Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00574
A DEVELOPMENT SERVICES DATE ISSUED: 3/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 11380 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Add (5) celular antennas to existing site.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2FR : sf N: 5: E: W:
OCCUPANCY GRP: U2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 10,000.00
Owner: Contractor:
UNIFIED SEWERAGE AGENCY WIRELESS FACILITIES INC.
150 N 1ST AVE 1840 MICHAEL FARADAY DR.
HILLSBORO, OR 97123 STE 200
Phone: RESTON, VA 20190
Phone: 703 - 904 -7400
FEES Reg #: LIC 145637
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 3/28/2005 $139.30
[TAX] 8% State Surchari 3/28/2005 $11.14
[BUPPLN] Pln Rv 3/28/2005 $90.55
Total $240.99
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 than 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 -0100. You may obtain a copy of these rules or ,, r-ct qu tions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
� I r
Issued By: hQ ZL Permittee Signature: / - t?e
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
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Building Permit 1E
A. �, _C) FOR OFFICE USE ONLY
City of Tigard �` G 1 DateByal� 9 �✓� ' Permit No' (A ^ 4y —O " c(
13125 SW Hall Blvd., Tigard, OR 97223 `loo`{ , Plan Review
Phone: 503.639.4171 Fax: 5O3.6 ^ !�..m" 1� 7 '\ Date/By: Q - 1 �s� Other Pernut:
�� @ '
Inspection Line: 503.639.4175 13 p 0 ' I- Date Read Juris: 0 See Attached Checklist for
Internet: www.ci.tigard.or.us r ,1� O G �� Notified/Method: Ti Cr Supplemental Information
�J G D�V ` t
" � . t � � QRT 1 1I A DA`FA:1 AND MILY DWELLING • 2- FA •
:ate, r 1 .° � ;4. . - a.._ .g., _ ..�
❑ 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
Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
4 work indicated on this application.
1- and 2- family dwelling Iii Commercial /industrial Valuation: $ 1 pOQ DO
ID
['Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
.N e : '$'. pis . ' V :„ a • ., a A
�. . � �� , ,� I p � s � ` � ��.�t�. , � Total number of floors:
Job site address: 1( S c2 New dwelling area: square feet
City/State/ZIP: -v.It.:Y, OZ x'121 -4 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: POZ . 1 W..IAI SatS Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
r L 's '`I I r RCYA - A' cuECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
I . I .: ' work indicated on this application.
Nop ..%vft_eS) CA AN ik837*.1i1JtrS 'TO 14,v) Ey,%5"t Valuation: $
C. Llvki •S viE_. Existing building area: square feet
New building area: square feet
. 4 ` *Ol i , :l ` .. ' , t. Number of stories:
�. 5 ..tea
Name: U,,I.;toS/ atil Alco affr e4. C tp.A. 7 7 Type of construction:
Address: I ( isC, 5 VV tEs 5 Occupancy groups:
City/State/ZIP: -.fir L) O� 9Cj'2'2,'t Existing:
Phone: (503) QQ j 'j7 Fax: ( ) New:
_
°F. 4''� yi M.1.. M° e 4 ' - . , ` . . o '7` a .. -.e
,ms ' i , g 3�
Business name: \J tt?C Wt \ 05. All contractors and subcontractors are required to be
Contact name: ..,,,, ��,�-F� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 444 - - 5 v.) tole .wt 'A„.45 jurisdiction in which work is being performed. if the
City/ State/ZIP: Qolt 1 j Of. Cy721cl applicant is exempt from licensing, the following reasons
apply:
Phone: ( jam) zii.i / ( i f ? I Fax: : ( )
, A
E -mail:
Oyt . v., i� rF VN c' fc...1JCT X.c.)M1P
r&I ,; � W t g e e s k ?� s
Business name: v,,j i-- I ---r la_ T _ I ::� -.. ,
/
— $FJTT,DING PERIVTIT FEES*
Address: it 5 W P pit$rZ. 1 11.VI 1D•
Please refer to fee schedule.
City/State/ZIP: p,I b . op_ a 723`1
Fees due upon application
Phone: ( ( s- 6 'S i- Fax: ( )
y Amount received
CCB lic.: 1 c
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: . N,R, t e Date: 1 v- - 2,2..-0 t 'f * Fee methodology set by Tri - County Building Industry
Service Board.
i:\ Building \Permits \BUP- PemutApp.doc 12/03 440- 4613T(1l/02 /COM/WEB) (�Q
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Building Division
Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
q
E, +" 1 ! i `k 1° 1 7 B "°' 1 1 :fi tl ffi! � s ® tl 9 Pte'
Ak*.' ,
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03
CITY OF TIGARD . -
BUILDING DIVISION PERMIT #: BUP2004 00'x74
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/2005 �
Phone: (503) 639 -4171 ' " i
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'
INSPECTION WORKSHEET FOR DATE: 6/291200 TIME: 7:08AM PAGE: 93
SITE ADDRESS: 16580 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: UNIFIED SEWERAGE AGENCY
DESCRIPTION: Add (5) celular antennas to existing site.
OWNER: UNIFIED SEWERAGE AGENCY, PHONE #:
CONTRACTOR: WIRELESS FACILITIES INC. PHONE #: 703- 904 -7400
Inspection Request Scheduled For: Date: 6/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 010358-01 503- 807 -0424 Y
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Corrections /Comments /Instructions: `����'
(0 ' 100
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITI . NAL FE' ASSESSED
Inspector: ,. Date: I - I i Phone #: (503) 718 -
i1/