Permit CITY OF TIGARD BUILDING PERMIT
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1111 C COMMUNITY DEVELOPMENT Permit#: BUP2012 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/21/2012
Parcel: 1 S136CCO2100
Jurisdiction: Tigard
Site address: 11746 SW PACIFIC HWY
Project: Verizon Wireless - POR Dartmouth Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Replace 6 of 12 existing antennas on existing cell tower, locatins and tip heights will not change.
Contractor: WESTOWER COMMUNICATIONS INC Owner: GRUNBAUM FAMILY TRUST
19500 SW CIPOLE RD BY GRUNBAUM, HANS H AND MARILYN K,
TUALATIN, OR 97062 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE: 503 - 210 -1000 PHONE:
FAX: 503 - 210 -1001
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Other Permit Fee - Additions, Alterations, 08/21/2012 $195.38
Demolition
Occupancy Grp: U Occupancy Load: Plan Review 04/17/2012 $127.00
Dwelling Units: 0 DC Provision Review, COM TI - Ping 08/21/2012 $64.00
Stories: 0 Height: 0 ft DC Provision Review, COM TI - LRP 08/21/2012 $9.00
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 08/21/2012 $23.45
Value: $8,000 Info Process /Archiving - Sm $0.50 (up to 08/21/2012 $15.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $433.83
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is sued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do • in accordanc= ith 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
da ATTENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 '0 ' • O. You may obtain a copy of the rules or direct questions to OUNC by calling 50 . . 987 or 1.800 332.2344.
/ / • sued By: • /��� Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available Inspec da
This permit card shall be kept in a conspicuous place on the Job site until • • mpletion of the project
Approved plans are required on the Job site at the time of each inspection.
V
Building Permit Application
Commercial FOR OFFICE USE ONLY .
54 City of Tigard R a ed s / PermitNo.: 4 P, / 0�QQ7
13125 SW Hall Blvd., Tigard R E CEWE O
7223 Plan Review ►e.
III . ' Phone: 503.718.2439 Fax: 503.5 1 ,r(( 8 61 7 2012 DateB : Jr ) /. 7 C� 1'� Other Permit:
T
TIGARD Inspection Line: 503.639.4175 H� Date Ready/By: . , Juris: 61 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 42. .'y Supplemental Information
my OF TIGA ; D� , M s#4/v/
TYPIV*rW{ f9Ik )IVI,tut, REQUIRED DATA: l- 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.
❑ I- and 2- family dwelling ® Commercial /industrial Valuation: $
El Accessory building ❑ Multi- family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
/17y6, JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:y 'W 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 Dartmouth Covered porch area: square feet
Cross street/directions to job site: Pacific Hwy and Hwy 217 behind drive- Deck area: square feet
thru coffee shop. This is an 130' wireless tower. Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE
Subdivision: I Lot no.: * CHECKLIST
Permit fees are based on the value of the work performed.
Tax map /parcel no.: 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.
Replace 6 of the 12 existing antennas on the existing cell tower. Locations and Valuation: $$8,000.00
tip heights will not change. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ 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 I Fax: ( )
New:
CO APPLICANT ® CONTACT PERSON
BUILDING PERMIT FEES*
Business name: Urban Wireless for Verizon Wireless (Please refer to fee schedule)
Contact name: Shanin Prusia Structural plan review fee (or deposit):
Address: 10376 SE Sunburst Way FLS plan review fee (if applicable):
City/ State/ZIP: Portland, OR 97086 Total fees due upon application:
Phone: (503) 720 -7295 Fax: : ( ) Amount received: /7.0
E -mail: shanin@UrbanWirelesslnc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top : ted Photovoltaic Solar Panel System.
Business name: I= LA.7 ST D ti.,* 2 Qo fi y u 1J IC4 -Tho I y /,'•Cs.Submit two (2) of roof plan with connect' • • etails
Address: and fire department a • • s, along with • - 110 Oregon
Solar Installation Specially . e . list.
City /State/ZIP: Permit fee (includes 1 :, ew $180.00
and a' trative fees .
Phone: ( ) L Fax: ( ) State surcha . 12% of permit fee): $21.60
CCBIic.: / g0 471 'My : 1.60
otal fee due upon application:
Authorized signature: This permit application expires if a permit is not
obtained within 180 days after it has been accepted
I
Print name: Shanin Prusia, Urban Wireless Date: L ifitt as complete.
1: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 4404613T(I 1/02 /COM/WEB)
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: �) u P 9'O i 2,-0007 3 ❑ Expedited Review
Plan Submittal Date: Y1 /7 //
To the Applicant:
> If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
> If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved. /
Pla 'ng Review (contact 442f2 at 503 - 7184 VV d �orr *___@tigard-or.gov)
l!� Zoning C Permitted Use Yes Le No ❑
Et Land Use Required: Yes ❑ No (explain below)
Notes: / ��S I '! Nzti ��" dPi(Pelf / 50 /�� 119,-1
40
Approved ❑ Not Approved Date:
.
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert@tigard - or.gov)
Notes:
0/
Routed back to Building Division Date:
I: \CURPLN
• Fee methodology set by Tri- County Building Industry Service Board. 7 r 111 .
Building Division vED
Accessibility: Barrier Removal ImprovementAPPa'7 2012
TIGARD
CITY OF TIGARD
BUILDING DIVISION
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I:\ Building \Permits \BUP -COM PcrmitApp.doc 03/03/2011
Building Division
Plan Submittal Requirements
T l G A R D Commercial & Multi- Family - New, Additions or Alterations
1. SITE PLAN (fully dimensional, drawn to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking, including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the 'Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape -ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations, plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit - based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
j ,,
I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
Building Division
:..
Plan Submittal Requirement Matrix
T I G A R D Commercial & Multi- Family - New, Additions or Alterations
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
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), if applicable.
I: \Building \Permits \BUP -COM PermitApp.doc 03 /03/2011
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