SGN2009-00220 f ,
CITY OF TIGARD SIGN PERMIT
• Permit #: SGN2009 -00220
COMMUNITY DEVELOPMENT Date Issued: 10/29/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AD03450
Jurisdiction: Tigard
Name of Business:
Business Address: 8777 SW BURNHAM ST
Applicant/Agent: City of Tigard,
Work Description: Placement of one (1) temporary sign (A- Frame) 4' X 3' Sign #1 Valid 10/29/09 -
11/29/09 Must be placed on private property, not in public right of way. Must meet
visual clearance area requirements
Permanent: No Freestanding: No Freeway: No
Temporary: 1 Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: Yes
Sign Dimensions: 4' X 3'
Total Sign Area: 12
Wall Area:
Wall Face (Direction): North
Sign Height: 4 ft.
Projection From Wall: in.
Illumination: No Illumination
Materials:
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $19.00
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.
Approved By: 32- L J e 4 VALLC r
•
Permittee Signature:
SIGN PERMIT APPLICATION
-` City of Tigard Permit Center 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project
I " �, WV / L FOR STAFF USE ONLY
Site 1/1 S7 r ill � l �(J'D - O j7 3-4-6 Address/ eet Addre ( Q — ]? - 7 (iv-' Permit No.:
Location Co rn eV H J/ 4 11/04 ' i f///
Suite /Bldg. # City/State Zip
Expiration Date:
Receipt #: 11 S S 3 / c
Na Approved By: S- lie �r
Property i 7-- aP 1 6 M I Date: to 1 i/ 01
Owner M ng Adds ( Suite Map /TL #: c I 0 h 0 34 s0
v V Zoning:
City/State Zip Phone
Tenant or Name Electrical Permit Required? El Yes ,d
Business Building Permit Required? ❑ Yes No
me
Rev. 7/1/09
r \curpin \ masters \land use applications \sign permit app.doc
C
Sign 1 4 '1 - i
Contractor. Mailing Ad i Suite
(Prior to permit
issuance, all a REQUIRED SUBMITTAL ELEMENTS
copy of City/State Zip Phone
hcenses are (Note: applications will not be accepted
required if without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) ❑ Completed Application Form
❑ ermanent ❑ Freestanding g ❑ Freeway
Proposed 111 2 Copies of Site /Plot Plan, Drawn to Scale
Sign Tem. .rary ❑ Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ • , er ❑ Billboard ❑ Balloon size requirement: 8'/2" x 11", or 11" x 17"
apply) q
FA New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
- Sign Dimensions: 9j 7( '7 L : (3 copies, if a building permit is required)
li size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
?-- ❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) ❑ $19.00 Fee (Temporary sign, any type)
(Complete all Directio Wall Faces (circle one):
items an this NOTES:
section) E W NE NW SE SW
• Wa ll signs do not need to be drawn to scale
ght to top of sign (feet): � gn scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
Copy: / placement.
Materials: Oft �I • Wall signs do not require site /plot plans.
• Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ es 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 s ace? of the permit, THE PERMIT WILL BECOME
❑ Yes No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage 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.
2 �1 I
DATED this 2 / day of ��'° , 20 01
a dt1 #.--- .
Signature of w er /Agent
4,L gIL go -tJ z
Contact.Person Name Phone No.
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
. T1 GARD
Receipt Number: 175839 - 10/29/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00220 Temp Sign Perm 1003100-43115 $17.00
SGN2009 -00220 Temp Sign Perm - LRP 1003100 -43117 $2.00
Total: $19.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 016548 STREAT 10/29/2009 $19.00
Payor: Adam Jensen COT
Total Payments: $19.00
Balance Due: $0.00
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