Permit CITY OF TIGARD BUILDING PERMIT
� Permit #: BUP2011 -00080
t - g COMMUNITY DEVELOPMENT
•'�.
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/24/2012
TIGARD Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: AT & T Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: Adding (3) antenna, extending concealment shroud, adding (1) cabinet to equipment platform.
Contractor: MONTI ELECTRIC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 220 BY THOMSON PROPERTY TAX SERVICES
TROUTDALE, OR 970660 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 491 -4909 PHONE:
FAX: 503 - 665 -7200
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 01/24/2012 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 01/24/2012 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 05/26/2011 $225.80
Stories: 0 Height: 87 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 01/24/2012 $27.10
Value: $10,000 Plan Review 05/26/2011 $146.77
Info Process /Archiving - Sm Sheet (up to 01/24/2012 $5.50
• 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $478.17
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 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.
Issued By: / � Permittee Signature:
Call , 5 by 7:00 a.m. for the next available inspection date.
This permit card shall .e 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.
Building Permit Application
Commercial r FOR OFFICE USE ONLY . .
City of Tigard R EC Date ,� Permit No.: � P�`! RO
- ° 13125 SW Hall Blvd., Tigard, OR 9722n 3�Q 2 6 2011 -Plan Review ,
Phone: 503.718.2439 Fax: 503.598.1960 /2 L L L Plys1 E / Date/B : •I Other Permit:
Ins ection Line: 503.639.4175 CITY :CARD R ry 1e1® ! ,
TIGARD p C� I 1 C e rt ! Date Ready :y: _ tuns: H See Page 2 for
Internet: www.tigard- or.gov BDIN( IO �a
9 UI DiVIS _.....•. ethos 7 5 // Supplemental Information
6 IVV c71 'V — A1 W /`
I
TYPE OF WORK REQUIRED DA A: 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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ❑ Commercial /industrial ,
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ® Other: Wireless Number of bathrooms:
, JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9585 SW Washington Square Rd New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: N/A Project name: AT &T PW11 WA Square Covered porch area: square feet
Cross street/directions to job site: SW Blum Rd Deck area: square feet
Take OR -217 N to Exit 5. Stay right and follow SW Greenburg Rd. Take l left Other structure area: square feet
on to SW WA Sq Rd, take right onto SW Blum Rd; tower will be on the left ,' REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: - I Lot no.: - Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 1S12600003000 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Adding 3 new panel antenna Valuation: $510,000.00
Extending existing concealment shroud Existing building area: 180 square feet
Adding 1 cabinet to the existing equipment platform New building area: 0 square feet
® PROPERTY OWNER ® TENANT Number of stories: 0
Name: Crown Castle /ESS VRS Type of construction: Telecommunicat
Address: 8547 154 Ave NE Occupancy groups:
City /State /ZIP: Redmond, WA 98052 Existing: Unoccupied
Phone: (425)202 -2775 Fax: ( ) New: Unoccupied
- ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Ryka Consulting (Agent for AT &T Mobility) 17
Structural plan review fee (or deposit): 1 clef .
Contact name: George Pierce
FLS plan review fee (if applicable): AYR -
Address: 918 South Horton St, STE 1002
Total fees due upon application: $34:131.
City /State /ZIP: Seattle, WA 98134
• Phone: (206) 406 -5117 Fax: : (206) 260-7930
•
Amount received:
E -mail: gpierce @rykaconsulting.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installa • - .
roof -top . ited Photo Voltaic Solar Pa - ' ystem.
Business name: TBD 446A/7"/ g.GFG/,21CI (it/ /2rLESS Submit two (2) se , oof plan wi • onnection details
and fire department acces , : _• - _ with the 2010 Oregon
Address: po ea/ 22 Solar Installation Specs. Cooe:. cklist.
City/State /ZIP: L 9 p 6 a Permit fee - udes plan revie
720�7D / d administrative fees): $180.00
Phone: (55'D3 ) i/9 / _ 9 6 9 , Fax: ( ) Stat rcharge (12% of permit fee): $21.60
CCB lie.: / 3,532_ (o 910 / 13 l'6,--- ( U 1 K Total fee due upon application: $201.60
- I/
Authorized signature: 7// / 1 This permit application expires if a permit is not obtained
_ within 180 days after it has been accepted as complete.
Print name: George Pierce Date: 3/29/2011 * Fee methodology set by Tri -County Building Industry
Service Board.
L \Building \Permits \BUP -COM PermitApp.doc 02/24 /2011 440- 4613T(11/02 /COM/WEB)
. .
IN LOLLOCATI ®N 'ECEJVED
... ,..
Supplemental Questionnaire APR 0 4 2011
TIGARD City of Tigard, 13125 SW Halt Blvd, Tigard, OR 97223 OF TIGARD
Phone: 503.639.4171 Fax: 503.598.1960
/ENGINEEMING
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: 9585 SW Washington Square Rd
Zone: MUC
Collocating antennas on: ® Existing tower ❑ Existing non -tower structure
Is this a new provider? n Yes ® No
If yes, list other providers currently collocating on same tower or structure, if any:
N/A
If no, indicate the previous approval (SDK, MMD or B UP #): WF2007 - 0010; BUP2008 - 00362
Height of antenna(s): 70' & ft. 1t. P ?111' V DUU'i
62' �cri} — co 3 l' 1 -
Color of antenna(s) and accommodating equipment (i.e. dishes):
Brown concealment shroud
Color of existing tower or structure: Brown
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: 3/30/2011
Name Printed: George Pierce Phone: 206.406.5117
� . OR OFFICE U ..
j' Iss I e, ; - Ess •t / 7 ❑ D0.0 iss e permit. Refer to planner.
iilk 1/
Planning Staff S . . e Date
I: \CURPI .N \ Masters \CollocateAntennas.doc