SGN2015-00036 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN = Request for Permit Action
I I,,,\I;I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD ® ' 1.
Building Division is
13125 SW Hall Blvd.,Tigard,OR 97223 St///,S •i
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-o .gov
■
FROM: I: Owner Applicant ❑ Contractor El City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) . ` 4 ' r IVIC1 `. , ,1 4 li'� / ri/lC
Mailing Address: - ( �Y1 C7 P SW 0( , y1
City/State/Zip: ):-\ J ,t(� aclov, C(l Z L q
Phone No.: S"3 26 1 - (-' (QQ
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
►: CANCEL/VOID PERMIT APPLICATION.
►Q REFUND PERMIT FEES (attach copy of original receipt and provide explanation below)500 '/
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
El REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). f 1-1
Permit#: S c W 2 t5 - 00 0 5C0
Site Address or Parcel#: /02-0(0 c WOL to V
h C i
Project Name: tkitt5kett J rvCt.C_ ItO
Subdivision Name: Lot#:
EXPLANATION: \J 1' c iz I,A,\t T A C C O EP c)
Signature: Date:
Lc --) - 1
Print Name: -gyp 1c P.A,- k7571Ci '
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. /67.oD - /33 . 4, 0 I 3 3, Vo
A 5'.ro - o?a . o-D r cry
I OR O1 f l(;1, l ,,I; 0\I.1
Route to Sys Admin: Date By Route to Records: Date 5 /� By .;
Refund Processed: Date .5/7 /5 /
By , ' Invoice Processed: Date By
Permit Canceled: Date V 15 By .a .A '.rcel Tag Added: Date By
I:\Building\Forms\RegPemvtAction_23144oc
T I GARD
City of Tigard
May 7, 2015
Custom Sign Company Inc.
Attn: Todd Phillis
9316 SW 12th Dr.
Portland, OR 97219
Re: Permit No. SGN2015-00036
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,
`7
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
lig " 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: 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#: 199619 Case #: SGN2015-00036
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 100-0000-43115 $133.60
Sign Permit-LRP 100-0000-43117 20.00
TOTAL REFUND: $153.60
APPROVALS: SIGN 'URES 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 ONLY
Case Refund Processed: Date: _S/j/6— By:
1:\Building\Refunds\RefundReyuest.doc x 09/01/2010
RECEIVED
MAR 042015•III City of Tigard CITY OF TIGARD
■
Sign Permit Application PLANNING/ENGINEERING
TIGARD 1
. .
GENERAL INFORMATION
5 6ln
\:un,••1 IX,,I,•p,,-n, .,••,,n
Site Washington Square TOO FOR STAFF USE ONLY
Address/ U h.., hermit No.: SC-1N ZO I S -000 3G
Location 10206 SW Washington Square Road
Approved By:
Tigard OR 97223 Date: 2/41 / 2"°1-S-
...011, Receipt#:
Washington Square TOO Map/T1,#:
Property
Owner \I.dhgc 1JJI," >wl. Zoning:
as above Allowable Total Area:
(.II•. '1.1n IIIN 'h.•n,
Tenant or
Electrical Permit Required% � es ❑ No
Business Washington Square TOO Building Permit Required? Yes ❑ No
__\mn, - --. It.,.-.t 12
Custom Sign Company Inc. , C,I,r,k, ma•I,T. 41ml n.,arrI'''' . "e"r..,n,,ii,d!w
Sign
Contractor \t.uhnc.\JJn s. >mI,
9316 SW 12th Dr
I In ?t.n, i.,r rh..n, REQUIRED SUBMITTAL ELEMENTS
Portland Oregon 97219 503-201-8469 (Note: applications will not be accepted
I),,_.,n I n,,., ci.I{..",11,.,n.,= I NI,.1>.,,. without the required submittal elements)
72764 04-03-15 iCompleted Application Form
Proposed Po ® Pc,.nanrm N t'..-„nJm;_ ❑ I`ree" ■• [Y2 copies of site/plot plan,drawn to scale
Ste' ❑ '""l'"`an ❑ K'"" ❑ '`'`nr.me (3 copies.if a building permit is required)
n:lKCi all that ❑ Call ❑ t he(
h
army: size requirement: 8'a"x I I”,or 11"x I
Er 2 copies of elevations,drawn to scale
® New sign? ❑ Alter to existing sign? (3 copies,if a building permit is required) .
Sign Dimensions: ,6-0"X ,8-6" size requirement: 8' x 11",to 24"x 36"
igl,QD .
Total Sign Area(sq.fr.): S1%-rO0 Fee (Permanent sign,any size)
72"Wall Area 102"=7.344"(144= 51 Soft
\C
Total ❑ S5-1.00 Fee (Temporary sign.any type)
Sign Data Area(sq.ft.)
I,-,no,t,.III Direction Wall Faces(circle one):
Iums In Ih4< NOTES:
G°"'" N. S E V. NE NW SE s\\•
I leight to top of sign(feet): 11'-6" • Wall signs do not need to be drawn to scale, but
Projection From Wall(inches): must include dimensions of wall face and sign
placement.
Materials:Steel Aluminun-Concrete-Plastic • Wall signs do not require site/plot plans.
Will sign have illumination? ® Yes ❑ No • Freestanding signs over 6 ft. required a building
*Pepe: ® Internal ❑ External permit.
Are there any existing freestanding or wall signs at this location.
including wall signs that overlap a tenant space?
❑ Yes El No
If"yes",a list or diagram of all sign dimensions and square (OVER FOR SIGNATURES)
foota a must also be submitted.
City of Tigard I 13125 S\V Hall Blvd..Tieard.OR 97223 I 503-718-2421 I www.tigard-or.gov I Page I 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 or a lessee in possession wilt
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 o:
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 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.
Todd Phillis - ;- :, 02-23-15
Applicant Signature Date
PP
Todd Phillis Agent 1111; 02-23-15
Signature of(hvncr;/ \gent Date
Todd Phillis Custom Sign Company Inc. 503-201-8469
Contact Person Name Phone No.
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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-HWV.217 ®®y Site Map
Existing Sign At Site
I‘I::' Cnstemer Approval
titled sip Salesperson Approval
ED
CUSTOM SIGN COMPANY INC. PORTLAND OREGON CCB#72764
Phone: 503-201-8469 toddcustomsign @gmail.com copyright 2015
SIGN # 1 on SW GREENBURG ROAD
10206 SW Washington Square Road Tigard Oregon 97223 Tax Parcel R1410066
283 in 56 1/2 in 444 in
Curb 24 in Planter Area
STOP
LIGHT 56 1/2 in
Planter Area BASE
1571/21n Existing Sign:
18 in !APP Center Line of New Sign 73" x 101" = 7,373" EXIT
ooa 20 in 7,373"/ 144" = 51.20 WAY
Sign 1 app 36"off grade sw
ENTRY WAY NEW SIGN 181/2 In to bottom of sign GREENBURG
TO PARKING FOOTING Overall Height Existing RD
LOT AREA 45"X 45"WIDE 16„ Sign : 11'-5”
48"DEEP -,—
161/21n
20 in
55 in
Scope of work for both signs 1 and 2: Planter Area
Sign and brick columns TO PARKING
WAY
Remove Existing 9 TO PARKING
steel post (cut at grade) and discard LOT AREA
New sign footing and sign as per attached drawing
Job# 1529-73-02-01 Power -Spriniker Lines -Landscape- to be moved our altered
Location:National Sign Corp 1529 as needed and to be done by others any other unforeseen
Folder: 1529-73 Washngton Square
Folder ground condtions (concrete bases- pipes- wires- eic.) that may appear when excauvating
File:1529-73-02-01 site map sign 1 cdl
PDF::site map sign 1 will be done on a T/M base
Drawing: 1 of 1
Date:02-23-15
Notes:600-800-1000
Meas:400
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