Permit CITY OF TIGARD BUILDING PERMIT
114
COMMUNITY DEVELOPMENT
COMMUNITY BUP2015 00277
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2015
l Com. Et' g Parcel: 1S134BC00600
Jurisdiction: Tigard
Site address: 12390 SW SCHOLLS FERRY RD
Project: T Mobile Subdivision: 1993-057 PARTITION PLAT Lot: 2
Project Description: Installing(6)and removing(3)antennas. Removing and replacing other equipment. 1/3/17,REPRINTED to
change contractor to Excel Construction.
Contractor: EXCEL CONSTRUCTION INC Owner: THOMPSON, DENNIS C
35858 N HONEYMAN RD 9295 SW ELECTRIC ST
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503-944-9817 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 09/29/2015 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 09/29/2015 $45.35
Dwelling Units: 0 Plan Review 09/23/2015 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/29/2015 $8.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $20,000 Misc Administration Fee 01/03/2017 $45.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $722.39
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENT ON' Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 0 through•'R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
lssu d By: t / ` /u —� , Permittee Siature: t-n
Call 603.639.4176 by 7:00 a.m.for the next available inspe on date.
This permit card shall be kept in a conspicuous place on the job site u completion of the project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT J
111 Request for Permit Action
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-o' ov$
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: Crown Castle on behalf of T-Mobile
INVOICE TO: (Business or Individual)
Mailing Address: 1505 Westlake Ave N, Suite 800
City/State/Zip: Seattle,WA 98109
Phone No.: 206-336-2863
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
® REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: BUP2015-00277
Site Address or Parcel#: 12390 SCHOLLS FERRY RD
Project Name: T-MOBILE L700 PO03932D
Subdivision Name: 1993-057 PARTITION PLAT Lot#: 2
EXPLANATION: Changing GC to EXCEL CCB#164432
Signature: J )
$n %i°� T,Q Date: 12/29/2016
Amelia Meckler, Crown Castle on behalf of
Print Name: T-Mobile
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
CITY OF TIGARD BUILDING PERMIT
f ' COMMUNITY DEVELOPMENT Permit#: BUP2015-00277
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2015
Parcel: 1 S134BC00600
Jurisdiction: Tigard
Site address: 12390 SW SCHOLLS FERRY RD
Project: T Mobile Subdivision: 1993-057 PARTITION PLAT Lot: 2
Project Description: Installing(6)and removing(3)antennas. Removing and replacing other equipment.
Contractor: MYCOM NORTH AMERICA INC Owner: THOMPSON, DENNIS C
1080 HOLCOME BRIDGE RD BLDG 200 ST 350 9295 SW ELECTRIC ST
ROSWELL, GA 30076 TIGARD, OR 97223
PHONE: 503-720-1110 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 09/29/2015 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 09/29/2015 $45.35
Dwelling Units: 0 Plan Review 09/23/2015 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/29/2015 $8.50
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 $677.39
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
952-001-0 rough O•• •52-00 -4090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. • • .800.332.2344.
Issue By: I 0 4 ) i Permittee Signature: ,.`
Call 503.639.4175 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.
To: Community Development/Planning Page 2 of 2 2015-09-17 21:26:47(GMT) R C E(X �J rah Shields
SE PP 17� 2015
City of Tigard CITY OF TIGARD
~ > > PLANNING ENGINEERING
• _ '4c CO:�1Ril'Ni 1•Y DEVELOPMENT DEPARTMENT PLANNING/
ENGINEERING
,,` Collocation - Supplemental Questionnaire
PROPERTY ADDRESS X i O k' nu 1 1 } i ,t (1\1
Location of collocation: 124614 SW SCHOLLS FERRY RD /^
TMoil le 90 zone:
Name of provider: ------____- -- --
X Approved
Contact name: Naida Khan naida @nwpermit.com N,,r Arprow.l
Collocating antennas on: II fi cisting lower B- .01 4 I):cte• L�! 7/41
❑ L:ustiug non-tower structure Reason nor ;ppmNed.
Is this a n..w provider?: ❑ Yes
I No
Other providers currently collocating on same tower or structure: +-N/A
05
BUP2002-00249 ^"°s° ^ -m^ M ::9=o=1
Indicate the previous approval:_ — _- _ ___
(Spirt,MMI#)
ANTENNA INFORMATION 'Antennas are located
Existing: New: inside cannisters.
Height of antenna(s): 45 (sq.ft.) Height of antenna(s): 45' (sq.ft.)
Color of antenna(s): Color of antenna(s):
Color of equipment: gray cannister Color of equipment: light gray cannister
.\ccommodating equipment•. _lccorwnodaring equipment: _ _ _ _ _ _
(i.e.dishes) (i.c.dishes)
\Fill new accessory equipment be installed?: 01 \'c..
❑ No
I,ocatic;n of new accessory equipmen;?: ❑ Within prtvioush approvkd fenced area
Within existing structure
❑ Other location:
(please describe.)
\X ill landscaping b..rernovc.d to accommodate the accessory equipment?: ❑ \'es(please describe blow)
B No
Naida Khan _ Naida Khan Sept. 17, 2015
Applicant's signature Prim name Dare— --
City Of Tigard • 13125 S/( Hall Blvd. • "1:gard,Oregon 97213 • wwwrigird-or.gov • 50-718-241i • Page l orb
Building Permit Application
Commercial FOK(11 I.1( I I `,1 )"I 1
Rece
City of Tigard Dare ived: / "M Perroit No.: G at,
_ • 13125 SW Hall Blvd.,Tigard,OR 97223 E`vED Plan R e ���
Phone: 503.718.2439 Fax: 503.598.l r(11`r v G Date/B : A�Ist �� Other Permit
TIGARD
Inspection Line: 503.639.4175 G�,/ Date Rea.'"W' lens: 65 See Page 2 for
Internet: www.tigard-or.gov rt(11C� Notified/Method 9 Vs—fig)" -- Supplemental Information
SEP 21 LU (0 I NcLi 4,
TYPE OF WORK F.�Gp,�D REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ ► ,
"V.vv,...G roslor4 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacementer: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling El Commercial/industrial
Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ®Other:collocation Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12390 SW SCHOLLS FERRY RD New dwelling area: square feet
City/State/ZIP:TIGARD OR 97223 1-mC‘.u. Garage/carport area: square feet
Suite/bldg./apt.no.: Project names GRtee BU#824347 Covered porch area: square feet
Cross street/directions to job site:SW Scholls Ferry Rd&SW North Dakota St 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.: 1S134BC00600 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Install 1 FBBC.Install 3 new FRLB.Remove 3 antennas.Install 6 antennas. Valuation: $$20,000.00
Remove 1 FSME and 3 FRIA.Remove 6 TMAs,Install 3 TMAs and 3 diplexers. Existing building area: square feet
Remove 2 FRP canisters Install 2 RFP canisters.Install pipe mast with unistruts New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:WILLIAM G.&DIXIE L.DAVIDSON Type of construction:
Address:8915 SW COMMERCIAL ST Occupancy groups:
City/State/ZIP:TIGARD,OR 97223 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Northwest Permit agent for T-Mobile,through Crown (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Naida Khan
FLS plan review fee(if applicable):
Address:9808 31st St SE
Total fees due upon application:
City/State/ZIP:Everett WA 98208
Amount received:
Phone:(360)945-2787 Fax: :(888)400-0383
E-mail:naida @nwpermit.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:MyCOM North America Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:1080 Holcome Bridge Rd.,Bldg 200,ST 350 Solar Installation Specialty Code checklist.
City/State/ZIP:Roswell,GA 30076 Permit fee(includes plan review
S180.00
and administrative fees):
Phone:(503)720-1110 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:1963333/yto Total fee due upon application: $201.60
Authorized sign • - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:6k'.1A ,�,,.1 f h Date: q. 6,15--- ` Fee methodology set by Tri-County Building Industry
v`^" " '► / Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(l 1/02/COM/WEB)
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12390 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Record Type:
Commercial - Building
Inspection Type:
299 Final inspection
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
BUP2015-00277
Inspector:
Chip Barnett
Contractor