Permit (181) CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2017-00275
T 13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 11/14/2017
6G' 9 Parcel: 25101 DD00800
Jurisdiction: Tigard
Site address: 14020 SW 72ND AVE
Project: T-Mobile Subdivision: None Lot: None
Project Description: Relocate(3)antennas,install(3)new antennas,(1)coup and hybrid cable,and relocate other existing equipment.
Contractor: SAC WIRELESS LLC Owner: I S PROPERTIES LP
540 W MADISON 16TH FLOOR BY FISCHER&COMPANY URI
CHICAGO, IL 60661 GALLERIA NORTH TOWER II
13727 NOEL RD, STE 900
DALLAS, TX 75240
PHONE: 312-809-8013 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee-Additions,Alterations, 11/14/2017 $377.90
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 11/14/2017 $45.35
Dwelling Units: 0 Plan Review 10/16/2017 $245.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 11/14/2017 $16.00
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 $684.89
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 50 32.1987 or 1.800.332.2344.
I
Issued By: Permittee Signature:
400'00I 503.639.4175 by 7:00 a.m.for the - 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.
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City of Tigard
1
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R>, Building Permit Review — Commercial - No Land Use
rP
Building Permit #: Ze af' O/ 7 e)Q 7S
Site Address: 11102-0 (SAI 12 Suite/Bldg#:
Project Name: --- MO X1 L'&
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 4,epIc cc em\--1,,,O of t Ic4 nets
Existing Business Activity: 1\114
Proposed Business Activity: i\JI-Pc
..3 Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ Yes !Z No
1(Zoning: C-I--
APermitted Use: .,.Nt.Yes ❑ No ❑ Spec Space
J(Confirm no land use required.
Business License:NI
Exists: El Yes. ❑ No, applicant notified to obtain business license
Notes: Fr-cvitmSivi pal, tic( L cte/r- co P9orcoDo I
Approved by Planning: *6-Tk.).4 XAAA24.—
Date: 10110 i 17
Revisions (after Building Submittal only) Reviewer
Revision 1: ❑ Approved ❑ Not Approved Date
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 4/61/7
Site Plans: #
Building Plans: # ,13
Building Permit#: 2PEnter building permit#above.
Workflow Routing: ' --113lannin
g ',g Permit Coordinator Building
Workflow Sign-off 1 -Sign-off for Planning(include notes from planning review)
Route Application Documents: C Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: % >
.fZc-3-(._ Date:/`/6/7
I:\Building\Fonns\B1dgPennitRvw_COM_NoLandUse 0709I5.docx
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:
F3SDC Fees Entered: Wash Co Trans Dev Tax: !i Yes 1 N/A
Tigard Trans SDC: 41 Yes N/A
Parks SDC: r Yes N/A /
I�OK to Issue Permit i /d/tei /l
Approved by Permit Coordinator: 'V' Date: <
1:\Building\Forms\B1dgPennitRvw_COM_N oLandUse_070915.docx
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--6u9,24 674 `--M0/3 (‘
City of Tigard 7 20?
COMMUNITY DEV
�� '�EzfRTMENT
•Collocation - upp emental Questionne
IGA
PROPERTY ADDRESS
111111111111111.15101111111
Location of collocation: P•/020 5W 7?,vo e
Name of provider: T I'SAo b�(Q Zone 1 L,_.
ppA
Not Contact name: �RrQi• Evervs !;&.j� .&u�v,5 CoKkoce o.r0 Nd
Collocating antennas on: Cf•c vn otppto
tower i=0.S E-(e, cG iM le/
By Date:
❑ Existing non-tower structure
Is this a new provider?: ❑ Yes Reason not approved:
,14 No
Other providers currently collocating on same tower or structure:
► rY E t• .., c,T66/
,�
Indicate the previous approval: = �
,.-..---•--�.-y-3�-s�--.-'�. , t. a. Applications Rau 09129//20„
(SDR,MMD#) •94-1-e. c`--`.. r.
ANTENNA INFORMATION
Existing:
New:
Height of antenna(s):
($ft) Height of antenna(s):_ �C (34 ft)
Color of antenna(s): ;a�
Color ofequipmentColor of antenna(s): Ore,� e
`� Color ofeq �pment:ui
Gt
Accommodating equipment: Accommodating equipment:
(2.e.dishes)
(i.e.dishes)
Will new accessory equipment be installed?: 0 Yes
!°+ No
Location of new accessory equipment?: 0 Within previously approved fenced area
❑ Within existing structure
❑ Other location:
(please describe)
Will landscaping be removed to accommodate the accessory equipment?: ❑ Yes(please describe below)
7dwi2 `5Z No
i I2`bv, ' <G ,ie
:...n co. ' 9 /Q `S c4
t Lea"•e.
r0-tctr--- (.V AW 5
Applicant's signature fr
Print name r f
Date
ua. r
...e,unp; ear wr„z >.q xca,,,.„att:; w�
City of T Hall Blvd.
13125 SW �. ���a�-f�,�:�. .��
T'
Lgard,Oregon 97223 • www.tigard-orgov • 503-718-2421 •
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