Permit CITY OF TIGARD BUILDING PERMIT
' COMMUNITY DEVELOPMENT Permit #: BUP2012 00132
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 251138000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: T- Mobile Collocation - Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Replace (3) existing antenna with new technology and adding (3) new antenna
Contractor: NORTHWEST INSTALLATION & COMMISSIONING LL Owner: CLEAN WATER SERVICES
PO BOX 991 2550 SW HILLSBORO HWY
SPOKANE, WA 99210 HILLSBORO, OR 97123
PHONE: 509 - 981 -5565 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee - Additions, Alterations, 04 /15/2013 $377.90
Demolition
Occupancy Grp: Occupancy Load: 12% State Surcharge - Building 04/15/2013 $45.35
Dwelling Units: 0 Plan Review 07/03/2012 $245.64
Stories: 0 Height: 0 ft Info Process /Archiving - Sm $0.50 (up to 04/15/2013 $17.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $20,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $685.89
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
1 Special Inspection (see plans)
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. ATTE - . ! =.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- •10 through OAR • 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss = d By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspe • on date.
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.
r e.----/
BuiIdinu Permit Application
Commercial RECEIV FOR OFFICE USE ONLY
City of Tigard R 47 Pennit No : p ` O 32.--
g JUL 0 3 2012 Date/B
r 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r'1.
Phone: 503.7182439 Fax: 503.598.1960 Date/By: �� � � (
I her Permit
t G Inspection Line: 503.639.4175 CITY OFTIGARC Date Ready /By: u / �� 1u H See Page 2 for
s Internet: www.tigard - or.gov BUILDING DIVISION ontiedIMethod: 7/1°4 - . '
�n M y Supplemental Information
,a ! ( d Lk ice(
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
L] 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.
❑ I- and 2- family dwelling ❑ ('om mercial /industrial Valuation: $
El Accessory building ❑ Multi-family Number of bedrooms:
❑ Master builder ® Other: Wireless Fac Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of tloors:
Job site address: 16580 SW 85 Avenue New dwelling area: square feet
City /State/ZIP: Tigard, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: PO01263A SW Hall and Dunh . Covered porch area: square feet
Cross street/directions to job site: 85 and SW Dunham Deck area: square feet
1-5 to Carmen Drive Exit go west on Carmen to Dunham Drive, turn right to Other structure area: square feet
1
SW 85 Ave turn Iett to Water Tank. REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Cook Park Neighborhood Lot no.: Permit fees' are based on the value of the work performed.
r Indicate the value (rounded to the nearest dollar) of all
1 Fax map /parcel no.: 2S113B000600 RI2929
i equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
r ProPosed Valuation: $20000.00
swapping 3 existing antenna with new technology and add 3 new antenna
and radio related supportment. No ground work is proposed outside the leased Existing building area: square feet
area. New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Clean Water Services ATTN: Rvb-Bteea f s k S Type of construction: I
Address: 2550 SW Hillsboro Highway Occupancy groups:
H City/State/ZIP: Hillsboro / OR / 97123 Existing:
Phone: (503)6$t.3600- - 7 .8 1 '"1( Fax: (503)681 -3603 New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Bu • name T Mob N est, LLC
(Pleaserejatb jeesehedule)
Structural plan review fee (or deposit):
Contact name: Mary Frosch obo Powder River Dev. Services
FLS plan review fee (if applicable):
Address: 8960 Alderwood Drive
City/State/ZIP: Portland / OR / 97220 Total fees due upon application:
Phone: (503) 250 -4639 Fax:: ( ) Amount received: • G
(-mail: mart' .frosch(a?powderriverdev.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: T#�' eX Submit two (2) sets of roof plan with connection details
B
l�l:S� / $ r!'1 U TfO eOt//� /SSIal� /i hi and tire department access, along with the 2010 Oregon
. Address: Pp x C}C i `Solar Installation Specialty Code checklist.
City /State /ZIP:. 0 f . 1 136 9' Permit fee (includes plan review
I -- $180.00
and administrative fees):
Phone: ( ) qg I - rsi Fax: ( ) State surcharge (12% of permit fee): $21.60
('('B lie.: / l Q
) 7 y /ii /i
Total fee due upon application: $201.60
Authorized si • .. tur• • This permit application expires if a permit is not obtained
jaif within 180 days after it has been accepted as complete.
Tint 1��' ' " ' " Date: 7 3 ZO (Z * Fee methodology set by Tri- County Building Industry
Service Board.
!`.Building \Pe . \: P OM PermitApp.doc 02/24/2011 440- 3613T(I1/02/COM /WEB)
,
RECE • ED
1 .
COLLOCATION JUL 0 3 2012
. . Supplemental Questionnaire cyoFi
T I GARD City of Tigard, 13125 SW Hall Blvd., Tigard, OR 97223 BUILDINQDNISIUN
Phone: 503.718.2421 Fax: 503.598.1960
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
-- M
Name of Provider: t c ts (( )/,l 6- T L�_...
Property Address/Location of Collocation S 1_4i / 674 C3
Zone: t -
Collocating antennas on: ❑ Existing tower z i Existing non -tower structure 2c-1SP qp
Is this a new provider? ❑ Yes LL' No
Ifyes, list other providers currently collocating on same tower or structure, if any:
C) L..) E CA rJCSU LA-2.
If no, indicate the previous approval (SDR, MAID or B UP #):
Height of antenna(s): 53 ft. 7 S &vv.& af ,- L r._;,j b ... Rik e-L9-
Color of antenna(s) and accommodating equipment (i.e. dishes):
1,41 ■ LL r-sT rb.. /-1/1 n &-( //
Color of existing tower or structure: / » - I S `
Will new accessory equipment be installed? Yes ❑ No
Ifyes, please answer the following:
Location of accessory equipment: Within fenced area previously approved
Within existing structure
Other location (Please describe below.)
O NA 0° T6ip 6-e l N0 e , e_f'
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) No
6(2c»,0\Q
ilta ma i S t ooposeo.
Applicant's Signa e: j Date: -76 4 2,
Name Printed: ���/ I Phone: g_)3 -
l i‘39
FOR OFFICE USE ONLY
$ OI{ to issue permit. ❑ Do not issue permit. Refer to planner.
a • CCA -.ta" 7 -3 - /e2-
Planning taff Signature Date
I: \CURPLN \ Masters \CollocateAnternas.doc