SGN2008-00096 Er Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.ligard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: BHGAH
INVOICE TO: (Business or Individual)
V ® 1 0 Mailing Address: PO Box 1670
0/06P City/State /Zip: Wilsonville, OR 97070
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL PERMIT APPLICATION. /VO F`un/p
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: SGN2008 -00096
Site Address or Parcel #: 15700 SW Upper Boones Ferry Rd, Tigard, OR 97034
Project Name: Holiday Inn Express
Subdivision Name: Lot #:
EXPLANATION: Withdrawn per 8/12/08 according to discussion held with Jatin Patel.
Applicant pursuing face change instead of new sign. No refunds due.
Signature: A� C��(,(," Date: 8/12/08
S � J � l ley Treat t�
Print Name:
Jtefund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be resumed to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date , ' i s pi--- By " -
Refund Processed: Date A5/,9- By. f( Invoice Processed: Date By
Permit Canceled: Date i /s`pf� By , Parcel Tag Added: Date By
Receipt # Date / Method Amount $
I:\ Building \ Forms \RegPer» tAction.doc Rev 07/26/07
31 'ilNJ 1'L 1UV11 1 11' 1'L11.,1111
0' `;. . - City g Perna Center 13125 SW Hall Blzd, Tigard OR 97223
Phone. 503.639.4171 Fax: 503.598.1960 -
GENERAL INFORMATION
Name of Development /Project
/4
/air FOR STAFF USE ONLY
Site /4 /� 1 V-- s 1
Address/ Street Address Permit No.: ( o/- ) gifry i( enrol) 4-
Location /5 s a604, 6oa-•4PI 7,-,-,7 Az
Suite /Bldg. # Qty/State Zip p Expiration Date:
% i A✓�� 0 / 70 3 q Receipt ># :
Name Approved By S ,, 1K
Property ... r41/7 All 1'19611°i 1 L(,C Date: 5!14 /0i
Owner Mailing PO Suite Map /TL# : �S 1 / a p D 01 Jl'D
P6 ' N /(/7 0 Zoning: (i 0)
Gry /State Zip Phone
W 1 ISOVI V►lIl 77610 Electrical Permit Required? ►Q Yes El No
Tenant or Name
Business 5 i‘d i, /1^e r7)"(/ Building Permit Required? ❑ Yes [�No
Name / Rev. 7/1/07
is \curpin \masters \land use applications \sign permit app.doc
Sign
Contractor Mang Address Suite
(Prior to permii
issuance, a
copy of all Gry /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses are (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
database) ❑ Completed Application Form
Proposed ❑ Permanent ❑ Freestanding kj 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 size requirement: 8 x 11 ", or 11" x 17"
apply) q
A New sign? 011 Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: pi i i + (3 copies, if a building permit is required)
(6 _ size requirement: 8 x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
/ 71 e ❑ $40.00 Fee (Permanent sign, any size)
Si Sign Data Total Wall Area (sq. ft.)
g ❑ $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) S E W NE NW SE SW
Height to top of sign (feet): 4-0 • 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 fire. e tar ��i... l c,, I/ • 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: Et 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
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.
DNI ED this 1 day of 1i , 20 Of/
Signa - e of Owner /Agent ' I , 4 - 11 , N 10;,14/(
i ,. - (1 A - 1 9 e- ( 50 Gl Contact Person Name hone o.
•