SGN2013-00092 Mil City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT X f f
V Request Permit Action 6//Z/p y
TIGARD 13125 SW Hall Blvd. • Tigard. Oregon 97223 • 503.7182439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor 11721 City Staff
(check one)
REFUND OR Name: _
INVOICE TO: (Business or Individual) nta&A(Ty (e-tvs D .t oJ!
Mailing Address: 1 &7 Frf
City/State/Zip: raid bl( ?7032
Phone No.: 5—° 3 ' W - 370
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: .. 61AJ2 O/3 - 0-0-e)7 2.
Site Address or Parcel#: 24/62 5 k (4J (u r RI,
Project Name: b-301/31K5 y f jy 1
Subdivision Name: /VA- / Lot#: u.5/26 /C of S'az)
EXPLANATION: / CA� lt:`.(.isk 1:w t v"fa /(-'‘.6)70
Signature: 67 I L =, Date: j/y'/y
Print Name: S �L1( r-
1
Refund Policy
1. The Director or Building Official may authorize the refund of:
.. a) any fee which was c...ueously paid or collected.
b) not more than 80%0 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date By Rte to"C'-:-;Admin: Date 4AWAN2 B ,AIIPAI
Refund Processed: Date ijir(VAIM B 4 4 7j nvoice Processed: Date B
Permit Canceled: Date MB= B, •,...,, ;arcel Ta:Added: Date B
Receipt# Date Method Amount;
I:\Building\Forms\RegPemaitAction.doc Rev 05/25/2012
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TIGARD
City of Tigard
June 19,2014
Integrity Signs Oregon
PO Box 88
Hubbard, OR 97032
Re: Permit No. SGN2013-00092 & SGN2013-00093
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9000 SW Washington Square Rd.
Project Name: Embassy Suites
Job No.: N/A
Refund Method: ® Check #214037 in the amount of$356.00.
❑ Credit card "return" receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$ .
Comment(s): Sign permits not required. Refund 100% of application fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,_
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Integrity Signs Oregon DATE: 06/12/2014
PO Box 88
Hubbard, OR 97032 REQUESTED BY: Dianna Howse
GP
TRANSACTION INFORMATION:
Receipt#: 192700 Case#: SGN2013-00092
Date: 8/15/2013 Address/Parcel: 9000 SW Washington Square
Pay Method: Check Project Name: Embassy Suites
EXPLANATION: Sign permit not required;refund 100% of aplication fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Sign Permit 100-0000-43115 $155.00
Sign Permit-LRP 100-0000-43117 23.00
TOTAL REFUND: $178.00
APPROVALS: SIGNA {_IRE DATE:
If under$5,000 Professional Staff (
If under$12,500 Division Manager
If under$23,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: i,`/ V/ By: '604/.
I:\Building\Refunds\RefundRequcst.doc x 09/01/2010
____
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• .., .City of Tigard
Sign Permit Application
TIGARD)
GENERAL INFORMATION
Name of Derelopmen t Proiect
Site Ery ba sstt �'w}eS FOR STAFF USE ONLY
Address/ Street Addicts
Permit e o.: 56A.' I 3—Of 00072,
Location GlOC() Su L .S?U'g4V) approve d By:Suite'Bldg
= Cr: :tz;e Zi
n n
—Ti laird 1 DR q 73 Date:
Name
Property v16cect- aMetc,hoc0 Receipt#:
Owner 'Mailing Address Suite ,Map/TL#: I-S 116 C3C,o 1 5500
Zoning: Mk)CJ
Cite- State tin Phone Allowable Total Area:
Tenant or Name
Business Er(tb( t Svt*e S Electrical Permit Required? ❑ Yes ❑ No
Name Building Permit Required: ❑ Yes ❑ No
•Sign 1�eCyr\i S 9 cs Ore c cn Re.-.t; 24 201:
I C='RPLN Maaen Land :se Applications Sign Pemcnitdcc
Contractor tt hxtg Addle=.t Suite
Po SOXree:.
lei' state z_ Phone So3_ -
kNb� C�oe �� a81- 314-3 REQUIRED SL:BMMITT: L ELEMENTS
Oregon Cons:.Con:.Board License 74 Ena Da:e (Note: applications will not be accepted
CG€> 1 14155 (o I(o i 7-(7l S without the required submittal elements)
Proposed Completed Application Form
oPo se Permanent Frees ta nding ❑ Freeway ❑
Sign Ter_iporar.- U Roof ❑ Electronic
.Check all that ❑ C�� ❑ Other ❑ 2 copies of site/plot plan, drawn to scale
apply (3 copies,if a building permit is required)
size requirement: 81 i"x 11",or 11"x 17"
"! New sign? Alter to existing sign? ❑ 2 copies of elevations, drawn to scale
Sign Dimensions: t it i u
3/4 ;3 copies,if a building permit is required)
Total Sign Area s ft.: size requirement: 8'-:" x 11",to 24"x 36"
q
t2.$ 0
❑ Application Fee
Sign Data Total Wall Area "
•
APPLICANTS:
To consider an application complete,you will need to submit ALL of the REQUIRED SUBMITTAL ELEMENTS as described on tht
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 witl
written authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided on the bad
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 he 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.
. .. - ../•-. _- Aat_ /
a//c /h.-?
Appli•,�it Si-,nature Date
_I,! , /
Signati. - e cner, Agent Date
£ .4. _ _u. _ S _5-03 - ,e 3 793
Contact Perso Name Phone No.
City of Tigard 1 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 I www.tigard-or.gov I Page 2 of 2
E M B A S S Y•
S U I T E S®
Portland-Washington Square
Re: Sign Permits
To Whom It May Concern:
I am the property owner of Embassy Suites, 9000 SW Washington Square Rd., Tigard, OR.
I authorize Jaylene Paulus of Integrity Sign Co., or any of their employees, an agent to Coast Sign, to
secure sign permits on our behalf.
Sincerely,
/07)(4/11 &-----
Denise M. Hyatt-Controller
For:
Paul Francisco
Chief Operating Officer
Windsor Capital Group
Windsor Management Services
USA
Embassy Suites •9000 SW Washington Square Road,Tigard,OR 97223
Official Sponsor of the U.S. Olympic Team For Reservations Call:1-800-EMBASSY • www.embassysuites.com TheHiltonFarnily
CITY OF TIGARD SIGN PERMIT
ill
II • Permit#: SGN2013-00092
COMMUNITY DEVELOPMENT Date Issued: 08/15/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Parcel: 1S126BC01500
Jurisdiction: Tigard
Name of Business: Embassy Suites
Business Address: 9000 SW WASHINGTON SQUARE RD
Applicant/Agent: Paulus,Jaylene
Work Description: Install one aluminum and plastic, internally illuminated monument sign at southeast
corner. 12.8 square feet, 3'1"x 4'1".To replace existing monument sign in same
location.
Permanent: Yes Freestanding: Yes Freeway: No
Temporary: Wall: No Electronic: No
Billboard: No Balloon: No
Banner: No A-Board: No
Sign Dimensions: 3'1"x 4'1"
Total Sign Area: 12.8
Wall Area:
Wall Face(Direction):
Sign Height: 6 ft.
Projection From Wall: in.
Illumination: Internal
Materials: Aluminum, Plastic
Electrical Permit Required: Yes
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: C96-7-) , `IL '
Permittee Signature: /
DETAIL @ DIRECTIONAL SIGN NN
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CITY OF TIGARD
I f= .pproved ..... --[?'(
1 ConditionallyApproved.. [ 1
�cr only the work as described�1
PERMIT NO <6 N2,62 1 3-O�
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D/F DIRECTIONAL SIGN (ES E-3) END VIEW
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FABRICATED DOUBLE FACE ALUMINUM CABINET W/MACHINE ROUTED LOGO&LETTER OPENINGS PAINT FACE K.FILLERS TO MATCH MATTHEWS BRILLIANT
METALLIC GOLD 46-400(VOC 286-400)w/SATIN GLOSS TOP COAT 42-228(42-228)
PAINT INSIDE OF LIGHTED CABINET W/LIGHT ENHANCING WHITE
LOGO DETAILS•3/4"THICK 7328 WHITE PLASTIC RECTANGLE PUSHED THRU ROUTED OPENING W/3M#3630-6520 GREEN VINYL COMPUTER
CUT OUT REVERSE WEEDED DETAILS APPLIED TO 1st SURFACE
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SURFACE/SECOND SURFACE DIFFUSER
NOTE: ROUTED COPY TO BE OUTLINED WITH 1st SURFACE 3630-69 DARK BRONZE VINYL APPLIED TO GOLD BACKGROUND
SIGN FACES INTERNALLY ILLUMINATED W/800mA HI-OUTPUT FLUORESCENT DAYLIGHT LAMPS
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FABRICATED ALUMINUM SUPPORT COVER PAINTED#313 DK.BRONZE WITH FINE TEXTURED FINISH(SEE SAMPLE)
TS2"x 2"x.187"STEEL TUBE SUPPORT 9"DIA.x 3'4'DEEP CONCRETE PIER.FOUNDATION SET r BELOW GRADE.
SUPPORTS DESIGNED FOR 30PSF WINDLOAD. NOTE: CONCEPTUAL IMAGE ONLY
SIGN CONTRACTOR TO MAKE FINAL CONNECTION AS DETERMINED BY LOCAL SIGN ORDINANCES.UNDERGROUND ELECTRICAL SERVICE TO SIGN BY VERIFY ARTWORK AND DIMENSIONS
CUSTOMER'S ELECTRICIAN. PRIOR TO FABRICATION
Date: Pr0ect Nam.: The Is an I unpublished drawing p„„ DESIGN DRAWING 20 of 20
No. Designer Date Revision Notes
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