SGN2012-00094 ,, CITY OF TIGARD SIGN PERMIT
" Permit #: SGN2012 -00094
COMMUNITY DEVELOPMENT Date Issued: 05/21/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S102BD00701
Jurisdiction: Tigard
Name of Business: Burgerville
Business Address: 12785 SW PACIFIC HWY
Applicant/Agent: Sams, Dave
Work Description: Wall Sign
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 93 "x66"
Total Sign Area: 36.17
Wall Area: 518
Wall Face (Direction):
Sign Height: 11.5 ft.
Projection From Wall: 5 in.
Illumination: Internal
Materials: Aluminum /acrylic
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: "Li
Permittee Signature: /� /,�.�'L1
CITY OF TIGARD RECEIPT
g+ n 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 186819 - 05/21/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00094 Sign Permit 100 - 0000 -43115 $144.00
SGN2012 -00094 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 1087 HWATKINS 05/21/2012 $165.00
Payor: Dave Sams of Advanced Electric Signs
Total Payments: $165.00
Balance Due: $0.00
Page 1 of 1
- 1:: SIGN PERMIT APPLICATION
CITY OF TIGARD ' /3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Projecl
Site ,a Q(' •, E( % i l 1 t;.. FOR STA FF1US E O!V LY ' , •
Address/ Street Address 44- .''Ocok
Location ' ep'z -
r�� S 5 < 1.,� '�P•.1 :��)i N44y Permlt` o �.,.�. ��� �lii t �`�`� . :,
Suite/Bldg. # City/State Zip ', . " •; t "` * Expiration Date •
Q` / ,' .
Name Recei / # 4 1CJ / (,/ T • : ;
�� CVii �� ( o M AT.Y\► Appro By: j� L , fa•r;, ,/
Property �� CV ii � �
Owner Mailing Address Suite • Da te: i r 1 ` •
IQ9 t,.1 i 2' Map/TL# ear ; 1 'y` c,r,i s - .
City /State Zip Phone "1.0 Zoning: 1 L` ` '` ' ` .45i r~ y : ; -1 ' . • •
AtiC AVtk fir %.4 9 -33' -r
' .�
I Tenant or Name t .., ' T `'> , esr' No
` Electrical Permit Required r �
Business t`f,' , � fr,.. "; � 1,- -, ,r... ti
Building Permit Required ? g „a; ®Yes`' ❑ No
Name
}, Rev 12/1 /2000 i. \cu •In \masters \revised\si n.: rmda••:doe '
Sign A b;:MI,:h.0 Ill Ec:-T;t) G 5 i c; Ns
1 Contractor Mailing Address Suite
j (Prior to permit
issuance, a I v aiwt Dl
i �ooy of all City/State Zip Phone 3E, (., REQUIRED SUBMITTAL ELEMENTS
::eases are
,F_ -.ed Lf 1,N) a.rvio W7\ r ; )4 j- Gs,2l. (Note: applications will not be accepted
e... ,,, toe Oregon Const. Cont. Board Exp. Date without the required submittal elements) I
Cat of rigard's License # I O , ` tai 1 "I y
tatapase)
❑ Completed Application Form
Proposed in Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary 2 Wall ❑ Electronic (3 copies, if a building permit is required)
(Cneck all that ❑ 9ther ❑ Billboard ❑ Balloon size requirement: 81/2" x 11 ", or 11" x 17”
® New sign? ❑ Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
(3 copies, if a building permit is required)
Sign Dimensions: 9 3 p ✓ 6 r/ size requirement: 8'/2" x 11 ", to 24" x 38"
Total Sign Area (sq. ft .): / -3 ` 7 ES ❑ $50.00 Fee (Permanent sign, any size)
Total Wall Area (sq. ft.) 5 i,n� ❑ $15.00 Fee (Temporary sign, any type)
Sign Data [5
;Complete all Direction Wall Faces (circle one):
items in mts NOTES:
Sec: .,n) N S EE W NE NW FF SW . Wall signs do not need to be drawn to scale.
Height to top of sign (feet): I) ;—' but must include dimensions of wall face and
' Projection From Wall (inches): S "• sign placement.
Copy: ch( LoGo . Wall signs do not require site /plot plans.
Materials: 1 TAL. . Freestanding signs over 6 ft. required a
Will sign have illumination? 2 Yes ❑ No building permit.
Type: 5:j Internal ❑External • If work authorized under a sign permit has not
Are there any existing freestanding or wall signs at this been completed within ninety (90) days after
the issuance of the permit, THE PERMIT WILL
location, including wall signs that overlap a tenant space?
BECOME NULL AND VOID.
i ❑ Yes ,c No
If "yes ", a list or diagram of all sign dimensions and (OVER FOR SIGNATURES)
y
square footage must also be submitted.
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360- 225 -6836 Z4-2,== '47:, COPYRIGHT 20 2 ADVANCED ELECTRIC SIGNS INC. C S AS SHOWN AND DE�PICTEDIN THIS SKETCHAND DOES NOT INt UDE CHANGES OR ANY ALTERATIONS • U.L. APPROVED
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