Permit CITY OF TIGARD BUILDING PERMIT
IN s COMMUNITY DEVELOPMENT Permit#: BUP2015-00148
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2015
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD
Project: Sprint Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replacing existing antennas. Scope or work includes ancillary equipment and cabling.
Contractor: CROWN CASTLE USA INC Owner: PPR WASHINGTON SQUARE LLC
1220 AUGUSTA DRIVE SUITE 600 PO BOX 847
HOUSTON,TX 77057 CARLSBAD, CA 92018
PHONE: 724-416-2000 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: OTR Type of Const: Permit Fee-Additions,Alterations, 06/04/2015 $564.15
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 06/04/2015 $67.70
Dwelling Units: 0 Plan Review 05/21/2015 $366.70
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 06/04/2015 $22.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $35,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,021.05
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. •:7-r :00. 2.2344.
Issued By: Permittee Signatur=. _.e... „0....„...,c,..... -.--
4:74,...5)----...._____03.639.4175 by 7:00 a.m.for the next •-ction date.
This permit card shall be kept in a conspicuous place on -to until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FO►t OF 1.1( I. I !,I_ 0\I1
City of Tigard 0 CENT Received , Permit No.. `
III
13125 SW Hall Blvd.,Tigard,OR 97 -1 Plan Review gaffe=
tt Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit.
T I G A R D Inspection Line: 503.639.4175 �/ S '�0\ Date Ready:y: 61 See Page 2 for
g g MQl Notified/Method: o f Ir, y Supplemental Information
Internet: www.ti ard-0r. ov
TYPE OF WOW�� 1 t+�i :1,Q,'.,4 .L..,,l S./`�"'�r �l
' �C�Q REQUIRED DATA 1-AND 2-FAMILY DWELLING
? Permit fees*are based on the value of the work performed.
❑New construction ❑I)ento)ttron �
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ®Other:Modification equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: S f f f
❑ 1-and 2-family dwelling ®Commercial/industrial _
El Accessory building ❑ Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
pa SITE INFORMATION AND LOCATION Total number of floors:
Job site addressSW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Sprint 2.5 879570 PO29XCOS3 Covered porch area: square feet
Cross street/directions to job site:SW Scholls Ferry Rd&SW Washington Squa Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: R0236587 iS 1 06 0000306 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.
Proposed modification to existing permitted telecommunications facility Valuation: $35-:01r0
Remove existing antennas and replace with 3 Tri-band antennas with 3 remote Existing building area: square feet
radio heads including ancillary equipment and cabling. New building area: square feet
® PROPERTY OWNER El TENANT Number of stories: 90'
Name:PPR Washington Square LLC Type of construction: II-B
Address:PO Box 847 Occupancy groups:
City/State/ZIP:Carlsbad,CA 92018 Existing: unmanned
Phone:( ) Fax:( ) New: unmanned
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Sprint PCS (Pleaserefertofeeschedule)
Structural plan review fee(or deposit):
Contact name:Agent for Sprint/Sandra Walden with Crown Castle
FLS plan review fee(if applicable):
Address: 1505 Westlake Ave.,N Suite 800
City/State/ZIP:Seattle,Washington 98109 Total fees due upon application:
Phone:(503)709-0820 Fax: :( ) Amount received:
E-mail: IC SOLAR PANEL SYSTEM FEES*
-mail:Sandra.walden @crowncastle.com
CONTRACTOR Commercial and res ential prescriptive installation of
roof-top mounted Pho Voltaic Solar Panel System.
Business name:TBD 6;44)v 6.001/1 6,14 d j i'^ Submit two(2)sets of r plan with connection details
� and fire department access, ong with the 2010 Oregon
Address: L)% f . Avr J" ,, ...Z./._}` ._ Solar Installation Specialty e checklist.
City/State/ZIP: j �0� ...Z./._ Permit fee(includes plan view $180.00
and administrative f ):
Phone:(r3Zy)ikp _, vn Fax:( ) State surcharge(12%of permit fee) $21.60
CCB lie.: 3�
(� 5aj d I� �,�/�/r / Total fee due upon application: $201.60
Authorized signature: �tIGL�f/t/`�� 4d This permit application expires if a permit is not obtained
~ within 180 days after it has been accepted as complete.
Print name:Sandra ci...
e n Date:5/1/15 * Fee methodology set by Tri-County Building Industry
L Service Board.
1:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440 4613T(11/02/COM/WEB) e(,,, VA it-366/-7(1
RECEIVER
COLLOCATION
MAY 182015
Supplemental Questionnaire
City of TiganA 13125 SW Hall Blvd,Tigard,OR 97223 CITY Of fICARD
Phone 503.718.2421 Fax: 503.598.1%0
BUILDING DIVISION
IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS,
PLEASE COMPLETE THE INFORMATION BELOW.
Name of Provider: Sprint PCS (879570 P029XC053)
Property Address/Location of Collocation: 9585 SW Washington Square Rd. tigard
Zone: MUC
Collocating antennas on: ® Existing tower 0 Existing non-tower structure
Is this a new provider? ❑ Yes ❑ No
Ifyes, list other providers currently collocating on same tower or structure,if any
AT&T Mobility
If no, indicate the previous apprnv al(SDR,MAID or BUP#): 5D_g 1? 9 9 - a o 01 a.
Height of antenna(s): 84 ft.
Color of antennas) and accommodating equipment(ie. dishes):
Within Canister
Color of existing tower or structure: Grey pole and canister
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.)
Antennas to be installed wishing a new canister at the top of the tower.
Will landscaping be removed to accommodate the accessory equipment?
❑ Yes (Please describe below.) ® No
Sprint proposes to install 3 triband panel antennas and 3 remote radio heads w ancillary equip under
new fabricated canister at top of tower
Applicant's Signature: Date: 4/30/15
Name Printed: andra Walden Phone: 503-709-0820
FOR OFFICE USE ONLY
IN OK to issue permit • ❑ Do not issue permit Refer to planner.
Gt • Cam— S I a- iS
Planning Staff Signature Date
L\CURPIN\Masten\CoDocatcAnt nnas.doc
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