SGN2006-00203 a CITY OF TIGARD SIGN PERMIT
'` ° ' DEVELOPMENT SERVICES PERMIT #: SGN2006 -00203
TI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/14/2006
PARCEL: 1 S135DD -05106
BUSINESS NAME: DR BRUNO DA COSTA DENTISTRY ZONE: C - G
SIGN LOCATION: 11995 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT: DR . BRUNO DA COSTA DENTISTRY
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: Y FREEWAY:
TEMPORARY: WALL: ELECTRONIC: Y
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 5' - "X 7' -
TOTAL SIGN AREA: 39 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: 5 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Placement of (1) one permanent 39.60 sq. ft. monument sign.
MATERIALS: ALUM /PLEX
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 39.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty 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.
APPROVED BY.
PERMITTEE SIGNATURE: ( / /'��
DATE: 11/14/2006
,
SIGN PERMIT APPLICATION
City of Tigard Permit Center 13125 SW Hall Blul, Tigard OR 97223
Phone 503.639.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project ��p�
Site nr�.NO dwp l7ff ofil /� FOR STAFF USE ONLY
Address/ Street Address Permit No.: ..) /kJ k '6 0 Z,v3
Location I f 9 g S Sw. phel Pie- Hair , Expiration Date:
Suite /Bldg. # City /State Zip
-r19' and q2. �7700-3 Receipt # : —
Name Approved By:
Property Date: 11 / i .f c,L
Owner Mailing Address Suite Map /TL# :
Zoning: C C7
City /State Zip Phone
Tenant or Name Electrical Permit Required? E Yes ❑ No
Business pa , Otatipo ex Building Permit Required? ❑ Yes ❑llo
Name `J l tl n Rev. 7 /5/06
Sign Hi & n �,N ` �i �/./" is \curpin \ masters \I and use applications \sign permit app.doc
Contractor Mailing Address Suite
(Prior to permit Olga) 51V' Hz .'2iKik
issuance, oof a
REQUIRED SUBMITTAL ELEMENTS
copy of all City /State Zip Phone Sp? ,
Ce ui ed `t ym DR , 4 w e"- , � p) (Note: applications will not be accepted
re
9 without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) / 0 ("t" S1 Al/7/o7 ❑ Completed Application Form
Proposed ❑ Permanent reestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary i'21 ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other ❑ Billboard ❑ Balloon size requirement: 8' /z" x 11 ", or 11" x 17"
apply) ze re q
[ .N sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: { 4 a , , Lop.. (3 copies, if a building permit is required)
n4. 1/44...) `� 0 !! . ? ' t ' 3!)(.7! 7 4 1 size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): yyieNuru — Lai Aa -t
40 #'— 1 S.33 ❑ $39.00 Fee (Permanent sign, any size)
Si n Da Total Wall Area (s ft /
g g ❑ $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): 5%1 '/ ♦ 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: DP. hit av 574 . ♦ Wall signs do not require site /plot plans.
Materials: Ay0411 i /V 1,0 14440yc, • Freestanding signs over 6 ft. required a building
Will sign have illumination? 74 Yes ❑ No permit.
Type: j. 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)
K
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.
DA 1lD this 1 `+ day of No 664 $gJQ• , 20 0 Co
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e • 'Owner /Agent
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Contact Person Name Phone No.
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7 CITY OF TIGARD 11/14/2006
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13125 SW Hall Blvd. 12:43:16PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200600000000005434
Date: 11/14/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2006 -00203 [SIGN] Sign Permit 100 -0000- 437000 34.00
SGN2006 -00203 [LRPF] LR Planning Surcharge 100- 0000 - 438050 5.00
SGN2006 -00204 [SIGN] Sign Permit 100- 0000 - 437000 34.00
SGN2006 -00204 [LRPF] LR Planning Surcharge 100- 0000 - 438050 5.00
ELC2006 -00656 [ELPRMT] ELC Permit 220- 0000 - 431510 53.40
ELC2006 -00656 [TAX] 8% State Surcharge 100- 0000 - 207020 4.27
Line Item Total: $135.67
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check HIGHLIGHT SIGN CORP DEB 5824 In Person 135.67
Payment Total: $135.67
cReceipt.rpt Page 1 of 1
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CITY OF TIGARD
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1199', SW PACIFIC HWY
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- 503-620-8205 TIGARD OR 9722 i kg,,, .1( fion t orvIRillt 1
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