Permit INI a CITY OF TIGARD BUILDING PERMIT
_ PERMIT #: BUP2007 -00543
COMMUNITY DEVELOPMENT DATE ISSUED: 4/29/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S134BC -00700
SITE ADDRESS: 12655 SW NORTH DAKOTA ST ZONING: C -
SUBDIVISION: PP1993 -058 LOT: 001 JURISDICTION: TIG
PROJECT: AT & T
Project Description: Install (2) additional antennas on existing cell tower.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 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: 55 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 15,000.00
Owner: Contractor:
RICHARDS, M DALE + BCI COMMICATIONS INC
ADAMS, HEATHER + 20 BUSHES LANE
HOUSE, MICHAEL D/TAMMY L ELMWOOD PARK, NJ 07407
TIGARD, OR 97223
Phone: Contact #: PRI 201 - 791 - 3200
FAX 503 - 393 - 3847
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pln Rv 10/16/2007 $101.04
[BUILD] Permit Fee 4/29/2008 $155.45
[TAX] 8% State Surcha 4/29/2008 $12.44
Total $268.93
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 Notification 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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. : — _ — ��" Permittee Signatur >:
1 Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
i 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.
i
12 (d 75 5
Building Permit 4 1i catibn ��;; _ I OR (i) FICE use ONLY
City of Tigard Received 7 PermitNo.:
SW Hall Blvd., TF 974^.2 + 2001 Plan Revie
" U 13125 Phone: : 503.639.4171 Fax: 59 . 0 Date/B : r Other Permit:
T GA R Inspection Line: 503.63.41 75 u ;� �` Date Ready /By: /, �`�'� ® See Attached Checklist for
Internet: www.tigad�ov �L �'- Notifed/Methodi��� /�'7 �jY I Supplemental Information
TYPE OF WORK REQ ATA: I- AND 2- T4MILY 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: $ tJ/A
❑ 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: 12655 SW NO 2 T,4 1)AKOTA New dwelling area: square feet
City /State/ZIP: TI 6 NZC ,o Z Gi 122 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: A r r 3 CrbQ Ap17 - PR 17 Covered porch area: square feet
Cross street/directions to job site: SW 125 A A,ii) SCHoe�S FURRY Rr Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: 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.: IS 1 34E000700 equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
It.1STALL TW W O NE f ENNAS C NTD S XISIII.IEa TbLFJEQ Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: �iq c}.R L . L.G. Type of construction:
Address: ' 2693 SL.) NORM 1)AkX TA ST Occupancy groups:
City /State/ZIP: j 3Ci,g4t) t Og ¶72.23 Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: AT &T W I REL FS S `/o 1 E, s c ASSOG i4TE All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: 'PAUL SLOB l( under ORS 701 and may be required to be licensed in the
Address: (021 5w sr , S.) rra Z n . jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
RTt r> ( OSZ q�2O5 apply:
Phone: (503)241 OV7 Y Fax:: (tSD3) 241- 2204
E -mail: p510+ek.w KprQre - 4co t Assoc. GOVT
CONTRACTOR OUT— l"O - 1 )
Business name: _____� - BUILDING PERMIT FEES*
Address: ��jj (Please refer to fee schedule)
alum /J'U �� �3DZ Structural plan review fee (or deposit):
City/State/ZIP:
Phone: ('f2) Fax: (S 3 q3 - 3 $y7 FLS plan review fee (if applicable): ._..
C
CB lic.: 7 f ' Total fees due upon application: /)/.
Amount received:
Authorized signature: j� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �AUi_ � 1wA1GE� I Date: ip�l /v-� * Fee methodology set by Tri- County Building Industry
Service Board.
, r:\ Building \Pamits\BtJP- PcmrtApp.doc 03111/06 410.4613T(11/02/COM/WEB)
l
CITY OFTIGARD ,
BUILDING DIVISION PERMIT #: BUP2007 -00FA3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/29/20013
Phone: (503) 639 -4171 Miltil -
Inspection Requests (24 Hrs.): (503) 639 -4175 '" ..
INSPECTION WORKSHEET FOR DATE: 5114/2008 TIME: 7:04AM PAGE: 35
SITE ADDRESS: 12655 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: PP1993 -0S13 LOT #: 001 TYPE OF USE:
PROJECT NAME: AT & T
DESCRIPTION: Install (2) additional antennas on existing cell tower.
OWNER: RICHARDS, M DALE 4, PHONE #:
CONTRACTOR: BCI COMMICATIONS INC PHONE #: 201 - 791-3200
Inspection Request Scheduled For: Date: 5/14 /2008 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
299 Final inspection 069860-01 206-310.7520 N - n q .
Corrections /Co ents /Instruction • • Iv
cut eJ YS Gc-S .r„ ' .
51Z-_____ . i
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it
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PAS F - ' RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
V6OL-----
Inspector: Date: S7 L f /d r Phone #: (503) 718 742