SGN2012-00106 CITY OF TIGARD SIGN PERMIT
II Pe rmit #: SG N2012 -00106
COMMUNITY DEVELOPMENT Date Issued: 06/19/2012
T I G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 2S112ACO2200
Jurisdiction: Tigard
Name of Business: Geo Pacific Engineering
Business Address: 14835 SW 72ND AVE
Applicant/Agent: Payne, Hal
Work Description: Proposal to construct one freestanding sign measuring 34" high by 28" wide, with a
maximum height of 48 ".
Permanent: Yes Freestanding: Yes Freeway: No
Temporary: Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 28" x 34"
Total Sign Area: 6.6
Wall Area:
Wall Face (Direction):
Sign Height: ft.
Projection From Wall: in.
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.
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Approved By: . ( I �
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/ Y1I Per mittee Signature ' •
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June 14, 2012
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fi, Location:
§^• 14835 SW 72nd Ave.
- Portland, OR 97223
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Scale:
Proportional
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C Freestanding SIGNAGE
Entrance freestanding Sign G R o U P
15812 Upper Boones Ferry
Lake Oswego OR 97035
P: 503-639-5656
These plans are the exclusive property of Distinct Signage Group and the result of the original work of Its employees. They are submitted to your company for the sole purpose of your consideration of ' F : 503 - 624 -8706
whether to purchase these plans or to purchase from Distinct Signage Group a sign manufactured according to these plans, Distribution or exhibition of these plans to anyone other than employees of your DititSi
company, or use of these plans to construct a similar sign is expressly forbidden. In the event exhibition occurs, Distinct Signage Group expects to be reimbursed $500 for time and effort in creating these W Ww snc g n.COm
plans. The respect of our creativity and time is appreciated by those who have worked on your behalf.
Sign Face 34 "h x 28 "w = 6.6 sq. ft.
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Pi �' 9 June 14, 2012
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Client:
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Jim Imbrie
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N mu 14835.W 72nd Ave.
A t gm ... • w Sign Location Portland, OR 97223
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S IGNAGE
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! , a r_ 15812 Upper Boones Ferry
Lake Oswego OR 97035
' P: 503-639-5656
These plans are the exclusive property of Distinct Signage Group and the result of the original work of its employees. They are submitted to your company for the sole purpose of your consideration of F: 503 - 624 -8706
whether to purchase these plans or to purchase front Distinct Signage Group a sign manufactured according to these plans. Distribution or exhibition of these plans to anyone other than employees of your
company, or use of these plans to construct a similar sign Is expressly forbidden. In the event exhibition occurs, Distinct Signage Group expects to be reimbursed $500 for time and effort in creating these W Ww. DIStinCtSign.COm
plans, The respect of our creativity and time is appreciated by those who have worked on your behalf.
I II CITY OF TIGARD RECEIPT
a 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 187225 - 06/19/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00106 Sign Permit 100- 0000 -43115 $144.00
SGN2012 -00106 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 003515 JFLOYD 06/19/2012 $165.00
Payor: Harold W Payne / Distinct Signage Group Inc
Total Payments: $165.00
Balance Due: $0.00
Page 1 of 1
City of Tigard
Sig Permit Application
TIGARD
GENERAL INFORMATION
Name of Development /Project
FOR STAFF USE ONLY
Site 6 .o fotetrt e. E44604.04I Inc.. c
Address/ Street Address Permit Na: t 6.N aOa - QOIOG /
Location 14 8 35 4V' 1 Zip, AdE, . Approved By: J
Suite /Bldg. # City/State Zip / ,C�
Tt e p 11 2 . 2 - (7 3 Date: "/!'/.1.
Name Receipt #:
Property fSE>t 0,1 GL--e. Map /TL #:
Owner Mailing Address Suite Z oning:
103, Ste( 1244 Allowable Total Area:
City/State Zip Phone �/�
(3) i " TT'- S Electrical Permit Required? ❑ Yes ❑ No
Tenant or Name
Business 6E 0 9 1Fte. EN&LO 6e4016, i g . Building Permit Required? ❑Yes El No
Name Rev. 7/1/11
X \ cumin \ masters \land use applications \sign permit app.doc
Sign DUSTIN GC $ (-Jhe* c14'Je
Contractor Mailing Address Suite
1 S b 1 z. O NE& bdo l is fev..t-`1
City/State Zip Phone REQUIRED SUBMITTAL ELEMENTS
LAKE avierro tio3r (F43) 63$-5654 (Note: applications will not be accepted
Oregon Const Cont. Board License # Exp. Date without the required submittal elements)
L (e + ❑ Completed Application Form
Proposed ❑ Permanent a. 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 »
apply) size requirement: 8 /z x 11 ", or 11" x 17"
❑ 2 copies of elevations, drawn to scale
,:gr New sign? El Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: 2 , L a x Z � ti W size requirement: 8t /z" x 11", to 24" x 36"
Total Sign Area (sq. ft.): ❑ $165.00 Fee (Permanent sign, any size)
Total Wall Area (sq ft.) I=1 $52.00 Fee (Temporary sign, any type)
Sign Data
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) D S E W NE NW SE SW
Height to top of sign (feet): 4$ t • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): must include dimensions of wall face and sign
Materials: Al.lffik( VM 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?
El Yes No
• 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 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 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.
-.Q P 6)//i112
Applic. t Sign ire UI Sl I M P8t)r Date
p 14_
S' • ature of Owner /Agent Date
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