SGN2012-00165 CITY OF TIGARD SIGN PERMIT
1 111 1 1 s . Permit #: SGN2012 -00165
COMMUNITY DEVELOPMENT Date Issued: 10/04/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S136DB00201
Jurisdiction: Tigard
Name of Business: Fred Meyer
Business Address: 11565 SW PACIFIC HWY
Applicant/Agent: Hayden, Melissa
Work Description: 5'X37' wall sign (B -1)
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 23'3 "X21"
Total Sign Area: 40.6
Wall Area: 13750
Wall Face (Direction): East
Sign Height: 20 ft.
Projection From Wall: 12 in.
Illumination: Internal
Materials: Aluminum & acrylic
Electrical Permit Required: Yes
Building Permit Required: No
Total Permit Fee: $171.00
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: 74
Permittee Signature:
CITY OF TIGARD •
11 11 4 a . 131 25 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 188664 - 10/04/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00165 Sign Permit - LRP 100 - 0000 -43117 $22.00
SGN2012 -00165 Sign Permit 100 - 0000 -43115 $149.00
Total: $171.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 08464Z DADAMSKI 10/04/2012 $171.00
Payor: Melissa Hayden - Security Signs
Total Payments: $171.00
Balance Due: $0.00
Page 1 of 1
al 1 i
SIGN PERMIT APPLICATION
City of Tigard Permit Center 13125 SW' Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
TIGARD
GENERAL INFORMATION
?::) (
Name of Development /Project
FOR STAFF USE ONLY
Site i l a 1AK:10-, �7�71UoZQ
Address/ Street Address Permit No.:
Location
IUee-le-it__ Expiration Date: ...------
Suite /Bldg. # Cite /State Zip
Receipt #:
Name Approved By: A6.19
Property + ite .Clet t� Date: /0 - t.) - tL
Owner Mailing Address Suite Map /TL #: ) ' ) 3110 />r-i ODZD 1
Zoning: e, 6
Cur/State Zip Phone
Electrical Permit Required? BY-es ❑ No
Tenant or Name /'
Business h-2e dk CO ""` ' -i er . Building Permit Required? El Yes 1:1"o Name Rev. 7 /I /U9
is \curpIn \master \land use applications \sign permit app.doe
Sign Security Signs
Contractor Mailing Address Suite
(Prior to permit 2424 SE Holgate Blv 1
issuance, a
copy of all City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses arc (Note: applications will not be accepted
required ;f Portland, OR 97202 503.546.7114
without the required submittal elements)
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's
database) 122809 ❑ Completed Application Form
Proposed permanent ❑ F .tanding ❑ Frccwa, El 2 Copies of Site /Plot Plan, Drawn to Scale
Sign El Temporary Wall ❑ Electronic (3 copies, if a building permit is required)
((:heck all that ❑ Other Billboard ❑ Balloon size requirement: 81/2" x 11", or 11" x 17"
apply)
E New sign? El Alter to existing sign ? s L ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: (3 copies, if a building permit is required)
a3`3//x/ 4 , t size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
C � D/
Q.1� SF � � $49c9��e (Permanent sign, any size) � 7/
Si Total Wall Area (sq. ft.)
Sign Data x► ❑ $19.00 Fee (Temporary sign, any type)
(C■mplete all Direction W Faces (circle one): apt- e
items in this -4 NOTES:
section) N i. W NE NW SE SW
f \�
Height to top of sign (feet): 2C)/ ♦ Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): 17 i I must include dimensions of wall face and sign
placement.
Copy: � � "L —
• Wall signs do not require site /plot plans.
Materials: � t >A ., 4 r ` LC-
♦ Freestanding signs over 6 ft. required a building
Will sign have ill ination? ErYes ❑ No permit.
.
Type: u I n ternal ❑ External ♦ If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overla tenant space? of the permit, THE PERMIT WILL BECOME
Yes ID No NULL AND VOID.
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 Z. day of e) , 20
Signature f Owner /Agent
Melissa Hayden 503.546.7114
Contact Person Name Phone No.
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_ . PT 22 Spke Bounty (FM -P315)
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The International Sign Service SHOWN OUTSIDE YOUR ORGANIZATION NOR Rev #2 Rev. #5 - -
USED, REPRODUCED, COPIED, OR EXHIBITED IN DATE DATE: 4 -29 -2010
THIS DESIGN REMAINS OUR EXCLUSIVE PROPERTY AND ANY FASHION UNLESS AUTHORIZED IN WRITING
CANNOT SE DUPLICATED WITHOUT WRITTEN CONSENT BY AN OFFICER OF CUMMINGS SIGNS. Rev. #3 Rev #6 ____ 5. Hawke