SGN2004-00210 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2004 -00210
DATE ISSUED: 8/20/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103 D D -00600
BUSINESS NAME: TIGARD GRANGE /TRISQUARE DANCE CLUB ZONE: C -G
SIGN LOCATION: 13770 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT: TRISQUARE DANCE CLUB
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 6'
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. Valid from 8/21/04 through 9/20/04.
MATERIALS: VINYL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED:
BUILDING PERMIT REQUIRED:
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:
a. °P-2-4-14-1—'-.1
PERMITTEE SIGNATURE: • r
DATE: 8/20/04
1
A\
,111I+ SIGN PERMIT APPLICATION
CITY OF TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project
r --- FOR STAFF USE ONLY
, Site 1 I'1 5 5 2•itce
Address/ Street Addresf Permit No.: 5G I4 awl-- ooa, 1 o
Location 11 77P t�
a'C [` y Expiration Date: 9 - XD - o'{
Suite /Bldg. # City /State Zip
C / r a ex t 9j Receipt #: . o o'{ - 3108
Name Approved By: C .
Property ( 9er r d if.-akt e Date: 8 -at}o`4
Own er M Pfddress Suite / Map /TL #: o?S/ o3(� D -- 00G:70
X Zoning: C " G
City /State Zip Phone
rI7GYr 0 ! S Electrical Permit Required? U Yes g No
Tenant or Name
Building Permit Required? El Yes Lg No
x Business T-ir,i � ff a4 ref li g e,
d Rev. 7/1/04 is \curpin \masters \revised \sign permit app.doc
Name
Sign
Contractor Mailing Address a REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a without the required submittal elements)
copy of all City/State Zip Phone
licenses are
required if ❑ Completed Application Form
expired in the : egon Const. Cont. Board Exp. Date
City of Tig. •' License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
_data• (3 copies, if a building permit is required)
Proposed ❑ Permanent ❑ Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign 'Temporary LI Wall ❑ Electronic
(Check all that ❑ Other 111 2 copies of elevations drawn to scale I
apply) ❑ Bi llboard ❑ Balloon (3 copies, if a building permit is required)
❑ New sign? ❑ Alter to existing sign? size requirement: 8 x 11", to 24" x 36"
Sign Dimensions: ❑ .$32.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): l ❑ $15.00 Fee (Temporary sign, any type)
Sign Data
Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
(Complete all Direction Wall Faces (circle one): NOTES:
items in this
section) N S E W NE NW SE SW
• Wall signs do not need to be drawn to scale,
Height to top of sign (feet): but must include dimensions of wall face and
Projection From Wall (inches): sign placement.
Copy: • Wall signs do not require site /plot plans.
)c Materials: tiftfEri V i yt v I • Freestanding signs over 6 ft. required a
Will sign have illumination. ❑ Yes W 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.
DI Yes Fp 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.
DATED this % 7-� day of /4 H y , 20 7 1f
/444/e_ f/
Signa ure of Owner / A ge t
Contact Person Name Phone No.
Po/P1 e e 5 f
e )1
CITY OF TIGARD 8/20/2004
13125 SW Hall Blvd. 9:18:50AM
Tigard, Oregon 97223 it
"'�� (503) 639 -4171
Receipt #: 27200400000000003708
Date: 08/20/2004
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2004 -00210 [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 TRISQUARE DANCE CLUB CAC In Person 20.00
Change CITY OF TIGARD CAC In Person (5.00)
Payment Total: $15.00
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