SGN2013-00146 4 CITY OF TIGARD SIGN PERMIT
2 Permit#: SGN2013-00146
COMMUNITY DEVELOPMENT Date Issued: 12/09/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 2S102AA00905
Jurisdiction: Tigard
Name of Business: Sierk Orthodontics
Business Address: 12000 SW MAIN ST
Applicant/Agent: Gaitz, Russell
Work Description: New non-illuminated wall sign, approximately 13 square feet,for a dental office located
at 12000 SW Main Street.
Permanent: Yes Freestanding: No Freeway: No
Temporary: Wall: Yes Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: No
Sign Dimensions: 22"x 7'7314"
Total Sign Area: 12.75
Wall Area: 504
Wall Face(Direction): South
Sign Height: 14 ft.
Projection From Wall: 2 in.
Illumination: No Illumination
Materials: Aluminum
Electrical Permit Required: No
Building Permit Required: No
Total Permit Fee: $178.00
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: f kif
Permittee Signature:
RECEIVED
DEC 092013
• City of Tigard CITY OF TIGARD
i PLANNING/ENGINEERING
Sign Permit Application
TIGARD
GENERAL INFORMATION
Name of Development/Project FOR STAFF USE ONLY
Site Sierk Orthodontics
Address/ StC1 Address Permit No.: SC2N2(71 —OO
Location 12000 Main St. �
Approved By:
Suitc/Bldg.# City/State Zip 1��
Tigard, Or 97223 Date: 1u
Name Receipt#:
Property Polly Sierk Map/TL#: Z54O2.A 00805
Owner '.Luling Addr, Suite Zoning: MUG BP
12000 SW Main St. Allowable Total Area: I590
<.irc Sate Ph,.1,
Tigard,Or 97223 503-702-1157
Electrical Permit Required? ❑ Yes 131K,
Tenant or
Business Sierk Orthodontics Building Permit Required? ❑ Yes No
\amc Re,.7/1/12
Meyer Sign Co of Oregon • cumin mastcrs\hnd use applications\sign permit apn4sc
Sign
Contractor \fan* \ddre.<
1 5205 SW 74th Ave
REQUIRED SUBMITTAL ELEMENTS
Tigard, OR 97224 503-620-8200 (Note: applications will not be accepted
tkeg»,c:..nst.( Hoard License# r.p.ua,e without the required submittal elements)
64014 02/04/15
❑ Completed Application Form
Proposed ❑ Permanent ❑ Freestanding ❑ f ree,vay ❑ 2 copies of site/plot plan,drawn to scale
Sign ❑ Temporary ❑ Roof ❑ Flectronic (3 copies,if a building permit is required)
(Check all that Wall ❑ Other t » » 11" 17"
apply size requirement 8/2 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: size requirement: 81/2"x 11",to 24"x 36"
22"x7'-7 3/4"
Total Sign Area(sq. ft.): 12.75 sq ft. ❑ $171.00 Fee (Permanent sign,any size)
Si Data Total Wall Area(sq. ft.) - 2 5 ❑ $54.00 Fee (Temporary sign,any type)
Sn 504
(Complete all Direction Wall Faces(circle one):
items in this NOTES:
sectiion) N O E W NE NW SE SW
Height to top of sign(feet): 14' • Wall signs do not need to be drawn to scale, but
Projection From Wall(inches): 2„ must include dimensions of wall face and sign
placement.
Materials:
Aluminum • 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?
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 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,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 below 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 tub owner of the subject property are required.
LAW /1//
Applicant Signature Date
-"As•ZeiLa1 40//3
Signature of Owner/ : • Date
P1/2Sel I Go,f' 67)3-C,16- 2bC
Owner/Agent's Name(Please Print) Title Phone Number
City of Tigard I 13125 SW Hall Blvd.,Tigard,OR 97223 l 503-718-2421 I www.tigard-or.gov I Page 2 of 2
CITY OF TIGARD RECEIPT
•
13125 SW Hall Blvd.,Tigard OR 97223
503.639 4171
TI(;Ani)
Receipt Number: 194214 - 12109/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
SGN2013-00146 Sign Permit-LRP 100-0000-43117 $23.00
SGN2013-00146 Sign Permit 100-0000-43115 $155.00
Total: $178.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 34611 AKOWACZ 12/09/2013 $178.00
Payor: Meyer Sign Co. of Oregon, Inc.
Total Payments: $178.00
Balance Due: $0.00
Page 1 of 1
DESCRIPTION OF WORK
MANUFACTURE AND INSTALL(1)SET
INDIVIDUAL REVERSE PAN
5'-t0., CHANNEL LETTERS ON BUILDING WALL
T-7 va''
1;"Space Off Wall
SQ. FT 14 QTY: 1
LOGO
r -1"aillIllib FABRICATED ALUMINUM
a, 1" DEEP REVERSE PAN LOGO
le PIN MOUNT WITH 1" SPACERS
PAINT LETTERS T/M TANGERINE PSV
sierk orfkodovrFics _...„ FABRICATED ALUMINUM
1" DEEP REVERSE PAN LETTERS
PIN MOUNT WITH 1" SPACERS
' •.w:.' PAINT T/M COCOA KRISPY
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F-
Z EXISTING SIGNS
24.5SF EACH
PROPOSED
SIGN
14'
36'