SGN2011-00100 ,� CITY OF TIGARD SIGN PERMIT
IN - Permit #: SGN2011 -00100
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
Wall Area: 506
Wall Face (Direction): North
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.
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RECEIVED
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Sign Permit Application r
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GENERAL INFORMATION
Name of Development /Project
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FOR STAFF USE ONLY
Site
Address/ Street Address Permit No.: J /3 Z.401 1 - 00 l 00
Location L.S ? y0 S V Pacl rL l7(,j,4 <,av Approved By: / C . e ,,,.ta
Suite /Bldg. # City/State Zip /
1 /5 o R q 1 / Date: V/1// /
Name ,/ Receipt #: 1 g
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Property 44 tti1 f 11aGf/�' L L ( Map /TL #:. 7 • S/ / O b Q if l - 8/70
Owner Mailing Address ' Suite a Zoning: C 6(` 0
/NO 5 V �itthrf f t 1J ` ! Allowable Total Area: � 15
City /State Zip Phone
1 /I <1n," GR 9/223 Electrical Permit Required? EKes 1=1
Tenant or Name
Business /34(k fad< Coen -r /Y,r Building Permit Required? ❑ Yes lag No
Name Rev. 7/1/11
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Contractor Mailiifg Address Suite
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City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS
(e l) f rit/ /6 f Syl- 77 q i j (Note: applications will not be accepted
Oregon Const. Cont. / 0� VIP'?
License # Exp. Date without the required submittal elements)
❑ Completed Application Form
Proposed ® Permanent ❑ Freestanding ❑ Freeway ❑ 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 »
a ppl y ) size requirement: 8 /z 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:
7i. /1 y / 1' size requirement: 8 x 11 ", to 24" x 36"
Total Sign Area (sq. ft.): /
g ® $165.00 Fee (Permanent sign, any size)
Si Data Total Wa Area (sq. ft.) 2S - 2 ❑ $52.00 Fee (Temporary sign, any type)
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s :
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) 0 S 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 LJ External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
• ❑Yes 121 No
(OVER FOR SIGNATURES)
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
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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 APPLICANTS) SHALL CERTIFY THAT:
o 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, 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.
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Apicant Signature Date
Signature of Owner /Agent Date
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Contact Person Name Phone No.
City of Tigard 1 13125 SW Hall Blvd., Tigard, OR 97223 1 503- 639 -4171 1 www.tigard- or.gov 1 Page 2 of 2
AWNING SIGN FACES
-- 3 2-13" — —
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
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CITY' OF TIGARD
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3 MEDf OREGON 97501 TNIS DOCUMENT CONTAINS CONFIDENTIAL OR PROPRIETARY INFORMATION OF CLASSIC TROLLEY. NEITHER THE DOCUMENT NOR THE INFORMATION THEREIN
o - Leading The Drive Thru Revolution 1.806- 460 -3934 IS TO DE REPRODUCED. DISTRIBUTED, USED OR DISCLOSED, EITHER IN WHOLE OR IN PART EXCEPT AS SPECIFICALLY AUTHORIZED BY CLASSIC TROLLEY
www.stccoffee.com A CAD DRAWING. NOT TO BE MODIFIED MANUALLY
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- ° CITY OF TIGARD, RECEIPT
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,
_ � :, 13125 SW Hall Blvd., Tigard OR 97223
. 503.639.4171
TIGARD
Receipt Number: 183938 - 09/15/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2011 -00100 Sign Permit 100 - 0000 -43115 $144.00
SGN2011 -00100 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
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