SGN2009-00197 _ CITY OF TIGARD SIGN PERMIT
Permit #: SGN2009 -00197
COMMUNITY DEVELOPMENT Date Issued: 09/10/2009
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DD00600
Jurisdiction: Tigard
Name of Business:
Business Address: 13770 SW PACIFIC HWY
Applicant/Agent: Gertz, Donald
Work Description: Placement of one (1) 10 s.f temporary banner. Valid 9/14/09 - 10/14/09. Sign #1. Sign
must be placed on private property
Permanent: No Freestanding: No Freeway: No
Temporary: 1 Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 2'x10'
Total Sign Area: 20
Wall Area:
Wall Face (Direction):
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Vinyl
Electrical Permit Required:
Building Permit Required:
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: '/ �'
Permittee Signature: Y n 0''�'� v .2
it
J
1 SIGN PERMIT APPLICATION
11. j 1 I : Ciy 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 /Q O )' 1. . C O T Y/ $ E(
l'o T ` �4 ND .B/Q N c °UNTiF't' fl/f�t� FOR STAFF USE ONLY
Site C & / -
Address/ Street Address Permit No.: d N ) 2 -tso9 —00/f
Location 137 70 S W tY U/ ie F5 ? b I q — to / Y (
Expiration Date: / f o l
Suite /Bldg. # City /State Zip
71 9 72. Z- 3 Receipt #:
Name Approved By: i
Property 77 G A A fi G RN � A � Date: Qfr ieli
Owner Mailing Address Suite Map /TL #:
S AI M..6 Zoning: C 9
City/State Zip Phone
Tenant or Name
Electrical Permit Required? ❑ Yes To
Business PT L 8 BR ANC y R5 C ®S Building Permit Required? ❑ Yes o
Name Rev. 7/1/09
is \curpin \ masters \land use applications \ sign permit app.doc
Sign /oNAt D GE i f 7 - -
Contractor Mailing Address Suite
(Prior to permit 9 cto( 5W City/State .7�1F1 o re
issuance, a REQUIRED SUBMITTAL ELEMENTS
copy of alCity/State Zip Phone
licenses are Li A T o 3 z 5-963
(Note: applications will not be accepted
required if A IOU 0 R g 7q6 2 `� without the required submittal elements)
expired in the Oregon Const. Cont. Board Incense # Exp. Date
Cary tabaa se) Tigazd's
database) ❑ Completed Application Form
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign L_l Temporary ❑ Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that Other ❑ Billboard ❑ Balloon
apply) size requirement: 81/2" x 11 ", or 11" x 17"
JT New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: / X Z / (3 copies, if a building permit is required)
size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
l fj ❑ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) 19.00 Fee (Temporary sign, type)
El $ �' P �' �'� any tYP )
(Complete all Direction Wall Faces (circle one):
items in this F R p p r OF 1 . NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): ♦ Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
Copy: ♦ Wall signs do not require site /plot plans.
Materials:
♦ Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes ❑ 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
❑ 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 C itA'e 5 4 day of S Pr , 20 0 9
D ort.dif
Signature of Owner /Agent
1.0)414 So 3 C, r? `Z. 5 963
Contact Person Name Phone No.
•
MI CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
• 503.639.4171
T1CaARD
Receipt Number: 175159 - 09/10/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00197 Temp Sign Perm 1003100-43115 $17.00
SGN2009 -00197 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
Cash KPEERMAN 09/10/2009 $19.00
Payor: Ptld Branch RSCPS
Total Payments: $19.00
Balance Due: $0.00
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