Permit CRY OF TIGARD BUILDING INSPECTION NOTICE .
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
j I ..
Inspection: _ ,1 . __, • W4 A A .: i C L4
%
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:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. , - Elect.
1
Date Requested: p G li lqc 61 Time: PM
Address:
/ ic. Z7
Builder: '579 e. /6l ( Permit #: 5/77 -ec9 -9
THE FOLLOWING CORRECTIONS ARE REQUIRED:
la, .5 lid
j Ate __, ,f- -- / - y- _ /
/' ,/ if /
Insp tor: •'';i Date:
APPROVED DISAPPROVED
_Call For Reinsp.
10/28/98
This HISTORICAL / RESEARCH INFORMATION is being provided for clarification: Addresses
were changed in the beginning of the project and there was a lot of confusion as to how inspections were
being called in and where they were data entered in P *P and what address they were filed under.
This information sheet is being filed in all the below address files.
MLP94 -0013 @ 12730 NORTH DAKOTA
SDR94 -0014 @ 12730 NORTH DAKOTA
ENG95 -0026 — HALF STREET IMPROVEMENTS
CPA95 -0002 — 12580 SCHOLLS FERRY
CPA95 -0005 — 12580 SCHOLLS FERRY
SIT94 -0029 SITE PERMIT ISSUED @ 12730 NORTH DAKOTA
There are (3) addresses attached to this site permit; 12700/12730/12744
BUP95-0039/BUP95-0038 @ 12550/12580 SCHOLLS FERRY RD — DEMO PERMITS
12550 File contains documentation regarding septic pump /fill
12700 NORTH DAKOTA — Bup95- 0075 /Shell (this address has numerous suites)
12730 NORTH DAKOTA — Bup95- 0025 /Shell (SORRENTO VET CLINIC)
12744 NORTH DAKOTA — Bup95- 0026 /Shell (KEY BANK)
I :Building/JeanneTemple/MLP940013
R "
CITY OF TIGARD BUILDING INSPECTION NOTICE -
Inspection Line (Rec- O- Phone): 639 -4175 Business Phone: 639 -4171
AA -le
oting usp. Ceiling Sprink. Rough -in Appr/Sdwik
undation Plbg. Underslab Mech. Rough -in Fireplace
st/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
'st/Beam Mech. San. Sewer Gas Line -Bldg.
�g. Underfloor Rain Drain Framing - Plumb.
arm Water Line Insulation -Mech.
iderflr. Insul. Shear Wall Gyp. Bd. - Elect.
ite Requested: U I I ' PM
Time: M.: J �—
:dress: Y1/.W k? - ,c - s,
C
:ilder: �� (-1 i�;.l Permit #: 5/ �/ - c'% U
iE FOLLOWING CORRECTIONS ARE REQUIRED: / 7 30 Ste/ ,4 ? 7•
j r �
0 g,
'4eiv\y- -
Date:
spector: -
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
CaII For Reinsp.
,
.. bow 1414■41 JAI 4144
1110 ' :HOS.
.., . 1.0 : 1 . • . ,5 A . „ 1/11-264 ,;. j , • , CI (14(xowlon ,„, • , , -: .„,..
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4. . I . • ., • s -•L ? . ,,, , it t.„..r, i I 4.1);Ifc•,,,...)1,. ,,,., .Ki 0 : ,,#. ....,:,.%„., 44 # ,/... . :,: :... ;;;.. -". '•,.., :
-; .',iiir y ,:, ';"0 r ; g,, 41 •••• ,. .-t -It. • -'" : It L a ' ti:i i.." „ , .:047.•: • .,7, • -.„ '•• ..... , • ' • kl•
I
..• •,‘•• .•I ••• ••• -,.. ' ' '' • • ' • r” 'f k • i • 4 f. 'e '' . :., 1,, ti/),.1,`,4 ,.i. ' "..". • • •• • • " •• • • • ' •
' )4e.,..,...itgals..• • •Od '• ion • • -• . 4 • L I's • / : , • --ty.o•tb•PitiruDFF,Iittetlf1VRT.101tONDAY‘•• .- • t R
. 4 , 1 . • 1- " Z' .••■•• .. .e... ' • - ..t'' ••••;i• - . - .- .11 I-I -v. f^ .' .* •. ,09.4,/ • *•' .A L........i..4.11.4• .4 ' se • - '''-
' • ..' " l' • -- f i isigiii I ' :C•.:: Aci• MOO - filoadlrio *c ''.: . .- ...- ' • • '•; - * --e-7.4.: '''' • • • • • . . •
• • >-•
ce
.,„., „,,, , . , ,,.. • . „.',:tirnef , : i i z .t . ...... ; ,...... vat) pliot ' : ' , Tie iiiiitgatiw., txi ., , , : . s,,, . ,
• •!,..,
,.: gals , .1. q p.c..• .. •,.,-. - ......4 ..„.,...;1,..... i 0 ,,,,- . • • •
t_____I. 'to Vi bid . •f U !YES trit. •:r ,• ... '‘•"• 1.7 1:11 " 4 /W. • ..."j• • .. SCI-10L ERFiWNORTri . DAR6TA
d'
,..,., ADDITIONAL WATER • ..' '
REAS -"4" FL itoo 4 1ii,X 9 64 '''' • ' • "" - cs' 'il4p • * tl;g2 rr••• "-
:' • ' - . O ' TIME: ; • t• j • ' '''.. • . •_1-14k1;"; • ,•• - -11 1•••: ••-•;•• . -, ca
. ..;• .i ADDED TO THIS . ,L,' - • - ), % ..4
CONCRETE WILL REDUCE JOB ..,c .': '; '' ' ' •DAM .••••• NI . 9 a A .. - Mg 50 3 = 95'1 - - • •
". itl, , .1 ,... '. .. . TIME ::••••• 10i 3a • . . ,
' ...?.:*;:•.',.. STRENGTH. ANY 0 O 0 • , ELP,. ' .. ' . . : :: . .. • ... i . •
,.. „, . ..., • ..•,.., • , A••'.4. .. e; , e 2 .1 4 . ; if ik• •••' '1 ' : DRIVER .
PLA*1. TOM PIT
yANDROEIKY .: .
• .
f.,'.1 WATER ADDED IS '0 WHEE RliQily J90 ,,.. ... 1 .... , :, . ! ,i,-, . .:.t..t ...t.i.„ .• .. . . ..
. 1, 0 R
wAn :.. , ,:.?Ro,s8.:1,.7.". 44 .4;... TUCK,/ . • • • : • . •$ •
•,..: AT CUSTOMER'S ".
WEIG ASTER .
- ...•
.7.$-' • It F.,..' •,,,. 4 • liM' :, ; EpygiionitsTrAcy .;.. .
.:....., QWN RISK, .., ;. ,0 ADDI CilWATER ARE
);:ts '.. eivi,...fi ...,,,- , 4 24;16 LOADS, . 1 . Acctifir I . : , I a. 16
.:.
• 4 ' .. tAi4
•st,44,40" ' f
....
•
:44 : qi: . • I. !/./.wr•'. :pi .mannier • r ' ' Ly4: A.i.: ••, 4NET s,,, .,1 . .
MUER 1NQUESTP plf; ,, .T.4 :44.: , Ali.V . ; •-' •:, itPECI4e hISTRUCTIONS: . ; .- 7 -• It ; , . • .
'0:ii."' ' • • ..,-•'' • ' ••• '‘,'•' - 1-J;virlER .-"•• v - ' ' ': . ' • - • '' :' ' • 4 .:T ...;4';••,: , •
1 • i . ,
. • • • .: • . ,:i , • ...• • ..•;=•;.; •
• : ••
• • .
I .....-
MATERIAL MIX DESIGN, SSD MOISTURE • *
C TION DESIRED AMOUNT : ACTUAL AMOUNT SSD CORRECTED AMOUNT
(
ORREC '• •
•
• •
• •
TRIM
WATER GAL ND
' .. .
WATER/
CEMENT
RATIO
' MAXIMUM
ADD
WATER GALS
I
PRODUCT # PRODUCT DESCRIPTION QUANTITY UNITS r UNIT PRICE AMOUNT
I i r GRAVILI._ PRO13INISS . 1 ,2 . 1 6 1 ON.
• . .
•
- .
• •
. • . , ...: ..-:'......• i.'..: .. . i 4.i... .:-.:.
...E4 :,•:.,, .
• '
....,. •. .. , .,, s ..
, .. . , . . .0 '' ; VIAP' 4N. ety M. • • ; • ' I - ;!'. • - ••:'. .. I'. ' j.t. ' •".. 4.
TERMS: NET — DUE AND PAYABLE BY 15TH OF MONTH FOLLOWING PURCHASE. A
finance charge of 1 V2 % per month, or a minimum of $1.00 , will be made on the unpaid
i i *
balance al the end of the following month's billing cycle. Thla lean ANNUAL PERCENTAGE • TOTAL
• -
I •
I RATE OF 18%. PERSONAL NOTICE: We reserve the right to claim lien for all labor and .. . - _ _. t it it TICKET I/ E"-tlirtYY-ti'—'w'
material furnished on this lob according to OREGON REVISED STATUTE 87.021.
• * R EIV :. • .1
I
•
I
CAUTION. Freshly mixed cement, mortar, concrete or grout may cause skin injury. Avoid contact with eyes .here possible ana wash L'posed areas promptly %%lib FORM 30 Revised 6/94
water, II any cement mixtures get into eyes, rinse Immediately and repeatedly with water and get prompt medical attention KEEP OUT OF REACH OF CHILDREN.
Lebanon A(
O SEHV1NG Y011 AT Ilarnstudu F., ab 95 6
" : n 451:4141 • P.O. Box 7, Lebanon 97355
Al S
327 • Tangent Operations 92d 64b1 • Porn..na Prestress 655 5111 2148"
1
..... ,. .. 2. ;i 7 .:. - 1-: ::„..... k ;:s•7 1 : 40. 1-2:- ...• . ;
<*: • ----
:
-- .4..„ - -A:' i-- ' : '
'
..
, ...,..,... •.. •
44.,..7,,,$.-
..„..,,,,,..._..„........
_,....,....,......,...‘,... _
. .• ...„,-.• .- , .., .
Z Horresbur; 995-633 3 Bak Item 3t74174 - .•: 0 ilimowes • • ;.Cf• . ' . — ' - •
MORSE BROS. z Lebanon Cispr-Jw 2: 23 D Atom 12625 at 1111Millgil .."‘:t.13 ill11.7326 - ' . . 7 ... ?'. s . -1 .. ..4 ; ' 2 , .
marmas CROUP
. Carvallo 752.1428 = Euorme 689-e& D , ., • ; .:, 0 4105 :- . • .- .0,. ''''
. . s•
MAP LOCATE BATCH TIME LEAVE PLANT ARR. GB BEGIN POUR - . FINISH POUR • • ' UMW 4111 : _---* ' - —
•
. .
1
' -,.,..-,-- E
WATER ADDED AT TEST CYL. 8 MINUTES F R YARD CUSTOMER ACCOUNT # 16 .,,,,,..w,, .• -: :
CUSTOMER'S REQUEST • TAKEN FREE UNL( 1DING JOB # - - 924 BID # - ' ' : . "--7 - 1 .. °1 - ''. 1. _,‘. • • '. -
TIME ALLOI ED ON - .;-:.
gals. to full load 0 YES FULL LO DS..
SOLD M. ...,Cf.l. 1 t':! ' -
r
gals to load 0 YES
Additional u aading
i . 2 /3 .
i time charged ; current. - --: - i - .g., 1,
, .....-5...... ,..„....-
I ,
gals. to Vs load. 0 YES hourly truc rate. . geuvow ' • '`"- ...t- i
1 ' . • ' pow. - - • ,i• FERRY?! «T : ...., •
ADDITIONAL WATER
REASON FOR DELAY "IME: ' •••••••••• ' gaigigaM : . - '
ADDED TDTHIS
DATE • - 03/09/,91/.0. %. '..g--
CONCRETE WILL REDUCE 0 JOB NOT READY
TIME • :.'. lir ,..:;‘ . C.. ' . QV: ' - li -- tj'yi' t -;;....'
STRENGTH. ANY • El LACK OF HELP .
WATER ADDED IS 0 WHEEL BARROW JOB • -.*.;...-....-• •:• oFINI • -". SOHNv r - - - - • ' - ---*
I AT CUSTOMER'S 0 WAMNG FOR TRUCK Ti UNLOAD GROSS : 24. TRUCK#,-,..-:lfik• '-'•' c_s ,- 2: `: ,;','.
. ,
1 t - OWN RISK. • 0 ADDING WAtER - • • s TARE
- NET ' • '-..:: -
0
WATER REQUESTED BY: ARRIVED JOB EARLY
I : ,, SPECIAL'- -, .
't •; - , . 7 , . -
1 u OTHER
. . . - • ... .. *.f. 4 4:_...t..,,,-4. , :r.,. - . y . • i... 7 . -
I •
_ . . e.....-„....,, )....,,,...--,...„!,..;,.- - - 4..7.:,-: •,... ,.., , 1; ;;,' f.....
• • ..-- ' :Z4 3: ;4 1. : ) , 4 1,174'.'14 *.. ;q:1 . '' '. '. - ii..... ..
MATERIAL MIX DESIGN, SSD motsTuRE DESIRi I AMOUNT ACTUAL AMOUNT,. SSD CORRECTED AMO .;;;
I CORRECTION - . , , -.. ..... • • .4 , . .;-, t=. .... .. ... -s - 1: - , r.:7 •L 'i : - ' •.-. _'"-, --
. :- . • --;'-'!. • ' It :: --:•.: • . .: . 'Y ;v jr -?. '.. - ■ - ' 'i 4 P
I • • . 1; ...„ g$1,,i 4- • LT .t: : ;. ' '%. . '
I • • . . . .........P' ili.r. I ..; '.......: "I ..... ::.;:', I. ' "'' 7 ;1;4 4r ; . • .' '.''''':
• .r.
I .
• : - -.. • - ".:,.' • • • •:• • • , ' :•••• - Iv• _.- • ..4,....•!..6-"...i,• .
. • - ..• - . ' • :... "':; ' .•":•!•• :•. -4-... ;;•,,...•.•.-
1 • - ..,...... ..• .. .... •:...;:.::. ,,... „
i . . .
• . • • •...., .. • ....: •:,..,..... , ...
,.,.
ri. . .
. - . -. - .•..,.. • , : • ••-••• :••:.
-.... -.:.•*.Lili,tv..x....i-..
i \ • • •
.,. ; --.•: - •• ......- • •• ,•; . • •••. -
• . • ...•..,.. . • • ..- - • t -` , 1 .,....„.?, ,,, • '... - . - AL
I".
. • -.- . • . -",:.•.-•, ..,.. :.--:. -It .' ,
- , •-• --__ r:.• 11".,
.' • ,%•.:.• :.i.;..•••• :••,- • -
•
PRODUCT # . • PRODUCT DESCRI PION , -- QUANTITY, -.% UNITS 4 UNIT -
1 eiee3aP . 3/P PEA .GRAVEL PRC ESS 1308 . '70 - - ' '''''.: s. - ,1•- .:.,':..":.
) •• ..r,„5 ;IS14,71; 4 A
..: ....". '.;.4. • • ..• . 2 ,.." . : ,: : 2 ; 1-r ; ' *--i....%.‘: ‘. rt 3-- •':?‘ '''''‘ ; , ' .. 4 A"k. 1 .)..1 1 ^ .' ' - • - '.':
, • .......4-a."A•amw.r..- 4.5%,........ _ -ovIstekiarx. 1 4111;1W-:
I ,-_. . " .:e
I •-;s • —
'....`,... 4 ^kt - i• • • -n • - . "1.-*...-":. . •1"1444.74.4 MMET '. . ' • • . — -.• • • - ,,
' -
1 • - 1 • ' .•'.....!?: • . .. ••••taks-ef-40....:' ".•...i.' t: • IN‘,' • - 4.... • -..• '' '
- .e•- r I -. ' ' .. ' 1'
• . .
i • - .,;:;, v• ,-- 4,e -Lerq t .4.„.. "'I .
-• ' ' ",.. • (•..';' 4 .1;.q.' .c't r•C- - '■ 's - • r: ,- . .:-.J■■•T.:* .is.• .• ia :7421 X. '; ' " A ' Z.it;:s 1 .7 2 A - 7 , 011046X4Wa - I c• -• '-: - ' ' '
I TERMS: N - • E • 'PAYABLE BY 15TH OF MONTH FO 'WING PU M .LA . . •.,. :,.•..... - •••
f' •)
I •- •• charge of'11/2% pet ttiMIA. or a minimum of 51.00, will be made on Tail
Itte oald
I at the end of the toilowlm motet's billing cycle. This is an ANNUAL PEACE AGE ' .." "" ' ••• •
i Jf18,th PERSOMALWCTICE: We reserve the right to claim lien for ell Is and . 1 1 1 ' / err ••1,:. rr
-- TocEi . • ' •
, materiel tomigiber On Mar)* IdcbitIlng to OREGON REVISED S1XTUTE 87.021 avt
. ..., . . _ .
CAUTIOU Freshly mixed cement, mortar, concrete or grout may cause skin mit, • id contact with eyes where possible and t..ash exposed d are rc promptly with n .1 ':' ........e. .....--s
mater. It any cement matures get into eyes rinse immediately and repeatedly wit ater and gel prompt medical attention KEEP OUT OF REACH OF CHILDREN :Z.. ,,,. is • • ''' -
''•'' .' • IV,. - t, i
,
taboomsn •milobstlim4111.17641 • P.CL Om 7. tam* MINI •
ALSO sernmo YOU AT Hornsby, .snoss 9951327 • Tangent Obsrobons IISSOI • Osslood Mum= 8554Th ":-■ .1:. -.....
S. -.,4.% .'. . ,;.,
-- — "-- — - — -- — — .— 0 ...— .-- ---- —
U I I Ilaru 9956336 1 I Sweet Home 3676174 ❑ Salem 3906955 I I Deer Island 397
MORSE BROS. _
f I Lebanon Dispatcher 258 1 l Albany 928.2547 a 25 92 &2115 U Bearerlon 6197526 11 Sl. Wens 397 -0111
M ATERIALS GROUP
' i CorraB,s 7523428 I I Eugene 689.6600 LI Sherwood 692 -0105 I I Slaylon 7696465
as
MAP LOCATE BATCH TIME LEAVE PLANT ARRIVE JOB BEGIN POUR FINISH POUR LEAVE JOB ARRIVE PLANT
WATER ADDED AT TEST CYL. 8 MINUTES PER YARD CUSTOMER ACCOUNT # I I ` I CODE t
CUSTOMER'S REQUEST TAKEN FREE UNLOADING JOB # r ' ' BID # >
TIME ALLOWED ON a-
gals. to full load ❑ YES FULL LOADS. O
SOLD TO C'LJi'f=1 IFTPd ti.tl: ;i1V(� T I IA I e f 1J
gals. to 2 /3 load ❑ YES Additional unloading u,
time charged at current l
I i l l l . I :f ( II
t hourly truck rate. ;31' :! 101..1..! Itl.:'I I ° I? LL
_ gals. to /3 load ❑ YES Y DELIVERY LIVERY ' ; f HA 1 I I 1 . 1 1 I I
I l f l, t i l l I 0
ADDITIONAL WATER REASON FOR DELAY TIME: °
ADDED TO THIS [] JOB NOT READY DATE Mr .:..'t.1'a ', P0 iI , I';,. ,L1 • • . I X
CONCRETE WILL REDUCE TIME I I .• I I 'I PLANT I ‘,1 PIT
STRENGTH. ANY ❑ LACK OF HELP
WATER ADDED IS ❑ WHEEL BARROW JOB DRIVER I I III ` I l; •i l
Af CUSTOMER'S ❑ WAITING FOR TRUCK TO UNLOAD GROSS "r .. 'r l • TRUCK # TRLR #
OWN RISK. CI ADDING WATER TARE I f .. 11,'I WEIGHMASTER I I' I
CI ARRIVED JOB EARLY NET I 11 u tIY I 1 I I I
WATER REQUESTED BY: CI OTHER SPECIAL INSTRUCTIONS:
MATERIAL MIX DESIGN, SSD MOISTURE DESIRED AMOUNT ACTUAL AMOUNT SSD CORRECTED AMOUNT
CORRECTION
TRIM
WATER GAL./YD.
I
WATER/
CEMENT
RATIO
c
MAXIMUM
ADD
WATER GALS.
PRODUCT # PRODUCT DESCRIPTION I QUANTITY UNITS UNIT PRICE AMOUNT
I I I i , , I I /". I "I I' ICI it i' I , I 1 1 I
I
I
TERMS: NET — DUE AND PAYABLE BY 15TH OF MONTH FOLLOWING PURCHASE. A �1
finance charge of 1 per month, or a minimum of $1.00, will be made on the unpaid TOTAL
'ce at the end of the following month's billing cycle. This Is an ANNUAL PERCENTAGE
OF 18 %. PERSONAL NOTICE: We reserve the right to claim lien for all labor and "r \ f �\ + I I ! I: y 'urnished on this lob according to OREGON REVISED STATUTE 87021. -a C V E TICKET # I RECEIVE BY
: Freshly mixed cement, mortar, concrete or grout may cause skin Injury. Avoid contact with eyes where possible and wash exposed areas promptly with FORM 30 Revised 6794
y cement mixtures gel Into eyes, rinse immediately and repeatedly with water and get prompt medical attention. KEEP OUT OF REACH OF CHILDREN. 2 1 n q
0 MORSE BROS. I] Harrisburg g 995-6336 U Sweet Home 367.6111 a
Salem 390-6955 I I Deer Island 397-4659
MATERIALS
GROUP I 1 Lebanon Dispatcher 256.7123 U Albany 928-2547 or 926 -2145
U Beaverton 649-7526 I 1 St Helens 397 -0111
I ! Corvallis 752.3428 I I Eugene 689.6600 U Sherwood 692 -0105
BATCH TIME I I Slayton 7696465
MAP LOCATE B
LEAVE PLANT ARRIVE JOB BEGIN POUR
FINISH POUR LEAVE JOB ARRIVE PLANT
WATER ADDED AT TEST CYL. 8 MINUTES PER YARD CUSTOMER ACCOUNT # I r ' 1 '
CUSTOMER'S REQUEST TAKEN FREE UNLOADING JOB # . CODE
TIME ALLOWED ON BID #
gals. to full load ❑YES
FULL LOADS,
gals. to 2 /3 load CI YES Additional unloading SOLD TO C;111 l lt't I : `r`� �t�'� I I ! ►I t ! III
time charged at current
gals. to 1 /3 load El YES hourly truck rate. DELIVERY
`'t-:l i t )t `, H. I O f. I. i 1 t i I I I •
E " (,I it 11 i. I I I I,' 1 11 1, ! I I 1 r 'i ii I 1 I; i
ADDITIONAL WATER POINT ' ` . ' '
ADDED TO THIS REASON FOR DELAY TIME:
CONCRETE WILL REDUCE ❑JOB NOT READY DATE '•. '• ,' -'''' ' ' I'P.O.# .11 11 t •1'•:1 1 . '.'
STRENGTH. ANY El LACK OF HELP TIME I PLANT I'' PIT '''
WATER ADDED IS ❑ WHEEL BARROW JOB DRIVER I I' I II I I 'i II i1 i i i I t ;
AT CUSTOMER'S ❑ WAITING FOR TRUCK TO UNLOAD GROSS ' 1 ' ' 1 TRUCK # TRLR #
OWN RISK. ❑ ADDING WATER TARE 1 I.. 11.'1
WEIGHMASTER I " ' I ' "I i t :1
WATER REQUESTED BY:
iii ARRIVED JOB EARLY NET I .'!,, I I It if I t 11 I I,l
111 OTHER SPECIAL INSTRUCTIONS:
MATERIAL MIX DESIGN, SSD MOISTURE DESIRED AMOUNT ACTUAL AMOUNT SSD CORRECTED AMOUNT
MOUNT
T RIM
W ATER GA
WATER/
CEMENT
RATIn
•
•. .v : T '�i. +: , .:�■ v ,/,', : \ :•fis r 7�r • �: : A. ,, i �"�, ■ , . ri1 0134.1 .Mice'
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OM , •• RUPEE
• JO. NAME AND LOCATION -
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.. RIPTION OF O CONTRACT
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• QUANT. j : OERCRNRION O!• MATERIAL USED ..b. • PRICE . AMOUNT `
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HOURS LABOR ® - . AMOUNT
TOTAL
MECHANICS MATERIALS
HELPERS CO WOAL R
I hereby acknowhdge Ma satisfactory I TOTAL LABOR I I
car 'ion of the above described work: TAX
aeon .44. I DATE /
CD
TOTAL