Permit CITY OF TIGARD BUILDING PERMIT
III COMMUNITY DEVELOPMENT Permit#: BUP2015-00280
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2015
Parcel: 1 S 135 BB00300
Jurisdiction: Tigard
Site address: 10185 SW CASCADE AVE
Project: T-Mobile Subdivision: OAKBURG Lot: 27
Project Description: Install(1)FBBC in existing equipment cabinet, Install(3)new RFLB behind new antennas.Remove and replace(3)
antennas.
Contractor: VERSACOM LP Owner: PORTLAND GENERAL ELECTIC COMPANY
8111 LBJ FREEWAY, SUITE 1500 121 SW SALMON ST
DALLAS, OR 97251 PORTLAND, OR 97204
PHONE: 971-479-0202 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 10/07/2015 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 10/07/2015 $45.35
Dwelling Units: 0 Plan Review 09/29/2015 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 10/07/2015 $7.50
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 $676.39
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 -• . ose rue -re, 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 callin. _: .232.1987 .2344.
Issued By: Ll �t�L Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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.
� S
Building Permit Application
Commercial RECEIVED l Ol' (11 1 1( 1 1 'I= O\IQ�1 n
Dattee/B : ' $ (7 /OJ.t.I/"i 0/57.10? O
_ City of Tigard Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Revie-"
Phone: 503.718.2439 Fax: 503.598.1w. P 2 9 2015 Date/B : aC Pty
==BIE Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready:y. Awls ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: �, Supplemental Information
1.11 I Ill 1 lJ Il ® `e�ti�J�
TYPE aJ�G QIVISI01' 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: 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:collocation Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10185 SW CASCADE AVENUE New dwelling area: square feet
City/State/ZIP:TIGARD OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project nam 40 7-2/41. ( . Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW Cascade Ave,near junction of 210 and 217. 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.:1S135BB00300 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.
Install 1 FBBC in existing equipment cabinet. Valuation: $520,000.00
Install 3 new FRLB behind new antenas. Existing building area: square feet
Remove 3 existing antennas and install 3 new antennas. New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:PORTLAND GENERAL ELECTRIC Type of construction:
Address:P.O.BOX 3340 Occupancy groups:
City/State/ZIP:PORTLAND,OR 97208 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Northwest Permit agent for T-Mobile,through Crown -
Structural plan review fee(or deposit):
Contact name:Naida Khan
FLS plan review fee(if applicable):
Address:9808 31st St SE
City/State/ZIP:Everett WA 98208 Total fees due upon application: ti
Phone:(360)945-2787 Fax::(888)400-0383 Amount received: p2 j. I
E-mail:naida @nwpermit.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:Versacom LP Submit two(2)sets of roof plan with connection details
and fire department a ss,along with th• : l I regoi3\
Address:8111 LBJ Freeway,Suite 1500 Solar Installation Specia ode ist.
City/State/ZIP: Dallas,OR 97251 Permit fee(includes $180.00
and admi• s .tive fees):
Phone:(469)834-6501 Fax:( ) State surcharge %of permit fee): $21.60
CCB lic.:207227
Total f.• • e 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:£h. 7 a yt Date: q Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
e . a
71 City of Tigard
•
COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: Pabl5'66 9,4s0
Site Address: 101'1)5 Sv\J Casco t R v - Suite/Bldg#:
Project Name: ¶- tJ ke A-y nvia.. Zep(act rne'4
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Re pl u cam- ai .v Vet\n& v,n 0.n e.421 s}i nel c e I ( -1-0 l e� .
Existing Business Activity: h J&-
Proposed Business Activity: ■t /O-
M-Verify site address/suite#exists and active in permit system.
IA-kiver Terrace Neighborhood: ❑ Yes 'No
Zoning: WA-C'
[Permitted Use: Yes Cl No El Spec Space
Confirm no land use required.
N+6 4 Business License:
MI '
Exists: ❑ Yes %Y No,applicant notified to obtain business license or
Notes:
Approved by Planning: C� a . Ctt- w.n , Date: 9 -a G -Ls-
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: Q//A 9//5"
Site Plans: # '2)
Building Plans: #
Building Permit#: Enter b uilding perms #above.
Workflow Routing: 0-Planning Permit Coordinator J ceding
Workflow Sign-off: Qign-off for Planning(include notes from planning review)
Route Application Documents: wilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
n ��9 /
By Permit Technician �� (_�JC Date: //7
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_070915.docx
4. . • 1
Permit Coordinator Review
❑ 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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
.4 OK to Issue Permit
Approved by Permit Coordinator: / Date: 1/S-
I:\Bui]ding\Fonns\B IdgPennitRvw_COM_N oLandUse_0709I 5.docx
To Community Development Page 2 of 2 2015-09-25 20:34:04(GMT) 18884000383 From Deborah Shields
RECEIVED RECE
City of Tigard �VEp
SEP 2 9.2015 SEP 2 8 2015
rr. COMM I'NITY DIsVI LOPM1:N�1 DI' RTME •1T
ti. "` ;,, ¶1:211.0 cation - Sup �'ueStlenn►fa �N RD
EER G
PROPERTY ADDRESS t 01 t.)5 I c)it '! A l k t s t ONLY
Location of collocation: T0257 SW CASCADE AVENUE •
Zone- .- Ail U`Y . .
Name of provider: TMobile - - — —
Naida Khan naida @nwpermit.com 1Ppttwrd .
Contact name: ri Not .1ppruy ed cA,� •
Collocating antennas on: ® Pxxisting tourer tier C dB-15 Date! _ •
❑ Existing non-tower structure Reason not sipper".ed: �— ..__y
Is this a new provider?: ❑ Yes
gl No
Other providers currently collocating on same tower or structure:
I C$iPPL,tl\Ma.o,...\L ..1 m.,ti.,,nc. .... P..•ost<snoii
Indicate the previous approval: _
(SDR,MM )#)
ANTENNA INFORMATION
Existing: New:
Height of antenna(s): 116.8' (sq.ft) Height of antenna(s): 115 8' (sq.ft.)
Color of antenna(s): Color of antenna(s): light gray
Color of equipment: Color of equipment:
Accommodating equipment:: Accommodating equipment:—. _ ___
(i.e.dishes) (i.e.dishes)
Will new accessory equipment be installed?: a Yes
❑ No
location of new accessory equipment?: 8 Within previously approved fenced area
11 Within existing structure
❑ Other location:
(please describe)
Will landscaping be removed to accommodate the accessory equipment?: ❑ Yes(please describe below)
I■] No
Naida Khan .'=' 9/25/2015
' '� Naida Khan
Applicant's signature Print name Date
'.n . . .......•... -... �-:r:w.•i.!tb..tl .«._'C'—ter.. _n� -:.:.�,y ...0, . c 4 r 1 .AC Jf S L Y Y
.._ ... ... ..•.'T:.f tit...H'.` . .•'a: ' v.!�.0•.-_ 1:.4'n r .1.i T':..... .. .
City of-Tigard • 13125 SW Hall Blvd. • '1 igard,Urcgnn 97223 • wwvttgard-or.gov • 503-718-2421 • Page 1 of 1
CROWNCrown Castle
v CASTLE 1505 Westlake Avenue North, Suite 800
Seattle, WA 98109
RECEIVE
September 29,2015 S E P 2 9 2015
CITY OF i1GAl(ll
BUILDING DIVISION
City of Tigard,OR
13125 SW Hall Blvd.
Tigard OR 97223
RE: Eligible Facilities Request to modify equipment on a communications Tower located at 10185 SW
CASCADE AVENUE,Tigard OR
Crown Site 8274140/Crown Site Name:Tigard
Customer Site ID POo1339B
Crown Castle on behalf of T-Mobile Portland is submitting the attached Eligible Facilities Request application
to add,remove,modify,or replace Transmission Equipment on a telecommunications Tower located at 10185
SW CASCADE AVENUE in the City of Tigard,OR.
Section 6409 of the Middle Class Tax Relief and Job Creation Act of 2012,commonly known as the"Spectrum
Act" (Pub.Law No.112-96,126 Stat 156),mandates that state and local governments"may not deny,and shall
approve,any eligible facilities request for a modification of an existing wireless tower or base station that does
not substantially change the physical dimensions of such tower or base station." Under federal law,an Eligible
Facilities Request is deemed granted sixty(6o)days after a complete application is filed with a local
jurisdiction.
T-Mobile proposes to modify an existing unmanned Wireless Communication Facility as follows:
• Install 1 new FBBC in existing equipment cabinet
• Install 3 new FRLB behind new antennas
• Remove 3 existing antennas
• Install 3 new antennas
Itemized list of submittal documents:
• Cover letter
• Approved Collocation Supplemental Questionnaire
• Commercial checklist
• Commercial building permit application
• Construction drawings,stamped and signed by an Oregon-registered engineer
The Foundation for a Wireless World.
CrownCastle.com
T-Mobile is committed to working cooperatively with all jurisdictions around the country to secure expeditious
approval of requests to modify existing personal wireless service facilities. If you should require more
information regarding the Spectrum Act,please do not hesitate to contact me with your questions.
Sincerely,
pe Naida Khan
Agent for T-Mobile,through Crown Castle USA
Cell: 604-314-4569
The Foundation for a Wireless World.
CrownCastle.com
1
Y714/4/0
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
a''PI Transmittal Letter
Fl,,A 1: n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Plans Examiner ATE CEIVED:
DEPT: BUILDING DIVISION RECE�VED
FEB 2 2 2016
FROM: Sandra Walden Y�
CITY OF TIGARD
COMPANY: Agent for T-Mobile BUILDING DIVISION
PHONE: 503-709-0820 BY _
RE: 10185 SW Cascade Ave BUP2015-00280
i (Site Address) (Permit Number)
Wireless Modification , Existing T. er
(Project name or subdivision : e and lot n .er)
ATTACHED ARE THE FOLL I NG ! /S:
Copies: Description: Copies: Description:
3 Additional set(s)of plans. Revisions:
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. 2 Engineer's calculations.
Other(explain):
REMARKS: The Mount Brackets for the antennas have been changed from the original planned.
A new Structural Analysis and Construction Drawings are included to Revise the issued permit
accordingly. Please contact me at sandra.walden@crowncastle.com with the fee required for this revision
or with any questions.
FO1 OFFICE USE ONLY _k!O
Routed to Permit Tech�nician: Date: :3 ( 1 ,CInitial
Fees Due: - Yes [J-1 O Fee Description: Amount ue:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): [] Yes , 0 No ❑ Done
Applicant Notified: „A,e, Date: 3/9/�G Initials: B-7-,
I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
A
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10185 SW CASCADE AVE, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00280
Jeff Grove
Violation Summary:
Inspector Contractor