11765 SW GAARDE STREET-1 11765 SW GAARDE STREET
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BUILDING PERMIT APPLICATION 1'IGARD DATF
THF UNDERSIGNED HCREBY APPLIES F07 A PERMIT FOR THE WORK HEREIN INDICATED BUILDER PHONE
O S S'10 BAND APPRCVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS, OWNER PHONE _
Ay LOT NO. _
OWNER �/ JOB ADDRESS �J
-7 /
'- ARCHITECT
ENGINEER
BUILDER �-� s�.'� ' ADDRESS
�� DESIGNER
URtaZ tel'_
STRUCTE ❑ NEW ❑ REMODEL Q6016ITION ❑ REPAIR ❑ RENEWAL. G FIRE DAMAGE ❑ DEIAOLI
E1'14ESIDENCE ❑ COMM ❑ EDUCATIONAL ❑ GOV'T ❑ RELIGIOUS ❑ PATIO ❑ CARPORT ❑ GARAGE ❑ STORAGE 0 SLAB❑ FE
OCCi.iPANCY LAND USE ZONE r BLDG.TYPE —_PLANK CHHECK BY 'T2&,'-/—HEAT--
A
�HEAT
SEWER PERMIT II _ ---- C�� di� _�------�� f/ �-? --la" ." � –
OCC.LOAD FLOOR LOAD HEIGHT �c%"�'-- NO.STORIES AREA�4/G/ NO.BEONooMS A.LUr
BUILDING DEPARTMENT SET BACKS FRONT REARj U LEFT SIDE ? J RIGHT SIDOS
Permit _ ��� v THIS PERMIT IS ISSUED SUBJECT TO THE REGULATIONS CC NITAINED IN THE BUILDING CODE,ZOI
REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT
PIS an Check WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIA
� WITH ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT W
Sul'total 7. RESTRICTIVE COVENANTS CONI RACTOR AND SUB CONTRACTORS TO HAVE CURRENT CITY BUSY
l' S LICENSE.SEPARATE PERIAITS REOUIRED FOR SEWER,PLUMBING AND HEATING.
Stat,T'>'
r SDC
Total 3 v - ------------- - -- -
PC8 APPLICANT OR AGENT
By _
Receipt No. —
Approved ADORFSS PHONE
SDC - I
PDC -
SEWER CONNc"CTION 5
SEWER INSPECTION $
SEWER 5URCHARGE 5
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INSPECTION NOTICE
City of Tigard [wilding Department
12420 S.W. Main St.
Tigard,Oregon 97223
Phone: 639.4171
Type of Inspection
Date Requested—___ ' '2 'S - '3 Tirre__X__ A.M. P.M.
Address __— —' ` om Permit #�
.Owner.__._— -- --------- ----- L,3t
Builder
The following Building Code deficiencies are required to be corrected:
--�---- .�?x_-tea----L.__W._...c�..i?C•t..0�� �j_U'1 �__r.
-----------------
Presented to Approved
1 Inspector Disapproved I
Date --
CALL POR REINSPECTION
!._7 YES It NO
SEWER PERMIT
UjSewerage Agency
of lyashington County CITY uF A-4 . DATE'
r to /y Q
OWNER: r I�! ` • siKCtr PHONE , 620-023*
OWNER 'S ADDRESS: II ��,�� 5�,? qav-�'t� 94% (�t�t4. AIL.
TYPE OF INSTALLATION,
It51 .SIDE SEWER ❑ LINE TAP AND SIDE SEWER ❑ LINE TAP
TYPE OF OCCUPANCY:
NEW ❑ EXISTING MSINGLE FAMILY ❑ COMMERCIAL
P<EXIST. (PRIOR TO 7-1-70 ) ❑ MULT. RES. ❑ INDUSTRIAL
FIXTURE UNITS DWELLING UNITS- (!)A*
-
ADDRESS OF STRUCTURE , &&V _
Permit Conditions: The applicant agrees to comply with all rules and regulations of the Unified Sewerage Agency.
When calling for Inspection, please refer to the Permit Number. The Application expires in one hundred twenty (120)
days. The amount pald will be forfeited should expiration occur.
The Agency does not guarantee the accuracy of the lo.:ation of side sewer laterals. If the sewer Is not located at
the measurement given, the installer shall prospect three feet In all directions from the distance and dapth gi%an.
If not so located, the installer shall purchase a 'Tap and Side Sewer' Permit at the current charge and the Agency
will install a lateral at the location specified by the installer.
FEES,
PERMIT FEE S ` r
CONNECTION CHARGE -f(2 r"
LINE TAP INSTAL(_ATrn�!
O - _ ISSUED BY
TOTAL
APPLICANT _ DATE
SEWER PERMIT
ADDRESS OF STRUCTURE _ I _�_Sa•�+t�� �
TAX MAP �r.2 S I_-3 C">_ TAX LOT _ t.O CC SYSTE14
LOT BLOCK OF
APF HONED !!Y DATE ISSUED BY DATE
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D. U. 'S 4G �_ REMARKS Mi+. l�Jrt. �'HfI SY � �'"_. �IIt� 4%k*04
INSTALLMENT PAYMENI AGREEMENT ANTI
DISCLOSURE STATEMENT
To the City Council of the City of Tigard, Oregon:
In accordance with the provisions of City of Tigard Resolution 83 -
which re'ates to City of Tigard policy on payment of charges in lieu of assess-
ments, ; HEREBY MAKE APPLICATION AND AGREE, .JOINTLY AND SEVERALLY, TO PAY said
charge in lieu of assessments as has been determined by the City Council of the
City of Tigard, Oregon, under Ord. No. 82-33, in 20 semi-annual equal installments
together with interest thereon at a rate of per annum. First payment is
due on Januar 1,___1 19.B_4__, and on six (TT-month *intervalS thereafter .
Interest to be paid Semi-annually at th,- time each equal in5t,rllment of the dsseSS-
mont 1�, paid.
If I neglect or refuse to pay any part of the installments provided herein,
including interest , within 50 da vs after the same shall have become due and payable ,
then the whole amount of the unpaid amount including accrued interest, shall become
due and payable at ce and shall be collected in the manner provided by law in-
cluding foreclosure on the below described real property. In case suit or action
is instituted for a declaration of rights under this Agreement or to enforce any
provisions of this Agreement, the parties agree that the prevailing party shall be
awarded reasonable attorney's fees and costs. Also, if any appeal is taken from
any judgment or decree under this Agreement, the parties agree that r(_-.,sonable
attorney' s fees and costs hall be awarded to the prevailing party.
The charge in lieu of assessments, annual percentage rate of interest, and
finance charges which I agree to pay are as follows:
1 . Amount of Assessment (cash price) . . . . . . . . . . . . . . . . $3 Wilamu_-
2. Amount Financed . . . . . . . . . . . . . . . . . . . . . . . . . $.3'000.00
3. Finance Charge ( It paid in 20 semi-annual installments) . . . . . $!-,-Z o__
4. Deferred P3}ment Price . . . . . . . . . . . . . . . . . . . . .
5. Anrxra 1 Fthrcentage Ra tc . . . . . . . . . . . . . . . . . . . . $ 11.09%
I understand that I may prepay a portion or the entire amount of the above
assessment without penalty.
I agree that in the event that this property changes ownership the remaining
balance becomes immediately due and payable.
Property affected by this improvement and subject to the Lien:
Tax Lot 3600 2S 3CD- 1765 S. . Gaard > d
It is understood tat ( I am (we) are en� .)t`iey o a copy of this Installment.
Payment Application and Disclosure Statement. The signature(s) below acknowledge
receipt of a copy hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this _ � day of
19
Witness:
, ��. �� ��.��-..�.c._(Seal )
rgna ore rsGTi>nesses rgnat. e n p cants and
Property Owner,