Permit , CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00056
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012
Parcel: 1S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT & T Subdivision: Lot: 0
Project Description: Replacing (6) antennas and adding (1) cabinet to existing equipment platform.
Contractor: LEGACY WIRELESS SERVICES INC Owner: HA& R, LLC
15580 SE FOR MOR CT ATTN: TAMMY HOUSE
CLACKAMAS, OR 97015 12655 SW NORTH DAKOTA ST •
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, 03/23/2011 $225.80
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 03/23/2011 $27.10
Stories: 0 Height: 0 ft Plan Review 03/23/2011 $146.77
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI - Ping 01/17/2012 $64.00
Value: $10,000 DC Provision Review, COM TI - LRP 01/17/2012 $9.00
Info Process /Archiving - Sm Sheet (up to 01/17/2012 $5.50
11x17)
Floor Areas:
Misc Administration Fee 01/17/2012 $5.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
•
Total $483.17
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 - . • • *AR 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 ;: 14 / • y: Permittee Signature: /`� 4Q��jj4(:!/7 rG�1
Call 503.639.4175 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 6 of 6 2011-03-23 17:46:37 (GMT) From: Ryka Communications
13/23/2011 OS: E)7 503b98196E1 CITY OF TIGARD PAGE 01/ OS
Buildiag, Permit Apalicafion
t, c p !ik „
• Commercial R a r L-A.1 LA V 11 ... . • . 4.0-k i-YiLLULIk. '.,* LI IN LI
— N I — ------: City of Tigard Receive ma. v
MAR 2 2 D qi 2 11 — t
Dna, . ,u/ wiz Pcm"e ., a x X 7
)3125 SW Halt flivd„ Tigard, OR 97223 6' lin Revirw': illr A _ • . .
• - ' - ::: a .- ' Phone: 501711;2439 Fax; 503,596,1960 4 ..,4„Date/By: it ? V/ . I 1 other Perms:
.. __
.trisp.cit.iarl Lillg: 503.639.4 175 crry OF TiGr'krkkmm_...... '..., 1 Ian: 05 SW INge 7. far 1
PLANNINTENCINEE'z. kw "1/5"/
'I )077" 1.-rea.? Svptodc...0,14atirfrowv.ptimi i
f h, , ,-hr-- 6
iftivicor4inik. • . • • . - '''7) 7 G r .''''' irk .l-q :--' 1 ; : ltk*iiiikigailitfk , iii .-- '' — '24iiiditria'Mif s :4;LiNiti . 1
I D New ecosocction D Demanded) n tc„....,,,i) !I _..., v 4, i .,,,J Pcma cm-3. are based OU the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
1 5 Addkiom I 0 Other: pi & D 0 f 9 ri 1 I (MOM, materials, labor, nvotitead. and the profit For die
r-7---7----=.--r--.- • •• • . . - .,....., - 7. '■•• • '., wide ittiii w thts andleadion.
i S
0 i- and 2-frefnily dwelling I Eicommemaihndus 'diary OF T613A.1 v"himin"'
0 Accessory building 0 Mufti-family BUILDMt2. Ui v i 5:L. N Niolber of hedronott:
J
—__.....
D Master builder 1 f:''s Other. Wireless [ Ninr,ber orbrithrticass:
I _
.: -' ' . '.. , ' • :, '- • .idatolitit,.iinvikairittititi!iikii.ockrttio• - . - . -1 . T ‘rAill ...rubt. of flows;
Job site address: 1265S-A. SW North Dakota St
--- New area: square feet
City/StstoillP; Tigard, OR 17223 Garagelearport mere squarre fact
Suiteirol4Amt_ no.: N/A Project name: AT&T PRT7 Schalk & 125th 4 Coveroll porch ewer square feet
......_ ---i
Cres,,1 steel/directons
i to job Rite: Meadow Creek Orgic. 1Mt: moon% ram,
---,—_,_1
Soholls Ferry exit (OR-217) go south 0.24mi and turn right onto SW Sdtolls Other %room area'. squint Rim _
Rd. Turn right onto Seholle Forty Rd, go 1.12mi. mm left on N Dakota St. , .',..;,'::,...kiti*Oili6T.
" " ' • ' •
Subdivision:. - I Lot no.: - Permit Rare are boned on the value of the work performed_
I
tr.41,Xtte an value (pounded to the riesi dollat) of all
Tax mal)/pareel no.: ISIZ3BC00700
oquipmem, materials tab. rowboat:I, and the profit for the
.... .. . , ,.
. • • •. • , I
Removing (6) panel antenna Valuation: 5610,=.6% _ 1
.--I
1 Adding (6) atitenittn, and equipment to existing plutform Existing building area 274 square feet
Adding 1 cabinet to the existing equiraeitt platform New building area: 274 square feet
Number of* 1
• , i
Nath R7tiR 1.1.0 (Managed by T6 Littleton Site Management I Type nrcoustmction: Telecornmonient
_ ..............._
Address: 12655 SW North T_Isikoni St I . Ocamaney grams...
City/State/71P: r...ta, OR 97713
Eiting; 'Unoccupied
. ,
Phone; (646)45'2-5455 I Pam (30106064636
Ncw; Unoccupied
. .
1 Bitetiness non Rylta Consulting (Agent for AT&T Mobik)
Structural plan review fee (ce dcpc. "t);
Comet oar= Celine Pierce
?LS plan review Rio (if applicable):
Address: 918 South Dorton St, ST. E. 100,-
Taw reed due upon applicatkm:
City/SterxTZTP: Seattle, WA 96134 —
,...,_
Annum received: 347.71
Phoie7 (206) 406-6117 Flut:7 (206) 260-7930
-----
1 : ,.,. :46 • 4 0* 0.1 04: 114 *, ,_. :****.;ii*ITA**741401
Email: gpieree(a)ryknennaniting,enn;
'
' •••• • • . .. 1 Curnrnereial and maltertiml preseriptiv eitistillatitin of
' . ' ... ., .,;...: ..'..• • • , '. ' ..: .. . , . . . • • roof-ton mounted PhestoVoltaie Solar Panel Sytem_
Business name: 1 Submit two (2) sets of roof plan with connection detatis
arid fine dew access, along with the 2010 Oregon
I
Address: i 668' 0 >f_ 6,4_ )10/2.....C3-r ._ _ j Solar Insiatiadort Special' Code checklist. ..
„..-- ------ —
Pent& fee (incharks plan review
City/State/ZIP:0i d...4 o 7 ,
$180.00
-,... and admialatrative f`,.-,,)
Plicee: 6 ) 46 -6-4.0 . It Fax! ( )
_ ..._ State ennerunge (12% of permit fee): 521,60
L CC 13 lic.,:. re:42 "..,
— , —__.— Total feed= upon application: I L 6201.60
Authorized silertem_ - This permitappticifi:on expireta if n ittroit is net oticattn.4
within 150 days after it has heels *crspt*d as complete.
1 . i int mas . pio461 ec-g 1 mic: 31A W20 9 j + Fez methodology set hy TO-Connty Building industry
Service Board.
1: \Buildingiretontn5DP-COM F'erailtApo.due 0'4/24/2011 440
111 El
Building Division
Development Code Provision Review
T IGARD Commercial Projects - No Associated Land Use Case
Building Permit No: i (A P I) c Lid S C 6-7-T-- ❑ Expedited Review
Plan Submittal Date: V? -1-1i i
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 • approved. '/
Planning Review (contact �s %� at 503 718 �r0 or @tigard or.gov)
Zoning C e Permitted Use Yes , No ❑
V Land Use Required: Yes ❑ No (explain below)
Notes:
(cpqL/)
- � kif,h ��
Approved ❑ Not Approved Date: 3-- D,L4 1 I
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
L \CURPLN
C ..x 'd, t::c. -n
COLLOCATION r;- ry }. C, :.
�-� . ,k. e' : fir-:
_ Supplemental Questionnaire \��,,� 2: F .f� 0 7
T I G A R D City of Tigar4 13125 SW Hall Blvd, Tigard, OR 97223 3
Phone: 503.639.4171 Fax. 503. 598.1960 �-� "G '\ "' T "i V f " u ld i,i me
d_9aRY"tlP3
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: 12655 -A SW North Dakota St
Zone: C -P
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 #): BUP2007 -00543
Height of antenna(s): 54' 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 ❑ 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: ....-.;:2 �- Date: //,,*201
Name Printed: GrDR6:1; Pa7sAfro. Phone: 2b6, yoc. 7
.. .. FOR.OFFIC . .
r Iss permit. p ❑ Do not issue permit. Refer to planner.
.3/2„5//
P Wrung Staff Signature Date
I: \CURPLN \ Masters \Co locateAntennas.doc
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
BUILDING DIVISION
•
TIGARD TRANSMITTAL LETTER
TO: 'T7V ate/ DATE RECEIVED:
DEPT: BUILDING DIVISION
RECEIVE
MAY 26 2011
FROM:
CITY OF TIGARD
COMPANY: • ge)o L /M 7■/ tJ/L f‹s BUILDING DIVISION
.
PHONE: •
By. li%
RE: 5&) A7( (9,�o/ = }- � te70 // r DOOS6
(Site A dress) (Permit/Case Num er)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain): Oz-L sts •12- 67
•
REMARKS:
FOR OFFICE USE ONLY
Routed to Permit Technici Date: � j Initials `'; •zj
Fees Due: ❑ Yes P' &o Fee Description: Amount Due:
$
Special
Instructions:
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I:\Building\Forms \Transmittal Letter - Revisions.doc 4/4/07