Permit CITY OF TIGARD BUILDING PERMIT
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• COMMUNITY DEVELOPMENT Permit#: BUP2015 00187
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2015
Parcel: 1 S136CCO2100
Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HWY
Project: T-Mobile Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: Remove(6)panel antennas,add(3)panel antennas,remove(3)remote radios,add(3)radios with ancillary
equipment and cables.
Contractor: VERSACOM LP Owner: GRUNBAUM FAMILY TRUST
8111 LBJ FREEWAY, SUITE 1500 BY GRUNBAUM, HANS H AND MARILYN K,
DALLAS, OR 97251 21390 SW EDY RD
SHERWOOD,OR 97140
PHONE: 971-479-0202 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM Permit Fee-Additions,Alterations, 07/16/2015 $377.90
Class of Work: ALT Type of Const: IIB Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 07/16/2015 $45.35
Dwelling Units: 0 Plan Review 06/30/2015 $245.64
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 07/16/2015 $75.00
Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-LRP 07/16/2015 $11.00
Value: $20,000 Info Process/Archiving-Sm$0.50(up to 07/16/2015 $17.50
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $772.39
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 wit 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: Permittee Signature:
all 503.639.4175 by 7:00 a.m.for the next available inspection • te.
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 iiECEI'VEn 1 o Ill 11(1.1 1 tiL O\l 1
City of Tigard Received (P 2> �
Date/By: , Permit No.: j 4 096/5-ev f'7
• 13125 SW Hall Blvd.,Tigard,OR 97223, 0 Plan Re
s Phone: 503.718.2439 Fax: 503.598.19600 •0 2015 Date/B y: ��v. 6 Other Permit:
I t_ I D Inspection Line: 503.639.4175 Date Ready : : Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OFTIC A ,,IA Notified/Method: ,
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Supplemental Information
'f 4,7 � r c rru, e.( (Y7ntIs-st CAki let.
TYPE OF WORK
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:Modification equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I_and 2-family dwelling ®CommerciaUindustrial Valuation: $
❑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: 11744 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project narrt j-(r-t,:,t.l(4. Covered porch area: square feet
Cross street/directions to job site:OR-99W and SW Pacific Hwy Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: IS136CCO Lot no.:2100 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.:R284105 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Remove 6 panel antennas,add 3 panel antennas Valuation: $20,000
Remove 3 Remote Radios(TMA),add three radios with ancillary equipment Existing building area: square feet
and Cables New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 100'
Name:The Grunbaum Family Trust Type of construction: II-B
Address:21390 SE Edy Rd Occupancy groups:
City/State/ZIP:Sherwood,OR 97140 Existing: unmanned
Phone:( ) Fax:( ) New: unmanned
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:7'-Mobile (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Agent for T Mobi/Sandra Walden with Crown Castle
Address: 1505 Westlake Ave.,N Suite 800 FLS plan review fee(if applicable):
City/State/ZIP:Seattle,Washington 98109 Total fees due upon application:
Phone:(503)709-0820 Fax: :( )
Amount received: 377.90
E-mail:Sandra.walden(a�crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:1$$ V .-/?/ CL tj\ C)2 Li I.) Submit two(2)sets of roof plan with connection details
..D �7/ and fire department access,along with the 2010 Oregon
Address: R ) L� -1. y! 5 i ` b0 Solar Installation Specialty Code checklist.
q Permit fee(includes plan review
City/State/ZIP: //GS 'Cie I 1 and administrative fees): $180.00
Phone:(C(7ii `i T1 .... Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: k",..'Q ',Zli /yr/ Total fee due upon application: $201.60
Authorized signature: `��-.,��//J�1 This permit application expires if a permit is not obtained
: c;,/4,-( LLei"�Ii� 771( t within 180 days after it has been accepted as complete.
Print name:Sanci a Walden Date:6/26/1.5 * Fee methodology set by Tri County Building Industry
Service Board.
L\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
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City of Tigard
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COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: _-6 &.QUO/S-GO /q 7
Site Address: /R-1-7/1-1 NT LO 4,ae / ,),, Suite/Bldg#:
Project Name: - U
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /61P e/e f / 6(17 c19. F11D/ _ '42r ltrlkt2 4
Existing Business Activity: 6U4 e/f2C C ePpi t tae7/k . Thr_1
Proposed Business Activity: /1 /1 ../f C
35'Verify site address/suite# exists and active in permit syst .
Ag14.iver Terrace Nei hborhood: ❑ Yes i0 No
Wing: Ci-
Vrmitted Use: LYes ❑ No ❑ Spec VConfirm no land use required.
Business License:
Exists: (Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: _ i.. _� Date:
30 S~
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: t/o5o//S�
Site Plans: # 3
Building Plans: #
Building Permit#: lam nte�r building permit#above.
Workflow Routing. {Planning L-Permit Coordinator •EH3uildmg
Workflow Sign-off: EkSign-off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
l
By Permit Technician _� / DG �� Date: �p 'j/�
I:\Building\Fonns\BldgPermitRvw_COM_NoLand Use_070I I 5.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:
OK to Issue Permit
Approved by Permit Coordinator: Date: T7424://
I:\Building Worms\BldgPermitRvw_COM_NoLandUse_0701 I 5.docx
RECEIVED
JUN 3 0 2015 RECEIVED
COLD ' + l Nu JUN 2 4 2015
� t� CITY OF TIGARD
$11 Supplemental ue8li'Onnaire PLANNING/ENGINEERING
I I( \! I I City of Tigan4 13125 SW Hall B/AL,Ti OR 97223
Phone: 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 (824338 P01373B))
Property Address/Location of Collocation: 11744 SW Pacific Hwy,Tigard, Oregon 97223
Zone: C-G
Collocating antennas on: ® Existing tower ❑ Existing non-tower structure
Is this a new provider? ❑ Yes ® No
Ifyes,list other providers cunent/y,collocating on same tower or structure,if any::
If no,indicate the previous approval(SDR,MMD or BUP#): 61/P f 4.,° Oo 5
Height of antenna(s): 130 ft.
Color of antenna(s) and accommodating equipment(i.e. dishes):
white
Color of existing tower or structure: tower and antennas are not currently painted
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.)
sarnll radio equipment on the ground(FRLBs). See Drawings
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) ® No
Applicant's Signature: ..., / _ Date: 6/23/15
Name Printed: dra Walden -T-Mobile Agent Phone: 503-709-0820
FOR OFFICE USE ONLY
1StOK to issue ❑ Do not issue permit Refer to planner.
L'.... " --
--.--,_ -.1L!
Planning Staff Signature Date
t•\C URPLN\Masters\CoIlocatcAntennas.doc
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