Permit y V CITY OF TIGARD BUILDING PERMIT
r'! COMMUNITY DEVELOPMENT Permit #: BUP2012 00216
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
Parcel: 251060000100
Jurisdiction: TIGARD
Site address: 16705 SW FRIENDLY LN
Project: T- Mobile Subdivision: 2002 -032 PARTITION PLAT Lot: 3
Project Description: Modification of existing cell tower. No collocations.
Contractor: NORTHWEST INSTALLATION & COMMISSIONING LL Owner: RALSTON, CHRISTOPHER J & SHERI L
PO BOX 991 21029 SW LEBEAU RD
SPOKANE, WA 99210 SHERWOOD, OR 97140
PHONE: 509 - 981 -5565 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee - Additions, Alterations, 06/20/2013 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12% State Surcharge - Building 06/20/2013 $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 06/20/2013 $13.00
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 $681.89
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 Codes and all other applicable law. All work will
be done in a • • - nce with 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
days. • NTION: Or-!on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -- • 1 -0010 through OAR '52-.: -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I sued By: Permittee Signature:
/At"
•
Call 503.639.4175 by 7:00 a.m. for the next available Inspe •'date.
This permit card shall be kept In a conspicuous place on the Job site un ompletion of the project.
Approved plans are required on the Job site at the time of each Inspection.
■
Building Permit Application
Commercial RECEIVE
FOR OFFICE USE ONLY
Ci of Ti an Re ceived , Permit No.:
tY g Date/B : /O��. / ? a42/ ° 13125 SW Hall Blvd., Tigard, OR 97223 OCT Plan Review �//
Phone: 503.718.2439 Fax: 503.598.1960 31 2012 Date/B : A/,f�� ®IM Other Permit:
-
f I L.,1 R U Inspection Line: 503.639.4175 n '`�'� Date Read . ® See Page 2 for
Internet: www.tigard - or.gov VI f OF MARI) Notified/Meth.d: / . maim Supplemental Information
■ 11 In, ICI l ° ,. v 7?J,!! ! / L7.����T .
• .
TYPE OF WORK RE 1,f RED 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.
El 1- and 2- family dwelling El Commercial /industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ® Other: WCF Colo Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16705 SW Friendly Lane New dwelling area: square feet
City /State /ZIP: Tigard, OR 97007 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: PO01733D Scholls Ferry Covered porch area: square feet
Cross street/directions to job site: From OR -99 turn right onto Bull Mtn Rd, Deck area: square feet
then turn right onto SW Roy Rogers, turn right onto Friendly Lane, site on Left Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Bull Mountain I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S1060000100 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 3 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: Christopher Ralston Type of construction:
Address: 14900 SW 150 Occupancy groups:
City /State /ZIP: Tigard, OR 97007 Existing:
Phone: ( ) 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*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
r . / ° Submit two (2) sets of roof plan with connection details
Business name: `l �/�f�li jg5?", //VS�G/ U /J ° ��Dl`/ / /OIV� ,' () P
an fire department access, along with the 2010 Oregon
Address: Po 66,t, (l? Solar Installation Specialty Code checklist.
City /State /ZIP: p koi-/J to 5 F9.y Permit fee (includes plan review $180.00
SS and administrative fees):
Phone: (599) �j'f1 - 5 -5 6 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB tic.: i a, 2,- gJ. Total fee due upon application: $201.60
Authorized signature: �� %�' 'tom This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Mary Fro ch Date: * Fee methodology set by Tri -County Building Industry
- Service Board.
I:\Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM/WEB)