SGN2009-00072 S T
CITY OF TIGARD SIGN PERMIT
Permit #: SGN2009 -00072
{ COMMUNITY DEVELOPMENT Date Issued: 04/02/2009
T [BARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S101AB01604
Jurisdiction: Tigard
Name of Business: Tigard Optometric Clinic
Business Address: 7307 SW BEVELAND RD 100
Applicant/Agent: Freedle, Eric
Work Description: Installation of (1) one permanent 30 s.f. wall sign.
Permanent: Yes Freestanding: Freeway:
Temporary: Wall: Yes Electronic:
Billboard: Balloon:
Banner: A- Board:
Sign Dimensions: 3'x10'
Total Sign Area: 30
Wall Area: 950
Wall Face (Direction): South
Sign Height: 8 ft.
Projection From Wall: 3 in.
Illumination: No Illumination
Materials: Wood
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $40.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all
other applicable law. All work will be done in accordance with approved plans. A permanent sign must be placed within 90
days from approval date or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon sign
shall expire 10 days from validity date.
A Approved By: n7coTh
Permittee Signature: n"--
n SIGN PERMIT APPLICATION
City grTigodPernit Center 13125 SW-Hall Bhd.., rigfin OR 97223
-
Ply 503.6 39.4171 Fax: 503.598.1960
•
GENERAL INFORMATIQ�I
Name of Develnpmcnt /Project
Site /64 2 Qr �1� c y, FORS . AFF USE.ONLY
,
Address/ Stn•r-.t Address
Location �. G' ,4"//� S2 Permit No,:, J `1 (�(�(� Z
Saito. /Bldg. # City /Sate zip Expiration X3QL'C:
. /'G 7 76/4/Z g70°3 Receipt A' : � � — 5 0 Co ..—
Name Approved By: sr., 'S�f
Property A-7- /G-.ea Date: `131 S
Owner Mailin Address Suits Map/r.# : - 2-5 / / 0 / Jo V q
9-1.tig6c.k4 - ' 0 Zoning:
Cky/Sate Zip Phone
/647 9 3 ((4?V .
Tenant or Name Electrical Permit Required? ❑Yes ❑ No
Business -/6 4 0 p 0 /3- 0 0 .4 w 6 - , - Building Permit Required? ❑ Yes ❑ No
Name Rev. 7/1/07
is \empin \masters \land we. applicatiom \sign permit app.doc
Sign
Cionti'actor Mailing Address Suite
(Prior ro permit •
isswinec.
copy of ail Cary /$tau Zip Phone RE� ,)D SUB1VOTTAL ELEMENTS
licenses are Noe: applications will t be accepted
required if ( t Pp li not
without the required submittal elements
expired in the Oregon {sonar_ Corn. Board T .iccasc # Exp. Date q su )
Qcyof Tiga refs
database) — _ ❑ Completed Application Form
Pro osed �
p ILLI Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Draam to Scale
Sign L Temporary ❑ wail ❑ Electronic a (3 copies, if a building permit J)
(Check all that 1 tTXTIt 1S required
VA.) ❑ C�[her ❑ Billboard ❑ BaI1c n 5.17 requirement: 81/2" x 11 ", or 11" x 17"
' ❑ New sign? ❑ Alter to existing sign? , ❑ 2 copies of elevations, drawn. to scale
Sign Dimensions: y 30 I 3 ?c/o (3 copies, if a building permit is required)
Total Sign Area (sq. ft.): c 3v d t
. size requirement: 8 x 11 ", to 24" x 36"
0 $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft_) .4, 1 coi 1
❑ $19.00 Fee (Temporary sign, any type)
(Compktc all Direction Wall Faces (circle one):
irerrta 111 this
section) N S E W NE NW SE SW ES �
Height to top of sign (feet):. g i ! • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): 2...3 a must include dimensions of wall face and sign
placement.
Copy T y / i ()/3 ()/3 G 1/ 64-1 Materials: + Wall signs do not require silo /plot plans.
• Freestanding signs over 6 ft. requited a building
Will sign have illumination? ❑ Yes No permit.
T pc: ❑ Internal f=1 External • If work authorized under a sign permit has not been I
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
❑ Yes ❑ No NULL .AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
foota _c must also be submitted. —
• (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 day of Hl 20+09
•
Signature of Owner Agent
_ Ste . 0e7
Contact Person Name Phone No.
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111 .,. , CITY OF TIGARD RECEIPT
q
1Z 1312 SW Hall Blvd., Tigard OR 97223
503.639.4171
T I G'AIt17
Receipt Number: 173063 - 04/02/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00072 Sign Permit 100- 0000 - 437000 $35.00
SGN2009 -00072 Sign Permit - LRP 100 - 0000 - 438050 $5.00
Total: $40.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 05515D KPEERMAN 04/02/2009 $40.00
Payor: Eric S. Freedle, OD
Total Payments: $40 00
Balance Due: $0 00
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