SGN2012-00179 a CITY OF TIGARD SIGN PERMIT
> s Permit #: SGN2012- 00179
COMMUNITY DEVELOPMENT Date Issued: 11/28/2012
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S102AB03600
Jurisdiction: Tigard
Name of Business: Rojas Market & Taqueria
Business Address: 12271 SW Main ST
Applicant/Agent: Payne, Hal
Work Description: Install a 32.3 sq. ft. non - illuminated wall mounted sign
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No •
Sign Dimensions: 150 in x 31 in
Total Sign Area: 32.3
Wall Area: 414.2
Wall Face (Direction): Southeast
Sign Height: 14 ft.
Projection From Wall: • 1 in.
Illumination: No Illumination
Materials: Acrylic and PVC
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $171.00
Conditions:
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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.
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S I G N AG E APPROVED FOF3 hoUC
G R O U P Rojas Market Date: October 25, 2012 Name:
3y ' - Title:
Scale Proportional
15812 Upper Boones Ferry 12271 SW Main St. Ti ard, OR Signature: Date: / /
Lake Oswego, OR 97035 g Salesperson: Hal Payne
Ph (503) 639 - 5656 Landlord Signature. Date / /
F (503) 624 -8706
distinctsign.com These plans are the exclusive property of Distinct Signage Group and the result of the original work of its employees They are submitted to your company for the sole purpose of your consideration of whether to
purchase these plans or to purchase from Distinct Signage Group a sign manufactured according to these plans. Distribution or exhibition of these plans to anyone other than employees of your company, or use of
these plans to construct a similar sign is expressly forbidden In the event exhibition occurs, Distinct Signage Group expects to be reimbursed $500 for time and effort in creating these plans The respect of our
creativity and time is appreciated by those who have worked on your behalf
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• City of Tigard
Sign Permit Application
TIGARD
GENERAL INFORMATION
Name of Development /Project
D w JAS. I L lQ J { FOR STAFF USE ONLY
Site t om►+
Address / Street Address --11 Permit No.: 5Q 2o/ 2 - 00/-2?
Location % WI 1 Mf -(N S l % Approved By: VSw
Suite /Bldg. # City/State f� Zip /
� o l� `i / Date: H / 2
Name Receipt #:
Property e t• t 6' • ` Z <)/ Map /TL #: / 5 /0 2 46 0 34. b°
Owner Mailing Address Suite Zoning: fri V — C 6 D
Allowable Total Area: IS %
City/State Zip Phone v
Tenant or Name Electrical Permit Required? ❑ Yes Not
j�
Business ��'� �� -&� Building Permit Required? 0 Yes N P A�
Name Rev. 7/1/12 NO
is \curpin \ masters \land use applications \sign permit app.doc
sign O 1S t Q :c S ICTNM 64-40P
Contractor Mailing Address � Suite
City/State Zip Phone 503 REQUIRED SUBMITTAL ELEMENTS
4U a 0c Q R-q 7 p 0/ _ (Note: applications will not be accepted
Oregon C oast. Cont. Boar license # lixp. o f without the required submittal elements)
18644- l - t 7 ` 0' Completed Application Form
Proposed R Permanent ❑ Freestanding ❑ Freeway e' copies of site /plot plan, drawn to scale
Sign Temporary ❑ Roof ❑ Electronic
(Check all that (3 copies, if a building permit is required)
apply) J� ^ a � 1ef
❑ size requirement: 81/2" x 11", or 11" x 17"
��yy.� r 2 copies of elevations, drawn to scale
Nestgn Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: / Go " k 3 size requirement: 8 x 11", to 24" x 36"
Total Sign Area (sq. ft.): 32 - 1:1 $171.00 Fee (Permanent sign, any size)
Sign Data Total W llArea (sq. ft.) _ ❑ $54.00 Fee (Temporary sign, any type)
e. (Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E W NE NW SE SW
Height to top of sign (feet): 1 • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): $41' must include dimensions of wall face and sign
•UC QMR (NC placement.
Materials:
• Wall signs do not require site /plot plans.
Will sign have illumination? ❑ Yes ,R' • Freestanding signs over 6 ft. required a building
Type: ❑ Internal LI External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
❑ Yes ,KNo
If "yes ", a list or diagram of all sign dimensions and 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 APPLICANI'(S) 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.
-Lie Ct ql -54.---.
D tSTf Ai tT c 1€016ita-Ge tk ii s /(2._
Applicant Signa Date
Signature of Owner /Agent Date
-\ +P -N- (o3) ( r)Yt - s0s(0.
Contact Person Name Phone N .
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 718 -2421 I www.tigard - or.gov I Page 2 of 2 '
CITY OF TIGARD RECEIPT
►1
g . . 13125 SW Hall Blvd., Tigard OR 97223
- • 503.639.4171
TFGAR.D
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Receipt Number: 189309 - 11/28/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00179 Sign Permit 100-0000 -43115 $149.00
SGN2012 -00179 Sign Permit - LRP 100 -0000 -43117 $22.00
Total: $171.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 011490 JFLOYD 11/28/2012 $171.00
Payor: Harold W. Payne II
Total Payments: $171.00
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Balance Due: $0.00
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