Permit n CITY OF TIGARD BUILDING PERMIT
B - COMMUNITY DEVELOPMENT Permit#: BUP2016 00045
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2016
Parcel: 1S136AD06300
Jurisdiction: Tigard
Site address: 10955 SW 65TH AVE
Project: AT&T Subdivision: None Lot: None
Project Description: Modification to existing tower:Replace(5)antenna,install(1)LTE WCS antenna,(6)RRH,(1)DC surge
suppressor,(1)fiber&(2)DC cables.Modification to ground equipment: Install 2C radio in LTE rack,(1)string
batteries (1)rectifier.
Contractor: VELOCITEL INC Owner: PORTLAND GENERAL ELECTRIC COMPAN
4004 KRUSE WAY PL, SUITE 220 121 SW SALMON ST
LAKE OSWEGO, OR 97035 PORTLAND, OR 97204
PHONE: 503-636-2500 PHONE:
FAX: 503-636-2501
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 02/09/2016 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 02/09/2016 $54.47
Dwelling Units: 0 Plan Review 02/09/2016 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 03/09/2016 $88.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 03/09/2016 $22.50
Value: $25,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $913.99
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. ATTE IAPB •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 10 through 0•- 952-00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: / AtF Permittee Signature: (vim 54/6--
inspection
\ Call 503.639.4175 by 7:00 a.m.for the next available datt
e.
This permit card shall be kept in a conspicuousplace on the site until completionr
p p jobof the project.
Approved plans are required on the job site at the time of each inspection.
;Building Permit Application
Commercial - FOR OFFICE ISE O\l.l
sL� FOR
„ ��/1
114 City of Tigard Q 0 f.:"L")(24, Permit No.:t '�y� Zi 13125 SW Hall Blvd.,Tigard,OR 9722 C9 C Plaan Revie +� �'`Phone: 503.718.2439 Fax: 503.598.19766.0 O U Date/By - I(.. Other Permit:
I 1 i I t Inspection Line: 503.639.4175 ! a� Date Re j Juris: Ei See Page 2 for
Internet: www.tigard-or.gov CITY OE TI ARD Notified/Methodd 3/s2 /6 I Supplemental Information
1� " aa .,« i44,u ,. H TiYIP,E 'W ,di i` ry4,4,, . Print name:Dan Dutton
❑New construction ❑Demolition REQUIRED DATA 1 AND 2-FAMILY DWELLING
®Addition/alteration/replacement ❑Other: it fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
,` ; i `” ' A-... OR OF,CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
r
❑ 1-and 2-family dwelling ®Commercial/industrial work indicated on this application.
❑Accessory building ❑Multi-family Valuation: $
❑Master builder ®Other:Wireless Number of bedrooms:
'`) ,, ,,,,i,-..,,,j„JOB',SITE•INFQRMA.TION ANDLOCATION - Number of bathrooms:
Job site address: 10955 SW 656 Ave Total number of floors:
City/State/ZIP:Tigard,OR 97223 New dwelling area: square feet
Suite/bldg./apt.no.: Project name:AT&T-PT87 Tigard NE Garage/carport area: square feet
Cross street/directions to job site:SWBarbur Blvd to SW Coronado St Covered porch area: square feet
to SW 64th Ave to substation.Site located NE of driveway. Deck area: square feet
Other structure area: square feet
Subdivision: Lot no.: *° �'` ': `
REQUDZED DATA:C0IYIMERCIAL-USE CIQ,IST
Tax map/parcel no.:1S138AD06300 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
q,'' - Ana DE5 -.,,, 0, i� 1i'OT2If. ' equipment,materials,labor,overhead,and the profit for the
Existing tower: Replace(5)existing Antenna;Install(1)LTE WCS Antenna work indicated on this application.
Install(6)RRH; (1)DC surge suppressor:(1)fiber(2)DC cables to surge supp Valuation: $$25,000.00
GRND:Install 2C radio in(E)LTE rack;(1)string Batteries(1)rectifier Existing building area: 325 square feet
❑ PR,WERTY IVWNER -` ►i 4TESANIT ; New building area: 0 square feet
Name:Crown Castle Number of stories: 1
Address: Type of construction: IIB
1505 Westlake Avenue North Suite 800
Occupancy groups:
City/State/ZIP:Seattle,WA 98109 Existing: Unoccupied
Phone:(206)-336-3208 Fax:( ) New: Unoccupied
El'APPLICANT ' Z CONTACT PERSON BUILDINGPERMIT FEES* .......---
BUILDING
Business name:FDII Velocitel,Inc.,for AT&T Mobility 1Plerueref �tojeesrhedrle) ; r "�
Structural plan review fee(or deposit):
Contact name:Christina Suarez •
FLS plan review fee(if applicable):
Address:4004 Kruse Way Place,Suite 220
City/State/ZIP:Lake Oswego,OR 97035 Total fees due upon application:
Amount received:
Phone:(541)490-3080 Fax::(503)636-2501
E-mail:christina.suarez@fdhvelocitel.com PHOTOVOLTAIC SOLAR'PANEL'SYSTEM FEES*
? CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Velocitel,Inc.,Jay Telford Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:4004 Kruse Way Place,Suite 220 Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego,OR 97035 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)636-2500 Fax:(503)636-2501 State surcharge(12%o of permit fee): $21.60
CCB lic.:200980
/ Total fee due upon application: $201.60
Authorized signature: y" �— This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I:\Building\Permits\BUP-COM PermitApp.doc 02/2 201 l 440 4613T(11/02/COM/WEB)
City of Tigard
1111 'I COMMUNITY DEVELOPMENT DEPARTMENT
T I G n R D Building Permit Review — Commercial - No Land Use
Building Permit #: �u I J ;_O/(p - Q 'O vs------
Site Address: j09 5 5 3 G 5-I-h, Ave , Suite/Bldg#:
Project Name: F tcC
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: (e#ace 5 ex\54-ins arr e.nf( a In„..A .1,-) ,±0,-11 np,W Pn rpni-e,v.i- o>"
ex l t4 inc) monopoe_ `��""
Existing Business Activity: W 1 feA e,5,-, coolrn vt(11 e (t-r;on
Proposed� Business Activity: Same
X71 Verify site address/suite# exists and active in permit system.
tZRiver Terrace Neighborhood: ❑ Yes No
oning: C—G
4/Permitted Use: 1Yes ❑ No ❑ Spec Space
t 1 Confirm no land use required.
liBusiness License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
l`- I
Notes: new \ OI, 166:10 C'ntrne,C* no ciry.Ar,(a(�, in VI:,tAQ,I imp
J I
Approved by Planning: yz, --Ti rr1-l ,�r\a, l Date: 11 9 I 1 6
Reviions (after Building Submittal only) Reviewer v Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: -/9/ 0
Site Plans: #
Building Plans: #
Building Permit#: 2—Enter building permit# above.
!d
Workflow Routing: [-Planning Permit Coordinator Id"Building
Workflow Sign-off: C'f Sign-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:
By Permit Technician _ ' • , ! Date: .00/9//A2
1:\Building\Forms\BldgPennit Rvw_COM_NoLandUse_070915.docx
l
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:
(
IfPSDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes - /A
Tigard Trans SDC: ❑ Yes Mi. /A
Parks SDC: ❑ Yes LLQ /A
p7OK to Issue Permit 40__
Approved by Permit Coordinator: Date: 2-/°//50
1:ABuilding\Forms\BldgPennitRvw_COM_NoLandUse_070915.docx
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