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SGN2002-00010 CITY OF TIGARD SIGN PERMIT • i E.11h DEVELOPMENT SERVICES PERMIT #: SGN2002 -00010 ' ° 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/18/2002 EXPIRATION DATE: BUSINESS NAME: OLD TIME COUNTRY DANCE PARCEL: 2S103DD -0060 SIGN LOCATION: 13770 SW PACIFIC HWY APPLICANT /AGENT: SUSAN RICE ZONE: C -G BUSINESS TAX NO: JURISDICTION: TIG SIGN PERMANENT: FREESTANDING: FREEWAY: TEMPORARY: X WALL: Y ELECTRONIC: OTHER: BILLBOARD: BALLOON: SIGN DIMENSIONS: 3' X 6' TOTAL SIGN AREA: 18 sq. ft. WALL AREA: 2,714 sq. ft. WALL FACE (DIRECTION): S SIGN HEIGHT: 18 ft. PROJECTION FROM WALL: 0 in. ILLUMINATION: NON DESCRIPTION OF SIGN: Temporary placement of (1) 3 ft x 6 ft banner. Valid 1/19/02 - 2/18/02. MATERIALS: VINYL EXISTING SIGNS: 1 ELECTRICAL PERMIT REQUIRED: N BUILDING PERMIT REQUIRED: N ADMINISTRATIVE EXCEPTIONS: TOTAL PERMIT FEES: $ 15.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. A sign permit shall expire 90 days from approval date. A temporary sign s I expire 30 days from approval date. A balloon sign shall expire 10 riavc frnm annrnval riata APPROVED BY: PERMITTEE SIGNATURE: DATE: 1/18/2002 ,... .: 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 . G, r-CP C ,^ct ✓j 3 c_ Address/ Street A ress Permit No.: E 6 ) 4_002 Op ■ I °Gi Location / 3 -7 7 0 S C.0 / c.tC/ L.. 14) Suite /Bldg. # City /State Zip Expiration Date: .. / . 7- ( ) Turd c 1 7 ZZ3 Receipt #: U'�_: 0C) � '�, Name y Approved By: _ i : . Property / i <' u �(� 7 CQ.yI� Date: -- -12).C) / � Owner Mailing Address Suite Map/TL #: S 1( 3 - W n b2 /( Nzz' 4 Zoning: C.. ( Tin Phone - nn y . i � DOr < c_J —Q 7 rZ ( I - - - - -- -- - -- -- - - Electrical Permit Required? ❑ Yes [ o Tenant or ; I . )/ 1, Building Permit Required? ❑ Yes No Business ..t./ Rev. 30- Ju1-01 is \cu •In \masters \revised \si•n •ermita••.doc i Sign Contractor Mailing Address • Suite REQUIRED SUBMITTAL ELEMENTS (Prior to permit (Note: applications will not be accepted issuance, 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) size requirement: 8 x 11 ", or 11" x 17" Proposed ❑ Permanent ❑ Freestanding ❑ Freeway Sign © Temporary ® wall ❑ Electronic' ❑ 2 copies of elevations, drawn to scale (Check all that ❑ Other ❑ Billboard ❑ Balloon (3 copies, if a building permit is required) apply) size requirement: 81/2" x 11 ", to 24" x 36" N New sign? ❑ Alter to existing sign? ❑ $50.00 Fee (Permanent sign, any size) Sign Dimensions: 3 i . 6, i ❑ $15.00 Fee (Temporary sign, any type) Total Sign Area (sq. ft.): NOTES: Sign Data Total Wall Area (sq. ft.) a 7i y ♦ Wall signs do not need to be drawn to scale but must include dimensions of wall face an (Complete all Direction Wall Faces (circle one): sign placement. items in this section) N (j E W NE NW SE SW o Wall signs do not require site /plot plans. Freestanding signs over 6 ft. required Height to top of sign (feet): J ' building permit. Projection From Wall (inches): 0 • If work authorized under a sign permit has no Copy: been completed within ninety (90) days afte Materials: A{ 6c2 r -e r — - the issuance of the permit, THE PERMIT WILT BECOME_NULL AND VOID. Will sign have illumination? ❑ Yes ®No Type: ❑ Internal ❑ External Are there any existing freestanding or wall signs at this 1- Not all jurisdictions accept credit cards, please call jurisdiction for more informa 0 location, including wall signs that overlap a tenant space? Visa MasterCard Credit card number / / ❑ Yes ® No Expires If "yes ", a list or diagram of all sign dimensions and Name of cardholder as shown on credit card square footage must also be submitted. $ Cardholder signature Amount (OVER FOR SIGNATURES) . -s 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 /0 , 20 6 /A C / aC�� P Sig"rrAre of Owner /Agent Si( R S� 3, S 3 8, 7 - 76 7 Contact Person Name Phone No. Receipt #: 27200200000000000237 Date: 01/18/2002 T I D E M A R K COMPUTER SYSTEMS, INC. Line Items: Case No Tran Code Description Revenue Account No. Amount Due SGN2002 -00010 [SIGN] Temp Sign Perm 100 - 0000 - 437000 $15.00 Payments: Method Payer Bank No Acct Check No Confirm No. Amount Paid Check SUSAN RICE 0 1114 $15.00 TOTAL AMOUNT PAID: $15.00 Sign Elevation it,f7) PY .... • Tigard Grange North Side 1 100' ■ 4' ■I lk \ lk 23' Okb TIME CO 0 j)141lh%6 S-J. -- 1 - 61,r(Z10 1-1 _=- ern r , Publ ,iLeActriyu_. 0,14 ,. .. il*Y OF 'tE I X i Cz)nd ::.'7:- :y Approved [ 1 . the wort-: as i;:escrivetil lel: Wri Le::4 to Follow 1 i .:;:.,;- 1, ,,,-":1-••-:..: '. /5 zd :i v.) • 14.1 1 , A . (-ei-A-4....0,_. .._ _.. _ ... Site Plan " Driveway Gravel and Grass Parking Tigard Grange 13770 SW Pacific Highway 3'x6' Banner Driveway Gravel and Grass Parking J