SGN2004-00271 •
C ITY OF TIGARD SIGN PERMIT
�; DEVELOPMENT SERVICES PERMIT #: SGN2004 -00271
'I -- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/28/2004
PARCEL: 2S 110DC -02400
BUSINESS NAME: DR BRANDON ZONE: C -G
SIGN LOCATION: 11565 SW DURHAM RD JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC: Y
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 7' X 1"10"
TOTAL SIGN AREA: 13 sq. ft.
WALL AREA: 1,200 sq. ft.
WALL FACE (DIRECTION): S
SIGN HEIGHT: ft.
PROJECTION FROM WALL: 8 in.
ILLUMINATION: INT
DESCRIPTION OF SIGN: Placement of one permanent wall sign. (7' x 1' 10 ")
MATERIALS: ALUM /PLEX
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES:
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: AL&tAxe a .
PERMITTEE SIGNATURE: '' 5—
DATE: 9/28/2004
a
,
d+" EtVii; SIGN PERMIT APPLICATION 6
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
T FOR STAFF USE ONLY
Site l R Za kbot-1
Address/ Street Address Permit No.: 527 N a o acI - C O 7
Location 115105 SW R y->, Rh
Suite /Bldg. # City /State Zip Expiration Date:
P- IoD TC_,49_, / 0(_ Q'7 C_ Receipt #: e26ay y3d
Name '� Approved By: L - �'cc..�r�
�'
Property A L , V ,O WY Date: 9 -.1a -04
Owner Mailing Address Suite Map/TL #: a S / / O OC - Cam? goo.
ci81 1 NE" II y ' aV Zoning: C - G
City/State kg (' o
Zip GG Phone
VI COUVL Z, k 33 -W -oa3S Electrical Permit Required? ❑ Yes ❑ No
Tenant or Name
Business Do lam. 2_41, { Building Permit Required? ❑Yes ❑ No
N ame g1 Rev. 8/7/2003 i:curpin\masters\revised\sign permit app.doc
Sign [4Y1 L.
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(
i ssuance Prior to , a permit 0 ( 'E. , 7 1 4 {b m/>;' (Note: applications will not be accepted
copy of all City/St Zip Phone 5723 without the required submittal elements)
licenses are P ao' De ct7�O 77? VSS 6 -
required if fJF- 1� Completed Application Form
expired in the Oregon Const. Cont Board Exp. Date
City of Tigard's License # Q �3 � (g / (�
2 Copies of Site /Plot Plan, Drawn to Scale
database)
Proposed (3 copies, if a building permit is required)
Pro
P ) P ermanent • Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign ❑ Temporary .1 Wall
(Check all that ❑ Electronic
apply) ❑ Other ❑ Billboard 111 Balloon [ 2 copies of elevations, drawn to scale
New sign? (3 copies, if a building permit is required)
g ❑ Alter to existing sign? size requirement: 81/2" x 11 ", to 24" x 36"
Sign Dimensions: , ,/ I • I U r, p $31.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
I a • g3 ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Toti Wall Ra ( ft.) a�0 Jurisdiction: City ❑ Urb
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) 0 E W NE NW SE SW
Heigh to top of sign (feet): 1 y ' 1 U is • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): $ but must include dimensions of wall face and
i n Y
rs� r- o rz. sign placement.
Copy: D? a ltbti/ ct+tcbea -m 4-1-0x7-/S • Wall signs do not require site /plot plans.
Materials: S E'i✓" A-TrIVAet. NI (A it, 4- Aix • Freestanding signs over 6 ft. required a
Will sign have illumination? CI Yes ❑ No building permit.
Type: Internal ❑ External • If work authorized under a sign permit has not
Are there any existing freestanding or wall signs at this been completed within ninety (90) days after
location, including wall signs that overlap a tenant space? the issuance of the permit, THE PERMIT WILL
❑ Yes No BECOME NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and
square footage must also be submitted.
(OVER FOR SIGNATURES)
• Letter of Authorization
M www.ramsaysigns.com
9160 SE 74th Ave Portland, OR 97206 5
P: (503) 777 -4555 1- 800 - 613 -4555 F: (503) 777 -0220
, / 1 ill 0 ° •=c • , represent that I /we are owners /landlords of the following real property:
11565 SW Durham Rd. Bid F Ste 100
Tigard, OR 97224
Washington
Including the building constructed thereon, which property is presently being rented to:
Dr. Brandon Sc rtc 9 119 VI
(tenant)
I/We acknowledge that Ramsay Signs, Inc. will be installing the following described sign(s) to:
Dr. Brandon Seri A) l —
(tenant)
Single face sign on Durham Rd.
Single face sign East elevation
Single face sign on South elev.
(description of sign)
Dated this c day of ....‘14.72.1.. , 20 d V
(Landlord /Owner or Authoriz- • Agent)
(Landlord /Owner or Authorized Agent)
MAILING ADDRESS: 9g3/ / . //,/ # ia Id-<__
L../4"- Le.-. y FV,,! z--
PHONE NO.: c:)� 0 3 S FAX NO.: 36c>-- 89S 7,27
.
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. ,-.
INTERNALLY ILLUMINATED WALL SIGN
A. •
ALUMINUM _. 8" , I m. LAG SCREWS WITH
CABINET 1 1"tt.A. - ANGLE CLIPS INTO
1■1111■
,i '• WALL ACROSS TOP
REMOVABLE
-- ,
,i
RETAINER .
ACRYLIC 0
OR POLYCARBONATE 1 . .,
.
SIGN FACE _ -
, .
..- ,
FLUORESCENT
1/2" CONDUIT
1---
LAMPS I _-
BALLAST . 1 20 V.
-----7---- r
N 1 THRU WALL
.L TO J-BOX
IN CONDUIT
0
i U.11.1■1■NI,A1 LAG SCREWS THRU
101 BACK OF CABINET
•#,
& INTO WALL.
•
(AS REQ)
WOOD WALL
DR -
/the 44,648/4 : -
Sc_ti tz IN t)
1 % NI Otton Co 1_
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•
CITY OF TIGARD 9/29/2004 •
13125 SW Hall Blvd. 11:57:17AM
/Mk Tigard, Oregon 97223
Allir (503) 639 -4171
Receipt #: 27200400000000004302
Date: 09/28/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00270 [SIGN] Sign Permit 100- 0000 - 437000 32.00
SGN2004 -00271 [SIGN] Sign Permit 100 - 0000 - 437000 32.00
SGN2004 -00272 [SIGN] Sign Permit 100 - 0000 - 437000 32.00
ELC2004 -00623 [ELPRMT] ELC Permit 220 - 0000 - 431510 160.20
ELC2004 -00623 [TAX] 8% State Surcharge 100- 0000 - 207020 12.82
Line Item Total: $269.02
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check RAMSAY SIGNS, INC CAC 1725 In Person 269.02
Payment Total: $269.02
• Page 1 of 1 cReceipt.rpt