SGN2013-00044 CITY OF TIGARD SIGN PERMIT
2 Permit #: SGN2013 -00044
COMMUNITY DEVELOPMENT Date Issued: 04/08/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S133AD16200
Jurisdiction: Tigard
Name of Business: Sesame Donuts
Business Address: 12700 SW NORTH DAKOTA ST 100
Applicant/Agent: Scott, John
Work Description: Install new wall sign 10.74 ft x 1.66 feet (20 inches), aluminum channel letters.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: Yes
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 10.74 ft x 1.5 ft
Total Sign Area: 16.11
Wall Area: 1000
Wall Face (Direction): East
Sign Height: ft.
Projection From Wall: in.
Illumination: Internal
Materials: aluminum
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: C . Caw^
Permittee Signature: �� J
• City of Tigard
Sign Permit Application
TIGARD Application
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site S escur/ e, Pon v S
Address / Street Address $ 1 // � // 1� A v l Permit No.: t'4ol O ►3 - 000 Li. q Location /6 5 it) , Tk - A pproved By: • C tev''a�
Suite /Bldg. # - C � ty ' /State Zip /�
Ilg! j 77& Date: il "" t - (3
Name r I Receipt #: 19 0 e/ ta
Property C \;C, L CtP.s`t- c)a A T QJ :5 Map /TL #: ((3341) I(oa 0O
Owner Mailing Address D Suite Zoning: L - `"
A30 g57 511 L�.+ Allowable Total Area: 1 d C IO' ' O'' Ci 0 ,
city /state , 7 7(,/ / Phone
/69d/eV e. 0 O 5 20 r ANO.3
Tenant or Name Electrical Permit Required? g Yes ❑ No
Business 5 , a 2),n / l S Budding Permit Required? pr Yes ❑ No
Name Rev. 7 /1/12
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Sign 5 /�onc('firl C/P /Gfa6 "al ac.
Contractor Mailing Address Suite /
,ma) .Sk). Erirnhay E/0 9
City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
- T;9 a ra e £ 9 3 5o3 -639 1 /'V O (Note: applications will not be accepted
ore n Const. Cc/nt. Board license # Esp. Date without the required submittal elements)
J s`� - ° 1 (0 9 ---11- ) 3 ❑ Completed Application Form
Permanent ❑ Freestanding ❑ Freeway Proposed ❑ 2 copies of site /plot plan, drawn to scale
Sign Temporary ❑ Roof ❑ Electronic
(Check all that (3 copies, if a building permit is required)
apply) Wall ❑ Other size requirement: 81/2" x 11", or 11" x 17"
❑ 2 copies of elevations, drawn to scale
[g New sign? ❑ Alter to existing sign? (3 copies, if a building permit is required)
12 1 v 4R 1 S ign Dimensions size requirement: 8t /z" x 11 ", to 24" x 36"
P 1 �
Total Sign Area (sq. ft.): 4o ❑ $171.00 Fee (Permanent sign, any size)
•
Total Wall Area (sq. ft.) ❑ $54.00 Fee (Temporary sign, any type)
Sign a SO =(;) ?
Si n Data
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) l `. s E W NE NW SE SW
Height to top of sign (feet): , Z • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): L " must include dimensions of wall face and sign
placement.
Materials: A /U/" ;nu (> 4t t
• Wall signs do not require site /plot plans.
Will sign have illumination? [ Yes ❑ No • Freestanding signs over 6 ft. required a building
Type: e g 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.
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 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.
„ ♦_: �1 4 I — J — am /3
Bp ant Signature Date
Signature of Owner /Agent Date
Contact Person Name 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 of 2
III CITY OF TIGARD RECEIPT
_ . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 190892 - 04/08/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2013 -00044 Sign Permit - LRP 100 - 0000 -43117 $22.00
SGN2013 -00044 Sign Permit 100 - 0000 -43115 $149.00
Total: $171.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Debit Card 422003 CCAINES 04/08/2013 $171.00
Payor: Tim Scott
Total Payments: $171.00
Balance Due: $0.00
Page 1 of 1
+
Job Name:
Sesame Donuts
Date :
3/14/2013
CITY OF TIGARD Dortland
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For only the work ,f? described in: wheie being seen is an an foirn.
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ph: 503-639-M59 fax: 503-345-0923
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Channel Letters: .
Backs and Retums.- Alumsnum 040.
.- . Returns--
4" Deep white - - :."ii 0 11 (A
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iiia Faces-------- (.177") White Acrylic .• 1 FCTRICAL ADVERTISING
with vinyl overlay
t.sy&1 LCpy. : Trim cap r whits Jeweite
Mumination— --- white LED's
install ation------ thru wall
8900 SW Burnham St. Tigard, OR 97223
ph: SO3-639-4910 (ex: SO3-620-9568
entail: idsco(tV.'signeraftvicetrivalv.v.