SGN2009-00201 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2009 -00201
COMMUNITY DEVELOPMENT Date Issued: 09/15/2009
T1G4RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S110DCO2200
Jurisdiction: Tigard
Name of Business:
Business Address: 15570 SW PACIFIC HWY
Applicant/Agent: Safeway,
Work Description: Installation of one permanent wall sign (electronic) 5' X 5'
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: Yes
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 5' X 5'
Total Sign Area: 19
Wall Area: 6250
Wall Face (Direction): North
Sign Height: 20 ft.
Projection From Wall: 5 in.
Illumination: External
Materials:
Electrical Permit Required: Yes
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.
Approved By: 4, & % - ""-t ad
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- SIGN PERMIT APPLICATIO�l_
• ® � � Cit3' of Tigard Permit Center 13125 SW Hall Blvd., T OR� 9722 � ,i : i ;�
7110-PR Phone: 503.639.4171 Fax: 503.598.1960 S E P -5 2009
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GENERAL INFORMATION J t
Name of Development /Project
---)�� ` r ) FOR STAFF USE ONLY
I
Site ?lJ C� r ��) iC EiAY4-
Address / street Address Permit No.: SC") ( vv No ,
Location
Expiration Date:
Suirc /Bldg. # Ctry /Sta . Zip
1 15 - • x16
Receipt #:
Name Approved By: s 71e4�
Property Date: q (il c)
Owner Mailing Address Suite Map /T1. #: P 1 / 0 be-- 0 A -1-1/L) "
Zoning:
City/State Zip Phone
Tenant or Name Electrical Permit Required? ❑ Yes ❑ No
Business Building Permit Required? ❑ Yes ❑ No
Natne Rev. 7/1 /07
is \curpin \ masters \land use applications \ sign permit app.doc
Sign Secuirty Signs
Contractor Mailing Address Suite
(Prior to permit 2424 SE Holgate B lvd
issuance, a
copy of all Ciry /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
license, are
Portland, OR 97202 503 546 7114 (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 122809
database) ❑ Completed Application Form
Proposed
I `I. I'cmmncnr Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary Wall Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard Balloon �❑
app size requirement: 81/2" x 11" or 11" x 17"
New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: e r — ■ (3 copies, if a building perrnit is required)
size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): 1 ��t_ �j
1 LD (� ❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) S 19.00 Fee (Temporary sign, any type)
SO
V ❑ $ (T p y yP )
(Complete all Direction Wall Faces (circle o e):
items in this NOTES:
section) N S E W NE NW SE SW
eight to top of sign (feet): ZQ o Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): L << must include dimensions of wall face and sign
Copy: placement.
Materials: �� o Wall signs do not require site /plot plans.
o Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes ❑ No permit.
Type: LK Internal ❑ External o 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 ❑ 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.
DATED this 1, day of (92 , 20 eff
Signature of Owner /Agent
Melissa Hayden 503 546 7114
Contact Person Name Phone No.
,
CITY OF TIGARD RECEIPT
6 � + 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
Receipt Number: 175210 - 09/15/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00201 Sign Permit 1003100-43115 $35.00
SGN2009 -00201 Sign Permit - LRP 1003100 -43117 $5.00
Total: $40.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 170994 STREAT 09/15/2009 $40.00
Payor: Melissa Hayden Security Signs
Total Payments: $40.00
Balance Due: $0.00
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