Permit CITY OF TIGARD BUILDING PERMIT
�. COMMUNITY DEVELOPMENT Permit#: BUP2013-00078
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2014
T I G A Et D g Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Verizon Wireless Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (4)replacement antennaes,(2)new panel antennaes on pipe mounts attached at parapet. (2)pipe mounts.
Installation new equipment cabinet on rooftop platform extension
Contractor: LEGACY WIRELESS SERVICES INC Owner: CLEAN WATER SERVICES
15580 SE FOR MOR CT ATTN:ACCOUNTS PAYABLE
CLACKAMAS, OR 97015 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 503-656-5300 PHONE:
FAX: 503-656-5305
Specifics: FEES
Description Date Amount
Type of Use: COM Permit Fee-Additions,Alterations, 02/03/2014 $377.90
Class of Work: ALT Type of Const: Demolition
Occupancy Grp: Occupancy Load: 12%State Surcharge-Building 02/03/2014 $45.35
Dwelling Units: 0 Plan Review 02/03/2014 $245.64
Stories: 0 Height: 0 ft Into Process/Archiving-Sm$0.50(up to 02/03/2014 $10.50
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 $679.39
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. 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 952-001-0090, You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •ermi'ee • ature:
f. !4175 by 7:00 a.m.for the next available inspe ion 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.
Building Permit Application
1 Commercial RECEIVED FOR OFFICE USE ONI.I
Received
City of Tigard APR 1( i 3 S( Permit No.: (P, 3.Y-? ,
13125 SW Hall Blvd.,Tigard,OR 97223 H P R 0 Plan Revs
Phone: 503.718.2439 Fax: 503.598.19 �/ n Date/By:
-+4�' �`� Other Permit:
TIGARD Inspection Line: 503.639.4175 71�TIGC�1�� Date Ready ,/ /, .1116, fa See Page 2 for
Internet: www tigard-or gov BUILDING DIVISION Notified/Method: 7/ // 3 - �(j Supplemental Information
TYPE OF WORK �C C ? REQUIRED DATA:1-AND 2-FAMILY DWELLING
qEl New construction ❑Demolition Permit fees*are based on the value of the work performed.
�j 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.
N Valuation: $
N. ❑ 1-and 2-family dwelling ®Commercial/industrial
NEl Accessory building ❑Multi-family Number of bedrooms:
❑Master builder �( 0 Other:
Number of bathrooms:
(2�"JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:/16850 SW 85'" j d5iU New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
ti Suite/bldg./apt.no.: Project name:POR Tigard HS Covered porch area: square feet
Cross street/directions to job site:From SW Durham Road,turn South on SW Deck area: square feet
85`''Ave,arrive at site on left. Other structure area: square feet
X REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit tees* are based on the value of the vMmi.performed.
Tax map/parcel no.:2S113B000600 — 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.
Installation of 4 replacement and 2 new panel antennas on pipe mounts attached
Valuation: $$20,000.00
at parapet.Two additional pipe mounts required.Install new equipment cabinet Existing building area: N/A square feet
4 on rooftop platform extension. New building area: N/A square feet
' . ❑ PROPERTY OWNER ® TENANT Number of stories: N/A
Name:Verizon Wireless Type of construction: Commercial
-- .Address:5430 NE 122°"Ave Occupancy groups:
City/State/ZIP:Portland,OR 97230 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:KDC Architects.Engineers,Pt (Please refer to fee schedule)
1?
Structural plan review fee(or deposit): $185.33
Contact name:Sean Lusby
FLS plan review fee(if applicable):
V) Address:6975 SW Sandburg Rd.,Suite 100
1 City/State/ZIP:Portland,OR 97223 Total fees due upon application: $185.33
'-- Phone:(503)341-6458 Fax: :( ) Amount received: 185.13
E-mail:sean.lusby @kdcarchitects.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
'14 CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:TBD [c Submit two(2)sets of roof plan with connection details
�`1 L`''t��S� �i tll ��e° and fire department access,along with the 2010 Oregon
Address: ,55r) SF .:e p plate C7- Solar Installation Specialty Code checklist.
City/State/ZIP: l , GC A[h S U, 47e,S-- Permit fee(includes plan review $180.00
G and administrative fees):
Phone:(,5j 5To - :3,5 Fax:( )
3) 0 51 State surcharge(12%of permit fee): $21.60
CCB lie.: st sQ y3� //Sl/ Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Sean Lusby Date:4/11/13 * Fee methodology set by Tri-County Building Industry
Service Board.
r. I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
514 Building Division
Development Code Provision Review
FIG`\R D Commercial Projects with Approved Land Use
Building Permit No.: bl.4 V i 3, DOD i.
Land Use Casefile No.: SOP_ jOV G 000/0
Routed Plans:
Submittal Date: (4--1t(1
( 3
Submittal Date:
Submittal Date:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies
to the Building Division. Only checked (1) items are approved. Items not approved and those listed in the
notes must be revised prior to re-submittal. For questions please contact the appropriate staff person(s) listed
above each section.
STAFF: please only mark those items on the left side that are approved.
Planning Review(contact /111414 at 503-718- I/1/4) or trilte @tigard-or.gov)
B Land Use Approval &/0c.r, ----""
Er- Building Plans Match Approved Plan: Yes L� No ❑
Iil Maximum Building Height j/c /KGt'- ‘-h'
❑ Conditions Met
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved 131Z Not Approved ❑ Date: Wes/5.-- /3
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
Engineering Review(contact Mike White at 503-718-2464 or MikeW @tigard-or.gov)
❑ Actual Slope: cyo
❑ PFI Permit#
❑ Conditions Met
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review(contact Albert Shields at 503-718-2426 or albert @tigard-or.gov)
❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit
❑ Engineering Okay to Issue Permit
Notes:
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant - --
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2
RECEIVED
APR 11 2013 RECEIVED
14
CITY OFTIGARD COLLOCATION RECEIVED
■ :UILDING DNISIO MAR 29"2013
-ssupplemental Questionnaire
1 (, ..0: 1) City of Tiganl, 13125 SW Hall Blvd,Tigard,OR 97223 CITY OF T IGARD
Phone: 503.718.2421 Fax: 503.598.1960 PLANNING/ENGINEERING
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: Verizon Wireless , ,)
Property Address/Location of Collocation: 1i _5" _W 85th Ave.
Zone: I-P
Collocating antennas on: ❑ Existing tower ® Existing non-tower structure
Is this a new provider? ❑ Yes ® No
Ifyes,list otherpmviders currently collocating on same tower or structure,if any:
N/A n
If no,indicate the previous approval(SDR,MMD or BUP#): g u ZODO-00332
Height of antenna(s): 62 ft.
Color of antenna(s) and accommodating equipment(i.e. dishes):
Light Grey
Color of existing tower or structure: Concrete Grey Building
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.)
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) ® No
Applicant's Signature: Date: 3/20/13
Name Printed: Sean Lusby - prized ' -.. Phone: 503-341-6458
OK : i s .. + t. ❑ Do not issue permit. Refer to planner.
At PRO -5 / �--
e0 7 Plan : Staf' ignature Date
I:\CURPI.N\Mlastets\CollocatcAntennas.doc
Branden Taggart
From: Sean Lusby <Sean.Lusby @kdcarchitects.com>
Sent: Monday,January 27, 2014 9:16 AM
To: Branden Taggart
Subject: RE: POR Tigard HS - Verizon Wireless Permit
Branden,
Let me follow up with the contractor on this, but yes, at this point I believe we will be picking up the BP. I actually didn't
realize it hadn't been picked up yet.
Thanks,
Sean Lusby
Si*Acoostwn Manager
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From: Branden Taggart [mailto:brandent@tigard-or.gov]
Sent: Monday, January 27, 2014 9:11 AM
To: Sean Lusby
Subject: POR Tigard HS - Verizon Wireless Permit
Hello Sean,
Your permit for Verizon Wireless located at 16580 SW 85th has been ready to be picked up since April 29, 2013. Are you
still intending to pick up the permit? Technically the permit should be expired by now, but if you can let me know what
your plans are, I may be able to hold off on expiring the permit.
Thanks,
Branden Taggart
City of Tigard
11 Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
1