SGN2003-00232 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2003 -00232
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/22/03
PARCEL: 2S 103BC -03900
BUSINESS NAME: BLUE HERON PARK ZONE: R -4.5
SIGN LOCATION: 12450 SW WALNUT ST JURISDICTION: TIG
APPLICANT /AGENT:
BUSINESS TAX NO:
SIGN
PERMANENT: X FREESTANDING: Y FREEWAY:
TEMPORARY: WALL: ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3'X5'
TOTAL SIGN AREA: 15 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION): S
SIGN HEIGHT: 5 ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of (1) one 15 sq ft permanent freestanding sign. Sign must be placed
on private property and not in public right -of -way or visual clearance area.
MATERIALS: WOOD
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:
F -Q�
PERMITTEE SIGNATUR • - ----
DATE: 9/22/03
;�,
x.,41: �•11 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
n/ c �� P FOR STAFF USE ONLY
Site j�
Address/ Street Address Permit No.: 5 A ) Z c 3- 00 1 3 2
Location eiTV 5 w (,,I )4 Expiration Date:
Suite /Bldg. # City /State Zip
TE5 C441 4 7, .3 Receipt #: J-- 0 3 — 4)-50
Name •• . // Approved By: r-g-a-p-
Property W! X Ctrl! ce ( /-�aC Date: of ,-al
// -
Owner Mailing Address Suite Map/TL #:
/ S`I"S V Zoning:
City /State Zip Phone
6o ?� ,5
64 Electrical Permit Required? ❑ Yes Eo
Tenant or a
Business Building Permit Required? ❑ Yes ElActo
Name Rev. 2/28 /2003 is \curpin \masters \revised \sign permit app.doc
Sign - Ac
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a a
copy of all City /State Zip Phone without the required submittal elements)
licenses are
required if ❑ Completed Application Form
expired in the Oregon Const. Cont. Board Exp. Date
City of Tigard's License # ❑ 2 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 ❑ Wall ❑ Electronic
(Check all that ❑ ❑ ❑ ❑ 2 copies of elevations, drawn to scale
apply) Other Billboard Balloon p
(3 copies, if a building permit is required)
® sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions:
3 2(5. ❑ $ Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): lS / , .. pi. $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 E W NE NW SE SW .
Height to top of sign (feet): sf • 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: o Wall signs do not require site /plot plans.
Materials: o Freestanding signs over 6 ft. required a
Will sign have illumination? ❑ Yes .-IQb building permit.
Type: ❑ Internal ❑ External o 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
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 day of , 20
•
Signs ure of Owner /Agent
Con act Person Name Phone No.
Aefefr. Ilk Ate/
! � r /l icel/ 44f5
CITY OF TIGARD
Approved............................... ...............................
Conditionally Approved ...................................... [�` )
[ )
For only the work as described in:
PERMIT NO._. �..IZ o CRS
See Letter to: Follow ........................
Attach ........................
Job Addr s • / - S . ... "y"`�
By:
Date � -
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CITY OF TIGARD 9/22/2003
13125 SW Hall Blvd. 3:55:39PM
ii,..de,�� ; ��� Tigard, Oregon 97223
L (50 3) 63 9-4 17 1
Receipt #: 27200300000000004230
Date: 09/22/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003 -00232 [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 WINDWOOD CONSTRUCTION KJP 26483 In Person • 31.00
INC
Payment Total: $31.00