SGN2002-00247 CITY OF TIGARD SIGN PERMIT
'� �� DEVELOPMENT SERVICES PERMIT #: SGN2002 -00247
1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/14/2002
EXPIRATION DATE:
BUSINESS NAME: TIGARD DENTAL PARCEL: 2S102AC
SIGN LOCATION: 12720 SW PACIFIC HWY
APPLICANT /AGENT: IN KWON LEE ZONE:
BUSINESS TAX NO: JURISDICTION:
SIGN
PERMANENT: X FREESTANDING: FREEWAY:
TEMPORARY: WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 17" X 240"
TOTAL SIGN AREA: 28 sq. ft.
WALL AREA: 1,440 sq. ft.
WALL FACE (DIRECTION): E
SIGN HEIGHT: 14 ft.
PROJECTION FROM WALL: 16 in.
ILLUMINATION: INT
i
DESCRIPTION OF SIGN: placement of a 28 SF sign advertising a dental office
MATERIALS: PLAS /METAL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: Y
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 30.00
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:
DATE: 11/14/2002
4
r
i�:ir.' SIGN PERMIT APPLICATION
CITY TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name ofDe / pment/Project /,� FOR STAFF USE ONLY
Site T�SCVU/i 1,�IG'G�.
Address/ StreefAddress Permit No.: SG • 1 , y
0 `D0' D . _ �6 a y 1
Location /2/7 )_(-) 5 q ,1 pa,C .t I-J t't/ Expiration Date: MAN
Suite /Bldg. # City/Stare Zip U - 4 3 3
A TrsG(11� Receipt #: I 1
Name Approved By: Q m k
Property
(2 Le_e_ .. // Date: II(IY2o0Z
Owner Mailing Address Suite Map/TL #: S 1 0'4. RC " 0 i') 0L{
67
Zoning:. C 3ID
City /State Zip Phone
// Electrical Permit Required? ,Yes ❑ No
Tenant or Name
Business Building Permit Required? El Yes L.1\lo
Name Rev. 01 -Jul -02 is \curpin \masters \revised \sign permit app.doc
Sign REQUIRED SUBMITTAL ELEMENTS
Contractor Mailing Address Suite
(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 Ore Const. Cont. Board Exp. Date
City of Tigard's ' ense # [ 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 ❑ Other ❑ Billboard ❑ Balloon Er 2 copies of elevations, drawn to scale
apply) (3 copies, if a building permit is required)
E "New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: /0 ► _ ' 2 $30.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): 3� /S� g S ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) / �
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) N S Q 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): DA . sign placement.
Copy: 4-1,2,;g ,S i._jr' • Wall signs do not require site /plot plans.
Materials: P/4-4r14', • 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 jNo
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
Signature of Owner /Agent
Contact Person Name Phone No.
CITY OF TIGARD 11/14/2002
13125 SW Hall Blvd. 1:49:16PM
Tigard, Oregon 97223
I (503) 639 -4171
Receipt #: 27200200000000004337
Date: 11/14/2002
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2002 -00246 [SIGN] Sign Permit 100 - 0000 - 437000 30.00
SGN2002 -00247 [SIGN] Sign Permit 100 - 0000 - 437000 30.00
Line Item Total: $60.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Check INKWON LEE BMK 1124 In Person 60.00
Payment Total: $60.00
Page 1 of 1 cReceipt.rpt
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