SGN2003-00324 CITY TIGARD SIGN PERMIT
DEVELOPMENT SERVICES PERMIT #: SGN2003 -00324
4'4i DATE ISSUED: 12/31/03
13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 D D -00600
BUSINESS NAME: OLD TIME SQUARE DANCE ZONE: C -G
SIGN LOCATION: 13770 SW PACIFIC HWY JURISDICTION: TIG
APPLICANT /AGENT: SUSAN RICE
BUSINESS TAX NO:
SIGN
PERMANENT: FREESTANDING: FREEWAY:
TEMPORARY: X WALL: Y ELECTRONIC:
OTHER: BILLBOARD: BALLOON:
SIGN DIMENSIONS: 3' X 6'
TOTAL SIGN AREA: 18 sq. ft.
WALL AREA: 2,714 sq. ft.
WALL FACE (DIRECTION): S
SIGN HEIGHT: 18 ft.
PROJECTION FROM WALL: 0 in.
ILLUMINATION: NON
DESCRIPTION OF SIGN: Temporary placement of (1) 3 ft x 6 ft banner. Valid 12/31/03 - 1/31/04 (Sign #1)
MATERIALS: VINYL
EXISTING SIGNS: 1
ELECTRICAL PERMIT REQUIRED: N
BUILDING PERMIT REQUIRED: N
ADMINISTRATIVE EXCEPTIONS:
TOTAL PERMIT FEES: $ 15.00
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 ys from validity date.
APPROVED BY:
PERMITTEE SIGNATURE: 1/-.44-41-.41
DATE: 12/31/03
A
..„....4-`,J.!L SIGN PERMIT APPLICATION
CITY OF TIOARD 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 FAX: (503) 684 -7297
GENERAL INFORMATION
Name of Development/Project FOR STAFF USE ONLY
Site / l ira rce 6.-ern, e_
Address/ Street Address Permit No.: k?j —0 0 3 Z y
Location (,3 7 70 54) Paco4. y Expiration Date: I /31 /0
Suite/Bldg. # City/State Zip
- 71 - 9a r OR f 7 Z Zj Receipt #: 200'3 —
Name r/ Approved By: - 7
Property Toga Yoa 6',134,1-e, Date: 17 ■/ /7
Owner Mailing- Kddress Suite Map/TL #:
C o u ( o ii/6 AMS lit or 1 Zoning: G Lr
City/State Tap Phone
Pd ( ail `l OR 97 Z/ Electrical Permit Required? ❑ Yes Eryo
Tenant or Name
Business T(y Sy(va,,t„ S frart. Owl ce_aub Building Permit Required? ❑ Yes No
Name 4 Rev. 30 -Jul -01 i:\curpin mastersVevisedlsign 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
- Nuked if El4ompleted Application Form
pired in the Oregon Const. Cont. Board Exp. Date
4y of Tigard•s license # (2 Copies of Site /Plot Plan, Drawn to Scale
database) (3 copies, if a building permit is required)
Proposed size requirement 8W x 11 ", or 11" x 17"
Pro
p ❑ Permanent ❑ Freestanding ❑ Freeway
Sign ® Temporary [ Wall ❑ Electronic ll 1 copies of elevations, drawn to scale
(Check all that ❑Other ❑ Billboard ❑Balloon (3 copies, If a building permit is required)
apply) size requirement 8 x 11 ", to 24" x 36"
® New sign? ❑ Alter to existing sign? ❑ . Fee (Permanent sign, any size)
Sign Dimensions: 3 I X I $y 0 Fee (Temporary sign, any type)
Total Sign Area (sq. ft.): 1 NOTES:
Total Wall Area (sq. ft.) • Wall signs do not need to be drawn to scale,
Alan Data c2, 7 �7 � but must include dimensions of wall face and
(Complete all Direction Wall Faces (circle one): sign placement.
items in this
section) N 0 E W NE NW SE SW • Wall signs do not require site /plot plans.
• Freestanding signs over 6 ft. required a
Height to top of sign (feet): / e building permit.
Projection From Wall (inches): 0 • If work authorized under a sign permit has_ not
Copy: been completed within ninety (90) days after
Materials: Afjfa earl n PT - the issuance of the permit, THE PERMIT WILL
BECOME NULL AND VOID.
Will sign have illumination? ❑ Yes Eg No
Type: ❑ Internal ❑ External
Are there any existing freestanding or wall signs at this / Not all jurisdictions accept credit cards, please call jurisdiction for more information
MasterCa
location, including wall signs that overlap a tenant space? O Visa Ord
Credit card number / /
❑ Yes ® No Expires
"yes ", a list or diagram of all sign dimensions and Name of cardholder as shown on credit card
( square footage must also be submitted. S
Cardholder signature Amount
(OVER FOR SIGNATURES)
c
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 i3 day of ' AV' , 20 i`) /
&1/GL4 i/ 14'n/L_
Signature of Owner/Agent
' 7/ 0 11() ) 1 4
•
Contact Person Name Phone No.
,.4
Site Plan N
I N
Driveway Gravel and Grass Parking
Tigard Grange
13770 SW Pacific Highway
____ L
I \
3'x6' Banner
Driveway Gravel and Grass Parking
J
Sign Elevation
Tigard Grange North Side
1W •
\
••■■■■•■ •■■■•I■ ■•■••••••■
4' 01 t 23,
15'
/ I
SQUARE DANCE LESSONS
CALL: 503-639-7191
CITY OF TIGARD 12/31/2003
13125 SW Hall Blvd. 4:11:06PM
Tigard, Oregon 97223
1.1. (503) 63 9-4 17 1
Receipt #: 27200300000000005595
Date: 12/31/2003
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SGN2003 -00324 [SIGN] Temp Sign Perm 100 - 0000 - 437000 15.00
Line Item Total: $15.00
Payments:
Method Payer User ID Acct. /Check Approval No. Row Received Amount Paid
Cash BEN YOUNGBLOOD MET In Person 15.00
Payment Total: $15.00
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