Permit . t
i;"' CITY OF TIGARD _ _ BUILDING PERMIT
PERMIT #: BUP2006 -00586
COMMUNITY DEVELOPMENT DATE ISSUED: 4/17/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S136CC -02100
SITE ADDRESS: 11744 SW PACIFIC HWY ZONING: C -G ,
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: T- MOBILE
Project Description: Install antenna array & radio cabinets @existing telecommuncations site.
REISSUE: tIck. FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: / FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK 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: 130 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: $ 40,000.00
•
Owner: Contractor:
• GRUNBAUM, HANS H AND MARILYN K LEGACY WIRELESS
TRUSTEES 15580 SE FOR MOR CT. .
21390 SW EDY RD CLACKAMAS, OR 97015
SHERWOOD, OR 97140
. Contact #: PRI 503 - 656 -5300
Phone: FAX 503 - 656 -5305
Reg #: LIC 150432
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pln Rv 12/14/200E $257.27
[FLS] FLS Pln Rv 12/14/200E $158.32
[BUILD] Permit Fee 4/17/2007 $395.80
[TAX] 8% State Surcha 4/17/2007 $31.66
Total ' $843.05 .
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 -010u. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
di
l iS c... _
Issued By: Permittee Signature: A fA„ e _____i
Call 503.639.4175 by 7:00 a.m. for an inspection that bu - ness 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.
Comniefcial Tenant Improve >rrfe y_
• - Building Permit Aaulicatio` toi vF, FOR OFFICE (SE ONLY
City of Tigard Received Permit o. n
• ° 13125 SW Hall Blvd.,
171 Tigard, 03 97223 0DEC 1 2006 Plan Revi ��� y, - .
• Phone: 503.639.4171 Fax: 503.598.196 l� `� p� , vl J / / Other Permit: '
Inspection Line: 503.639.4175 Date Re. 7 : ' ��� /�Ir El See 'age 2 for
f I G n It U Internet: www.ti d ov / / PP
www.tigard Y Ur ^ IIiji t Notifed/M od: / + �Su Supplemental Information
•
TYPE ilfilt r QUIRE t 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
11Addition/aiteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Multi-family Valuation: $
❑ 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: 1 (14+ (Pa oi-FI c nwa j New dwelling area: square feet
City /State/ZIP: - a r n Garage /carport area: square feet
•
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
• qq - A a W rn ac I t Other structure area: square feet
' S. f a � `J 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
G
Tax map /parcel no.: ` J equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
• e, I' / _Sir _. A I I Al A ' �_' , Valuation: $ 4 t � '
it � �% o . I I . di _ Existing building area: square feet
*11 ., :,I il 1 t , . -' F- New building area: 120 square feet
❑ PROPERTY OWNER 7 TENANT Number of stories:
. - Name:1 u on I -0 Type of construction:
Address: ti' 3 2 i ll) ( 5 Jj i l ,1 1 Occupancy groups: ZWC
City /State/ZIP: l l J CA , . R
� � q46 Q0 Existing:
Phone: ( ) Fax: ( ) New:
A PPLICANT CONTACT PERSON NOTICE
Business name: \T vPiri re All contractors and subcontractors are required to be
Contact name &'r , licensed with the Oregon Construction Contractors Board
j � � � under ORS 701 and may be required to be licensed in the
Address: V iui]I , , . is . t Q jurisdiction in which work is being performed. If the
City /State/ZIP: du g o i �i� I OP 419 applicant is exempt from licensing, the following reasons
�-p� apply:
. Phone: (63) q -3-7,51.1 Fax :: 6 `-'t -t C1 -nF
E -maa:C 1 11. p 6 IU n oarn
t' CONTRACTOR
Business name: L p fQC V (2, C / es5 5�� �_ BUILDING PERMIT FEES*
Address: li 10t / + (j to f - (Please refer to fee schedule)
� 1 Structural plan review fee (or deposit): T 7
City /State/ZIP: l " ja kico I,� ok 9 9 '7 OI�
�"
' FLS plan review fee (if applicable): Q g2
/
Phone: (50/1 — �'? Fax: 603) 65510- 5305 p
CCB lic.: `t/"`r Total fees due upon application: C. 1":5
j (L Amount received: vAs-i-
Authorized signature: op ,� p o e. , [� v This permit application expires if a permit is not obtained
•
wi thin 180 days after it has been accepted as complete.
Print name: (�` P ��v c �I w I Date: �2 L� 4' Fee methodology set by Tri- County Building Industry
`--'� Service Board.
I:\BuildingTermits\BUP -TI- PermitApp.doc 0323/06 440 -4613T(11 /02 /COM/WEB)
Building Division
Plan Submittal Requirement Matrix
T I G A R D Commercial & Multi - Family - New, Additions or Alterations
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 indude location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 2 **
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 \Permits \BUP- TI- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION tY PERMIT #: BUP2006 -00586
13125 SW Hall Blvd., Tigard, OR 97223 ,� DATE ISSUED: 4/17/2007
Phone: (503) 639- 4171M4w 3+I�I
Inspection Requests (24 Hrs.): (503) 639 -4175 F_ ..
INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE: 45
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: T- MOBILE
DESCRIPTION: Install antenna array & radio cabinets c? existing telecommuncations site.
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: LEGACY WIRELESS PHONE #: 503-656 -5300
Inspection Request Scheduled For: Date: 7/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 051502 -01 503-804 -2517 N
Corrections /Comments /Instructions:
. i
•
%PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1/ Inspector: Date: 142 ! d Phone #: (503) 718 -
CITY OF TIGARD ` '`
BUILDING DIVISION y PERMIT #: BUP2006 -0068G
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/200/
Phone: (503) 639 -4171 I�I
Inspection Requests (24 Hrs.): (503) 639 -4175 P_
INSPECTION WORKSHEET FOR DATE: 6/11/2007 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: T- MOBILE
DESCRIPTION: Install antenna array & radio cabinets @existing telecommuncations site.
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: LEGACY WIRELESS PHONE #: 503-656-5300
Inspection Request Scheduled For: Date: 6/11/2007 Pour Time: 12:00
Code # Inspection Description Confirm # Contact # Message
220 Slab 049978-01 503. 2093020 N
Corrections /Comments /Instructions:
PASS % • • 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL // 'ALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
Inspector: Date: d / ° 7 Phone #: (503) 718- 2-C9 V_
CITY OF TIGARD L ,, '`
BUILDING PERMIT #: BUP2006 -00586
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/17/2007
Phone: (503) 639 -4171 .44.141(111‘
Inspection Requests (24 Hrs.): (503) 639 -4175 :� _ ..
INSPECTION WORKSHEET FOR DATE: 6/11/2007 TIME: 7:00AM PAGE: 33
SITE ADDRESS: 11744 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: T- MOBILE
DESCRIPTION: Install antenna array & radio cabinets @existing telecommuncations site.
OWNER: GRUNBAUM, HANS H AND MARILYN K, PHONE #:
CONTRACTOR: LEGACY WIRELESS PHONE #: 503- 656 -5300
Inspection Request Scheduled For: Date: 6/11/2007 Pour Time: 12:00
Code # Inspection Description Confirm # Contact # Message
270 Reinforcing steel (rebar) 049957 -01 503-209-3020 N
Corrections /Comments/ Instructions:
i
Ji:4 PASS r P' 'T AL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ! CA FO -INSPECTION ❑ ADDITIO A/ EES ASSESSED
// _Inspector: Date: Phone #: (503) 718