Permit CITY OF TIGARD BUILDING PERMIT
" COMMUNITY DEVELOPMENT Permit #: BU P2011-00059 /
- I1GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: DS 1Qf2U'I'I' OIb� / "�
/
Parcel: 2S102AD03450 Cif
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Project: City of Tigard Subdivision: Lot: 0
Project Description: Adding antennas, (1) cabinet and replacing (2) antennas to existing equipment platform.
1/25/2012: Permit issued in error on 8/10/2011. Actual issue date is 1/25/2012, good for 180 days from 1/25/2012.
DLH
Contractor: MONTI ELECTRIC Owner: TIGARD, CITY OF &
PO BOX 220 TIGARD WATER DISTRICT ET AL
TROUTDALE, OR 970660 13125 SW HALL BLVD
TIGARD, OR 97223
PHONE: 503 - 491 -4909 PHONE:
FAX: 503 - 665 -7200
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 08/10/2011 $27.10
Stories: 0 Height: 0 ft Plan Review 03/23/2011 $146.77
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI - Ping 08/10/2011 $64.00
Value: $10,000 DC Provision Review, COM TI - LRP 08/10/2011 $9.00
Info Process /Archiving - Sm Sheet (up to 08/10/2011 $6.00
11x17)
Floor Areas:
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. A ION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00
- 010 t l ough OAR 957- 001 -0090. Yo y obtain acopy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
C Issu B �', f ,` I/4(44 Permittee Si natu•-: -1■., 'i /'
Call 503.639.4175 by 7:00 a.m. for the next available inspection . ate.
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 5 of 6 2011-03-23 17:46:37 (GMT) From: Ryka Communications
03/23/2011 09:07 5035981960 CITY OF TIGARD PAGE 04/05
Building Permit Application trt rrt f% r- II 1 fr. ii
ti
Commercia ..,/ l ..
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A ,, ,,, City of Tigard gillarL
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; r . - 11125 SW 490 9Ivd., Ti MAR 2 2 ?O11 d. OR 97123
Pht - 503 71112439 PI1X7 503,5911 1 960C1 TY OF TIGARD O O
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Inspection Um: 303,639,4175 PLANNING/EN(.31NEEFI e :
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: - interntl; gconvilgtrdcW.grA. / 41 71.0 S ;! I
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1 0 New construction 0 DemeInzoo d ,,, , ' , . ,,,, .,.., I P Th1t r ee' NC based on tb vih,e o thi . woik nsrfine
— , indicate the value (rounded to the nearest dollar) of ell
Z Addition/alteration/replacement --- 0 Other IA AI) 6 ) q 91111i cquipmcnt, mannish, labor, overhead, or die. prot for the
t hiS P l ' CIttieitt-
0 i - and 2-family dwelling
1 0 C°tlirnercielftniit7li OF Ii13,4:1)
1 El Accessory building Li sfluhLt'Amil-BULDINU Ui v itAva 1 r of bedrooms:
El Molter builder i El Other: Wireless ! J Number of bathrooms:
, r . :'":.::;.;''. F '.:' , ::.'•. ; '., :;: :) 11 * -----'"---------- 4010: 4 4,0,00481,10.11000 , X 1 t1W4tlegiO;,':..::'':,..'.:''::'..-;?,:;....': : :: ! : 7021 PM gf tic/
Job sire address: $777 SW Burnham Si I New d wiling tree square feet
...,„ ... .,
i City/State/ZIP: Tigard, WA 97223 Oaragricarport arm square feet
-1 ....,....._ ........ .. ._ ......_.
1 Suitnabldg./apt, N/A Project nest= AT&T PT119 DT Tigard 1 I Covered pt
orh arca: sqiutre feet
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I Cross smettdirer.tions to job site: SW Aelt Ave
Deck aree: SWAM feet
, . .,
Pawl OR-99 W turn let onto SW liall 0Ivd, go .055m i; turn tight onto SW Blirehant Other sin/dine alum Num feet
1 st and go 328ft: monopole is on yom. right I itiagialltkal.
Subdivision. I Lot no.: 3401 I himit 'fi.vi - tate bi on the wine of the manic pertortned.
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1 Itulicate the value (monded to the neareg.dOlits) of all
Tax map/motet no.: 28102AI/0,3401
t equimnent, mannish. labor, ove+ead„
and the profit for the
_ LReptgeing existing 2 aide= sertor frsuiN with new liafitweigh 3 etetor olmtficio 1 /oblation: eS10,0flI1.00
. —
1 Adding additional arMronas and equipment to new platform 1 Psis.ring hmit0rig MTV 322 mare feet
_________........
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Adding 1 cabinet to the (abaft equipment shelter , N.......,,,, ram 322 squat feel
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1 1.:.;1:•:' : ,,,t1titili.:.:....;• : : - : , .,.!:..[.;,i• Nundicr of stalest I
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Name: City of Tielird ...... _.
_ ,..... I Type of constructiror Ttlecommtuniest
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0 .insfekc: 1.1125 SW 1iag gbh' ! ...1 I... f,,,, rl3u5:
1 City/State/ZIP: Tigard, OR 97223
Existing: 13nottopied
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Photm: (503)639-4171 Fax: ( ) ;
''..,;:. -'• iiatgitat : 1,:;::!::.•';1!:•;;;;•'::':;3;7:.!::1101i00411difitili::"':: '---,- ;; :: ; ; ': -. •';'Z' 4 1#1 0 P4M0 1 00grIM4S7.1 - !'' , ..'.•' ..',"‘..'''.: '•
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n , 'S ,,,," w4orpiopotit, ,:.e•!: -•:...,-;
, Thisi ame: Plyh a Conrail (Agent fo r AT&T Mo bility)
! 1 Structural plan plan review fee (or &posit):
Contar --- ;; ------- earne: George Pierce 1 i —
.
-... ...._ ;, 3 FLS Man review fee (if applirahle.): I
Ati .
thezt. WA liori_____________I, STE I Mi South 2 I 1*---, —
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CityiSigiteiZIP: Semitic, svA 94134 . : 1 Toed fees due upon application:
i : 1
Ammon received! .347.7 1
Pltur^: (206) 406.5117
PM: : •(:1' 2fia-M1
':''' lit - 1; . t • . - , '.;,- .,- ',.' ta10#, hea&i'.■ ', :
E-rtmil: gpiereectrylmeons.ulting.eom
- . - ... Commemis1 and residential presetMtive installation, of
..,... 4 00 4 ..! . ;:::::',.: : : : •,''..;'41 ; .i .. ' ..'' I mof-top oemoted IX/on/Voltaic Solar Panei System_
1 !liminess rarr.c:1310C , w ao A, erete_ ! Submit two (2) sets of roof plan with connection details
and Ike department access. alcsig with the 2010 Oregoo
LA ddress: 1 Slar l000ltatirot goori, Cod th
_______.1 —
City/Stale/ZIP:
! I Permit fee (inciudes plan review
sod administrative .fccs); , S180,00
_
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Phone: ( ) i Fut )
I_ Slate surcharge (1 rA, of permit flee): I S21,60
Cal lie_.: —
L /91'
----4 I 1 Total fee due Upon applicstion, S201.60
A uthorized signanec: G o / r / ......: ___
/ 7.7---
Thls 1.KFffilt APPTication empires ii a peratit is nor obtained
within ISO days miter it Ws been mcceptcd mg complete.
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* Pee methodology Set by Tri BulidblZ Industrl
larint name: I Dec: 3 ) 3431
I I Serviee Goted.
I ABnikiiroz\i'crmits , A1.3F-CONI PctmitAPOAoc 02/24)2011 440-46 l .3T(3 if evcomlikr f3)
114 CATION
Supplemental Questionnaire MAR 2 22011
T I G A. R D City of Tigard, 13125 SW/ Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax. 503.598.1960 Cr OF r i a 1E)'
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: 8777 SW Burnham St
Zone: MUCBD
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 (SDI, MMD or B UP #): BUP96- 00355/BUP2005 -00553
Height of antenna(s): 75 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? ►1 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:
FOR OFFICE USE ONLY .
n Issue rmit„ ❑ Do not issue permit. Refer to planner.
3 -z3 //
Planning Staff Signature Date
I: \C URPLN \Masters \CollocateAntennas.doc
1 °j Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: G ) / 1-- iX x 61 ❑ Expedited Review
Plan Submittal Date: 3
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 a . proved.
r / ,/ l
[
Planning Review (contact �( at 503-718 :2W or @ tigard- or.gov)
J \Zoning , ' C1 Permitted Use Yes No ❑
fi Land Use Required: Yes ❑ No ❑ (explain below)
Notes: I r . 2 _
/ • / jl ee �,r Ay," -
Approved 0 Not Approved Date: v;
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
. Routed back to Building Division Date:
I: \CURPLN