Permit (62) CITY OF TIGARD BUILDING PERMIT
' COMMUNITY DEVELOPMENT
Permit#: BUP2017-00161
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/14/2017
t Parcel: 2S1136000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Verizon Subdivision: None Lot: None
Project Description: Modifying antennas and related equipment: Removing(9)antennas and installing(6)antennas.
Contractor: M&A CONTRACTING INC Owner: BURLINGTON NORTHERN INC
1366 LEE ST SE PROPERTY TAX DEPT
SALEM, OR 97302 PO BOX 961089
FORT WORTH, TX 76161
PHONE: 503-581-6125 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 12/13/2017 $317.06
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 12/13/2017 $38.05
Dwelling Units: 0 Plan Review 12/13/2017 $206.09
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 12/13/2017 $17.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $16,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $578.70
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 suspe •ed 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 c•• • - •- < direct questions to OUNC by calling 503.232.1987-- 1.800.3 2.23 4.
Issued By: r •• u'tee Signature:
14‘7 "..
_ id/
C. 50 175 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 th •roject.
of each inspection.
plans are required on the site at the time
Approved qjobp
Building Permit Application
Commercial
FOR OFFICE LSE ONLY'
City of Tigard 1 a eived
11/ • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: /377--
Plan
3-jT Permit No.:it� j 7' f,'
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review pp.,
s�
T I G A A D Inspection Line: 503.639.4175 l c }(� 7 Date/By:A —: 0 ( 1"Other Permit:
Internet: www.tigard-or.gov l l�I! i C- r Date Remy: luris: I See Page 2 for
Notified/Method:0 i • /7 i
p ��, Pte.-400-N-
- I �'G Supplemental Information
TYPE OF WORK I ` O ARD • II, / •,
DIVISION
REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction NC '�i IVISION
❑D 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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $16000
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16580 SW 85TH AVE New dwelling area: square feet
City/State/ZIP:PORTLAND,OR 97224
Garage/carport area:
square feet
Suite/bldg./apt.no.: I Project name: oy� cj. POR ____ lS
� 1/ '
0/4'k� Covered porch area: square feet
Cross street/directions to job site:SW DURHAM RD&SW 85th Ave
Deck area: square feet
Wireless facility on school rooftop.
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Modifiying antennas and related equipment per enclosed plans. Valuation: $
Rcervv‘1...,
(-) iorvve.4
eiArtrAIA.A5; iWj7., i
li}i"&j1 2 A1Nstwi Existing building area: square feet
J New building area: square feet
0 PROPERTY OWNER I ® TENANT Number of stories:
Name:Verizon Wireless(VAW),LLC d/b/a Verizon Wireless
Type of construction:
Address:5430 NE 122"i Ave
Occupancy groups:
City/State/ZIP:Portland,OR 97230
Existing:
Phone:(503)208-5319 Fax:( )
New:
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Black Rock Consulting (Please refer to fee schedule)
Contact name:Brandon Clower Structural plan review fee(or deposit):
Address:5505 SE Tolman St FLS plan review fee(if applicable):
City/State/ZIP:Portland,OR 97206 Total fees due upon application:
Phone:(503)208-5319 I Fax::( ) Amount received:
E-mail:dbrandonclower@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:T.B.D. /a M �V./1 /7„A,4 re 6,-11.,k_.1 I- Submit two(2)sets of roof plan with connection details
Address ( !w! t `sZ. and fire department access,along with the 2010 Oregon
Ce q L. Solar Installation Specialty Code checklist.
City/State/ZIP: c`(,l2 047. e�11 7,i'f Permit fee(includes plan review
Phone:(<�5 ) /--6/.;_<---- I Fax:( ) and administrative fees): $180.00
State surcharge(12%of permit fee): $21.60
CCB lic.: /77N.;c,
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I Print name:D.Brandon Clower Date:6/5/17 * 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)