SGN2005-00097 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2005 -00097
DATE ISSUED: 4/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CC 00500
BUSINESS NAME: HOMETOWN BUFFET ZONE: C -
SIGN LOCATION: 13500 SW PACIFIC HWY 17 HOME TOWN BUFFE JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 8'
TOTAL SIGN AREA: 24 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): W
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placment of (1) one temporary 24 sq.ft. banner. Valid 4/12/05 thru 5/12/05. Sign
#2
MATERIALS: VINYL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 17.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. A permanent sign must be placed within 90 days from
approval date or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days
from validity date.
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APPROVED BY: /
PERMITTEE SIGNATURE: •
DATE: 4/12/2005
1
A tiol &
-VI I i SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
�� -4� � FOR STAFF USE ONLY
Site 4 T?7
Address/ Street Address Z,° O $' —00057
Permit No.: CTdd
Location / 3� �ie ^ ,Cv2letef a a/ /
Expiration Date: 4 1 2 !� 5 r ' Z /cam
Suite /Bldg. # City /State Zip
%� � / z, e pp/L,y ,23 Receipt #: ZOO loo /(o
Name Approved By:
Property Date: W/ 2-4
Owner Mailing Address Suite Map/TL #:
Zoning: C (
City /State Zip Phone
Tenant or Name 111 E tkJ
Electrical Permit Required? ❑ Yes [11:-.No
pI� `—� Building Permit Required? Yes _ o
Business /I!'f L? -7209„- � l G
Name Rev. 1/3/05 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuaoc a w ithout the required submittal elements
copy of all City /State Zip Phone q elements)
licenses are
required if ❑ Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # ❑ 2 Copies of Site /Plot Plan Drawn to Scale
database)
(3 copies, if a building permit is required)
Proposed ❑ permanent ID Freestanding El Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign porary ❑ Wall ❑ Electronic
(Check all that ❑ Other El Billboard 1:11 Balloon ❑ 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
Y New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: k' -' �� ❑ $37.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
y ❑ $17.00 Fee (Temporary sign, any type)
Si n Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
g
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E V NE NW SE SW
Height to top of sign (feet): • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): but must include dimensions of wall face and
sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
Will sign have illumination? El `IP
Yes - building permit.
No • If work authorized under a sign permit has not
Type: ❑ Internal ❑ External been completed within ninety (90) days after
Are there any existing freestanding or wall signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that .verlap a tenant space? BECOME NULL AND VOID.
❑ Yes Itii► o
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
(OVER FOR SIGNATURES)
1
I hereby acknowledge that I have read this application, that the information given is
correct, that I am the owner or authorized agent of the owner, and that plans submitted are
in compliance with the City of Tigard.
DATED this day of P4 / , 20 9 5—
tip
4 ilk.
Signature7i Owner Agent
7 etl/ 6 ( 3(9 3 z(-p\ 2 ql/
Contact Person Name Phone No.
CITY OF TIGARD
Annroved [ )6
C:! Approved [
1 c.dv tne, wortes_described in
PERMi1 NO. , ---) 6 7 , `-i2cC5
See Letter to: Follow [
thacta
Job A p
By:
CITY OF TIGARD 4/12/2005
13125 SW Hall Blvd. 1:52:02PM
tA i Tigard, Oregon 97223
4 �.. (503) 63 9-4 171
Receipt #: 27200500000000001616
Date: 04/12/2005
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2005 -00097 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
SGN2005 -00097 [LRPF] LR Planning Surcharge 100 - 0000 - 438050 2.00
Line Item Total: $17.00
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Cash HOMETOWN BUFFET KJP In Person 20.00
Change CITY OF TIGARD KJP In Person (3.00)
Payment Total: $17.00
cReceipt.rpt Page 1 of 1