SGN2003-00223 {
CITY OF TIGARD SIGN PERMIT
44, Pi DEVELOPMENT SERVICES
PERMIT #: SGN2003 -00223
��1 13125 SW Halt Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 9/15/03
PARCEL: 2S 101 AA -08300
BUSINESS NAME: ROTH OFFICE BUILDING ZONE: MUE
SIGN LOCATION: 12511 SW 68TH AVE JURISDICTION: TIG
APPLICANT /AGENT: J T ROTH CONSTRUCTION INC
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: Y FREEWAY:
TEMPORARY: WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 42" X 36"
TOTAL SIGN AREA: 10 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT: 3 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one permanent 10.5 sq ft monument sign.
MATERIALS: BRICK
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N •
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 31.00
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: 9/15/03
1 . i.A7 CITY OF TIGARD SIGN PERMIT
(� DEVELOPMENT SERVICES PERMIT #: SGN2003 -00223
, ,J� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/15/03
PARCEL: 25101 AA -08300
BUSINESS NAME: ROTH OFFICE BUILDING ZONE: MUE
SIGN LOCATION: 12540 SW 69TH AVE JURISDICTION: TIG
APPLICANTIAGENT: J T ROTH CONSTRUCTION INC
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: Y FREEWAY:
TEMPORARY: WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 42" X 36"
TOTAL SIGN AREA: 10 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT: 3 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one permanent 10.5 sq ft monument sign.
MATERIALS: BRICK
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 31.00
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 expireys from validity date.
APPROVED BY:
PERMITTEE SIGNATURE:
DATE: 9/15/03
•
k.�•1ir 1, 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
" FOR STAFF USE ONLY
Site 0-60 5 511 �!
Address/ Street Address Permit No.: S G fO Z4 3 — Z'71 to
Location
Expiration Date:
Suite /Bldg. # City /State Zip
8/4ni) M-2r3 Receipt #: z`'
Name Approved By:
Property eSV V 41-a✓l, Z e Date: 9//f
Owner Mailing Address Suite Map/TL #: ' a / / —5 7. y , 9s`n'- g.,..,), 1)7[7 )
"/27 Sti/ y Zoning: &t K E..
City/ to Zip Phone
7olifkiP9 9 ? J - Electrical Permit Required? ❑ Yes Mr No
Tenant or Name
Business /7 L 1/y' Building Permit Required? ❑ Yes No
Name
� Rev. 2/28/2003 is \curpin \masters \revised \sign permit app.doc
Sign (°% y / %' �� O71
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit / 2i.ev 3; 9� 2_00 (Note: applications will not be accepted
issuance, a
copy of all City/State Zip Phone without the required submittal elements)
lic
re ensed are 1 7�2-c3 ,5 2'
required if /6 ❑ Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # J ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database) Moo
(3 copies, if a building permit is required)
Proposed 3 3<reestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ❑ Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ Billboard ❑ Balloon El 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
iew sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: ./
��Z x 3i ❑ $ 80 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): /O, r
7 0 ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
(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): j • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): but must include dimensions of wall face and
sign placement.
Copy. • Wall signs do not require site /plot plans.
Materials: /JJtteis • Freestanding signs over 6 ft. required a
Will sign have illumination? 9f'es ❑ No building permit.
Type: ❑ Internal xternal • 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 over ap a tenant space? the issuance of the permit, THE PERMIT WILL
BECOME NULL AND VOID.
❑ 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 /5 day of —‘ , 20 03
Signature • j { ner /Agent
/W. /J
Contact Person Name Phone No.
/ 1 - / ♦ /
9' 9. / 8 9. / 9.. / 9'-I ' / 9 ' a. s. / NOTE S :
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Conditionally Approved _ .• ( ]
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3 -SPAE W PERMIT NO. --7-7
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CITY OF TIGARD 9/15/2003
13125 SW Hall Blvd. 1:23:16PM
i. ,ii ,T 11I��\ Tigard, Oregon 97223
1 (50 3) 63 9-4 17 1
Receipt #: 27200300000000004097
Date: 09/15/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003 -00223 [SIGN] Sign Permit 100- 0000 - 437000 31.00
Line Item Total: $31.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check J.T. ROTH CONSTRUCTION INC KJP 7570 In Person 31.00
Payment Total: $31.00
•
12/30/03 TUE 13:16 FAX 503 292 0737 TRAUTMAN PERRIN HALE 2001
JT' ACORCP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
1 2/30/2003
y PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Trautman Perrin & Hale Insurance In ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5319 SW Westgate Drive Suite #250 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Portland OR 97221 -2431 '—
INSURERS AFFORDING COVERAGE NAIC ti
INSURED I INSURER O regon Mutual Insurance Co.
Sicincraft Electrical Advertising LLC _ ____
Jerry Scott INSURER B: Liberty Northwest Insurance Co.
9033 SW Burnham I "SURER° - -- —
' INSURER 0:
,Tigard OR 97223 Washington County -
INSURERS
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT. WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
P OLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lNSR IADO•LI POLICY EFFECTIVE I POLICY EXPIRATION
LTR IINSIe 1 YPEDFINSURAVrF POLICY NUMBER DATE(MMIDD(YYI I DATE(MICDONY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
K COM`AERGIAL GENERAL LIABILITY DAMAGe TOREN fa)
PREMISES (Ea occ4ence) $ 1000000
A CL AIMSMADE X OCCUR MEDEXP(Anyompers�nl S 5000
OMO 5403871560 08-01-03 08-01-04 PERSCNAL3ADVINJU.RY $ 2000000
P GENERAL AGGREGATE 5 2000000
GEN'LAGGREGATE LIMIT PERK PRODUCTS- COMP/OP AGG 5 2000000
X j policy I " JC {7 Xi LOC
'WOWS ILE LIABIL!TY COMBINED SINGLE LIMIT
ANYAU TO I (Ea accident) s 1000000
X ALL CIN"NEDAUTOS BODILY INJURY • $ — -'
A X SCHEDULED AUTOS (Per person)
HIRED AUTOS OMO 5403871560 08 -01 -03 08 -01 -04
---- BODILY INJURY 5
NON -OWNED AUTOS (PeracciCefl I
- -- - - - - r
�--- — PROPERTY DAMAGE 5
(Peraccident)
GARAGE MAMMY AUTO ONLY -EA ACCIDENT $
ANYAUTO
-� OTHER THAN _EAACC $
AUTOONLY: AGG $
r r EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE 1$
Y OCCUR 1 I CLAIMS MADE AGGREGATE III LIS
DEDUCTIBLE I S
RETENTION S $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS' LIABLITY x_11)RY LIMJTS ER
F:IPgRINEPJEXECCfT71F r+�t C �-1 El_ EACH ACCIDENT S 500000
B OFFiC!:RM, qNY PROPRIETG EMBEITEX,CLJDeD7 WC4- 31VC-5O2533'01207 -11'03 07 -11 -04 E.L. DISEASE- FA EMPLOYEE I$ 500000
9PEC
Uyyas, PROYIS!CdesFnba 1SI N3 below E-LDISEASE - POLICY LIMIT 500000
OTHER I
'
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHIC EXCLUSIONS ADDEDBY ENDORSEMENT/ SPECIAL PROVISIONS
City of Tigard is also listed as an additional insured.
CERTIFICATE HCLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION
City Of Tigard DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO me LEFT, BUT FAILURE TO DO SO SHALL
13125 S W Hall Blvd.
n p IMPOSE NO OBLIGATOR OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Tigard, OR. 97281 REPRESENTATIVES.
ALrTHOR R PRE TATIVE f -
ACORD 21S (2001/0 )8) - Q . ��.�
®ACORD CORPORATION 1988
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