Permit CITY OF TIGARD BUILDING PERMIT
1.• COMMUNITY DEVELOPMENT Permit#: BUP2013-00268
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2014
Parcel: 1 S136CCO2100
Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HWY
Project: Verizon Wireless Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: Replacing 6 of the 12 existing antennas on the existing cell tower. Locations and heights will not change.
Contractor: T3 CONSTRUCTION LLC Owner: GRUNBAUM FAMILY TRUST
1520 AUSTIN RD BY GRUNBAUM, HANS H AND MARILYN K,
ROSEBURG, OR 97471 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE: 541-673-4377 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 03/26/2014 $225.80
Demolition
Occupancy Grp: U Occupancy Load: Plan Review 10/31/2013 $146.77
Dwelling Units: 0 12%State Surcharge-Building 03/26/2014 $27.10
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 03/26/2014 $16.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $10,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $416.17
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 co. of the rules or direct questions to OUNC by calling 503.2 = ;87 or 1.800.332.2344.
4
Issued By: �� / l—� Permittee Signature: - .
•
a I . 175 by 7:00 a.m.for the next available inspection
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
Commercia [OR (►I I I( I I •,I (►\I l
, Received
City of Tigard iEE D ate/B : I h�. Permit No.: .2 �. p ,
13125 SW Hall Blvd.,Tigard,OR 97223 Q 1 !�0 Plan Revi
II Phone: 503.718.2439 Fax: 503.598.1960 QC1 J Dateg : di���t Mtn der Permit:
1 I i,1 Pp Inspection Line: 503.639.4175 11 1 , Date Ready/13 : ✓ jam.; s: ® See Page 2 for
Internet: www.tigard-or.gov GM `,,,.tified/Method: / /3 .L3 ':9'I Tr' , Supplemental Information
V .t ► - /
I
TYPE OF WORK ' REQUIRED DATA:I-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 CI Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11744 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project nam e. vct,)-tav UJ,yr L,. Covered porch area: square feet
Cross street/directions to job site:Pacific Hwy and Hwy 217 behind drive- Deck area: square feet
thru coffee shop. This is an 130'wireless tower. 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.: 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.
Replace 6 of the 12 existing antennas on the existing cell tower. Locations and Valuation: S$10,000.00
tip heights will not change. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name:Verizon Wireless Type of construction:
Address:5430 NE 122"Ave Occupancy groups:
City/State/ZIP:Portland,OR 97086 Existing:
Phone:(503)720-7295 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please
Business name: Urban Wireless for Verizon Wireless "efe1tafascsednit�
Structural plan review fee(or deposit):
Contact name:Shanin Prusia
FLS plan review fee(if applicable):
Address: 10376 SE Sunburst Way
Total fees due upon application:
City/State/ZIP:Portland,OR 97086 .
Phone:(503)720-7295 Fax: :( ) Amount received:
E-mail:shanin@UrbanWirelessInc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:TBD f Submit two(2)sets of roof plan with connection details
�r'OY �r{ �� and fire department access,along with the 2010 Oregon
Address: /5-#2.4z, ��p Solar Installation Specialty Code checklist.
City/State/ZIP: `_` Permit fee(includes plan review
ty �� ' 0� � �� and administrative fees): $180.00
Phone.( / (_ �Q23 c..13 i7 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: /)76, r/ �G lslS
t 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: Shanin Prusia,Urban Wireless Date: {v f q 1 1i3 * Fee methodology set by Tri-County Building Industry
Y Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)