Permit rt CITY OF TIGARD BUILDING PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: BUP2015-00182
TICiARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2015
Parcel: 25101 DD00800
Jurisdiction: Tigard
Site address: 14020 SW 72ND AVE
Project: T-Mobile Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Remove(9)antenna panels and add(3)antenna panels. Remove(6)radios and add(3)ground mounted radios
with ancillary equipment.
Contractor: VERSACOM LP Owner: I S PROPERTIES LP
8111 LBJ FREEWAY, SUITE 1500 BY FISCHER&COMPANY URI
DALLAS, OR 97251 GALLERIA NORTH TOWER II
13727 NOEL RD, STE 900
DALLAS,TX 75240
PHONE: 971-479-0202 PHONE.
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 07/16/2015 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 06/25/2015 $45.35
Dwelling Units: 0 Plan Review 06/25/2015 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 07/16/2015 $12.50
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 $681.39
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: i •. • -: Signature:
—
C.' 4175 by 7:00 a.m.for the next available in .ection •ate.
This permit card shall be kept in a conspicuous place on the job site completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Building Permit Application
Commercial R R!/ !! FOR OFFICI I sr O\I 1
III City of Tigard , ` I �( ® Date/B i > rte) Permit No.: P 5 g
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 N 2 y O, Date/By. I.5 Other Permit:
I;I> Inspection Line: 503.639.4175 2015 Date ReadyBy: '7 / Q Jar,, ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: //�//5 z �� Supplemental Information
CITY OF TIGARD ff
tfk
BUILDING Dt /IS:ON ' ""''1"l,5�...�7, G..l,/-c.,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
E]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:Modification 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: $
El 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: 14020 SW 72"d Ave New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:TMO 1700 824674 P001316D Covered porch area: square feet
Cross street/directions to job site: Hwy 214&72m1 Ave Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.:$0450003 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Remove 9 panel antennas,add 3 panel antennas Valuation: $20,000
Remove 6 Remote Radios,add three gound mounted radios with ancillary equipment Existing building area: square feet
and Cables New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 100'
Name:1-S Properties L.P. Type of construction: II-B
Address:PO Box 87908 Occupancy groups:
City/State/ZIP:Vancouver,WA 98687 Existing: unmanned
Phone:( ) Fax:( ) New: unmanned
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:T-Mobile
Structural plan review fee(or deposit):
Contact name:Agent for T-Mobi/Sandra Walden with Crown Castle
FLS plan review fee(if applicable):
Address: 1505 Westlake Ave.,N Suite 800
City/State/ZIP:Seattle,Washington 98109 Total fees due upon application:
Phone:(503)709-0820 Fax: :( )
Amount received: 377.90
E-mail:Sandra.walden @crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: ,/ p S,.� 16-,A,l 7, �6---)0� Submit two(2)sets of roof plan with connection details
Y Ls and fire department access,along with the 2010 Oregon
Address: &//I i e1.7 /�Q.,in y , Sol 7r /S?)�� Solar Installation Specialty Code checklist.
City/State/ZIP: ��✓ Permit fee(includes plan review
Y ��� 1 (>� 7�� / $180.00
l and administrative fees):
Phone:(y7).,) 7c51 —e9 Y Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 20 7z2-7 Total fee due upon application: $201.60
Authorized signature: , permit application expires if a permit is not obtained
jithin 180 days after it has been accepted as complete.
Print name:Sand en GC.� Date:6/25/15 * 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)
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
►c,nri� Building Permit Review — Commercial - No Land Use
Building Permit #: /)C,{,i0 p9-01 S— 00 1 $a-
Site Address: 11 010 c w 12 n ( cv-L Suite/Bldg#:
Project Name:
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: G2A.I S t te, - -&n 0 re— q 100 i' ik. GI r + - ri li1..) r act ct 3
A Y)jf n c J
Existing Business Activity: 'Q_,k l S h yi.) CCU.. �f
Proposed Business Activity: 1/ y
V ify site address/suite#exists and active in permit system.
'- B aver Terrace Plan District ❑ Yes —$'No
X Zoning: 1 L
f7Permitted Use: ,Yes ❑ No ❑ Spec Space ,n V P t q _D 00 2 -2._/p Confirm no land use required. 1�
Business License:
Exists: ❑ Yes El No,applicant notified to obtain business license
Notes:
Approved by Planning: / c 0 ViZe"._ ,I a Date: G /2s/is
Revisions (after Building Submittal only) Reviewer Date
Revision 1: Cl Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: Leas/I.C—.
Site Plans: #
Building Plans: # 4—
Building Permit#: .12"rnter building permit#above.
Workflow Routing. anning 2 Permit Coordinator Building
Workflow Sign-off: Sj -off for Planning(include notes from planning review)
Route Application Documents: Btuil' ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 6', oto Date: 64 SY/
I:1Building\Forms\BldgPermitRvw_COM NoLandUse 031015.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
J'OK to Issue Permit ' , y
Approved by Permit Coordinator: C'' X" �cw nc.4--/ Date: (o
/1-1N-e-tyl't:sociasi.}ALb-
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse 031015.docx
RRCE ViD
COLLOCATION JUN 2 4 : pj5
Supplemental Questionnaire CITY OF TIGARD
PLANNING/ENGINEERING
( I(,:\I;. Ci
I) t7 of Tigarr4 13125 SW Hall Bird,Tigard,OR 97223
Phase: 503.718.2421 Fax 503.598.1960
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider. T-Mobile (824674-P001316D)
Property Address/Location of Collocation: 14020 SW 72nd Ave.,Tigard,Oregon 97224
Zone: I-L
Collocating antennas on: ® Existing tower ❑ Existing non-tower structure
Is this a new provider? ❑ Yes ® No
Ifyes, list other providers currently collocating on same totter or structure,if any:
If no, indicate the previous approval(SDR,MAID or BUP#): 6i/A 20/z--- - e)00 2c
Height of antenna(s): 128 ft.
Color of antenna(s) and accommodating equipment(i.e.dishes):
Antennas to be painted to match the existing antennas (if currently painted)
Color of existing tower or structure: can't tell from photo,will be GC responsibility
Will new accessory equipment be installed? ® Yes ® No
Ifyes,please answer the following:
Location of accessory equipment ® Within fenced area previously approved
❑ Within existing structure
❑ Other location (Please describe below.)
new baseband module and remote radios with diplexers,see drawings
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) ® No
Applicant's Signature: ..„,,, _ ti, Date: 6/23/15
AMP ti.
Name Printed: Walden -T-Mobile Agent Phone: 503-709-0820
FOR OFFICE USE ONLY
piOK t issue pit ❑ Do not issue permit Refer to planner.
Planning Staff Signature Date
I\CURPI.N\Haste\ColkxatrAnrermas.doc
h ■.
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
14020 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00182
Jeff Grove
Violation Summary:
Inspector Contractor