14954 SW KENTON DRIVE .. �n...r�cvnwa�w+wwV•wwat� ..
g14��JwNiii9Y.«.w�+ .uwwr�''ri*.a.r+�sitk;�MMr�W,i�M�'N7Y/WiN41� ,ki�nuwwry�t'a•�,,,baWW'Ma�uii?:FMW�N'N7��larriM :,..aau a�,.a:xti,H:.:.
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14954 SW KEN'1VN C^iVE __
RYOFTIFARD
RD CERTIFICAX
COMMUNITY DEVELOPMENT DEPARTMENT WN OCCUPANC.YOF
13125 VN HWI Bwd.P.O.gm nW,I lgmM,Orow n gi (603)4R74176 PERMIT #. . . . . . . : MSTq i Oia.39
S37 4171
PATE
5ITE ADDRESS. . . a 14Y54 SW KENTON DR PARCELi 201122-CS-A0139
"iUDDIVISION. . . . 9 ASHFaRD OAKS 3 ZONTNGz R-7
A-00K. . . . . . . — . 1 LOT. . . . . . . . . . . . . 1139
,L ASS OF WORK. oNEW
'C vr,p of USE. . . #6F
OCt.UPANCY GRP. iR3
OCCUPANCY LOAD1225 4
TENANT NAME. .
Remarks?
Ownvr:
MELVIN WAYMIRE
1PO BO'X 231164
TIGARD OR 97223
llhonr- #a 639-6742
MFLVIN WAYMIRE
l-,O BOY "11164
ll(,s4Fu OR 97223
1-1ho— #s 639-6742
Re(I #. . v 315975
Occttparozy of the aburef,-rence,A buildiixg is hertaby given, and ce%^tifies
i�ho coNplianre with the State Of Oregon E:,,.wc-ialty Codes for the groltp,
occ=upancy, &,,,I t.%.e t,,tider which the reference p-wmit Was i %supd.
C'
FT RE: DEPARTMiENT UILDIN6C:.T r
BUILD,
POG3T IN CONST 10JOUS PLACE
�NSPSCTION NOTICE
City of Tigard Building Department
13125 611 Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec--o-Phone): Z:39-4175 Business Phone: 639-4171
i
Inspection: - — —
c.x:tinq Pibg. Un rlab !tech. Rough-in C ApprJSdwlc
Pound. Plbg, Top Out Gas Line FINAL:
Post/Beam Btruct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plug. Underfloor Nater (Line } Gyp. Bd. -Koch.
DateRequented: `5 /-/ � _ _Time:
Addt ;i,: _�Z/ L T Permit
Builder-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspectoor�rr:!� (i, _ L/ rate.
IiV�ip►PPROV?D DISAPP O D _ APPROVED SUBJECT '_fl ABOVE.
��� Call For Reinap.
INSPECTION NOTICE
city of Tigard Building Department
13125 SW Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbq. Underelab Mach. Rough-in Appr/Sdwlk
Found. Plbq. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbq. Underfloor Water Line Gyp. Bd. Hoch.
L - squested: � T 1 �- _Time: AN _ PH
Address:�1 Tlf - Permit
Builder:.
THE FOLLOWING CORRECTIONS ARS REQUIRED:
f
j
C'
inepectoVAPPROVED
^�,► baa ts:
DISAPPROV`D APPROVED SUBJECT TO ADM
Call ftr FAinsp.
IN$PECTZON NOxI41[
city of Tigard Building DePsrtleent
13125 SA Ball Blvd. Tigard, Oregon 97223
Inspection Line (pec-o-Phone): 639-4175 Buulneee Phone: 639-4171
Inspections _— --- -
Underalab Much. Rough-in E Appr/Sdw1k
Foct'ng Plbg. 6
F, Plbg. Top Out.
Gap Line FINAL:
Poet/Bea. StrucY.. Sen. S(PnBr
Framing -Bldg.
Post/Ream Mech. Rain Drain
Insulation -Plumb.
Pl.bq. Underfloor Water. Line Gyp. Bd.
6
h.
` _ rK
J TimA+
Date Requested:—
`
/ �" Z. Permit is
Ada �ae: f
Builder:
THF FOLLOWING CORRE IONS AAE REQUIRED!
Com,.,-�G�, _��,�, �•�.—.------
Inspector: <<
APPROVED DI8APP _S)APPROVED SUBJEOT TO ABOVE
call ForrAinsp-
i
I
INSPECT, I�IU�I +f-
City of Tigard Building Departaant
13125 SW Nall Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Bunineee Phones 639-4171
Inspections --
Footing Plbg. Underelab Mech. Rough-in Appr/Sdw1 k
Found. P1bg. Top Out Gas Line FINALS
Past/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Koch. Rain Drain Insulation -Plumb.
Pibg. Underfloor Water Line Gyp. ed. -Mach.
yy
Date Requested: / Time: AM 7,is PM
Address: �l 130 01 1r� Q�� 4
THE FOLLOWING CORRE IONS AAE REQUIREDs
Inspectors �—� '4` � Dates-
APPROVED DIB ROVED APPROVED SUBJECT TO ABOVE
call For Reinep.
INSPNCTION N0-X198 �
City of Tigard Building Departsmot
1.3125 SM Ball Blvd. Tigard, orogon 97223
Inspection Line (Ree-O--Phone)s 639-4175 Business Phones 639-4171
Inspections,.,`___
Footing Plbg. Underalab Mech. Rough-in Appr/Sdwlk
Round, Plbg. Top Out Gna Line FINAL:
Poet/Ream Struct. San. Sewer Training -Bldg.
Pont/Ream Aoch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Lina �yp. Hd -Mech.
Date R4 nsented:1 _j�___— Time: AM —PM
Addreae: .L_._ : �_ Permit t:
Builder:^�//.At.��7._��J
THE FOLLOWING CORRECTIONS ARE REQUIRED:
0
InspectorsA-Z
( -
APPROVED DISAPPROVED APPP.OVED SUBJECT TO ABOVE
Cell For Reinap.
!f10F`ECTION NOTICE
City of Tigard Building DepartMOnt
13125 aw Ball Blvd. Tigard, Oregon 97223 v�
Inspection Line (Ree-O-PhgAe)t 639-4175 Business Phones 639-4171
Inspection:
Footing Plbo./dnderslab Mach. Rough-in Appr/3dwlk
Found. Plbg. Top out Gas Line FINALS
Post/Beam Struct. San. Bower Framing -Bldg.
Past/Be .m Hach. Ral.n Drain Insulation -Plumb.
Plbg. Underfloor Water Line
Gyp. Bd. -Moch.
Date Requested: �c�_5/ �/(J Timet ��11�y PH
Addresee- /-/`1 7 7 L" _T Permit #����U�
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
t
i
Inspectort_
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call !or Relnsp.
INSPZCT12F NOTICE
City of Tigard Building Owpartiment
13125 SW Hall Blvd. Tigard, Oregon 97223
Insp,acti.on Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Underelab Hoch. Rough-ia Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Post/Detam Struct. San. Sewer Framing -Bldg.
Post/Ream Moeh. Rain Di in Insulation -Plumb.
Plbg. Undorflcxsr Water Line Gyp. Bd. -Hoch.
Date Reques/t:edt �f 3 ^ —�� Timet
1 AMC j
Address: �l"1/1 � :; �+ Permit #e l 4)"2J 7
;7
Tile FOLUMING ("P#gCTIONS ARE REQUIRED:
Inspector: __ Date:'
_APPROVED DISAPPROVED APPROVED SUBJEGC TO ABOVE
Call For Reinsp.
IN Y CTION ��$
of Ti.gar' itat'idinq pert"
1'3125 Bp li.11 Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Phone): 639-4179 Business Phone(!�p= "'----
Inspection•
Appr;Sdwlk
Footing Plbg. Underal.ab wCh. Aough-lq
(fa■ LiM Ft AL:
pound. Plbq. Top Out
Poet/Beam Struct. San. Sewer
Framing -Bldg'
Rain Drain
insulation "Plumb'
Poet/Beam Meet:.
deter -Li�njw
Gyp. Bd. -Mect.
plbq. Underfiooc
Date Requ"Hted:
YeroniV#S 'a�
Address:
Builder:
THE gOLL(YAING CORRECTIONS ARE REQUIREDS
i
r
- t
---
-------------• Dates_ --
—
Inspector. ----- —
APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE
call For Reinsp.
I_NBPSCfION NOTICE /�
City of Tigard Building Department
13125 SW Ball Sled. Tigard, Oregon 972231
Inspection Lino (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:_
Footing Plbg. Onderelab /Noah. Rough-i_n Appr/Sdwlk
Pound. Qlbg�!,pMt Line
FINAL:
/I
Post/Beam Struct. San. Sower "from nq -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plhg. Underfloor Nater Lino Gyp. Bd. -Mach.
Date Requested:_ _ 0 ' Z
l./ -----Timet t+_�'�,-y 4YAN pP�N
Address: `' 1 /y�1� h�/ . Permit 1
Builder:_.._((
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector: ✓��' _` _ r� —�
-- - _.— -_..------- --- Date: _—Wit--- -Z----. :
APPROVED _ DISAPPROVED APPROVED SUBJECT TO ABOVE
--Call For Reinsp.
INSPECTION NOTICE ��
City of Tigard Building DeparUoent
13125 ON Hall Blvd. Tigard, Oregon 97223
Inspection Gine (Rec-O-Phone): 639-41.75 Businasa Phone•. 639-4171
Inspect.ion:__ ----- —
rooting Plbg. Underelab Mech. Rough-in Aker/Sdwlk
Pound. Plbg. :'op Out
Ga[, Line FINAL:
-Bldg.
Poet/Beam Struct. Ban. Sewer Fr.nming g•
Ponc/Beam Meth•
in Drain,. Innulation -Plumb.
p Dnderfloor Nater Lino
0YP Be• -Mech.
-! Timet
Date Requested:_ —
Addreea:
Permit #1
Builder:
_
THE FOLLOWING 00 OTIONS ARE REQUIRED:
9
i
inspectorX
� —.-- --- .-
APPROVED __ DISAPPRIVED _ APPROVED SUBJECT TO ABOVE
call For Reinsp.
I
ML6Y_C_ I:ON N ICE
CI_ty o4 Tigard Bui.idimg Department
13125 ON 8,111 Blvd. Tigard, Oregon 97223
Inspactior, Line (Rec-0-1hone): 639-4175 Business Phon 4 9-4 71
Inslection:yA
Footing Plbg. Unduralab Hach. Rough-in App-/Sdwl.k
Pound. Plbg. Top Out Gas Line FINAL:
`Pkat/Beam Struct. San. Sewer Frra4ng -Bid
Post/Beam Mech. Rain Drain Insulation -Plumb.
. Onderl100!___> Water Line Gyp. Bd. -Mach.
Date Requestedt�
Addres•r �y ,'?r Permit #�
/ : _
Builder!!
f
970= FOLLOW1110 CORRECTIONS AAS REQUIRED:
G
i
J
Inspector: _
PPPROVED DISRPPROVED APPROVED SUBJRCT TO ABOVE. -
--call For Reinsp.
LN-fippgTIOM MD ;
City at Tigard Bui.ldiaqing Departmwnt
13125 Sit 9a11 Blvd. Tigard, Oregon 97223
InspeTtion Line (Rec-u-Phone): 639-4175 Business Phone: 639•-4171
Inspection::
ootingplhg. Underslab Mech. Rough-in Appr/.Sdwl.k
ound� Plbg. Top Out Gas Line FINAL:
V
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Wafter Lin(e� Gyp. Bd. / _Mech,
Date Requested: Timr:yU 3AN ---PM
Address a //y t Permit
Builders ..t._-'
TNM IOMANINO Molle ARR PEQUIR.RD:
Inspector _ __ Date.-A
APPROVND DISAPPROVED APPROVED SIMYEc-r TO ABOVE
Ca11 For Reinsp.
CITY OF TIGARD RECEIPT (IF V.IAYMF-'I\;I' PF(-.EIPT NO, a 9&.' i"'22482
CHECK AMOUNT 4750. 98
NAME WAYMIRE, ME: LVIN 0. 1 SL OR CASH AMOUNT 0. 00
P. O. BOY e,31164 PAYMEN'r DATE a 01/27/92
I-TGARD, OR sti9r)I v 113 10114
9
PURPOSE Of" PAYPIE'NlAMOUNT PAID PURVIOSE OF PAYMENT AMOUNT PAID
RM
41P. 00 PLUMBING PERM 147. 50
MEC"01%1 I COL PE 314 00 93T. BUILD PER 29. 9 1*3
FLAN CHECK FE 27. 55 Sfr-WER LISA 1900. 00
SEWER IN5PECT 35. 00 PARKS SVC 500. 00
STORM DRATN SDC 280. 00 MAGS TRANSIT TIF FEES 100. 00
RESIDENTIAL TRAFFIC FEES 1280. 00
TOTAL AMOUNT PAID
cinrOF TIGARD
=OF mAs-rER PERMIT
I
COMMUNITY DEVELOPMENT DEPARTMENT Ai AD #. . . . . . . .. MST91-0239
cff� 7
1326 SW HWI Blvd. P.O.BM 23M.TOW,Orepn 9��'(SW)6X4176 011119M
Cr7
'jITE ADDRESS. . . .- 14934 SW KENTON DR PARCEL: 2S112C8_A0139
SUBDIVISION. . . . : ASHFORD OAKS 3 ZONING: R-7
BLOCK. . . . . . . . . . . LOT. . . . . . . . . .
BUTt-DING
RE I SS31JE: DWELLING-UNIT';: l BASEMENT. . . . . . . . ^ f
CLASS OF WORK. sNEW BEDf?MS:--- BATHSs3 GARAGE. . . . . . . . . . :4e8 S
TYPE OF USE. . . iSF FLOOR AREAS-.--------- RFOUIRED SETBACKS---
TYPE JF CON-JT. :5N F I RST. . . . : 1007 s LEFT. . :7 f RIGHT.
OCCUPANCY GRP. -R3 SECOND. . . :80;*3 s FRONT. :,:-0 ft REAR. . :24 f
STOk T ES. . . . . . 12 THIRD. . . . :0 s f RE QU I R F D-----------
HEIGHT. . . . , - - . :25 ft TOTAL--- ---: l8J0 5f SMOKE DETF.CTORS. :Y --------
FLOOR LOAD. . . . :40 psf VALUE. . . . . $ : 92044 PARKING SPACES. 0
Remat,ks :
------------------------------------ PLUMBING -----------------------___--- --
SINKS. . . . . . . . . : I FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O ------- ---
LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . ..@
TUB/SHOWERS. , . . :3 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE (ft ) . :o GREASE TRAPS. . . . . . . :o
DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :o
GARBAGE DISP— sl RAIN DRAIN (ft ) . :0
WASHING ,iACfJ. . . : 1. GF RAIN DRAINS. . : 1
MECHANICAL FEES
FUEL TYPES-.-.-.-.-.-.- UNIT HT RG. . :0 t y 1:)e amount by date
/GAS/ VENTS . . . . . :0 TIF' s 1360- 00 JLH 01/17/92
MAX INPUT.0 BTU VENT FANS. . :4 SPRT 1 412. 00 JLH 01/17/92
FURN ( 100K . . : J HOODS. . . . . . .. I BPLC $ 267. 80 JLH 12/23/91 .:,2i092,
FURN ) =100K . . .-o WOODSTOVES. :0 891PC $ i20- 60 JLH 01/17/92
FLOOR FURN. . . . :o CLO DRYERS. : I SSDC $ 280- 00 JL . 01/17/92
BOIL/CMP < 31 !r_,6,0
OTHER UNITG:0 PARK $ 500. 00 JLH 01/17/92
Owner,- GAS OUTLETS: 1 MPRT $ 39- 00 JLH 01/17/92
MELVIN WAYMIRE ------- MPLC $ 9. 75 JL.H 01/17/92
PO BOX 231164 m5pc $ 1. 95 JLH 01/17/92
PPRT $ 1.47. 50 JLH 01/17/98.
TIGARD OR 97283 PSPC $ 7. 38 JLH 01/17/92
Phone #: 639--6742
MELVIN WAYMIRE
-0 BOX 231164
TIGARD OR 972d3
Phone 0: 639-6742
Reg *. . s 35976
This permit is issued subject to the regulations contained in the $ 3065. 98 TOTAL
REQUIRED INSPECTIONS
Tigard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Fit-eplac.,e Inst,.
applicable laws. All work will be done in accord with approved Post/Beam 9' rust Gas Line Insp
... U
plans. This permit will expire if work not rt within 180 Post/Seam Ple,chan Insulation Insp
days of issuance, or if work is suc an 188 days. Plm/undslab Insp Gyp Boat-d Insp
PLM/(Jndet,f I oor Rain drain Insp
echonical Insp Water-, Line rl-,P
'Ssl..ted fly , NUMb 70P Out APPt'/ScJw1k fnsp
Framing Insp Mechanical Fina !
C,111 for inspection 639-4175
5FWPR CONNECTTON
CITY OFTIFARD PFRMIT
TMItD PERMIT #. . . . . . . : c
AD ��WRqj�__o
COMMUNITY DEVELOPMENT DEPARTMENT MOM .015
13126 SW HWI Blvd P.O.Sm 23M.T4",or*@_ c. 76
* DATE ISSUED: 01 /21 /9,n
'*.'ITE ADDRESS. . . . 14954 SW KENTON DR
5UBDTVISION. . . . : ASHFORD OAKS 3 PARCEL-: 2SI12CB—AO139
BLOCK. . . . . . . . . . j t OT... . . . . . . . . . . . : 139 ZONING: R-7
TENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS,
CL-ASS OF WORK. . . :NEW DWELA...ING UNITS. . :
TYPE OF USE:. . . . . :Sr NO. OF BUIL.DINGS.- I
INSTALL TYPE. . . . :BUqwR IMPERV SURFACF. -,f
Remark S : I
Owner.,: FEES
MELVIN WAYMIRE type Amot.int by dato
PO BOX 231164 r-ecpt
PR M T 1900- 00 JI-H 01117192
$
TIGARD OR 97i:_'23 3'- 00 JIJA 01/ 17/90 '
PV)one #: 639--6742
Contr-artot
CONTRACTOR NOT ON FILE
Phone #i
Req $ 19313. 00 TOTAL
REQUIRED INSPECTION5
This Applicant agrees to C01PIV with all the rules and regulations Spwet, Jnnpection
Of the Unified Sewage Agency, The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
Permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the leasureAent
given. the installer shall prosoect 3 feet in all directions from
the distance given- if nf;t so jocatpd, the install IUII ourchase
a 'Tat) and Side Sewer" Permit and the wi ns all a latirai.
and
t
By:
Call for' inspection 639-417;
PLUMBING PERMIT
' �
PERMIT #. . . . . . . .. MST91.-.-0239
OFTION� rcivy4ywm
COMMUNITY DEVELOPMENT DEPARTMENT 01/21/92
W268WHWISIVd.PABOX23397,TlpM.OMW Of (9N)N*4175 DATE ISS
PARCEL
SITE ADDRESS. . . : 14954 SW KENTON DR ZONINGS ESIIECB -AO I314
SUBDIVISION. . . . a ASHFORD OAKS 3 : R-7
BI-OCK. . . . . . . . . . a LOT. 1139
CLASS OF WCJRK. . oNEW GARBAGE D I SPOSALS.
TYPE OF USE. . . . sSF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. » aQ,
OCCUPANCY GRP. . tR3 FLOOR DRAINS. . . . . . . fO TRAPS. . . . . . . . . . . . . . a0
STORIES. . . . . . . . 12 WATER HEATERS. . . . . . 31 CATCH BASINS. . . . . . . :0
FIXTURES--------------- LAUNDRY TRAYS. .. . . . . 10 SF RAIN DRAINS. . . . . ; I
S I NKS. . . . . opo - 11 GREASE TRAPS. . . . . . . ..IP
LAVATORIES. . . . . c4 OTHER FIXTURES. . . . . SO
SEWER I...I NE (f t ) - - - - 10
TUB/SHOWERS. - . - t WATER LINE (ft) . . . . 4 lkZ
WATER CLOSETS— :,i
RAIN DROIN (ft) . . . . :0
OWNER:
IIELVIN WAYMIRE TIF $ 1380. 00 JLH 01/17/92
1 ,(,l LA()X 231164 BPRT $ 412. 00 JLH 01/17/92
BPLC $ 267. 80 JLH 12/23/91 22109-',
I'IGARD OR 97223 005PC $ 10. 60 JLH 01/17/92
',hone #1 639-674E SF)DC $ 280� 00 JLH 01/17/98
PARK $ 500. 00 JLH 01/17/92
Plumbing Contract Or MPRT t :3'). 40 JLH 01/17/92
MPL C $ 9. 75 JLH 01/17/98
m5pc $ t. 95 JLH 01/17/92
Addre s PPRT $ 147. 50 JLH 01/17/92
7. 38 JLH 01/17/92
P.- 0 n e#I.
rPEGJ I ONEi
REOUTRED IN,
r.)ermit is issued subject to the v-@9- Foot /found I-,isp Pair, drain Insp
i.sJ.ations containpd in the Tigard MUniCiPrill prjst /peaq Struct ,, ,ter Line lnrp
State of ol-e. Specialty Codes and all
ottley- appliamb) e dawn. A,., work will by I clone post /Beem Mochati Aipr/SdWlk Inst:
in accordance. witk approved plans. This undslab Insp M !chavjical Final
,@t-,mit will e�cpire if work is not ;�tArterj pl..M/Uri dz r f I o c)r Plumb Final
of if work is Mechanical Inqp Building final
within 100 days Of i,ssual-lcel Plumb Top nut Erosion Control
,;;..;Spended For wore that, 180 days. Framing tnsp Crawl Drain
Gari Line In%p
I q ulation ItIsp
Insp
ctor
Gep Board
n a k—t..—It
Put tj or i z ed P1umbinr Cont
I- for inspectbon 639-4175
ror,t r a c t or, Not e F; -
L----------------
i
r�
r
r
CITY OF TIOAPD Fi .f." TF!Y OF PAYMENT RECEIP*r h,ff?,
d fi i;�IF� a WAYM I RE", Mr.LV I N U. , HL DR CHECK AMOUNT a ?�:�1h, 00
1)DRE:,Scj r V1. 0. BOX r:3I 164 CASH AMOUNT k1, pig
T IOARD, oR PA 4F.NT I)AT1:
PLINIPOSF. OF, ppyMl N 1' AMCIUN C 1''Cl T 1:1 1'IJFtFCl£�F OF_ PAYMENT A,10 ANT PAID i
pl FIN CFiE t K �'C_.,.i r. -54 P
f
I
' I
10TAL. AMOUNT PAID � _