SGN2007-00227 pp l, CITY OF TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2007 -00227
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/17/2007
PARCEL: 25101 DA -00100
BUSINESS NAME: PACIFIC SOURCE HEALTH PLANS ZONE: C -P
SIGN LOCATION: 13010 SW 68TH PKWY 140 JURISDICTION: TIG
APPLICANT /AGENT: PACIFIC SOURCE HEALTH PLANS
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 34.5 X 33' 6"
TOTAL SIGN AREA: 96 sq. ft.
WALL AREA: 3,080 sq. ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT: 24 ft.
PROJECTION FROM WALL: 12 in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Placement of one (1) permanent wall sign 34.5 X 33' 6"
MATERIALS: ALUM / PLANT
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 40.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Speaalty Codes and all other applicable
laws. 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: /� "d "`
PERMITTEE SIGNATURE:
DATE: 12/17/2117
' .,.,,e SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Ha11 Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
FOR STAFF USE ONLY
Site fi9GaF,C Sov2CE tiiee4Lr» PU9NS
Address/ Street Address Permit No.: 5444 °9- 6dc)- -7
Location [30/0 S W (o 61:-1-+ AgRkt..)/
Suite /Bldg. # City /State Zip Expiration Date:
St);/e, No 7710920, bit. q7 ZZ (/ Receipt #: gob/ 5 7
Name Approved By: 5'rR ►H"1
Property fAGFi( A/ Q/LOPt'/tMel..r Date: l - fri(o7
Owner Mailing Address Suite Map/11#: `- 5/ IN 'q - (7010
6600 5lN 1051-- 5 I75 Zoning: tke i-ll.tC
City /State Zip Phone
Se/91/ • 02. 97009 530 - 6242 -3Pro
Tenant or Name Electrical Permit Required? 1 Yes El N
Business &I-cif So u{_G� j l�L7H RANI
Building Permit Required? ID Yes
Name // v i D s w o FFo RD Rev. 7 /1/05 is \curpin \masters \revisedlsign permit app.doc
Sign S uN rtjs•e, Sib•S INC. '
Contractor Mailing Suite
(Prior to permit (0 7'/ Z Sw 174i" REQUIRED SUBMITTAL ELEMENTS
issuance, a PLAct (Note: applications will not be accepted ,
copy of all City /State Zip Phone without the required submittal elements)
licenses are
required if ALDO, Oft. 9 7 0 o 7 5 64/Z -14'57
expired in the Oregon Const. Cont. Board Exp. Date ❑ Completed Application Form
City of Tigard's License #
database) l 5'6 5_6
3 - D S Ill 2 Copies of Site /Plot Plan, Drawn to Scale
(3 copies, if a building permit is required)
Proposed ❑ Permanent ❑ Freestanding • g El Freeway size requirement: 8 x 11 ", or 11" x 17"
( Che all that ❑ Temporary [X Wall ID Electronic
apply) ❑ Other ❑ Billboard El Balloon El copies of elevations, drawn to scale
[ET New sign? (3 copies, if a building permit is required)
g ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: �
34' A x 3,3• ❑ $38.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
�P • 3 ❑ $18.00 Fee (Temporary sign, any type)
Total Wall Area (sq. ft.)
Sign Data 24 -x MD / ,- ° 080' Jurisdiction: ❑City ❑ Urb
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S W NE NW SE SW
Height to top of sign (feet): 2. y • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): 1 2_ but must include dimensions of wall face and
Copy: O,gGr Fr , G Eov,(cL sign placement.
N €AL*H PLANS • Wall signs do not require site /plot plans.
Materials: hLtmli , l /PtAIS+gc./N tort • Freestanding signs over 6 ft. required a
Will sign have illumination? ales ❑ building permit.
No • If work authorized under a sign permit has not
Type: ['Internal ❑ External been completed within ninety (90) days after
Are there any existing freestanding or wall, signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? BECOME NULL AND VOID.
►r Yes ❑ No
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 J 7 7 day of i) e- c t,Z 20 07
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Contact Person Name Phone No.
CITY OF TIGARD /
c,prnved �, �
Cor A dii�onall _ be
y Approved �
For only the work as desc in
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One illuminated channel letter sign in equal size to the existing US Bank ®T0 C121+
sign as illustrated. One year warranty on all parts and labor. Installation
included in cost of sign. Electrical connection will be made by Sunrise --4!!!!1!111°#1
Signs if electrical is supplied to facia by 36" out through facia with MC
cable by qualified electrician of customers choice. P r o f e s s i o n a l Signs & Graphics
Permits are extra at cost. 5 0 3. 6 4 2. 1 4 5 4
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There is one existing sign on this building It is the exact same dimensions
as the proposed signs."
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Professional Signs & Graphics
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Er il CITY Of TIGARD 12/17/2007
�� 13125 SW Nall RIvd. 3:24:58PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000005477
Date: 12/17/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2007 -00227 ['SIGN] Sign Permit 100- 0000 - 437000 35.00
SGN2007 -00227 1,LRITI Lit Planninu Surcharge. 100-0000-438050 5.00
ELC2007 -00$49 [ELPRMT] ELC Permit 220-0000-431510 53.40
ELC2007 -00$49 [TAX] S% State Surchanze 100- 0000 - 207020 4.27
Line Item "Total: S97.67
Payments:
Method Paver User ID Acct. /Check No. Approval No. 1 -low Received Amount Paid
CreditCard DAVID bV SWOFFORD ST 019482 In Person 97.67
Payment Total: S97.67
cReceipt.rpt Pac 1 or I