Permit n CITY OF TIGARD BUILDING PERMIT
E2 ° COMMUNITY DEVELOPMENT Permit#: BUP2016 00054
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2016
Parcel: 2S102BD02600
Jurisdiction: Tigard
Site address: 12965 SW PACIFIC HWY
Project: AT&T Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37
Project Description: Replace panels on existing cell tower.
Contractor: VELOCITEL INC Owner: KIM, PENNEY
4004 KRUSE WAY PL, SUITE 220 395 NW SILVERADO DR
LAKE OSWEGO, OR 97035 BEAVERTON, OR 97006
PHONE: 503-636-2500 PHONE:
FAX: 503-636-2501
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 02/17/2016 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 03/07/2016 $54.47
Dwelling Units: 0 Plan Review 02/17/2016 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 03/07/2016 $88.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 03/07/2016 $15.00
Value: $25,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $906.49
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. ATT N: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are se OAR
952 1-0010 through C.R 952-001-1190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I ued By: 0 OA . 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.
w I
Building Permit Applicat > 11N•..
Commercial �j`C�,IV�'1 FOR OFFI('1: I SE ONLI
City of Tigard Received Date/By: A EV Permit No.: uP6�jl4---04,
13125 SW Hall Blvd.,Tigard,OR �7 1 7 2016 Plan Revie• 1• I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: e- / t;."---tc.
Other Permit:
TI G A R D Inspection Line: 503.639.4175 CITY Date Ready7Sy. Juris: 0 See Page 2 for
Internet: www.tigard-or.govb OF FIGAxll Notified/Method: �7: l(p i I Supplemental Information
DUILI s e ,i i�///
,,s ':x. . _.i..��< 4_':', �tx�xi `U, $ <'"-vv i,im' �-, , ' ;:;, o '„ ,,•,lu( :'')4:,..L„— ,::.,DpATA: +,„1 ii r*,,0:,' .**!:,i
❑New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORYOF CONSTRUCTION= -, work indicated on this application.
El1-and 2-family dwelling 0 Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
ElMaster builder ®Other:Cell Tower Number of bathrooms:
JOB SITE:_INFORMATION AND LOCATION Total number of floors:
Job site address: 12965 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name•L1 2Z Tjgar 33,4.0 /I► i"7- Covered porch area: square feet
Cross street/directions to job site:OR99W&SW Walnut Street Deck area: square feet
Other structure area: square feet
REp! ERE AT CO IMFIRCIAL-IJSE Ch ECKLIST
Subdivision: Lot no.:2600 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S-10-2BD-02600 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
',,-7-=`DESCRIPTION O WORK work indicated on this application.
Swap out(3)panel antennas,Remove(6)TMAs,Add(3)Radioheads, Valuation: $$25,000.00
Remove(6)Coax Feeders,Add(2)3/4"Fiber Feeders Existing building area: N/A square feet
New building area: square feet
roi ROPERTX'0:401' °❑`TRNANT Number of stories:
Name:American Tower Delaware Corp Type of construction: IIB
Address:1101 Perimeter Drive,Ste 225 Occupancy groups:
City/State/ZIP:Schaumberg,IL 60173 Existing: U
Phone:(847)240-1508 Fax:( ) New: U
-,0 APPLICANT, r-- 0 CONTACT PERSON -. BUILDING PERMIT FEES* - -
Business name:FDH Velocitel,Inc (Please refer tofee schedule)
Structural plan review fee(or deposit):
Contact name:Natalie Erlund
FLS plan review fee(if applicable):
Address:4004 Kruse Way Place#220
Total fees due upon application:
City/State/ZIP:Lake Oswego,OR 97035
Phone:(503)539-9247 Fax::( ) Amount received
PHOT`OVOLTAIC;SOI. R P,AI4EL�SY 1 E,S*
E-mail:Natalie.Erlund@FDHVelocitel.com � _• �. _ . , I , . •..
✓ qh CO 4.; y,n,,ohs., ,
Commercial and residential rescritive installation of
. • . :+, 9i1 ..Anil; �
roof-top mounted Photovoltaic Solar Panel tem.
Business name:FDH Velocitel,Inc Submit two(2)sets o oof plan with c• ection details
and fire department acce along •I the 2010 Oregon
Address:4004 Kruse way Place#220 Solar Installation Specialty .o'• checklist.
City/State/ZIP:Lake Oswego,OR 97035 Permit fee(include . . •view $180.00
and a. • strative e
Phone:(503)349-2149 Fax:( ) State surcharge 2%of permit fee): $21.60
CCB lic.:200980
FC(
Tota '-e due upon application: $201.60
Authorized signature: f or This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Natalie Erlun ate:2/9/16 * 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)
City of Tigard
IIICOMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: jix_bot& -OQ751
Site Address: 1 2 G1 (o s Sr,v- Co U r^ c (+vv , Suite/Bldg#:
Project Name: Pt-77 f i5cir WSt
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: -RepI U Le- p U rt(s 00 evil t7 7 0.,L rt)w-C-e-
Existing Business Activity: i S h o Cak -c
Proposed Business Activity: // /
Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: E Yes ,A No
g. Zoning: c- C-1
Zf Permitted Use: ❑ Yes ❑ No E Spec Space
AConfirm no land use required.
6Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: ' Date: Z� 6
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: /7 f 4
Site Plans: #
Building Plans: #
Building Permit#: ❑r Enter building permit#above.
Workflow Routing: Planning frPermit Coordinator 2lding
Workflow Sign-off: ri Sign-off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician ' , 4�: _! . Date: W7/40
1:\Building\Fonns\BldgPermit Rvw_COM_NoLandUse_070915.docx
+t'
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:
` DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes /A
(( Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes L.N/A
[?OK to Issue Permit
Approved by Permit Coordinator: Date: Pl/i
I:\Building\Fonns\BldgPennitRvw_COM_NotandUse_070915.docx