SGN2014-00063 CITY OF TIGARD SIGN PERMIT
n Permit#: SGN2014-00063
COMMUNITY DEVELOPMENT Date Issued: 05/27/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S103DD00600
Jurisdiction: Tigard
Name of Business: HANDS BERRY STANDS
Business Address: 13770 SW PACIFIC HWY
Applicant/Agent: RICKARD, JAMES
Work Description: TEMPORARY SIGN PERMIT FOR A 3'X 4'TEMPORARY SIGN BETWEEN JUNE 1.
2014 AND JUNE 30,2014
Permanent: Freestanding: No Freeway: No
Temporary: 1 Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: Yes
Sign Dimensions: 3'X 4'
Total Sign Area: 24
Wall Area:
Wall Face(Direction):
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: WOOD
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $178.00
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: ,
Permittee Signatur,. / i„ii / //I►i
CITY OF TIGARLI
Approved..................................... ....... 1
Conditionally Approved
For only the work as
PERMIT NO.
See Letter to:
Attach....... .......t>4:1
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N . City of Tigard
. . Sign Permit Application
TIGARD -
GENERAL INFORMATION
Name of Development/Project
/� /� �r`�,� FOR STAFF USE ONLY
Site (16 AR V ro��tv6 ! Y 4-,Ai
L�Address/ Street Address Permit No.: AO/41 `-' 000 C3
Location /3772 5W p4 A"re NW
Approved By:
Suite/Bldg.# City/State /� Zip�} -z,
/i�Aflf/ er 7 ��2 J Date: �J
Name 1 Fee:_ `�(1-73 3
Property SSS/GA COs/�vea EA Receipt#:
Owner ailing Address Suite Map/TL#:
f )?1/3.(0/1W,71 Ivo zoning:
City/State Zip f Phone y Allowable Total Area:
r16m Duda pwi9ti�s p es'
Tenant or Name
Business )PhDs V 1G folk O Nd5 Electrical Permit Required? ❑ Yes ❑ No■
ame ��/� Building Permit Required? ❑ Yes ❑ No
Rev.10/21/2013
113
Sign I:\CURPLN\Masters\Land Use Applications\Sign Permit.doc
Contractor Mailing Address Suite
city/State Zip Phone
REQUIRED SUBMITTAL ELEMENTS
Oregon C.nst.Cont.Board License# Exp.Date
❑ Completed Application Form
Proposed ❑ 2 copies of elevations on 81/2"x 11"or 11"x 17"
P ❑ Permanent ® Freestanding ❑ Freeway
Sign ❑ Temporary ❑ Roof ❑ Electronic pages (must be drawn to scale for freestanding sign)
(Check all that
apply) ❑ wall ❑ Other ❑ 2 copies of site/plot plan,drawn to scale,on
81/2"x 11"or 11"x 17"pages (required for
❑ New sign? 1:1 Alter to existing sign? freestanding signs only)
Sign Dimension: y El Application Fee
Total Sign Area(sq.ft.): NOTES:
Total Wall Area(sq. ft.) /..1 • Applications will not be accepted without;ill required
Sign Data = submittal elements.
(e.,,,,,plete all Direction Wall Faces(circle one): • Wall sign elevations must include dimensions of sign
item„in this and wall face and show the location of sign on the wall.
section) N S E W NE NW 5E S\\
Height to top of sign(feet): • Freestanding signs over 6 ft. in height and walls signs
of which any element weighs 20 lbs. or more require a
Projection From Wall(inches): permit from the Building Division for construction. If
Materials: Wd4/O any element of a wall sign weighs 70 lbs. or more,
Will sign have illumination? ❑ Yes ® No plans must be prepared by a structural engineer.
Type: ❑ Internal ❑ External _ • When a Building permit is required, 2 additional
Are there any existing freestanding or wall signs at this location, copies of elevations and, if sign is freestanding,
including wall signs that overlap a tenant space? site/plot plan must be submitted with application.
❑ Yes ❑ No
If"yes",a list or diagram of all sign dimensions and square
_ footage must also be submitted. (OVER FOR SIGNATURES)
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"Pennittee"and shall provide financial assurance for work.
* When the owner and the applicant are different people, the applicant must be the purchaser of record, 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 below 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.
, gX(//e66(---21/
cant • attire Date
Signature of Owner/Agent Date
.' /.'i/1_/1
t er/Agent's Name `P ase Print) Tide Phone Number
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
5W �-- 13770 SW PACIFIC otQ,�.wAy -T- TIaliAD GMNCA. NO 14115 --- 7 NE '
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This agreement is entered into for each of the respective parties between:
Jessica L Cousineau, for the Tigard Grange No. 148, and//Y - -1,034c.i.atiallol.r.
C 11,/tA j .c H A Ai_2 , for the renter.ee Na Date Position
Name Date Position
Renter's Mailing Address: , r, ,j
i 1 5 • /f -Al/? _cig ‘'Y%f G% Q-7// 3
Renter's Phone Number:
9 3-3e;7- 7f9 23 367-‘;*3
Phone Number Alternate Fax
Renter's Email Address:
Grange Rental Manager: Jessica Cousineau Phone: (503) 317-6694
Email: rentals(a�tiaardgrange.com
Alternate Contact for Grange: Mark Schnetzky Phone: (503) 807-7619
Tigard Grange Hall Rental Agreement—Page 6of 6
TIGARD
City of Tigard
June 19,2014
Cynthia Denee Hand
139 South 11th Ave.
Cornelius, OR 97113
Re: Permit No. SGN2014-00063
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 13770 SW Pacific Hwy
Project Name: Hands Berry Stands
Job No.: N/A
Refund: ® Check#214030 in the amount of$117.00.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund overcharge for temporary sign permit.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
i:\Building\Refund\lli 5r3tto alY-d efiaTigard,i(Qregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Cynthia Denee Hand DATE: 6/12/2014
139 South 11'Ave.
Cornelius, OR 97113 REQUESTED BY: Dianna Howse
JF
TRANSACTION INFORMATION:
Receipt#: 196208 Case #: SGN201-1-00063
Date: 5/27/2014 Address/Parcel: 13770 SW Pacific Hwy
Pay Method: Check Project Name: Hands Berry Stands
EXPLANATION: Overcharged temporary sign at the rate of permanent sign;refund remaining balance.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Cash Over 100-0000-48001 $117.00
TOTAL REFUND: $117.00
APPROVALS: SIGNATUREES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
IF under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE O? J Y
Case Refund Processed: Date: , (�i /V/y By: �- f
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1111 ■ ' Request Permit Action
lit;A it l, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223
Phonc: 503.718.2430 Fax: 503.598.1960 www.rigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 194 Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) C,vti V L
a o Po od
Mailing Address: j / Soilitt Z// A✓e.
City/State/Zip: CQIv, 14,5 , OR. 7//3
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
VANCEL/VOID PERMIT APPLICATION.
EFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: SjO/ /` 000 6'3
Site Address or Parcel #: /3 7 76 /lac, Ay ( Gi'4iv J e
Project Name: Mvle4 J l4i4 S
Subdivision Name: Lot #:
EXPLANATION: S4e 002/t CSC t7 '1/ /I) - ii1�/dl�inA �.
periv•gm PL / y . CU 4,mow- irt,s,f LS77ir
1.),J- vv c Cwrec,� 6 -. i�t >< um>.r,/- /, 7 -�- //7, 9
5-) 7— / "
Signature: Date:
Print Name: U.A 0 1%6
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICI? l'SI: ONLY
Rte to Sys Admin: Date By Rte to Admin: Da /9 /f/ By 449;29r
Refund Processed: Date to//� /y B Jr nvoice Processed: Date By
Permit Canceled: Date ,t//� By '"Iiii Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012