Permit (42) CITY OF TIGARD BUILDING PERMIT
■ COMMUNITY DEVELOPMENT Permit#: BUP2017-00246
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 05/14/2018
Tf( AI<.f7 9
Parcel: 1 S 136CCO2100
Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HWY
Project: Verizon Wireless Subdivision: None Lot: None
Project Description: Adding(2)remote radio units to existing antenna mount.
Contractor: STRATA INC Owner: GRUNBAUM FAMILY TRUST
PO BOX 2988 BY GRUNBAUM, HANS H AND MARILYN K,
CHELAN,WA 98816 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE: 425-259-6016 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 05/14/2018 $119.33
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 05/14/2018 $14.32
Dwelling Units: 0 Plan Review 09/06/2017 $77.56
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 05/14/2018 $22.50
Bedrooms: 0 Bathrooms: 0 11x17)
6
Value: $3,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $233.71
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. Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19870 1.800.332.2344.
Issued By:
4' G�
Permittee Signature:
Call 603.639.4175 by 7:00 a.m.for the next available inspect•irate.
This permit card shall be kept in a conspicuous place on the job site until c• pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application y
Commercial ,. , si•.',,-
.a FOR OFFICE USE ON1 1
City of Tigard Received q� _ 7 7 y
1 ) C�B : s ( PermitNo.. 8j LTaI y "�
_. 13125 SW Hall Blvd_,Tigard,OR 97223 '' Plan Review , d �
Phone: 503.718.2439 Fax: 503.598.1960 ate By: '! l7I mer Permit:
Inspection Line: 503.639.4175 UN
d" Y e F�
1 f C A K Q p C l I �f ;� I d 1 s IR, Jute Ready i /� Iuris: ' 65 See Page 2 for
Internet: wwwaigard-ongov Wed/ thod: /! es, Supplemental information 1
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction 1 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
IA Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
0 1-and 2-family dwelling /1 Commercia/industrial
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total nwnber of floors:
Job site address: 11744 SW Pacific Highway New dwelling area: square feet
I City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:POR Dartmouth //Cry yj 14/ (e,1) Covered porch area: square feet
Cross street/directions to job site:Hwy 217 , Deck arca: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCL4L-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.: 15136CCO2100 or R284 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Add(2)Remote Radio Units to existing antenna mount ! Valuation: $$3,000.00
/> ice„ �rtf/Cr� I Existing building area: square feet
[� ��'� New building area: square feet
0 PROPERTY OWNER it TENANT Number of stories:
Name:Verizon Wireless VAW LLC d/b/a Verizon Wireless Type of construction:
Address:5430 NE 1224d Ave Occupancy groups:
City/State/ZIP:Portland,OR 97230 Existing:
Phone:(503)408-3450 Fax:( ) New:
El APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Verizon Wireless
(Please refer to fee schedule
Structural plan review fee(or deposit):
.
Contact name:Shanin Prusia,Urban Wireless
1. _
FLS plan review fee(if applicable):
Address:10376 SE Sun Burst Way
City/State/ZIP:Happy Valley,OR 97086
-- Total fees due upon application: 1`7.7 _:.z,
Phone:(503)720-7295 Fax::( ) f Amount received:
E-mail:Shanin a?ITrbanWirelesslne.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
p Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:TBD 5104 N Submit two(2)sets of roof plan with connection details
d
and fire department access,along with the 2010 Oregon
Address: ,, . , ,, ie)
61^(29F0 Solar Installation Specialty Code checklist.
City/State/ZIP: dy u 4 / (o( ( Permit fee(includes plan review $180.00
and administrative fees):
Phone:( i �'[� •2.S"C '6001 e State surcharge(12%of permit fee): $21.60
1 CCB tic.: ---7 576 d
Total fee due upon application: I $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Shanin Prusia,for Verizon Wireless Date:8/31/2017 ' * Fee methodology set by Tri-County Building Industry
I Service Board.
I:\Building\Permits\Br rP-COM PennitApp.doc 02/24/2011 440-4613T(11/02/COM,/WEB)
City of Tigard
.111 q COMMUNITY DEVELOPMENT DEPARTMENT
■
TICARD Building Permit Review — Commercial - No Land Use
,F
Building Permit #: /i9 2/ 7 —c), Lj 2
Site Address: //NV "-iv'/2-u-,74;c-ZMAI- Suite/Bldg#:
Project Name: 1Je alicl.4c
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review /�
Proposal: ,f f '7 ,00 (:=2-?) —Lehte0 .- �7«t D 1iili j A )(A7In
?' A) 2117)U111`-'
Existing Business Activity: k?reCi',g y C C'i/h
Proped Business Activity: i/ // i t (2. "--------
Verify site address/suite# exists and active in permit sys
\ll ' ver Terrace Neighborhood: ❑ YesP,ciz
VJ o
omng
Zermitted Use: Yes 0 No 0 Spec Space
nfirm no land use required.
iZl Business License:
Exists: Yes 0
No,applicant notified to obtain business license
Notes: /i) v k t// 1 J39�na-e
t
Approved by Planning: Date:
=� ``�� — 913-/) --
Revisions (after Building Submittal only) Reviewer Date
Revision 1: yg Approved ❑ Not Approved 61 Q/h_ 11/I / 11
Revision 2: Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 1/s7, 2
Site Plans: #
Building Plans: #
Building Permit#: te nter building permit#above.
Workflow Routing: ening Coordinator [din
Workflow Sign-off: �. ' g
,� i -off for Planning(include notes from planning review)
Route Application Documents: L�'"Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
----7By Permit Technician: aecr-6, .. Date: 7 7
I:\BuildingTorms\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) LOLL. V�` �7
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
MI '9 C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes gN/A
Tigard Trans SDC: CIYes N/A
Parks SDC: ❑ Yes C;7 N/A
01 11., to Issue Permit
Approved by Permit Coordinator:
Date:/NI
I:\Building\Forms\BIdgPermitRvw_COM_NoLandUse_070915.docx
't e
R
•
4:101)11.: 51'1G;)(141'1?' ft
x
,n'sf(11:PING DIV/RON
Urban Wireless Inc.
Letter of Transmittal
; To: Branden Taggart ; I From: Shanin Prusia
I Date: August 31, 2017 i I Urban Wireless, Inc !
— -
RE: POR DARTMOUTH/Verizon Wireless Application
Enclosed you will find the following:
1. Commercial Building Permit Application
2. 2 sets of drawings for review
3. 2 sets of structural calculations
4. Plan check submittal fee (Please email or mail a receipt to the address below)
Please let me know if you have any questions or if I can be of assistance on any other
sites.
Thanks,
Shanin Prusia
President
503.720.7295 Mobile
Urban Wireless Inc.
10376 SE Sunburst Way
Portland, OR 97086
shanin@UrbanWirelessInc.com
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
III a le Transmittal Letter
r i c,A E:n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: £ U J DAT
DEPT: BUILDING DIVISION krtytylyt,i
L NOV 1 4 201
FROM: a,h 1r, PI" !A(11& CITY 01,'.116,110
COMPANY: V Q,ri?Q.) tdOia .., Lu S BUILDING DIVIS O
PHONE: 5b _��,O -"Mgr By.
RE: ,� !744 PC,CPA-c O QI-t.P x017— oo246
(Site Address) (Permit Number)
Aarkl--htio
( roP ject name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
a— 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. A. Engineer's calculations.
Other(explain):
REMARKS: NOWl '4c.,A (a c $ `� L��"• I'\
eu.#h V OL , cul C1 3 o V foil� , ad , 17e.,d( O .,b & c
FOR OF ICE U E ONLY
Routed to Permit Tech�nic�ian: ��te: ( �Z�l Initials: oTo
1
Fees Due: ❑ Yes L O// Fee Description: Amount s ue:
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑No ❑ Done/A.__
Applicant Notified: Date: it Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11744 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Building BUP2017-00246
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor