SGN2012-00187 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2012 -00187
COMMUNITY DEVELOPMENT Date Issued: 12/05/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S136AD06502
Jurisdiction: Tigard
Name of Business: Blitz Sports Pub
Business Address: 10935 SW 68TH PKWY
Applicant/Agent: Becker, Tim
Work Description: 2.5 X 2.5 ft wall sign cabinet "Lottery"
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 2.5 X 2.5 ft
Total Sign Area: 6.25
Wall Area: 336
Wall Face (Direction): West
Sign Height: 11 ft.
Projection From Wall: 6 in.
Illumination: Internal
Materials: Aluminum /Plastic
Electrical Permit Required: Yes
Building Permit Required: Yes
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: 7
Permittee Signature: tely
CITY OF TIGARD RECEIPT
� ,,
� � 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 189383 - 12/05/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00187 Sign Permit 100- 0000 -43115 $149.00
SGN2012 -00187 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 00740S HWATKINS 12/05/2012 $171.00
Payor: Douglas Carrick
Total Payments: $171.00
Balance Due: $0.00
Page 1 of 1
RECEIVED
• City of Tigard
Sign Permit Application DEC 0 3 2012
TIGARD �r � Tj('
rW> fNUi T 1 NG
GENERAL INFORMATION
Name of Development/Project
Site 17) I 1 t l q W ) SO)rh PIA b FOR STAFF USE ONLY
Address/ Street Address \ * Permit No.: .-411 — 012 7
Location I O g 3 5 ( < P Ku) j� Approved By:
Suite /Bldg. # City /State Zip .J
T)nYct 9122 3 Date: / Y6 /
t #:
p ��
Name Receipt �
Property Madden Grp LLC Map /TL #:
Owner Mailing Address Suite Zoning C - 6
I J N vJ 13t14 Pcvt Allowable Total Area: / 1 :-', - • .( ;• / ` . :"-•'' . •) 7 F
City /State Zip Phone
4ovkta 001.0i Tenant or Name, � I Electrical Permit Required? Yes El No
Business Ti ►-y1 V ec,k Permit Building Peit Required? Yes ❑ No
Name Rev. 7 /1/12
is \curpin \ masters \land use applications \sign permit app.doc
Sign Car r1 0 4 -
Contractor Mailing Address Suite
I g■l KAVneetca br.
City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
Vey Ai and oil 2-1- ' D3 -591 -gift (Note: applications will not be accepted
Oregon Const Co}rt. Board license # Exp. Date without the required submittal elements)
Er Completed Application Form
Proposed ® Permanent El Freestandin Freestanding ❑ Freeway E y r2 copies of site /plot plan, drawn to scale
Po
Sign ❑ Temporary ❑ Roof ❑ Electronic (3 copies, if a building permit is required)
(Check all that Er wall ❑ Other t >>
apply) size requirement: 8 /z x 11", or 11" x 17"
Er2 copies of elevations, drawn to scale
New sign? ❑ Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: 2 t 5 X 2 5 size requirement: 8t /z" x 11 ", to 24" x 36" 1
Total Sign Area (sq. ft.): .25 , $171.00 Fee (Permanent sign, any size)
Total Wall Area (sq, ft.) ❑ $54.00 Fee (Temporary sign, any type)
Sign Data efP /23 10 3 2.. _ - 1.2, 5 i
(Complete all Direction Wall Faces (circle one):
items in this 1 NOTES:
section) N S E ® NE NW SE SW
Height to top of sign (feet): i, • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): n must include dimensions of wall face and sign
Materials: 0 f i • a placement.
• Wall signs do not require site /plot plans.
Will sign have illumination? ® Yes ❑ No • Freestanding signs over 6 ft. required a building
Type: Ei Internal ❑ External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
Yes ❑ No
If "yes ", a list or diagram of all sign dimensions and square (OVER FOR SIGNATURES)
footage must also be submitted.
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 APPLICANT(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.
•.AS/Cy‘) ►,I 2-q I 1
Applicant Signature Date
PP �
See ai c\n ea pre.c te, 111 I ►Z
Signature of Owner /Agent Date
\iSDIn St/U/1 V 8110 3 D3- 35q 2 -
Contact Person Name 4 Phone No.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 718 -2421 I www.tigard - or.gov I Page 2 of2
',, Merchandising Presite
P.O. Box 12649
OREGON Salem, Oregon 97309
LOTTERY,
Retailer Name: , 5 4 . ' S ` 111 / Retailer I.D. No 0f � Cj c-
Addres C) --
_ .- � ° /PO �" i / :acs Zip
Coun ,. d / .1 Contact Person:// /
Hours of Operation Mon -Th (2 / / Fri: . Zr Sat: 1( Sun:
N EW INSTALLATION * 0 RELOCATION ❑ UPGRADE ❑ REPAIR ❑ REPLACE ❑ REMOVE
Sign Type: ❑ Interior Dispenser Model: Miscellaneous: ❑ Play Station
Exterior Wall Mount* ❑ 412 ❑ 416 Ultimate 0 Other _
0 Pole* ❑ 412FW ❑ 420
❑ End Projection Mount* ❑ 416 ❑ 420 FW
❑ 416 FW ❑ Overhead
*Exterior sign Repair /Replacement/Removal requires a photo so contractor can determine if a ladder or boom truck is needed.
*Photos are required for all installs.. Draw a square on the photo to identify install location.
SIGNS
Interior Sign - Is there wiring or an outlet within six feet of where the Lottery sign will be mounted ❑ No
or g s. Is there a junction box/power within 10' of where the Lottery. sign will be mounted Yes . ❑ No
DISPENSERS
- In- Counter Dispenser - Photo should include front and back view of counter .
Is there an electrical outlet within six feet? ❑ Yes ❑ No
Is there electrical wiring or an electrical outlet that may impact dispenser installation? ❑ Yes ❑ No
Does the installation require removing shelves/drawers /partitions? ❑ Yes 0 No -- •
Overhead Dispenser
Quantity of Scratch -its to be displayed Dispenser configuration games wide X games high. .
Distance from ground to ceiling? feet.
Are there electrical wiring, light fixtures, or overhead racks that may impact dispenser installation? ❑ Yes ❑ No F
i;
Additional comments/instructions. Details such as nearest cross street, special instructions, electrical issues, etc.
COST RESPONSIBILITY �.
I understand the Lottery contracts to have this work done, and, if costs are incurred due to changes in equipment location, or the
: equipment cannot be installed by the contractor in the location arranged because of any action, inaction, statement, hindrance, or
other complication caused by me or my employee or representative, I will be responsible for paying those costs. I also understand
the costs could be up to and including $1,000.
I understand and accept that, if such costs are incurred, I will receive an invoice from the Lottery, and I agree that I will pay such
costs immediately. I understand and agree that failing to do so may be a violation of my contract with the Lottery and the Lottery
may pursue action. I also understand and agree that, should my contract with the Lottery be terminated or denied for any reason, I
will still be responsible for these costs.
I have read the above paragraphs carefully. My signature below indicates that I understand and accept the financial liability
referred to in those paragraphs.
Retailer Signature: Date: 27
Print Retailer's Name G am FSR Name ZA ��I a Route
Revised: 4-1 -10 Item No. 0040
SALES DEVELOPMENT
l - 6 4 OF TIGARD i fr1 V °'
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.. -. NEW 30" X 30 "SIGN, - -. a - - _ � W m
- . ' - MOUNT TO EXISTING ,? CO
WALL, PER DETAILS. 3 � f r� 7 s 3 3 6 t. r S: o a
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_ 11' I SCALE 1 " =30' 1 J o u Q
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m U) -J Z j U z 0 u] ELEVATION
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NOV. 10, 2012
O 1 - X - X - X 9'-0" 9'-0" 81 SF I 7202-08
0 - X X - X - 6'-0" 6'-0" 36 SF
30 X - X - - 1 X 2' -6" 2'$" 6.25 SF
SITE PLAN TOTAL SIGN AREA: 123.25 SF
1
SCALE 1 "= 40' -0"
CARRICK ELECTRIC
Oregon Lottery Sign
General Sign Specifications and Attachment Information
Sign Dimensions
30'/2 "X30% "X6"
Weight
48 Lbs w/o face or back plates
51 Lbs w/ (2) faceplates
52 Lbs w/ (1) faceplate & (1) backplate
Sign Construction
1/8" extruded aluminum with two stiffener walls used for the wiring channel;
external welded corners reinforced with 1/8" 1" X 1" X 2" angle internally welded into each corner.
Captive faceplate channels both front and back.
Back plate when used, 30" X 30" X 1/16" sheet aluminum is inserted into the faceplate channel.
Manufacturer
May Advertising
PO Box 161789
Fort Worth, Texas
1- 800 - 800 -4629
UL Listing
Electric Sign
120V
3 Amp
No. BP 187098
Sign Attachment Information
Wall signs are attached dependant on the mounting surface and material:
Wood: (4) #10x2" Pan head screws
Concrete or (4) Y4" lead drive anchors
Concrete block
Stucco w/ (4) 3 "x3/16" Toggle bolts
Mesh back
Sheet Steel (4) 3 "x3/16" Toggle bolts
Existing poles signs are attached with:
Wood square pole or wall (6) #10 X 3" screws
Steel pole (3) Hangermate ASTM B633 self drilling anchors for 3/8" bolt
Mfg # 050 - 163 - 631359 or equal.
(3) 3/8" X 3/4" Bolts and washers
Bracing when required is accomplished by attaching either to a sign case above, if available
or by adding a .875" tubular strut from the sign to the side of the sign pole. In the case of a wall
mount the strut is brought from the sign top front corner to the wall at approximate 45 degree
angle.
04/23/20,0.7 12:04 FAX 5036458273. CARRICK
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