SGN2012-00104 ap CITY OF TIGARD SIGN PERMIT
Permit #: SGN2012 -00104
COMMUNITY DEVELOPMENT Date Issued: 06/18/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S102AC00800
Jurisdiction: Tigard
Name of Business: Alternate Universe LLC
Business Address: 12551 SW MAIN ST
Applicant/Agent: Davison, Darren
Work Description: Application to install a 2.8' x 16' wall sign at 12551 Main Street.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 16' x 2.8'
Total Sign Area: 44.8
Wall Area: 381
Wall Face (Direction): Southeast
Sign Height: ft.
Projection From Wall: in.
Illumination: No Illumination
Materials:
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $165.00
Conditions:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable law. All work will be done in accordance with approved plans. A permanent sign must be placed within
90 days from approval date or sign permit shall expire. A temporary sign shall expire 30 days from validity date. A balloon
sign shall expire 10 days from validity date.
Approved By:
Permittee Signature:
CITY OF TIGARD
Approved [(a
Conditionally Approved [
For only the work s d$� in:
PERMIT NO. . 6 /Vo)4 /1--GbiO
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CITY OF TIGARD RECEIPT
� 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 187197 - 06/18/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00104 Sign Permit 100 - 0000 -43115 $144.00
SGN2012 -00104 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
Check 1169 JFLOYD 06/18/2012 $165.00
Payor: Darren C Davison
Total Payments: $165.00
Balance Due: $0.00
Page 1 of 1
71111
City of Tigard
S Permit Application
TIGARD �l
GENERAL INFORMATION
Name of Development /Project
Site /�kiR.rWor, 0 "44 �es Li-C. FO STAFF USE ONLY
Address/ Street Address V / i N9 A / -- adi �
Permit No.: U v�V /
Location / 2, CS 5w MaIrl 5
Approved By: J 2F
Suite /Bldg. # City/State 1 Zip ^ /�
Toy 4.4 Oa_ 97213 Date: 6 G
Name Receipt #: /67�T 7
Property , /K .. -e-0 C k Map /TL #: A p /�
Owner Mailing Address ✓✓ S te Zoning. U�i0
/ 2 5 5 / SRi Alai h Allowable Total Area:
City/State Zip Phone
?► A.4 oi 97223 Csv3) 613 0
9 Electrical Permit Required? El Yes [•'] No
Tenant or Name
Business A I W4 it, v rt $e..■ Building Permit Required? ❑ Yes ❑ No
Name Rev. 7/1/11
is \curpin \ masters \land use applications \ sign permit app.doe
Sign
Contractor Mailing Address Suite
City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS
(Note: applications will not be accepted
Oregon Const. Cont Board License # Exp. Date without the required submittal elements)
11 Completed Application Form
Proposed 1111 P ermanen t ❑ Freestanding ❑ Freeway ❑ 2 copies of site /plot plan, drawn to scale
Sign El Temporary El Roof ❑ Electronic
(Check all that (3 copies, if a building permit is required)
wall ❑ Other
aPP size requirement: 81/2" x 11 ", or 11" x 17"
❑ 2 copies of elevations, drawn to scale
• New sign? El Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: / 6 ► x' 2 $1 size requirement: 81/2" x I1 ", to 24" x 36"
Total Sign Area (sq. ft.): / ill $165.00 Fee (Permanent sign, any size)
Sign Data Total Wall Area (sq. ft.) �� o ❑ $52.00 Fee (Temporary sign, any type)
331 i).6%
(Complete all Direction Wall Faces (circle one): p
items in this NOTES:
section) N S E W NE NW 0 SW
Height to top of sign (feet): I i ► • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
placement.
Materials: P boAd /4)v.... tuwt (
J Q ♦ Wall signs do not require site /plot plans.
Will sign have illumination? El Yes • No • Freestanding signs over 6 ft. required a building
Type: ❑ Internal al External permit.
Are there any existing freestanding or wall signs at this location,
including wall signs that overlap a tenant space?
El Yes $ No
If "yes ", a list or diagram of all sign dimensions and square
(OVER FOR SIGNATURES)
footage must also be submitted.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503 -718 -2421 I www.tigard - or.gov I Page 1 of 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" shall be designated "Permittee" and shall provide fmancial 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, and
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 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.
4 f /SsJ2
Applicant Signature Date
Signature o _Owner /Ags t.-! / Date
AA tr.A .0 AV l so .4 c $O ?) 200 — '74
Contact Person Name Phone No.
City of Tigard I 13125 SW Hall Blvd., Tigard, OR 97223 I 503- 639 -4171 I www.tigard- or.gov I Page 2 of 2