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SGN2011-00101 14 CITY OF TIGARD SIGN PERMIT g ., Permit #: SGN2011 -00101 COMMUNITY DEVELOPMENT Date Issued: 09/16/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S110DB01700 Jurisdiction: Tigard Name of Business: Black Rock Coffee Bar Business Address: 15290 SW PACIFIC HWY Applicant/Agent: Black Rock Coffee Bar, Work Description: Installation of (1) permanent 8 s.f. wall sign. Permanent: Yes Freestanding: No Freeway: No Temporary: Wall: Yes Electronic: No Billboard: No Balloon: No Banner: No A- Board: No Sign Dimensions: 7.2'x1'1" Total Sign Area: 8 WaII Area: 506 Wall Face (Direction): South Sign Height: ft. Projection From Wall: 4 in. Illumination: Internal Materials: Channel Forms,Vinyl Electrical Permit Required: Yes Building Permit Required: No Total Permit Fee: $165.00 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 B : ,�' 1, �N Y - Permittee Signature: 64A-, RECEIVED ill . C ity of Tigard S Permit Application SEP 1 3 2011 TIGARD CITY OF 6 TIGARD 7' ^2'. - la : , wC -t r i ,TM +:1 -- *.t :; .,_ s aim* -�_." ' ? w . ` sue'. ? n<_ '::�si��'EASA i -T r_- y. � i iG GENERAL INFORMATION Name of Development /Project t� ( f y b FOR STAFF USE ONLY Site J /G�'c/ , I \ec ,f (C /i a i r Address / Street Address Permit No.: 5 (j4)tai - 00 / 0/ n Location iS 2 fa 5 1 -tc/t hi oh keRi/ Approved By: /C. `a-t�� 44 Suite /Bldg. # City /State Zip / rdail nn 7226/ Date: Rlf // Name / Receipt #: 8 3 9 3 7 C Property 44 IN road Z L ( Iv1ap /TL #: Z S I/ 2A � /) O O Owner Mailing Address ' Suite Zoning: C. C2 (PP) 10/% ,5 L7/J'tii s1 ir, " Allowable Total Area: /s eitt City /St Q ate Zip' Phone liar /kid �a` i7223 - Electrical Permit Required? oXes ❑ No Tenant or Name Business /34 / k RAN e Cog /3,/r Building Permit Required? ❑ Yes No Name Rev. 7/1/11 is \curpin \masters \land use applications \sign permit app.doc Sign .S;gn $ E I . .�i ?r, � g Contractor MAddress Suite 13y3 )7 1 / ?aw City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS Ceo frit/ PPi4 f O cJ 9 ,� / _ 77q _ 91/e j (Note: applications will not be accepted Oregon Const. Cont. Board .f./,_ d License # Exp. Date without the required submittal elements) ❑ Completed Application Form Proposed Dzi Pe rmanent Freestanding Freeway ❑ g ❑ y ❑ 2 copies of site /plot plan, drawn to scale Sign ❑ Temporary ❑ Roof ❑ Electronic (3 copies, if a building permit is required) (Check all that ❑ Wall ❑ Other t » 11" a ppl y ) size requirement: 8 /s x 11", or 11 x 17" ❑ 2 copies of elevations, drawn to scale ® New sign? ❑ Alter to existing sign? (3 copies, if a building permit is required) Sign Dimensions: 74- X ' t size requirement: 81/2" x 11", to 24" x 36" Total Sign Area (sq. ft.): g ® $165.00 Fee (Permanent sign, any size) Total Wall Are q. ft.) a ❑ $52.00 Fee (Temporary sign, any type) Si Data = 2 (Complete all Direction Wall aces (circle one): items in this NOTES: section) N O E W NE NW SE SW Height to top of sign (feet): • Wall signs do not need to be drawn to scale, but Projection From Wall (inches): y must include dimensions of wall face and sign Materials: placement. • Wall signs do not require site /plot plans. Will sign have illumination? ® Yes ❑ No • Freestanding signs over 6 ft. required a building Type: ® Internal ❑ External permit. 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 (OVER FOR SIGNATURES) footage must also be submitted. -:t„ — t- T;,,,> «,1 I 1117c cW T4a1I RL,r1 Tinarrl !lQ QT)')1 1 5 (13_71 52_7471 I sanznzt tioarrl_nr OM/ I Poop 1 n!'2 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" shalt be designated "Permittee" and shalt 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 ii the plot plan, attachments, and exhibits transmitted herewith, are true, and the applicants so acknowledge that any permit issued, based on this application, and may be revoked if it is found that any such statements are false. e The applicant has read the entire contents of the application, including the policies and criteria, and understands the requirements for approving and 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. • SIGNATURES of each owner of the subject property are required. Applicant Signature Date Signature of Owner /Agent Date f"0 - ? y? - PPP Contact Person Name Phone No. City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 1 503- 639 -4171 1 www.tigard- or.gov Page 2 of 2 AWNING SIGN FACES 72l12 bIack . , • roc , . . - Black Rock: 2 pillow pan channel forms with white returns, white faces with black vinyl outline and black trim cap Star: stand alone pan channel form with black return, red vinyl on white plex face and black trim cap • Stall E 1 11'4f:7—'171R ca F. . I=o Michael Suulay CrTY OF TIGARD t 3 1. mditionaUy I Approved nniv the work as described in: ee Letter to: FollOW ................................. .4 Job Address: IC ° S v: no:-17 7 — • r V 26-6 s " 11'-10i" 14'-8,4 ■ .- - ---L . . ' i' ( o z - - - -� ��• SILHOUETTE STACKED STONE u W �— —=1 VIEW OF co MIIMAIIIIIIIISIIIINIM Cr..' "AM o ...... HVAC UNIT 2 LL • • - (4) EMERGENCY OVERFLOW --� - o UPPER (2 PER SIDE) zt ASS: . • 2 MAX A B VE ROOF — � • ".'ice_ • 11' 3 " ��S - . � - -- �- „ MI R ©F LINE • o n '''k9 -- III .. .. --- % • nomonommo. a. OMNI �i —■■■• W L.L. w o 11 a o \ ;� \ \ g 10'2^ > W W °"''' 0Scar'• ELEV - 15 OOA u, i ; ;;_ Q 3/8 ° = 1' DWG type CUSTOMER A... FILING REVISION Z Prot Scale, 'x�����,��� W SEED TO CUP COFFEE SOLUTIONS A; 1 u_ t.t 14' X MAX 35' PREFABRICATED BUILDING ■/ry Coffee y� PL DATE • Seed To Cup Coadee Solutions ' 00A 0,07 -11 EBK - PRELIMINARY COPY c 7 OT API. m, 2011 RIGHT SIDE ELEVATION 336 MASON WAY REV DATE BY APPROVAL REVISION NOTES 3 MEDFORD, OREGON 97501 THIS DOCUMENT CONTAINS CONFIDENTIAL OR PROPRIETARY INFORAUTION OF CLASSIC TROLLEY. NEITHER THE DOCUMENT NOR THE INFORWTION DIEREIN 0 Leading The Drive Thru Revolution 1 -8N- 460 -3934 IS TO BE REPRODUCED. DISTRIBUTED, USED OR DISCLOSED. EITHER IN WHOLE OR IN PART, EXCEPT AS SPECIFICALLY AUTHORIZED BY CUSSIC TROLLEY. www.stccoffQe.com AL CAD DRAWING. NOT TO BE MODIFIED MANUALLY. L J • CITY OF TIGARD RECEIPT � , 13125 SW Hall Blvd., Tigard OR 97223 • - 503.639.4171 TIGARD Receipt Number: 183939 - 09/15/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SGN2011 -00101 Sign Permit 100-0000-43115 $144.00 SGN2011 -00101 Sign Permit - LRP 100-0000-43117 $21.00 Total: $165.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 057200 KPEERMAN 09/15/2011 $165.00 Payor: JUSTIN LESHER Total Payments: $165.00 Balance Due: $0.00 Page 1 of 1