SGN2005-00138 • .
C ITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2005 -00138
DATE ISSUED: 5/17/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102BD 00100
BUSINESS NAME: ST. ANTHONY SCHOOL ZONE: R -12
SIGN LOCATION: 12645 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 6'
TOTAL SIGN AREA: 18 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one temporary banner. (3' x 6') Valid from 5/18/05 through 6/18/05.
Sign #1
MATERIALS: VINYL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES:
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.
APPROVED BY:
PERMITTEE SIGNATURE: /a 0/../
DATE: 5/17/2005
1
A 1
AO
� jl SIGN PERMIT APPLICATION
CI OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
FOR STAFF USE ONLY
Site fi' /x7 -0N y/ PRE--(+2_,
\ / Address/ Street Address Permit No.: J(; J aoOS -- Do 135
\ Location / / !1 � `� P ^Rc �/
J p — Expiration Date: ( l 8
Suite /B d g. # City / State Zip
6AoN 17aa3 Receipt #: p?oo5 - aaoc.)
Name Approved By: 0 .
Property i 9� Date: 5 - I - o S
Owner Mailing Address Suite Map/TL #: .;?S t o. B D - oo ° of
Zoning: P - IA.
City /State Zip Phone
or Name Electrical Permit Required? 111 Yes VI No
V /Tenant
Business ' 7. , J L3'6_ j1 ! Building Permit Required? ❑ Yes [}Z� No
Name Y Rev. 1/3/05 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address ... e _ REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a w ithout the required submittal elements
copy of all City /State ; -' Zip Phone q elements)
licenses are -
required if
expired in the„--- Oregon Const. Cont. Board Exp. Date ❑ Completed Application Form
City of Ti rd`s License #
_ data e) 11 2 Copies of Site /Plot Plan, Drawn to Scale
(3 copies, if a building permit is required)
Proposed Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign Temporary ❑ W all ❑ E lectronic
(Check all that El copies of elevations, drawn to scale
apply) ❑ Other 111 Billboard ❑ Balloon
(3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
x Sign Dimensi
}( ❑ $37.00 Fee (Permanent sign, any size)
x Total Sign Area )7. ft.): ❑ $17.00 Fee (Temporary sign, any type)
Si n Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
9
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W N E N W S E S W
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? ❑ 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 overlap a tenant space? BECOME NULL AND VOID.
❑ Yes ❑ No
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
(OVER FOR SIGNATURES)
a� \
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 , 20
Signature of Owner /Agent
Contact Person Name Phone No.
CITY OF TIGARD 5/17/2005
13 12 5 SW Hall Blvd. 2:22:29PM
*tom � Tigard, Oregon 97223
. ,L `_ (503) 639 -4171
Receipt #: 27200500000000002200
Date: 05/17/2005
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2005 -00138 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
SGN2005 -00138 [LRPF] LR Planning Surcharge 100- 0000 - 438050 2.00
Line Item Total: $17.00
Payments:
Method Payer User ID AcctJCheck No.Approval No. How Received Amount Paid
Check ST ANTHONY SCHOOL CAC 11956 In Person 17.00
Payment Total: $17.00
cReceipt.rpt Page 1 of I