Permit • ..
..,... ,.
Ah, CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00204
�i�i DEVELOPMENT SERVICES DATE ISSUED: 6/27/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 1026 D -02600
SITE ADDRESS: 12955 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT: 037 JURISDICTION: TIG
Project Description: Add (6) antennas to existing wireless communication monopole & equip. pad.
REISSUE: .J1 FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: U , FIRST: sf N: S: E: W:
TYPE OF USE: - COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3N 143 sf N: S: E: W:
OCCUPANCY GRP: UNK TOTAL AREA: 143 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:
MARA HYLTON WIRELESS ALLIANCE INC
• 6802 SOUTH 220TH ST 27501 SW 95TH AVE STE 955
KENT, WA 98023 WILSONVILLE, OR 97070
Phone: 475 - 251 -8480 Phone: 406 - 250 -4545
FEES Reg #: LIC 146700
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUPPLN] Pln Rv 5/16/2005 $90.55 .
[BUILD] Permit Fee 6/27/2005 $139.30
[TAX] 8% State Surcha 6/27/2005 $11.14
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: 1 Permittee Signature: L
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.
J dt9 Sw 3aC rcl C. tiwy
Building PerIIlitR i D FOR OFFICE USE ONLY
City of Tigard R eceived S , .-0 Permit N..:10 (/s 4965 oo / V
13125 SW Hall Blvd., Tigard, OR 97223 Pla Review
Phone: 503.639.4171 Fax: 503.598 0 i 6 e� / oo� A l uN�r� by ,I� DateB : e Other Permit:
Inspection Line: 503.639.4175 F (�, A �® F'1 l Date Ready : Tv/ Juris: El See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF 4 Notifie eth / O -17(1 Supplemental Information
BUILDING DIVISie� c 1 40 e `.
• TYPE OF WORK RE 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
'Addition/alteration/replacement ❑ Other:CE,, SiTr C 01 C equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION - _ •• work indicated on this application.
❑ 1- and 2- family dwelling I] Commercial /industrial 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: )2 8 5\x/ I r K. 0 �� New dwelling area: square feet
City/State/ZIPr � . n � C(-) q Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: l Covered porch area: square feet
Cross street/directions to job site: ..SC . v I (, poi T.( An Ap 31-4T Deck area: square feet
G 1 , O 1 Other 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.: ZS 1.0 - b4 ._ c32..(00 Indicate the value (rounded to the nearest dollar) of all
u ,y
equipment, materials, labor, overhead, and the profit for the
- ' DESCRIPTION OF WORK work indicated on this application. •
t Valuation:
C- $ I C), ()��
S►Te (CD)pt4rf- kn1�1S MtOV .0 D►T °� —
5 s 171.\V IT a 2, nS r . aKt Si , "l $ 1-4 1 Existing building area: square fe
a N ew building area: square feet
n tiNNMPol,r - EG)Otp o.i (4(2.010 - hevj 9 - q KI SLAB g I ►3 q
,PROPERTY OWNER • ❑ TENANT Number of stories:
Name: M� i_1�l Type of construction:
Address: ' 1 ( T
�$Q'2 S (�vy1..� �O ST Occupancy groups:
City/State/ZIP: 4.1,3T 1 � A 9 0?..." Existing:
Phone: (4 7 151 - e 9 g Fax: ( ) New:
. ❑ APPLICANT • ' . ❑ CONTACT PERSON •
. , ■ . NOTICE _ - : �f a _;
. .
Business name: All contractors and subcontractors are required to be
o licensed with the Oregon Construction Contractors Board
Contact name: CAA AR.L.I.S I rs5 rum c - N � V i b R
CA under ORS 701 and may be required to be licensed in the
Address: SitD S \ y' T) I jurisdiction in which work is being performed. If the
City/State/ZIP:P OR 011 Ci applicant is exempt from licensing, the following reasons
apply:
Phone: (56') , X4,4 -3955 Fax:: ( )
E -mail: O LlgSQ, ® SP ► R r0►4 t .col -r .
r • CONTRACTOR . ; . . - .
Business name: - Th E o W .. 4A G 3 S Ca'\`‘e
: {w , .^,,T .3.4DI_N 9.PE I T
Address: .
City/State/ZIP: Please refer to fee schedule.
Fees due upon application 9 a ,)3
Phone: ( ) Fax: ( )
CCB lic.: /y0 7 a 3 •aQ�c., Amount received
' Lk) Date received:
Authorized signature: W This permit application expires if a permit is not obtained
�� 1 // within 180 days after it has been accepted as complete.
Print name: CI„I AP-L- r s \AV 1 r�_S Date: S I 1 l6 I ()s * Fee methodology set by Tri-County Building Industry
Service Board.
i:\ Building \Permits\BUP- PennitApp.doc 12/03 440- 4613T(l1/02/COM/WEB)
J ✓
Building Division
iy 'j � Plan Submittal Requirement Matrix
. Comm & Multi - Family - New, Additions or Alterations
..Y
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 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 #: - aps_
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 1 1 011 1(ll
Inspection Requests (24 Hrs.): (503) 639 -4175 . �! +L
1 INSPECTION WORKSHEET FOR DATE: t L72 TIME: PAGE:
SITE ADDRESS:12$Th5 5 CO r - ' _1Fl— CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: tOQgs ( PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
IRY t /0
Corrections /Comments /Instructions:
A r
/1
� at . ���
i ' a"' _.__
i
,, PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FP,{.E • CALL OR INSPECTION ❑ ADDITI &NAL F' ES ASSESSED
Inspector: � /ate: A OA. Phone #: (503) 718 -�' T
CiTY`OF TIGARD , ,.
BUILDING DIVISION PERMIT #: BUP2005-00204
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/27/2005
Phone: (503) 639 -4171 A l ��na `��
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I ..,
INSPECTION WORKSHEET FOR DATE: 7/21/2005 TIME: 7:09AM PAGE: 61
SITE ADDRESS: 12955 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 TYPE OF USE:
PROJECT NAME: CINGULAR
DESCRIPTION: Add (6) antennas to existing wireless communication monopole & equip. pad.
OWNER: HYLTON, MARA PHONE #: 475 -251 -8480
CONTRACTOR: WIRELESS ALLIANCE INC PHONE #: 406- 250 -4545
Inspection Request Scheduled For: Date: 7/21/2005 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
220 Slab 011889 -01 503- 860 -4402 Y (0: 20
ICJ
•
Corrections/Comments/Instructions:
_g_ ( E: 0)-..-------
in PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL _ U CALL FOR SPECTION ❑ ADDITI• AL FE- ASSESSED
ik 1,-W-1-71`- `Inspector: , , �'' Date: 2/ _ ' one #: (503) 718 -