10590 SW CENTURY OAK DRIVE ADDRESS:
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i:Vecords\microFlm\targets\buiIding.doc
CITY OF TIGARD BUILDING INSPECTION N-MCE
Inspection Line (Rec-O-Phone): 639-41-3 Business Phono: 64 71
Inspection:
6'
Footing Susp. Ceiling Sprink Rough-in Appr/Sdwlk
Foundation, Plbg. Underslab Mech. Rough-in Fireplace
Post/Ream St•uct. Plhg. Top Out Elec. Rough-in FINAL:
Post/Beam Miuch. San. Sawer Gas Line -Bldg.
Plbg. U-iderlloor Rain Drain Framing -Plumb.
Alarm Water Line Insulativm -Mech
Underilr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: a C
Time: AM PM
Address: U 5 yclp L(�n
Permit #:
THE FOLI.OWIN CORRECTIONS ARE REQUIRED:
— i
Inspector
ED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp.
LZ
CITY OF TIGARD BUILDING INSPEC:i'CN NOTICE _3 /
inspection Line (Rec 0 Phone): 639-4175 Bua.:ir-of-s Phone: 639-4171
Inspection: G
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Po 'Beam Mech. San. Sewer Gas Line -Bldg.
IPlbg. Underfloor Rain Drain Framing -F ,�mb.
Alarm Water Line Insulatio-i -Mf."Al.
Underflr. Insul. Shear Wall Gvp. Bd. B�t�
Date Requested: �� r_Time: AM Fhb
Au'�dress.
Builder. ; "'
Permit #:?�f�,i�c
THE FOLLOWING CORRECTIONS ARE REQUIRED:
el
Inspector. _ Date:
APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp. C
CITY OFTt;ARD BUILDING INSPECTION NOTICE
Inspection Line (R(,--O-Phone): 639-4175 Business Phone: 639 7
Inspection:
Footing Susp. Ceiling Sprink. R,-ugh-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beare Mech, San. Sewer Gas Line -Bldg.
Plbq. Underfloor Rain Drain raming 7 -Plumb.
Alarm Wate• Lino Insulat� -Mech.
Underflr. Insul. Shear Wal ( '@� $d. -Elect.
D,Ate Requested: � �'"I 1 _Time: AM PM
Address:-- �J,
II
^Milder. _ Permitk,_ { — ��.� 1-4 4`
THE FOLLOWING CORRECTIONS ARE REQUIPFD:
Inspec•tor: Dol4pf
R VO ED _DISAPPROVED _APPNOVED SULIJECT TO ABOVE
_Gall For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 BL;iness Phone: 639-4171
Inspection:__
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdw k
Foundation Plbg. Underslab Mech. Rough-4'n Fireplace
Post/Beam Struct. P!bg. Top Out Elec. Rough-in FINAL:
Post.Beam Mech. San. Sewer ``' 3rCif5�- -Bidg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation 4ech.
Underflr. In�il. Shear Wall _Gyp. Bd. -Eloct.
Da'e Requested: ` _ ime: AM PM 14:11
Adclross:,5 �_ L r —a(-< r .
Builder:_ _ Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector. �/I. Q Date: "
APPROVED —DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Rein,,p.
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PIanck!Rec. #
Permit # CLZ "If,
_ o�
Phone (503) 639.4171 Date Issued ]-Z-1 S
CITY OF TIGARD FAX (503) 684-7297 Issued by "3• f`�c..IV��Arin
TDD No. (503) 684-2772
Inspection (503) 639-4175 _
1. Job Address: 4. Complete Fee Schedule Below:
Name of Devtelopmrlent �brlir�J�L—S Number o.Inspections per permit allowed
Address_ /Ct Jr /�L_.��U ('C�/YUl y, e4 USC. Servicd included: Items Cost(ea) Sum
City/State/Zip 7-j'6410) �• /^Z 2'T 4a. Rb,ridential-pow unit —� 4
1000 eq fl or bee $110 00
Nameor name of busine3S EaarldAiortxl 500 sq 11 or I
Name (or ch portion thersol $2600
Commercial❑ Residential �L Limited Energy $2500
Each Manul'd Home or Modulor 2
Dwelling Service or -*scar lies:lo
2a. Contractor Installation only: 'b.Services or Fooders
F46(-1-3,
Installation,alteration,or relocation 2
Electrical C ,ntractor L l�C� .SL sL%!. 200 amps or lose $6000 2
I ' 201 amps to 400 amps W 00 2
Address / G. S/t t'�•�z'Sf 801 amps to 1000 amps $18000 —
City__f,� yif1• Stated Zip_ ��7 401 amps 10 neo amps _� $120 00 _ 2
2
Phone No. •C,/1 ml" Over 1000 amps or volts $34000 2
Contractor's License No. - 371�1
;_� G �_
Reconnect only iso 00 _
Contractor's Board Rog. Nc. ` "
g � 4c. Temporary Services or Feeders
Lnlallalton,alteration,or relncat,on 2
Signature of Supr. Elec' ` 200 amps or loss $6000 2
License No. 317Y1' 5 hone o. � Irl 201 amps to 400 amrM __ $1500 2
.irL. 401 ampe to 8011 amps 111100 00
Over am smps to 1000 volts
24. For owner Installations: see•b•°bo°e
4d.Branch Circuits
Print Owner's Name New,attorrion or extension per panel
Address a)Tho loo for branch circuits with
CIh}��� State Zip purchase of eervke or Hadar Are. 2
`)'_ — End,branch circuri $9 00
Phone No. b)The lop for bn:nch circuits without
The installation is being made on property I own which is purchpisa of service or Aredor Ara. 2
not intended for sale, lease Or rent. Eacl additional
circuit brunch
$3500 J 2
Each adcleianel brertcfn drain $600
Owner's Signature _ _ 4e. Miscellaneous
(Service or feeder not included$
3. Plan Review section (it required). EBLr`pump nr vnga6on circle 11000 2
Each syn or ou'line lighting $4000
Signal cin.0(s)or r limited energy 2
Please cneck appropriate Ilem and enter fee In section iB. penal,alteration or ondension e40 00
4 or mure residential unite in ccq structure Minor Labola(.0) $10000
Service and feeder 22.5 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or stnicture containing special occupancy the allowable In any o. the above
as described in N E.0 Chapter 5 Par insppr,.eon $3500 _
Por hour _ $55 00
In Plant � $6500
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5s. Enter total of abo✓e lees $
5%Surcharge(05 X total fees) $
PERMITS BECOME VOID Ir WORK OR CONSTRUCTION Subtotal S
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OP IF 5b. Enter 25%of line A for t
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sac 3) $ _ 1
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtoral $
COMMENCED. ❑ 'Trust Account M $
Balance `Sue $ 5 S
J
.esr�wwrope.raa
CITY OF TIGARD RECFidT OF PAYMENT RECEIPT NO. 05-'26858b
CHECK AMOUNT s 52. 50
IWAME z Jpc ELECTRICAL SERVICES CASH AMOUNT s 0.0Q1
pf)[)RFSG 14657 SW TEAL BLVD. SUITE ;?55 PAYMEN'r DATE 0 07/P7/95
BEAVERTON, nR SUBDIVISION
9'7007•-
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OP PAYMFNT AMOUNT PAID
EL.FurRICAL. PERMIT 050. 00 ST. BUILD PIER 59)
1.0590 SW CENTURY OAK DR.
EL 95-OPOS
'roTAt. AMOUNT PAID 52. :50
T1GARDCITY BUILDING PERMIT
PERMI T #. . . . . . . : BUX•`95--024':;
COMMUNITY DEVELOPMENT DEPARTMENT DOTE ISSUED: 07/06/95
13126 9W Hall Blvd.Tigard,Oragon 07223.9109 (503)03?-44�T�1
PARCEL: 2S 110nD---02700
a I ' L i1DDREG5. . . 1051)0 SW CENTURY OAK DR
SUBDIVISION. . . . : SUMMCRFIEL.D ZONING: R--7
BLOCK. . . . . . . . . . . LO'C. . . . . . . . . . . . . :34
REISSUE: FLOOf? AREAS- __- .__. ._ E:XTERIOR WnL1_ CONSTRUCTION
CLASS OF WORK. :"4) FIRST. . . . . f rJ: S. c.: W:
TYPE OF USE. . . .3F SECOND. . . : sf PROTECT OPENINGS?--__._-_--___-
TYPE OF CONST. :5N THIRD. . . . : s f N: S: E:: W:
OCCUPANCY GRP. :R3 TOTAL--.-_._.._..-: 0 s f ROOF CONST: f=IRE RE r? :
OCCUPANCY LOAD- BASEMENT. : s f AREA SEP. RATED:
)TOR. : 1 HT. : t (JARAGE. . . : s f OCA U SEP. RATED
BSMT?: MEZZ?: REQD
FLOOR LOP0. . . . : ps f LEFT: ft RGHT: ft F1 R 5PKL: SMOK. DET. . :
DWELLING UNITS: FRNT: ft REAR: ft FIR ALFM: HNDICF' ACC:
BEDRMS: BATH-7)- IMI ' tea-URf=ACE: PRO CO"iR: PARKING:
VALUE. $;; L,000
Remarks : in5t.al I ing d0i.tble doors
Owner: ____.______.__ ______.._._____._._ FEES ---._--.--_--___--
KEN JOHAVNL S typw amnf.lnt by date ret_pt
10590 SW PRMT $ 32. 50 SW e17/06/95 —
CEMTURY C.'AK DR H'LCK i 21. 1,?, DON 07/03/95 95- ,='C7.-j33
'IGARD OR 97.21E4 SPCT Za 1. 63 SW 07/1216/95 —
F-'hone 1#; 244_-0156
Cont r•act or :
OWNER
Phasic i#: 35. Cry TOTAL.
Reg #. . : 00121000
---__-- REOUIRED INSPECTIONS; ---
This permit is 13sued subject to the regulations contained in the Framing Insp
Tigard Municipal Code, State of Cre, Specialty Codes and all other Ins 1.11 at i o n Ina p
applicable laws. All work will be do1,, in accordance with Gyp Eloard Insp
app-oyed plans. This permit will expire if work is Tat started Firial ITispertion
within IN days of issuance, or if work is suspended for more
than 180 days.
F'e r-m i tee S i g n a t 1-i t-e :
I s s 1_t e d EJ
Call far inspection 639-4175
Permit#:�ILOT q!5-— c2z I l —
Address: 5 511JC ►n t :L QA IC
(F Issued by: l.t��� _ Date: _
Statement: Information Notice to Rrope;ly Owners
About Construction Responsibilities
Note:: Oregon Law, ORS 701.055(4), requires residential construction permit arpli-
eants who are not registered with the Construction Contractk,rs Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, el-wrical, mechanical, and plumbing permits. Licensed
architect and engineer arplicants, exempt.from registration ur ter ORS 701.010(7),
need not submit this.statement. This statement will b.-filed with the permit.
Fill in th approyriate bla,-•ks and initial boxes 1 and 2, and either box 3A or 313:
1. wn, .reside in,or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
hefore or upon completion.
3A. My general contractor is
(Name) Contractor regis. #
I will instruct nay g^neral contractor that all subcontractors who work on the structure must be
registered with the Construction Contactors Board.
OR
3B. I will be my own general contractor.
113/ .
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Constru i n R ponsibilities on the reverse side of this form.
Sin re of pe app scant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: T;ds lrlformation Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Board in accordance with ORS 701.055(5).
If you are acting as your own contractor to construct a new home or:Hake a substantial improvement to an existing structurrn,
you can prevent many problems by being aware of the following responsibilities and areas of c ncern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure,you will, in most instances,be ruled to be an employer and the people
you hire will be employees. As the employer,;you must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income tixes from employee wages at the time employees
are paid. You will be iiable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Ore,pn Dept.of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you ave required to pay a tax for unemployment insurance purposes on the
wages of all employm.s. For more information,call the Oregon Employment Division at the Department.of I-lurman Resources
at 378-3'57,4.
Workers'compensaCon insurance: As an employer,;ou are ,ubject to the Oregon Workers'Compensation Law,and must
obtain workers'compo:Cation insurance for your employees. It'you fail to obtain workers'compensation insurance,you may
be sube c
ject to penalties and will be liahle for all claire i.. -)ne of your emp!oyr�s is injured on the job. For more information,
call rhe Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S.Internal Revenue Service: As an employer,you must with nold federal income tax from employees'wages. You will be
liable for the tax payment even if you didn't actually withhold the tr v For more information,call the Internal Revenue Service
at 1-800-929-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this project,you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspectiops.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools,paint -spray,water damage from pipe puncture ,,fire,or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employee%.
Vxpertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish
trades,and to notify building officials at the appropriate times so they can perforin the required inspections.
If you have additional questions, write or call the Construction Contractors board(FO Box 14140,Salem,OR 97309-5052,
503/378-4621). The Board is located at 7(X)Summer St.NE Suite 3(X), in Salem.
prop-own.pm4
1/94
CIT' JF TIGARF) -- RECEIPT OF PAN'MFNT RECEIPT NO. s95-267650
CHECK AMOUNT 1 34. 13
NAME s JOHANNES, MARGARET CAqH 4MOUNT t �.00
ADDRESF v 10590 SW CENTURY OAK DP PAYMFNT DATE : 07/06/q5
TIGr,RD, OR SUBDIVISION s
9"72 '4—
PURPOSE OP PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMnUNT PAID
BUILD?WG—' ERM_ iT(.TP'9 5--0 P.4 9— 1. 63
TOTAL AMOUNT PAID 34. 13
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CLAD
FRENCH SLIDING DOORS
Desi�r
S E R I E S Scale 3" = t'O" INSTALLATION DETAILS: 2 x 4 Frame and Brick Venter
THRU WALL CAVITY FLASHING 8-21
RECOMMENDED AT HEAD
SUGGE51'FD I'SF.c)F INSULATION
TO FILL ALL oUIDS AT DOOR
PERIMETER BY OTHERS
WOOD TRIM BY OTHERS
WHENOR OTHER
UNSTABLE SHEATHING
IS USED,
PROVIDE SOLID BLOCKING FOR
FIN ATTACHMENT
FIN 1T HEADD ND JANIBS ELATION
SHIM AND PLUMB UNITS AS
.. AS REQUIRED
\ BACKER ROD AND SEALANT
c� BY OTHERS
buz] PROTECT UNITS FROM EXCESS
$ W MORTAR WHEN PLACING BRICK
9E 2 AROUND OPENING
25 fE
HEAD
I
A -
�I
1/4" FRAME
(fi1 _ DOOR OPENINd
JANIB
SET UNIT IN CONTINUOUS SEALANT
��� OPENING MUST BE LEVEL PRIOR TO
INSTALLING UNIT
SILL
NOTE:THESE DETAILS ARE FOR TYPICAL SINGLE PUNCH OPENINGS.
SEE VOLUME 3•-APPLICATION DATA FOR MULTIPLE-UNIT DETAIL CONSIDERATIOINS.
� a�arisa�ana !
CLAD
FRENCH SLIDING DOORS
S E R�gner THERMAL PERFORMANCE DATA
x-s
General Notes:
• Performance data is based on the WINDOW 4.0 computer program for analyzing Inside screens.blinds and shades improve U and R values.and they lower'he
wind„w perfornnance shading coefficient from values shown. Refer to Volume 5-Application Data
• Tetal unit"U"and"R"data represents units of site A us ,e 1/8"glass and units of for thermal periomr nce of Pella"between glass"accessones
size B using 4mm glass. All data for I"I.G.is using Amt glass. All other data
represents units of size A evaluated with 1/8"glass.
_- Winter (11 (1) 12) (2) THestTrans-
(Jl dL Visible
DESIGNER SERIrS� Center- Total Unit Total Unit Inside %relative humidity Center. Light
CLAD FRENCH SLIDING DOOR Glass"U•' "U" "R" Glass when condensation Glass 1.81. Center-Glass)
Value Value Value Surface appears on roomside Shading Damage Trans•
Type of Glaring A B A 8 Temp.("F) center of glass Coefficient FunHlon mission
SMARTSASH"' 11 SYSTEM
IV Clear with 118'^oar DGP 0.51 0.47 2.13 --- 45 40 0.811 183 55 0.59 81
1f8'Clear with 1/8'low•E DGP 0.38 0.40 2.52 --- 51 50 0.63 169 45 0.50 74
1/;'•PAm with 1/11'Clear DGP 0.31 047 •-- 2.13 ••. 45 40 0.70 148 31 0.37 61
1/11'BroiiL+wM 1/8'low-E DGP 0.38 0.40 2.52 --- 51 50 0.65 135 25 0.32 56
1/8'Gray with IV Clear DGP 0.51 0.47 2.13 --- 45 40 0.66 119 28 0.35 54
1/8'Gray with 1/8' w•E DOP 0.38 0.40 •-• 2.52 51 50 0.60 126 23 0.31 1 50
SMARTSA`,H" ill SYSTEM
I 5/s'Clear I wl.18'Clear DGP 0.32 0.37 --- 2.73 --- 53 56 0.81 168 47 0 52 75
516'Clear I.O.wl 1/8'low-E DGP 0.25 0.33 --- 3.07 •-• 57 63 0.75 154 39 0.45 69
51s'IneWShieldMI.G.vo 1/8'Clear DGP 0.20 0.30 ••. 3.39 --• 60 70 0.44 90 12 0.29 65
5111'InsulShield I.G.w/1/8'low-E DGP 0.18 0.28 3.62 61 74 0.41 85 10 0.26 80
INSULSHIELDID `(GLAZING
5/8'InsulShield HM I.G.w/118'low•E DGP 0.12 0.25 3.97 --- 63 80 0.37 75 1 0.18 53
SMARTSASH"' -1'I.G.
1'Clear I.G. 0.49 0.47 0.47 2.14 2.11 45 41 0.87 182 55 0.59 82
l'InsuL9*d I.G. 0.25 0.34 0.34 291 2.93 57 63 0.46 96 14 0.32 71
1'Bronza/Ctear I.G 0.49 0.49 0.46 2.04 2.16 46 41 0.67 141 25 0.32 56
( 1'Gray/Clear I.G. 0.49 0.46 0.46 2.17 2.16 46 41--- 0.62 132- 25 0.33 50
I (1) Unit size and type are based on ASTM E1423.91: (3) UV Transmission is the transmission in the.30 to 38 micron wavelength range
A=72"x 82"frame size B-72"x%"fndme size
(2) Based on glass system only at d outside temperature of 0' F.inside temperature o1 141 LBL Damage Function is a new function developed by Lawrence Berkeley
10"F,and 15 mph outside wind. Roomside barriers to imerior air Flow(blinds. Laboratories which considers the damage effects of both UV light and visible
shades.drapes,and screens)improve U and R values,rod tend to lower inside glass light. It is a better predictor of fading potential through glazings than u
surface temperature and humidity levels at which condensation occurs. Outside measurement of UV transmission alone. Low LBL Damage Functions pre
screens tend to raise inside glass surface temperature and the level of relative h tmid- dict low levels of fading
itv at which condensation first occurs. Condensation mass appear at edges of glazing
at lower indoor relative humidity.
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• Residential Building Permit Awlication
City of Tlgard
13125 SW Flail Stvd.
r1g81d, OR 97223
(R)3) 639-4171
10590 S.W. CENTURY OAK DRIVE
_
8ubdrvlolon: TIGARD, OREGON 9" tot# 34 Office!A90 Only
PlanckiRec #
Valuation: apnrox.S2.000.00
Comer Lot? Y N Permit#
ag Lot? Y N Reis�uc� cf _
Map A TL Op - z 700
K. Keu & Margaret JOhannes
------- %Waco caul e
s, 10590 S.W. CENTURY OAK DRIVE
TIGARD, OREGON 97224 Planning .-
---- Engineering
Phr ; 684-1019 WORK: 244-0158
Other
✓C,ntractor: OWNER
ms Reaulred
Address: SAME — Subcontractors
— -- - - ------ Truss Details
Phone: —_ _ Other
Contractor's License #
(attach copy of current Oregon license)
Contact Name & Phone:
Subcontractors: Archltect/Englneer:
Plumbing: Address:
Mechanical:
(attach copy of current OR Contractor's License)
Phone:
truss roof (side wall) put in 4" x 12" header. Install one pair 6'-0" x 6'-8"
exterior sliding doyrs. Move refrig. to :yew location. Move the stove
JOB DESCRIPTION: over 21 , Remove 4 -0" section of i►c n hearing wall. Make it into a nodi
wall. Electrician will get own permit. (T-Electrical 629-8664)No electrical
utlets in wallre 1'ding dooI will be installed.
Applicant Sig nat & h' e number
Received by: �1(� _ Date Received: S
Permit d Account Description Amount Amt. Pd. BA ifue
01
Bldg. Permit (BUILD) JD 3
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mach:
Plan Check (PLANCK) r 1 3 7 1
Bldg:
Plumb:
Mach: �_ M
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF MF-R)
Mass Transit TIF (TiF-MT)
Commercial TIF (TIF-C)
Industrial TIF MF4)
Institutional TIF (TIF-IS)
Office TIF (71F-0) ^�
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) _
TOTALS: ��!
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CITY OF" T I GARD - RECEIPT OF PnYMF:NT RL C:E I P'T NO. :95-P67533
CHECK AMt)UNT t 21. 13
NAME JOHANNES, MRS. M. CASH AMOUNT 0. 00
ADDRESS a 10590 IOW CENTURY (-)AV DR. 4,PYMENT VATF: : 07/03/95
TIGARD, OR 5IJBDIVISION a
9;c 2Q--
PIJRV,Of..,E OF PAYMENT FIMOUNT PAID PURPOSF OF PAYMENT rotntiN, Pnin
Pl_AN CHFC'K F'F 7- 3R 21. 13
TUT'AL AMOUNT RAID - - ? 21. 13