Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00553
Al i•t DEVELOPMENT SERVICES DATE ISSUED: 10/19/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102AD -03450
SITE ADDRESS: 08777 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Upgrade, replacement & addition of (2) antennas per (2) sectors.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: NONE : sf N: S: E: W:
OCCUPANCY GRP: NONE 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:
CINGULAR WIRELESS LEGACY WIRELESS
617 EASTLAKE AVE EAST 4252 SE INTERNATIONAL WY # F
SEATTLE, WA 98109 MILWAUKIE, OR 97222
Phone: Phone: 503 - 656 -5300
FEES Reg #: LIC 150432
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 10/14/200E $139.30
[TAX] 8% State Surchan 10/14/200E $11.14
[BUPPLN] Pln Rv 10/14/200f $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 direct questions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By J 9i Permittee Signatu
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.
l i '27 5 641 t3 Onlifr:
.. . .. Building Permit Application -- • FOR O i� I ICE IJSL O N L Y , ..., . ,.. ..
�J of Tigard I 1 ECE V : ) Date /By % ' -11' / - Permit � l z
Ci f _ ,��.��
• `
13125 SW Hall Blvd., Tigard, OR 97223 iew � I� dJ
Phone: 503.639.4171 Fax: 503.598.1960 ,y ��M,ay NP I `
., ! Dat e/B Rev . t �1�:11 ►/41/� Other Permit: G
Inspection Line: 503.639.4175 OCT 4 _ . ` f ... Date Ready/By: ' Jurist ra See Attached Checkl for
w.
Internet: wwci.tigard.or.us Notified/Method 10; di. f 1 � Supplemental Information
CITY OF TIGARD " / , � t , f /P
•
TYPN-W DIVISION' ref-
L U IRED 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
XAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit , the
•
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1 - and 2- family dwelling 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: 8777 SW Burn ham SA- • New dwelling area square feet
City /State /ZIP: Pori -1anof D2 97 .2.23 Garage /carpo :rea: square feet
• Suite/bldg./apt. no.: I Project name: Covered p ch area: square feet
Cross street /directions to job site: /, ' Deck ea: square feet
a rose .14 6 : 1 Ot er structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 075/02. A n 3 l - �� Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK . . work indicated on this application.
Valuation: $ /U a
C&,? �jth1, z,l e. �1p/1,901:14 , r4plaann,nf —
and Jadd on € an/ fnas pt.- a stew, -s Existing building area: square feet
New building area: p square feet
' PROPERTY OWNER , ❑ TENANT Number of stories:
Name: :i-oiale _a
C Type of construction: 00 i 6 /4.. woe
Address: t / 7 e
6 1,1- Occupancy groups:
City /State /ZIP: <J ta i A 98ieg Existing: A
Phone: ( ) Fax: ( ) New:
❑ APPLICANT . ❑ - C PERSON NOTICE
Business name: PrtriLe. am at Ascoaa.Ics All contractors and subcontractors are required to be
Contact name: Kn n Lame. under with the Oregon Construction Contractors Board
tt�� � under ORS 701 and may be required to be licensed in the
• Address: 98 E. 6utr1side. `)atte, „!t% jurisdiction in which work is being performed. If the
City /State /ZIP: Po ,.-41 a .,, d OR C/)4 Z/ applicant t is exempt from licensing, the following reasons
�c-7 ),2,—.4....9.70.2. a I
Phone: (503) 0/ ... I Fax: (503
E -mail:
C ONTRACTOR .
Business name: L29QC[. (,r J Cr � �c BUILDING PERMIT FEES*
Address: 4 / 2 5 - 1N� l SLu F Please refer to fee schedule.
City /State /ZIP: Pt? ref a nd, 04 q 7 Z / to Q Fees due upon application
Phone: 50 3 ) I'�51!0 .. .�3t7Q Fax: (50 eD4 9 . - 02
• CCB lic.: /50 43.2, Amount received
Date received:
Authorized signature: p L.,t fe ro y ( This permit application expires if a permit is not obtained
/` �J I v within 180 days after it has been accepted as complete.
Print na Date: � /•Z7 /J &H. * Fee methodology set by Tri- County Building Industry
Service Board.
is \Building\Pennits\B - Ti- PermitApp.doc 12/03 440- 4613T( /02/COM/WEB)
•
`4 T l
i
Building Division
' ��I�� Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard •
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at . •
• Submittal
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 • ' • 4 `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.
is\ Building \Petmits\BUP- TI- PermitApp.doc 12/03 440-4613T(I I /02/COM/WEB)
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 3tjP. ?04jt�t�,.f3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10//900006
Phone: (503) 639 -4171 ��� " j(j
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 21312006 TIME: 7:02AM PAGE: t� I
SITE ADDRESS: 010777 SW BURNHAM Sr CLASS OF WORK:
SUBDIVISION:' LOT #: TYPE OF USE:
PROJECT NAME: C(NGULAR WIRELESS
DESCRIPTION: Upgrade, replacement & addition of (2) antennas per (2) sectors,
OWNER: GINGULAR WIRELESS, PHONE #:
CONTRACTOR: LEGACY WIRELESS PHONE #: 603 - 656 -6300
Inspection Request Scheduled For: Date: 2..13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
296 Misc. inspection 02619101 206~484 -4619 N
Co.rreections /Comments /I ctions:
1
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL I CALL FNR INSPECTION n ADDI ONA FEES ASSESSED
Inspector: • / Date: S v., Phone #: (503) 718 - 4 Z3