SGN2009-00027 Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: SGN2009 -00027
Site Address or Parcel #: 12085 SW 135 Ave, Tigard, OR 97223
Project Name: Greenfield Village Apartments
Subdivision Name: Lot #:
EXPLANATION: Permit created in error
Signature: Date: 2/13/09
Shirley Treat
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80 % of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date Q/ ' By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date ®- /p p By Parcel Tag Added: Date By
Receipt # Date / Method Amount $
I:\ Building \Forms \RegPerrnitAction.doc Rev 07/26/07
pp CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2009 -00027
TIGARD DATE ISSUED: 2/13/2009
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104BA - 00100
BUSINESS NAME: GREENFIELD VILLAGE APARTMENTS ZONE: R -25
SIGN LOCATION: 12085 SW 135TH AVE JURISDICTION: TIG
APPLICANT /AGENT: GREENFIELD VILLAGE APARTMENTS
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: Y FREEWAY:
TEMPORARY: X WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 2'
TOTAL SIGN AREA: 6 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): N
SIGN HEIGHT: 3 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one (1) temporary (A- Frame) sign 3' X 2' Valid 2/16/09 - 3/16/09
Sign #1 Must be placed on private property, not in public right of way. Must meet
visual clearance area requirements
MATERIALS: WOOD
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 19.00
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.
Liked
APPROVED BY: G
PERMITTEE SIGNATURE: �`` e `^
DATE: 2/13/2009
r SIGN PERMIT APPLIAI'I City of Tigard Permit Center 13125 SITS Hall Blvd., 7 igard, OR 97223 '`° �°
' ., d Phone: 503.639.4171 Fax: 503.598.1960 013 ' is _ FEB 1 1 0
g 2009
GENERAL INFORMATION L. ,�,jF111\, /'^ eft n AF
• Name of Development / Project
FOR STAFF USE ONLY
Site G gef Pi F1 ELD V I LL46 A PART/ 4 /&V
Address/ Street Address Permit No.: S&P . ( 7 °q - 6-1Yr)
Location ‘ Za 65 S w 13S Ave
Expiration Date:
Smite /Bldg. # city /state Zip aVq U -*a--
1 1 T(6AAt aK 9 722- 3 Receipt #:
Name v \ roved B S (/ et/4 M 4Oft6 , CA rg4 z tOGE ACM - ESTR1� PP )
Property CAf RON b4v1S S>;IevtCCs Date: / / ° " 1
Owner mailing Address ME - suite Map /TL #: o 2 3/ O / ' 1 ` 01)1
(20 6-S S W l 3 *10 ( •
zoning: se '5
City/State Zip Phone - -
NM) P. q 7223 co 3 S214-&1Z7
Tenant or Name Electrical Permit Required? El [
Yes ' No
Business GR.F /F, Ea V 1 L. L/16 f 1T3 , Building Permit Required? ❑ Yes [r No
Name Rev. 7 /1/07
NIA is \cutpin \piasters \land use applications \sign permit app.doc
Sign
Contractor Mailing Address Suite
(Prior to permit - — -- - - - -
issuance, a
copy of all (;ity /state rip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired in the Oregon Const. Cont. Board I,icense # is p. Date
(;it) nf'rigard's
database) tx Completed Application Form
Proposed ❑ P ermanent Freestanding I�rcc�ca •
�C ❑ g ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
I7( I
Sign Tempr ,n. ❑ Wall ❑ I•;Iectr „nic � ""C (3 copies, if a building permit is required)
(Check all that ❑ Othe Rf �❑ Billboard ❑ Ball,
/z
a ppl y ) size requirement: 81/2” x 11", or 11" x 17"
14 , New sign? ❑ Alter to existing sign? c6. 2 copies of elevations, drawn to scale
Sin Dimenn r » o ( (3 copies, if a building permit is required)
{ 3 t 6 1 i -6 w► TO 2 ` size requirement: 81/2" x 11", to 24" x 36"
Total Sign Area (sq. ft.): D ET Z
D ❑ $40.00 Fee (Permanent sign, any size)
Total Wall Area (sq. ft.) (
Sign Data /40 IN $19.00 Fee (Temporary sign, any type)
((;complete all Direction \\/all Faces (circle one):
items in this NOTES:
section) 0 0 E \V NE NW SE SW
Height to top of sign (feet): 7 , 60 o Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): N'A must include dimensions of wall face and sign
Copy: ', placement.
ry o Wall signs do not require site /plot plans.
1laterials: u-No
o Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes Z No permit.
'Type: ❑ Internal ❑ External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
IA t i 511PW S $ Yes ❑ No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
k (OVER FOR SIGNATURES)
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 1 3T t day of I f eizUl , 20 oq
Pas-
Signature Owner/Agent
T " ( Z E /OA POD -5 v 5 - S- 1 - 6327
Contact Person Name Phone No.
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