SGN2009-00142 CITY OF TIGARD SIGN PERMIT
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Permit#: SGN2009-00142
COMMUNITY DEVELOPMENT Date Issued: 06/09/2009
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Parcel: 2S112DD01600
Jurisdiction: Tigard
Name of Business:
Business Address: 15495 SW SEQUOIA PKWY 150
Applicant/Agent: Acceleration Chiropractic,
Work Description: Installation of(1)one 21.02 s.f. permanent wall sign.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: No
Sign Dimensions: 30 5/8"x 98 1/2"
Total Sign Area: 21.02
Wall Area: 722
Wall Face(Direction): East
Sign Height: 17 ft.
Projection From Wall: in.
Illumination: No Illumination
Materials: Alum/wht komatex
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.
Approved By: , ,' P Q 4 . _
Permittee Signature: Y _
II
SIGN PERMIT APPLICATION
City of Tigard Permit Center 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax:503.598.1960
TIGARD
GENERAL INFORMATION
Name of Development/Project
FOR STAFF USE ONLY
Site Acral et04*(O,1 Ch i rO Ufc..4 _ ,
Address/ Street Address f Permit No.: .>.Ci7...t.S3q 001`P_--
Location 15'145 ,5tAi „5aQ�1�6.- +�P kY Expiration Date:
Suite/Bldg.# City/State Zip
5J Ti aa.r . O R a 72 2 Y Receipt#:
Name Approved By: k
Property Peat- ¶r4 Date: iP 19 I
Owner Mailing Address Suite Map/TL#: r--77-- �/
{53505W SeAkQ;alti 30 0 Zoning: -J�"-t'
City/State Zip Phone
Po t -kutOR `17zzl S03-62y.43 00 Electrical Permit Required? ❑ Yes "it] No
Tenant or Name
Business Building Permit Required? ❑ Yes No
Name Rev.7/1/07
is\curpin\masters\land use applications\sign permit app.doc
Sign COMM GrG iw1 'D es q: SIs'�-CMS
Contractor Mailing Address �r1_ /�L Suite'
iissuance,rior to pertttit r 051
i 5u) / oal k,'s�4 t
copy of all /City/State Zip Phone REOUIRED SUBMITTAL ELEMENTS
licenses are (Note: applications will not be accepted
required if 111,4144:1N,OR Q7b62 503-$15-7000 without the required submittal elements)
expired in the Oregon Const.Cont.Board License# Exp.Date
City of Tigard's 715 7 L
database) 0 Completed Application Form
Proposed Permanent ❑ Freestanding ❑ Freeway ❑ 2 Copies of Site/Plot Plan,Drawn to Scale
Sign El Temporary ❑ Wall El Electronic (3 copies,if a building permit is required) •
(Check all that
El Other ❑ Billboard El Balloon size requirement: 81/2"x 11'',or 11"x 17" •
apply)
[✓rNew sign? 0 Alter to existing sign? ❑ 2 copies of elevations,drawn to scale
Sign Dimensions: (3 copies,if a building permit is required)
305/' x 7612— size requirement: 81/2"x 11",to 24"x 36"
Total Sign Area(sq.ft.):
21. 2— I ❑ $40.00 Fee (Permanent sign,any size)
Total Wall Area(sq.ft.)
I 72 Z /��A .
Sign Data
El $19.00 Fee (Temporary sign,any type)
(Complete all Direction Wall Faces(circle one):
items in this NOTES:
section) N S 0 W NE NW SE SW
Height to top of sign(feet): 12> • Wall signs do not need to be drawn to scale, but
Projection From Wall(inches): ,&— I must include dimensions of wall face and sign
placement.
Copy Cr �` t'`A. C k ' A��IV 4` • Wall signs do not require site/plot plans.
j
Materials:,1 z 5 A I tA.^M1.A, -t M.,t L Ic cfNAi cA • Freestanding signs over 6 ft. required a building
Will sign have illumination? El Yes DTI.;o permit.
Type: ❑ Internal El External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overlap a tenant space? of the permit, THE PERMIT WILL BECOME
❑ Yes [[WN
o NULL AND VOID.
If"yes",a list or diagram of all sign dimensions and square
footage must also be submitted.
(OVER FOR SIGNATURES)
I hereby acknowledge that I have read this application, that the information given is correct, that I am
the owner or authorized agent of the owner, and that plans submitted are in compliance with the City
of Tigard.
DA 1ED this ci day of ,) c k,f�Z .20 C7 `I
7-1
L_$ignafure of Owner/Agent
(: !`le Clare 1,41- 6tf-S-?Doo G- 503. 70? -6 'c
Contact Person Name Phone No.
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CITY OF TIGARD RECEIPT
•Ir'#
j 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 173908 - 06/09/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PMD
SGN2009-00142 Sign Permit 100-0000-437000 $35.00
SGN2009-00142 Sign Permit-LRP 100-0000-438050 $5.00
Total: $40.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 59239 KPEERMAN 06/09/2009 $40.00
Payor: Commercial Design Sysytems, Inc.
Total Payments: $40.00
Balance Due: $0.00
•
Page 1 of 1
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ITEM 1 MATERIAL CT CODE
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<r) NOTES INITIALS:
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