Permit (114) 51 CITY OF TIGARD ,. • • BUILDING PERMIT
i COMMUNITY DEVELOPMENT ,. • ?' Permit#: BUP2019-00245
T I G ART) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 101)., 4 f / Date Issued: 09/12/2019
Parcel: 1 S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT&T Subdivision: 1993-058 PARTITION PLAT Lot: 1
Project Description: Replacing(3)radios and power cabinet. Adding(3)diplexers,(3) SOAR repeaters, additional collar mount,
additional support cabinet,and update equipment in existing cabinets.4/28/20: REPRINT to change contractor.
Contractor: CAPSTONE SOLUTIONS INC Owner: HA&R, LLC
8195 166TH AVE NE, STE 100 ATTN:TAMMY HOUSE
REDMOND, WA 98052 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 503-707-2656 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IV Permit Fee-Additions,Alterations, 09/12/2019 $301.85
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 09/12/2019 $36.22
Dwelling Units: 0 Plan Review 09/03/2019 $196.20
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/12/2019 $17.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $15,000 DC Provision Review,COM TI-Ping 09/12/2019 $102.00
Misc Administration Fee 04/28/2020 $45.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $698.77
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
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: A * eAroevee.7. 7----- Permittee Signature: l‘'4 �h'
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 RECEIVE
Commercial FOR OFFICE USE ONLY
City of Tigard MAR 3 0 2D20 Date/Bed
Permit No.:
;. i • 13125 SW Hall Blvd.,Tigard,OR 97223 .rq ,-_-, D Plan Review
Phone: 503-718-2439 Fax: 503-598-19 ' '' }: DateB : Related Permit
Inspection Line: 503-639-4175 �t MIMING DIVISION Date Ready/By: kris: ® See Page 2 for
IR.AM) P�
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
0 I-and 2-family dwelling El Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
"request to change the contractor information on permit number Valuation: $
BUP2019-00245." Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
pErAPPLICANT -CONTACT PERSON BUILDING PERMIT FEES*
Business name: S /,, / (Please refer((pike schedule)
,[Off* Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Amount received:
Phone:( ) Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Capstone Solutions Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:8195 166th Ave NE STE 100 Solar Installation Specialty Code checklist.
City/State/ZIP:Redmond, WA 98052 Permit fee(includes plan review $180.00
and administrative fees):
Phone:( 206)503 1483 J Fax:( ) State surcharge(12%of permit fee): $21.60
'
CCB Lie.: 196584 `7 r//1 f/2-2. Total fee due upon application: $201.60
Authorized signature:..44c Cztez..04,Q
C�/J' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Adam Chavez Date:3/30/2020 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP_COM_PemtitApp.doc Rev.04/21/2014 440.4613T(I l/02/COM/WEB)
CITY OF TIGARD BUILDING PERMIT
' '. COMMUNITY DEVELOPMENT Permit#: BUP2019-00245
I G A R f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2019
T
Parcel: 1 S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT&T Subdivision: 1993-058 PARTITION PLAT Lot: 1
Project Description: Replacing(3)radios and power cabinet. Adding(3)diplexers,(3)SDAR repeaters,additional collar mount,
additional support cabinet,and update equipment in existing cabinets.
Contractor: CROWN CASTLE USA INC Owner: HA&R, LLC
1220 AUGUSTA DRIVE SUITE 600 ATTN:TAMMY HOUSE
HOUSTON,TX 77057 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 724-416-2000 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IVPermit Fee-Additions,Alterations, 09/12/2019 $301.85
Demolition
Occupancy Grp: U Occupancy Load: 0 12%State Surcharge-Building 09/12/2019 $36.22
Dwelling Units: 0 Plan Review 09/03/2019 $196.20
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 09/12/2019 $17.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $15,000 DC Provision Review,COM TI-Ping 09/12/2019 $102.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0 -
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $653.77
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 Special Inspection(see plans)
'PM Alain)! Protected Corrfcfors: 4 . --
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 952-001-6'90. Y�, may o-ain a•.py of the rules or direct questions to OUNC by calling 503.232.1187 or 1.800.33 .2344.
/, �/ t /
Issued By: * Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec!•n date.
This permit card shall be kept in a conspicuous place on the job site until completion of he project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial RECEIVED FOR OFFICF FS1.ON I:1
City of Tigard
P 3 Recei ! 3 /f42 ` .,.? /s—
II as a 13125 SW Hall Blvd.,Tigard,OR 972 2019 Plan Date/By:
vie U
-Phone: 503.718.2439 Fax: 503.59 Date/By: 7' / fOther Permit:
Inspection Line: 503.639.4175 I OF TIGARD DateReadyBy: f12 Other
Juris: la See Page 2for
TIGARD
Internet: www.tigard-or.gov BUILDING DIVISION ttifiedimeth.. /� ' Supplemental Information
� i -witir...aalll
;-� °. _i aearo aa3'a&aR 9"�d'sar aa� a daxae sta rs.a.+s•
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder 0 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12655 SW North Dakota St. New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.:A Project name:856366 Scholls&125th ATT Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R2143964 REQUIRED,DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.: 1S134BC00700 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF N O work indicated on this application.
Replace(3)radios and power cabinet. Add(3)diplexers,(3)SDAR repeaters, Valuation: $$15,000.00
additional collar mount,additional support cabinet,and update equipment in Existing building area: square feet
exisiting cabinets. New building area: square feet
181 PROPERTY OWNER 0 TENANT Number of stories:
Name:HA&R LLC Type of construction:
Address:12655 SW NORTH DAKOTA ST. Occupancy groups:
City/State/ZIP: TIGARD OR 97223-0801 Existing:
Phone:( ) Fax:( ) New:
Da APPLICANT ®:® CONTACT PERSON % BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Crown Castle(on behalf of New Cingular Wireless) Structural plan review fee(or deposit):
Contact name:Zach Phillips
FLS plan review fee(if applicable):
Address:5111 N.Bowdoin St.
Total fees due upon application:
City/State/ZIP:Portland,OR 97203
Amount received:
E-mail:zach.phillips@crowncastle.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Crown Castle Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: las 0 J?is /�)/i(/� 5/.t,("f 6� Solar Installation Specialty Code checklist.
City/State/ZIP: ,,,s-741),,...„t (/ Permit fee(includes plan review $180.00
Y � and administrative fees):
Phone:(??.11) -7to't(. —2/q✓ ,E) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:203500 Total fee due upon application: $201.60
Authorized signature: r, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Zach Phillip Date:8.30.19 * 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)
City of Tigard
N .
COMMUNITY DEVELOPMENT DEPARTMENT
T1cARo Building Permit Review — Commercial - No Land Use
Building Permit #: ) l/G„2011'f”00)1-15-
Site Address: 126SS cV iW kwiL nALk Suite/Bldg#:
Project Name: AT T
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review lc-1) r 1 I
Proposal: fep 1 CO r4 c a1J� La,entt. f fAl�` d yL 5, C 3) Coo +c� 1'trJ
0,,a iv,„1 (Ala, Maa,�-) „ILO-chid 5 ip.-- CC6in1-) , deIt�t 4,i.pie rid- k 604) (4iAc*.
l / FI
" y U
Existing Business Activity: \l id 1.411,-,,/nia 1 C;01
Proposed Business Activity:
ever
erify site address/suite# exists and active in permit systh.
Terrace N ig rhood: ❑ Yes Il No
Ltl Zoning:
.i ermitted Use: ❑ Yes ❑ No ❑ Spec Space
Confirm no land use required.
P'Business License:
Exists:/n� II ❑ Yes ❑ No,applicantpp� notified to obtain businesslicense
-�^
Notes: 17L1a 4 ~Ps( url'i, n W e l b. '6°,4X1,0 .4- I a 6 4 3l!4 C .
Approved by Planning: .9cDate: .7- l i
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: �/
Site Plans: #- _ --
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: Planning ❑ ll'R nit Coordinator Building
Workflow Sign-off: 7 Sign-off for Plan ng(include notes fr planning review)
Route Application Documents: 'Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
✓� ��,.��//`,
...- 7
By Permit Technician: « Date:
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:
CDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes jir N/A
Tigard Trans SDC: ❑ Yes "/A
Parks SDC: ❑ Yes r/ N/A
OK to Issue Permit
Approved by Permit Coordinator: ate: q1.4
.4/!f
I:\Building\Forms\B1dgPermitRvw_COM_NoLandUse_070915.docx
RECEIVED
City of Tigard SEP 0 3 2019
COMMUNITY DEVELOPMENT DEPARTMENT CITY OF TIGARD
PLANNING/ENGINEERING
TIGAKD Collocation - Supplemental Questionnaire
PROPERTY ADDRESS FOR STAFF t.SE ONL_'
12655 SW North Dakota St.
Location of collocation:
Zone:
Name of provider: AT&T
Zach Phillips CI Approved
Contact name: ❑ Not Approved
Collocating antennas on: By: Date:
E Existing tower
Reason not approved:
❑ Existing non-tower structure
Is this a new provider?
❑ Yes
❑ No
Other providers currently collocating on same tower or structure: i.\Community Development\Land Use Appiicatons\02_Forms and
Templates\Land Use Applications\Future Forms Rev.12/14/2017
Indicate the previous approval: BUP2011-00056
(SDR,MMD#)
ANTENNA INFORMATION
Existing: New:
HeiHeight of antenna(s): 55 s . No new antennas
g (q ft.) Height of antenna(s): (sq. ft.)
Color of antenna(s): Color of antenna(s):
Color of equipment: Color of equipment:
3 radios 3 radios
Accommodating equipment: Accommodating equipment:
(i.e.dishes) (i.e.dishes)
Will new accessory equipment be installed? I Yes ❑ No
Location of new accessory equipment?
In Within previously approved fenced area
❑ Within existing structure
❑ Other location:
(Please describe)
landscaping be removed-To accommodate 41e accessory egiilpmenr Yes TT NU---
If
:If yes,describe here:
Zach Phillips 8/30/19
plicant s signature Print name Date
SONNOWNONINNIMISMSIEW
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 1