SGN2015-00037 lig City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
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Re uest for Permit Action
r i .;,A r 1) 13125 SW Hall Blvd. •Tigard,Oregon 97223 . 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
V 0 2.
Building Division —57,// :i�,�
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Owner Applicant I Contractor ❑ City Staff
Check(1)one
REFUND OR Name: _r ^INVOICE TO• (Business or Individual) ( f •vv"t . 1 (C'y' (./v `+�� Z -
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Mailing Address: q�k SW 0 I .
City/State/Zip: f 11AGt4tt(11 6icov, C'(1 z_./CI
Phone No.: -J`�3 - 201 ' VI44 (OQ
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
K CANCEL/VOID PERMIT APPLICATION. ye,,el. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).�%
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). M.41❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel ' ermit).
Permit #: 6G ■ t 5 - 00 031
Site Address or Parcel#: (C)Z 0(4) c.0 Lc krw -J h C fcctd
Project Name: U jCt51n114Gn tjA( 710
Subdivision Name: JJ Lot#:
EXPLANATION: \JO - Y x,'1/\1 I' c\ C C o EP
Signature: A v Date: 14
Print Name: ---rock-k- Vle■■l trj
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests. /6 7 � /3 3 - 4 O — 33 '1"
6 pZ.s. � — , O7) .i J
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date 7 ,1.' By 47.7
i
Refund Processed: Date 677 /_$ By ;44 Invoice Processed: Date By
Permit Canceled: Date -S' 7/4.5- By �I(1., ,arcel Tag Added: Date By
I:\Building\Forms\RegPerrnitAction_09 31
• .
TI GARD
City of Tigard
May 7, 2015
Custom Sign Company Inc.
Attn: Todd Phillis
9316 SW 12th Dr.
Portland, OR 97219
Re: Permit No. SGN2015-00037
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10206 SW Washington Square Rd.
Project Name: Washington Square Too
Job No.: N/A
Refund Method: ® Check#217286 in the amount of$153.60.
❑ Credit card "return" receipt in the amount of$
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): Per applicant's request as permit was not needed. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
la j
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
ErCity 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: Custom Sign Company Inc. DATE: 4/30/2015
Attn: Todd Phillis
9316 SW 12th Dr. REQUESTED BY: Dianna Howse
Portland, OR 97219
TRANSACTION INFORMATION:
Receipt#: 199618 Case #: SGN2015-00037
Date: 3/4/2015 Address/Parcel: 10206 SW Washingst Sq Rd
Pay Method: CreditCard Project Name: Washington Square Too
EXPLANATION: Per applicant's request as permit is not needed. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Sign Permit 103-0000-43115 $133.60
Sign Permit- LRP 100-0000-43117 20.00
TOTAL REFUND: $153.60
APPROVALS: SIG TITRES DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE Y
Case Refund Processed: Date: I S77,/s By:
RECEIVED
.1111 ___ . City of Tigard MAR 0 4 2015
Sign Permit Application CITY OF TIGARD
T I G A RD PLANNING/ENGINEERING
GENERAL INFORMATION
S ik 2
\inn..i Ih,aI villa nr 1'r,9u-r
Site Washington Square TOO FOR STAFF USE ONLY •
Address/ "r"' \dd",, Permit No.: SC-1N 2-015-0 0 031
Location 102064 SW Washington Square Road
Approved By:
Tigard OR 97223 Date: 3 / 4 / 2A I S •
x.nn, Receipt It:
Washington Square TOO \la , l l..
Property P
Owner Mader„ \ddr,,- Mut, Zoning:
as above _11lowable Total Area:
I.,r •.u, i.qr 1,1,.,m
Tenant or \' Electrical Permit Required? 21.-Yes El No
Business Washington Square TOO Building Permit Required? 123 Yes ❑ No
\.um Rr%.T.I 1=
Custom Sign Company Inc. ' a°,,,I" "r=aura 1aml u,a apphc.uv.n. .r,„pa Mtn app d■M.
Sign
Contractor >tuhnu \ddr,,, Nwr,
9316 SW 12th Dr
%r 1'11. REQUIRED SUBMITTAL-ELEMENTS
Portland Oregon 97219 503-201-8469 (Note: applications will ngi be accepted
,h,r..,,r.•nst.(..mr.Ir.yard 1.ram,= I(,r.D.u, without the required submittal elements)
72764 04-03-15 ❑. Completed Application Form
Proposed 1.,....-,:. la 2 copies of site/plot plan,drawn to scale
Po ® Parm�mnt ® I•rcc•st:rxhn• ❑
Sign ❑ lune.rm ❑ R•+d ❑ P1aar.mtr (3 copies,if a building permit is required) .
+r Aka.all that
0 \V I" ❑ t'ther
'PO size requirement: 8'2"x 1 1".or 11"x l-"
Er 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; 8' x 11",to 24"x 36"
6-0 x 8-6 42.00
Total Sign Arca(sq.fr.): Er SliC00 Fee (Permanent sign,any size)
72"x 102"=7.344"(144= 51 scift
Total Wall Area(sq.ft.) I ❑ S54.011 Fee (l cmporary sign,any type)
Sign Data -
1.."rlar,.dl Direction\\-all Faces(circle one):
grams in rills NOTES:
N S E 't NE N\\" SE SW\'
height to top of sign(feet): 11'-6" • Wall signs do not need to be drawn to scale, but
must include dimensions of wall face and sign
Projection From Wall (inches): placement.
Materials:Steel Aluminun-Concrete-Plastic • Wall signs do not require site/plot plans.
Will.sign have illumination? El 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 Z] No
If"yes",a list or diagram of all sign dimensions and square (OVER FOR SIGNATURES)
foota must also be submitted. __ _
City of Tigard 1 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2421 I www.tigard-or.gov I Page 7 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"Perminee"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 witt
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 cc
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 arc 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.
Todd Phillis
Applicant Signature Date
Todd Phillis Agent 02-23-15
Signature of Owner/Agent Date
Todd Phillis Custom Sign Company Inc. 503-201-8469
Contact Person Name Phone\o.
toddcustomsign @gmail.com
City of Tigard I 13125 SW Hall Blvd..Tigard,OR 97223 I 503-718-2421 I www.tigard-or.gov I Page 2 of 2
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CUSTOM SIGN COMPANY INC. PORTLAND OREGON CCB#72764
Phone: 503-201-8469 toddcustomsign @gmail.com copyright 2015
SIGN # 2 at the corner of Washington Square Road -Entance to Parking
10206 SW Washington Square Road Tigard Oregon 97223 Tax Parcel# R1410066 Existing Sign:
73" x 101" = 7,373"
149 7,373"/ 144" = 51.20sgft
60 in 132 in APP.Center Line for new sign sign 2 app. 36" of grade to bottom
overall height: 137" 11'- 5" to top
WASHINGTON Planter Area l Parking Area
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Job# 1529-73-02-01
Location:National Sign Corp 1529
Folder:1529-73 Washngton Square
Folder: -----11_
File: 1529-73-02-01 site map sign 1 cdl
PDF::site map sign 1
Drawing: 1 of 1 SEE DRAWING FOR SIGN 1 FOR SCOPE OF WORK
Date:02-23-15
Notes:300-400-500
Meas:300-350400 ENTRY WAY TO PARKING LOT AREA
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