Permit CITY OF TIGARD BUILDING PERMIT
i ■ COMMUNITY DEVELOPMENT BUILDING
BUP2014-00020
TI G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2014
Parcel: 2S11313000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Verizon Wireless Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Modifying antennas.
Contractor: T3 CONSTRUCTION LLC Owner: CLEAN WATER SERVICES
1520 AUSTIN RD 2550 SW HILLSBORO HWY
ROSEBURG, OR 97471 HILLSBORO, OR 97123
PHONE: 541-673-4377 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 01/27/2014 $256.22
Demolition
Occupancy Grp: Occupancy Load: 12%State Surcharge-Building 01/27/2014 $30.75
Dwelling Units: 0 Plan Review 01/27/2014 $166.54
Stories: 0 Height: 0 ft Info Process/Archiving-Lg$2.00(over 01/27/2014 $6.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $12,000 Info Process/Archiving-Sm$0.50(up to 01/27/2014 $6.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $465.51
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 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C=nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. • 987 or 1.800.33 44.
Issued By: Permittee Signature:
5 by 7:00 a.m.for the next available inspe6tion date. /
This permit card shall be kept in a conspicuous place on the job site until comple .• of the project
Approved plans are required on the job site at the time of each ins•ection.
Building Permit Application ,--,
Commercial �.' yf'' FOQR OFFICE USE ONLY
III City of Tigard DateeBy� % �31t1 /� ! ) Permit No.:" 13125 SW Hall Blvd.,Tigard,OR 97OCV
O°� Plan Review / / �G/`x��0 �
. Phone: 503.718.2439 Fax: 503.598.1960 p��- A Date/By: p ,/ g.,Agh 11 der Permit:
T I G A R D Inspection Line: 503.639.4175 \t�� Y �1s�v ate Ready/13y: kris: See Page 2 for
Internet: www.tigard-or.gov JY` ,IN (1° otified/Method:y/it jsi a 7. Supplemental Information
4) .∎pi t w of A.ACI
TYPE OF WORK ' `Ait'0{"'' . 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
®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 ®Commercial/industrial Valuation: $12,000
❑Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16580 SW 85TH AVE New dwelling area: square feet
City/State/ZIP:PORTLAND,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name Covered porch area: square feet
Cross street/directions to job site:SW DURHAM RD&SW 85t°Ave Deck area: square feet
Wireless facility on school rooftop. Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 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.
Modifying antennas and related equipment per enclosed plans. Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name:Verizon Wireless(VAW),LLC d/b/a Verizon Wireless Type of construction:
Address:5430 NE 122"Ave Occupancy groups:
City/State/ZIP:Portland,OR 97230 Existing:
Phone:(503)208-5319 Fax:( ) New
❑ APPLICANT IN CONTACT PERSON BUILDING PERMIT FEES*
Business name:Black Rock Consulting (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Brandon Clower
FLS plan review fee(if applicable):
Address:5505 SE Tolman St
Total fees due upon application:
City/State/ZIP:Portland,OR 97206 [
Phone:(503)208-5319 Fax::( ) Amount received: ,$` 6 5 5'I
E-mail:dbrandonclower@gmaiLcom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business namf .B B T3 �7 S j--(�` Le-C._ Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: L 7-40 '-t-s-11 - Solar Installation Specialty Code checklist.
City/State/ZIP: Root. Permit fee(includes plan review $180.00
b ° 0� )di 7/ and administrative fees):
Phone:(5y,tj ) 0 7 3,11 7 Fax:( ) _ State surcharge(12%of permit fee): $21.60
CCB lic.: t ?Co `
rjlo Total fee due upon application: $201.60
Authorized signature This permit application expires if a permit is not obtained
"e,--- within 180 days after it has been accepted as complete.
Print name:D.Brandon Clower Date: 1/21/14 * Fee methodology set by Tri-County Building Industry
Service Board.
L\Building\Permits\BUP-COM PermitApp.doc 0224/2011 440-4613T(11/02/COM/WEB)
Building Permit Number: 9 ,Rp 1 y—ujAO
i1Bui1 "
lding Permit Review
Commercial Project — No Associated Land Use Case
TIGARD
Site Address: /65,5t Sc,J g',5 ',n
O Verify site address is valid.
i, Project Name : vci 2*/i UJ,.cr (ems
on
3, Planning Review ���
Proposal: R t7C1G l.Q a tiC innaS and ref o ce V thi Li- Gj l { Add 3 12-RS Ct nci
t � SU)' Ci S1,102 n°-SSPI'
I2/Zoning: VYes 1-17❑ Permitted Use ❑ o El Spec Space
1 .6 ❑ Land Use Required ❑ Yes No
p c Notes:
t
1 z
a. Approved by: '/ / C Date: .211C/ILI-
'
Revisions (after Building Submittal only) Reviewer Date
4 Revision 1 Approved ❑ Not Approved ❑
4 ,,\1 Revision 2 Approved El Not Approved CI.t.
Revision 3 Approved CI Not Approved ❑
3►
Building Permit Submittal
Original Plan Submittal: Date: 0 3/>h d.T By: e17.
Site Plans: # 3
Building Plans: # ,3____
Create Case Record#: Ent r case# above for Building Permit Number.
Workflow Routing: PYPlanning ❑ Engineering ❑ Permit Coordinator lg-i$uilding
Workflow Sign-off: ❑ Sign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: ❑ Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: Date:
Notes:
l:\Building\Forms\BldgPermitRvw_COM_NoLandUse_123013.docx
COLLOCATION
RECEIVED
Supplemental Questionnaire FEB 1,0 2014
TIGARD Go,of Tiaanrt, 13125 SW Hall Blvd,Tigard,OR 97223
CITY OF TIGARD
Nome: 503.718.2421 Fax 503.598.1960 PLANNING/ENGINEERING
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: Verizon Wireless
Property Address/Location of Collocation: 16580 SW 85TH AVE,Portland,OR 97224
Zone:
Collocating antennas on: ❑ Existing tower ® Existing non-tower structure
Is this a new provider? ❑ Yes ® No
If'yes, list other providers currently collocating on same tower or structure,jog:
n/a
If no, indicate the previous approval(SDR,MMD or BUP#): _ (,/'
Height of antenna(s): 63 ft. 2D114 ^ 00026)
Color of antenna(s) and accommodating equipment(i.e. dishes):
Light Gray. -No Change
Color of existing tower or structure: Building is white/beige. Equipment-Light Gray.
Will new accessory equipment be installed? ® Yes ❑ No
Ifyes,please answer the following..
Location of accessory equipment ❑ Within fenced 4rea previously approved
® Within existingistructure
❑ Other location rPkase describe below.)
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below:) ® No
Applicant's Signature: �s�/ Date: 2/7/14
Name Printed: D Brandon Clower Phone: 503-208-5319
FOR OFFICE USE ONLY
to issue permit. ❑ Do not issue permit. Refer to planner.
P g Staff Signature ate
1:\CU RP1 N\Mastets\CollocatcAntennas.dac
January 21, 2014
VIA US Post Priority Mail
City of Tigard
Attn: Permit Center Building
13125 SW Hall Blvd
Tigard, OR 97223
RE: Verizon Wireless Site at 16580 SW 85th Ave, Portland, OR/ POR Tigers HS
To whom it may concern:
I am making this submittal to obtain a building permit from your jurisdiction for Verizon Wireless'
wireless communications facility(antenna on rooftop) located at the address above. All specifics are
included in the plans.
Building Permit Submittal:
1. Check in the amount of$465.51 ($453.51 Submittal Fee+$2/pg Archiving Fee for CDs)
2. Building Permit application.
3. Three (3) sets of 11"x17" drawing set (all wet stamped).
4. Three (3) sets of structural analysis (all wet stamped).
Please return a receipt for the check via email as a PDF to dbrandonclower @gmail.com. If you have any
questions I can be reached at 503-208-5319.
Sincerely,
on Clower
Representing Verizon Wireless
503-208-5319
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16580 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Building
299 Final inspection
PASS - No C of O
May 23, 2014 at 9:05:14 AM
BUP2014-00020
Chip Barnett
Violation Summary:
Inspector Contractor