SGN2007-00025 •
C ITY OF TIGARD SIGN PERMIT
° DEVELOPMENT SERVICES PERMIT #: SGN2007 -00025
TrGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/12/2007
PARCEL: 2S103DD - 00800
BUSINESS NAME: WINDFALL DELI ZONE: C -
SIGN LOCATION: 13815 SW PACIFIC HWY 100 JURISDICTION: TIG
APPLICANT /AGENT: WINDFALL DELI
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC: Y
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 2' - X 2' -
TOTAL SIGN AREA: 6 sq. ft.
WALL AREA: 390 sq. ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT: 12 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. A temporary sign shall expire 30 days from validity date. A balloon sign shall expire 10 days from validity date.
A ----: ; ;4e::):e- ' /t " - a -- t
APPROVED BY.
PERMITTEE SIGNATURE: (r) 'U '— C -�
DATE: 2/12/2007
Olto
. iii 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
incicall�� Sl(d0 FOR STAFF USE ONLY
Site
Address/ Street Address Permit No.: J C / � 7 ._ c ,`. <
Location . Is 61-0 4 -I.1W LA Expiration Date:
Bldg. # City /State 1 Zip
-- Tha l cse._ 9riaa3 Receipt #:
Name Approved By: /s
Property ('-') Cjh (Q L- day Date: ? pJ/ L. 7
Owner Mailing Address Suite Map/TL#: :� 5 / L, j ) f ) (_. , 1 .3/(-- --
Zoning: (1 C7
City /State Zip Phone
Tenant or Name Electrical Permit Required? Yes ❑ No
Business •j liaLQ — Lairru..1 Sir Building Permit Required? ❑ Yes p-
Name Rev. 7/1/05 is \curpin \masters \revised \sign permit app.doc
Sign I , rD S ...._-0(..-
Contractor Mailing Addre s Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit 31 � /' S� (Note: applications will not be accepted
issuance, a l l��
copy of all City /State Zip Phone without the required submittal elements)
q uired are
required C _ (t m ■ 9
re wired if �— �1'�'"` 9936a
S&3-36q -az I
expired in the Oregon Const. Cont. Board Exp. Date ❑ Completed Application Form
City of Tigard's License #
database) (p yr](o / 3 / 6 2 Copies of Site /Plot Plan, Drawn to Scale
d El
(3 copies, if a building permit is required)
Proposed Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ❑ Temporary , Wall ❑ Electronic
(Check all that 111 2 copies of elevations, drawn to scale
apply) ❑ Other El Billboard ❑ Balloon
(3 copies, if a building permit is required)
X . New sign? ❑ Alter to existing sign? si e requirement: 8 x 11", to 24" x 36"
Sign D gnsigns:
i o— L." x —(0. a $38.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): b • s-
❑ $18.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) Jurisdiction: El City 111 Urb
1.VXAo 7
(Complete all Direction Wall Faces (cir le one):
items in this ' NOTES:
section) N S 0 W NE NW SE SW
Height to top of sign (feet): la : ( ti • 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: 1_� 1 C O(ea • Wall signs do not require site /plot plans.
Materials: ,... 0 �
- 0 c k.., t • Freestanding signs over 6 ft. required a
Will sign have illuminationN Yes ❑ building permit.
No • If work authorized under a sign permit has not
Type: to 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.
AI , 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 --)1 day of __,,n ,200' - ]
Signature of Owner /Agent
6' h �a.�L.c�.s .533 -36V
Con act erson Name Phone No.
(S /cC
.,, Merchandising Presite
LOTTERY P.O. Box 12649, Salem, Oregon 97309
Retailer Name: % l
s n e. it " I;- ' - e%�r fe *-- DE F Retailer ID No.: g 25 Z-S "
Address: /Z5 /i ce, Cit / ,.0 Zip < �c7 _ _?
County j rvi Contact Person:..� V���9 Phone._ ) ‘ -'' l '
Hours of Operation: Mon - Thurs.: 7^ za.4- i Fri.: L/ Sat.: l r Sun.: L /
EW NSTALLATION* ❑ RELOCATION ❑ UPGRADE ❑ REPAIR ❑ REPLACE ❑ REMOVE
Sign Type: ❑ Interior Dispenser Model: ❑ 412 Miscellaneous: ❑ Play Station
Exterior Wall Mount* ❑ 412 FW ❑ Other
❑ Pole* ❑ 416
End Projection Mount* ❑ 416 FW
pig ❑ Play Here Mobile (20" X 30 ") ❑ 416 Ultimate .
J' L -E -D (Beta Brite) ❑ Overhead -
❑ � Other /
B����aakopen� c �
;
*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
/nteriorSivn Is there wiring or an outlet within six feet of where the Lottery sign will be mounted? ❑ Yes ❑ No
ExteriorSigns Is there a junction box /power ithin 10' of where the Lottery sign will be mounted? &les ❑ No
•
LED Beta Brite Distance from ISYS to L -E -i ,� .I - stimated cable length)
Install under Keno Monitor es ❑ 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
/n - Counter Dispenser Photo should include front d back view of counter
Is there an electrical outlet within six feet? es ❑ 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, Tight fixures, or overhead racks that may impact dispenser installation? ❑ Yes ❑ No
Breakopen Dispenser .
❑ New Breakopen Retailer - Dispnser 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 •A _ Au -- Date: ` " 'd
'Tint Retailer's Name - 01til a... -Pcirrriz. FSR Name! /_0.�'....i '. yip dry Route # 7,,
• • CITY OF TIGARD
Approved - I) 3
Conditionally Approv ed .
For only the work as described in:
PERMIT NO. S 7 ,4) 7 "
See Letter to: Follow
Attach ��
2 ,_��, JobAddr =ss: • •,
1" Retainer [ B y: D 2-Az- ,
.
N
OREGON
LOTTERY®
S/F Illuminated Wall Cabinet
SPECIFICATIONS
Cabinet S/F CABINET
Aluminum Fabricated, Fainted high gloss white ON FX-ICr►ot' WALL
* 6" Deep Cabinet with 1" Retainer
EXTERIOR SIDING
Illumination Q�� + PLYWOOD SHEATHING
800 MA CWHO Fluorescent Lamps It o
2"X6" WOOD STUDS 16" 0.C.
I
Face
3/16" White Folycarbonate
•
Install- Flush to Wall ALUMINUM CABINET
INTERNAL 1 Y "x 1 Y" x 3/16"
ANGLE ALUM STRUCTURE
File Name - 640 -06
SO FT - 6.25
Scale 1 Y2",1' _ )! "x4 " HEX-HEAD LAGS INTO
WOOD STUDS.
SIGN FACE
(NTS)
WT: 1 S IIQ )
oi) /e C
DESIGN # 640 -U6 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 S'1 iK Xog Accepted:
DATE 10 -23 -06 XApprApproved for Construction:
World I SINCE 193?
DRAWN BY E. Degener Q Wg Customer
REPRESENTATIVE S. Beck / AsZoates 3165 Commercial St. S.E. Name/Title
Salem, OR 97302
LOCATION
Salem Phone (503)364 -2211 Fax (503)364 -4315 Signature
SCALE 1 1/2"= 1' QUANTITY - www.martin- bros.com Date
FORM # 06 -16 -04
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II L/I CITY OF TIGARD
L/LUO/
C II 1 3125 SW Hall Blvd. 8:36:17AM
.. -. Tigard, OR 97223 503.639.4171
TIGARD)
Receipt #: 27200700000000000628
Date: 02/12/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2007 -00025 [SIGN] Sign Permit 100 - 0000 - 437000 34.00
SGN2007 -00025 [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 18758 In Person 38.00
SERVICE
CreditCard WILLIAM R. STONE - MARTIN kjp 012081 In Person 1.00
BROS INC
Payment Total: $39.00
cReceipt.rpt Page 1 of 1