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14525 SW 130TH AVENUE i I I 4525 561 139tH AVENUE: r ., CITY OF TIGA RD (��NID CERTIFICATE OF COMMUNn'Y DEVELOPMENT DEPARTMENT OCCUPANCY 13126SW HWI Blvd. P.O.Bm 23397,TOW,Or"pn IMM( 030-4175 591 x XX 7F7 PERMIT #. . . . . . MST9 1-0204) 639 4M DF4TE'. ISSUED: 05/20t9a* �31TE ADDRESS. . . : 14525 �,",W 130TH AVE PARCEL 2G109PD-WDF*27 SUBDIVISION. . . . : WOODFORD ESTATES 70NING: R--7 ALOCK. . . . . . . . . . : L01.. . . . . . . . . . . . . 127 ----------- -------------- CLASS OF WORK. eNEW TYPE OF USE. . . 6S OCCUP.qNCY GRP. :R3 OCCUPANC, LOAI)i2a5 4 TfNANT NAME. . . MEL VIN WAYMIRE 1''O'0 BOX 231164 TIGARD OR 97223 Phone iti 639-6742 MKI.-VIN WAIlMTM�. PO BOX 23x l64 TIGPRD CR 97223 Picone #: 639--5742 RwU #. . r 3S971 0cmiparicy of thr above referenced building Is hereby givurt, and certifier, the complitrice with the tate Of Oregon Specialty Codei for the group, ac--cupancy, and use under which the refet-enrpd permit was isilurd. FIRE DEPAItTMENT I I L D I Nw[rI BIJII_UI :)FFICIAL POST 114 CUNSPICUOU% !--L.ACE jN$P2t i 1 CN NPMCIL City of Tigasni Building Depw7taent 13125 SW Ball el- % Tigard, oregon 97223 Inspection Line (Rec-O-Phone): 539-4175 Business Phone: 639-4171 Inspection: _�-.� -- ---- Fcoting Plbg. Underelab Mech. Rough-in Appr/Sdwlk Found. Pl.bg. Top Out Gas Line FINALS f�c Poet/Beam Struct. San. Sewer Framing -Bldg Poet/seam Mach. Rain Drain Insulation -Plumb. Plbq. Underfloor Water Line Gyp. Bd. -Hoch. Date Re. steds �+ _ yf Tom= - PK Address: ��I`7.� 5 0/ ✓' PernitL- r Builder: THE FOLLOWING CORUCTIONSIM CORRECTIONPAWIREDI 4.C.ti�'1�1i.::tom lnepoctors,_ _JC4z APPROVED DIShPPROVRD APPROVED SUBJECT TO ABOVE `� Call For Reinap. MSPECTION NOTICE 1yyy�„i`YYi City Of Tigard Building Depertmeent a ) 13125 tIN Ball Blvd_ Tigai-dd, Oregc.n 97223 Inspection Line (Ree-O-Phone): 639-4175 Business Phora: '639 Inspection: Footing Plbg. UnderelabT Mech. Rough-in Apr !7dwlk Found. Plby. Top out Gas Line FINAL: Poet/Beam Struct. San. SewerPirL arsing ` —Bldg. Poet/Beam Mech. Rain Drain / �✓� Ir,sulatlon _Plumb. Plbg. Underfloor Water Line OYP d. eeh.� Date PM Permit #,G-, [. Builder: TAE FOLLOWING CORMCTIONS ARE REQUIRED: Inapectors _ Dater�� ' �! APPROVED DISAPPROVED -- - APPROVED SUBJECT To ABOVE Call For Reinsp. /L ( INSPECPION NOTICE t city of TL7ncd 9uiliing pert ' 1 1 13125 Sq t UV 3x1Blvd. Tigard. Oregun 9722.1 I spection Line (Rec-O_P1 hone):39_4175 Business Phone: 639-4171 Inspsctiont Footing —_ Plbg. Und stab Mech. Rough-in Appr/Sdwlk Found. ` Plbg. T Out Gan Line FINl►L'L7 Poet/Beam Struct. �"�' Sewer Fuming -Bldg. Poet/Beam Mech. Rain Drain Insulation -Plumb, Plbg. Underfloor Nater bins _ Com' ed' -Rech Date Requtretedt__ _ Times �pH PN Addree3: __ � Z / `� Permit ie Dili ider: 1,e THE FO'„LOWTNO CORRl� IONS A.R. RtQUIRBDt — ----- hY ---------------- -------------- ----------- ------- ----------------- ------ .................. -------------- Inepdctor: '- \J1►PPRO�►!D b:rl►P! _ ' APPRO{IRD BUBJECl' TO A�jyt ___Call For Rsinep. INSPECTION NOTICE City of Tigard Building Departleet 13125 Sp Bell Blvd. Tigard. Oregon 97223 Inspection Line (Roc-O-Phone): 639-4175 Businens Phone: 639-4171 Inspections Footing Plbg. Underelab Rech. Rough-in Appr/Sdwlk Fcund. Plbg. Top Ou, Gas Line PTNAI.s Post/Beam Struct. San. Sewer Framing -Bldg. Meeh. Rain Drain Insulation -Plumb. ) Plbg. Underfloor Water Lina Gyp. Bd. _Hoch Date Requested:_ "Is- A5 -<� 2— Times PM Addreess Ll IS— -417- Permit Builder: THE FOLLOWING CO `TIONS ARE REQUIRED: i Inspector ? Data:?�_ ` ;7 APPROVED DISAPPROVED APPROVRD SU"CT TO ABOVE Call For Reinnp. INSPECTION NOTICE City of Tigard Building Depar'tsient: 13125 SM Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone: 639-4175 ^ ni-Head Phone: 639-4171 Inspection:__ Footing Palg. Underelab Mech. Rough-in Appr/Sdwlk Found. Plt,. "_'-r out Gas Line FINALz Post/Beam Strurt. San. Sewdr lFraming -Bldg. Post/Beam Mech. Pain Drain Insulation -Plumb. Plbg. Underfloor Water Line Gyp. Bd. -Meeh. Date Requested: �7 �L 1.� Time: AM __PH Address: / r Permit � Builder: THE FOLLOWING 00jaCTIONS ARE REQUIRED: 1 I O Com, .5 42ti L Q Ll{' - S LW- _ a✓ TIL.- Inspector a Inspectora APPMl11iD pISAPp PROVED SUBJECT TO ABOVP Call For Rsinap. i I INSPECTION NOTICE City of Tigard Building Departzent: 13125 Sit Hall Blvd. Tigard, Oregon 57223 Inspacticn Line (Rec--O-Pho"): 639-4175 Businens Phone: 63^-4171 Inspection:__._. Footing P1bq./tihderelab Meeh. Rough-in App:! Mw qw gar INSPECTI__QN NOTICE City of Tigard Buildioq Depart--n'^73 13125 SN E1 Blued. Tigard. no: 639-4171 -- Inspection Line (Roc ones 639-4175 Bueineaa Ytto Inspection:_._ r`— � Appr/8dwlk Footing P UnderMYab Koch. Rough-in Gas Lino rI11 & 41bq. Top Out Four3. Post/Beam Strutt. San. sewer E'raminq -81dq. Post/Beam Mech. Rain Drain insulation -Plumb' Plbg. Underfloor. Nater Lino Gyp. Bd. -Koch. PK Date Rer,:testeds G� / Z�i'�s' / �D permit nd�.eee: Builder:__ � THE rOI.L'Ji1ING CORRECTIONS ARE REgUIRIDs _.----- Inenertors --� Datst 2_2 J►pPROM DISAPPROVED APPROM) SUBJECT TO ABOVE -- call For Reinsp. grit W M-FLJRLMFA "-� INSP*CTION NOTICE City of Tigard Building Departien,t 132.25 SW Ball 01,*d. Tigard, Oregon 97223 Inspection Line (Rec-o-Phone): 639-4175 Buninegs Phone: 639-4171 Inspection:_.__ Footing Plbg. Underalab Mech. Rough-in Avnr/Sdwlk Found. Plbg. Top Out Gas Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Cont/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underflooi Water LineG� yp. �-h/erh. D:.te Requested: � Time: /l AM PH Addren9: 1v t5ds— Permit But'—wr: THE FOLLOWING COqoaCTIONS ARE REQUIRED: Inspector: Date- /"APPROVED ate:/"_APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE _Call For Relc-p. INSPECTION NOTICE City of Tigard Building Departsaent 1312S SW Ball Blvd. Tigard, Oregon 97223 Inspection Line (Rec-O-Phone)• 639-4175 Business Phone: 639-4171 Inspection: -. ---- -- Footing Plbg. Underelab Hoch- Rough-in Appr/Sdwlk Found. Plbq. Top Out Cas Line FI'lAI.s Poe[/Ream Struct. San. Sewer Framing -B:.Ag. Post/Beam Hoch. Rain Dra:n Insulation ) -Plumb. Plbg. Underfloor Water Line ^^ Gyp. Bd. -Hoch. Date Requested: -12 �fc�-� Times _XAH PH Add rese•_ - Permit /�l� Builder: � 'HE FOLLOWING CO IONS MM MQUIMI Inspectors f` Date:_L A'I"pROVZD DISAPPROVED APPROVED SUB-ITCf TO ABOVE Call For Re:nep. 11SPECfION N,.TT:CE City of Tigard Building Departeent �65� 13125 9W Ball Blvd. Tigard, oregnn 97223 Inspection Line (Rec-o-Phone): 639-4175 Business Phone: 639-4171 Inspection•_ ���"'i �""'� — Footing Plbg. Undaralab Maieh. Rto qh- Appr/Sdwlk Found. Plbg, Top Out / Oas Line j FINAL: Post/Bean Struct. San. Sewer 1` a?�camia -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plbg. Underfloor Water- Line Gyp. Bd. -Mach. Date ;taquau:.ed:_,��� �_�-----'=�me: AM _— PM Addrouss � J � � �' Permit S__/1j Build&-: 34 TBE FOLLOWING CORRECTIOEiS ARE REQUIRED: Inspect Date., APPROVED DISAPPROVRD APPROVED SUBJRCT TO ABOVF. Call For Reinsp. Y. I .,OM1 Il18PSC^ION NOTICE City of Tigard Building Departmnt 13125 sw Ball Blvd. Tigard, ^regon 97223n_c'� Inspection Line 4Rec-0-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Plbg. Underelab e�E � Appr/Sdwlk Found, Plbg. Top Out -G`a"s '.ine FINAL: �� Poet/Beam 8ttno San• Sewar } Framing -Bldg. Post/Boom Neoh in Drain Insulation -Plumb. cc' Ondorfloosor Line Gyp. ad. -Mach. Date --ested Times AM PH Date Request/ed: -- — Addreest L y� �Q Permi7t #I ! f Builder: THE FOLLOWING C0Vk14�"lI0lls ARE REQUIRED: 9 Inspector Date:/ APPROVED DISAPPROVRD APPROVED S:'e-TRUr 'M A1nOVF. Call For Reinep. INSPECTION NOTICE City of Tigard Building Depart.wnt 13125 SLI Ball. Blvd. Tigard, Ortxlo972: . Inspection Lina (Rec-O-Phone): 639-4175 Business Phone: 639-4171 ^ I Inspections Footinq Plbg. Underelab Mech Rough-in AF?r/Sdwlk Found. Mg. Top Out Gas Line FINhI,: Poet/Beam Struct. San. Sewer Framing -Bldg. Pont/Beam Me h. Rain Drain Insulation -Plumb. i Plbg. Underfloor Nater Lime Gyp. Ed. -Meeh. Date Requested: (r 3- —Tim: � AM 2�- PM Address: I ZJ I If Permit #:_2f-"7 Builders - 1, 2- r { TBE FOLLONIMO CORRECTION8 ARE REQUIRED: i Inapectorl _ Data: _APPROVED DISAPPROVED f APPROVED SUBJECT TO ADM Cal! For Reinap. INSPECTION NOTICE City of Tigard Building Departmext 13125 m 8811 Blvd. Tigard, Oregon 97223 Inapection Lire (Rec-0-phone): 639-4175 Business Phone: 639-4171 Inspection: - — 'Footing Plbg. Underalab Mach. Rough-in Appr/Sdwlk Found. Plbg. Top Out Gam Line FINAL: Post/Beam Struct. San. Sewer Framing -Bldg. Poet/Beam Mach. Rain Drain Insulation -Plumb. Plbg. UndpcV oor Nater Lim Gyp. Bd. --Koch. Date Re"y'Hate.i —Ti-me: &-:L-Am _—PH Addres j: �•/>�� /� J� 'v�""" Permit /:V! Builder: ��/` �� -.6-7 -- THE FOLLOMINO RMCTIONS V10 MWIMMI Inspector:_ _ hatwl APPROVRD DISAPPROVRO APPROVBD BCBJBCT TO ABM Call For Reinsp. I qW1 MUM CITYOFTIGrARD ® J— CFlYMPTIMMA110v COMMUNITY DEVELOPMENT DEPARTMENT 011100N MASTER PERMI'l 13125 SW Hell Blvd P.O.Box 23397.DpW,Oregon 97223(SM)639-4176 [JERMTT #. . . . . . : MST91-020c) 639-4171 DATE ISSUED: 01/07/92 �13ITE ADDRESS. . . : 14525 SW 130-11A AVE PARCEL: 6UBDIVISION'­ . . : WOODFOPI_ ESTATES ZONING: R-7 P'.-DGK. . .. . . . . . . . LOT. . . . . . . . . . . . :1:?7 BLJILDINC-', REISSUE: DWELL. 111r- [JNITS: I BASEMENT. . . . . . . . :0 s GLASS OF WORK. :NEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . :749 Sf TYPE OF IJ'z.':)E. . . :S F FI.-.onR AREAS-­­­­- REQUIRED SETBACKS-­­­­ TYPE OF CONST. -SN FIRST. . . . - 14MB Sf LEFT. . :7 fl- RIGHT. : t ft. OCCUPANCY GRP'. : R3 SECOND. . . : I Oc-'. S f FRONT. :20 -Ft REAR. . :20 ft STORIES. . . . . . . :2 THIRD. . . . :0 S f REQU I RED- 'iEIGH1.. . . . . . . . :25 -F t TOTAL.-------:2"'4 32 s SMOKE DETECTORS. :Y I LOOR LOAD. . . . :40 psf VALUE. . . . . $ : 125354 PARKING SPACES— :0 Remarks - PLUMBING SINKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :O BACKFLOW PREVI\JT'RS. . :O LAVATORIES. . . . . :Fj WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0 I"UB/S:40WERG. . . :2 LOUNDRY TRAYS. . . I CATCH BASINS. . . . . . . :0 WATER CLu-;EIS. . :3 SEWER LINE (ft ) . it) GREASE TRAPc, :0 DISHWASHERS. . . . : 1 WATER LINE ( Ft ) . : 100 O'THER FIXTURE5. . . . . :0 GARBAGE DISP. . . : 1 RAIN DRAIN (ft ) . :O .!PSHING MACH. . . : 1 SF RAIN DRAINS. . .1 MECHANICAL - FEEF-- --------------- FUEL TYPES----------- ---- UNIT IATRS. . -0 type amol.tnt by date reept /GAS/ VENTS . . . . . :0 TIF 1380. 00 RLT 01 /07/92 MAX INPUT:0 BTU VENT FANS. . :4 BPRT 1 498. 00 RLT 01/07/92 '-URN < 100K . . .0 HOODS. . . . . . : :1 B P L C $ 323. '70 JLH 12/23/91 FURN ) =100K . . : I WOODSTOVES. .0 S5PC s 24. 90 RLT 01/07/92 FLOOR FURN. . . . :0 CLO DRYERS. : I SEDC f, 280. 00 RLr 01/07/c%-::, F.A0IL/CMP ( 3HP:0 OTHER UNITS;0 PARK t 500. 00 RIA' 01/07/92 GAS OUTLETS; 1 MPR7 4• 40. 50 RLT 01/07/92 Owner: IVIPL(" $ 10. 13 RLT 01 /0*7,192 lv',ELVIN WAYMIRE M5PC $ 2. 03 RLT 01/07/9E IDO BOX 231164 PPIRT 1. 155. 00 PLT 01/07/92 P5PC 4 7. 75 RLT 01/07/92 I TGAI1D OR 97223 !-'hone #.- 639-6742 Contractot-: --------------------------------- MELVIN WAYMIRE 1 ,( 2 ) [A�'X 1`31164 1 IUARL) OR 9/223 ilhone #.- 639-6742 35976 ------------------------------------- $ 3222. 01 TOTAL ?his permit is issued subject to tf-P requiations contained in the --•----- REOL11RED INSPELTIONS -- Tigard Municipal Code. State of pre. Specialtv Codes and all other Foot/found Insp Fireplace Insp applicable laws. All work will be done in accordance with approved Post /Beam Stt-ki(-t Gas Line Irsp plans. This permit will expire if work is not//started within 180 Post /Seam Meehan InSLIlat i Otj Insp cays of issuance. or if work is i u for4orOhmn 18I.days. 1:11m/LincislAb Ineir, Gyp Hoard Ins; PLM/Undat-f toot, Rain dt,ai.n Inbp : -et-mittee Sicinatlt�-# I M a c h a Ti i c!a I Insp W a'� :?r Line Ii isp PlUMb TOP Out AJ1Pr/SdW1k Insp ISsl.led Ft-aminq Insp Mectiani(_-Al Fit-al f fnt- tiny pert ion SEWER CONNECTION C11YOFTIFARD ® PIE RM IT CITYOFTMID F-EPM]:"f #. . . , . . . : SWR91 -0 u 1 COMMUNr^r DEVELOPMENT DEPAWMENT oeN 13125 SW HWI BW P.O.Box 23397,TOW,Onpon 97223 t603)6394175 C, 1 71 DATE ISSUED: SITE ADDRESS. . . : 14525 SW 130TH AVE F'ARGEL: 2SI09AD--WDF27 �IUBD I V I c;I ON. . . . : WOODFORD ESTATES ZONING,- R-7 FLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :27 T'Et\IRN'f NAME. . . . . : USA NO. . . . . . . . . . : FIXTURE UNITS. . . : CLASS OF WORK:. . . :NEW DWELL I NO UN I TS. . : 1 1'Y1JE OF USE. . . . . :SF NO. OF RUILDINGS: 1 TNSTALL TYF,E. . . . :DUSWR IMFIERV GURFACI=. . : : sf Remarks : 11wner: ---------------------------•-------- _ _- ___________ — FEES ----------_--- HELVIN WAYMIRE type amol.int by date recpt BOX 231 164 F,RMT $ 1900. 00 RLT 01/07/92 INSF' $ 39. 00 RL_T 01 /07/92 I I CARD OR 97223 Whone #: 639-674 ' Contractor : CONTRACTOR NOT ON FILE Phone #: 1 1935. 00 TOTAL REQUIRED INSF,ECTIONS This Applicant agrees t^ comply with all the rules and regulations :-;ewer Inspection of the Unified Sewage Agencv. The permit axpires in '�,ys from the date issued. The total amount paid will be forfeited if the oermlt expires. The Agencv does not g-jarantee the accto acy ,f the side sewer laterals. If the sNwer is not located at the measurement given. the installs- shall prospect 3 feet in all directions from the distance given. If not so located, the instjller shall purchase a "Tap and Gide Sewer" permit and the 4vcy toll install a lateral. C-'e r m i t t e e S i g n a t l.t r e . ss,-red By Call for insopc•tion — 639-4175 Va M PLUMBING DERMIT CITYOFTIGAPERMIT #. . . . . . . MST91-0209 RD CITYOFTIMR0 COMMUNITY DEVELOPMENT DEPARTMENT MGM VATE ISSUED: 01/07/9c--' 13126 SW HON Blvd P.O.Elm 23M.T*W,omoon 97zn(5o3)&%4i7s .1'C ADDRESS. . . . 14525 SW 130TH AVU PARCEL: BDIVISION. ., . . : WOODFORD ESTATES ZONING.6 R-7 0 C K. . . . . . . . . . . LOT. . . . . . . . . . . . . ..27 OF W `RK. . :NEW GARBAGE DISPOSALS. . Il 'YF'-'E OF USEI. . . ISP WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTR9. . 1@ -jrCUPANC Y G4P. . %R3 FLOOR DRAINS. . . . . . . 20 TRAPS. . . . . . . . . . . . ..0 --T'DP,IES. . . . . .-2 WATER JLJE S'1 NS. . . . . . . !0 ATERS. . . . . . It CATCH BA, J X I'LJRES------,.,-. LAUNDRY TRAYS. . . . . . .. I SF PAIN DRAINS. . . . . : 1 `1 NKS. . . . . . ... . I GREASE TRAPS. . . . . . . :0 -AVATORIES. . . 0'. 115 OTHER FIXTURES. . . . . 30 ! US/SHOWERS. . . . - SEWER LINE (ft) . . . . :0 AAI ER CLOSETS. . ;3 WATER LINE ';IL,HWASHERS. . . . Ll RAIN DRAIN (ft) . . . . :0 i '�emar,ksa ..� -�r ,� � , . , OWNER __—_—___FEES__....___._._.__ _._,...... MELVIN -------FEEcj--- MELVIN WAYMIRE TIF $ 17,80. 00 RLT 01/07/9r'.1' WO BOX 231164 BPRT t 49 CA. Oel RLT 01/07/132 BPL.0 * 323. 70 JI-H IR/23/91 TIBARD OR 97223 B5PC f 24. 90 RLT 01/07/92 r'-Ihune #s 639-6742 3SvC $ 200. 00 RLT 01/07/9P PARK $ 500. 00 RLT 01/07/92 Ljumbing Contractor: MPRT $ 40. 50 RL-T 01/07/9 MPLC $ 10. 13 RLT 01/07/92 ,lames 115PIC $ 2. 03 RLA' 01/(87/92 Oddresss PPIRI t 155. 00 RLT 01/07/9c' ilityl J3 t'j t Q p5pc $ "Z. 75 I.-L_ 1' 01 /07/9 7ipt --_Phone#t REQUTREI) INSPECTIONS This rjej-mit is issued subject to the i-f?q - 1.1111t.i,ons contained in the Tigard Muni,:. ipal Foot/found Insp Rain drain Ilksp. !'ode, State of Ore. Specialty Codes ay�d all Post/Beam Struct Water Line Insp. ether applicable lawv!. All work voill be done Post/Beam Meehan Appt-/Sdwlk Insp j,n Accordance with approved plans . This PIN/tAndslab Insp Mechahival F.'inal permit will expire if work is not started FILM/Underfloor Plumb Final within 11310 nays of issuance, ov if woi-k is Mechai,ical Insp Building Final p41nded for more than 180 days. Plumb Top Out Erosion Cunt r,oi f=raming Insp Firoplace Insp Gas Line Insp IntiuliAtion 111-P d --A nyp Board lti-p t h C 0kUt-41 Call for inspection 639-4173 N t Cll,, OF TIGARD RECEIPT OF T.,AYMENT RFCEIPT NO. CHECK AMOUNT a 44107. 01 NAME WAYMIRE, ME-A UIN 0. JR. GASH AMUUNT ¢ 0. 00 ADDRESS a WAYMIRE, .JUDITH G. PAYMENT DATE ¢ 0 1 0 7 p. t.), BOX 231164 SUBDIVISION 71GARD, OR 9782.7— PLW.9(6[,- OF PA- ME AMOUNT PAID PURPosE OF vAYMENT AMOLIN1 PAID I.I) PERM MST91-0209 498. Oel PLUMIAMS PERM 00 i6 I , - - MECHANICAL PF 40. 50 ST. BUILD PFPI :�4. f.-)8 PL ON CHECK FE 83. 8-3 SFWF R USA SWR91-0231 1 IWO. 00 SE's l•!; INSPECT ' 5. 00 RESIDENTIAL 'CRA FIC FEES 112,50. 00 MA1.11, TRANSIT 1'1,f- FE.[:,S i�'o. 00 PARKS SDC W. 0 . 9TRLET SOC 2180.(10 14', J, SW 130TH AVk..-'NUE—M131' 91-0209.3 T(ITAL I)MfALJN-t PAID 49W. ?1 CITY ()V* TTGARD RECEIPT OF PAYMENT RE('EIPT NO. W(WWRE, MELVIN 0. , BL DR CHECK AMOUNT , 0 ADDRESS P. O;jjiElC'X 231164 CASH AMOUNT t -rlo D, OR 00 V'AYMFNT DATE a t l91 51J A 0 1 V I S I ON F."URPOSE OF PAYMENT AMOUN,r nn i n PLJRPM4E OF PlAYMMT AMOUNT PA I D PLAN CHECK FE 10-51 R Z, VOVAL AMOUNT PAlt)