Permit h •i! f 1 ITY OF TIGARD BUILDING PERMIT
C PERMIT #: BUP2006 -00222
re DEVELOPMENT SERVICES DATE ISSUED: 7/21/2006
'�--- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136CC -02100
SITE ADDRESS: 11744 SW PACIFIC HWY ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Co locate wirless equipment upon & below existing cell tower.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : sf N: S: E: W:
OCCUPANCY GRP: NONE TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: 130 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: $ 20,000.00
Owner: Contractor:
WESTERN PCS CORP. BARAN TELECOM INC.
75353 NE AMBASSADOR PL. 2355 INDUSTRIAL PARK BLVD.
PORTLAND, OR 97220 CUMMINGS, GA 30041
Phone: 503 - 284 -8714 Contact #: PRI 503 678 - 455 - 1158
Reg #: LIC 127341
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 5/23/2006 $235.30
[TAX] 8% State Surcha 5/23/2006 $18.82
[BUPPLN] Pln Rv 5/23/2006 $152.95
Total $407.07
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: P ermittee Signatur
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
//794' 5i - i/. c t 1_ . IV IN Building 'Permit App 'T:k;;lq / ' / I OR O1 FIC I IJS1; ()Nix •
City of Tigard Received _ n �r P erm i t No.: _ / p F
Y g DateB : � 4 1 .if t ._
13125 SW Hall Blvd., Tigard, OR 97 Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 MAY 2 ' 200 r Date/13 : , V:i/� Other Permit:
Inspection Line: 503.639.4175 ^'I I Date Read . y: ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF T1GARD Notified/Method: Supplemental Information
p
UTT TOPI WO PISTON REQUIRED 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
r o ir i Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling Commercial/industrial
❑ 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: 03 S\AI Fa Z VAL t\ New dwelling area: square feet
City / State/ZiP: 1 25x64 n Z 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name CS 0 'MA.- !4S Covered porch area: square feet
Cross street/directions to job site:
tA, v 1 t �J Deck area: square feet
b pUln al .. A Q ` Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: '1 02,43 4. ( i A ` � 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.: `Sp ` 3 b C,,C, 1,23 pD
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
C„ - I Pe.a tdJ1 (Ct1,44.4 '. 410, ..0A* eJ,DM� Valuation: $ 2D. p�0
IC•t. Low a h e N1.1.5-1-1 �.� i ` �, Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: .4 (M s + ��+ Type of construction:
Address: ', ( 3 cop SW' ia.4 Occupancy groups:
City /State/ZIP: Slrlerw Ooi R 4 71 OPP Existing:
Phone: ( ) Fax:( ) New:
K APPLICANT CONTACT PERSON NOTICE
Business name: Cavil GV LG All contractors and subcontractors are required to be
Contact name: licensed d with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6s pi N E ( D sic" c.A. S V , A, • 2. jurisdiction in which work is being performed. If the
City/ State/ZIP: VAr 4 o v er W A 4 ebb Z.
applicant is exempt from licensing, the following reasons
i Phone: ( S03 'ask, - & Z.b I Fax: :114 ® 3 f+i • I JO 81
E -mail: doh i, 1 Arm 0 ca SC. latA1ehe► . GDW'I
CONTRA, OR
Business name: .._, ` ............. _ BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City / State/ZIP: Fees due upon application
Phone: ( ) I Fax: ( ) Amount received vD i a?
CCB lic.: . / •911.71 .
Date received: j ,23 Q(
Authorized signature: ! � This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: e fro ti I Date: S • Ira 0.1) * Fee methodology set by Tri - County Building Industry
Service Board.
i:\ Building \Pennits\BUP- PermitApp.doc 12/03 440-4613T( I I/02/COM/WEB)
CITY. OF,TIGARD
411
BUILDING DIVISION PERMIT #: B1JP200f, 00222
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/21/7005
Phone: (503) 639 -4171 A �'` '
Inspection Requests (24 Hrs.): (503) 639 -4175 . - 'IL
INSPECTION WORKSHEET FOR DATE: 12/20/2006 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTERN PCS MONOPOLE
DESCRIPTION: Co-locate wirless equipment upon & below existing cell tower.
OWNER: WESTERN PCS CORP., PHONE #: 503.284 -8714
CONTRACTOR: BARAN TELECOM INC. PHONE #: 5 -1158
Inspection Request Scheduled For: Date: 12J20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message VA
299 Final inspection 041321 -01 209-304 -6424 Y
Corrections/Comments/Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL MI CALL FOR INSPECTION ❑ ADDITI• AL F ES ASSESSED
Inspector: / r /
1.7 Date: C CSC i tiop Phone #: (503) 718 - '74r.