Permit (29) CITY OF TIGARD BUILDING PERMIT
' . COMMUNITY DEVELOPMENT Permit#: BUP2016-00126
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/03/2016
Parcel: 2S106AD00100
Jurisdiction: Tigard
Site address: 16744 SW SCHOLLS FERRY RD
Project: T Mobile Cell Site Modification Subdivision: Lot: 3
Project Description: Installation of(3)panel antennas on an existing telecommunications facility.
Contractor: SBA NETWORK SERVICES LLC Owner: RALSTON,CHRISTOPHER J&SHERI L
8501 CONGRESS AVENUE 21029 SW LEBEAU RD
BOCA RATON, FL 33487 SHERWOOD, OR 97140
PHONE: 561-995-7670 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 05/03/2016 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 05/03/2016 $54.47
Dwelling Units: 0 Plan Review 04/12/2016 $295.07
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 05/03/2016 $20.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $25,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $823.49
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. 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 503.232.1987 or 1.800.332.2344.
Issued By: 44/1„.,e,„
Permittee Signature: 47 e.''.-Z V;7'.1'...7
03.639.4175 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.
r
Building Permit Application
Commercial I OR OI I I( I I sI O.I
71 City of Tigard R CEIVED ReceivedtBy: ''. Permit No.:
Date/By: `� W /(o BlifI10"� g�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1'x.'R 6 2 016 I Si'f, 9 Z� Other Permit:iY) , i • - • ,.,
rrM..'-
, , ,\,\,, Inspection Line: 503.639.4175 Date R :. una: 0 See Peatal:formation
Internet: www.tigard-or.gov ^ITY OF ;Gq D Notified/Method: �7 `, i , y supplem
Eim G DIVISION e iil .,Vr4t '-'"`m'''''
TYPREQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16744 SW Sebolls Ferry Rd/ New dwelling area: square feet
City/State/ZIP: Beaverton,Oregon 97007 Garage/carport area: square feet
Suite/bldgJapt.no.: Project name:879602 TMO L700 Covered porch area: square feet
Cross street/directions to job site:Bull Mt Rd,right on SW Roy Rogers Rd, Deck area: square feet
right on SW Friendly Lane Other structure area: square feet
(Site address according to tower owner is on Friendly Lane) REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.:R4821 Permit fees'are based on the value of the work performed.
Tax map/parcel no.:Parcel 2S 106AD00100 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.
Installation of three panel antennas on an existing telecommunications facility Valuation: S$25,000.00
i Three antennas were removed in a project in 2012/13 Existing building area: n/a square feet
MMD2016-00006 Planning Approved under 6409 see attached letter to Cheryl Caines New building area: n/a square feet
0 PROPERTY OWNER 0 TENANT Number of stories: 80'
Name:Christopher&Sheri Ralston Type of construction: IIB
Address:14900 SW 150th Occupancy groups:
City/State/ZIP:Tigard,Oregon 97224 Existing: unmanned
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:Crown Castle USA refer rofee seitael
Structural plan review fee(or deposit):
Contact name:Sandra Walden
FLS plan review fee(if applicable):
Address:1505 Westlake Ave North,Suite 800
Total fees due upon application: 377.90
City/State/ZIP:Seattle,WA 98001
Phone:(503)709-0820 Fax::( ) Amount received:
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 ,r41, //ieo 4�..v�ceS_ �G Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: �/ Solar Installation Specialty Code checklist.
City/State/ZIP: 1 Q '� 3 tor7 Permit fee(includes plan review $180.00
q Q/ I �L / and administrative fees):
Phone:( ) gq 9-—SA/
.77 t:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: a if)a /,)/ b Total fee due upon application: $201.60
Authorized signature: f'" This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:San en 4/1/16 * 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
r COMMUNITY DEVELOPMENT DEPARTMENT
I 14
T l c n u n Building Permit Review — Commercial - With Land Use
Building Permit #: et,,, p j(,_0,(d(o
Site Address: /(L '/' ,Tio s7e ADA 7Suite/Bldg#:
Project Name: —7'=
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: //9•5 // ,' ,,?i( jilado -.-Ci371 'i )i C[)h?/nbmiet, Yis
Vi/Verify site address/. ite# exists and actio in permit system.
'ver Terrace Neighborhood: V Yes E No
V and Use Case#: I1� ��2DIl� �DDO�D
T21).
PlanyMatch Approved Land Use: q
ti Site Plan Nif I ndscape Plan ❑ Other:
Urban Forestry PlanElevation Plan
Building Height: Maximum Height A.* Actual Height /00 /
tPConditions Met: Cl Prior to Submittal ❑ Prior to Permit Issuance
Business Licen .
Exists: UYes ❑ No,applicant notified to obtain business license
I} ublic Facilities Improvement rovement �FI p ) Permit:
Required: ❑ Yes, applicant was notified V(No Applied For: ❑ Yes ❑ No, stop intake
Notes:
Approved by Planning: ____ - ' Date: -///e///,
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3:
❑ Approved d ❑ Not Approved
pp
Building Permit Submittal
Original Submittal Date: lad)//G
Site Plans: # 3
Building Plans: # 3
BuildingPermit#: buildingpermit# above.
,__, --
Workflow Routing: E 1 I ing F��Eng eering eI�ermtt Coordinator EI-Building
Workflow Sign-off: -off for Planning(include notes from planning review)
Route Application Documents: ung: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: moi- i;
l:\Building\Fonns\BldgPennitRvw_COM_W ithLandUse_0709I 5.docx
Engineering Review
Slope at building pad:
PFI Permit#:
Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: 4'L
Date: 4-4;4.
Revisions (after Building Submittal only) Reviewer Date
Revision 1: E Approved ❑ Not Approved
Revision 2: D Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
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:
L:R/SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N" N/A
Tigard Trans SDC: ❑ Yes V N/A
Parks SDC: ❑ Yes A".-N/A
OK to Issue Permit
Approved by Permit Coordinator: eikt,uf..-
C(,,,t,nl,J Date: Lf -( Y-14
I:
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
16744 SW SCHOLLS FERRY RD, TIGARD, OR,
97007
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2016-00126
Jeff Grove
Violation Summary:
Inspector Contractor