SGN2011-00058 114 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2011 -00058
COMMUNITY DEVELOPMENT Date Issued: 05/12/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S135DD04400
Jurisdiction: Tigard
Name of Business: SW Family Physicians
Business Address: 11900 SW GREENBURG RD
Applicant/Agent: Cally,
Work Description: The Center for Medical Weight Loss - SW Family Physicians
Placement of (1) one 36" x 43" temporary A -frame sign. Valid 5/13/11 - 6/12/11. Sign #1.
Sign must be placed on private property and not in the public right -of -way or visual
Permanent: No Freestanding: No Freeway: No
Temporary; 1 Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 2' x 3'
Total Sign Area: 12
Wall Area:
Wall Face (Direction):
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials:
Electrical Permit Required:
Building Permit Required:
Total Permit Fee: $52.00
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:
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Permittee Signature:
IT SIGN PERMIT APPLICATION
City of Tigard Permit Center 13125 SW Hall Blvd, Tigard, OR 97223
B T A Phone: 503.639.4171 Fax: 503.598.1960
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site MA, �ll^ t ") s /Ll a rIS I
' "
Address/ Street Address Permit No.: J G °� Cj i y v U t) S p)
Location
11°100 SW C1 � b 2� . - -
Suite /Bldg. # C' /State Zip A pp rov ed By: ��
C' L ,
id „c r 111 Date: 5 ). —) i
Name Receipt #:
Property 's JJ f1)1-2-- Map /TL #:
Owner Mailing Address Suite Zoning: (el C
30 , _11'•-z_ cco cio n"-SL---' Allowable Total Area:
City/State Zip Phone
Electrical Permit Required? ❑ Yes No
Tenant or Name
Business ✓ C� Building Permit Required? ❑ Yes ] No
Name Rev. 3/3/2011
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Contractor Mailing Address ll Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit
issuance, a 9 q �- „ ` ^ C„ r^ �� f �
( W/ (� (Note: applications will not be accepted
copy of all City/State Zip Phone without the required submittal elements)
licenses are
required if ❑ Completed Application Form
expired in the Oregon Const. Cont. Board License # Exp. Date
City of Tigard's ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database) ,
(3 copies, if a building permit is required)
Proposed ❑ Permanent Freestanding ❑ Freeway size requirement: 8 x 11 ", or 11" x 17"
Sign ❑ Temporary ❑ Wall ❑ Electronic
(Check all that Other ❑ Billboard ❑ Balloon ❑ 2 copies of elevations, drawn to scale
apply) (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:
X ❑ $164.00 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): ❑ $52.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) NOTES:
(Complete all Direction Wall Faces (circle one):
items in this • Wall signs do not need to be drawn to scale, but
section) N S E W NE NW SE SW
must include dimensions of wall face and sign
Height to top of sign (feet): A///- placement.
Projection From Wall (inches): 4///4- • Wall signs do not require site /plot plans.
Materials: ♦ Freestanding signs over 6 ft. require a building
Will sign have illumination? ❑ Yes It No permit.
Type: ❑ Internal ❑ External
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
'�
Yes �. No
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
(OVER FOR SIGNATURES)
APPLICANTS:
To consider an application complete, you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on the
front of this application in the "Required Submittal Elements" box.
NOTE: Person specified as "Applicant" shall be designated "Permittee" and shall provide financial assurance for work.
* When the owner and the applicant are 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.
BY SIGNING BELOW, 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.
• $ �'� /� � - //
Applicant's Signature / Date
Signature of Owner /Agent Date
/
Contact Person Na Phone No.
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 182474 - 05/12/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2011 -00058 Temporary Sign Permit 1003100 -43115 $45.00
SGN2011 -00058 Temporary Sign Permit - LRP 1003100 -43117 $7.00
Total: $52.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 712164 BTAGGART 05/12/2011 $52.00
Payor: Dee Heaney
Total Payments: $52.00
Balance Due: $0.00
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