SGN2012-00002 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2012 -00002
COMMUNITY DEVELOPMENT Date Issued: 01/05/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S101 BB00400
Jurisdiction: Tigard
Name of Business: Park 217 Sign
Business Address: 11844 SW PACIFIC HWY
Applicant/Agent: Brevig, Alexander
Work Description: Installation of one (1) permanent wall Sign (Pole Sign) 105" x 96"
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 105" x 96"
Total Sign Area: 70
Wall Area:
Wall Face (Direction): North
Sign Height: 20 ft.
Projection From Wall: in.
Illumination: Internal
Materials:
Electrical Permit Required: Yes
Building Permit Required: Yes
Total Permit Fee: $165.00
Conditions: 1 Pln Gen ELECTRONIC MESSAGE CENTERS
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.
Approved By: � d
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Permittee Signature: ,7/ � �r/
RECEIVED
16 .. City ofTigard JAN 0 5 20 1,
S Perm Applicat CITY OF TIGARD
TIGARD Di A "'"'P cricirlccruriC
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site Park 217 Sign )
Address/ Street Address Ph pc_ e W 1 Permit No.: t om^' ' 919(
Location 11844 SW Ga:d e /Va.,
Suite /Bldg. # City /State Zip Approved By:
Tigard, OR 97223 Date: 11511 c 2
Name Receipt #: [O6
Property 02510
Walton CWOR BC 8 LLC map/1 : a510 1 (r► 1I30i�rD
Owner Mailing Address Suite Zoning: AM.- eil.
1* SW Columbia St. 950 Allowable Total Area: 70 0- 6? - ac-A446 ■4
City/State Zip Phone
Portland, OR 97258 503 - 221 -2293
Electrical Permit Required?
Tenant or Name 121 es ❑ No
Business Park 217 Sign Building Permit Required? Yes ❑ tit,
Name Rev. 7/1 /11
is \curpin \ masters \land use applications \sign permit app.doc
Sign Columbia Signs, Inc.
Contractor Mailing Address Suite
4700 E. Fourth Plain BIvd.
City/State Zip Phone • REQUIRED SUBMITTAL ELEMENTS
Vancouver, WA 98661 360 696 -1919 (Note: applications will not be accepted
Oregon Const Cont Board License # Exp. Date without the required submittal elements)
149601 12/13/2013 ® Completed Application Form
Proposed ® Permanent ® Freestanding ❑ Freeway ® 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 11" 17"
apply) size requirement: 81/2" x 11 rr , 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)
Si g" mens 105. x96 » size requirement: uirement: 8 x 11", to 24" x'36"
Total Sign Area (sq. ft.): 70 SF 2 Fee (Permanent sign, any size)
Total Wall Area (sq. ft) ❑ $52.00 Fee (Temporary sign, any type)
Sign Data =
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) 0 E W NE NW SE SW
top to to � (feet): 20' from Grade
Height of t Wall signs do not need to be drawn to scale, but
g
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
Materials: t Wall signs do not require site /plot plans.
Will sign have illumination? ® Yes ❑ No t Freestanding signs over 6 ft. required a building
Type: ® Internal ❑ External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
❑Yes El No
(OVER FOR SIGNATURES)
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
City of Tigard 1 13125 SW Hall Blvd., Tig1irOR 97223 1 5018-2421 1 www.tigardor.gov 1 Pagel of2
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.
t 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.
t 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.
//Q f\f Ccu tie Pa g1c-
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Applicant Signature Date
• / /A/Z 4d 4 uP4 / zap 2 - -
Si• ature of Owner /Agent Obeid-67 t rh/2.0,4" Date
Lai Contact ' erson Nam Phone No.
City of Tigard 1 1325 SW Hall Blvd., Tigard, OR 97223 1 5039.4171 1 www.tigarabr.gov 1 Page2 of
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 185084 - 01/05/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00002 Sign Permit 100 - 0000 -43115 $144.00
SGN2012 -00002 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
Check 19508 STREAT 01/05/2012 $165.00
Payor: Columbia Signs
Total Payments: $165.00
Balance Due: $0.00
Page 1 of 1
SIGN PROPOSAL This original artwork is protected under FEDERAL COPYRIGHT LAWS. Make No reproductions of this design without wrifen permission from Columbia Signs, Inc. Licensed • B • Insured WAConfador#COtUASl943(3 - ORConirxforX149601
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may of reproduced I adds used in esigns the e permission
„��...... - //' and Full consent of Columbia bia Signs. Inc, n[n addition all designs. bids. contents . drafts. contents of proposals
and any specifications contained this layout may not used to segue price comparisons.
^ ^ 1 / 217 \ 1 �, Redisribution of infomtatlon contt ained on this form i full II acknowledgment atxl apprrnal of the ' '// // /� \\ `/\
7 terms and price listed. Violators will be prosecuted to t h e hill extent of the law. I F YOU HAVE
ANY QUESTIONS. ASK FIRST
Office 560 - (*Rd K I9 ! Fax - 560-030 -d7y7 -