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SGN2007-00024 II CITY OF TIGARD SIGN PERMIT 1111 ` DEVELOPMENT SERVICES PERMIT #: SGN2007 -00024 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/2007 PARCEL: 2S 110AB -00200 BUSINESS NAME: PENNY'S FISH & CHIPS ZONE: C -G SIGN LOCATION: 14295 SW PACIFIC HWY JURISDICTION: TIG APPLICANT /AGENT: BUSINESS TAX NO: SIGN PERMANENT: X FREESTANDING: FREEWAY: TEMPORARY: WALL: Y ELECTRONIC: OTHER: BILLBOARD: BALLOON: SIGN DIMENSIONS: 2' -6" X 2' -6" TOTAL SIGN AREA: 6 sq. ft. WALL AREA: 640 sq. ft. WALL FACE (DIRECTION): E SIGN HEIGHT: 17 ft. PROJECTION FROM WALL: 8 in. ILLUMINATION: INT DESCRIPTION OF SIGN: Installation of (1) one 6.25 sq. ft permanent wall sign. MATERIALS: ALUM 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. Atemporary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days from validity date. APPROVED BY: PERMITTEE SIGNATURE: O n g '� ` •�" DATE: 2/7/2007 Ak ._•ili��. SIGN PERMIT APPLICATION 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 eI(\rvis Ti 4-1 il CJ1i pS Address/ Street Address Location / y a 4 S � ,� � lC __II \\ Permit No.: � � lJ 2�1 _ p t) 2)4 NW23 Expiration Date: - Q' 5 3 9 Suite /Bldg. # . City /State Zip TIS (..\, o 9riaa4 Receipt #: Name Approved By: K V Property Can kru r.A\ire CQ r‘k � Date: ' I. I n 7 Owner �e Suite Map/TL #: co Tore San�lh 4.... Zoning: CZ City /State Zip Phone *3_00 - --XO(o Electrical Permit Required? Tenant or Name I q III-Yes 111 No Business *nn C�t �S , _Jj te� J ' Building Permit Required? ❑Yes O�No U_ �' Name Q Rev. 7/1/05 i:\curpin\masters\revised\sign permit app.doc Sign �n JAS . n C., Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS (Prior to permit issuance, a 3 1b$'C,;ia'Vlp'IkLA.Ld • S E. (Note: applications will not be accepted copy of all City /State Zip Phone without the required submittal elements) licenses are required if S 1,Q e w t) ti gr)30 , , 9)3 36LI -aa II 1E Application Form expired in the Oregon Const. Cont. Board Exp. Date City of Tigard's License # tp 4� I 3 /fig E2 Copies of Site /Plot Plan, Drawn to Scale database) (3 copies, if a building permit is required) Proposed Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17" Sign Temporary X Wall ❑ Electronic (Check all that ❑ Other El Billboa ❑ B alloon 2 copies of elevations, drawn to scale apply) (3 copies, if a building permit is required) New sign? ❑ Alter to existing sign? ize requirement: 8 x 11", to 24" x 36" Sign pim ?nsions: , U- L.' X a - � " $38.00 Fee (Permanent sign, any size) Total Sign Area (sq. ft.): a (o . El $18.00 Fee (Temporary sign, any type) Sign Data Total W ZD iX 3? ft.) (0410 Jurisdiction: ❑ City ❑ Urb (Complete all Direction Wall Faces (circle one): items in this a NOTES: section) N S (ED W NE NW SE SW Height to top of sign (feet): /7.! ` " a Wall signs do not need to be drawn to scale, Projection From Wall (inches): 8 u but must include dimensions of wall face and sign placement. Copy: Ote ,5ar L 4-\-' r � t. ' 1.0 (0 0 • Wall signs do not require site /plot plans. Materials: c E a_r k . 4 c,.p,,,3; SRoco a Freestanding signs over 6 ft. required a Will sign have. illumination? Yes building permit. No a If work authorized under a sign permit has not Type: Tyl, 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. A ,Yes ❑ No If "yes ", a list or diagram of all sign dimensions and square footage must also be submitted. . (OVER FOR SIGNATURES) P 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 31 S day of a\cAanv-ctn , 20 0 • ' :tea: �� 1 1 . • AIL! .9 • /�. 6 LNft- L� Signature of Owner /Agent Si z,-, • P. PaLL LLL S - .r-h� 11S. 3- 3(1)q 1 i Contact Person Name S is H S Phone No. • ' /- i 1--3 ild OREGON Merchandising Presite /7143 LOTTERY P.O. Box 12649, Salem, Oregon 97309 Retailer Nam . / /1 Retailer ID No.: Address S �W ` ! '� �/��j���: //c-y'' City: r � �� Zip: Y ' Count 4 C ontact Person: &- "r/ •Phos f � t) "7819:, Hours of Operation: Mon - Thurs.:Y /D Fri.: 37 Sat.: �' Sun. c5 %" Er NEW INSTALLATION* ❑ RELOCATION ❑ UPGRADE ❑ REPAIR ❑ REPLACE ❑ REMOVE Sign Type: ❑ I terior Dispenser Model: ❑ 412 Miscellaneous: ❑ Play Station Lxterior Wall Mount* ❑ 412 FW ❑ Other ❑ Pole* ❑ 416 ❑ End Projection Mount* ❑ 416 FW 1 ❑ y Here Mobile (20" X 30 ") ❑ 416 Ultimate L -E -D (Beta Brite) ❑ Overhead ❑ Other Breakopen � 0 f ❑ � Other 7 *Photos are required for all installs. Draw a square on the photo to identify install location. * Exterior Sign Repair /Replacement /Removal requires a photo so contractor can determine if a ladder or boom truck is needed. SIGNS interior Sirn Is there wiring or an outlet within six feet of where the Lottery sign will be mounted? ❑ Yes ❑ No Exterior Signs Is there a junction box /power Whin 10' of where the Lottery sign will be mounted? 8'Qes ❑ No LED - Beta Biile Distance from ISYS to L -E -D 7C / (estimated cable length) Install under Keno Monitor Q'Yes ❑ No (If no, provide photo identifying install location) Play Here Mobile Installed by contractor for corporate accounts if distance from floor to ceiling is more than 15' Ceiling type: ❑ Drop /False Ceiling ❑ Hard Ceiling ❑ Open Truss DISPENSERS In - Counter Dispenser Photo should include front and back view of counter Is there an electrical outlet within six feet? 9'Yes ❑ No Is there electrical wiring or an electrical outlet that may impact dispenser installation? ❑ Yes ❑ No Does the installation require removing shelves /drawers /partitions? ❑ Yes ❑ No Overhead Dispenser Quantity of Scratch -its to be displayed Dispenser configuration games wide X games high Distance from ground to ceiling? feet Is there electrical wiring, light fixures, or overhead racks that may impact dispenser installation? ❑ Yes ❑ No Breakopen Dispenser ❑ New Breakopen Retailer - Dispenser and installation provided at no charge to the retailer. AND /OR ❑ Purchase Breakopen Dispenser - Dispenser Cost $188 Quantity EFT Total $ Need Breakopen Dispenser Backer Board? ❑ Yes ❑ No Wall Type: ❑ *Studded (requires backer board) ❑ Brick ❑ Block ❑ Other - Identify Provide a Breakopen Backlit Sign with Breakopen Dispenser? ❑ Yes ❑ No Is there an electrical outlet within 11' of the installation site for the backlit sign? ❑ Yes ❑ No Additional comments /instructions. Details such as nearest cross street, special instructions, electrical issues, etc. Retailer Signature -/ Y"t` # Date: // © 6 Print Retailer's Name 72 y J /-1-gNa F FSR Name �/e/Vi V1 Route # _ZgOCL___ ('Al I C's nr / C l ("MDR ACKIT Form 0040 OREGON STATE LOTTERY Sign Installation Worksheet SERVICE AND INSTALLATION PERSONNEL TO FILL -IN SHADED AREAS Retail Location: I`�<< iP /V -_- f q I. O.S.. Work Order Reference o: /_ _ — - _ MBS Job # Date Work Performed: Description of Work: _ � %(r� ` ,1)4 -IL /Oit�r �' j C_ Travel Calculation Addresses: (For MapQues verification) Previous Stop: Next Stop: COS1' CALCULATIONS: Vehicle Mileage Rate mi. x $.445 = (round trip miles)* *Round trip miles are computed from Contractor's shop or last job to Retailer's site and from Retailer's site to Contractor's shop or next job. HOURLY TRAVEL RATE: x .70 x hrs. = (hourly rate) (travel hours) ** ** Travel hours are billed in 1/4 hour increments. Travel hours are computed from Contractors shop or last job to Retailer's site and from Retailer's site to Contractor's shop or next job. HOURLY ONSITE RATE: x hrs. = (hourly rate) (no. of hours) * ** MATERIALS Qty Item Cost Qty Item Cost • ** Onsite hours billed in '/4 hour increments Materials: (actual cost plus 10 °%o) _ Equipment Rentals: (actual cost plus 10 %) _ Site Survey Process Fee: ($30.00 plus mileage): _ Permit Application Process Fee: ($50.00 no mileage) – _ Permit Reimbursement: (actual cost only) _ Misc. Charge: (Pre - approved by Lottery) ___ TOTAL II CITY OF TIGARD Approved [K ! Conditionally Approved ....... For only the w as described in: ~ ' PERMIT NO. /y m -c3o a See Letter to: Follow Attac 2 6 „ .. 1" Retainer E';/ C n N OREGON • LOTTERY - S/F Illuminated Wall Cabinet SPECIFICATIONS Cabinet S/F CABINET Aluminum Fabricated, Painted high gloss white ON Ex-1-e ri 01' WALL 6" Deep Cabinet with 1" Retainer EXTERIOR SIDING Illumination PLYWOOD SHEATHING 800 MA CWHO Fluorescent Lamps Sf' / 2 "X6" WOOD STUDS ® 16" O.C. Face 3/16" White Polycarbonate ALUMINUM CABINET Install- Flush to Wall INTERNAL 1 X "x 1 Y" x 3/16" ANGLE ALUM STRUCTURE File Name - 640 -06 SO FT - 6.25 Scale - 1 % " -1' WOOD STUDS.AD LAGS INTO SIGN FACE (NTS) WT: \I loo) /B--Z3 —C7 DESIGN # 640-06 PROPERTY OWNER APPROVAL THIS DESIGN AND ENGINEERING IS SUBMITTED SOLELY AS A PART OF OUR PROPOSAL AND IS TO REMAIN PROPERTY OF MARTIN BROS., INC. . AND ANY OTHER USE HEREOF IS PROHIBITED AND SUBJECT TO DESIGN AND USE CHARGES. CUSTOMER Oregon Lottery XDrawing Accepted: ( DATE 10 - - ' in_ � ` LO �" Sri XApproved for Construction: DRAWN BY E. Degener Q 6 - 1 sINCE ,937 I Customer REPRESENTATIVE S. Beck. I s °°' 3165 Commercial St. S.E. Name/Title LOCATION a TI�/}� Salem, OR 97302 Signature SCALE 1 1 /: "= 1' QUANTITY Phone (503)364-2211 www. arts Fax (503)364 4315 g www.martin- bros.com Date FORM # 06 -16 -04 z:,.. . - .... . ..„ . . , . . , .a: •—•••■••••• L, L . 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' Lan e k55Y1 �g � � 1 B84- ift.) ` % .76,41—"... ../ wagile....‘' k \A) IL \ CI 9 J CITY OF TIGARD ,�tt 13125 SW Hail Blvd. 3:02:21PM ' �# 41 Tigard, OR 97223 503.639.4171 7 T+I GARDt Receipt #: 27200700000000000539 Date: 02/07/2007 Line Items: Case No Tran Code Description Revenue Account No Amount Paid SGN2007 -00024 [SIGN] Sign Permit 100- 0000 - 437000 34.00 SGN2007 -00024 [LRPF] LR Planning Surcharge 100- 0000 - 438050 5.00 Line Item Total: $39.00 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid Check MARTIN BROS SIGNS & KJP 18756 In Person 38.00 SERVICE CreditCard WILLIAM R. STONE/MARTIN KJP 007841 In Person 1.00 BROS INC Payment Total: $39.00 cReceipt.rpt Page 1 of 1