SGN2012-00167 CITY OF TIGARD SIGN PERMIT
11 11 •� Permit #: SGN2012 -00167
COMMUNITY DEVELOPMENT Date Issued: 10/04/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S136DB00201
Jurisdiction: Tigard
Name of Business: Fred Meyeer
Business Address: 11565 SW PACIFIC HWY
Applicant/Agent: Hayden, Melissa
Work Description: 11'9 "X40" wall sign (C)
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 11'9 "X40"
Total Sign Area: 39
Wall Area: 13750
Wall Face (Direction): East
Sign Height: 20 ft.
Projection From Wall: 12 in.
Illumination: Internal
Materials: Aluminum & Acrylic
Electrical Permit Required: Yes
Building Permit Required: No
Total Permit Fee: $171.00
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: Alt/
∎
Permittee Signature: A�� //
CITY OF TIGARD RECEIPT
n
Ilii 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 188666 - 10/04/2012
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2012 -00167 Sign Permit - LRP 100 - 0000 -43117 $22.00
SGN2012 -00167 Sign Permit 100 - 0000 -43115 $149.00
Total: $171.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 08464Z DADAMSKI 10/04/2012 $171.00
Payor: Melissa Hayden - Security Signs
Total Payments: $171.00
Balance Due: $0.00
Page 1 of 1
II
4 SIGN PERMIT APPLICATION
City of Tigard Permit Center 13125 SU Hall Blvd., Tigard, OR 97223
T I G A R D Phone: 503.639.4171 Fax: 503.598.1960
C—■
GENERAL INFORMATION
Name of Development /Project FOR STAFF USE ONLY
Site i 1 SCC) .UGas 7 6- N �p 7
Location
Address / Street Address 1 Permit No.: � ��
���� Expiration Date:
Suite /Bldg. # City /State Zip
Receipt #:
Name Approved By: Nar
Property rt tLfAL ,OP-e d e 1� Date: I o - t'I ` /
Owner Mailing Address [ Suite Map /TI, #: IS I314;1 8 0 O - ?0 I
Zoning: 0- 4
City /State Zip Phone
Electrical Permit Required? Yes ❑ No
Tenant or Name /'
Business . 4- (esA �' �(_ f� . Building Permit Required? ❑ Yes [ -1cro
Name 1 Rev.7 /I /u9
s \curpin \masters \land use applications\ sign permit app.doc
Sign Security Signs
Contractor Mailing Address Suite
(Prior to permit 2424 SE Holgate Blvd
issuance, a
copy of all City /State Zip Phone REQUIRED SUBMITTAL ELEMENTS
licenses arc (Note: applications will not be accepted
required if Portland, OR 97202 503.546
without the required submittal elements)
expired in the Oregon Const. Cont. Board 1.icense # Exp. Date
City of Tigard's
database) 122809 El Completed Application Form
Proposed Permanent ❑ 1 estanding ❑ Frecwa■ El 2 Copies of Site /Plot Plan, Drawn to Scale
Sign ❑ Temporary Wall ❑ Electronic (3 copies, if a building permit is required)
(Check all that ❑ Other Billboard CI Balloon size requirement: 8' /z" x 11", or 11" x 17"
apply)
12 New sign? ❑ Alter to existing sign? / ❑ 2 copies of elevations, drawn to scale
!/ / ii �d g . Sign 1 i nc s: • /Via q s, if a b permit is required)
�p ( size e requirement: uirement: 8' /z" x 11", to 24" x 36"
Total Sign Area (sq. ft.). i J7 v �
ent sign, any size) / 7/
Si Data Total Wall Area (sq. ft.)
gn i 7 ", 3 ( El $19.00 Fee (Temporary sign, any type)
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
section) N S �I;.W NF. NW SE Sr SW
Height to top of sign (feet): ad • Wall signs do not need to be drawn to scale, but
Projection From Wall (inches): 17 s / must include dimensions of wall face and sign
placement.
Copy: /I • Wall signs do not require site /plot plans.
,
Materials: ( twu.r+4 4 R,4 !►L
Y`( ♦ Freestanding signs over 6 ft. required a building
Will sign have ill nation? iYes El No permit.
Type: Internal ❑ External • If work authorized under a sign permit has not been
Are there any existing freestanding or wall signs at this location, completed within ninety (90) days after the issuance
including wall signs that overla tenant space? of the permit, THE PERMIT WILL BECOME
Yes 1:1 No
NULL AND VOID.
If "yes ", a list or diagram of all sign dimensions and square
footage must also be submitted.
(OVER FOR SIGNATURES)
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 Z day of In , 20 la
Signature f Owner /Agent
Melissa Hayden 503.546.7114
Contact Person Name Phone No.
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