Permit CITY OF TIGARD BUILDING PERMIT
311 COMMUNITY DEVELOPMENT Permit #: BUP2012 -00215
T!GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2013
Parcel: 1 S135BB00300
Jurisdiction: Tigard
Site address: 10185 SW CASCADE AVE
Project: T- Mobile Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: Modification of existing cell tower. No collocations.
Contractor: LEGACY WIRELESS SERVICES INC Owner: PORTLAND GENERAL ELECTIC COMPANY
15580 SE FOR MOR CT 121 SW SALMON ST
CLACKAMAS, OR 97015 PORTLAND, OR 97204
PHONE: 503 - 656 -5300 PHONE
FAX: 503 - 656 -5305
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee - Additions, Alterations, 04/03/2013 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12% State Surcharge - Building 04/03/2013 $45.35
Dwelling Units: 0 Plan Review 10/31/2012 $245.64
Stories: 0 Height: 0 ft Info Process /Archiving - Sm $0.50 (up to 04/03/2013 $32.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $20,000
Floor Areas:
Total Area 0
Accessory Struct: 0
Basement 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $700.89
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty • - • - applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days : issu- -- or if work is s. 'ended for more the 180
days. ATTE r- • • • law requires you to follow the rules adopted by the Oregon Utility ■otification Center. • •se rules s t forth in OAR
952 -001- 0 through OAR 95 •01 -r• • u may obtain a copy of the rules or direct questions to OUNC • calling 503.232.19:7 or 1.:. •.
Issue By: / /a�- �'2.�f Permittee Signature: _�� / = �'
• Call 503.639.4175 by 7:00 a.m. for the next available inspection d. e.
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.
Building Permit Applicat'
Commercial C EI V ED
CI of Tigard g Received Permit No
ii •
�J .0-CT i7 1 2012 Date/By: <// / A /29.04 a is
13125 SW Hall Blvd., Tigard, OR 97, Review ►
s Phone: 503.718.2439 Fax: 503.5 �' ^ • ^ ^ Date/By: ' I 1` -2___. Other Permit:
T ci n It I) Inspection Line: 503.639 ` r IUIKXJ Date Ready :y: Juris: H See Page 2 for
Internet: www.tigard- or.gov BUILDING �l7 �fISION Notified/Method. ( A / Supplemental Information
V V �� DIVISION 1 . /u, �i�QB
TYPE OF WORK RE TIRED 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
® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ® Other: W'CF Colo Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10185 SW Cascade Avenue New dwelling area: square feet
City /State /ZIP: Tigard, OR 97008 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: PO01339B Tigard Covered porch area: square feet
Cross street/directions to job site: From OR -217 to Greenburg Rd Exit, turn Deck area: square feet
Left onto Greenburg, turn right onto Cascade Blvd, site on left. 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.
Tax map /parcel no.: 1S 135BR 00300 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.
Swap 6 antenna with 6 new antenna along with 5 Radio Remote Units, 1 Hybrid Valuation: $20,000
cable and 2 COVP units. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Crown Castle Type of construction:
Address: 6547 154 Ave NE Occupancy groups:
City /State /ZIP: Redmond, WA 98052 Existing:
Phone: (425)202 -2774 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: T- Mobile West, LLC (Please refer ro fee schedule)
Structural plan review fee (or deposit):
Contact name: Mary Frosch
FLS plan review fee (if applicable):
Address: 8960 Alderwood, NE
Total fees due upon application:
City /State /ZIP: Portland, OR 97220
Phone: (503) 250 -4639 Fax: : ( ) Amount received:
E -mail: Mary.Froschl @T- Mobile.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
4 Commercial and residential prescriptive installation of
;Q CONTRACTOR ,, roof -top mounted Photo Voltaic Solar Panel System.
Business name: T // W l .¢_[_D Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City /State/ZIP: Permit fee (includes plan review $180.00
and administrative fees):
Phone: ( ) Fax: ( State surcharge (12% of permit fee): $21.60
CCB lie.: /SP
3 • /�� 5 Total fee due upon application: $201.60
Authorized signature: fi e This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Mary Frosch . Date: * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 02/24/2011 440-461 3T(I 1 /02 /COM/WEB)