15679 SW 82ND AVENUE-1 i
15679 SW 82ND AVENUE -
k-r .RTIF"ICATE OF
CITYOFTIFARDOCCUPANCY
CEiYOF TkF.4itD
PERMIT T tl« . « . . . . : M3Y9® 91L'7
COMMUNITY DEVELOPMENT DE AMUM e>eeoore
13125SW►WIBlvd. P.O.Box 23397,Tokrd,Oregon 9;223(503(e3"176 DATE ISSUED: 1.0/10/90
SITE ADDRESS. . . a 15679 SW 82ND AVE PARCEL.: 2 5112 CC•-08400
SUBDIVISION. . . . a LANf31REE ZONING:
BLOCK. . . . . . . . . . t LOT.. . . . . . . . . . . * . V16
CLASS OF WORK. eNEW
I YPL OF USi: . . . :SF
JCCUPANCY GRP„ :R3
OCCUPANCY LOADaL220 4
'TENANT NAMEr. « . a
Rema rC r:
fiwrtier a __...._.________-.».____......_____„...__..____
rTTAN PROPERTIES
PO BOX 6835
ALOH I OR 9/007
Phone N: 6455477
C:ontrActor: _.._... _....... -
'1 ITAN PROC'L:R'C IE:S
110 BOX 68,35
ALOHA OR 91007
Phone M: 64564'77
Req #. . o 305519
Or-rmpaknry of the above -ceferrernces'd truildirlq is hereby gi,.-Pi►, avid certifies
the rompliancee with the Stage Of Oregon rpec.ialty Vociees for the group,
accupanry, and use under whiCh the refeare!rnr..e d permit wits iecwueed.
FIRE:: DEPARTMENT DUILDINik INSPE
BUIL.DINO FIC
PONT IN C:ON3PICUOUS PLACE
I
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 2.3397
Tigard, Oregon 97223 ail
Phone: 63/9-4175
Type of Inspection09
L--'
Date Requested -�� - _ Ti a_.— A.M._ ,X P.M.
Address _ 15-10 7f �� h� _ Permit
# _
Owner Lot_ . yL.�.
Builder
The tohowing Buihiinq Code deficiencies are required to be corrected:
1,00--Lt► - -------
Presented to -_- ' ? Approved
Inspector / Q - ❑ Disapproved
Data —
CALL FOR REINSPECTION
❑ Yn Cl NO
INSPECTION NOTICE C' ✓'
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection i --
Date Requested '` Time_._A.M._
Address _� h Permit
--
Lot
Builder
The following Bub!rting Code deficiencies are required to be zorrected:
Presented to _ _ __ Approved
i
Inspector _ - -- Disapproved
Date _-
CALL FOR REINSPECTION
Cl YES f J NO
UUUU- YPU-U
INSPECTION NOTICE
City of Tigard Building Department 1
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639--:175
Type of Inspection -------
Date
---__Date Requested� ` Time A.M._- P.M.
� c
Address _ � _ Z 7,-1 Permit
Owner _ /5� 1� _ Lot #
---
Builder
The following Building Code deficiencies are required be corrected.
1
Presented to A _._ ro ed r
Inspector ❑ Disapproved
Date _ _ - -'" .�
CALL FOR REINSPECTION
Cl YE! 0 NO
INSPECTION NOTICE
CitV of Tigard Building Flepartment
P O Box 23397
Tigard, Oregon 97223
Phone: 639-41i5
Type of Inspection Z��
/
Date Requested__. � �, � 1G
_ Tinne A.M. P.M.
Address i / �h Permit *.52'6
Owner Lot #_
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to proved
Inspector �' ❑ Disapproved
Date c:
CALL FOR REINSPECTION
❑ Y118 8-N-
INSPECTION NOTICE-
City of Tigard Building Department
P O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection -----
Date Requested / r -�� Time--- A.M. ( P.M.
Address ._�C i �2-7 Permit
Owner r__ IF j Lot #
BuilderThe following Building Code deficiencies are required io be corrected::
Presented to _ ______ ^Approved
Inspector _ I �-- _� u Disapproved
Data ----
CAI.L FOR REINSPECTION
❑ YEs ❑ No
"ll' i OF TIGARD OF PAYMEN'r RECEIPT NO.
("HECI-* AMDUNT
PROPF—PTILS, CASH AMOUNI
PAYMENT Nil E
SLIPEi IV IS.]nVi
FlJF'F;,—)SE OF POsYMENT AMOUNT PAIC r'UF`PC.VSF.'l IF' P ,YMEJIT AMOUNT PAID
TOTAL AMOUIT f!;'A [L)
WRWT M
INSPECTION NOTICE 1
City of Tigard Building Department
P.O. Box 23397 / •�
Tigard, Oregon 97223 f
Phone: 639-4175
Type of Inspection
Date Requested 7 i JG Time _ A.M. /X-P.M.
Address S Permit
Owner — _ Lot #_
Builder ✓ __ �� ------____
The following Building Code deficiencies ara req uir d to be corrected:
:j ---
Prpsented to ❑ Approved
Inspector Disapproved
i2 w
CALL FOR REINSPECTION
YES 0 NO
I
INSPECTION NOTICE
77g/ / City of Tigard Building Department
(� P.O. Box 23397 -
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested Time A.M. X P.M.
Address �� JCC (�� �^ Permit # %
Owner Lot # _
Builders
The following Building Code deeficie"4-1 arR required to be corrected:
• I
-1Yr0M e-sft l _ M��,SQ A+I-_ uc 1pe-c'-L ClJJ &�
CCA ,A�.e �un�'b�-T ,peo.v►n ✓►or �e�..a�^ .�/
y� �r-c-
Presented to _� ❑ Approved
Inspector isapproved
Date
CALL FOR REINSPECTION
❑ YE$ ONO
AI► I>t Ii!! !� i/ � fit �
INSPECTION NOTICE
City of Tigard Building Department
P.O. box 23397
Tigard. Oregon 97223
Phone: 639-4175
Type of Inspection -L'��--- "/ ',-e— -- —
Date Requested �� � Time A.M._ [� P.M.
Address Permit #I
SOwner. Lot
BuilderThe following Buildisig Code deficiencies are required to be corrected:
Presented to _^��y-� Approved
Inspector,ITJl �� __ -1 Disapproved
Date
CALL FOR REINSPECTION
El YES ❑ NO
7
INSPECTION NOTICE �/
City of Tigard Building Department
I
P.O. Box 23397
Tigard, Oregon 97223
Phone. 639-4175
Type of Inspection
Date Requested 7 + `&4;;4:2 Time A.M. P.M.
Address ._.�. _lrz—/j O _ Permit- f 7
Ow•-.er—_, ,�.. ____—_____ Lot #
Fuilder +a, ��✓1,.�_ ________
The following Building Code deficiencies are r1equired to be corrected:
- - � vco A Le 47t
PA..' Com
- - 22!!�P -- --
tae jet jeEgol' --
Presented to
Inspectorappf roped
Date -- ---
CALL F R 1 F,CTION
�'.YEa 0 NO
INSPECTION NOTICE -- c�
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested �h –�–�G Time A.M. ___P.M.
Address _____ 2!1 h�— ----- Permit
Owner _—_ T _.. __ Lot #
Builder
The following Building Code deficiencies are, required to be corrected:
I
I
Preswnterl to _ - --
[] ,Approved
Inspector �-Oisapproved
Date
CALL FOR REINSPECTION
0 YES Cl NO
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
P,h�one/839-4175-
Type of Inspection --
Date Requested !�– !lL Time —_ A.M. P.M.
Address _J5-4, 2 -- h -- — Permit
Owner-----.__--- ---�— Lot #
BuilderThe following Building Code deficiencies are required to be corrected:
Presptited to -- --- /LrApproved
Inspector _ ___ [J bisapproved
aDate
CALL FOR REINSPECTION
[] YES [A NO
t
CITY OF TIF/421) MASTER PERMIT
�72�WARD PERMIT .. . . . . . . .. MST90-0127
COMMUNITY DEVELOPMENT DEPARTMENT ON PRIM. PERMIT 0. : MST9@--012'7
13125 SW Hall Blvd. P.O.Box 23397,Tigard,Oregon 97�
DATE ISSUED: 04/17/90
t)ITE ADDRESS. . . 15670 L-;W 82ND AVE PARCEL.: 2S112CC--08400
SUBDIVISION— . : LANG;'PF7- ZONING:
BLOCK. . . . . . . . . . :* LOT. . . . . . . . . . . . . : 16
BUILDING .......
RLISSUE:MST90-0108 DWELLING UNITS.- I BASEMENT•.. . . . . . . . :0 sf
CLASS OF WORK. :NEW BEDRMS:3 BATHS.-3 GARAGE. . . . . . . . . . :353 Sf
TYPE OF USE. . . -SF FLOOR REQUIRED SE'*TDACKS-------------
TYPE OF CONST. :5N FIRST. . . . :950 Sf LEFT. . - II ft RIGHT. :5 ft
OCCUPANCY GRP. :R3 SE COND. . . -.698 Sf F--RONT. :20 ft REAR. . c30 ft
STOR I ES. . . 0 THIRD. . . . ..0 15 f REQUIRED--_._..__._._._._.__.....____..__
HEIGHT. . . ., .. . .. . ".20 ft Sf SMOKE DETECTORS. :Y
[1-0 0 R L00.1). . »40 psf VALUE. . . . . $ 75570 PARKING SPACES— :0
Rema-6m:
—- ...... PLUMBING
'i;INKS. . . . . . . . . . .. I FLOOR DRAINS. . . . cO BACKFLOW PREVNTRS. . ::0
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWERS. . . . :2 LAUNDRY TRAYS. — :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :3 SEWER LINE (ft) . :0 GREASE TRAPS. . . ... .0
DISHWASHERS. . . . gl WATERLINE (ft) . ; 100 OTHER "FIXTURES. —, ::o
GARBAGE DISP. . . c RAIN DRAIN (ft) . :0
WASHING MACH. . . .- 1 SF' RAIN DROINS. . : l
MECHANICAL F-EES
UNIT HTRS. . .0 type an)0U11t by (late recpt
/GAS/ VENTS . . . . . :0 PAYM $ 40. 00 JLH 03/29/90 108146
MAX INPUT:O F4 T U VENT FANS. . :4 Bl--IRT $ 361. 00
FURN ( 100K . . : I HOODS. . . . . . : I BPLC $ 40. 00
FUR14 >=:100K . . :0 WOODSTOVES. sO 115PC $ 1.8. 05
I-LOUR FURN. . . . e Id CLO DRYERS. : I BPLC $ -Z4-1-419
BOIL/CMP OTHER U N I T S:0 STDC $ 600.00
GAS OUTLETS: 1 SSDC $ 250. 00
Owner: PARK $ 250.00
I ITAN PROPFRTIES MPRT $ 39.00
PC) BOX 68315 MPLC 9. 75
M5PC 1. 95
(11 OHA OR 9*7007 PPRT $ 132. 50
Phone 04% 6455477 P15PC $ 6.63
C(i n t r a c.-t o r a ......- PAYM $ 1693. 63 JI-H 04/17/90
TITAN PROPERTIES
110 BOX 6835
01-C)HO OR 9700-e'
I-11-ione #: 6456477
30558
$ 1733.63 TOTAL
This persit is issued subject to the refulations contained in the REQUIRED INSPECTIONS
Tilard Municipal Code, State of Ore. Specialty Codes and all other Foot/found Insp Plumb Top Out
applicable laws. All work will be done in accordance with approved Wtr Proofing Psm F'raming Insp
plans. This petmit will expire if cork is not started within 180 Post/Beam Insp Fireplace irisp
days of issuance, or if work is suspended for more *n r 168 days. Crawl Drain Gas Line Insp
Im/tAndslab Trmp Insulation Insp
Permittee Si,S1' 1-1latL11'e: PLM/Underfloor Gyp Board Insp
F"tng Drain Bsmlt Rain drain Insp
ISSUed By: Mechanical Insp Water Line Insp
Call for inspection 639-4175
CITY OF TIFA RD SEWER PERM CONNE(.-,TIQN
I T
(cny LWA 7RD PERMIT 0. . . . . . . SWR90--013*7
COMMUNITY DEVELOPMENT DEPARTMENT OR104M PRIM. PERMIT #. I-11ST90-0127
131253WHWIBW. P.O.Box MQ7.Tlqwd,Orr-:..o 97e43h(I?I�Y6
DATE' ISSUED: 04/17/90
SlIE ADDRESS. . . . SW 82ND AVE PARCE'L: 2SI12CC-08400
SUDDIVIS'EON. . . . « L-ANGTRE*.E' ZONING:
. . . . . . . . . . LO'T.. . . . . . . 16
TLNANT NAME:.. . . . . ..
USO NO. . . . . . . . . . ..40655 VIXTURE.' UNITS. . . :
CLASS OF WORK. . . -NEW DWI:':*'.L-I.-IlqG UNITS-- ].
OF USE. . . . . ..SF NO. OF' BUILDINGS.- 1
INSTALL TYPE. . . . :14USWR IMPLRV SURFACE. . « :Sf
Renlarks:
Owilev-. FEES
TITAN PROPERTIES type aniCKII-It by date r e c 1:)t
110 DOX 6835 PRMT $ 1250. 00
INSP $ 35.00
ALOHA OR 97007 PAYM $ 1285. 00 JI.-H 04/17/90
f-1horie H.- 6455477
Co 1.1tr actors
CONTRACTOR NOT ON FILE'.
F�tiurie #o $ 1285. 00 TOTAL
Req
RE 0 U I 1,E 1) INSPE'CTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Iiispectioil
of the Unified Sewayp Agency. The permit expires 120 days from
the date issued. Thp total amount paid will be forfeited if the
permit expires. The Agency does not quarantpp the accuracy of the
side sevor laterals. If the sever is not located at the measurement
................ .............
given, the instiller shall prospect 3 feet in all directions from
the distance given. If not -,o located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agency will instal I I a lateral.
Flertnittee Siqriatt.trea
—----------- ............. ..............
Call -fur ivisr)ec.,tiori — 6"39 4175
CITY OF TTGAPD RECETPT OF' PAYME-ji-r- PECETFT NO.
rHELk '010UN'l- 9-f B.6 ,
TTT(.'tN PROPERTIE-T,
,-'&OREGS PO Pox t,i37,!c, CASH AMOUNT ri. 00
PAYMENT DATF.". Cl(I 17 c;M
ALOHA. OR c 7 0 0-7--0 F3,-S 1 SUBD I V T)I r)rq
f'I-W,'FOSE OF PAYMENT AMOUN'r PAID PURPOSE OK Pi--§yME-jq-r i-4110UNT F-Alf)
lI..DlP4(3 PrFRMJT .561 . 00 PLUMPTNG r-,ErktllT
PIE CHi-J,J 7 PERMIT 17-2."50
39.00 ST. BUILD PERMIT TAX 5'. :;:r',. 6;?
PL(44 C'HE(.,'I; FEE '4. 50 SEWED USA -
S)RMER INSPEGJJO�j 35. c1c) TTREI�T SDC: 121504 00
PARKS F3DC 600. DO
'5ToF,,m w-,,,fum SL(� 250.00
r- IAL 01.10UNT PAID 2978. 6 3
CITY OF TIFA RD
ari se PIAN CHECK APPLICATION
COMMUNITY L;-EVEL_OPMENT DEPARTMENT " PLAN CHECK N
13125 S W.Hall Blvd..P..+ Box 23397,Tigard,Oregon 97223,(%3,'6391175 �y7{J ry,
�. PERMIT q L � - ''7 _
DATE ISSUED
-/JOBY1Al kESS: TAX MAP/LOT
_.SUB: �� _X E.0-1 C �- LAND USE.: - , "
VALVAI'ION: _ __- _ USD '
OWNERSPECIAL NOTES
NAME: � � _ _ REISSUE OF: _ -�
ADDRESit: _ L LAST REISSUE
FLOOD PLAIN/
SENSITIVE LAND:
PHONE -, ..5�-.L J -
APPROVALS REQUIRED
CONTRACTOR PLANNING: --__
NOME v ���52 � ENGINEERING:
ADDRESS: _- — _ F IRE DEPT - --�
OTHER:
PHONE :v _ _ _ __ ITEMS REQUIRED
BUII.DLRS BOAti!) #___- EXP DATE -a i' G- LIST/SUBCONTRACTORS:
- BUS TAX:
ARCH/ENGINEER CALCULATIONS:
NAME : TRUSS DETAILS:
ADDR(=SS: OTHER:
PHONE:
COMMENTS:
-- -_ , ,�
SUBCONTRACTOC:o: P1.UMB /�' `'i�__.__-�_�� MECH: f•ter� 7
PERMIT N .%CCT N DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
_k.L2 10 432 00 Building Permit Fees
1t, -431 00 Plumbing Permit Fees
11` 431 01 Mechanical Permit Fees
10 230 01 State Building Tax (5%) ,
Buildinq c�
Plilmbinc(
Mech
10 -433 00 Plans Check F__e -
Building
PIumbirig
Mech _ V /
30--202 00 Sewer Connection ✓ i" �_ �. ,
30- 444 00 Sewer Inspection
51-448 00 Street System Dev Charge (..')C) -
52--449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Cf-g (SSDC)
IC-230 06 I i re _
1 TOTAL
APP ICAN SIGNATURE
Received By: ! _ Ditto Received:
en/3582P/18P
(WV40F�TW�WAIRPD 601
CITY'®F TIOARD PLAN CHECK APPLICATION
PLAN CHECK qCOMMUNITY DEVELOPMENT DEPARTMENT
13125 S W.Mail Blvd.,P.O.Boa 23397,fl Utd,Oregon PERMIT N
Q pon97223,151131639�176 DATE ISSUED
JOB ADDRESS: %j ( i AX MAP/LOT
SUR: LLOT: LAND USE:
VALUATION: —x..5.5 Z0.
ClWNER SPECIAL NOTES
NAME: Tt rA,a) /.'ar !,'T/f REISSUE OF : l'1I.5t"/d -ao t� j
AOURESS: _ _i LAST REISSUE:
8[�1[�i_r Ct .__`�►�i�lu'1 — FLOOD PLAIN/
SENSITIVE LAND:
APPROVALS REQUIRED
CONTRACTOR PLANNING: _
NAME: `S�,c+r.i.C_ ENGINEERING: _
ADDRESS: _ FIRE DEPT
— OTHER
PHONE ITEMS REQUTRE_O
LIST/SUBCONI-RACTORS:
ARCH ENGINEER BUS TAX:
i •, NAME: CPLCULATION' _ +
ADDRESS: _ _ TRUSS DETAILS: —
_- PARKING PIAN: i
LANDSCAPE PLAN:
PHONI': OTHER: -`-- --
COMMENTS:
PERMIT # ACCT H OESCRTPTiON �_ AMOUNT AMOUNT PO, HAL, DUE.
/nSf ib -OVC18 10 -432 00 Dui ldiny Po mit Foes "
10-431 CIU Plunlhinq Permit Fees t_-'-.: . ?� ..So
10-431 01 MOCII.niCal Per-Init Fees
10--230 01 State Uui Iding Tax
Plumbing
Mitch
10--433 OO Plans Check �Fqe f,,� �� 1i'ucLj, •- ;
u i l d l ng �` y
P 1 un►b i rig
Mecham
209 00 Sower' Canneel.lanko30 444 00 Slewltr Inspectirsn -
. 5 u
bl 44U 0U Street System Uev Charge (SOC) ✓ u ✓ rG
!i2 -449 00 Parks SysLuin Dyv Charge (ND(,) ....... r s
31. 49_10 00 Sturm Or,ainage Syst. nov Chr'q (;SOC)
10-•230 te9 I RI I)
10 230 CIG W,+shin 1011 Cmanly rizr HI (9hX)
I0_I20 00 (lour t/Wodgi?wuud --.---...---
'111(At ��•++�•�
lit c 11
Rucoivsed Hy: _ flato Rrceived: l— �v
cn/3'j0/P/IOP
CITY OF TlGAkV _ RECUIPT OF F14YMEW REC NU: Cj0l a l:,l
CHECK AMOUNT ar 40.00
NAME t 7 I TAN FROPERI I F S CA%4 AMOUtlT t .CIO �
ADDRESS: P'AYME'NT DATE : 01—•31'0-90
1567'; 5W 82140 AMIE
f URPIZE Oh PAYMFNT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
rLotJ CHEC.k rEE i1-76R) 40.00
I
I
i
T'O'TAL AMOUNT PAIL) — — 40.00
I
I
QrJEROSION CON] ROL INFORMATION
(;FNERAL CONTRACTOR NAME& ADDRESS: CASE111,I",N0.:.__� �^
�, _t; r L�. PERMIT'NO.:
f I tfW JL� ) �y
APPLICANT NAME AND ADDRESS:
EXCAVATION CONTRACTOR r i T a i
NAME&ADDRESS: (�yv -- "?
T'G �r�J At-ul 40 . Oi -
OWNF.R NAMI:AND ADDRESS:
'IE'L EPHONE NUMBERS:
APPLICANT: G �l!- (o�l`�`I PROPERTY DESCRIPTION:
OWNER: STR T AD KESS AND CROSS STf EF L'/LOC,AT'ED
GENERAL CONTRAC -
EXCAVATION CONTRACTOR:_f ---
SHEVIOB
LEGAL i*scR1PT10N:
24 HR/AFTER HOURS EMERGENCY TAX LOT NO.: _
('(PERSON, 'i'll E,TELEPHONE: 1/4 SUCTION:
SITE SIZE,ACRES:•
-- --- DISTURBED/YORK ARFA,ACRES:—
LOCATION
CRES_LOCATION& ADDRESS W 11FRE SPOILS
LEAVING SITE.WILL Ill:TAKEN SITE RUNOFF DRAINS TO: (CIRCLE ONE)
(NOTE:P17tMT1 S MAY BF.REQUIRED) (CATCI I.13ASIN DITCH PIVE CREEK
(CIRCLE ONE) PRIVATE PROPERTY
--'-- �_UBLIC_RIGHT OF WAY
�,ROS1QjV D11�1EN I'A'l'ION CUlV'I'ROL (ESS -MI ASURES
MINIMUM ESC REQUIREMENTS MINIMUM FSC REQUIREMENTS
DI WING CONSTRUCHON: FOLLOW ING CONSTRUCTION:
SEDIMENTATION FACILITIES STABILIZE EXPOSED SURFACE
STABILIZE 1)CONSTRUCTION ENTRANCE REMOVE AND RESTORE'II:.MPOR ARY ESC
PERIMETER RUNOFT-CONTROL FACILITIES
CLEARING AND GRADING RESTRICTIONS (1,F.AN AND REMOVE ALL SILT AND DEBRIS
COVEIR I'RA('1'ICI-'S VNSI IRF OPERATION OF PL•RMANT FACILI I1FS
CONSTRUCHON SEQUENCE 0-1111;R _
01111:R
PIAN 17OR EROSION CONTROL PREPARED AND S1111N111*11:1)IN ACCORDANCE WEEII-FECHNICAL GUIDANCE IIANDROOK'•.
FROSION CONTROL PLAN DRAWING,AS REQUIRED,HAS PIAN CONSIRUCTION NOTES COMPLETE.INCLUDING EMERGENCY
PHONF.NUMBER, SCHEDULUSTAGiNG FOR INSTALLATION AND REMOVAL OF EROSION CONTROL MEASURES,AND
AITI.IC'ABLE STANDARD NO FS
I HAVE READ AND WILL COMPLY WETH THE;ABOVE AND WILL CONSTRI)CT AND MAINTAIN FSC MEASURES AS NECf-SSARY
TO CONTAIN SEDIMENT'ON TIIE CONS'T'RUCTION SEl'E.
OWNER S ATURE AI'I'LI AN ',NAI'I1RE
0H WIAI IISI. I)NI.Y
RI ( Flr l
DA I i- ACCEPTED
Hal. BY