Permit 1CITY OF TIGARD BUILDING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: BUP2014-00242
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2015
Parcel: 1 S134BC00900
Jurisdiction: Tigard
Site address: 12394 SW SCHOLLS FERRY RD
Project: T-Mobile Subdivision: 1993-058 PARTITION PLAT Lot: 3
Project Description: Replace(6)antennas with(6)new antennas.
Contractor: HPS CONSTRUCTION INC Owner: DAVIDSONS TIGARD SUV LLC
598 BASELINE 8915 SW COMMERCIAL ST
PO BOX 890 TIGARD, OR 97223
CORNELIUS,OR 97113
PHONE: 503-357-4217 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR T Permit Fee-Additions,Alterations, 02/11/2015 $453.95
ype of Const: Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 02/11/2015 $54.47
Dwelling Units: 0 Plan Review 10/21/2014 $295.07
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 02/11/2015 $12.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $25,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $815.99
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 Center. 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 503.232.1987 or 1.800.332.2344.
Issued By: ` rmittee Signature:
� r
.4175 by 7:00 a.m.for the next available inspection date.
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 Application
Commercial ■R� FOR(A__'OFFICE USE.O\I.1
IICity of Tigard ■ ( Date/13y: /0 " /4( ,,c�j Permit No.: 4 �ap�' - ')���
• 13125 SW Hall Blvd.,Tigard, V Plan Re w
i Phone: 503.718.2439 Fax: 503.5{ Date/By Other Permit:
Inspection Line: 503.639.4175 uET-2 1 2014
Date Read ���Z �� �u�s
TIGARD
y y / 0 SeePage2for
Internet: www.tigard-or.gov NotifiedMedrod. ��/di//.f .9D---
Supplemental Information
GOOF TIGARD miNifti0101WWW 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.
❑ 1-and 2-family dwelling Valuation: S
®Commercial/industrial
❑Accessory building ❑Multi-family
Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12394 SW Scholls Ferry Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:T-Mobile/Greenway Covered porch area: square feet
Cross street/directions to job site: SW 121st Deck area: square feet
Barber to SW Schools Ferry Road, 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.: 151346C0090(1 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.
Replace 6 antennas with 6 new antennas. The antennas will be within a new steal Valuation: $$25,000.00
Existing building area: 100 square feet
New building area: N/A square feet
® PROPERTY OWNER ❑ TENANT Number of stories: N/A
Name:William and Dixie Davidson Type of construction: U
Address:8915 SW Commercial Street Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer b fee schedale)
Business name:T-Mobile
Structural plan review fee(or deposit):
Contact name:Mike Unger
Address:6224 SE 18`"Ave FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: Portland,OR 97202
Amount received: /5( _ tY'T•
Phone:(206)604-5538 Fax: :( )
E-mail: mungeNa;odtlia.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive instal ation of
CONTRACTOR roof-to. r ounted PhotoVoltaic Solar P:• ystem.
Business name:TBD /1- / sivvt , Submit two ' • s of roof plan ". connection details
's��, and fire departme ' cess,al• :with the 2010 Oregon
Address: J .I e e Solar Installation Speciar.• ..• checklist.
Permit fee(I • 1 des plan - .ew
City/State/ZIP: lL� �
'iT S 9 7//� :•. administrative fees . $180.00
Phone:(s-i ) 7.r GE}
' 1 Fax:( ) States •charge(12%of permit fee): $21.60
CCB lie.:
153 Total fee due upon application: $201.60
Authorized signature:�� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1 Date: * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
RECEI VED
OCT 21 2014
is COLLOCATION CITYO�BARD
Supplemental Questionnaire
Buitnkr4 rwfmo
T I G A R D of i tani.1 i!_S sir yM�ad,OR 97:23
Moor: 503.-18.2121 1•:r: 503.391.1960
IF YOU ARE APPLYING FOR AR MIN'TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORM.\TIO\ BELOW.
Name of Provider: T Mobile
Property.Address/Location of Collocation: 12394 SW Scholl's Ferret ltd. —
Zone: C-G
Collocating antennas on: ❑ Existing tower ® Existing non-tower structure
Is this a new provider? ❑ Yee ® No
IfjYs,Iii/Ober prwiders drm'nIL 0110alill O/:s,are,fewer or strm'tarr,if tug:
N/A
I/'no.i,di.ate the pmvnns approrrd(Wit,.1118)or bL'P#): MMD2002-00016
Height of anteasna(s): 44 ft.
Color of antenna(s)and accommodating equipment(i.e.dishes):
Off white ---
Color of existing tower or structure: Off white _
Will new accessory equipment be installer'? ® Yes ❑ No
Ifyes.pkiue anise:rJGefolonin,e:
Location of accessory equipment: ❑ Within fenced area previt iusly appro ell
® Within existing structure
❑ Other location(Pkaie describe below.)
The additional 7't1:1s will be located within the proposed shroud. _
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes(Please dri ribe below.) ® No
Applicant's Signature: Date: C 2, /
Name Printed: g4,145 CcN Phone: O — —cS acs
— —-- — FOR O FFICE USE ONLY
® OK to issue permit. ❑ Do not issue permit. Refer to planner.
. CetwA.w '/q/,4
Planning Staff Signature Date
I: <:.'RPI.r!.`•Sastcrt\eilli cu.
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