Permit a "'CITY OF TIGARD BUILDING PERMIT •
PERMIT #: BUP2008 -00362
COMMUNITY DEVELOPMENT DATE ISSUED: 12/30/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD MGMT OFFICE ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: AT & T
Project Description: Collocation on existing cell tower located on north edge of Wa Sq property across from Dick's sporting
goods.
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: 2N sf N: S: E: W:
OCCUPANCY GRP: S2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: 75 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: $ 35,000.00
Owner: Contractor:
WASHINGTON SQUARE LLC M & A CONTRACTING INC
BY THE MACERICH COMPANY 1366 LEE ST SE
9585 SW WASHINGTON SQUARE RD SALEM, OR 97302
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 581 - 6125
Reg #: LIC 177866
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
IBUPPLN] Pln Rv 10/29/200E $183.85
[BUILD] Permit Fee 12/30/200E $282.85
[TAX] 12% State Surch 12/30/200E $33.94
Total $500.64
I
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
oft e rules • irect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I ued By — �
I ill l _ii4 I 9
Permittee Signature •
Allim
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.
'
" Building Permit Ap lication
Commercial .&"'j • fl FOR OFFICE USE ONLY n
City : it,' �iird O \ . . ,� I Received n f Permit No.: . (,( fi g- 0 036, `
- all B lv�'d, OR 97223 / Date/By:. nReview
f
� 131'131 ''I,` Plan ���
C Phon• 03.63 4'A� Fax
5a I96t / c Date/By:
1 1^ �' .2A.. o1 Other Permit:
f I G A k D inspection 1.6 e 503.6 � ,Q / ! /,' ' Date Ready/By: luris Ei See Page 2 for
Internet: w*w.tiga / - Notified/Method:� Supplemental Information
� 0�� TYPE OF WORK 1 REQUIRED D DATA: AND 2 FAMII.Y DWE ING ‘1).) ❑ New construction � ❑Demolition J 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 CONSTRUCT' •' work indicated on this application.
❑ 1- and 2- family dwelling 4 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:
. It Job site address: 01 5g 5 S viA,..j.,0, „ S TZ p New dwelling area: square feet
v City /State /ZIP: - T1 � a ,-,N r p R 91 Z z 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: � � WaS�■e‘e'. Siv'tf� Covered porch area: square
feet
' Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R EQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* arc based on the value of the work performed.
Tax ma / arcel no.: Indicate the value (rounded to the nearest dollar) of all
P P S 1 Z (o C7O o c0 3 0 o equipment, materials, labor, overhead, and the profit for the
c4 DESCRIPTION OF WORK R`c r 1).6,1'21% 1 K No , work indicated on this application.
Q TnsA\ \c or\ c A.n.-tnitti Sc 1" n '� � Valuation: $ V , v
t1/4-a■-% Ck S t ce At.e Alb. ,0[4 W ; -1-',.\-- Existing building area: N a C h sgaare feet
-{ . - e K r i J C. r....,-, C�3 k ea szg a (i New building area: `' square feet
❑ PROPERTY OWNER ® TENANT Number of stories: ' `
Name: , e c r y \S oV\ n 50. .. •••• C r....-1/.. (� q4 � Type of construction: '� ''
Address: ZS y -) \ 5 4. A N E Occupancy groups: V n Ocw pi r
City /State /ZIP: Q QN,��� %,.! A q$ D 5 Z Existing:
Phone: ( 73) 3r/ 9 - y 2.g 3 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
usin e: . e .) -,. ' All contractors and subcontractors are required to be
ontact n •. e: 1-0,•v%. s� , v `�; licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: t 3 p •AA li.).J o_.r ^r tc...1_ s u,` k 3,,, jurisdiction in which work is being performed. If the
City /State/ZIP: �e�i't -(.c I.J k G 8� g applicant is exempt from licensing, the following reasons
apply:
; Phone: ((DSo) 3•$O ^ - 5 l — OS o Fax:: ( )
p ..... E -mail: �p.r • 5 p .0 1b: z a& 56, i ..... (o nn vv v�
\ . (o.
CONTRACTOR
Qs Business name: - A CA. BUILDING PERMIT FEES*
Address: (Please refer fee schedule)
Structural plan review fee (or deposit):
O City /State /ZIP:
FLS plan review fee (if applicable):
c t Phone: ( ) Fax: ( )
CCB lie.: Total fees due upon application:
Amount 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: I Date: * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 2/23/07 440 -4613T(I1 /02 /COM/WEB)
. ..
a Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STAT rm Ij ( 0 t ) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done, •
excluding painting and wallpapering: [1] $ ,
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(0 Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and •
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
1: \Bull ding \ Permits \BUP -CO11 PermitApp.doc 10/30/07
.1\ I'
° Building Division
e..
Plan Submittal Requirements
T I G A R D Commercial & Multi- Family - New, Additions or Alterations
1. SITE PLAN (fully dimensional, drawn to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking, including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of .
plans required based on submittal type (no redlines or tape -ons accepted).
All details listed below shall be incorporated into the plans: = _
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections. -
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations, plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit - based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
l:\ Buildin \Permits \BUP -COM 1'crmitApp.doc 10/30/07
a C 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 include location of all accessible parking)
Plumbing (site utilities) 2
r _
Building 2*
•
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 -COM PermitApp.doc 10/30/07
PST- r qs8dtS tc.)/6< sc
B_,uildin Permit Application O Commercial S°' FOR OFFICE USE ONLY
City of Tigard • Dateived �D �9 � '%J Permit No.: .. i S/„� 2
13125 SW Hall Blvd., Tigard, OR 912 t. t �,
` . Phone: 503.639.4171 Fax: 503.598.1960 QC,\ �' r � E' ' Other Permit:
Inspection Line: 503.639.4175 � `' O G �1 ` �\ R � � O � �:. to Rea. y /By: ® See Page 2 for
T I G A It I: , Internet: www.tigard -0r.gov �V D \ ` ? Notifi t 1 F4;�L Supplemental lemental Information
61100 , tom,( a :�
TYPE OF WOI 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:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (15'n SW \x/As Nh t h ( t .y l C Je4 vpk,,'ei R New dwelling area: square feet
City / State/ZIP c,o2U Or2_ q12.2-3 Garage /carport area: square feet
Suite/bldg. /apt. no.: 1 Project name: ` re Covered porch area: square feet
Cross street/directions to job site: r., D%t-C' )- oviS Oh ShPel Deck area: square feet
f ,- j 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.
f s� �� � vOl7 .iU� Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: .X) equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. 00
1 � vir1C/ ix- t . , 0 n Valuation: $ '
• I'r�C3
�A-t- S ►} C7w ►�► a S
square feet
21c1si". Pl 1 T-, I wlor►o o) u. . Cab 1 v,.e1- i O
J- 2 New building area: square feet
on S1� -C.J �� 10.T Cif' I W r f h t h �,X' I bl w � rid C.A hn t+�ti � � � (�
❑ PICOPERrY OWNER I TENANT Number of stories: 1 ,,Y1tlklr, O 1t
Name: k i f T . Type of construction: J 5
Address: I11 G t w 1d �c 3 �i G ZZ I E- 7 Z�JD til1 Occupancy groups: — 2,
City /State/ZIP: y , W was z a S vb., p � Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT . s, CONTACT PERSON NOTICE
I Business name: All contractors and subcontractors are required to be
'I Contact name: CI icAvA s VII Ems licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 52_56 W noSC\,., jurisdiction in which work is being performed. If the
City /State/ZIP: �tO} 6 _,....d, l J R � J Z3 applicant is exempt from licensing, the following reasons
apply:
Phone: 15O3) 3 , q , 3 Cili 5 Fax:: ( )
E-mail: ;�p-r 115 n (1O'"% CAI4„ '►'le
r — CONTRACTOR
Business name: -riereiiip H O - k COO-ne a. BUILDING PERMIT FEES*
Address: (Please refer to fee schedule .
City /State /ZIP: Structural plan review fee (or deposit): !S3 . 8S
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): /
Vote Total fees due upon application:
' l
CCB lic.: 7
Amount received: I / 3.
Authorized signature: Thi permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
r Print name: lOoti 1 �) �y S Date: ` 0 hpqo U • Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440 -4613T(I I /02 /COM/WEB)
•
'* e
111111 • I
e
a Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given .
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex •
� '• "' restroom: $
(e) Accessible telephones: $
(0 Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms:- $
TOTAL (shall equal line [2] of Valuation Computation): $
•
I: \Building \Permits \BUP -COM PcrmitApp.doc 10/30/07
05/14/2008 04:19 3602107831 PACIFICMOUNTAIN PAGE 02/02
• •
RECEIVED
� - R COLLOCATION OCT 2 92008
w '
Supplemental Questionnaire. CITY OF TIGARD
TI i; ; I? n Oy of TJgard, 13125 S1PH,a11 Blvd, T§g¢ , OR 97223
Aux 503.639.4171 Fax: 503.598.1964 gIJtLOtIVG DIVISION
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider
Property Address /Location of Collocation: In r
Zone: M t,i C—
q
U
Collocating antennas on [.. Existing tower
❑ Existing non-tower structure
Is this a new provider? Yes
❑ No
Ifyes, ke other providers currrntfr collocating on mnn ibnmr or rfri a ye, #
.AI 5 _
If no, indicate the previous appra pal (SDR, MMD or B UP#):
Height of antenua(s): •J, ft
Color of anteuna( and accommodating equipment (ie. dishes):
Cobs o t ring tower or structure: r ek, _ _
Will new accessory equipment be installed g Y . . -
(] No
. f yes, please answer the follavinB:
Locatlofl of accessory equipment: 0 +'ithin fenced area
• Within exi previously approved
sag structure
❑ Other location (Please describe below.)
❑ Will landscaping be removed to accommodate the acre ory equipment?
Yes (Pkase describe below.)
0
Applicant's Signature: l 1 _ •
Name Printed: U _ ��I , o � Date: I � • O
y e -
i _ Phone: 3(rLai I_'
® Zssu permit. L '. _ . ._ ' ` r' }
E l Do not issue ; =
40 - , - ■JL . erk_A-4-7,---.-) _....S.74.52/02_______
\ pemsit. Refer to planner.
P • . : Staff s' . turn
Date
I. \CLIRPL AMastce \COL`aaceAn ark. dog