Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2017-00046
T( A.R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2017
Parcel: 1 S134BC00700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT&T Subdivision: 1993-058 PARTITION PLAT Lot: 1
Project Description: Replacing(3)antennas, removing GPS antenna and feeders,adding(3)radioheads to existing monopole wireless
transmission facility,and adding equipment to existing ground pad.
Contractor: VELOCITEL INC Owner: HA&R, LLC
4004 KRUSE WAY PL, SUITE 220 ATTN: TAMMY HOUSE
LAKE OSWEGO, OR 97035 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
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, 03/14/2017 $453.95
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 03/14/2017 $54.47
Dwelling Units: 0 Plan Review 02/22/2017 $295.07
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 03/14/2017 $90.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 03/14/2017 $32.50
Value: $25,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
-Garage,___Q
Mezzanine: 0
Total $925.99
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 suspen•-d for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those .es are se orth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of -ru- •irect questions to OUNC .calling 503.232,1987 or 1.800. : . 44. 1
Issued By: � Permittee Signature: • efi `
Cal s.175 by 7:00 a.m.for the next available i.._pecti ..te.
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
Cityof Tigard Received r� ' '}
- g T. F DateBy: ;tT �Y' Permit No.: 8(/J j✓'+X 0 /
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 r: '2, DateBy16
: �. Other Permit:
T I G n R D Inspection Line: 503.639.4175 ° eLL' �� Date ReadyB Juris: H See Page 2 for
Internet: www.tigard-or.gov d.o� Notified/Me /7 t(.`"'" Supplemental Information
! *Ty:t ) Ila i
❑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
c
A:; `) work indicated on this application.
El1-and 2-family dwelling E1Commercial/industrial Valuation: $
111Accessory building 1=1 Multi-family Number of bedrooms:
111Master builder ®Other:Cell Tower Number of bathrooms:
! i ® i ! Total number of floors:
Job site address:12655-A SW North Dakota St New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:PR77 Scholls&125th LTE Art/ Covered porch area: square feet
Cross street/directions to job site:OR-210&SW North Dakota Street Deck area: square feet
Other structure area: square feet
,6 !sleti'Z'W-dito
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:R20332709 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
work indicated on this a..lication.
SWAP OUT(3)ANTENNAS,REMOVE GPS ANTENNA&FEEDERS,AND ADD Valuation: $25,000
(3)READIOHEADS TO EXISTING MONOPOLE WIRELESS TRANSMISSION Existing building area: N/A square feet
FACILITY.ADD EQUIPMENT TO EXISTING GROUND PAD. New building area: square feet
. . .. ' x`11.,' , ; Number of stories:
Name:Clifford&Earlene Sheley Type of construction: IIB
Address: 18390 SW Shaw St Occupancy groups:
City/State/ZIP:Aloha,OR 97007 Existing: U
Phone:( ) Fax:( )
New: _ U
� � � �►a: � , :; �. . _f ��_ _,,_
Business name:FDH Velocitel,Inc
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:
r O OETI; I s i `
E-mail:Natalie.Erlund@FDHVelocitel.com ,,,�1I' �. ; l ,, „;. _,..�..
Commercial and residentialprescriptive installation of
C � 0,
z ` ,.,4 - roof-top mounted PhotoVoltaic 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)349-2149 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:200980
Total fee due upon application: $201.60
Authorized signat ,e: This permit application expires if a permit is not obtained
����,/,��1 - within 180 days after it has been accepted as complete.
Print name:Natalie !: tun :2/21/17 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
4
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
IN
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: dii/2 / 7• 7 Lip
Site Address: 12,(055 &K) N 064 DAr --(- Suite/Bldg#:
Project Name: j-tf- Si101(S I Z (Yl,
(Name of commercial busine,s occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: pep,No i5ty efly ac lq IA r w, l► a ,,,,,,,t,Iv -tD r
Existing Business Activity: N/A
Proposed Business Activity: n(/A,
IR-Verify site address/suite# exists and active in permit system.
-a River Terrace Neighborhood: ❑ Yes TA. No
Zoning: C—P
Permitted Use: Yes ❑ No ❑ Spec Space
,,Igt"Confirm no land use required.
Business License: 14(k.
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes: VeplaCty9 2®(l)1 one„ t- -no ( i vit Ggc,
Approved by Planning: ,t - Date: Z'2 2-f I"?
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approve& ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: ,ls,
Site Plans: # ',
Building Plans: #
Building Permit#: erer building permit#above.
Workflow Routing: Planning hermit Coordinator ding
Workflow Sign-off: �'$ign f 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: __ Date:
I:\Building\Forms\BldgPermitRvwCOM NoLandUse 060116.docx
IV ►
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:
77S C Fees Entered: Wash Co Trans Dev Tax: 0 Yes J/A
Tigard Trans SDC: 0 YesT/A
Parks SDC: 0 Yes l/A
K to Issue Permit •� /
Approved by Permit Coordinator: Date: !/ 'L7 4
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12655 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Building BUP2017-00046
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor