Permit (33) CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2015-00302
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2016
T I t.;;tR n 9 Parcel: 1S136AD06300
Jurisdiction: Tigard
Site address: 10955 SW 65TH AVE
Project: Verizon Wireless Subdivision: VILLA RIDGE Lot: 2
Project Description: Collocation for new carrier. New ground equipment&generator.
Contractor: CAPSTONE SOLUTIONS INC Owner: PORTLAND GENERAL ELECTRIC COMPAN
8195 166TH AVE NE, STE 100 121 SW SALMON ST
REDMOND,WA 98052 PORTLAND, OR 97204
PHONE: 503-707-2656 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 06/09/2016 $917.70
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 06/09/2016 $110.12
Dwelling Units: 0 Plan Review 06/09/2016 $596.51
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 06/09/2016 $220.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 06/09/2016 $17.50
Value: $75,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,861.83
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 e•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.
Issued By: ` P / - 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.
A. 4
Building Permit Application
Commercial FOR 01 I I( I. 1 'sI ()NI 1
Cityof Tigard EDto/P4 �! a0/�O 4
2,-- Permit No.:
g Date/By: i 3 �,
13125 SW Hall Blvd.,Tig Plan Revi
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: �' ", Other Permit:
,c \R I, Inspection Line: 503.639.4175 q 6 2015 Date ReadyBy: SII loris. B See Page 2 for
Internet: www.tigard-or.gov OCT f� Notified/Method:�r /�j �� I Supplemental Information
CITY OF TIGARD V/I td/c67 v
�pypgL MIUISION REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ��luJ�, 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10955 SW 65th Avenue New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:POR Villa Ridge Covered porch area: square feet
Cross street/directions to job site:Site located off SW 65°'Avenue off SW Deck area: square feet
Coronado Street(Behind Fantasy Adult Video) 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.: 1S136AD06300 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New carrier collocation on existing 94'monopole. New accessory ground Valuation: $$75,000.00
equipment and generator to be located within existing fenced lease area. Existing building area: square feet
Modifcation will not increase tower height nor expand premises. New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name:Verizon Wireless Type of construction:
Address:5430 NE 122°Avenue Occupancy groups:
City/State/ZIP:Portland,OR 97230 Existing:
Phone:(503)408.3436 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Pltaaerefermfee schedule)
Business name:Lexcom Development
Structural plan review fee(or deposit):
Contact name:Reid Stewart
FLS plan review fee(if applicable):
Address: 10570 SE Washington Street,#203
Total fees due upon application:
City/State/ZIP:Portland,OR 97216
Phone:(503)720.6526 Fax::( ) Amount received: 466,,60
E-mail:reid.stewart@lexcomcorp.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive install • of
CONTRACTOR roof-top m. ted Photo Voltaic Solar P ystem.
Business name:TBD-Out to Bid �' ,�,/E �t,�77e "/_.s- Submit two sets of roof plan wi onnection details
and fire departm.r t access,al with the 2010 Oregon
Address: tF/?_$ ��6 ,i9-- E.-/ /1/E ,J' ' `e,--0 Solar Installation .• i Code checklist.
A_ / Permit fee '• u.• plan review
City/State/ZIP: c�A/ ?,6F-05:,2_ d adminis i • ive fees): $180.00
Phone:1503) 707—+•x6,54, Fax:( ) Stat- rcharge(12%of pe ' fee): $21.60
CCB lie.: /? 5y' ,, Cr,/y/er ,,/J C Total fee due upon applicatio,: $201.60
Authorized signature: '— t"6/i e �-7 n e /c `his permit application expires if a permit is not obtained
7611, within 180 days after it has been accepted as complete.
Print name:Reid S • art Date: 10/22/2015 * Fee methodology set by Tri-County Building Industry 1
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
r !
CityofTigard CE/
IIIII OCT �F4
COMMUNITY DEVELOPMENT DEPARTMENT C� Z,
TIGARD
BuildingPermit Review — Commerciale F. • use
0/I/kiRn
ON
Building Permit #: p /S>00 3 o 2-
Site Address: 10155 (S U) 1p5÷'' A--0-- Suite/Bldg#:
Project Name: ue,.-i t-,.,,, PpR Vit( o` VII 9
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: flaca.•,ne,•f- o� a►+ item o-- cf. 9 w tA• d <. p ,r,nc )r j.&..
t-.i s h M tns i„tel a_rr 4"M u,l; -.
Existing Business Activity:
Proposed Business Activity:
Verify site address/suite# exists and active in permit system.
I .
River Terrace Neighborhood: ❑ Yes XNo
SZoning: G --C
Permitted Use: Fr Yes ❑ No ❑ Spec Space
Confirm no land use required.
XBusiness License: Wet
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: Cf' t d_ a . LDwA.Lo Date: (0 -aco -15
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: /0/9-47,<-
Site
0/9,47,Site Plans: #
Building Plans: # �j
Building Permit#: j::; 'Enter building permit# above.
Workflow Routing: ,2"-Planning L] lermit Coordinator Li'Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Juilding: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician. )C.:t.0 Date: ier/ /i t"
I:\Building\Fonns\BldgPennitRvw COM NoLandUse 0709I5.docx
t ,
Permit Coordinator Review
E 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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes !— /A
Tigard Trans SDC: ❑ Yes !:...N/A
Parks SDC: ❑ Yes L /A
OK to Issue Permit
)A
Approved by Permit Coordinator: v1 Date: 145/24
L'Bui Iding\Fonns\B IdgPennit Rvw_COM_NoLandUse_0709I 5.docx
RECEI
USD
514City of Tigard OCT 2 6 2015
I COMMUNITY DEVELOPMENT DEPARTMENT OF G
Collocation - SupplementalQuesti
TIARD ��
PROPERTY ADDRESS 1()It :r\I I I ,I. UN I.)
Location of collocation: 10955 SW 65th Avenue r r,,
Zone: l� ' `�
Name of provider:
Verizon Wireless
Reid Stewart XApproved
Contact name: ❑ Not Approved
Collocating antennas on: 'Existing tower By C.0_ ,,k Date: 10 ..e26-(S
❑ Existing non-tower structure Reason not approved:
Is this a new provider?: '1Yes
❑ No
Other providers currently collocating on same tower or structure:
AT&T& Cricket (Cricket is being decommissioned and Verizon is taking place)
Indicate the previous approval: SDR2000-00022 1:\CURPLN\Masters\Land Use Applications Rev.09/29/2014
(SDR,MMD #)
ANTENNA INFORMATION
Existing: New:
1--Ieight of antenna(s): N/A (sq. ft.) Height of antenna(s): 96.1" (sq. ft.) 1
Color of antenna(s): N/A Color of antenna(s): Grey
Color of equipment: N/A Color of equipment: Grey
Accommodating equipment: N/A Accommodating equipment: RRUs& Surge Suppressor
(i.e. dishes) (i.e.dishes)
Will new accessory equipment be installed?: VrYes
❑ No
Location of new accessory equipment?: ' Within previously approved fenced area
❑ Within existing structure
❑ Other location:
(please describe)
Will landscaping be removed to accommodate the accessory equipment?: ❑ Yes (please describe below)
1rNo
•/ / Reid Stewart 10/22/2015
Applicant's s u, ature� Print name Date
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 1