SGN2012-00033 IN ' , CITY OF TIGARD SIGN PERMIT
:. Permit #: SGN2012 00033
:, l' COMMUNITY DEVELOPMENT Date Issued: 03/16/2012
T .. , , . — -- 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S136DCO2504
Jurisdiction: Tigard
Name of Business: Tigard Triangle Smiles
Business Address: 7275 SW DARTMOUTH ST
Applicant/Agent: Tigard Triangle Smiles,
Work Description: Installation of (1) one 75.2 s.f permanent wall sign.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 31 -1/2" x 28'
Total Sign Area: 75.2
Wall Area: 1510.5
Wall Face (Direction): South
Sign Height: 32 ft.
Projection From Wall: 8 in.
Illumination: Internal
Materials: Aluminum
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.
Approved By: /
Permittee Signature: )C C,A _
RECEIVED
MAR 0 2 2012
11114 City of Tigard
I
1. CITY OF TIGARD
Sign Permit Application PLANNING /ENGINEERING
TIGARD Application
GENERAL INFORMATION
Name of Development /Project
Site rIC� KI0 'Z'(2C w� 5 FOR STAFF USE ONLY
Address / Street Address Permit No.: 6 4 4 1 2 12 - Coo 33
Location —1-27-s— J U-e V &r✓VtoD K
Suite /Bllddgg. 1 ��� IK fl 6-)1 # City / /State Zip l Approved By ►"
: 1
tl T � q Date: 3/44/2-.
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Name Rceipt #: I a •4 re
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Property ht A A -A /' A L ■0 )2/5/1,C5-47,„c Map /TL #: 3 ZSay
Owner Mailing Address Suite Zoning: G G�
(* 50 /VW i 7O e p�* Allowable Total Area: is r� •
tit /St. c - ip Phone
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Tenant or Name Electrical Permit Required? IA-Arrs ❑ No
Business TC irc) 'PGt () F C�� Building Permit Required? El N
Yes g-o
Name Rev. 7/1/11
/ ( , /1 ' / f�
Contractor 1 ai is \curph, \masters \land use applications \sign permit app.doc
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ractor l ling Addr -s V Suite
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City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
T 0 �Q 2 5f: S gd r U LCO (Note: applications will not be accepted
Oregon Const. Cont. Board License # Exp. Date without the required submittal elements)
4,e-i 0 t y 7 q- - 12 ❑ Completed Application Form
'ermanent Freestanding Freeway Proposed ❑ g ❑ y ❑ 2 copies of site /plot plan, drawn to scale
Sign Temporary ❑ Roof ❑ Electronic (3 copies, if a building permit is required)
(Check all that 111 ❑ Other
apply) size requirement: 81/2" x 11 ", or 11" x 17"
111 2 copies of elevations, drawn to scale
A :r .------ New sign? ❑Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions I , (Z ' t x 2 • size requirement: 8 x 11", to 24" x 36"
s ,, Total Sign Area (sq. ft.): T 2_, iii $165.00 Fee (Permanent sign, any size)
I S1 QS Total Wall Area (sq. ft.) ❑ $52.00 Fee (Temporary sign, any type)
Sign Data cJ_ /?1 = _
(Complete all Direction Wall Faces (circle one): y
items in this NOTES:
section) N `: J E W NE NW SE SW
Height to top of sign (feet): S2___• • Wall signs do not need to be drawn to scale, but
J3(et Projection From Wall (inches): g t • must include dimensions of wall face and sign
placement.
Materials: • Wall signs do not require site /plot plans.
Will sign have illumination? .f, Yes ❑ No • Freestanding signs over 6 ft. required a building
Type: 0k-in ❑ External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
�i o all sign dimensions No
If "yes ", a list or diagram o a �nsionsaa an nd square (OVER FOR SIGNATURES)
footage must also be submitted.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 718 -2421 I www.tigard - or.gov I 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 APPLICANTS) 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.
_1 3 (2_
Applicant Signature Date
(
3 2 (�
Signature of Owner /Agent Date
Contact Person Name Phone No.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 639 -4171 I www.tigard - or.gov I Page 2 of 2
I
" � CITY OF TIGARD RECEIPT
IN 13125 SW Hall Blvd., Tigard OR 97223
—' 503.639.4171
T-1GAILD
Receipt Number: 185960 - 03/16/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00033 Sign Permit 100 - 0000 -43115 $144.00
SGN2012 -00033 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 33328 KPEERMAN 03/16/2012 $165.00
Payor: MEYER SIGN CO. OF OREGON
Total Payments: $165.00
Balance Due: $0.00
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