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Permit CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: BUP2015-00181 T R. ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2015 Parcel: 2S102CC01100 Jurisdiction: Tigard Site address: 13680 SW PACIFIC HWY Project: T-Mobile Subdivision: FREWING'S ORCHARD TRACTS Lot: 15 Project Description: Remove(3)antennas and add(3)antennas. Remove(6)radios and add(3)radios. Contractor: VERSACOM LP Owner: TIGARD-ORENOMAH LODGE NO.207 OF 8111 LBJ FREEWAY, SUITE 1500 PO BOX 230184 DALLAS,OR 97251 TIGARD, OR 97281 PHONE: 971-479-0202 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 07/16/2015 $377.90 Demolition Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 06/25/2015 $45.35 Dwelling Units: 0 Plan Review 06/25/2015 $245.64 Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 07/16/2015 $12.50 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 $681.39 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 503.232.1•:7 or 1.800.332.2344 Issued By: /' •. ee Signature: ' L dr Cal''9.4175 by 7:00 a.m.for the next avMkjuleinepatlion 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 Commercial RECEIVED FOR 01 1.1( I. 1 SE 0'LI City of Tigard 9�Z 2 15 Received permit No.: n 1111 g Date/I3 t� I,L P e/5--60 0 r • 13125 SW Hall Blvd.,Tigard,OR Plan Re • Phone: 503.718.2439 Fax: 5 T 1 r �', Other Permit: -1, � I f�� Date/By: �, �• I I t; \it I) Inspection Line: 503.639.41 SS i f; nip/�SI®N Dare Ready : turis ® See Page 2 for Internet: www.tigard-or.gov bulLDS Notified/Method: �/� /I, Supplemental Information _ ' F3,r•s t L.d .i TYPE OF WORK 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:Modification 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: 13680 SW Pacific Hwy New dwelling area: square feet City/State/ZIP:Tigard,Oregon 97223 Garage/carport area: square feet Suite/bldg./apt.no.: . Project name:TMO L700 825028 P004037C Covered porch area: square feet Cross street/directions to job site:Pacific Hwy&Watson(entry on Watson) 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.:2S102CC01100 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. Remove 3 panel antennas,add 3 panel antennas Valuation: $20,000 Remove 6 Remote Radios,add three radios with ancillary equipment Existing building area: square feet and Cables New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: 100' Name:Tigard Oreno Lodge Type of construction: Il-B Address:PO Box 230184 Occupancy groups: City/State/ZIP:Tigard,Oregon 97281 Existing: unmanned Phone:( ) Fax:( ) New: unmanned ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name:T-Mobile (Please refer to fee schedule) Structural plan review fee(or deposit): Contact name:Agent for T-Mobi/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: 377.90 E-mail:Sandra.walden @crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System. Business name TBD. / �j Co Al /) 6;0 Submit two(2)sets of roof plan with connection details �-° and fire department access,along with the 2010 Oregon Address: /// / Qj 7>L L ) s<__,i 11-14:. /5�`. Solar Installation Specialty Code checklist. City/State/ZIP: �}/ V 5 71 Permit fee(includes plan review $180.00 ` � and administrative fees): Phone:(9'-7)) L/7q — c e Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lie.: Z 0 Zz 7 Total fee due upon application: $201.60 Authorized signature: �Z�� t c� d. 7►1/ his permit application expires if a permit is not obtained �l� within 180 days after it has been accepted as complete. Print name:Sand n Date:6/25/15 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB) I 4 • City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT Building Permit Review — Commercial - No Land Use Building Permit #: LAP 15- X l 'g 2� l Site Address: 13 to e)0 S W Poi c.-ii-c__ 4-+-vvy Suite/Bldg#: Project Name: (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: f�VY) OV2. 3 PU►n e l Gi Y1 1- - c13 61..r)oc GI ou 3 iom '4k. Cl r rremn Ct) Existing Business Activity: )( 1 S t' Y13 'f')W -T Proposed Business Activity— NIA- 0 Verify site address/suite#exists and active in permit system. –R Rl er Terrace Plan District ❑ Yes ❑ No Zoning: C-0 Permitted Use: ❑ Yes ❑ No ❑ Spec Space (3 V P 2-00(7 —0 OS Qi ,6 infirm no land use required. XBusiness License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: 0 /1^i LG--1 j i( © Date: ) 2 Si ( S Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: 4,41-c/i S Site Plans: # 3 Building Plans: # Building Permit#: E-Enter building permit#above. Workflow Routing: El.—Planning iermit Coordinator R uilding Workflow Sign-off: )Sign-off for Planning(include notes from planning review) Route Application Documents: 1,343uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: C iT)( v&.4-ij Date: 4A CA l I:\BuildineFormsl BIdgPenni tRvw_COM_NoLandUse_031015.docx Permit Coordinator Review El Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: ArOK to Issue Permit Approved by Permit Coordinator: C- v»-✓ Date: , — to — (5 (:\Building\Forms\BldgPermitRvw_COM_NoLandUse 03 1015.docx RECEIVED COLLOCATION JUN 2 4 2015 Supplemental Questionnaire CITY OF TIGARD Pp lemental Q i PLANNING/ENGINEERING I I t \I;I I City of Tigar4 13125 SW Hall Blvd,Tigart4 OR 97223 Phone: 503.718.2421 Fax: 503.598.1960 IF YOU ARE APPLYING FOR A PERMIT TO COLLOCATE ANTENNAS, PLEASE COMPLETE THE INFORMATION BELOW. Name of Provider. T-Mobile (824338 P01373B)) Property Address/Location of Collocation: 11744 SW Pacific Hwy,Tigard,Oregon 97223 Zone: C-G Collocating antennas on: ® Existing tower ❑ Existing non-tower structure Is this a new provider? ❑ Yes ® No Ifyes, list other providers c er rntly collocating on same tower or structure,if arty:: If no,indicate the previous approval(SDR,MAID or BUP#): r ( 47- 00 5 Height of antenna(s): 130 ft. Color of antenna(s) and accommodating equipment(i.e. dishes): white Color of existing tower or structure: tower and antennas are not currently painted 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.) samil radio equipment on the ground fFRLBs). See Drawings Will landscaping be removed to accommodate the accessory equipment? ❑ Yes (Please describe below.) ® No Applicant's Signature: ,..1,, / _ - Date: 6/23/15 Name Printed: .•,dra Walden-T-Mobile Agent Phone: 503-709-0820 FOR OFFICE USE ONLY PSI OK to issue permit , ❑ Do not issue permit Refer to planner. r - ,4L 7 Planning Staff Signature Date I.\CURPLN\Masters\CollocateAnten nas.doc