLVD STE 300 1366 LEE ST SE
PORTLAND, OR 97219 SALEM, OR 97302
Phone:
Contact #: PRI 503 - 581 -6125
Reg #: LIC 177866
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pln Rv 1/23/2009 $124.28
[BUILD] Permit Fee 2/4/2009 $191.20
[TAX] 12% State Surch 2/4/2009 $22.94
Total $338.42
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 requires you to follow the rules adopted by the
Oregon Utility Notific. ..n Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct q : stion - s' 10 OUNC by calling 503.246.6699 or 1.800.332.2344.
# / Issu: d By: 10 j I, �/ A Permittee Signature CL �.
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.
U 4- fA-ly. 9 -, +E i LL– —
Bti -tdin Permit Application
Commercial RECEIVE Di. - = _ F O R`OFFICE'.'USErOaL 1 '
City of Tigard JAN 2 3 2009 Received '2,_ r 1 Permit No.: , ! • 46 `
IN
- Plan Rev 13125 S W Hall Blvd., Tigard, OR 97223 Plan ie
Phone: 503.639.4171 Fax: 503.598.1960 Da t elBy :
rni Other Permit:
CITY OF TIGARD 0 See Page 2 for
T i G .A .R .D BUILDING DIVISIO oti
Inspection Line: 503.639.4175 date Reaa kris:
Internet: www.tigard or.gov fied /Method: ` ' �^ Supplemental Information
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
7-,- "+ -,-: - " " `- - work indicated on this application.
_ CATEGORY OF CO ' .
El 1- and 2- family dwelling IRt Commercial /industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
s JOB SITE INFORMATION• AND LOCATION Total number of floors:
Job site address: £ Z 7s s'.4 i 4 1 L S jr R E E T New dwelling area: square feet
City /State/ZIP: Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 5 a ee.A) jy ., 4 . M Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
', REQUIRED'DATA: COMMERCIAL - USE CLIECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map/parcel no.: Z, S Z 0 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
t,.., ' ' work ind icated on this application.
°, ,, -.. <. -- .:... -� : `DE OF �.VVORIZ - � �- - _ PP
, -1)Q A) E'N .'-!v r 7VA/ .S. T' a' x 1.K r//V 4 valuation: $ 2 O 00o.
1.9 6 ; /vs t4 L L r 9 o,h<.t. L0N pro a moi Existing building area: square feet
- � 7 New building area: square feet
PROPERTY'. OWNER - ' - , `;`<❑ _:TENANT Number of stories:
Name: i3 (.4 4 n 14r9-M e)L41 I VI y -S f S C r ote , y ,,, , ' Lug Type of construction:
/ Address: D tri) i3 GI dL/t! itfi - M S T `� Occupancy groups:
City /State/ZIP: 7 IG 4 . 6.2. el 71-2.3 Existing:
Phone: ( ) Fax: ( )
New:
Al,- APPLICANT' . = r. - . g= CONTACT'
NOTICE
Business name: e („E42 I i2.0 t t - t. L c__ All contractors and subcontractors are required to be
Contact name: J.EtJ i N ' 4,4_4.1-/A/ licenses with the Oregon Construction Contractors Board
/- under ORS 701 and maybe required to be licensed in the
Address: U 4- et j Ni,,) i zi 'Cr' PL . jurisdiction in which work is being performed. If the
City/State /ZIP: PeAr I-A NO Z L. applicant is exempt from licensing, the following reasons
apply:
Phone: ( 603) 4 i C; 0;31 4- Fax: : ( 5o 3) 41A- o, 1I,-
E-mail: I.C. G '7 y4.G C& tic .. 44)6'✓L
., CONTRACTOR -
Business name: H 4- t2 J j � /v -0 ` 1 - .
2 O� C- } _. BUILDING PERMIT FEES*
J
Address: ) 4i� L..EE �T' � .`i✓ . — ' ( Pl _. -`
Structural plan review fee (or deposit): ,2Lk , Z 8
City / State/ZIP: t L C I`I 612_ 9 �02 .
—
l FLS plan review fee (if applicable):
Phone: (565 / 5S/ -- U/1 2-5- Fax: ( )
f 7 g W � Total fees due upon application: 22_9 LI
CCB lic.: 1 �
'' /2 Amount received: 1 " - 2_2
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: `< r t i i N -J • iviA,. r / ate' /- Ti ' �'t] * Fee methodology set by Tri- County Building Industry
eo...:... 11,.......4 L1/4A
ierl*r,, 4
'
ItiV h - LA CA 4 '3 `Yf�
is *" - , p. Supple ;- ai a uestionnajre JAN 2 3 2009
afrgeolog � " x , Crap+ ,y Tigcud, 13125 SP' nail Blvd, Tggar4 OR 97223 OF TIG
1 Phone: 503.639.4171 Pew:: 503.598.1960 B U DIN GDIV I
ARE � � /'� PERMIT �+ /'� � ANTENNAS,
ION
IF YOU ��RE APPLYING FOR A Y O COT LOCATE TENNAS,
PLEASE COMPLETE E THE INFORIV1ATION BELOW.
Name of Provider: (- ,41/2. Gvi 2C v1 L-4.-C.,
Property Address /Location of Collocation: 7 7 75 £.J g. s —
E '4 a s .,
Zone: o ° .� i 2-.....4 2- D i3 2 .'d- - -
Collocating antennas on: 2 Existing tower
❑ Existing non-tower structure
Is this a new provider? 121 Yes ❑ No
fyes, list other providers currently collocating on same tower or structure, of , y;
@ 2-,.;:; l,,,i I t , 2, LE S
If no, indicate the impious app val (SDI., MAID orBUTP #):
Height of antenna(s): `C C ft.
Color of antenna(s) and accommodating equipment (i.e. dishes):
Color of existing tower or structure: , (e4 Lti 4
Will new accessory equipment be installed? (I Yes
❑ No
Ifyes, please answer the following:
Location of accessory equipment: I Within fenced area previously approved
❑ Within existing structure
❑ Other location (Plean describe below)
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below) 5 No
Applicant's Signature:
\.. _._...... Date:
Name Printed: 4
r�- h+' Phone: 5 a, ;� � & � c. � 3 9
;� J.y a�. tl Y'i 3 C4�"'a .
r "L..�l.�ti � � i t '" i r. 7 ` + s s.t � her v�i�; ' � '�`
ea. ( .-til l 7.,i Y S . Z ` . £� 4 E 7f12`�'� a IR �-� i. ,_r - p + V I Ft v -5 1 �t .+ ` y
C r- srs .... -� I- ±".,r._., r t �1 kr �`S+F'+x'SL� `y ;i i.. yYkl 3 k. aT y '�+` }' t � ylo -s s _ r��.� Y't 7?�p�.;J
XIs LT. • er11�It. :.,s .. -t��. �.� u.i ,�u „ \vCiu2 ,st.: �? � � s ;+T'i� �4 , t » ci
.. _ 1 ❑ Do not issue permit. Refer to planner.
pi „g Staff Signature Date
I: \CURPLN \Masters \CollocateAnterms.doc