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Permit CITY OF TIGARD BUILDING PERMIT 1 COMMUNITY DEVELOPMENT1114 Permit it: BUP2017-00287 T f c ;\I<:!f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2018 Parcel: 2S102BD02600 Site address: 12925 SW PACIFIC HY Jurisdiction: Tigard W Project: Verizon Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37 Project Description: Cell tower equipment modifications:Antennas,RRU's,surge suppressors,and hybrid cables. Contractor: KMM TELECOMMUNICATIONS INC 4051 N HY 121 SUITE 400 Owner: KIM, PENNEY W GRAPEVINE,TX 76051 395 NW SILVERADO DR BEAVERTON, OR 97006 PHONE: 844-566-8488 PHONE: FAX: Specifics: FEES Type of Use: COM Description Date Amount Permit Fee-Additions,Alterations, 11/05/2017 $377.90 Class of Work: ALT Type of Const: Occupancy Grp: U Occupancy Load: Demolition Dwelling Units: 0 12%State Surcharge-Building 11/05/2017 Plan Review $45.35 Stories: 0 Height: 0 ft 10/31/2017 $245.64 Bedrooms: 0 Misc Administration Fee 11/05/2017 $4.75 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 11/05/2017 Value: $20,000 11x17) $17.50 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $691.14 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 /0�/ yGC Permittee Signature: .i Call 603.639.4176 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. OCT 3 0 2017 City of Tigard i rY liGARD �' COMMUNITY DEVELOPMENT DEPARTMENT �l11LfJN(. DIVISION( t TIGARD Collocation - Supplemental Questionnaire PROPERTY ADDRESS Location of collocation: 12925 SW Pacific Hwy,Tigard,OR 97223 American Tower Corporation/Verizon Zone " Name of provider: Owen Nason,Powder River Development .Vpi ov Contact name: ment Services p �h � PPxaved Collocating antennas on: ® Existing tower By: " Date f / 77 El Existing non-tower structure Reason not approved: Is this a new provider?: ❑ Yes No f .. Other providers currently collocating on same tower or structure: ea-fc G 1 Z J©Z(Q ieicURp N\Masce Land Use Aypircai�s Rev.oslIndicate the previous approval: lot (SDR,MMD #) ANTENNA INFORMATION Existing: New: Height of antenna(s):83.9 ft tip heighq ft.) Height of antenna(s):84 ft tip height (sq.ft.) Color of antenna(s): white Color of antenna(s): white Color of equipment: white Color of equipment: white Accommodating equipment: N/`� Accommodating equipment: N/A (i.e. dishes) (i.e. dishes) Will new accessory equipment be installed?: In Yes ❑ No Location of new accessory equipment?: ❑ Within previously approved fenced area M Within existing structure ❑ Other location: (please describe) Will landscaping be removed to accommodate the accessory equipment?: ❑ Yes (please describe below) No Owen Nason 10/26/2017 Applicant's signature Print name Date City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 1 1 SFr ti c '` 11 1 7 3 0 In Via. *.tea I S Ya...f k i ill " bre" W•I i„`%' ' Powder River Development Services, LLC 219 S Wooddale Avenue Eagle, ID 83616 (208)938-8844 office POWDER RIVER (208)938-8855 fax Development Services,LLC www.powderriverdev.com September 27, 2017 Debbie Adamski City of Tigard Community Development 13125 SW Hall Blvd Tigard, OR 97223 RE: Site Modification for Verizon Wireless Site No: ATC 82805 Tigard/99 Site Address: 12925 SW Pacific Hwy Tigard,OR 97223 Parcel#2S102BD02600 Dear Ms.Adamski: Powder River Development Services is representing American Tower Corporation(ATC)regarding a modification of Verizon Wireless'wireless telecommunications facilities on an existing self-supported tower structure at an existing wireless telecommunication facility located in the City of Tigard, referenced above. The Scope of Work Includes: Remove(6)panel antennas, (3)RRUs(radio units)from tower Install(6)panel antennas,(12)RRUs,(2)RAYCAP splitters/surge suppressors, (2)hybrid cables on tower Install(6)RRUs,(2)RAYCAP splitters/surge suppressors in shelter 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 construction drawings with site plans,(1)set of structural calculations and a check in the amount of$245.64 for the required building permit intake fees. 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, Owen Nason owen.nasonApowderriverdev.corn (208)938-8844 City of Tigard n COMMUNITY DEVELOPMENT DEPARTMENT Ill i T1cARD Building Permit Review — Commercial - No Land Use Building Permit #: 64626/ 7— 2-.g 7 Site Address: Ig./a5 S I,t) Pe.c. ;( hiCL7 Suite/Bldg#: Project Name: Var.:20 n (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review (� ' Proposal: Cothy cctll�;or.. CS (.42 r.;2or 4r1 )7/74?e 61/ PlOi►epqpie Existing Business Activity: ...--- Proposed Business Activity: .-------- -ErVerify site address/suite# exists and active in permit system. ,E7 River Terrace Neighborhood: ❑ Yes Er-No .0'Zoning: C—4 p-Permitted Use: . —Yes ❑ No ❑ Spec Space .-Eonfirm no land use required. [2 Business License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: /jam Date: /0731//7 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: `"1 i 7 Site Plans: ## Building Plans: ## ' Building Permit#: L' nter building permit ve. Workflow Routing: arming ermit Coordinator C}-l'u adding Workflow Sign-off: E'1gn_off for Planning(include notes from planning review) Route Application Documents: [ �ding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: jr,,,,,tA_ „ Date: /0/30 7 40, I:\Building\Porms\BIdgPermitRvw 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: *t?DsDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes N/A OK to Issue Permit ?f Approved by Permit Coordinator: 40D—ate: /4'/3 t 17� I:\Building\Forms\B1dgPermitRvw_COM NoLandUse_070915.docx City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12925 SW PACIFIC HWY, TIGARD, OR, 97223 December 21 , 2018 at 9:04:21 AM Record Type: Record ID: Commercial - Building BUP2017-00287 Inspection Type: Inspector: 299 Final inspection Chip Barnett Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor