Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2012 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/08/2012
Parcel: 2S114AA00300
Jurisdiction: Tigard
Site address: 16295 SW 85TH AVE
Project: A T & T Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: Co-location of (3) antennas on existing Sprint tower.
Contractor: STEELHEAD COMMUNICATIONS INC Owner: WH SHIPMAN LIMITED
28120 ST ROUTE 410 E SUITE A3 BY NORRIS & STEVENS INC
BUCKLEY, WA 98321 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 360 - 829 -1330 PHONE:
FAX:
•
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee - Additions, Alterations, 08/08/2012 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 12% State Surcharge - Building 08/08/2012 $54.47
Dwelling Units: 0 Plan Review 07/18/2012 $295.07
Stories: 0 Height: 0 ft Info Process /Archiving - Sm $0.50 (up to 08/08/2012 $13.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $25,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $816.99
Required: Required Items and Reports (Conditions)
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. ENTION: • = !•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 01 -0010 through OAR 9 001 -• • • • You may obtain a copy of the rules or direct questions to OUNC by calling 503232.1987 or 1.800.332.2344.
Is ed By: 02: 0 / i. Permittee Signature:.
Call 503.639.4175 by 7:00 a.m. for the next available Inspect! te.
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.
7'
'r Building Permit Application '
Commercial roll orrice: u >Nl_l
City of Tigard R Dat te e 7 1 /A , i Permit No.: 4
° 13125 SW Hall Blvd., Tigard, OR 9722 II Plan Review 1
C Phone: 503.718.2439 Fax: 503.598.1 1 8 2012 DaDate/13 : Aiif�� Other Permit:
TI G A R D Inspection Line: 503.639 D ate early/ hod. t/2 � y ®mental Information 1 Page 2 tor
Internet: www.tigard- or.gov CITYOFTIGARD Supplemental
Ili.nING DIVISION SPa40- rrJ /Z4
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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms: a
1.
❑ Master builder ❑ Other: Number of bathrooms: .
JOB SITE INFORMATION AND LOCATION
Total number of floors:
Job site address: 16295 SW 85 Ave. New dwelling area: square feet
City/ State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: PR52 Durham f ' fAl'( Covered porch area: square feet
Cross street/directions to job site: SW Shaffer Lo, . Deck area: square feet
Other structure area: square feet
R1268764 REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S114AA00300 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.
Add 3 LTE antennas onto existing self support tower. Valuation: $25,000
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Comcast Type of construction:
Address: 14200 Brigadoon Ct. Occupancy groups:
City/State/ZIP: Beaverton, OR 97201 Existing:
Phone: (360)688 -3188 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: PTS (on behalf of AT &T) (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Zach Phillips
FLS plan review fee (if applicable):
Address: 1001 SE Water Ave., Ste 180
City/ State/ZIP: Portland, OR 97214 Total fees due upon application:
Phone: (503) 708 -9200 I Fax: : (503) 232 -8219 Amount received:
E -mail: zphillips@ptswa.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name:.'F$ec tGEL/T,� ati� ,, ,� ,7Ct l Submit two (2) sets of roof plan with connection details
• n t 'r and fire department access, along with the 2010 Oregon
Address: G L1 p` D / aQ !a 'SA IL 4!o E 2% 4-3 Solar Installation Specialty Code checklist.
City/ State/ZIP: ---� t14...kLtJ ` LOO qi 3 ( Permit fee (includes plan review $180.00
l and administrative fees):
Phone: ( N g 2..9 --! 950 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: ,q, 3/ 5/ l � - 1, , (y Total fee due upon application: $201.60
Authorized signature: 7...4.11;trZ5- / x Twi h n 180 days a ti r it ha s b e ef a ccep is oc
within 180 days after it has been accepted as complete.
Print name: (mot /lam ( V y I Date: 7 ( U f t • Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 02/242011 440- 4613T(11 /02/COM/WEB)
COLLOCATION
Supplemental Questionnaire
TI G A R D City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2421 Fax: 503.598.1960
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider. AT Cr
Property Address /Location of Collocation: I C Z q S Stv g54-L Ave.
Zone: 1-e
Collocating antennas on: IR Existing tower El Existing non -tower structure
Is this a new provider? ❑ Yes No
Ifyes, list other providers currently collocating on same tower or structure, if any:
If no, indicate the previous approval (SDR, MMD or B UP #):
Height of antenna(s):
Color of antenna(s) and accommodating equipment (i.e. dishes):
Lich& 1 fk-(
Color of existing to4er or structure: /
Will new accessory equipment be installed) Yee ❑ No
Ifyes, please answer the following: tyt IIO PV
Location of accessory equipment: El Within fenced area previously approved
E. 'Within existing structure
❑ Other location (Please describe below.)
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) [ No
Applicant's Signature: G((1 Date: "Z
Name Printed: Z. J- ■ t Phone: co 1, 7d7, Z50
FOR OFFICE USE ONLY
OK t 'sue • : ❑ Do no issue permit. Refer to planner.
—t6, ! ;1,'/1/440 7 5
Plannin_ 7 17 attire Date
I:\ C URPLN\Masters \CollocazeAntennas.doc