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Permit (225) 71 CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: BUP2019-00164 Date Issued: 08/14/2019 T I(;r1 lip 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106AD04900 Jurisdiction: Tigard Site address: 16668 SW AUTUMNVALE LN Project: T-Mobile Subdivision: RIVER TERRACE EAST Lot: 156 Project Description: Replacing antennas,replacing and adding remote radio heads,and installing new hybrid cable. Ground work includes replacing(1)cabinet,adding(1)cabinet,and replacing radio modules within the cabinets on the concrete pad within the fenced compound area. Contractor: SAC WIRELESS LLC Owner: RALSTON, CHRISTOPHER J 540 W MADISON 16TH FLOOR RALSTON, SHERI L CHICAGO, IL 60661 21029 SW LEBEAU RD SHERWOOD, OR 97140 PHONE: 312-809-8013 PHONE: FAX: FEES Specifics: Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: IIA Permit Fee-Additions,Alterations, 07/22/2019 $586.19 Demolition Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 07/22/2019 $70.34 Dwelling Units: 0 Plan Review 07/10/2019 $381.02 Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 07/22/2019 $102.00 Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 07/22/2019 $17.50 Value: $37,000 11x17) Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $1,157.05 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fre 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/btain a cop .f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I Issued By: / / Permittee Signature: -('�� ��µ 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. Building Permit Application Commercial T FOR OFFICE USE ONLY Cl of Tigard EC EIV ED Received 111 v 13125 SW Hall Blvd.,Tigard,OR 972B - Plan Review,......�/ /'' „9/444) �"�/"t x�/1 �i�`� �y Phone: 503-718-2439 Fax: 503-598-1960DateBy: J -s) Related Permit: T I G AR D Inspection Line: 503-639-4175 J U L 1fj9 0 2 Date ReadyBy: /// 7uris: i3 See Page 2 for Internet: www.tigard-or.gov fied/Meth Z� / .`c Q Supplemental Information TIG TYPE CITY ©BARD /;i: , , ,,` z,=' ,, „f,y f ,i.',• /,%//, ,�:i..,,:;;., /i...aim4 T. OFF.1 - ,.:ii/r ,f,,,, ',,- 4/% QUu2ED:::D f7 A1lJle2 FAMII WE,LING f ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑X Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the work indicated on this application. �;friAJATEGORYQO�STRF� ' O / ir ; ,,, El1-and 2-family dwelling ElCommercial/industrial Valuation. $ IIIAccessory building 111Multi-familyNumber of bedrooms: ❑Master builder ['Other:Cell Tower-Equipment Mod Number of bathrooms: ,/z-e. 7' .;��r;,� f :.zrO%; �,,�//; iii ;.ow,„', c/ r �/;09B SITE"INFORMATIOiNtANiI+'OCATIOY :'-'4:',, Total number of floors: Job site address: 16668 SW Autumnvale Lane New dwelling area: square feet City/State/ZIP: Beaverton,OR 97007 Garage/carport area: square feet Suite/bldg./apt.#: Project name: 879602/Barrows Road Covered porch area: square feet Cross street/directions to job site: Site is located south of Scholls Ferry Road about 1/8 Deck area: square feet mile west of SW Barrows Road. Access is via River Terrace Blvd.to Friendly Lane to Other structure area: square feet Autumnvale Lane. Tower is located on residential lot in local subdivision. ''''r0 r�r ' " �t�, r� ,REQTk`IRED D�T�i:COYIvIER�IAL-U�E�HECKL IST Subdivision: River Terrace East 1 Lot#: 156 Permit fees*are based on the value of the work performed. Tax map/parcel#: 2S106AD04900/R2201576 Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the i, M'./ i/4 ,,EfRIPIIOjQ , rriF%% 1 , work indicated on this application. r, , 7N� ,:,, ) � f h ,;. Replace antennas,replace and add remote radio heads,and install new hybrid cable. Valuation: $ 37,000.00 Ground work includes replacing(1)cabinet,adding(1)cabinet,and replacing radio Existing building area: square feet modules within the cabinets on the concrete pad within the fenced compound area. New building area: square feet �frf,; .: 4 � EffT �A �RY 'fi � ' � / I1 TA ��r ' �� Number of stories: N/A / , ir j , r Name: CCGS Holdings LLC(Crown Castle) Type of construction: Cell Tower Equipment Address: 2000 Corporate Drive Occupancy groups: Non-occupied City/State/ZIP: Canonsburg,PA 15317 Existing: Phone:( 866 )444-8102 Fax:( ) New: 14PfL' N 1 f / 1fQQiY"IACCrr R;SOr.% fr7 / f L i*mrr FE Si `. , ;;W ,48 /. o ,r ,',4r ,,, ,f, ,. -7.0'/A-- t, ', '' /£ / Wzjerrjischedie / ; Business name: Crown Castle Structural plan review fee(or deposit): Contact name: Kent Flake FLS plan review fee(if applicable): Address: 2055 S.Stearman Drive Total fees due upon application: City/State/ZIP: Chandler,AZ 85286 Phone:_480 )735-6951 i Fax•• ) Amount received: - - -- - _ J 4/ '4 "/.'i!/IJT,"'/4w' /�/'/ n, ` 'ry'44 9f-•f* lJ7GGua/ E-mail: kent.flake@crowncastle.com 4,9To 4/2 orr 74,1 44/4/M *, o •r00y j,/,r„r r � ,, ,art �_ :„.„/,,,,,,, �; //,, ,F Commercial and residential prescriptive installation of i,.//,'f W,lli!fr4 40;i1/'r//'1,�.'1,.fr ,r,,,,1,ONN,N`T'. ''''''5.41,1,,,',-OR if r' ';/r; .,,,f'f •.,l , .�,,,fj 1 c,r ,�,� roof-top mounted Photovoltaic Solar Panel System. Business name: TBD .)AG 1,-),:e€ L£5 5 Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: 7 6,2 �'� `C!7h. �� City/State/ZIP: Solar Installation Specialty Code checklist. 1 Permit fee includes plan review $180.00 ��'� �jOGGand administrative fees): Phone:(3/L) �'D c 3 I Fax( ) State surcharge(12%ofpermit fee): $21.60 CCB Lie.:�� f' 31 L!) Total fee due upon application: $201.60 i Authorized signature: // %O/ ) This permit application expires if a permit is not obtained �if__ within 180 days after it has been accepted as complete. Print name: Kent Flake Date: 07/09/19 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP_COM P• itApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) City of Tigard 111111 q COMMUNITY DEVELOPMENT DEPARTMENT 1 TICARo Building Permit Review — Commercial - No Land Use Building Permit #: � /";21�t..vc)/6„,i1 Site Address: /666F Ski 47104);11/14) , Suite/Bldg#: Project Name: 7- ,oL �.e (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: .- dG-'lit`/.�'/,dir .,.o e 0 nay.) eiC«S5o7 7„,rma-, ;op G,o( 2, �cere:'c/ Existing Business Activity: QNe4 4c;4,./y Proposed Business Activity: iz)#,r,P/e c;),4 J2—"Verify site address/suite#exists and active in permit system. [��River Terrace NeighboRElrhood: oes No —2”Zoning: �`jj 'Permitted Use: $Yes ❑ No ❑ Spec Space .,1: -"Confirm no land use required. ❑B ss License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: ` - Date: 77/€/9 Revisions (after Building Submittal only) Reviewer ( Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: El Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: lOih Site Plans- # - iejrn Building Plans: # � Building Permit#: laf,Enterbuilding permit#above. Workflow Routing: L '1 ening [i-hermit Coordinator ding Workflow Sign-off: [�i-'�Sign-off for Planning(include notes from planning review) E� Route Application Documents: 'Bu11ditig: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: 7/ // I:\Building\Forms\BldgPetmitRvwCOM 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: DC Fees Entered: Wash Co Trans Dev Tax: El al/N/A Tigard Trans SDC: ❑ Yes Q N/A Parks SDC: ❑ Yes 12(N/A K to Issue Permit iDate:Approved by Permit Coordinator: A°/.1 I:\Building\Forms\BldgPennitRvw_COM_NoLandUse_070915.docx