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Permit CITY OF TIGARD BUILDING PERMIT 7, COMMUNITY DEVELOPMENT Permit#: BUP2018-00022 T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/10/2018 Parcel: 2S101DD00702 Jurisdiction: Tigard Site address: 6900 SW SANDBURG ST Project: Verizon Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4 Project Description: Installing(6)panel antennas,tower equipment,concrete pad,ground equipment,and a backup generator. Contractor: STRATA INC Owner: HDG LP PO BOX 2988 13212 NE 16TH ST#212 CHELAN, WA 98816 BELLEVUE,WA 98005 PHONE: 425-259-6016 PHONE: FAX: • Specifics: FEES Description Type of Use: COM Date Amount Permit Fee-Additions,Alterations, 04/10/2018 $619.25 Class of Work: ALT Type of Const: IA Occupancy Grp: Occupancy Load: Demolition Dwelling Units: 0 12%State Surcharge-Building 04/10/2018 $74.31 Stories: 0 Plan Review 04/10/2018 $402.51 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 04/10/2018 Bedrooms: 0 Bathrooms: 0 11x17) $20.00 Value: $40,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $1,116.07 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: ` I"� •rmittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available in=.e�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. 1 Building Permit Application Commercial / FOkOO FFR I: l Sl" yl,l City of Tigard fiECE 1l11 n 7.,ived DateBy2/ 1 13125 SW Hall Blvd.,Tigard,OR 97223 : Permit No.: q ! Plan Review "'�' �� 1 . Phone: 503.718.2439 Fax: 503.598.1960 FEBCD 2 �)Date/By: e i�=ir. Other Permit: Inspection Line: 503.639.4175 TIGARD P Date Read B H See Page 2 for Internet: www.tigard-or.gov CITY OF rIGA ifie ethod: e;2//' tuns: I BUILDING_DMVISIO , , Supplemental Information TYPE OP WORK REQUIRED DATA:1-AND i FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed. Addition/alteration/replacement 0 Other Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION " work indicated on this application. 0 1-and 2-family dwelling ®Commercial/industrial Valuation: $ ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: '04.SITE INFORMATION;AND LOCATION , Total number of floors: Job site address:6900 SW SANDBURG ST New dwelling area: square feet City/State/ZIP: TIGARD,OR 97223 Garage/carport grt area: square feet Suite/bldgJapt.no.: Project name. -A (kip, zavy Covered porch area: square feet Cross street/directions to job site:From I-5,take exit 291,merge right Deck area: square feet for Carman Dr.toward King City.L onto Carman Dr road,R onto SW 72nd Ave. Other structure area: square feet R onto SW sandburg St.Stie on the right behind the building I1I17ltDATA;COMMERCIAL-USEE ' Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.:2S101131/00702 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DES( PTION'OF WORK work indicated on this application. Install(6)panel antennas,(3)RAYCAP OVP,(9)RRUs,(5)hybrid cables, Valuation: $ (1)antenna low platform to the tower.Install equipment �i�, ground concrete pad. Existing building area: square feet Install(3)RAYCAP OVP with ground Equipment and(1)20KW backup generator New building area: square feet G 'PROPERTY,OWNER I 0 TENANT Number of stories: Name:HDG L.P. Type of construction: Address:13212 NE 16u'Street Occupancy groups: City/State/ZIP:Bellevue,WA 98005 Existing: Phone:( ) Fax( ) New: Z+ APPLICANT .; * CONTACT" PERSON BUILDING' PERMIT FETE* . Business name:American Tower/Verizon C/O Powder River Developmen �+r +lc1t Contact name:Vinh Dinh Structural plan review fee(or deposit): Address:219 S Wooddale Avenue FLS plan review fee(if applicable): i City/State/ZIP:Eagle,ID 83616 Total fees due upon application: if(j?„.S' Phone:(206)2955926 I Fax:( ) Amount received: E-mail:vinh.dinh@powderriverdev.com PHOTOVOLTAIC SOLAR PANEL SYSTEM.FEES* CON'FRAI ',,,,,, Commercial and residential prescriptive installation of ,, roof-top mounted PhotoVoltaic Solar Panel System. Business name:TM , if. r . ,r t Submit two(2)sets of roof plan with connection details Address: ( y 4,-.1t; and fire department access,along with the 2010 Oregon r. 4, d`,' Solar Installation Specialty Code checklist. City/State/ZIP: n•-•L�-. tVA . et,q z(c A L Permit fee(includes plan review L� 7 and administrative fees): $180.00 Phone:O ,x7.7 q j ci , I Fax:(A ) State surcharge(12%of permit fee): $21.60 CCB lic.: '"� e� r7 P l Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained 1/ L-6 within 180 days after it has been accepted as complete. I Print name:Vinh Dinh I Date:2.1.18 I * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02ICOM/WEB) City of Tigard RECEIVED FEB 07 COMMUNITY DEVELOPMENT DEPARTMENT 2018 TIGARD •11111 - ,fi 'Collocation - SupplementalQue . 14, L � F,N PROPERTYADDRESS FOR STAFF USE ONLY Location of collocation: 6900 SW SANDBURG ST, TIGARD, OR 97223 Zone: I-1° Verizon Name of provider: _/ Contact name: Vinh Dinh ltd Approved ❑ Not Approved Collocating antennas on: / By: SC-- Date: 2—/Z;I, ® Existing tower Reason not approved: ❑ Existing non-tower structure Is this a new provider? ® Yes 0 N Other providers currently collocating on same tower or structure: I;\Community Development\Land Use Applications\02_Forms and Nextel Templates\Land Use Applications\Future Forms Rev.12/14/2017 Indicate the previous approval: BUP98-00246 (SDR,MMD#) ANTENNA INFORMATION Existing: New: Height of antenna(s): 9T 6° (sq. ft.) Height of antenna(s): 64' (sq. ft.) Color of antenna(s): Light gray/white Color of antenna(s): Light gray/white Color of equipment: Light gray/white Color of equipment: Light gray/white Accommodating equipment: none Accommodating equipment: (i.e.dishes) (i.e.dishes) Will new accessory equipment be installed? [i Yes ❑ No Location of new accessory equipment? IJ Within previously approved fenced area ❑ Within existing structure ❑ Other location: (Please describe) Will landscaping be removed to accommodate the accessory equipment? ❑ Yes ®No If yes, describe here: Z7Vinh Dinh 2.1.18 Applicant's signature Print name Date City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 1 Branden Taggart From: Vinh Dinh <vinh.dinh@powderriverdev.com> Sent: Thursday, February 8, 2018 5:54 PM To: Branden Taggart Cc: #Building Permit Technicians Subject: RE:Verizon Permit 6900 SW Sandburg St: BUP2018-00022 Hi Branden, My apologies. Work valuation is$40,000. Also, I can pay online if that makes the review process faster. Let me know if you need anything else. Thank you Vinh Dinh Powder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 www.powderriverdev.corn (206) 295-5926—Phone (208)963-4015—FAX POWDER RIVER Dtvcto®neltStryststi.i t From: Branden Taggart [mailto:brandent@tigard-or.gov] Sent:Thursday, February 08, 2018 5:20 PM To:Vinh Dinh <vinh.dinh@powderriverdev.com> Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject:Verizon Permit 6900 SW Sandburg St: BUP2018-00022 Hi Vinh, We received your Verizon permit for installing antennas and equipment located at 6900 SW Sandburg St. However, we do not have a valuation for the work. What is it? Thank you, 1 F Samuel Copelan From: Lina Smith Sent: Thursday,January 25, 2018 4:16 PM To: 'Vinh Dinh' Cc: Samuel Copelan Subject: RE: Cell tower collocation questions Hi Vinh, I spoke to my supervisors, and we determined planning/land use review won't be required for this project, based on the Code section copied/pasted below. Chapter 18.450 Wireless Communication Facilities 18.450.030 Uses Permitted Outright A. Collocation of antenna(s)on existing towers in commercial and industrial zones. Installation of an antenna(s) on an existing communication tower of any height is permitted outright,provided the additional antenna(s)are no more than 20 feet higher than the existing tower,no more than three providers are collocating on the towers, and the color of the antenna(s)blends with the existing structure or surroundings. D. Installation of accessory equipment shelters. Any provider who is authorized to collocate on an existing tower or non- tower structure as provided in subsections A through C of this section, shall be allowed to install any necessary accessory equipment shelters and related equipment at or near the base of the tower or structure,within the structure, provided: 1. The accessory equipment shelter and related equipment are either located completely within the existing structure, or are located within the fenced area previously approved; 2. The equipment shelter and related equipment shall comply with the development standards, such as setbacks, height limitations and lot coverage, of the base zone; 3. No previously-approved landscaping shall be removed to locate the accessory equipment building and related equipment. If any such landscaping is removed,the applicant shall be required to replace it with the equivalent quantity and type of landscaping on site, in a manner to achieve the original intent, or to achieve sufficient screening of any proposed new shelter and/or equipment if the original intent would no longer be applicable. If any removed landscaping cannot be replace on site,then the applicant shall be subject to a site development review as provided in Section 18.450.040. You can move forward and apply for your building permits. Please contact the Building Division at (503) 718-2439 or tigardbuildingpermits@tigard-or.gov for more information. If you'd like, you can include the completed Collocation Supplemental Questionnaire with your building permit submittal, to help city staff process your permits: http://www.tigard- or.gov/city hall/departments/CommunityDevelopment/Collocation SupplementalQuestionnaire.pdf. Thank you, Lina Smith Assistant Planner City of Tigard I Community Development 13125 SW Hall Blvd.Tigard,OR 97223 E-mail:LinaCS@tigard-or.gov 1 From:Vinh Dinh [mailto:vinh.dinh@powderriverdev.com] Sent: Wednesday,January 24, 2018 4:51 PM To: Lina Smith <LinaCS@tigard-or.gov>;#CD PoD<CDPoD@tigard-or.gov> Subject: RE: Cell tower collocation questions Thank you Lina. I look forward to hearing back from you. Regards, Vinh Dinh Powder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 www.powderriverdev.com (206) 295-5926—Phone (208)963-4015—FAX POWDER RIVER DeweNprow Seip:es.I C From: Lina Smith [mailto:LinaCS@tigard-or.gov] Sent: Wednesday,January 24, 2018 4:49 PM To:Vinh Dinh <vinh.dinh@powderriverdev.com>;#CD PoD<CDPoD@tigard-or.gov> Subject: RE: Cell tower collocation questions Hi Vinh, let me double-check with my supervisors and get back to you either tomorrow or Monday (our office is closed on Fridays). Thank you, Lina Smith Assistant Planner City of Tigard I Community Development 13125 SW Hall Blvd.Tigard,OR 97223 E-mail: LinaCS@tigard-or.gov From:Vinh Dinh [mailto:vinh.dinh@powderriverdev.com] Sent: Wednesday,January 24, 2018 3:39 PM To: #CD PoD<CDPoD@tigard-or.gov> Subject: FW: Cell tower collocation questions Hello, I'm working on a collocation project for Verizon on an ATC owned tower. Currently there is 1 carrier on the tower (Sprint) a 90'.Verizon is proposing to collocated on the tower @ 60' and equipment area near the base of the tower. Verizon also proposed a 20kw diesel emergency generator. See attached preliminary plan and generator spec sheet for more details. 2 3 Lat/Long: 45.42028,-122.7472 Address: 6900 SW Sandburg St.Tigard, OR, 97223-8008 The diesel generator is noise rating is 65 dBA with its enclosure.This generator would only operate during an emergency. I would like to know for this specific site collocations if a noise report is required with the BP submittal? Also I would like to confirm: 1. This type of collocations only requires planning review during BP submittal and is and admin approval? 2. What is the turn around time for approval once submitted? 3. Could you let me know the total fee or total intake fee requires for this project(project value is$40, 000) Please let me know if you have any questions. Thank you. Vinh Dinh Powder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 www.powderriverdev.corn (206) 295-5926—Phone (208)963-4015—FAX rte : POWDER RIVER Oeretmgnea!EeeeuteSatC DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." Powder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 POp p R ' v C' p (208) 938-8844 office Development Services, LLC G I[ (208) 938-8855 fax www.powderriverdev.com February 1,2018 RECEIVED City of Tigard FEB 0 7 2018 Building Department 1315 SW Hall Tigard, OR 97223 Blvd. BUILDING DIVISION RE: Site Collocation for Verizon Wireless Site No: ATC 414382 SANDBURG-A Site Address: 6900 SW SANDBURG ST TIGARD, OR 9722 Parcel#2S101DD00702 Dear CI es-Co tnu y Building: Powder River Development Services is representing American Tower Corporation (ATC)regarding a collocation of Verizon Wireless'wireless telecommunications facility on an existing monopole structure. The Scope of Work Includes: Install(6)panel antennas, (3)RAYCAP OVP, (9) RRUs, (5) hybrid cables, (1)antenna low platform to the tower. Install ground equipment concrete pad. Install (3) RAYCAP OVP with ground Equipment and (1)20KW backup generator. There will be no change in the existing tower height and there will be no expansion of the existing compound. Enclosed you will find: (1)completed City of Tigard Building Permit Application, (3)sets of 11X17 construction drawings with site plans, (2)sets of structural calculations and a check in the amount of$402.51 for the City of Tigard plan review fees. T„ p 4.4 veerrept5 Upon approval of our application please let me know either by telephone or by email and we will dispatch a contractor to pull the Building Permit. If possible, please email an electronic copy of our approvals and permits to my attention. The contractor will provide you with their information, a copy of their contractor's license, and pay the remaining balance of the permit fees when they arrive to pull the BP. If you have any questions or need additional information, please let me know. Thank you for your assistance, tiOn.....- k...alt..r"------ Vinh Dinh vinh.dinhApowderriverdev.corn (206)295-5926 City of Tigard i II ■ ~ COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Commercial - No Land Use Building Permit #: 6946?0 E F—a)oa Site Address: '1 00 .fit,✓ se,,J b c3 1-. Suite/Bldg#: Project Name: \tr-i_ n (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: &t 0utt t� d,' Vtrl.La., cr\k 0.1 fci;kn9 Mf,1.c,p,;it it-rJt iv re- Existing Business Activity: U,/ittltlj Ce clistiu' C `` r �iL�I�'tY� l�117 Proposed Business Activity: J rtltjl ( ,nr„,‘ l,,,,i-D, F„ci,17 yeerify site address/suite#exists and active in permit system. ver Terrace Neighborhood: ❑ Yes [ No i2 Zoning: I-p li�Y/Permitted Use: ❑ Yes ❑ No CI Spec Space 2t/Confirm no land use required. Business License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: J ,t/' ,. r `�tiv Date: 2-I2-1 fi Revisions (after Building Submittal only) Reviewer Revision 1: El Approved ❑ Not Approved Date Revision 2: El Approved El Not Approved Revision 3: ❑ Approved El Not Approved Building Permit Submittal Original Submittal Date: )_/i///,/�e # Site Plans: __I Building Plans: # Building Permit#: n'te uilding permit ove. Workflow Routing: Plannin ermit Coordinator din Workflow Sign-off: g g 0/6-off for Planning(include notes from planning review) Route Application Documents: Wig: original permit application, site plans,buildingplans, beam calculations and trust details,if applicable, etc. engineer and Notes: By Permit Technician: i __ < _ , Date: 2//,)// I:\Building\Forms\BldgPermitRvw COM_NoLandUse 060116.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: ❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes war /A Tigard Trans SDC: ❑ Yes 0N/A Parks SDC: ❑ Yes '!"" /A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: 21/3" 1 I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT ■ TIGn ri n Building Permit Review — Commercial - No Land Use Building Permit #: 8t4flO/F--- Site Address: 6`1 Qq SL' J b rr Seo Suite/Bldg#: Project Name: VG+*i I{1 ' ',' , _ _ L - 1 '6 :A-753. 3, (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review r Proposal: &lloutf tin df Vtnii orl a, ?A3f'g Monofiit S JGl't` Existing Business Activity: \i/irc1yJ Co Ihs+Jnittik-. Rti hf 1-y Proposed Business Activity: kvIrtitii C4 r.t-Ndn;Lnl-tvn FkC1li}7 eerify site address/suite# exists and active in permit sy�stteem. ver Terrace Neighborhood: ❑ Yes LTJ No a: Zoning: 1-1- !,I��'I ermitted Use: ❑ Yes ❑ No ❑ Spec Space L(�' Confiirm no land use required. 0 Business License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: C t Gv. Date: 2-)2-i d Revisions (after Building Submittal only) Reviewer Date , Al /J Revision 1: Approved ❑ Not Approved k o `'l(i l?j Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved 0 Not Approved Building Permit Submittal Original Submittal Date: ,2-/� /f Site Plans: # e,�. Building Plans: # '�/'° Building Permit#: me uiiding permit ove. Workflow Routing: 1 canning ermit Coordinator ding Workflow Sign-off: � �'�-off for Planning(include notes from planning review) Route Application Documents: LYBuilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: i ....c. Date: /�/j yy I:\Building\Forms\BldgPermhRvw_COM_NoIandUse_060116.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: 'EFtDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes 1.1' /A Tigard Trans SDC: 0 Yes i!-N/A Parks SDC: 0 Yes 'E."" /A f !C' to Issue Permit ,47/ %Frit PPby A roved Permit Coordinator: -4te: 21/3"A r I:\Building\Forms\BldgPermitRvw_COM_NoLandUse 070915.docx AN„,,E1 APR H ? 2018 4104110 f.31 P "PMz' POwder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 (208)938-8844 POWDER RIVER (208) 938-8855 off fax Development Services, LIC www.powderriverdev.com April 7,2018 City of Tigard Building Department 13125 SW Hall Blvd. Tigard, OR 97223 RE: BUP2018-00022,6900 SW SANDBURG,Verizon Site No: ATC 414382 SANDBURG-A Parcel#2S101 DD00702 Dear Building Department: Verizon would like to revise the scope of work on their recent application: BUP2018-00022,6900 SW SANDBURG. The revised Scope of Work is as followed in red. On tower: Install(9)panel antennas, (3)RAYCAP OVP,(9)-RRUs, (12) RRUs,(5) hybrid-sables, (3)hybrid cables, (1)antenna low platform to the tower, (1)microwave dish with (2)ODU, (6) 7/8"coax cable,and (1)CAT5e. On ground: stall ground equipment concrete pad. Install(3)RAYCAP OVP with ground Equipment and(1) 20KW backup generator. There will be no change in the existing tower height and there will be no expansion of the existing compound. Enclosed you will find: (1)revised City of Tigard Building Permit Application, New(3)sets of 11X17 construction drawings with site plans and(2)sets of structural calculations reflecting the revisions. Please add any additional review fee to the final balance and we will pay upon issuance. If you have any questions or need additional information,please let me know. Thank you for your assistance, Vinh Dinh vinh.dinh@powderriverdev.com (206)295-5926 FOR OFFICE USE ONLY–SITE ADDRESS: &7(..-26 4cet., 4.5- ~ 4ei )-' Y 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 1111 Transmittal Letter I I t,A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: I On DATE RE WED: DEPT: BUILDING DIVISION 'E rkIED APR 1 b 2018 FROM: V/y�ij /l2 v/! COMPANY: J°DGJ�r'f £vc✓ dc( 2 ft r-frr c:; _ ..: PHONE: aDc,,, "az j S — s-- --/2.„ By: — RE: (.0 CbD Seri S411(6t'l--- # if /S tem-�DU.Z2 (Site Address) (Permit Number) VC/I'27A2 (Project name or subdivision name and lot num - ) ATTACHED ARE THE FOLLOWING IT S: Copies: Description: Copies: Description: Additional set(s) of plans. [b Revisions: Cross section(s) and detai s \/t Wall bracing and/or lateral analysis. Floor/roof framing. 11 Basement and retaining walls. Beam calculations. I :‘,A � Engineer's calculations. Other(explain): REMARKS: ada' 75 et l a/4h,va C" 6/e_5 /Sl / 7-0 So4- ,, (j) ti i h,W 6v/rC1 (0 011e - 31i i Vc � (;j l'04 yr tanol 0 FOR OFFICE USE ONLY Routed to Permit T: •• ian: Date: 4 ) g- Initials: Fees D ?gJ Y:: El No Fee Description: Amount . .s H r Pim re./ $ 4 Co e Pieektnie /310 . oD Special Instru' ions: R-9 nt Permit(per PE): ❑ YesDI No' El Dopy)._ _ iplicant Notified: 'f Date: (/f/('0Initial . I:\Building\Forms\TransmittalLetter-Revisions 061316.doc