Case File ADDRESS:
i ',records',micro`lm\targets\building doc
INSPECTION NOTICE p
Cit- of Tigard Building Departtent +
131125 811 Ball Blvd. Tigard, Oregon 97223
Inapeotinn Line (Rec -O-Phone): 639-4175 Business Phone: 639-4171.
Inspectlon:_
Footing Plbg. Underalab Mech. Rough-in Appr/Edwlk
Found. P).by. Top Out Gan Line lINAL~i
Pontlactam Struct. San. Sower Framing -Bldg.
Poet/swam Mach. Rain Drain Insulation (I__Plumb
PIbg. Underfloor Water Lin. C� Gyp. Bd. -Hoch.
Data Requested: �'�-� - 1 Time: _ A14 PH
Address: _ ---- Permit Q ZtO.�
THE FOLLOWING CORRECTIONS ARE REQ(IIRED:
Inspector: �---� �-'-�`-
/ Dats:
APPROVED DISAPPROVED APPROVED SUBJECT To ABOVE
^-Call For Reinsp.
C
Cf.�R'l'I F'I f;FtYE CIF
OCCUY
IY OF TIGARD PERMIT 0. . . . F'A.z MST9.3 -02651
COMMUNITY DEVELOPME=NT DEPARTMEN1 DATE ISSUED: 09/21/93
13125 _ V ieII B!vd Tlgerd,Oregon 47.. 3.8109 (503)639-4171
PARCEL: tS134CB -1 5'.500
SIDE ADDRESS. . . a i i.3 SW NN'tUN Dr.
SUBDIVISION. . , . ANION 4-.4RK I I Z(IN INOs R- i FAD
BLOCK- - . . L OT. . . . . . . . . . . . . 0082
CLASS OF WOPK. :NEW
TY'�'E OF USE. . . aSF
Of'CUPANCY ORD. a R3
r'X.C;LIPANCY LOAD:222 4
TENANT NAME:. . . a
Remarks: PATH I
Owners _. ._.._...._._...._._.._.._ ...___.._........ ._._.._.._...__.._._ _._.
MELVIN 6 WAYMIRE JR
P n 9Gx 23116t,
•T I UARD OR 9728,.
Phone #t 639--6742
C:(]Trt rayl?t GYM t
MELVIN WAYMIRE
PO BOX C31164
TIBARD UR 97281
Phone 11a 639-6742
Reg 0. . s 3,79976
Occupancy of the above referenced building is hereby Iliven, and certifies
tho romplianr-•e ioith the State Of Dragon Spec-iaity Codes for the group,
or-cuprancy, and tune under which the rleferer•iced permit w iss"red.
F r 1?E Y]EF fif2TMEN'T 8 INC, IN :wC"fOR
AM<14d—1� __ ----
- —' BU l D I NG GFV-F C I AL_
00G'1 IN CONSPICUOUS PLACE
INSPECTION NOTICE
City of Tigard Building Department
13125 SII Ball Blvd. Tigard, Onnyon 97223
rnspectiun Line (Rec-O-Phona): 639-4175 Business Phone: 639-4171
Inspection:—__
Footing Plbg. Underslab Mech. slough-in Appr!E;dwlk
Found. Plbg. Top out Gas Line FINAL
1
Post/Beam Struct. San. Sewer Framing
Post/Beam Hach. Rain Drain Insulation
Plbg. Underfloor Water Lina Cyp. Bd. -Mach. j`
Date Requested:—��� +� � y--Time: —il►M�_pm
- _� `" .� Q `--.
7.idreen: � _L ✓�� -- — Permit �:- 1�.Y���-�..,]_
THE FOLLOWING CORRECTIONS AR1, REQJUIREu: ' 1
- - --
Inspecttor: / v`�' �+�.. Date: ^�
APPROVED - DISAPPROVAID APPROVED SUBJECT TO ABOVE
`V �✓( Call For Reinsp.
INSPECTION NOTICE.
City of Tigard Building Department
13125 811 Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec•-O-Phones 639-4175 Businrss Phone: 639-4171
Inspections_��
Footing Plbg. Underslab Mech. Rough-in �pp��7
Found. Plbg. Tap Out Can Line FINALS
Post/[feats Struct.. San. Sewer Framing -Bldg.
Poet/Ream Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Rd. -Mach,
Date Req-:nated=_ �/ f Timet _AM PM
Address• _ I � �i ��y � ._ Permit #s l
Buildar=
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector= � _ Date=
�_APPROVI►D DISAPPROVED APPROVRD 8[18JECT TO ABOVE
_Call For Reinsp.
IbSENCTION NOTLC! %f
Cit? of Tigard Buildior; Department �1
13123 611 Ball Blvd. Tlgswd, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-41'15 Business Phones 639-4171
Insiactions
Footing Plbg. Underslah Hoch. Rough-in fpr/sdwlk
Found Plbg. Top out +las Line FINAL:
i
Poet/Beam Struct. San. Sw-er Framing -Bldg.
Post/Beast Hoch. Rain Drain Innslatiun -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Hoch.
Date Requeetedi /ao�
Addreee s 2-�j �j I i�.`C1V Permit i s
Builders
TRE IOLI.OMING CORRSCTI R � QtlIREDs
Ole-
h�� d ee- - cam/ -
,4T .&_j71crv6, 4,7vD Cv
Inspector: `1 r4_3
D
_ _ -- �
ates
APPROVRD _ DISAPPROVED APPROVED STY
RJR(-1 TO ABOVE
__�eti For Reiusp.
1V3M9TI2N NO7��8 11 A)
City of Tigard Building Departwnnt
1.3225 SO Hall Bled. Tigard, Oregon 97223
Inspection Lin* (Rec--C-Phone): 639-4175 Business Phone: 639-4171
I nepect tan s_� --
Footing P1bg. Underslab Hech. Rough-in Appr/sdalk
Found. Plhg. Top out Cas Lina FENAL:
Post/Beam struct. San. sewer Framing -Bldg.
Pont/Bean Hoch. Rain .train Insulation _PIund),
Plbg. Underfloor Nater Line per, �,
-Rech.
Data Requested -PH
Permit Address: A_/Jj /�/ l �'��
Pereit
Builder:---,4ti.�J -�i2F�
THE FOLLONING CORN ION REQUIRED:
P
c �
1
_ I
t
i
Inspector:
PROVED DISAPPROVES APPROVED SUBJECT To ABOVE
---(*I l rnr Reinap.
111,
inN NOT}CSB
City of Tigard Building Department
13125 ON Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rer.-O-Phone)t 639-4175 Business Phones 639-4171
Inspectiont , Lt^-
Footing Plbg. Underslab Hoch. Rough-In Appr/Sdwlk
Found. Plbg. Top Out Gas Line F'NALt
Poet/Beam Struct. ban. Bever Framing -Bldg.
Post/Beam Mach. Rain Drain l fnsulat.ion ) -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
Data Requeetedt � Timrt __.L AM pN
Permit I e 1f
Bu.ldert—_T���L
TBS FOLLOWING IONS ARL RSQUIRLDt
V-
....
-
YO
��.G-vs n �� S�' �� a.n cam_ (2�C-.�.�' ,r 2�-�..-•�g
Inspectors_
_ Datet=? ,
--APPROVSD DT_SAPPROV1tD ✓ "PvtOVzD SVRJLCT TO ABOWL
/
--Call For Reinsp.
�r�
IN9PR&7ION NOTIC.7E
Citi Ot Tigard Building Der•tom+t
L3125 BN Ball alvd. Tigard, Oregon 97223 J 1
Inspection Lino (Ree-O-PIone)i 639-4:7 8criness Phone: 639-4171,
Inspection;
rooting --_�
Plbg. Undorslab ch. Rough-in i 4pr/Sdwlk
Pound. Plbq. Top Out Ola LSM )
oFINAL:
Post/Bear Struct. San. Sewer ing—�/ -Bldg.
Post/Ream Hach. Rain Drain Insulation -Ply.
Plbg. Underfloor -� paten Lina gyp. Bd. -If�oh.
Date Rfqd
uwote :_ i J �
/ Permit #s LJ
Ruilder.:—z
THE FOLLO"Im COCTIONs ARE RIEpUIRR.D:
pf L-12
Inspectolrs Date: ( 4
APPROVED DISRPPROV;pPMM AgWiGT Tn ABOVR
_call For Reinsp.
S XCTION tLOTICg
Cita of Tigard Building Department
713:125 SR Ball Blvd. Tigard, Oregon 97223
Inspection Lfne (Roc-o-Phones 639-4175 Business Phones 639-4171
Inspections_
Footing Plbg. Underalab M ch. Rough•-tn Appr/Ddwlk
Found. Plbg. Top nut Gas Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
1
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line 7, Gyp. Bd. -IpOA.
Data Requesteds 119 - •4�� l f Times AM h PM
Address �1 I1� ` Permit #s
Builders r I ,
TBE FOI.I.OWM WRRECTIONS AS AR•R_ RRQUIREDs
Inspectors Dates =2_
APPROVED _ DISAPPROVED APPROVED SUB.TECT TO ABOVE
Call For Reinsp.
INS ECTION NOTICE
City or Tigard null.diag Departaent
13125 t!M Sall 9 v.1. Tigard, Oreryon 97223
Inspection Line {Rec-O-Phones 639-417: Business Phone: 639-4171
Inspection s��._._--��_Footing Plbg.Plbg. On-4^_slab Mech. Rough-ir. Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAI.s
4poat/Mas struat. > Ban. Sewer Framing -Bldg.
vot/Mas► Hoch. Rain Drain Insulation -Plumb.
tlbq. ItMesfloor Nater Line Gyp. Bd. -Mech.
Date Requested$ [ -1(7 ! 7 2 _ _Times AM pN
Addrewe:
Builders
TBH FOLL0VING LOMB APB RBQUIRBDt
Inspectors
APPROVBD DISAPPROVED APPROVED SUBJECT To ABDVE TLL
__Call For P.einsp.
Ill�L'�6�?� NOTICE
Cit' Of Tigard Building Department
131.25 aw umll Blvd. Tigard, OtegOn 97222
Inspection Line (Rec-o-Phons)z 639-4175 Business Phones 639-4171
Inspections_
Footing Plbg. Underelab Koch. Rough-in Appr/Sdwlk
Found. Plbg. Top out Cas Line FINALS
Post/Beam Struct. /aB. eewarJ Framing -Bldg.
Poet/Beam Ke.-h_ jp Dra \ Insulatiar: -Plumb.
Plbg. Underfloor Ler Lim Gyp. Rd. .6spti.
Date Requwsted)s ,Timet
Addree s s /Gr 3/� / , Mr.it V f?S
Builder=
THE FOLLOWING CORRECfIJ1fS ARE REQUIRED:
Inspectors_
; APlBOVED DISAPPROVED APPROVED SUBJRCP TO ABOVE
Call For Reiner.
s,�¢j�ECTIO,�.�10TICE
city of Tigard Building Departs—t
13125 EM Ball Blr,'.. Tigard, Oregon 97223
Inspoctic c I•!.ne (Hoc-C-P;ton, ;t 639-4175 Business Phones 639-4171
Inn w ttons- — __ _ -- —_— -- - ----------------
t .9 piby. nndacslvh Hoch. Rough-in Appr/Sdwlk
�� —, Pi' Top Out Can Line FINAL:
Post/Mas Struct. San. Sower 4raming -Bldg.
Post/Beam Hoch. Rain Drain Insulation -Plumb.
Plbg. ondorfl•ior Water
Lino Gyp. ad. -Hoch.
Data p--quenteds 1! ]` -/,2///+ Timet AN PN
A�•;reaes /� �� C�L�� /}C/ /ii Permit it
Builders�_y
THS Ir)LLOWINO COMWdjOKf Alt= RRQUIRZDt
Inspectors_- - -`-- Dates
{� APPROVCa DISAPPROVRD APPROVED SUBJECT TO ABOV1
Call For Reinsp.
CITY Or TIGARD RECEIPT OF PAYMENT RECEIPT NO. :93--240346
CHECK AMOUNT a `5;31,5. 35
NAME. WAYMIFir, mEi- CASH AMOUNT a . 13L 71
.
ADDRESS a PAYMENT OW t 05/20/93
SUBDIVISION
PURPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID
Pr RM Bi-61 C6 1�46 418. 00 PLUMBING PEPM 1;J5. 00
ME.-CHANICAL PE 45- 00 ST. BUILD PER 29. 40
PLAN CHECK FF 3 1-7-1. 95 SEWER USA 1,njiA. 00
SEWER INSPECT 39- 00 PARKS SDC 500. 00
STORM DRAIN GJC 'Z..'Ao. 00 RF-'ql0FNTIAL TRAFFIC FEES 1350. 00
MASS ANG IT TIF FEES 110. 00 PLAN CHECK FF 40. 00
PLAN LHECK F-E 00
L.(:)T 62 ANTON Pf4RK, I4313 SW ANTON DR
PLANCK LOTS 10 ' 9. 103 ANTON PARK 2'
TOTAL. AMOLIN'l* PAID - - - -> 53 15. 35
PLUMBING PERMI'i
I'-q0 ,CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUEDs 05/19/93
13126 SW Hall 8hid.Tigard,Oregon 972230199 (503)630-4171
CLASS OF WORK. . sNEW GARBAGE DISPOSALS— il
LAUNDRY TRAYS. . . . . . ::@ SF RAIN DRAINS. . . . . it
WATER CLOGETS. . :2 WATER LINE
� 05/113/93
PARK $ 500. 00 JH �
MPLC $ 11. 25 JH Q15/19/93
M5PC 2. 25 JH 05/19/93
�
Rog
This permit is issued .;ubject to the vrg.
ulations contained in the Tigard Munic.ipal Foot/found Insp Rain drain I n
Lode, State of Ore. Speciplty Codes and all Post/Seam c3truct Water Lin@
other app'�ic*ble laws. All work will be do,-,,e lvpos�/Beam Mechan Appv-,/Sdwlk Insp
in accordance "it�i approved plans. This Olm undslab Insp Mechanical [- i na I
permit will expire if work i% not started PLM/Underfloor Plumb Final
within 180 days of issuance, or if work is Mechanical Insp Building Final
suspended for more than 180 dsys. Plumb Top Out Erosion Control
Fireplace Insp
Gas Line Insp
Insulation Insp
A Gyp Board Insp
Contractor
\
|
S." P E R MI I
CITY OF TIGARD L�t ;,111 MA T T L.R 4v . . . . . . .
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)619-4171
E
3W (ANTON 1.- I S
1)1 V,4-b I U N. . . . I ANTON PARK II ZUNINU: R-7 F-11)
. . . . . . . . . L01. . . . . . . . . . . . . g 08c,
BUILDING
aStJ m; D -LP
L1146 UNITG; I kULMENT. . . . . . . . .Vi
WE
OF WORk. NLW BEDR14,B IS BA THS:, G(IR46E. . . . . . . . . . .410
PL 11r' U';-3E. . . t SF FLOUR kizQUIREL SE.TEIVAC�KS----
0r- C,0 N I t5N FIRST. . . . a 1476 s f LEFT. . :, ft RIGHT, : 5 Y
i' 'q)
LIPANCY !--4iV . R3 4,20. f FRONT. f t RLAR.
SL
i IR 1 ES. . . . . . . . ' THI kD. . . . .-0 Sf REWIRED-
ft Tu T N1.- I.Gli tf SMG1',L L(.'i-ORS. Y
LJAD. . . . 40 p a I VAI-JE. . . . . $ 1 94688
PLUMBING
PLOOR DRAIN6. . . . .k) :Q
i--0)ATORILS. . . . .. . WATER IAL'ATFF',;. 01 TRAPS. . . . . . . . . :0
"IJU/tji 10WE,R"'i. . . . , LAUNDRv TRAY:3. :0 (.Arch bil!jINS. . . . . . . 1.0
,40'F-P. CLOSETS. SEW LINE (ft) . t GREASE 'TROOb. . . . . . . .0
J".lif*9'�i iE It. , . WHI LK LOIL ( f t ) - - 104,1 uIT HIEI� r I X
G��,IALiL 1)."'s Sp'. . I RAIN DRAIN ( f t ) -':0
W, I-IHING MOCH. . . 1 OtA I"'o D k i I I I,I
VILCHAN FL[,�
UNIT' 1-1 T k'.J. . id type x M L by date )-ecpt
VLNTS .0 TIF 11i 1460. 00 JH 05/19/9,
lyli")( INFIUT40 BTU V V j 4 T 1' 0114 '. . .1-1i BI. 14'i $ 4.1,6. 00 JH 05/11)/9
III 1-116-114 HOODS. . . . . . :1 BPLE-1 1. 710 JU-1 05/07/9.3
::-0. I)w XA 0"It/111)
i- -oDR FURN. . . . e0 LLO DRYLRS. 1 f:,E;1)G i Lew. 00 JH 05/19/93
-)HP20 CITHL13 Or4l."Ttic1 Pi-tkk I. we'. 00 114 0`i/1`)/':?.s
GAS MPRI $ 45. 00 j H 05/1'9,,
J, 19
04LI-VIN G WA`tMIPE JR fti c $ x. 45 ill 117m/19/N 3
1 8 OX .I's i o Pi,- l, T $ I L-"- 00 J1,4
P5PL i 6. L5 JH 05/1r;/91"
MELVIN W«YMIU'1��-
1446*1 111W 1201+4 AVE
�`hbtie #t 6351-674L
R e TA # .359 ''
0. 35 r
",15 vervit ji 1110d 5Vj.-W. ,i the requiatiotis contlihed in the REQ(J1kr-1, 1 NbPEi.,J ) `- N:�
*ji-Icipal Latik, State cl Ly,-*;' bprialty Lodes and a,'. o0er Fuot/fct!.And lrlsf) F it eplac.,F T1
icat,@ liaoi, All 000rk wi 111 De dace im K-co-danco with approved Post/Beam Strkl(.L Lire Ins".
P*S, -4111 perut will exp".9 15 rot ktatted W401a 180 Pct5t/Seam ,'pec' r,sul Ition Ills,
daps of istuancr, um if n. than IF* days. Plm/undslab i. . and Insp
PLM/1JT1 d tr f I u o v- rl'iI.1.11 draj.n v,5 p
'wtpv "'itt Mech.mical Insp Water Lire losp
Plumb TO Out Ppprr/Sdwlk lnrp
Fraving inrip M 6 ch ia-ii i L a I P j Ila
f c)Y, n s p v c t i cl ri - b s'3-41 J
L
SLWLR LUNNLIL'i ILJ14
P-rI ;-
CITY' ®F T i GARD PiL-RMIT #. ','.o.t.
COMMUNITY DEVELOP&ENT DEPARTMENT 9
13125 SW Hall Blvd.Tigard,Oregon 97223e6199 (503)639-4171
11T.' AD GR I izZ 313 SW ANI UN 1)R PARCLL: 15134CB-155017!
& .) -*1 pl")
Bi.iJGf-)JBL)1 V' ,' 1 ON. AN) ON PA RK i 1 WNING. R
... . . . . . . . . . .* LO'[. . . . . . . . . .
TENANT' NONL.
USA NO. . . . . . . .I F I XTORE UNI T'S.
UT WUNK, NIEW VWL LL ING UN I TS. I
YPL- Ut:' USE. . . . . :9F NO. OF BUILVINGS: 1
,'3144L.. , TYPE. . . DUI_iWR IMPERV SURFACE. .
,cemarkss
(Dolner, - P-LE53 -
WOYMIRL JR type
Cl ',UX P-31164 PRMT $ 2100. 00 11`-1 0 5 1 1)
TTG44RAL; UR 145'8 A'
C06t), a;-'tclt-
11'47iili'TOR NO 'LIN I kLE
TUTP41-
Reg
RLUUILREQ D INUPLCTIUNCI
thlit Applicant aj�mz to cosply With all the r1i"01 and '-egulations Sewer Ii iciri
of the Llrifiel Sewage Agency. 'he perut eq,res IFA days fr,oK
%,)E date jiyjed. The total asount paid wili be forfeited It the
perkit exp,.tet. The Agency does not guarantee the sc.-uracy of the
;in senor iateralt. if the sewer it out locates' fit the vessureatnt
given, the iritalser shall prospect 3 feet in ,!! Omecrtiors froo
the di'taricp given. if not to located, the r -ihall puroast,
a "Tap and Side iaii a lateral.
y
(2vA t I f-o r i Ti s pect i o r! 134- 417
. CAo - i
13123 SW Hall blvd. PI NCK/RECT
CITY OF TIOA.IRU ""ox 2-13"
PERMIT # Zn2jf 3-D_a 57" _
COM biUNIIY DEVELOPMENT DEPARTMENT gard,Oregon 97223
(503)63"171 DATE ISSUED
JOB ADDRESS: _12313 S.W. Anton Dr. , Tigard TAX MAP/LOT
SUB: Anton Park�2 _ LOT: _ 82 _ LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME; Melvin G. Waymire, Jr . _ REISSUE OF:
ADDRESS: P.O. Box 231164 LAST REISSUE: _
Tigard, OR 97281 FLOOD PLAIN/
PHONE: 639-6742 SENSITIVE LAND:
CONTRACTOR APPROVALS R�UIREU Syb'iZ, "�
NAME: _ Melvi.n G. Waymire, Jr. PLANNING: sEQ_��. ---
ADDRESS: same ENGINEERING:
FIRE DEPT:
PHONE: — OTHER' ./74�_ �.�.
CONTR. BOARD 0: 35976 EXP DATE: ��/94
ITEMS REQUIRED
SUBCONTRACTORS.: PLUMB: Harmony Plumbing ng cl_ LIST/SUBCONTRACTORS:
MECH: General Furnace BUS TAX:
ARC %ENGINEER CALCULATIONS: _
NAME: _ uartr.j�gint Design Group TRUSS DETAILS:
ADDRESS: __ 11Q.25 S.W. Q eenbura 1W. XB3 v OTHER: _
_.
Tigard, OE 97223 --
PHONE: 624-•6388
PROPOSED BLDG. USE: --
COMMENTS: -&'f
'PEI N1 SIGNATI -- - — --
11 I �.
Received By: '1_= Date Received: l z'
I
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees !Y!" ����
10-431 00 Plumbing Permit Fees
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5q) <2 9•yy � aY�u
Building
Plumbing
Mechanical
10-433 00 Pans Check Fee rLb'�' 9�f / 1—�' _-32 �i
Building .271, 76
Plumbing
Mechanical
I0-230 06 Fire
v?3d 30-202 00 Sewer Connections
30-444 00 Sewer Inspection 3 3l _ 3 j--
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31--450 00 Stgrm Drainage S-yst Dev Chrg
(SSOC)
24-445-01 Water Q,.iality Fee in lieu of
24-445-02 Water Quantity (Fee in lieu of)
TOTAL 3>� ` S-7)
n��ii:i587('.WP1
1r
CITY OF T I GARD - RF..CE I PT OF PAYMENT RECEIPT NO. s 93 .;:391+169
CHECK, AMOUNT s 250. 00
N4 MC s MEL.V IN 0. WAYM I RE Cg6H nMOUNT s N. ON
{�� T)f7E.Sra s PO BOX 231164 PAYMENT DATE. 05 0'7/9 3
TIGARD, OR SUBDIVISION s
C#7 R i—
PUkPOSE OFPAYMENT AMOUNT PAID PURPOSE: OF PAYMFNT i1MOUMf PAID
V-11-AN C.Hf~C;N. f='E=� 5-17R ._._.__ 250. 00
f
I
I i J,:%1 3 SW ANION DRIVE, LOi IN?
10 i AL. NMtIUNT PAID — —> 050. 00