SGN2004-00135 CITY OF TIGARD SIGN PERMIT
i , DEVELOPMENT SERVICES PERMIT #: SGN2004 -00135
6 � ' ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/16/2004
PARCEL: 2S 102CC -00500
BUSINESS NAME: HOMETOWN BUFFET ZONE: C -G
SIGN LOCATION: 13500 SW PACIFIC HWY 17 HOME TOWN BUFFE JURISDICTION: TIG
APPLICANT /AGENT: HOMETOWN BUFFET
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 8'
TOTAL SIGN AREA: 24 sq. ft.
WALL AREA: sq. ft.
WALL FACE (DIRECTION):
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one temporary banner (3' x 8'). Sign #1. Valid from 6/17/04 through
7/17/04.
MATERIALS: VINYL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes
and all other applicable laws. 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��
PERMITTEE SIGNATURE:" "'Y"'
DATE: 6/16/2004
4 SIGN .
PERMIT APPLICATION
CITY OF TIGARD 13125 SW Ha11 Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
Site // e i A / %$ Z--
FOR STAFF USE ONLY
Address/ Street Address SGN G9,004 -- ao4 O0 t3S
Location /2S C70 No.:
/2S S O Act A /7 / 7 — 1 '7--0.1
Suite /Bldg. # City/State Zip
Expiration Date:
T 6 4Ac/ Off. F 72a,1' Receipt #: a d a q o259 S
Name 4 Approved By: C• . • ear -,,,,w
Property 74c, /. c- Occr Date: Co -1 Co -- d 4
Owner Mailing Address Suite Map /TL #: as /oa e c - oogoo
v d r oo /714.6. ett, v /Uo Zoning:
G
City/State Zip Phone
44 1/i/IL ,i c
Tenant or Name Electrical Permit Required? ❑ Yes No
�( Business g,2 A, A v 7`'y L Building Permit Required? ❑ Yes ] No
Name _ Rev. 8/7/2003 is \curpin \masters \revised \sign permit app.doc
Sign
Contractor Mailing Address suites REQUIRED SUBMITTAL ELEMENTS '
(Prior to permit -- (Note: applications will not be accepted
issuance, a / w ithout the required submittal elements) copy of all City/State l
Zip Phone q )
licenses are
required if ❑ Completed Application Form
expired in Oregon Const. Cont. Board Exp. Date
City o ' ard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
abase)
(3 copies, if a building permit is required)
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign 25 Temporary ❑ Wall ❑ Electronic
(Check all that ❑ Other ❑ Billboard ❑ Balloon El copies of elevations, drawn to scale
apply)
(3 copies, if a building permit is required)
❑ New sign? El Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
x Sign Dimensions: 1
3 X $31.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.):
o?h/ 0 15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft Jurisdiction: ❑ City ❑ Urb
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S E Q NE NW SE SW
Height to top of sign (feet): • Wall signs do not need to be drawn to scale,
Projection From Wall (inches): but must include dimensions of wall face and
sign placement.
Co py : • Wall signs do not require site /plot plans.
Materials: /J /ti3/L • Freestanding signs over 6 ft. required a
Will sign have illumination? ❑ Yes [Zf No building permit.
Type: ❑ Internal ❑ External • If work authorized under a sign permit has not
Are there any existing freestanding or wall signs at this been completed within ninety (90) days after
location, including wall signs that overlap a tenant space? the issuance of the permit, THE PERMIT WILL '
BECOME NULL AND VOID.
MYes ❑ No
If "yes ", a list or diagram of all sign dimensions and —
square footage must also be submitted.
(OVER FOR SIGNATURES)
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.
f z`
DATED this cP /0 V /v day of , 20 O y
Signature of O ner /Agent
i64 6444ecAi 6-z v s o Z 79 y
Contact Person Name Phone No.
CITY OF TIGARD 6/16/2004
13125 SW Hall Blvd. 3:16:58PM
l o ll . Tigard, Oregon 97223
HAIRII■ IL (503) 639 -4171 ,
Receipt #: 27200400000000002598
Date: 06/16/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00135 [SIGN] Temp Sign Perm 100- 0000 - 437000 15.00
Line Item Total: $15.00
Payments:
Method Payer User ID Acct. /Check Approval No. How Received Amount Paid
Cash HOMETOWN BUFFET CAC In Person 20.00
Change CITY OF TIGARD CAC In Person (5.00)
Payment Total: $15.00
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