SGN2019-00095 IN CITY OF TIGARD
SIGN PERMIT
Permit#: SGN2019-00095
COMMUNITY DEVELOPMENT
Date Issued: 08/28/2019
T klA lz.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S112DD01000
Jurisdiction: Tigard
Name of Business: Best Western Plus
Business Address: 15700 SW UPPER BOONES FERRY RD
Applicant/Agent: MEYER, SAVANA
Work Description: 69-square-foot sign on north-facing wall. Sign is more than 20 pounds and will have
illumination.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: No
Sign Dimensions:
Total Sign Area: 69
Wall Area: 6720
Wall Face(Direction): North
Sign Height: 46 ft.
Projection From Wall: 5 in.
Illumination: Internal
Materials: Aluminum composite, LED
Electrical Permit Required: Yes
Building Permit Required: Yes
Total Permit Fee: $228.00
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.
_____ ...... ydeze..„._') •
Approved By:
cm' _.,
Permittee Signature: - c--- (
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City of Tigard RECEIVED
1,1 COMMUNITY DEVELOPMENT DEPARTMENT AUG 2 8 2019
TIGARDSign Permit Application CITY OF TIGARD
( ANNGINEEBING
SIGN LOCATION V.,..- REQUIRED SUBMITTAL
�� �t
Address: �� c`Fxrl�ercSuite#: ELEMENTS
City/state: ,c-cyte 743: cit-e bJ 2 copies of elevations on 8'/2"x 11"
Tenant or business: q..e-t l_-)C 1 3 �ro t eS 1`, t-d or 11"x 17"pages (Wall sign
J elevations must include dimensions
of sign and wall face and show the
Property owner name: location of sign on the wall.
Address: F estanding sign elevations must
e drawn to scale.)
City/state: Zip:
Phone: Email: 2 copies of site/plot plan,drawn
to scale,on 81/2"x 11"or 11"x 17"
C pages(not required for wall signs)
Sign contractor: -1-10 1 N G\` l,Pra-l-C',c Jai c;-r-)S LLC
u� . 0 -st or diagram of all existing sign
Address: 14-103 C,6 \0c.. 1..sJ�lw f'7 Y cA._. dimensions and square footage
City/state: N al Zip: C.11-01.- Application Fee
Phone:'35S-21,3- 00 Email: `,,E��c-`U GE' . tt�c,n,eleste_kcic,S, ft. .,c n s, TE
4�,
NOTES:
CCB License #: lS , Expiration date: (4'4 Z,7c;
Contact person: C {may k,3Pk t- V.E2 • 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)
New sign by a structural engineer.
_Er ❑ Freestanding ErElectrical • Building permits require 2 sets of
❑ Alteration to kr Wall construction drawings and,if sign is
❑ Freeway
existing sign freestanding,2 copies of site/plot plan
LI Roof ❑ Other and 2 sets of engineering must be
Sign#: I submitted with building permit
application.
Sign dimensions:Zd-`t. p
1 (h) x_(w) = l,S, sq.ft. sign area
FOR STAFF USE ONLY
New sign:(D3,C-1 sq.ft. + Existing sign area f%2.3 sq.ft.=_Total
ti
Total signarea: sq.ft.h7,3 q. h is�building face sq.ft._I,>Is%of bldg face �
Height to top of sign: ft.Projection from wall: `6' in. ..
alb.' x��-5,k L 0 5 arc( ice_
Materials:
R
Is the sign under 20 lbs.? ❑ Yes / No
(Building Permit required if over 20 lbs.)
Direction wall faces (circle one): Ns E W NE NW SE SW
Will the sign have illumination? Zi Yes ❑ No
If yes,what type: ,F:( Internal ❑ External ,,- ,
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 1 of 2
APPLICANTS
NOTE: Person specified as "Applicant" shall be designated"Permittee" and shall provide financial assurance for work.
*When the owner and the applicant arc 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.
SIGNATURES of each owner of the subject property required.
(AQ\
• ' :nt's s't-: . - Print name ` Date
Owner's signature Print name Date
Owner's signature Print name Date
SIGN PERMIT APPLICATION
City of Tigard • 13125 SW Mall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov • 503-718-2421 • Page 2 of 2
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TIGARD
City of Tigard
January 28, 2020
Rudnick Electric Signs
1400 SE Township Rd
Canby, OR 97073
Re: Permit No. SGN2019-00095
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15700 SW Upper Boones Ferry Rd
Project Name: Best Western Plus
Job No.: N/A
Refund Method: ® Check#234514 in the amount of$182.40.
❑ Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$ .
Comment(s): Per applicant's request as job was cancelled. Refund 80%of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
YC__
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
1 ul
m City of Tigard
'ICAitL, 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: Rudnick Electric Signs DATE: 1/17/2020
1400 SE Township Rd
Canby, OR 97073 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 425530 Case#: SGN2019-00095
Date: 8/28/2019 Address/Parcel: 15700 SW Upper Boones Ferry
Pay Method: CreditCard Project Name: Best Western Plus
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Sign Permit 100-0000-43115 $182.40
TOTAL REFUND: $182.40
APPROVALS: SIGNATURES/DATE:
v,
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: `21%A / By: / [''
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
:IN
OF TIGARD RECEIPT
I 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Best Western Plus
Site Address: 15700 SW UPPER BOONES FERRY RD AJQ
Receipt Number: 436199 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2019-00095 $-182.40
Total: $-182.40
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 234514 DHOWSE 09/03/2021 $-182.40
Payor: Rudnick Electric Signs
Total Payments: $-182.40
Balance Due: $182.40
Page 1 of 1
74 CITY OF TIGARD RECEIPT
= 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Best Western Plus
Slte Address: 15700 SW UPPER BOONES FERRY RD (/��jj
/ZlG//Off _
Receipt Number: 425530 - 08/28/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBERG PAID
SGN2019-00095 Sign Permit 100-0000-43115 / `7e $228.00
Total: $228.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 5499923 LSMITH 08/28/2019 $228.00
Payor: SAVANA MEYER
Total Payments: $228.00
Balance Due: $0.00
Page 1 of 1
REC FMIFD
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENP 1 9 2019
III 1. Request for Permit Action BUILDING DIVISION
ISIO
N
T I G A R D 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD I
Building Division ` 1
13125 SW Hall Blvd.,Tigard,OR 97223 j//o/2,J
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPemits@tigard-or.gov
FROM: ❑ Owner ,E pplicant ontractor 0 City Staff
Check(1)one
REFUND OR Name: �
INVOICE TO: (Business orindividuaq 1 ,0OA0.c "\c tic; .. �s ghb
Mailing Address: it-kt
City/State/Zip: on`` 's
Phone No.: j�- 7L0+
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
Er CANCEL/VOID PERMIT APPLICATION.
EREFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DU a schedule and provide explanation below).
Permit#: t ICY) s m
Site Address or Parcel#: ' iN3CCi rise
Project Name:
Subdivision Name: Lot#:
EXPLANATION: C),;,nec tiu.- -A Orr,ncvzk\e 92.Sri
Q � 3�1 C7cl�s,\ —t; r6.r�'N LL,C v
8409'oa' 1/4,A228= 4/eta?, 4,40
Signature: Date: f(tkl" I`(- ZCI 4
Print Name:
Refund Policy
I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
e2,2 cT — /d 2- i/o y� e
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date %'3 Z, B.•1 +
Refund Processed: Date//j 7/' By dir.A. Invoice Processed: Date By
Permit Canceled: Date/ // z,, By arcel Tag Added: Date By
I:\Building\Forms\RegPemutAction 205 doc