Permit (20) iliN ,,
CITY OF TIGARD BUILDING PERMIT
11COMMUNITY DEVELOPMENT Permit#: BUP2017-00018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2017
Parcel: 2S 102 B D02600
Jurisdiction: Tigard
Site address: 12965 SW PACIFIC HWY
Project: A T&T Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37
Project Description: Adding(3)radio heads to existing tower,adding sector frame stiffener to tower,and adding radio equipment to
existing ground pad.
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, 02/09/2017 $453.95
Demolition
Occupancy Grp: U Occupancy Load:
12%State Surcharge-Building 02/09/2017 $54.47
Dwelling Units: 0 Plan Review 01/30/2017 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 02/09/2017 $90.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 02/09/2017 $30.00
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 $923.49
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 u;. 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. 32.1987 or 1.800.3
• / / A
Issued By: ,/,...._e......miro, ,+,. Permittee Signature: `��/f�/�j/ ��� r
�� . ., -mss
x3.639.4175 by 7:00 a.m.for the next available ins.ection .
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 FOR OFFICE USE ONLY
City of Tigard Received
a Permit No.:
v 13125 SW Hall Blvd.,Tigard,OR 97223 _ ate/By / de /7 • 614/) r/Z-(k� t TZ
11 - Phone: 503.718.2439 Fax: 503.598.1960 � � an Revi w
" f _— ate/By: , j \-7 Other Permit:
TI G n R D Inspection Line: 503.639.4175 "" Date Rea. / Juris: 0 See Page 2 for
Internet: www.tigard-or.gov sf �� ft ? 1� Notified Method: 7 Supplemental Information
'V y} �7 C •
1 L/L / /
X11
<., a bI ' ! , !Ail ; . i .
❑New construction ❑DelottO °" 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
=_+ r t ," work indicated on this application.
El 1-and 2-family dwelling CICommercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
111Master builder ®Other:Cell Tower Number of bathrooms:
iOB SITE• 3 ! . L® ,,. l Total number of floors:
Job site address:12965 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:PL77 Tigard West LTE 4C Covered porch area: square feet
Cross street/directions to job site:OR99W&SW Walnut Street Deck area: square feet
Other structure area: square feet
(? I I tDATA; O i t M E
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: �j (u Z. - Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
,¢ ;? i
DESCRIPTIONiOFi ° O41
' £.,. E. . work indicated on this application.
ADD(3)RADIO HEADS TO EXISTING StA -, 0 p -mValuation: $25,000
,, 1!e--bF-f ---- ? \j� Existing building area: N/A square feet
` -lb .� u New building area: square feet
'
►1 ® } r p- T Number of stories:
Name:American Tower Delaware Corp Type of construction: IIB
Address:1101 Perimeter Drive,Ste 225 Occupancy groups:
City/State/ZIP:Schaumberg,IL 60173 Existing: U
Phone:(847)240-1508 Fax:( ) New: U
i '+....y t: r a' - : k 3' � is" .tea c ..
.- IC CO OT 1'EIL'$O 1 ' 1
sno-
,a, �, a ,�., , #, it T
Business name:FDH Velocitel,Inc `i6 . -i '= - =ease ertojeeseheeir;.� .;, e
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:
PHOTOVO S PA1 EI vFEE
E-mail:Natalie.Erlund@FDHVelocitel.com ... : ..
Commercial and residential prescriptive installation of
_,. t . . •_:.C " , 0 w .. , K' roof-top mounted Photo Voltaic Solar Panel System.
Business name:Velocitel,Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:4004 Kruse way Place#220 Solar Installation Specialty Code checklist.
City/State/ZIP:Lake Oswego,OR 97035 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)349-214 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.:200980
Total fee due upon application: $201.60
Authorized signature: v "* ""� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Natalie Erlun Date:1/30/17 * 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)
1.
City of Tigard
III ® COMMUNITY DEVELOPMENT DEPARTMENT
■
T l A R o Building Permit Review — Commercial - No Land Use
Building Permit #: 0 /`7 c : d ze
Site Address: )d q (o 5 Sl ) Pa U 4 c {-{ u tj Suite/Bldg#:
Project Name: f+- T 1 1 c,,A. kies4- QA-(( S 1 k_
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: '-' r1S.4-u,\,‘ r0.441 t„ ve aas 40 a vi •e y2, &-li'Act d �l( 4 r •
Existing Business Activity: kJ rt-t e,SS ca.C.A.l. Arti
Proposed Business Activity: S CA..NA-2�
.Verify site address/suite#exists and active in permit system.
IV-River Terrace Neighborhood: ❑ YesNo
eZoning: C - CP
,- Permitted Use: AC Yes ❑ No ❑ Spec Space
Ar Confirm no land use required.
N( ) Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: C�F�_ Date: t 30 1 7
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: i/ 7
Site Plans: #/
Building Plans: #�
Building Permit#: GEbuilding,�permit above.
Workflow Routing: ,,_.�t'Iannttlg L�Permit Coordinatorg
Workflow Sign-off: CI'Si off for Planning(include notes from planning review)
Route Application Documents: ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,..":„;:f52- Date: /`gip /j 7
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_060116.docx
,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:
i'"(iiDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
•Lp OK to Issue Permit
Approved by Permit Coordinator: I ate: / i 9---
I:\Building\Forms\BldgPermitRvwCOM NoLandUse 070915.docx