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THE FOLLOWING INFORMATION MUST BE INCLUDED WITH YOUR APPLICATION: Please complete a separate application form for each sign. Payment for amount of permit. For freestanding/monument/pylon sign - a site plan with setback from property line dimensions and art work with dimensions of sign, and engineered design for footings and foundation. For wall sign, art work with dimensions of sign and drawings of building façade showing location of sign. If illuminated or if electrical services are needed, a separate electrical permit is required. If leased space, need to include a letter of approval from the property owner. SIGN LOCATION Name__________________________________________________________________________________ Address________________________________________________________________________________ City ____________________________________State__________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ PROPERTY OWNER Name__________________________________________________________________________________ Address________________________________________________________________________________ City ____________________________________State__________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ SIGN CONTRACTOR Company Name _________________________________________________________________________ Address________________________________________________________________________________ City ___________________________________ State___________________ Zip _____________________ Contact _____________________________________Day Phone # ________________________________ Email Address __________________________________________________________________________ SIGN DESCRIPTION Electronic ($100 per sign plus completion of electronic sign license, see Page 2) (1000.4114) Permanent ($75 per sign) (1000.4114) Temporary ($50 per event, up to 60 days per year. Max of one temp sign displayed at a time.) (1000.4114) Temporary sign displayed dates: START DATE ________________________ END DATE ________________________ Sign Type and Dimensions Wall Sign: Width ____________ Height: _______________ Square feet _____________________________ Freestanding: Face Width_________ Height____________ Sq. ft__________ Overall Sign Height _________ Setbacks: Front _________ Side ____________ Temporary Width___________ Height ______________ Sign Square Feet______________________ Display location _______________________ Illuminated Sign: Internally illuminated Externally illuminated Not illuminated Type of Work: New Sign Replacement Sign Alter Existing Sign Changeable Copy: No Changeable Copy Manual Changeable Copy Electronic Changeable Copy (Electronic sign will require annual license review & renewal, see Page 2) Applicant Signature: ____________________________________________Date:_________________ Applicant Printed Name: _______________________________________________________________ SIGN PERMIT & ELECTRONIC SIGN LICENSE APPLICATION City of Lakeville – Planning Department 20195 Holyoke Avenue - Lakeville, MN 55044 952.985.4420 - www.lakevillemn.gov Allina Health Lakeville Primary Care 17489 Dodd Blvd Lakeville MN 55044 Archetype Sign 9611 James Ave S Bloomington MN 55431 Chad Kranz 612-701-2231 ChadK@archetypesign.com 70.5 3 ft23.5 ft Chad Kranz 08/01/2023 Jason Senske 612-434-5262 jason.senske@allina.com West Wall SIGN PERMIT & ELECTRONIC SIGN LICENSE APPLICATION Page 2 Electronic Display/Changeable Copy Sign License By signing below you are certifying the electronic signage meets the following performance standards: 1.The display sign shall not change more than once every seven (7) seconds. 2.The display sign shall not include scrolling, flashing, animation, or other effects. 3.The display must be static and the transition from one static display to another must be instantaneous without special effects. 4.The display image or message must be self-contained, without continuation in content to the next image or message. 5.The brightness of the sign shall not exceed 5,000 NITS after sunrise and before sunset or 500 NITS after sunset and before sunrise each day. 6.The sign shall be equipped with an automatic dimmer control or other mechanism that automatically controls the sign’s brightness to comply with this condition. 7.The display must be designed and equipped to freeze the device in one position if a malfunction of the electronic display occurs. 8.The display must also be equipped with a means to immediately discontinue the display if it malfunctions, and the sign owner must immediately stop the electronic display when notified by the City that it is not complying with the stipulations of this section. 9.The sign shall comply with Chapter 23 of the Zoning Ordinance. Signature_______________________________________ Date______________________________ Print Name______________________________________ Email ________________________________ EXPIRATION AND RENEWAL OF LICENSE: •All licenses expire on December 31st of each year. •License may be renewed only by making application as provided in Section 3-22-4 of the City Code. •Application for renewal shall be made at least sixty (60) days before the expiration date. •Each renewal license shall be issued for a maximum period of one (1) year. •Annual license renewal fee is $50.00 Office Use Only Sign Permit Type: Permanent Sign _____ Temporary Sign _____ Electronic Sign _____ Work Type: New _____ Addition _____ Repair _____ Demolish_____ Replace _____ Alter/Remodel _____ Move _____ Owner: Public _____ Private _____ Zoning District: Commercial _____ Industrial _____ Residential_____ Freeway Corridor _____ Required Inspections: Footing _____ Final _____ Permit Fee: Permit Fee _____________ Miscellaneous ___________ Total ___________________ Comments: ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ Approved by:____________________________ Date:___________________________________ (REVISED APRIL 2022) X X X C-3 X $75.00 $75.00 8 August 2023 *Email kjenson@lakevillemn.gov after installation for final inspection. 1.1 West Elevation (Partial) Scale: 3/32’’ = 1’-0’’1 Channel Letters on Raceways Channel Letters & Logo | Raceways Scale: 1/2’’ = 1’-0’’2 282" 40 3/4"36” 233 5/8” RACEWAY 1 82” RACEWAY 2 106” RACEWAY 3 91” 3”4 3/8” PROFILE 70.50 SQFT ILLUMINATED SIGN (CONCEPTUAL) MOUNTED TO WALL USING LAGS AND LAG SHIELDS Description Install Raceway Illumination A B PHOTOCELL CONTROLLER SIGNCOMP: 2 PIECE 8" CHANNEL LETTER RACEWAY (FRONT 1981/BACK 1982) PAINTED TO MATCH MOUNTING SURFACE (TBD) SLOAN PRISM 6500K WHITE LED MODULES 140 L.E.D. MODULES - 94 LINEAL FEET TOTAL (3) - 60C3-60W (NON-DIMMING)(701507-60C3) 100-277 VAC 60 Hz - 0.80 A - 60 W @ 12 VDC8 Channel Letters & Logo 3” ALUMINUM RETURNS - PAINTED GREY MP74935 (PMS 423C) - 3/16” WHITE ACRYLIC FACES (2447) (CNC) - DIGITALLY PRINTED CLEAR VINYL OVERLAYS: TO MATCH: PMS 7689C & PMS 7737C (C/W/C) ACTUAL COLORS TO BE VERIFIED 1” SILVER TRIMCAP PRE-FINISHED WHITE ALUMINUM BACKS 9611 James Ave S. Minneapolis, Minnesota 55431 952 641 9600 archetypesign.com This print is meant as a representation of a sign show vin consideration of being manufactured by Archetype. Materials may influence final result. Samples available upon request. Graphic Design time is included in the total purchase price. Designs contained herein are not meant to be exhibited to others outside of included parties and employees. Designs received from Archetype may not be manufactured by others without reimbursement for time spent in the creation of these designs or any resemblance. Drawings may contain elements considered artistic intellectual property of Steve Carpenter, owner. ©Archetype Page: Type: Approved: Contact: Description: Project: Job Number: Date: Rev. 1: Rev. 2: Rev. 3: Rev. 4: Rev. 5: Designer: Jenny Kruse 952 641 9602 jennyk@archetypesign.com Allina Health Lakeville Primary Care Lakeville, MN Q-104814 06.16.23 06.21.23 07.13.23 07.17.23 07.28.23 DG 1.3 Channel Letters on Raceways - Detail TRIM CAP .040 PRE-FINISHED ALUMINUM RETURN 4.375’’ .050" PRE-FINISHED WHITE ALUMINUM BACK 3/16" ACRYLIC FACE LED UNITS CLASS 2 LOW VOLTAGE WIRES TO LED DRIVER LED DRIVER NON-CORROSIVE WALL ANCHOR SIZE & ST YLE DETERMINED BY MOUNTING APPLICATION RACEWAY COVER RACEWAY FRONT RACEWAY BACK RACEWAY BRACE / BRACKET DRAIN HOLES (1) 1/4" HOLE PER 4' RACEWAY THROUGH WALL - PENETRATION SEALED W/ SILICONE FINAL ELECTRICAL CONNECTION BY OTHERS 6' MIN. CONDUIT W/ 3- 12 GA. WIRES (WHITE , BLACK & GREEN) 3’’ Section Scale: 3”=1’-0”1 CHANNEL LETTER (3’’ DEPTH) ON 2 PIECE 8’’ NARROW RACEWAY 9611 James Ave S. Minneapolis, Minnesota 55431 952 641 9600 archetypesign.com This print is meant as a representation of a sign show vin consideration of being manufactured by Archetype. Materials may influence final result. Samples available upon request. Graphic Design time is included in the total purchase price. Designs contained herein are not meant to be exhibited to others outside of included parties and employees. Designs received from Archetype may not be manufactured by others without reimbursement for time spent in the creation of these designs or any resemblance. Drawings may contain elements considered artistic intellectual property of Steve Carpenter, owner. ©Archetype Page: Type: Approved: Contact: Description: Project: Job Number: Date: Rev. 1: Rev. 2: Rev. 3: Rev. 4: Rev. 5: Designer: Jenny Kruse 952 641 9602 jennyk@archetypesign.com Allina Health Lakeville Primary Care Lakeville, MN Q-104814 06.16.23 06.21.23 07.13.23 07.17.23 07.28.23 DG