Permit (176) CITY OF TIGARD BUILDING PERMIT
IN ■ COMMUNITY DEVELOPMENT
Permit#: BUP2018-00237
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2018
T I[_ A l;.C� g Parcel: 1S136CCO2100
Jurisdiction: Tigard
Site address: 11744 SW PACIFIC HWY
Project: T-Mobile Subdivision: None Lot: None
Project Description: Replace(3)antennas,add(3)radios,(1)hybrid line,(1)COVP,(1)handrail kit,(1)kicker antenna reinforcement
system. On the ground,add a support cabinet,(1)COVP,(1)ice canopy,work light,and update equipment in the
cabinet.
Contractor: NORTH SKY COMMUNICATIONS LLC Owner: GRUNBAUM FAMILY TRUST
11818 SE MILL PLAIN BLVD SUITE 410 BY GRUNBAUM, HANS H AND MARILYN K,
VANCOUVER, OR 98684 21390 SW EDY RD
SHERWOOD, OR 97140
PHONE: 360-254-6920 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIIB Permit Fee-Additions,Alterations, 09/17/2018 $301.85
Demolition
Occupancy Grp: Occupancy Load: 0 12%State Surcharge-Building 09/17/2018 $36.22
Dwelling Units: 0 Plan Review 08/27/2018 $196.20
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 09/17/2018 $98.00
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 09/17/2018 $25.00
Value: $15,000 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $657.27
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: /44Permittee Signature: J ,./`
Call 503.639.4175 by 7:00 a.m.for the next available inspection
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 RECEIVED FOR OFF ICF t sr. Oy1.1,
Received fj � .--� G�6 3
City of Tigard AUG 2 7 2018 DateBy: P/27//c '���' rmitN lj '" `�' 7
IN/� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �
Phone: 503.718.2439 Fax: 503.598.}`fly Date/By: Z lj `) ' f Other Permit:
I 1�_A R D Inspection Line: 503.639.4175 til 1 T of TIGARD Date Ready/By: JAS I ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:I if
l� Supplemental Information
TYPE OF WORK REQUIRED DATA.1-AND i-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.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑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:11744 SW Pacific Highway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ,%— /t-'/C.6/4.... -C: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CILLCKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:15-1-36CC-02100-0O1 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.
Replace(3)antennas.Add(3)radios,(1)hybrid line,(1)COVP,(1)handrail Valuation: $$15,000.00
kit,(1)kicker antenna reniforcement system.On ground,add a support cabinet, Existing building area: square feet
(1)COUP,(1)ice canopy,work light,and update equipment in other cabinets. New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name:HANS&MARILYN GRUNBAUM Type of construction:
Address:21390 SW EDY RI) Occupancy groups:
City/State/ZIP:SHERWOOD OR 97140-8617 Existing:
Phone:( ) Fax:( ) New:
>i4 APPLICANT C4 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer softie scbeduIe)
Business name:Crown Castle(Tower Owner)
Structural plan review fee(or deposit):
Contact name:Zach Phillips
FLS plan review fee(if applicable):
Address:5111 N.Bowdoin St.
Total fees due upon application:
City/State/ZIP:Portlands,OR 97203 f
Phone:(503)708-9200 Fax::( ) Amount received: / � ..
E-mail:zach.phillips.contractor@crowncastle.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*.
Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name:TBD U C �/ If ct Submit two(2)sets of roof plan with connection details
i\t,
1/ )," 1 Jj vLi K , . and fire department access,along with the 2010 Oregon
Address: �' ��(1 1 ��%l 0 < i 4,, �(/ Solar Installation Specialty Code checklist.
Permit fee(includes plan review
City/State/ZIP: l _ �j(t'.tl Al/� LJ G� and administrative fees): $180.00
r
Phone:(/1106) - "1 (, Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 0 —i 1 7 Total fee due upon application: $201.60
Authorized signature: . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Zach Phillips Date:8.23.18 * 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
.1 �� COMMUNITY DEVELOPMENT DEPARTMENT
:
1111
TIGARIJ Collocation - Supplemental Questionnaire
PROPERTY ADDRESS FOR STAFF I.SI-. ()NIA
11744 SW Pacific Hwy
Location of collocation: C G
T-Mobile Zone:
Name of provider:
Zach Phillips with Crown Castle (tower owner) gApproved
Contact name: ❑ Not Approved
Collocating antennas on: By: Al-- Date: g. 2.1
® Existing tower
Reason not approved:
❑ Existing non-tower structure
Is this a new provider?
❑ Yes
Other
No
Other providers currently collocating on same tower or structure: I:\community Development\Land Use Applications\02_Forms and
Templates\Land Use Applications\Future Forms Rev.12/14/2017
Verizon and T-Mobile are the carriers on the tower.
Indicate the previous approval: BUP2007-00041
(SDR,MMD#)
ANTENNA INFORMATION
Existing: New:
135'-10" 135'-10"
Height of antenna(s): (sq. ft.) Height of antenna(s): (sq. ft.)
s Standard white Standard white
Color of antenna(s): Color of antenna(s):
Color of equipment: Gray Color of equipment: Gray
Accommodating equipment: Hybrid cables/Coax Accommodating equipment: Hybrid cables/Coax
(i.e.dishes) (i.e.dishes)
Will new accessory equipment be installed? 7 Yes ❑No
Location of new accessory equipment?
i] Within previously approved fenced area
❑ Within existing structure
❑ Other location:
(Please describe)
Will landscaping be removed to accommodate the accessory equipment? ❑ Yes ni No
If yes,describe here:
f ZqJ f415 107
tit/(
. .1) c. is signature Print name Date
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 1
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
111 ■
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: Z ui'.2 i -727.7Z 3 7
Site Address: l I,liy SW QGICU L Hvv.1 Suite/Bldg#:
Project Name: T—M o 1.)j
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: CORRoC -its,.. avid CA.V10N
Existing Business Activity: W CF
Proposed Business Activity: V�J -
',Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood:C
Id ❑ Yes No
\Zoning: —G
Permitted Use: Yes ❑ No ❑ Spec Space
Confirm no land use required.
Business License: N
' '
Exists: ❑ Yes '❑ No,applicant notified to obtain business license
Notes: Mks `t_ I4SD -O3o . 13 anct D.
Approved by Planning: krpiii) C� i� Date: s/u 1153
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved Cl Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: i7�7,/if
Site Plans: # ,'
Building Plans: ##
Building Permit#: eJ Enter building permit#above.
Workflow Routing: g-"Planningrmit Coordinator B't-uilding
Workflow Sign-off: --Sign-off for Planning(include notes from planning review)
Route Application Documents: uilding: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: S .a ,; e,, _._ Date: 6'7.2 7 /ef--1
I:\Building\Porms\B1dgPermitRvw COM NoLandUse 060116.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
0 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:
IVS �lDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes L� N/A
Tigard Trans SDC: 0 Yes CSN//A
Parks SDC: 0 Yes Ly'N/A
OK to Issue Permit
Approved by Permit Coordinator: / ate: �� r
I:\Building\Forms\BldgPermitRvw_COM NOLandUse 070915.docx