SGN2002-00235 CITY TIGARD SIGN PERMIT
pal& DEVELOPMENT SERVICES PERMIT #: SGN2002 -00235
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 4171 DATE ISSUED: 11/4/2002
EXPIRATION DATE
BUSINESS NAME: TIGARD DENTAL IMAGES PARCEL: 2S102AC -01704
SIGN LOCATION: 12720 SW PACIFIC HWY
APPLICANT /AGENT: ZONE:
BUSINESS TAX NO: JURISDICTION:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 8X2
TOTAL SIGN AREA: 16 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: temporary banner
MATERIALS: VINYL
EXISTING SIGNS:
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 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: V('t ci)
DATE: 11/4/2002
CITY OF TIGARD 11/4/2002
13125 SW Hall Blvd. 2:47:27PM
Allo c ' �� ii Tigard, Oregon 97223
(503) 639 -4171
Receipt #: 27200200000000004209
Date: 11/04/2002
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2002 -00235 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
SGN2002 -00236 [SIGN] Sign Permit 100- 0000 - 437000 30.00
Line Item Total: $45.00
Payments:
Method Payer User ID Check No. Approval No. I -Iow Received Amount Paid
CreditCard MARIA WIKTOR MET 803716 In Person 45.00
Payment Total: $45.00
410,
,. • „, rb ti , l+h SIGN PERMIT APPLICATION
AU 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 Ti &A f2.D DENTAL AMA -(DES c�
Address/ Street Address Permit No.: S&P 2492, 002-3
Location 1.2120 Su PAC I FIC H u y Expiration Date: l iM/U Z
Suite /Bldg. # City/State Zip
2 1-I 6 QD Cilaa3 Receipt #:
Name Approved By: 1 1
Property
P QTU CZ U I I4.10R Date: l i' /c(M 7
Owner Mailing Address Suite Map/TL #:
12720 St4 PAclFlc Pftli 2 Zoning: L' C
City/State Zip ( Phone
TI G�1 aD X1223 503) 644 -qor7 Electrical Permit Required? ❑ Yes j2(No
Tenant or Name
Business TI(7ADENTAL 09 4(766 Building Permit Required? ❑ Yes irNo
t2j�
Name Rev. 01 -Jul -02 is \curpin\ masters \revised \sign permit app.doc
Sign
C REQUIRED SUBMITTAL ELEMENTS
Contractor Mailing Address Suite
(Prior to permit (Note: applications will not be accepted
issuance, a
- without the required submittal elements)
copy of all City /State Zip Phone
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 Li Freeway size requirement: 8 x 11", or 11" x 17"
I
Sign R Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ B illboard ❑ B alloon
apply) ❑ ? copies of elevations, drawn to scale
3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11 ", to 24" x 36"
Sign Dimensions: S $ 2
❑ $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): i6 j" $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) 16
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) N @ E W NE NW SE SW
• Wall signs do not need to be drawn to scale,
Height to top of sign (feet): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
Materials: • Freestanding signs over 6 ft. required a
building permit.
Will sign have illumination? ❑ Yes ® No • If work authorized under a sign permit has not
Type: ❑ Internal ® External been completed within ninety (90) days after
Are there any existing freestanding or wall signs at this the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space? 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 WOVEN (SEC , 20 9L
Signature of Owner /Agent
/161 'l, or (5 - 90/
Contact Person Name Phone o.
c.b TIG -PeD
D cN A c. 141/41 AGES
Z,14 (503) 6 y - 9017
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