SGN2003-00248 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2003 -00248
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/10/03
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:
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): W
SIGN HEIGHT: ft.
PROJECTION FROM WALL: in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Placement of one (1) temporary banner sign. Sign #1. Valid from 10/10/03
through 11/10/03.
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: '
PERMITTEE SIGNATURE: -''
DATE: 10/10/03
i✓, , -..i
Will?' S 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
Site 1 `�W 4v/1/4/ £L FOR STAFF USE ONLY
7 1642,(W-6'
Ni Address/ Street Address Permit No.: 5 G, w 3 - boa 8
Location /3500 ScA ,1° -c Nwy I t/ I o J O 3
Expiration Date:
Suite /Bldg. # Cit /State Zip
,';'40 p '7 02 9723 Receipt #: a200 _ 4 a�
Name / ' Approved By: C - a�
Property
rA C.U11' n Date: ^ -- o3
Mailing Address Suite Ma /TL #: .g6 oa C C — 60.500
Owner n1s po / 1 M O l Q Zoning: • C G
City/State Zip . Phone
Y ogIVilth K 4 6 it. 7 Electrical Permit Required? ❑ Yes ). No
Tenant Name `
Business l � j ,u.E.I' ` pvJ -r- Building Permit Required? El Yes Xi No
Na1Tle Rev. 2/28/2003 is \curpin \masters \revised \sign permit app.doc
Sign •
Contractor Mailing Address Suite REQUIRED SUBMITTAL ELEMENTS
(Prior to permit (Note: applications will not be accepted
issuance, a
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 Exp. Date
City of Tigard's License # ❑ 2 Copies of Site /Plot Plan, Drawn to Scale
database) (3 copies, if a building permit is required)
Proposed ❑ Permanent El Freestanding ❑ Freeway size requirement: 8 x 11", or 11" x 17"
Sign Temporary ❑ Wall ❑ Electronic
(Check all that Other ❑ Billboard ❑ Balloon El 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: a'
3 x v ❑ 3 $37.
, 0 08 Fee (Permanent sign, any size)
Total Sign Area (sq. ft.): .a4 ❑ $15.00 Fee (Temporary sign, any type)
Sign Data Total Wall Area (sq. ft.) Jurisdiction: ❑ City ❑ Urb
(Complete all Direction Wall ces (circle one): NOTES:
items in this
section) N S E W 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.
Copy: • Wall signs do not require site /plot plans.
Materials: (/ /Ng f_ • Freestanding signs over 6 ft. required a
Will sign have illumination? Yes No building permit.
Type: ❑ Internal External • If work authorized under a sign permit has not
Are there any existing freestanding or wall s' ns 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.
Yes ❑ 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.
0(4 DATED this da of , 20
Y
Signature of ner /: gent
NZiotak 5 -h2`1 22 C
Contact PersoniName Phone No.
CITY OF TIGARD 10/10/2003
13125 SW Ha11 Blvd. 11:56:40AM
,.,., Tigard, Oregon 97223
igit3/4I■ II. (503) 63 9-4 171
Receipt #: 27200300000000004483
Date: 10/10/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003 -00248 [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
•
Page 1 of 1 cReceipt.rpt