SGN2017-00003 CITY OF TIGARD SIGN PERMIT
i� Permit#: SGN2017-00003
COMMUNITY DEVELOPMENT Date Issued: 01/03/2017
I I(;A�`I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S101 BB00301
Jurisdiction: Tigard
Name of Business: Jacksons Shell
Business Address: 11834 SW PACIFIC HWY
Applicant/Agent: Kimmel, Dave
Work Description: Reface of existing freeway-oriented sign.
Permanent: Yes Freestanding: Yes Freeway: yds
Temporary: Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: No
Sign Dimensions:
Total Sign Area:
Wall Area:
Wall Face(Direction):
Sign Height: 45 ft.
Projection From Wall: in.
Illumination: Internal
Materials: Plastic
Electrical Permit Required: Yes
Building Permit Required: No
Total Permit Fee: $201.00
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 Signature: ' 2i Z�,y�,-,�
RECEIVED
City of Tigard JAN 03 2017
.71 _ COMMUNITY DEVELOPMENT DEPARTMENT CITY OF TIGARD
Sign Permit Application PLANNING/ENGINEERING
TIGARD
SIGN LOCATIONREQUIRED SUBMITTAL
Address://e'. q'SO .ae,tie,ilw Suite#: ELEMENTS
City/state:. ! !ond , OR.._ Zip: d2 copies of elevations on 8'/z"x 11"
Tenant or businessk1 t ckcon c 57? or 11"x 17"pages(Wall sign
1 elevations must indude dimensions
Property owner name:Ta eu)e 5 i E/1er y / L of sign and wall face and show the
_ location of sign on the wall.
Address: 345--b E eor4,,erci a/ Freestanding sign elevations must
City/state: /4'f Br ie i 4 el f -r-T1 Zip: $Mala- drawn to scale.)
Phone: -B 36 7a mail: copies of site/plot plan,drawn
to scale,on 81/2"x11"or 11"x17"
Lie
pages(not required for wall signs)
Sign contractor: Ue 5 Lo ®/
List
Address: /(o �{/�T ST or diagram of all existing sign
/dimensions and square footage
City/state:?"14:315ie .A Zip: 42-) 7 ff. Application Fee
Phone:(9,e-34c 2f z Email: Era i//t 4m 5&c fe5ca.C4 Pc
CCB License #: /B'I C Expiration date: NOTES:
Contact person: crr c- w r I it awns • Freestanding signs over 6 ft.in height
and walls signs of which any element
weighs 20 lbs.or more require a
building permit for construction.
SIGN DATA(Complete all items in this section) If any element of a wall sign weighs
70 lbs.or more,plans must be prepared
TYPE (Check all that apply) by a structural engineer.
0 New sign 1glFreestanding Electrical • Building permits require 2 sets of
X Alteration to Freeway ❑ Wall construction drawings and,if sign is
freestanding,2 copies of site/plot plan
existing sign ❑ Roof ❑ Other and 2 sets of engineering must be
Sign#: submitted with building permit
application.
Sign dimensions: (h) x (w) = sq.ft. sign area
New sign: sq.ft. + Existing sign area sq.ft. = Total 1 OR `I A 1"' n F ONLY LY _ 'yam 2
Total sign area: . sq.ft. / building face sq.ft.= %of bldg face Case No.: S q1 V Q 01 -C �JJ
Height to top of sign: 1c-ft. Projection from wall: in. Related Cas No(s):
Materials:
Fee: --TQ 1
Application accepted: J1
Is the sign under 20 lbs.? 0 Yes 0 No By: 1--C Date: //13/
(Building Permit required if over 20 lbs.)
Direction wall faces (circle one): N S E W NE NW SE SW Application determined complet
By: L S Date:
Will the sign have illumination? . Yes 0 No
If yes,what type: pi Internal 0 External IACURPLAMesemMand Use Applkations Rey.o3/03/2015
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 1 of 2
APPLICANT'S
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.
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,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 or 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.
SIGNA RES of Sash owner of the subject property required.
CCGc2 L---siZa l }?v itr e-t e / 12 -2g -/G
Applicant's signa re Print name Date
-TACK -DAvrS t2-27- <L
Own'gnature Print name Date
Owner's signature Print name Date
SIGN PERMIT APPLICATION
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-0cgov • 503-718-2421 • Page 2 of 2
RECEIVED
TAM,M"ION SCECIFICARIONS''
JAN 0 3 2017 l'AM IFfE.._. IMF SHIER PECTIN_FLEA FACE
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