Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2004 -00558
� DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12955 SW.PACIFIC HWY PARCEL: 2S102BD -02600
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G
BLOCK: LOT: 037 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FA FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: .S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: 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
Remarks: Add (3) new antennas to existing wireless communications monopole.
Owner: Contractor:
KIM, ROBERT + HAE LIM LEGACY WIRELESS
1360 SW WOODWARD WAY 4252 SE INTERNATIONAL WY # F
PORTLAND, OR 97225 MILWAUKIE, OR 97222
Phone:
Phone: 503 - 656 -5300
Reg #: LIC 150432
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUPPLN] Pin Rv 11/29/2004 $121.75
[BUILD] Permit Fee 12/16/2004 $187.30
[TAX] 8% State Surchari 12/16/2004 $14.98 .
Total $324.03
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: _2;Zry__
Permit tee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
i.1 rs5 S AI paa &-I 1 6 Hwy
poi- P /7; A rd `
Building Permit li p ED FOR OFFICE USE ONLY
City of Tigard
Yv�4 ,l Received — i
13125 SW Hall Blvd., Tigard, OR 97223 p � `i� Plan Review D � r_ �, ��
Phone: 503.639.4171 Fax: 503.598.1960 \A V k Other Permit:
Q ;' r ' D au 18 : � i — V S l'
Inspection Line: 503.639.4175 ? r* 1 . _r ��- ti Data Ready/By: ® S Attached Checklist for
Internet: www.ci.tigard.or.us G1 \ y ®`V, J NotiSed/Method: Supplemental Information
cd S'::'i; c;� , ; fi : _i ;TYPE U 1`s -T r , _" REAfiIRED DATA: 1'— AM1`2YFA'MII; 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
g lAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
t a : .iw•k • Y • sex ,.o- a - ro -•,.
�.;° + �� �� �7' • ' =; °� .:A-.: work indicated on this application
. . _ q,., tix = :t7�Sp: .AZ:. mw: e+:.pRSC2c. r ' - . „ .- i!?C;t; i. =! ..4° ": =t.:i -.
❑ 1- and 2- family dwelling �Commercial/industrial
Valuation: $
, ❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
Z i ^'t �"y 7 " . w. "nV,r v. ° 3" • Total number of floor:
Job site address: /Z /SS SW PA Ci 4, /4r,✓Y New dwelling area: square feet
City/State/ZIP: 7' /4 ,4 ,.4) Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Poi X19/? - i4 i) Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet -
.t,�;.}s.xh„ �"•rc� sst��c:rir-�.ra;.t�.r. -, u. -�;r -
4'" :• - rAf CQ R - °U E C i.6....
Subdivision: 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.: 2s/ 2.8i) "Ti_ Zh, equipment, materials, labor, overhead, and the profit for the
v- -„- �` _ e .'+ '.' _ ; .a „ >s - at. x t .�! �Y,;g�,. ri. r Y�j1:
;2.,;1:.. '4C,7"3 �,.'..
, .e. :?° .' , . r �; work indicated on this application.
1 Valuation: $ /5, OQO_ 00
A•oid r
ee- r10 -✓ a.14 en n 41 j-v 4..1 ell -11.1
Al w'e-Ieu Co M A4KK i (04 I , Wtr kl U n o )e. Existing building area: 3 c square feet
T � New building area: e;3" square feet
' `' PRQ It T "OW�JER - 'k ": , Y t ,,:- , •" y kw ; Number of stories: '
Name: \l./, t 20v% (^) L / ess Type of construction:
Address: 'j 4-30 /VP:" / ZZ ✓td A'1/e.nHg. Occupancy groups:
City/State/ZIP: Po r +i 4 .Gl O 2 9 7 23 o Existing:
Phone: ( ) Fax: ( )
New:
ss � _ ,
z. , - , ,...• ..- 1«..- r (ki : N _ _ c'c ��yy y.. �0 * ' " ' �
L 'P,° ='ti:, y f�: _: '
. . � �. .l .. °"*P. (!.-C �sk�'�: K�r� �''�EMCi= s`:'i ._.
`'
+ Business name: AF(,, re. / a CO *, Mk-n i Gq �j On S All ? contractorss 4 and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: /40 L / ( 1 C,./...1.7.,,, under ORS 701 and may be required to be licensed in the
(•:
Address: .25171 SO 0.n tom/' /L// � ' Sa j k- E jurisdiction in which work is being performed. If the
City/ State/ZIP: 4), DSO n J/ � ' e- U 97070 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) - 074 4. I Fax: : (Co 3) ¢b/ — O/ - f
E -mail: 14 , 4 , (t , I. e4 Ai aTtfo i m� ;a;. 6l c . . - - -;-,- ' t t,6 •.: .,,, c .. i � •, :' , -:v` , , ..
Business name: �� ` L r‘ O/ Vj/ aif 6 -• 5g�D�"�itirmIT!• FEES•
Address: y25 gs' , Nrl RNA - n 0 /v,) L W.OY, 5'v/, r
City/ State/ZIP: 1 v/ it (^/ (/K/ O P lease refer to jee schedule
A
Phone: (Sa3) ( 5 _ S 36 0 Fax: ( ) Fees due upon application 7
CCB lic.: / 5'® Amount received
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ZE t' 4 r a.r �7`n Date: / (/ 24/ t • Fee methodology set by Tri- County Building Industry
• Service Board.
is \Buildmg\Pemriq\BUP- PemtitApp.doc 12/03 440- 4613T(l1 /02/COM/WEB)
r ,
Building Division
Plan Submittal Requirement Matrix
U' Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
3 4 f' r . ', . 1 e• p. ' 1 11 • l' a s§.i -o �"' I a lit.
1 1 ne . 'P I I I �t l 17 t45"�e 1�r!
.u:� l 1 ..� �5.�
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3**
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
•
• Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\ Building\Fornu \COM- P1anSubReq.doc 12/24/03
� CITY OF TIGARD - . .
i BUILDING DIVISION PERMIT #: BUP2004 -00558
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/16/2004
Phone: (503) 639-4171 hp l ��
Inspection Requests (24 Hrs.): (503) 639 -4175 - '__ .
INSPECTION WORKSHEET FOR DATE: 4/20/2005 TIME: 7:11AM PAGE: 88
SITE ADDRESS: 12955 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 • TYPE OF USE:
PROJECT NAME: VERIZON WIRELESS
DESCRIPTION: Add (3) new antennas to existing wireless communications monopole.
OWNER: KIM, ROBERT + HAE LIM, PHONE #:
CONTRACTOR: LEGACY WIRELESS PHONE #: 503- 656 -5300
i Inspection Request Scheduled For: Date: 4/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 004882 -01 503. 860.4402 N
Corrections /Comments /Instructions:
II
. 04,_
„I.- Wi .
.....--- 1 I I V
I"
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ • LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 0 `J Phone #: (503) 718-