SGN2013-00037 CITY OF TIGARD SIGN PERMIT
Permit #: SGN2013 -00037
COMMUNITY DEVELOPMENT Date Issued: 03/19/2013
TIGARD 13125 SW Halt Blvd., Tigard OR 97223 503.718.2421 Parcel: 1S136DD05300
Jurisdiction: Tigard
Name of Business: Broad River, LLC
Business Address: 11850 SW 67TH AVE, STE# 100
Applicant/Agent: Pawlowski, Jeff
Work Description: New 3' x 17'4" wall sign at 11850 SW 67th Ave.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A- Board: No
Sign Dimensions: 3' x 17' 4"
Total Sign Area: 51.75
Wall Area: 2240
Wall Face (Direction):
Sign Height: 30 ft.
Projection From Wall: 13 in.
Illumination: Internal
Materials: Aluminum
Electrical Permit Required: Yes
Building Permit Required: Yes
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: knlny I ►�
Permittee Signature:
I � CITY OF TIGARD RECEIPT
I : 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 190657 - 03/19/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2013 -00037 Sign Permit - LRP 100-0000-43117 $22.00
SGN2013 -00037 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 05129Z AKOWACZ 03/19/2013 $171.00
Payor: Jeff Pawlowski
Total Payments: $171.00
Balance Due: $0.00
•
Page 1 of 1
!Ai .. • City of Tigard
■
Sign Permit Application
TIUARt)
GENERAL INFORMATION
Name of Dceelnpment /Proiect
( ti ii litttn FOR STAFF USE ONLY
Site n
Address/ Street Address Permit No.: S6M2- 013 —000 57
Location 11850 SW 67th Ave. .1.1 IOO
Suite/Wk. tt City/State 7.Ip Approved By:
I Portland (Tigard), 97223 Date: 3 tMl I i i .
_ Name , Receipt II; , q(X 57
Property Pik) 1 (A1 LZC. co P IV Wf L G( di Map/T1.11; A � ( J S 1 DD0.SD
?O
ktt
Owner Mailing Atess MU
Suite Zoning: E.
/ Allowable Total Arcs:
ci,,,s,.• Zip MOM' O 3 ) ` Z 4'
' 4 0 R. 9, oa J 31o
Tenant or Nanu Y Electrical Permit Required? �cs ❑ No
Business O (M q 8 K i W . ` LL C. Building Permit Required? cs ❑ No
Name / ace. 7/1/12
I: \comin \manst Nun! we applications \sign print app.due
Sign liS&A Sign (Cr Awning
Contractor Islailing Addre.s Suite
89975 Prairie Rd.
Cit /state Zap phone REQUIRED SUBMITTAL ELEMENTS
Eugene, OR 97402 541-485-5546 (Note: applications will not be accepted
(kcgrusCons,. Cont. Hoard license N Esp. Date without the required submittal elements)
163470 3/16/15
ID/Completed Application Form
Proposed Permment p IrevestamYn* ❑ Precseay 2 CUpics of site/plot plan, drawn to scale
Sign ❑ Tc ❑ Roof ® Ckctmoic
(Check all that (3 copies, if a building permit is required)
apply} ® ‘,;,„if ❑ Other ' /a
_
siz requirement: 8" x 11 ", or 11" x 17"
-- 2 topics of elevations, drawn to scale
El New sign? ❑ Alter to existing sign? (3 copies, if a building permit is required)
Sign Dimensions: 3 -0" x 17'.4" size equitcmcnt: 81/2' x 11", to 24" x 36"
Total Sign Area (sq. ft.): 51.7,► �J/$ 171.00 Ike (Permanent sign, any size)
Total Wall Area (sq. ft.) ? '; ❑ $54.00 Fcc (Temporary sign, any type)
Sign Data 22 I(1 I = i .
(Complete all Direction Wall Faces (circle one):
items in this NOTES:
't r N S E W NE NW SE SW
t leight to top of sign (feet): ;311' • Wall signs do not need to be drawn to scale, but
Projection Front Wall (inches): r r must include dimensions of wall face and sign
placement.
Afatctials: Aluminum, Acrylic • Wall signs do not require sitc /plot plans.
Will sign have ill E Yes ❑ No • Freestanding signs over 6 ft. required a building
Type: 0 Internal ❑ External permit.
Are there any existing freestanding or ►vatl signs at this location,
including wall signs that overlap a tenant space?
Q Ycs ❑ 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 Ball Blvd., Tigard, OR 97223 I 503 -718 -2421 I www.ligarcl- or.gov I Page 1 of 2
APPLICANTS:
To consider an application complete, you will nccd to submit ALL of the RI3QUIRED SUBMITTAL I3LEMENTa as described on the •
front of this application in the "Required Submittal Elements" box.
NOTE Person specified as "Applicant" shall be designated "Pc mince" and shall provide financial assurance for work.
• When the owner and the applicant arc 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 ills 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 ate in compliance with the City of Tigard.
SIGNATURES of each owner of the subject property are required.
KJ/44/ 3IVl2J
App ant Signature ha, p LL,C Date
PN� P - c'�L3 S
Sign ire of Owner /Agent Date
Yid ke, Ski S 1 L1S ' S�'
Contact Person Name Phone No.
City of Tigard I 13125 SW I Tall Blvd., Tigard, OR 97223 I 503 -718 -2421 I www.tigard- or.gov j Page 2 of 2
CITY OF TIGARD
Approved....
Conditionally Approved
For only the work as described in:
PERMIT NO. 5--Al2o I - oo -- 1
See Letter to: Follow I 3
A , ach Wall 1 Wall 2
Job Address: I W , • • ti 3 • 32' x 74' = 2368 SqFt 32' x 42' = 1344 SqFt
®Y: - - I. ceo.u,4- Date: 311`) 1-3 2368 SqFt x 0.15 = 355 SqFt Allowable 1344 SqFt x 0.15 = 202 SqFt Allowable
Elevation / Proposed Wall Sign Existing Wall Sign
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