SGN2009-00215 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2009 -00215
COMMUNITY DEVELOPMENT Date Issued: 10/22/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AA04900
Jurisdiction: Tigard
Name of Business:
Business Address: 12260 SW MAIN ST
Applicant/Agent: Carver, Kelly
Work Description: Placement of one (1) permanen wall sign 7' X 9'
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 7' X 9'
Total Sign Area: 63
Wall Area: 600
Wall Face (Direction): East
Sign Height: 26 ft.
Projection From WaII: 1.5 in.
Illumination: No Illumination
Materials: CAB /Gemini Plastic
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $40.00
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.
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Approved By: !_. , 4 -
Permittee Signature:
,
f , SIGN PERMIT APPLICATION
• City of Tigard Permit Center 13125 SIV Hall Blvd., Tigard. OR 97223
Phone: 503.63 9.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site /1I/iAtle _ 6 X4 L CO/L1 -- (yt I
Address/ Street Address J Permit No.:
Location / Q f � 4 /tl' .T-
Expiration Date:
Suite /Bldg. # City /State Zip 175 7 ,X1
774440 e3 I ` 97 Receipt #:
Name / �✓ Approved By: S -
Property A /4044 / L / //e- Date: ( d f [ 1 0/ ,
Owner Mailing Address /� / Suite Map /TL #: ZS ( 0 3- 4 A o J '1 CV
/9 ec) / ) t IA /A zoning: Q-46
City/State J Zip Phone ....1
9
/'�� 7, A di 9X - 6 �� - 6 Of'' Electrical Permit Required? ❑Yes ErNo
Tenant or Name
Business / eer f ��� j/ L Building Permit Required? ❑ Yes ErNo
Name Rev 7/1/07
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Contractor Mailing Address Suite
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Issuance, 41 r ! /i /
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/ REQUIRED SUBMITTAL ELEMENTS
copy of all City!State Zip Phone sw
licenses are _ �p (Note: applications will not be accepted
required if b i J �- /Tr, / al 970(,% / 9 7' B y without the required submittal elements)
expired in the Oregon Const Cont. Board License # Exp. Date
da ta ta ase) Tigard's �r ' _ b
aa�s ( � g Completed Application Form
Proposed 1Z, Permanent ❑ Freestanding ❑ Freeway , c ] 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary g wall ❑ Electronic I (3 copies, if a building permit is required)
(Check all that
❑ Other ❑ t
❑ Billboard Balloon size requirement: 8 h" x 11 ", or 11" x 17
aPPly)
y l New sign? ❑ Alter to existing sign? ,M 2 copies of elevations, drawn to scale
Sign Dimensions: 7 / X ? / (3 copies, if a building permit is required)
size requirement: 81/2" x 11 ", to 24" x 36"
Total Sign Area (sq. ft.):
76 SQ $40.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft)to OD S .01 ❑ $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S 00 W NE NW SE SW
Height to top of sign (feet): Z6, i • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): )..1 a e t must include dimensions of wall face and sign
placement.
Co py' f Ce.;)/SAL /06 • Wall signs do not require site /plot plans.
Materials: ci, 4, A - 6 . P • Freestanding signs over 6 ft. required a building
Will sign have illumination? ❑ Yes No permit.
Type: p Internal ❑ External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
A Yes ❑ No NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
(OVER FOR SIGNATURES)
99/24/2009 21:08 5032199223 NWFRAMING WAREHOUSE PAGE 03
I hereby ado u i edge that I have read - this application, that the information given is connect, that I am
the owner or authorised agent ethic owner, and that plans submitted are in compliance with the City
of Tigard.
DA'z Dthis s day of t'- r� - 4-- ,20 c.) c1,
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CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
!: x ,;u 503.639.4171
.TIGARD
Receipt Number: 175729 - 10/22/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2009 -00215 Sign Permit 1003100 -43115 $35.00
SGN2009 -00215 Sign Permit - LRP 1003100 -43117 $5.00
Total: $40.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 7503 STREAT 10/22/2009 $40.00
Payor: Impact Sign Co
Total Payments: $40.00
Balance Due: $0.00
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