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Permit (10) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTIII f. R4Epi: E21-21/01}7 111 II Re - uest for Permit Action �, riTovn . 10 TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223. 503-718-24393 5 - . •-o_•.1 ON TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBui-ldingPermits@tigard-or.gov FROM: 'Owner n Applicant n Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) - l p ..r - Mailing Address: 4 )Olt 161,,,,f-e_ jc» Rt 4, ,: c a r i City/State/Zip: 2`° .. OR70. 3 Phone No.: CS-43).9 - , 0 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (/): n CANCEL/VOID PERMIT APPLICATION. LI 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). Peiiuit#: (317620/‘ - 023$ Site Address or Parcel#: ei±tttre-ej tit Project Name: F'-' Subdivision Name: Lot#: EXPLANATION: rile . .JY, r ti .c+e . Signature: Date: I-')/--- op' Print Name: C6 f jr2., r 4 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which was erroneously paid or collected, • Not more than 80%of the application or plan review fee when an applicationis withdrawn or canceled before review effort has been expended.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\RcgPermi to ction_092314.doc CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT f f Permit#: BUP2016-00085 GAR13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016 Parcel: 25101 DD00101 Jurisdiction: Tigard Site address: 6975 SW SANDBURG ST 100 Project: AT&T Subdivision: None Lot: None Project Description: Replacing(4)existing antennas and installing(6)RRH antennas.4/18/17, REPRINTED to change contractor from Velocitel to Mastec. Contractor: MASTEC NETWORK SOLUTIONS LLC Owner: WESTON INVESTMENT CO LLC 1203 114TH AVE SE 2154 NE BROADWAY, STE 200 BELLEVUE,WA 98004 PORTLAND, OR 97232 PHONE: 425-214-9727 PHONE: FAX: 503-210-1001 Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 04/11/2016 $453.95 Demolition Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 04/11/2016 $54.47 Dwelling Units: 0 Plan Review 03/23/2016 $295.07 Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 04/11/2016 $17.50 Bedrooms: 0 Bathrooms: 0 11x17) Value: $25,000 Misc Administration Fee 04/18/2017 $45.00 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $865.99 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENT1ON: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0 -0010 through••' 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I ued By: � ePermittee Si 'ature: Call 503.639.4175 by 7:00 a.m.for the next avai btetrsp ion date. This permit card shall be kept in a conspicuous place on the job site . til completion o e project. Approved plans are required on the job site at the ti e of each inspection. Building Permit Applica ' acEivEfj Commercial FOR OFFICE USE ONLY Sj Received is '1 City of Tigard f3 y 2 2017 Date/By: Permit No.: D`df�t'ti—C }K 13125 SW Hall Blvd.,Tigard,OR 9 3 • A i p- Plan Review Phone: 503-718-2439 Fax: 50 6 Date/By: Related Pencil: TI G 1RD Inspection Line: 503-639-4175 I o�TIGARD Date Ready/By: loris. H See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information BUILDING DIVISION Pfi ,��.n, :li W , in li 0'i 9 �.$ � ui � � � iiia. �<�" r Iri 'TYPE OF' 131iie 44r 1:'4°.� id''°. i - ai6TAR1 UATdirII AI1i?' FA YII�EI.LII� a , .. �.. - �. f� i � a� -. � .: ❑New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the ii NCTEG)$y Qw C(riSTRR IOI '420 g11i €N, work indicated on this application' ' 14 4 c1 0 }-and 2-famit y dwettin Valuation: $ g ❑Commercial/industrial Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: r, )a;, iy , c ti' �9' V,� Total number of floors: JOB-SATE'I. ---,„ Taal AXYU,LOCATION-„ 4 _ Job site address: -- q,Jt ra4 Ed. New dwelling area: square feet City/State/ZIP: "} L+°t 1 ("31 el 7„p..„4, Garage/carport area: square feet 1 Suite/bldg./apt.#: Project name: Q 3C Covered porch area: square feet Cross street/directions to job site: j'1 Deck area: square feet $j Other structure area: square feet 'REQ ID T'At iOMi44IGI#CIA iISE r C1 U T Subdivision: Lot#i Permit fees*are based on the value of the work performed. Tax map/parcel#: Indicate the value(rounded to the nearest dollar)of all -41.' �h equipment,materials,labor,overhead,and the profit for the. qi ,i, DESCRIPTION QF WORK-; "' work indicated on this application. {` Valuation: $ Existing building area: square feet New building area: square feet r 1. b �-r TNN � i1�i = PROPERTY OWNER . „ -, : �l�❑ I; ANldl � Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax ( ) New: s- �� , ❑ A +EIO ,� ..p-1,.`,....,��� OA J'ERSNiUT S* , 10„,- - ,,,,,,, 1 -„,, O, ;r ,,1 . OA74, ---1,,,y,,-T411-PER E Business name: #1 $r.. , . ,t: . (Pteasreedfe ff mel=. "',1,5117',iiF= E Structural plan review fee(or deposit): Contact name: J(',e s,.l 'tit-PIP 3 FLS plan review fee(if applicable): [ 4203`r Address: //'i-dr Total fees due upon application:City/State/ZIP: lett l"1 d Phone:(1.(' , -) ,,-1 ,., 7 7 Fax::( ) Amount received: E-mail: I ROT O�!QLTATC SQLAR PrINF� SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of '-'t- . Mc,T fj /_ roof-top mounted PhatoVoltaic Solar Panel System. Business name: ,/ y l,Lrt 'T eG Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: if_.2,,5 //hi E Solar Installation Specialty Code checklist. City/State/ZIP: ,( Gil/tr C it Permit fee(includes plan review $180.00 , ( and administrative fees): Phone: ( ) w Fax:( ) State surcharge(12%of permit fee): $21.60 CCB I,ic.: 19 q 7O vh 7 /7 Total fee due upon application: $201.60 Authorized signature: ,,,,,i',,,,,„<„,, � This permit application expires if a permit is not obtained F within 180 days after it has been accepted as complete. Print name: /t',6. ,....x ., Date: ,..4,'", 6 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits1BUP_COM_PemutApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) r CITY OF TIGARD BUILDING PERMIT • COMMUNITY DEVELOPMENT Permit#: BUP2016-00085 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016 TIC A 1Z D9 Parcel: 25101 DD00101 Jurisdiction: Tigard Site address: 6975 SW SANDBURG ST 100 Project: AT&T Subdivision: None Lot: None Project Description: Replacing(4)existing antennas and installing(6)RRH antennas. Contractor: VELOCITEL INC Owner: WESTON INVESTMENT CO LLC 4004 KRUSE WAY PL, SUITE 220 2154 NE BROADWAY, STE 200 LAKE OSWEGO,OR 97035 PORTLAND, OR 97232 PHONE: 503-636-2500 PHONE: FAX: 503-636-2501 Specifics: FEES Description Date Amount Type of Use: COM Permit Fee-Additions,Alterations, 04/11/2016 $453.95 Class of Work: OTR Type of Const: VB Demolition Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 04/11/2016 $54.47 Dwelling Units: 0 Plan Review 03/23/2016 $295.07 Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 04/11/2016 $17.50 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 $820.99 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:,aei __ ` O Permittee Signature: IA,G\ all 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. , build ng Permit Application 3/ti Commercial FOR OFFICE USE ONE). /"'1 Received City of Tigard g EIVE.,D Date/By: h� PermitNo.: �,/_�1..�(*5`— e.I Y—I�CL1W 13125 SW Hall Blvd.,Tigard,sCh. 7 Plan RY e �` �j Phone: 503.718.2439 Fax: 5O3.598t1I9�Q3 2016 Date/By: 4 Other Permit. �- t i l�D Inspection Line: 503.639.4175 IMVI KK Date Ready/By: /� n_ Juris BI See Page 2 for Internet: www.tigard-or.gov Notified/Method: y/G/ ,g7 — f aj Supplemental Information mi. OF TIGARD f ", �ltk , ,': -r3 I 1 D T u l , ,§ „„V,,.7‘, ;: ❑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 El Other: equipment,materials,labor,overhead,and the profit for the -!,,t E A1tAOJz, a g work indicated on this application.GRXt OF X� ";„ .kt- .}-k' ` ED1-and 2-family dwellingValuation: $ El D Accessory building 111Multi-familyNumber of bedrooms: El Master builder El Other: Number of bathrooms: : .J^ S E' � Wt.' Va .,4a�.a ' Total number of floors: :”r s ca 4�- - -,.i.„.0. Jv o- ,,- "z'..; 5 ._4.14,_:,”;u''*= ¢ Job site address:6975 SW Sandburg Street New dwelling area: square feet City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: `a© Project name:AT&T PR35 Tigard Covered porch area: square feet Cross street/directions to job site:SW 72' Ave Deck area: square feet Other structure area: square feet 1 II 311_1 - ° i8l 3��;,•r%'..--':- .?'-''! Z' 17 -,,,,,,,,.::.A.-7.,-�.. .-,-".:-,',..--..-0.1:-.-44. a.�n '�' :�.��`..> Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.:2S101DD00101 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead, the profit for the q ; O t , ; t work indicatedon this application. • fl ,g, o - AT&T proposes to upgrade their telecommunication facility by replacing four(4) Valuation: $$25,000.00 of the existing nine(9)antennas and installing six(6)new RRHs. Existing building area: square feet New building area: square feet 1 d ``"li , .' ® ',,`fid ." '_ € �F t . Number of stories: Name:American Property Management do Phil Hansen Type of construction: Address:2154 NE Broadway,Suite 200 Occupancy groups: City/State/ZIP:Portland OR 97232 Existing: Phone:(503)624.8240 Fax:(503)624.0845 New: "h' Q-,l' 1iiWP', +., ...,u, 0 C6 GT PERSOpf ,1.47?.-4-,;' B I IDI >N RMII.T,,EES* ' - f ' !,;";•E.,. -.t:Tease` er�pjeischedule) ,- +,-mt= . <, ,„ Business name:AT&T Mobility do FDH Velocitel,Inc. Structural plan review fee(or deposit): Contact name:Tom McAuliffe FLS plan review fee(if applicable): Address:4004 Kruse Way Place,Suite 220 Total fees due upon application: City/State/ZIP:Lake Oswego OR 97035 Amount received: Phone:(503)936.0002 Fax::( ) E-mail:tom.mcauliffe@fdhvelocitel.com PHOTOVOL`I'AIGSO iii 1�CEL SYS[` IFEES* '''`` I'� fr.,, > ¢ 1 -.,„•,,,,-;.;,.n.,, ,,,--„,.. Commercial and residential prescriptive installation of �„.5 .` ;,.ir 3 ,. .. . ..: ; ,,, -",, roof-top mounted Photo Voltaic Solar Panel System. Business name:Velocitel do Tom McAuliffe Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:1033 Skokie Blvd,Suite 320 Solar Installation Specialty Code checklist. City/State/ZIP:Northbrook IL 60062 Permit fee(includes plan review $180.00 and administrative fees): Phone:(503)936.0002 Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.:200980 Total fee due upon application: $201.60 Authorized signature: 7,(A),<)/It ^ This permit application expires if a permit is not obtained /moi within 180 days after it has been accepted as complete. Print name:Tom McAuliffe Date:03-16-16 * 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 ou COMMUNITY DEVELOPMENT DEPARTMENT ■ Building Permit Review — Commercial - No Land Use TIGARD Building Permit #: ldde! _VC:04E6- Site Address: 6G S Svc/ S on d J L)r-9 S+• Suite/Bldg#: Project Name: PsT T PR 35 -nu of r-r .. (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: Io p I u u- P X I S t19 poi�1e i s ; G n(k 1 rl s tT' 6 r1 w RR Existing Business Activity: C x0 t iJ (.Q,(/L (clNP mfbrl I- Q h CC)01- Proposed Business Activity: ✓l Q (_ 1/) Verify site address/suite# exists and active in permit system. zf River Terrace Nei hborhood: ❑ Yes JZI No ,e Zoning: C' Zr Permitted Use: Yes ❑ No ❑ P Spec Space Confirm no land use required. ❑ Business License: Exists: ❑ Yes ❑ No,applicant notified to obtain businesslicense li �n s e Notes: Approved by Planning: Alb Lam .10 c� Date: 3/-1. / 1 (o Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved E Not Approved Building Permit Submittal Original Submittal Date: 5/V /(o Site Plans: # Building Plans: # 3 Building Permit#: niter building permit # above. Pla Workflow Routing: nningg "---t Coordinatording Workflow Sign-off: f for Planning(include notes from planning review) Route Application Documents: uilding: original permit application, site plans,building plans, engineer and beam calculations and trust details, if applicable, etc. Notes: By Permit Technician: /v Date: 023//(j I:ABuilding\Forms\BldgPennitRvw COM NoLandUse 07o9I5.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: ?fg,SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes P /A Tigard Trans SDC: ❑ Yes ► /A Parks SDC: ❑ Yes AD\l/A OK to Issue Permit Z �h Approved by Permit Coordinator: 4,17/- Date: 3 /7 i I:,BuildingFonns\BldgPennitRvw_COM_NoLandUse_0709I5.docx FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ill Transmittal Letter r t G A RD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: Brarrcten T�aggarf �� DATE V.,I:,;: , .t , DEPT: BUILDING DIVISION F a_ 1 1}.,1 a) '''t ":t FROM: Tom McAuliffe J (a IF i ' t : Rif 1 `',Ii COMPANY: FDH Velocitel sT,r, PHONE: 503.936.0002 11/ MAP RE: 6975 SW Sandburg Street BUP2016-00085 (Site Address) (Permit Number) AT&T PR35 Tigard (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies � Description.'' a 1 Copies `;"I Description 3 Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: l_,,,,p qrz _ --i, „A ie,f•-•,41_2_,,,i' .,s S p: ® • 6._...,-. 1A- --/ i O—Lt.e___ z ,,i:' RFFI E-:USE ONLY Routed to Permit Technician: Date: $ /6, Initials: Fees Due: ❑ Yes KNo Fee Description: Amount D : Special Instructions: Reprint Permit (per PE): I I Yes I V-No Lf Done Applicant Notified: rei n Date: ;/ y//b t, -77-..-.c,;./ Initials: de I:\Budding\Forms\TransmittalLetter-Revisions.doc 05/25/2012