Permit CITY OF TIGARD BUILDING PERMIT
- J COMMUNITY DEVELOPMENT Permit #: BUP2011 -00120
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/09/2012
Parcel: 2S102BD02600
Jurisdiction: Tigard
Site address: 12925 SW PACIFIC HWY
Project: Verizon Wireless Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37
Project Description: Replacing 6 of 12 antennas on existing tower.
Contractor: WESTOWER COMMUNICATIONS INC Owner: VERIZON WIRELESS
19500 SW CIPOLE RD 5430 NE 122ND AVE
TUALATIN, OR 97062 PORTLAND, OR 97086
PHONE: 503 - 210 -1000 PHONE: 503 - 720 -7295
FAX: 503 - 210 -1001
FEES
Specifics:
Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 02/09/2012 $195.38
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 02/09/2012 $23.45
Stories: 0 Height: 80 ft Plan Review 06/14/2011 $127.00
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Sm Sheet (up to 02/09/2012 $20.50
Value: $8,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $366.33
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 obtai. r C. • ules or direct questions to OUNC by calling 503.232. r 1.800.332.2344.
Issued By: 'if Perm ttee Signature:
39.4175 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 ing Permit Application
Commercial ‘
r FOR OFFICE USE oNLi
City of Tigard Date/B : Received '� i., Permit No.: �t ifk �-�
V
13125 SW Hall Blvd., Tigard, OR 97223' pp `L � 11 Plan Re / `1►
Phone: 503.718.2439 Fax: 503.598.1961 ` \�\ 1 `Y Date /B : I v� `m mu Other Permit:
TI G A R D Inspection Line: 503.639.4175 ,U\ � ` (�'+i�® a ate • eady :y. See Page 2 for
Internet: www.tigard- or.gov axf` fi Je -thod: �
o O V .) D ei 1
..C\ (� i Supplemental Information
TYPE OF WORK du.11‘‘' / ' EQUIRED 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
CATEGORY OF.,'CONSTRUCTION work indicated on this application.
El I- and 2- family dwelling ® Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
, JOB SITE INFORMATION' AND LOCATION Total number of floors:
Job site address: 12925 SW Pacific Hwy New dwelling area: square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite /bldg. /apt. no.: Project name: POR Tigard / 99 Covered porch area: square feet
Cross street /directions to job site: Pacific Hwy and Walnut Street, behind Deck area: square feet
commercial strip mall. This is an 80' wireless tower. Other structure area: square feet
REQUIRED DATA: COMMERCIAL-USE CHECKLIST
Subdivision: 1 Lot no.: 02600 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: WCTM 2S1 02BD equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Replace 6 of the 12 existing antennas on the existing cell tower. Locations and Valuation: $58,000.00
tip heights will not change. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ °TENANT ' Number of stories:
Name: Verizon Wireless Type of construction:
Address: 5430 NE 122" Ave Occupancy groups:
City /State /ZIP: Portland, OR 97086 Existing:
Phone: (503)720 -7295 Fax: ( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refento fee schedule) .
Business name: Urban Wireless for Verizon Wireless .
Structural plan review fee (or deposit):
Contact name: Shanin Prusia
FLS plan review fee (if applicable):
Address: 10376 SE Sunburst Way
City /State /ZIP: Portland, OR 97086 Total fees due upon application: �� (-
Amount received: �r-�
Phone: (503) 720 -7295 Fax: : ( ) lfp
E -mail: shanin @UrbanWirelesstnc.com PHOTOVOLTAIC SOLAR PANELS STEM "FEES*
CONTRACTOR Commercial and residential prescriptive installation of
J ___ _ - roof -top mounted Photovoltaic Solar Panel System.
Business nameB9- r-- Submit two (2) sets of roof plan with connection details
`'"'/ /vi- and fire department access, along with the 2010 Oregon
Address: / 5? 'c' y . C / k / 'r) Solar Installation Specialty Code checklist.
City /State /ZIP: ,C 7 cy 9 •c 7 Permit fee (includes plan revie
— and administrative fees): $180.00
Phone: ($o') c2 /d 1� _4 " Fax:
�� (_- ) t State surcharge (12% of permit fee): $21.60
CCB tic.: / '7 j C 7 /[ /� Total upon - $20 t60 —
Authorized signature:. t L 1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Shanin Prusia, Urban Wireless Date: /% //; * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM/WEB)