Permit CITY �F TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00518
44 DEVELOPMENT SERVICES DATE ISSUED: 5/19/2005
F`- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134DC -00600
SITE ADDRESS: 11355 SW TIGARD ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Add (2) additional anetennas to an existing wireless 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: 5N : 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: 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: $ 8,000.00
Owner: Contractor:
ANDERSON, LARRY R AND WIRELESS FACILITIES INC.
CYNTHIA M 1840 MICHAEL FARADAY DR.
11355 SW TIGARD ST STE 200
TIGARD, OR 97223 RESTON, VA 20190
one: Phone: 703 - 904 -7400
FEES Reg #: LIC 145637
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pin Rv 10/29/2004 $126.11
[BUILD] Permit Fee 11/5/2004 $48.04
[BUILD] Permit Fee 5/19/2005 $72.06
[TAX] 8% State Surchari 5/19/2005 $9.61
(additional fees not listed here)
Total $207.78
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 1- 800 - 332 -2344.
Issued By: Permittee Signature:
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.
, i . ' ' ..4 / 61-14 -d 4 4.4.4. / A,LA.
Building Permit Apps 1f �® FOR OFFICE USE ONLY
City of Tigard 6I 1 1/ Received '
Permit o
13125 SW Hall Blvd., Tigard, OR 97223
Date/By � oZ9 o y 11 j�(/\�,ZO 00)
„ -r Plan Review C
Phone: 503.639.4171 Fax. 503.598.19d 1 , 1 2 92004 G� . e� �,,� � 4 Date/By: J /-'5 O f/ ✓O Other Permit Inspection Line: 503 639.4175 61 I _; Date ReadyBy: lure ® See Attached Checklist for
Internet: www.ci.tigard.or.us Ui I Y OF FIGARO Notified/Methodl //9/ �f� f ! Er Supplemental Information
BUILDING DIVISION c w�ia / - _ „"
''' - -- •` K-
-TYPE 'OF- WOR• _ <
i ,'_ - - .-•,= .• _ REQUIRED DATA: 1- AND;24'AMILY 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 Additton/alteration/replacement ❑ Other• equipment, matenals, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION• .t •:-.-?: " ;'- A-4,-3':':•:-.:- -,s work indicated on this application
1- 2-family dwelling ,�/
Valuation a
y g Uv Lommerctal/industnal (7 i O�
❑
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms
-I ?C • JOB` SITE INFORMATION ; AND= LOCATION:_' ' ••, ' -
Total number of floors:
��-5
� 5S, y S w �' � „ L., New dwelling area: square feet
• ■Job site-address: 14-56S, i r ;`• `x E• • " ° N was �, : „,, ,
City /State/ZIP:fl a rot Q 223 Garage/carport area. square feet
Suite/bldg. /apt. no.: t ` ' / ) Project name: cpP Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
6W 101 i (1 () - . 6W T� arC1 ( C )'� -, Other structure area: square feet
tv •REQUIRED COMMERCIAL -USE; CHECKLIST"
Subdivision: IV / A I Lot no.: — Permit fees* are based on the value of the work performed.
Tax map /parcel no.: RQ 2 uclq LP 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.
A l (a l 1 4 W x c - 11 on 1 (.{ ,Nn 1 Ian Valuation: $ t 000
n P'fi
- r0 a � I r-l. ies5 tl) ' • Existing building area square feet
Z OO 3t�t� 5 ) Y Y New building area: • square feet
I PROPERTY OWNER' -3 ?: > ❑ T - ,- .• 1 " -¢
AN Number of stones
Name: L ,L 1 a A au a - . el Type of construction:
Address: 1 i 3F `, W T 0 6t. Occupancy groups:
T�
City/State/ZIP: a rct . o p al-223 Existing:
Phone: (r ) Fax: ( )
�,� _ New:
E '�'PLICANT :� [v]'CONTACT -PERS ONy '` , '; : ,. —
:° '; �' .NOTICE.- •. ,:,',:,,'=,..---, r " `; •
Business name: N en *WC �5c All contractors and subcontractors are required to be
Contact name: (I h I j��' r5 licensed with the Oregon Construction Contractors Board
� � "� 1n under ORS 701 and may be required to be licensed In the
Address: 4° 4 6 S d ` a r {V) rr (3 \((( junsdiction in which work is being performed. If the
City/State/Z1P: 0 ' g C n 1 � (/- 'iji1��C "1 � 1 'J ' 1 applicant is exempt from licensing, t following reasons
t5Q �' f" J I (1} a 1
Phone: ( � � Fax:: ) �C) _ �'T�� C
E- mail: 60phI mPV frs B \N 1 corn
,j r c • " rCONTRACTOR- t `
Business name: Y V t - 1
1 ,-{ 2' >-°'• '--` B
;',UILDING' PERMIT FEES*
Address: 4421-F) 6W .9 n.-.„ Ara iv
P
City /State/ZIP:
cTl () Fl"i 2nd, 012_ c/1-3c1 applica
plic refer to fee schedule.
Phone: (6/A) q9- --,11-9.- Fax • (6:3 ) C19-3 -54-5s Fees due upon
—
CCB Iic.: I 4-5 � - Amount received
1 �VA�) W-ILMM� Date received:
AuIltonzed signature: This permit application expires if a permit is not obtained
p c within 180 days after it has been accepted as complete.
Print name: 60 p hi j ute �/ V �/ N r l) Date: 1,0 - 2g . (>4-
1 * Fee methodology set by Tri- County Building Industry
` J Service Board.
i \ Building \Permits'BtJP- PemutApp doe 12/03 440- 4613T(I1 /02/COM/WEB)
1 1
•
Building Division
Plan Submittal Requirement Matrix
• Commercial & Multi - Family - New, Additions or Alterations
City of Tigard •
of Submittal r {y# of Plans
,, (Inclu'd'es, new, °additions and alterations.) Required .at
T�t ' o j S r � ' :_`.'� r��c„i�:^ -'..�� :, ;,�_� "v; �; '�_ �..;:y'
1 ._ �� - _ C;1i^ s .� Subni ttalF- :
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.\Buildmg\Forms \COM- PlanSubReq doc 12/24/03
CITY OF TIGARD
BUILDING DIVISION - " PERMIT #: BUP2004 -00518
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/19 /2005
Phone: (503) 639 -4171 /In�ry�,� i � j e l l
Inspection Requests (24 Hrs.): (503) 639 -4175 � °°
INSPECTION WORKSHEET FOR DATE:. 7/6/2005 TIME: 7:12AM PAGE: 77
SITE ADDRESS: 11355 SW TIGARD ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VERIZON -
DESCRIPTION: • Add (2) additional anetennas to an existing wireless tower.
OWNER: ANDERSON, LARRY R AND, PHONE #: V '
CONTRACTOR: WIRELESS FACILITIES INC. PHONE #: 703- 9047400
Inspection Request Scheduled For:. Date: 7/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 010757 -01 971 -253 -0153 N
rAS ; o 65C 5'30S
Corrections/Comments/Instructions:
•
AIM I
111//
A pp-
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL OR INSPECTION ❑ ADDITI A EES ASSESSED
M-/
Inspector: � Date: VJ Phone #: (503) 718-
,