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10288 SW 71ST AVENUE-1 �rrsr rrrr 10258 SW 71st I G1 [n 0 I W III W W W W�Wxwx CIW0FTll7ARD 74 CERTIFICATE OF C f I Y�10*T W IRI D T 10 C CU PA N C Y COMHUNrTY DEVELOPMENT DEPARTMENT oftem PERM I T . . . . . . . z MST90 13126 SW 4WI 8W. P 0.80X 23397,T4011d,46gon 07223(WS6W-4175 1 .1 YC AWRESS. I e288 f)W 71"IT AVE PARCEL.i I S I 36AA SUBD I V I S I ON. . . . : AUM DOWNS ZONING: BLOCK. . . . . . .. . . . .I CLASS OF '40RR. CNEW TYPEOF' USZ. . . :6F OCCL PANCY GRP. :Rte! OCrUPANCY L.,DAD- 118 4 Trj4(j- NT NAME. . . : PPmarks : Pet-wit for "Earth 5tovell rivilet 'Jove modk,l TP40 added 9-6-90 Owrerl `J4M 51RICH MNSTRUCTION INC 61455 SW NYBERG LN 1-103 TLPIJ-0 I 1\1 OR q7o6p SAM '3ARICIA CONSTRI.XTION INC: 6455 SW NYBERG LN 1-103 TUALP't IN Uri 97062 61~'67 uccupanvy 01; the above referenced buildinA Is her *by givown, and LLArtjr-.je. % tha compliance with the State Of Oregon �')pecialty c0d1*0 fOr the OVOUP, OcCluparvey, and use 1-trider which the refprenced permit Was iqsktpd. F IRE DFPAF MENTI OP _,DINS UISPEC'T i Li f ,17 PM31- IN CONSPTCOOLj3 r,l-nrtz, INSPECTION NOTICE city of Tigard Building Depart-Aent *3125 SM Ball Blvd_ Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)t 639-4175 Bueiness Phone: 639-4171 Inspection:___ -- --- Footing Plbg. Underelab Hoch. Rough-in hppc/sdwik Found. Plbg. Top Out Gas Line Poet/Beam Struct. SAn. Sewer Framing Post/Beam Mech. Rain Drain insulation -Plumb. PLYxl. underflaoc Nater Line Gyp. 6A. -Huch. 7 / itne: -- �l Permit 4: Addioss•__ 6•ildert,.- THE !'7I.LONING CORRECTIONS ARE REQUIRED: 41 ( 41 C r i. -rc_wt Pu it a.F y 1( v I I1101pactor:_ APPROVED DISPFPROVRn ` APPROVHD CURJRCf To AROV19 Call F,.r Poinap. Maim - NSP CrIOV WM141E City of Tigard Building Department 1312S SM Hall. Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)s 639 175 ,13uniness Phone: 639-4171 :napecf-lon•_ L Fcoting Plbg. Underal Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out C-is Line FINAL: Poet/Ream Struct. San. Sewer Framing -Bldg. Post"Beam Mech. Rain Drain Inuul.ation -Plumb. Plbg. Underfloor Water Line Gyp. Rd. -Mech. Date Requested: 1��� + N �P Address: / ' 7� 5� CPermit #s Builder: THE FOLLOWING OORRRCTIONS ARE REQUIRED: — t "J S. Inepect lt�1 .� 1 ��� -- Date: 2 -CT(I PROVED DISAPPd APPROVED SUBJECT TO ABOVE Call For Reinsp. INSPECTION_NOTICE City of Tigard Building Department • 13125 817 E.*11 Blvd_ Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Bueineee Phone: 639-4171 Inspections__— Footing Plbg. tlnderelab Mach. Rough-in Appr/Sdwlk Found. 01bg. Top Out Gas Lina FLNALa� Poet/Be®m Struct. San. Sewer Framing -Bldg. Post/Beam Mech. Rain Drain Ineulatiorutt:b. Plbg. Underfloor Water Line Gyp. Bd. -Hoch. Date Requeeteds/ 1 I� �G) _Timet __AM Address: r_I(�LTiU -lI Permit �: `�� THF. FOLLOWING CORRECTIONS ARE REQUIREDi Inspectors Dates APPROVED DISAPPROVED _ APPROVED SUBJECT TO ABOVE _--Call For Reinap. t M ■r v w mr WMW INSPF,CTION NOTICE City of Tigard Building Department 13125 BF Ball Blvd_ Tigard, Orogon 97223 \ Inspection Line (Rec-O-Phone): 639-4175 Busineus Phone: 639-4171 \1 Inspection: i Fero ming Plbg. Urderslab Mach. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINALt Pout/Beam struct. San. Sewer Fraying -Bldg. Poet/Beam Mach. Rain Drain Insul.atio.. -Plumb. s'lby. Underfloor Water Line Gyp. Bis. -Meth. Date Requested: �`7 � �LJ ,_Times AM Addreses— �V�O.! �� �t Permit #sy� _ Builders THE FOLLOWING CORRECTIONS ARE REQUIRM vc:••`—cam 6_z z.t L:-.MM Inapectort l _ // _ Datet FR011A0 DISAPPROVED Z_-IIPMIIOVED 8U6JdGT TO ABOVE ____._Call For Reinap. INSYE�TION NfYrICEC /� City of Tigard nuildinq Departs nt ✓ 131:25 SLI Bali Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone): 639-4175 Buainess Phone: 639-4171 Inspections —_ —.___-_-�— ---- Footin, P'bg. Underelab Mech. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. San. Sower, Framing -Bldg. Poet/Beam Mech. sin Drain Insulation -Plumb. PIM. Underfloor Nater Line Gyp. Bd. -Moch. Date Requeated: ��— z) Time: — AM -- / PM Address: __— permit M: �1�'��S* Buiidert THE FOLLOWING CORRECTIONS MP.E REQUIRED: t i L Inspector:._ / nate:__ APPROVED DISAPPROVED APPROVED SUR.,'RCT TO ABOVE Cell For Relnsp. INSPECTION LOOTICB City of Tigard Building Dvparlmeent 13125 SF Hall Blvd. Tigard, Oregon 47223 Inspection Line (Rec-O-Phune)r 639-4175 Business Phone: 639-417 d Inspection: --- Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk Found. Plug. Top Out Gas Line FINAI.: Post/Beam Struct. San. Sewer Framing -Bldg. Pest/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Mech. Irate Rayueste//d��1:_ �� +� ,/U Time: AM 1'M Address: V • If ZZ � Permit Builder: r119 r1lE FOLIANING 00RRECTI0N8 ARE REQUIRED: �''2 Nom'?—.�CI.Q�.-���-�.�'�"i ►lc=._vcl,�1y Inspector: Dat.t1 'r--'T+�- L�- APPROVED DISAPPROVEDAP RP'�D SUBJECT TO ABOVE Call For ReinsP. INSPECTION NOTICE City of Tigard Building Department t j P.O. Box 23397 Tigdrd, Oregon 97223 Phone: 629-4175 f Type of Inspection �`{F��iCC�'r�� Date Requested__� � s TIM8 —TA M. P.M. Address _: / S Permit # ?z2 Owner Lot #_ Builder- The following Building Code deficiencies are required to be corrected: Presented to _ —_ j3proved ( r1 Inspector � _� _ 1.J DlwpproV*d Date CALL FOR REINSPECTION C1 YE8 0 NO INSPECTION N01-ICE City of Tigard Building Department r a P.O. Box 23397 Tigard, Oregon 97223 4 Phone: 639-4175 Type of Inspection �=��/ �_i�vS✓i+,gTu.t„J_ _� ' Date Requested /0 Time �' A.M. P.M. Address /02 � '7/-0- Permit # Owner ---- -- ---- -- Lot # BuudFr The following Building Code deficiencies are required to be corrected: 141r5�511 !c: v — M Presented to Approved Inspector s Oltepproved Date CALL FOR REINSPECTION F-1YES a NO INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Department n,J Tigard, Oregon 97223 it Phone: 639-4175 Type of Inspection Date Requested Time A.IOr P.M. Address / Permit Owner Lot Tho following Building Code deficiencies are required be corrected: Presented to 4.4pproved Inspector U DIapproved Date CALL FOR REINSPECTION F] YES I-] NO MWIWInliff-MMW INSPECTION NOTICE Cii� of Tigard Building Department ✓ P.O. eox 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection /r Date Requested_ %� Tim ) ./ M✓= / M. Address 7/ Fermi Owner / Lot Builder s i The following Building Code deficiencies are required to be corrected: 1 �-%� �.� ��7s/ �Lam- G:•,�•i�v ��- _ __ _ Presented to pproved Inspector �_� Disapproved Dare CALL FOR REINSPECTION YES ❑ NO J INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oiegon 97223 Phone- 639-4175 Ty of lnspecti� Date RequestedTim, A.M. P.M. Address /eQ"'-ee Permit *0- Owner A Lot # Builder The following Building Code deficiencies are required to be corrected: W""/ r� y S Presented to �. kpprovodl Inspector El Disapproved nate CALL FOR REINS ECTION 0 YEA D NO INSPECTION NOTICE -7 .- . City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 97223 Phone: 639-4175 Type of Inspection Date Requested C 1. _. Time A.M. _ P.M. -� Address a� __. 1 _---- — Permit _—__u—` —L Lot # -- Builder ----- The following Builaing Cade deficiencies are required to be corrected: Presented to __ Approved Inspector ___ isapprovpd Date —_ CALL FOR REINSPECTION C7 YE! 0 NO CITY OF T'OARD Ai�� MASTER PERMIT cnyi RD) PERMIT #. . . . . . . : MST90-0276 COMMUNITY DEVELOPMENT DEPARTMENT root PRIM. PERMIT #. i MST90---0276 13125 SW HWI Blvd. P.O.Box 2MG7,Tigiud,Cwegon 97 M. J�03)"6?0,4175 \-,77,// DATE ISSUED: 09/06/90 SITE ADDRESS-- , IOR86 SW 71ST PARCEL: IS136AA-06800 SUBDIVISION. . . . : AU11 DOWNS ZONING: BLOCK— LOT. . . . . . . . . . . . . :2 BUILDINU REISSUE: DWELLING UINITS:1 BASEMENT. . . .. . . . . :0 sf CLASS OF' WORK. -.NEW BEDRM5:3 PATHS:2 GARAGE. . . . . .. . . . . :440 s TYPE OF USE. . . :SF FLOOR REQUIRED SET BACKS-------- _•-•••• TYPr.,-. OF CONST. -.9N FJRST. 1.529 Sf I.EF'T. . :6 ft RIGHT. .- J.2 ft QCC,UPANCY GRP. sR.3 SECOND. . . :0 S-f FRONT. :20 -Ft REAR— :40 ft JORIES. . . . . . . .. I THIRD. . . . ..0 sf REQUIRED-.-.- -� - ___._.__._ _.._.._..... it:::I EQUIRED----- I o Frr. . . . . . . . .. le ft TOTAI -. 1529 Sf SMOKE DETECTORS. :Y i:'LOOR LOAD. . . . ..40 ps-f VALUE-- $: 73938 PARKING SPACA-E."S. . .0 -nia-rksa Pernii.t for "Earth Stove" pellttt atove niode.1 TP40 added 9--6-90:1K ................ r,:1LUMPING SINKS. . . . . . . .. . . .. I FLOOR DROINS. . . . :0 BACKr-LOW PREVNTRS, . :0 I AVATORIES. . . . . ::3 w AT P.,r. HF..mT E R 13. . . - I TRAPS. . . . . . .. . . . . . . . ..0 T`UB/SHOWERS. . . . :2 LAUNDRY 'TRAYS. . . -.0 CATCH BASINS. . . . . . . :0 WATER CLCSETS. . :2 SEWER I INE (ft) . ..0 GREASE TRAPS. . . . . . . :0 D1,SHWASHERS. . . . : I WATE I ",R LIME (ft) . : 100 OTHER FIXTURES. . . . . GARBAGE DISP. . . : I RAIN DRAIN (ft) . -,:0 WASHING MACH. . . : 1 Sr' RAIN DRAINS. . -. I FEES ........- UNIT HTRS. . .-O type aniMtllt by date /GAS/ VENTS . . . . . PO PAYM $ 100. 00 JLH 08/06/90 P.0.3401 110X INPUI -F) 1.4 TU VENT F'ANS. . c 3 9 I'D C $ 600. 00 I URN ( 1001! . . cl HOODS. . SODC $ 375.00 WOODS;.0 a�� FURN >-1001,1, . . .-0 �F. PARK $ 250. 00 Ff..-OOR F11RIA., . . . .0 CLO DRYERS. : I 11PRT $ 36.00 P(J'[L/C M F) ( 3 H P-0 OTHER UNI TSa ' MPLC $ 9. 00 GAS OUTLETS-41. 1151-IC $ 1 . 80 P P R*r $ 125. 00 011 SARICH (:IIONST'RUCTION 114C r:';1 $ 6. P15 t:;4`5 SW N Y,a E:'.'R G L N 1 103 PPR 1 $ 355. 00 D P L C $ 230. 75 TUALAIIN OR b 5 P C $ 17. 75 11hc)rie "t 503-692-7208 PAYM $ .1906. 55 JLH 08/27/90 �: k.) -I t r a t-t av 11PRI. $ 14. ;50 �.;(-)M SARICH CUNSIRUCTION INC; MSPC $ 0. 73 FA'5!5 SW 101.1F."R63 LN 1-1.03 Y 11 $ 15-23 BCR 09/06/90 1 (-I()L ATI N OR 97066 Jr:'JJ(:)rie "." ',503-69P-7208 #. . n bi267 $ 2021. '78 TOTAL This permit is issued subject to the regulations nontained in the REQUIRED INSFIECTIONS Tigard Hunicipal Code, State Of ON. 3pecialty Codes and all other J-.,o0t/fOUnd Insp MpchariicAl Insp applicable laws. All mtk will be der* in accordance with approved Wtr Proofiiiq Bmni PlLtmb Top OUt plans. this permit will expire if work is not started within 19 Post/Pearn Strt,tct Framinq Insp days of issuance, or if work is suspended for 0 than i,W)Wys- Post/Beam Meehan F'ireplace Insp C-ra w 1. D rAJ.vi Gas Lirle Insp Plnl/Mid!;I-ab p k.t e d 14 v FILM/Unde-f-f lar,r Gyp Board Insp ............. .................. F'tviq Drain F.snivt RAJ.o dy,Aiii Irimp Cal;. f'c)-(, I vis pec.,t iu 11 639-4175 l ' CITY OF l')GARD RECEIPT OF PAYMENT RECEIPT NO. s 90 204467 CHECK AMOUN'T5 2 NAME SAM SARICH CONSTRUCTION CASH AMOUNT 0:00, ,I)DRESS s 6455 SW NYBERG LANE, PAYMENT DATE e 09/Clb/90 SUTTE 1-103 SUBDIVISION TUAL ATIN, OR 97062— 10288 SW 71ST F'UPPOSE OF PAYMEIAI AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAIL ME CHAN I CAL.. PE 14.Z 0 ST. BUILD PER 0. 73 �:"EFER TU% MST N90-0276 10TAL. AMOUNT PAID t5.2-1 IA IIS ® W W /l INSPECTION NOTICE City of Tigard Building Department P.O. Box 23397 Tigard, Oregon 971'23 / Phone: 639-4175 Type of Inspection Date Requested L 61L — Te ' ""H• � r P.M. Address __ a Z� Permit Owner ,c,�.._ Lot # BuilderThe following Building Code deficiencies are required to be corrected: +611 ,�o c,✓ yo.,vr ��'���-- _ — I �aG�y P�Si�v _ •me r` r. iiei Presented to --- Approved I ❑ Disapproved Inspector _- Date CALL FOR REINSPFCTION 1 YES I I NO CITV0FTIGARD MASTER PERMIT* � COMMUNITY DEVELOPMENT DEPARTMENT ClTYMG PERMIT » • » . : MST90-0276 13126 SW Hell Blvd. P.O.Box 23397,Tigard,or.gon 97 3 }� P F�I M» PERMIT 4i. i*I S T'�0••-0 2 7 C 4 DATE: ISSUED: 08/27/1)0 10288 SW 71ST PARCEL: 1S1360A 0f,flt: o Sl. BDIV]:;31'0N. .. .. » .: AUM DOWNS ZONING.- I..OT'. . . » .. ., . ,. » ._ . .. :A7 BUILDING REISSUE: DWELLING UNITS: 1 BAS11HEN'T'. .. . . . . » . :0 sf CLASS OF WORK. :NEW BEDRMS:3 BATHS.-2 GgRAGE:. » » . . . . » :440 S'P 'TYPE OF USE. . . :SF• FLOOR AREAS-••-•-••-•-•-•-••••-• :�EQUIRE:D SETBACKS------ TYPE OF CONST. g5N FIRST. . . .. ° i.529 sf LEFT. . :6 ft RIGH'I•. - 1.,2: fr: OCCUPANCY GRP. :R3 SECOND. . .. :0 Sf FRONT-20 ft REAR— :40 ft STORIES. . . . . . . .. 1. THIRD» . .. . ::0 sf RE0U1:RED- -_._W.____._.._...__.._._._._.__......... ITFrTGHT.. . . . . . . . .. 18 ft TOTAL,---- : 1 529 sf SMOKE DETECTORS. ,-Y FL(:IOR LOAD. 40 p s f VALUE. . . .. . $:: 739313 PARKING SPIOCES.. . -0 Ren arks: _.._._...._...__._.._._,__w.,._......._,._.___...___._.._._._. PLUMPING -...__..__.._...._..__.._.._....._. _..._..__.__....__......_._.._.____...._.._ SINKS. . » . . . . . . . : :l FLOOR DRAINS. . . . :0 BACKF''LOW PIREVNTRSi. :0 LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 T'RAVIS. . . . . . . .. . TUB/SEDWERS. . . . :2 LAUNDRY TRAYS. . . -0 CATCH BASINS. ,. ., .. . .. ,. :0 WATER CLOSETS. . -2 SEWER LINE (ft) . :O GREASE DISHWASHERS. . ,. . : 1. WATER LINE (ft) . : 1.00 "►THER FTXTURES). ,. „ » ., r 0 / C;ARBAGE DTSP. . » : :1 RAl:hl DRAIN (ft) . :0 WASHING Mr,,.;H. . . : 1 SF RAIN DRAINS. . 1. MECHANICAL -_._........_._..._.._...._.._._....._ _._..._...._._. ...__..__..__. ._. FEES FUEL UNIT IATRS). . :O type amo►.►nt by date •reept /(.iAS/ / VENT'S . . . . . :0 PAYM $ 100. 00 JLH 08/06/90 211340:1. MAX .T.NPUT:0 BTU VENT FANS. . -3 13TDC $ 6001, 00 F URN < 100K . . : :I. HOODS. . . . . . : 1 GSDC $ 375. 00 t Ul-"tN ):=100K . . :0 WOODSTOVE:S. :0 PARK $ 250. 00 / FL 0 0 R TURN. . . . :0 CLO DRYERS. : 1 MPRT' $ 36. 00 (:01L/CMF' < 31-4V,a0 0THF::R UNITS3:0 I'IPLC 1i 9. 00 GAS OUTLETS: 1 MSPCI $ 1. 80 Clwner: _._.. ._..__ ..__......._ ...._........._.__._,_._..__ _........_...._. ..._ PPR.r $ 125.00 i SiARIC:H CONSTRUCTION INC P5VIC; $ 6. 25 64555 SW NYBERG I 1•_103 BPRT 1; 335. 00 1 / FPLC $ 230. 75 11.1 ALAT'I:N OR `: 70(,2 P PC. $ 17. 75 Fhonr N p 503-692-1208 PAYM 'f 1906- 55 JLH 08/27/90 �:3AM SARICH CONSTRUCTION INC f,4 5 SW NYBE:RG LN 1_•1.0.:3 T UALATIN OR 97062 � hcane N: 503 692 7208 Ra rl N. » : 6126"? _.._._._._.........___..._._.._.._._.... _....___.._.._ ---_._.._ $ 2006. 155 TOTAL This permit is issuer subject to the requlations contained in the --- - - RRQUIRE.D INSPECTIONS - _ _- Tigard Municipal Code, State of Ore. Specialty Codes and all other F'-'oot/found Insp Mechanir.al. Insp applicable laws. All work will be done in accordance with approved Wt•r P-rc►c►fir►g Hsm Plumb 'T'op Out Plans. This permit will expire if work is not startod within 1 Post/F.+ean► Strutt F•ran►ir►g Insp days of ,ssuince, or if work is suspended fat Nore th 181 d s. Post/Peam Meehan F'i•re!placo Insp C-r•awl. Drai.Y► Gas l._ine I►•►sp llor•mi ttee Si.gnaturee . / 1-e." 5_e►r;C1T:'l.m/und%1ah Inssp 1►1s►.►la►ti.on Insp t=��PLM/Underfloor Gyp boa-rd Insp I. �s s e d 13 y a _�_.._. ._ ........__ _..__ F't n g D r a i.r► B s ni t Rain d r a i r► Insp Ca:11. for :ir►spection 63'd -41'75 UUUU UUUU 1 -10 -7, SEWER CONNECHON P E R M 11' cn C CI7YOFTIGARD j - Pl.-�RMI*I' It. SWR90--0330 yOFTMAND COMMUNITY DEVELOPMENT DEPARTMENT MG190 0;.2 7 6 13125 SIN Hell Blvd. P.O.Bax 23397,TIgaM,Oregon 9M.0046"75 VWTE 15131JED. 03/27/90 ADDRE 10288 SW 71ST 14)RCEL: IS1.36A0 1,)6(:100 0.. Stfl'.4DIVISION. . . . Z J N I N .) - , - AL01 DOWNS) P I OCK. . . . . . . . . . . LOI . . . .. . . . . . . . J'ENONT NAME. (JSA F .1X1 L)R E (JN 1 FS. C'I ASS Cl WORK. 1,1E.W 1)W E.L L 1:N G L)INIT I'S. :1. 'I YPE OF LISE. SF NO. OF BUILDINGS.- I INSI'01-1- TYr-`r:. . . ,, .BUSWR 11,11-DERV S(JRFACE. -.sf R(-.4 111 i;k-r lk S Owlle-rt: 5AN SARICH CONS1'RW."I'1011 1114C.' t,Y Pe i.-Inlak.tl-lt b Y (J a t -rec.,Pt (-',-1.-55 S;» NYBERG LN 1-103 1*-,,R 111' $ J.5(40., 00 1.N S V, $ :3`5. (do TIJALATIN OR 97062 1----A Y M $ 3,535.00 E(CR 08/2?/90 I-Ifiorie Na 50:3•..G92•-7F_'08 NO'T* ON FILE $ 1.535. 00 TOTAL R REPUIRED INSPEC"JIONS fhis Applicant agrees to comply with all the rules and regulations 5VW(-r Tllspectic)ll of the Unified Sewage Agency. The permit evpires i20 days from tne date issued. The lotal amount paid will be forfeited if the ............... ....... permit expires. The Agency does not guarantee the accuracy of the side sewer laterali. If the sewer is nit located at the measurement given, the installer, shall prospect 3 feet in all directions from ......... the distance given. If not so located, the installer shall pur hese A "Tap and Side Sewer" Permit and the Agency wild install Ar to/r/1. ............ 1)e-rniittee 13j Ia iiAti.i-re: .1% (I e d B Y I C a I I fa-(, i ri s p e c t i c)ri 6 39-41'75 TY OF TIGARD Pl..':(."::EIPT OF F-,A'ellEt4T RECEIPT r,40� 40t CK-T.'K AMOUNT I (p")'. W A ME SAM SARIC.H CONSTRUCT' 314 CASH AMOUN r (). i)(- ADDRESS e-)45,:o SW NYFIEPL3 LN PAYMENT DATE y Ci8rc:t6 S 1.1 F,11D I V I S I ON TUALAI I N. OP q7062-- F"UPPO7E OF PAYMENT AMOUNT PAID PUPPOSE Ot" PAYMENT AMOUNT f:"AID PLAN C-HEPs: F-T El--I.' P I AMOUNT F"'i)[0