SGN2009-00209 _.n
CITY OF TIGARD SIGN PERMIT
Permit #: SGN2009 -00209
COMMUNITY DEVELOPMENT Date Issued: 10/12/2009
TR3AR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135BB00500
Jurisdiction: Tigard
Name of Business:
Business Address: 10487 SW CASCADE AVE
Applicant/Agent: Koupal, John
Work Description: Placement of one (1) temporary ballon Sign #1 Valid 10/16/09 - 10/26/09 Must be
placed on private property, not in public right of way. Must meet visual clearance area
requirements. Can not exceed 10' in height
Permanent: No Freestanding: No Freeway: No
Temporary: 1 Wall: No Electronic: No
Billboard: No Balloon: No
Banner: Yes A- Board: No
Sign Dimensions: 12' X 2'
Total Sign Area: 24
Wall Area:
Wall Face (Direction):
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Vinyl
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: .//) - 12 - 2-4.--- n -- &-D
Permittee Signature: cM ez.-4 6
Irri 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
hA FOR STAFF USE ONLY
Site 11 \Vk. \-- Lk r 4-Lk l �
Address/ Street Address Permit No.: "Co f) a-V V l p - et).-
Location 16u g7 I CA S C
K � Expiration Date:
Suite /B dg. # City /State Zip
aC 4 b R 5 aJ 3 Receipt #: 1 5- c `i
Name Approved By: l
�n ,Q D ate : / D r ' 6 7
Property 1 I t) r(S , -lr ` --� - ,,�,1
Owner Mailing Address Suite Map /TL #: 1 S 1 Sig 01) SU v
T ', rG rtnc,r A 3 d 0 Zoning: M u
ity State Zip
SRS '� �Q �a`a� Phone �' q3 6 Electrical Permit Required? ❑ Yes ZNo
Tenant or Name
Business (Y\ K l o.f 4.6-L.A._ Budding Permit Required? ❑ Yes 2
Name Rev. 7/1 /09
is \curpin \ masters \land use applications \sign pemut app.doc
Sign
Contractor' Mailing Address Suite
(Prior to permit
issuance, a
copy of all City/ ate Zip 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 License # Exp. Date
City t Tigazd's
database) El Completed Application Form
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign Temporary ❑ Wall p Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard ❑ Balloon t " 11", 11"
apply) size requirement: 8 /z x 11 , or 11 x 17 "
New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: I e 1 I (3 copies, if a building permit is required)
size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
01 ❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.)
❑ $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): l a a . ♦ Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): r (q t must include dimensions of wall face and sign
placement.
• Copy: nS ` Qp tn. Wall signs do not require site /plot plans.
Materials: J t y ( 1 - • Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes EYNo permit.
Type: ❑ Internal pit 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
❑ Yes Fs No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
`� I/ � � l //5/ (OVER F SIGNATURES)
![ l
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 k day of 0 C d j" , 20 0
&
• vture of Owne /Agent
Contact Person Name Y,6upii Phone No.
•
'',' "• CITY OF TIGARD RECEIPT
4
• 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T1QARD
Receipt Number: 175594 - 10/12/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00209 Temp Sign Perm 1003100 -43115 $17.00
SGN2009 -00209 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 38540B STREAT 10/12/2009 $19.00
Payor: John W Koupal
Total Payments: $19.00
Balance Due: $0.00
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