SGN2011-00102 - -ip q - CITY OF TIGARD SIGN PERMIT
Permit #: SGN2011 -00102
COMMUNITY DEVELOPMENT Date Issued: 09/16/2011
TIGARD- 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S110DB01700
Jurisdiction: Tigard
Name of Business: Black Rock Coffee Bar
Business Address: 15290 SW PACIFIC HWY
Applicant/Agent: Black Rock Coffee Bar,
Work Description: Installation of (1) permanent 18 s.f. wall sign.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 2'x9'
Total Sign Area: 18
Wall Area: 252
Wall Face (Direction): North
Sign Height: ft.
Projection From Wall: 4 in.
Illumination: Internal
Materials: Channel Forms,Vinyl
Electrical Permit Required: Yes
Building Permit Required: No
Total Permit Fee: $165.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable law. 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.
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Approved By: '
Permittee Signature:,
RECEIVED
IN _ a City o f Tigard S E P 1 3 2 011
Sign Permit Application CITY OF TIGARD
TIGARD P(,A 1P�Ilh,�*�. /�!(;IVFER�I�
GENERAL INFORMATION
Name of Development /Project
/ bar
FOR STAFF USE ONLY
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Site a(�1� /l'L - 4 (0/((.. St l� �� '°01 tl �
Address/ Street Address Permit No.:
Location is 2 yo S V Pao' IQ high c.ar approved By: / C' ems✓
Suite /Bldg. # City/State Zip
Ci
' ;9a / OK 1726-/ Date: 9f / p ! ii
Name / Receipt #: 6 O yt)
Property 44 WE 1a; •Z
• ( Map /TL #:
Owner Mailing Address Suite Zoning: Cj �''SI�v � n (� �7 OD
�=1 ( O
i
^/ j� 99 `
/NO f � / r iy'1�11f �G`� l/ .— � Allowable Total Area:
City /State Zip Phone
/ /ygJ o% 97
Electrical Permit Required? 4es ❑ No
Tenant or Name
Business 134//- Ra(( Ca /Per 4p- Building Permit Required? ❑ Yes 'No
Name !� Rev. 7/1/11
fit ( / is \curpin \ masters \land use applications \sign permit app.doc
Sign S1g/rJ Efc. in(
Contractor Maili g Address Suite
I )y) As /icc Road
City/State Zip /� �,y� Phone REQUIRED SUBMITTAL ELEMENTS
p
l Pal ire e Po,;l /- / (1 97,, < sy(' 77q.- q gy (Note: applications will not be accepted
Oregon Const. Cont. "Board License # Exp. Date without the required submittal elements)
❑ Completed Application Form
� Permanent ❑ Freestanding Freeway Proposed ❑ y El 2 copies of site /plot plan, drawn to scale
Sign ❑ Temporary ❑ Roof ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Wall ❑ Other
apply) size requirement: 81/2 x 11", or 11" x 17"
❑ 2 copies of elevations, drawn to scale
® New sign? ❑ Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: 2 X q size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): ig ® $165.00 Fee (Permanent sign, any size)
Si Data Total Wall Area (sq. ft.) 7 %
❑ $52.00 Fee (Temporary sign, any type)
2 °
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E 0 NE NW SE SW
Height to top of sign (feet): • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): y must include dimensions of wall face and sign
placement.
Materials: a Wall signs do not require site /plot plans.
Will sign have illumination? Yes ❑ No a Freestanding signs over 6 ft. required a building
Type: ® Intemal External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
❑ Yes ® No
If "yes ", a list or diagram of all sign dimensions and square
(OVER FOR SIGNATURES)
footage must also be submitted.
City of Tigard 1 13125 SW Hall Blvd., Tigard, OR 97223 1 503- 718 -2421 1 www.tigard - or.gov 1 Page 1 of 2
APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on the
front of this application in the "Required Submittal Elements" box.
NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for work.
* When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in possession with
written authorization from the owner or an agent of the owner. The owner(s) must sign this application in the space provided on the back
of this form or submit a written authorization with this application
BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT:
• If the application is granted, the applicant will exercise the rights granted in accordance with the terms and
subject .to all the conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan, attachments, and exhibits transmitted
herewith, are true, and the applicants so acknowledge that any permit issued, based on this application, and
may be revoked, if it is found that, any such statements are false.
• The applicant has read- the entire contents of the application, including the policies and criteria, and
understands the requirements for approving and denying the application.
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.
SIGNATURES of each owner of the subject property are required.
Applicant Signature Date
Signature of Owner /Agent Date
Contact Person Name Phone No.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 1 503- 639 -4171 1 www.tigard - or.gov Page 2 of 2
APPLICANTS:
To consider an application complete, you will need to submit ALL of the REOUWRED SUBMITTAL ELEMENTS as described on the
front of this application in the "Required Submittal Elements" box.
NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for work.
* When the owner and the applicant are different people, the applicant onust be the purchaser of record or a lessee in possession with
written authorization from the owner or an agent of the owner. The owner(s) must sign this application in the space provided on the back
of this form or submit a written authorization with this application
BY SIGNING BELOW, THE APPLICANT(S) SHALL CERTIFY THAT:
o If the application is granted, the applicant will exercise the rights granted in accordance with the terms and
subject to all the conditions and limitations of the approval.
o All. of the above statements and the statements in the plot plan, attachments, and exhibits transmitted
herewith, are true, and the applicants so acknowledge that any permit issued, based on this application, and
may be revoked if it is found that any such statements are false.
o The applicant has read the entire contents of the application, including the policies and criteria, and
understands the requirements for approving and denying the application.
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.
SIGNATURES of each owner of the subject property are required.
Applicant Signature Date
Signature of Owner /Agent Date
Contact Person Name Phone No.
City of Tigard 13125 SW hall Blvd., Tigard, OR 97223 1 503- 639 -4171 1 www.tigard- or.gov 1 gage 2 of 2
WALL SIGN FACES
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1 . Black Rock: Individual pan channel letter forms - white face and retums, black vinyl outline and black trim cap
Star: stand alone pan channel - with white return, red vinyl on white plex face and black trim cap
Coffee Bar: pan channel rectangle with white return, black vinyl letters on white plex face with black trim cap
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For only the wo as described in:
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1:1 14' X 26' PREFABRICATED BUILDING
PLOT DATE' Seed To Cup Coffee Solutions BDA 04.-11 OK - PRELIMINARY COPY
0 Apt OS, 2011 FRONT ELEVATION MEDFORD ORTIGR97501 REV DATE BY APPROVAL REVISION NOTES
3 BIBCk Rock THIS DOCUMENT CONTAINS CONFIDENTIAL OR PROPRIETARY INFORMATION OF CLASSIC TROLLEY. NEITHER THE DOCUMENT NOR THE INFORMATION THEREIN Lr
CI L eading The Drive Thru Revolution 1 -800- 460 -3934 IS TO BE REPRODUCED. DISTRIBUTED, USED OR DISCLOSED, EITHER IN WHOLE OR IN PART EXCEPT AS SPECIFICALLY AUTHORIZED BY CLASSIC TROLLEY.
www.stccoftee•cOm A CAD DRAWING, NOT TO BE MODIFIED MANUALLY.
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: 74 ' -' CITY OF TIGARD RECEIPT
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g 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
'TIGARD
Receipt Number: 183940 - 09/15/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2011 -00102 Sign Permit 100 - 0000 -43115 $144.00
SGN2011 -00102 Sign Permit- LRP 100 - 0000 -43117 $21.00
Total: $165.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 057200 KPEERMAN 09/15/2011 $165.00
Payor: JUSTIN LESHER
Total Payments: $165.00
Balance Due: $0.00
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