Permit 111 CITY OF TIGARD, BUILDING PERMIT
P ERMIT #: BUP2007 -00051
COMMUNITY DEVELOPMENT DATE ISSUED: 3/2/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134BC-00600
SITE ADDRESS: 12390 SW SCHOLLS FERRY RD ZONING: C -
SUBDIVISION: PP1993 - 057 LOT: 002 JURISDICTION: TIG
PROJECT: CLEARWIRE US LLC
Project Description: Monopole co locate. Add 4 antennas, 4 micro dishes.
REISSUE: Orr— FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: Ate' 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: 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: $ 20,000.00
Owner: Contractor:
CLEARWIRE WIRELESS BROADBAND OREGON ELECTRIC GROUP
5808 WASHINGTON BLVD. NE 1010 SE 11TH AVE
SUITE 300 PORTLAND, OR 97214
KIRKLAND, WA 97033
Contact #: FAX 503 - 535 - 2620
Phone: 425 - 216 - 7600 PRI 503 - 234 - 9900
Reg #: LIC 203
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pin Rv 1/29/2007 $152.95
[BUILD] Permit Fee 3/2/2007 $235.30
[TAX] 8% State Surcha 3/2/2007 $18.82
[FLS] FLS Pin Rv 3/2/2007 $94.12
Total $501.19
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: jtee , Permittee Signature: t V • Cals---0"".
V ` r-1
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.
lks Comm / a .b Tenant im em sc Aci %s '/ c
P
Building Permit Application,
FOR oFFlcl USE ONLY
R eceived
ili City of Tigard DateiB / 42f 0 , 15 •!)D0 _0005
° 13125 SW Hall Blvd, Tigard, OR 97223 Plan Revie
t7' Phone: 503.639.4171 Fax: 503.598.19gAN / t � 2007 Date/B q - / - C3 Other Permit pi a77 177 -D00,-
I I G A It 17 Inspection Line: 503.639.4175 ,.- ' 1 Dale Ready/By tuns See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method Supplemental Information
RIIILDl DIVISION
TYPE OF WORK 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
'ddition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
13 I- and 2- family dwelling commercial /industrial Valuation S
El Accessory building ❑ Multi - family Number of bedrooms:
ID Master builder ❑ Other: Number of bathrooms
JOB SITE INFORMATION AND LOCATION Total number of floors
Job site address: 1 Ci Q SW -` 0I b t' 12•D New dwelling area square feet
City /State/ZIP: 1 1%%zryi N 0 . 0 (2, Garage /carport area: square feet
Suite/bldg. /apt. no : Project name: L s i.1,?...G Covered porch area: square feet
Cross street /directions to job site: E_ d 1 re_. On S on s\-Nee,}" 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.: I 51 34 F±C, 00 (1 0 V equipment, materials, labor, overhead, and the profit for the
DESCRIPTION 4-//���� WORK J� 1 work indicated on this application.
C I 51-f G co , -1 oc.03-C.. c1d'4 O�Y17�.hhe,s o,),(1 Valuation S ZED 000
t Existing building area 2_0 0 square feet
m IG�W O..Ve C11 JktS OVI e_43 n cl f LI
v r On Opole, New building area 4 9 square feet
❑ PROPERTY OWNER I 151,TENANT Number of stories' b Y1n O"1° 90
Nam e:(Le y..Wt tg. Ls3 1 atiQz 5 tip noxibC Type of construction: 3. Fs
Address: 58 0 -0 v
L� �. (1411>rt an a . )U� 30O Occupancy groups: Ut
City /State /ZIP: Ki t.. 4 cohd t l...J k C 033 Existing.
Phone' f..IZS 2i co - Q Fax: 2 li c - 1ci 0 Q New:
'a APPLICANT ELCONTACT PERSON NOTICE
Business name: ovjd eft- RI v G"- ne.ve.1 O9 tr1n�)..,1' All contractors and subcontractors are required to be
Contact name' 0..N-A W �e.>n S licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5 2, D OS R . jurisdiction in which work is being performed. If the
y1 0. �� applicant is exempt from lice sing, the following reasons
City / State/ZIP: r y�cl A "�
� O apply: S 1 I Se)... . q 5
Phone: 565 ] - 3q $C, I Fax:: ( ) -
E -mail: vI �S `I.'.sT 1 S ?It"t n)tie. . c,01,..,,,,
CONTRACT • R
Business name i. , ■ I l,t`■ i ' BUILDING PERMIT FEES* • var
Address• 1 (Please refer to fee schedule)
Structural plan review fee (or deposit)•
City / State/ZIP.
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application: / �� GfC
O rNoi ,
/ _- A? -0 1 Amount received:.
Authorized signature
LA.
J�. This permit application expires if a permit is not obtained
- 1 within 180 days after it has been accepted as complete.
" Print name A .1e.S ' W IQ. t S Date: i I 1, 01 • Fee methodology set by Tri- County Building Industry
Service Board.
I:\ Building \Permits\BUP- TI- PermitApp doc 03/23/06 440 -4613T(I I/02 /COM/WEB)
I
r
i
Building Division
P lan Submittal Reqem
• T I G A R D Commerci & Multi- Famil -New Addient tions oMatrix
o r 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 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System - ' ' - 2 ** .
•
Mechanical 2 ,
Plumbing (building fixtures) 2
Electrical i 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 \Permits \BUP -TI- PermitApp.doc 03/23/06
CITY OF TIGARD -
i' ' BUILDING DIVISION PERMIT #: BUP2007 -00051
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2/2007
Phone: (503) 639 -4171 414 A /
Inspection Requests (24 Hrs.): (503) 639 -4175 "'II
INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 99
SITE ADDRESS: 12390 SW SCFIOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: PP1893 - 057 LOT #: 002 TYPE OF USE:
PROJECT NAME: CLEARWIRE US LLC
DESCRIPTION: Monopole co- locate. Add 4 antennas, 4 micro dishes.
OWNER: CLEARWIRE WIRELESS BROADBAND, PHONE #: 426-216 -7600
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 - 234.9900
Inspection Request Scheduled For: Date: 5/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 048095.01 503-849-2053 N
Corrections /Comments/ Instructions:
I L 2-6 - Q — 06 6 (c ci — - t:.4..SLe_Q all
Lo ,4
S
J
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` 4-FaH s ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�t o
Inspector: Date: \7 i Phone #: (503) 718 -