14800 SW KENTON DRIVE t
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14800 SH; KEN'R)N DR I V E
F CIWW TIFARD camoh, IL 10,
COMMUNITY D—VELOPMENT DEPARTMENT .- T(f' F Or-
13126'-W HWI Blvd.P. OM Tlg"-OMM 7=(5W)WO-0 -7"-/ 0CLU76 ommPAP-ICY
E'L RM I I'
0
i,ww ISSUEEDs 10/09/gie
SITE ADDRESS. . . 1 l4e00 SW KF'NTnN DR
SUAVIVISION,ON. . ., s f'"'ARCFL: ?Sl lPrL; 1,itjoi4i
SLOCK. . . . . . . . . . L01.. . . . . . . . . . . . . 70NINOv
CLASS OF WORK. INFW
TYPE OF, USS- - - I F3F
OCCUPANCY CRF''. sP3
(')C[.'UP(4NC'Y I OAVIi•!25 4
71--NANT' NHME. .
Re MiArl'V U
ow n.or,I
MELVIN WAYMIRE
FAIJX 234. 164
1: OR 97iR3
P OnO 41 (139-6-74R.
DIEL.VIN WAYMIRE'
fit) BOX 231164
'FICIARD 97PP3
l-'flc)rle dt r. 6Z49--b , 4,7-`
Ppq ff. . a 359—f"
l-JC'C'Updknuv of the Kai�r�ve
V"v f Of fit:Oct buj cl i vig Ven,
the . C'ertiflep
"RlF)li&llrf* t'litl-1 the �"tal'-? (jf SPerialty Codes for the
0(-'c'L4Pmvlr--y, anti whic-A-k the ruffow- emceci j.,)Or,mjt wag isirkker.j.,
F-IRE DEPAR714FIN7
.................
PL)I L 0 ler
POST* JN C019c3p.11
PL OCE
Al c, �$ f;�
NSPECTiON NO!ICE 0 V c L' /' 5
City of Tigard Building Departmen
13125 SM Ball Blvd. Tigard, Oregon 9 I
Inspection Line (Rea-O-Phone): 639-4175 Buaineye P1
Inspection: ---_---
Footing P1bq. Underelab i,vch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line ��FINAL=
Poet/Beam struet. San. Sc:wtir Framing 9
Poet/Deem Mech. Rain Drain Insulation IUMM.)
Plbq. Underfloor Water Line c;p. Rd.
Date Requ Toted t_ _—___ _Timee i 1FN1 _—__PM
Address:
ty� t►
Builder: -- -- -
THE FOLLOWING CORRECTIONS ARE REQUIRED:
1
f
---- - /--».-- ---
I ` Date I!
Inspector
APPROVED _ DISAPPRO'VSD hPPROVED SUBJECT TO ABOVE
Cal.1 For Reinsp.
LNSPECTION NOTIO I i
city o1 Tigard Buildjng Depwrt Ant
13125 9% TCI11 Blvd. TigareJ, Oregon 97223
Inspection Line (Rec-O—hone)s 639-417/5 Bus ineas Phone: 639-4171
--
Footing Plbg. Underslub Mech. Rough--in Appr/Sdwli
Found. Plbg. Top Out Cas Line FINALS
Pont/Beam Struct. San. Sewer Framing -Bldg.
Pont/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd
Requested:..- _TLmes PN
-,east Permit #1
Bullder:_ � Q�.l". `(�1�. �d_�b��
J
THE FOLLOWING CORRECTIONS ARE REQUIRIRDs
i ,� C' .1•G�.fir I�i��.ve k..v... � a►•1 � Z-- r
I
i
Ir spectors ,11�, �: // •4 Dates
APPROVED DTSAPPRO D APPROVED OUBJECT TO ABOVE
Call Por Reinsp.
NSA PECTION NOTICE
city of Tigar: vusildiny Degsertmen"- /j
113.25 r.W Hall f,lvd. Tigard, Oregob 97223i-
Inspection Line (Rec-O-Phcae)s 639-4175 Business Phone: 6:39-4171
Inspections
Foot it- Pl'bg. Underelab Mech. Rough-.'.n Appr/Sdwlk
5
Pound.
Plbg. Toy Out Cas Line FINAL.
Poet/Ream 9truct. Sart• Sewer Framing -Bldq.
Poet/Ream Mech. Rain Drain
Insulation -plumb.
o
Plbq. 1Inderflnor Nater Line ( a.p� E_ -Koch.
Bd.`1
ro
Date Requested: ! % �`�'' —Time: _ AM PM
Address:. ' y/" Permit -�-
i
Builders-��+�+�'/ - —
THE FOLLOWING CORRECTIONS ARE REQUIRED:
h
Inspector _ T_ Data 44�
' APPROVED _— JISAPPROVYSD APPROVED SUBJECT TO ABOVE
Call For Rainsp.
SPE TION NafICE r�S
City of Tigard Building Department
13125 SM Hall Blvd. Tigard, Oregon 97223
Ingpection Line (Rec-O-phone): 639-4175 Businens Phone: 639-4111
Inspectlon:
Footing Plbq. Undervi-b
McCh. Rough-in A,ppr/sdwlk
Found. Plbg.. Top outs Can Line 1IINAL:
Pont/Beam Struct. San. Sewer 'Framing -Bldg. PPP
Poet/Beam Hoch. Pain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
Dete Rnqueatedt Times
AM PK
Address: V V %�Z- (�i��
� Permit /r
Builder:__..,-
THE FOLLOWTND ODAAiOTTONS RBQUIREDf
— �_ r• / c 6
Tnepert
Dates__ `—
APPAOM DISAPPROVED APPROVED BUBJ1tcT TO ABOVE
Call For Reinap.
I
h
and Building
Ci.ty� of. Ti q Tigard, 0j"gOn 9;223
1.3125 SN Hall Blvd. Phones: 639-4171
Inapoction Gine (Rec-o-Phone): 639-4175 Buelnvse
I nspect i on t_..------- Appr./Sdwlk
Underalab Nerh• Rough-in a
Footing Plbg. lI1C'AL s
Plbg• Top Out
Gas LineFound. _B1dQ• +
San. Sower
Framing
Poet/Beam struct. „plumb,
�Ineulatlon �
Rain Drain �� _.
Poet/Beam ",ch* Rain
Gyp. Dd. � �
Plbg. Underfloor
Mater' Ltne AN r 1
Date Requested:_ � /-- L
Address t __�„•_......
tdPrt • � �
lope ARF. REQUIRED: _�--
THE FOI.T.oWTNC .�RRlS ----.__^-•-,---^•�
C 7
"''-•" bate
Inenector
CT To ABOV'
APPROVED DISAPPROVED
APPROVED SUB•IR
Call ror RvinsP.
IF
PECf ON NOTICE
City of Tigard Buildir) On;partner
it
13125 SN Hulk Blvd. Tigard' ` ogon 97223
Inspection Line (Rec-o-phone): 639-4175 na9ineBs Phone: 639-417).
Plbg. Underalab Koch. Rough-in Appr/Sdwlk
Footing pINAL:
Pound.
Plbg Tap Out aas. Line
Framing -Bldq
Poet/B+.am Strur-t. San. Sewer /
(�Ineulation -Plumb.
poet/Beam Mech. Rain Drain
Plbg. Underfloor Water Line
(;ys�. Bd. -Mech.
Times AM PM
Date Requested:
pddreaes
Permit t=1-----�
Builder:
THE FOLLOWING CORR IONS ARE REQUIRED I
_............
---
-------------
-------------
4' CXl
Inspectors 4
/A APPRO{ILD __ DISAPPROVED APIROVED SUWTCT TO ABOVE
✓�
Call For Reinsp.
INSPECTION NOTICE
City of Tigard Building Department
13125 tiff Ball Blvd_ Tigard, Oregon 47223
Inspa^tion Line (Rec--O-Phone): 639-4175 Bualnena Phone: 634-4171
Inspection:__ _ ---___._ _p.---___--------._--- _ --
Footing 1bg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg Top Out Gan Line FINALS
Poet/Seam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Innulation -Plumb.
Plbg. Underfloor Water Line Gyp. lid. -Mach.
Date Requested, rr _�� Time: _.Y_AM _ VPN
Address,- !J� i Perm f /s-ik-
Bui-lder:_----
THE FOISOWLNO CORREegONS ARE REQUIRED%
InspBctprl� ` 6i [__,�/ `------- Dates y -
_APPROvab DISAPPROVED ApPROVro gUWZCT To ABOVE
r
call For Reinh +.
INSPFCTION NOTICE
C:.ty of Tigard Building Department
13125 SK Ball Blvd. Tigard, Oregon 91223
Inspection Line (Rec hone): 639-41.75 Business Pt:or:e: 639-4171
Inspection:__,__.
Footing P,l Und9rslab Mech. Rough-in Apps/SdWlk
Founsi. Plbg. Top Out Gas Line FIRALt
Poet/Beam ,3truct. San. qcwer Framing -Bldg.
poet/Beam Meeh. Rain Drain Insulation -plumb.
Plbg. Underfloor Water Line Gyp. Bd. .-Koch.
7
Date Requested:_ O �--- TW" [��) PM
Address:� Qir, 4ets:it
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRAD:
Date:_ -_� 9 9 v
1 APPROVFD DISAPPROVED APPROVED SUB.7ECT TO ABOVE
Call For Rainsp.
j,�8�EC1•'}U�1 NOTICE r!" '�"—•� m
City of Tigerd Building Departs;ent
1312S SW BA).l Blvd. Tigard, Or#Wn 97223
Inspection Line (Rec-O-•Phone): 639-4175 Business Phons : 639-4171
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk R
Fo•snd. Pibg. Top Out Gas Line FINAL-
Post/Beam Strutt. Sass. Sewer Framing -Bldg.
f
Post/Beam Mach. Rain Drain Inenlation -Plumb.
i
'Plbg. UndwrWater Line Gyp. Bd. -Mach.
Date Requeeteds_,!L 7 y 7C `7- -'- .—Times
Address• � �,��� �L/ Permit �s
Builders —__--
THE FOLLOWING tzcTIONS ARE REQUIRED:
S
Inspector:A7//_ j� Date-
APPROVED DI9NPPROVED APPROVED SUBJECT TO ABOVE
call For Reinsp.
INSP(�C1'ION NOTI 1E �t=t
city of Tigard Building h*Pa / '
13125 811 Hall Blvd. Tigard, Oregon
Inspection Line (Rec-O-Phone): 639-4175 flusineab Phone: E�`-' 41.71
w
A-
PIN.
PIN. Underslab Mech. Rough-in in
Footing '.
Out.
pound.
Gap Line
FINAL:
Plbg. Top
-Bldg.
San. Sewer
Framing
oet/Beam strict.
Insulation -Plttmb�
Rain Drain �
Post/Beam Mach. -Neth.
Gyp. Bd.
pibg. Underfloor Water Line
__Time= AM PM
Date Req=iested= —
permit r= _ U
Address=
Builder:
CTIONB ARE 1 RED=
THE FOLLOWING --
----- ------
Dates
Inspector _ — —__.
_ APPROVRO
DISAPPROVED APPROVED 8US"CT To PROVE
Cell For Reinep.
IF
TIT "
City of Tigard Building Depart:oent
131.25 SW Hall, Blvd. Tigard, Oregon 97
417
Inspection Lina (Rec-O-Phone)+ 639-4175 Business p n
Inspection:
Mach. Rou h-in Appr/Sdwlk
Footing
Plbg. Undeselab g
Found. Plbg. Top Out
Cas Line FINAL:
-�'- -Bldg.
Post/Beam Struct.
San. Sewer Framing
Post/Beam Mech. Rain Drnln
Insulation -Plumb.
- -Mech.
Plbg. Underfloor Nater Lina Gyp. Bd.
TLme+: .----AM
PM
/ Date Requested: C/^
Permit 1:
Addreews� "7 � �
nu i lder:
CORRgCTI/ g ARE RgQUIRED:
THE FOt.LONINO _
-- 4
_ Dates
Inspect or: _,�
11PPROV19D DISAPPROVRD APPROVED SUBJECT TO ABOVE
Call For Reinsp-
INSPECTION NOTICE
City of Tigard Buildingpepartroent
13125 SM Hall Blvd- Tiyarci, Oregon 97223
Inspection Line (Roc-O-Phone): 639-4175 Buniness Phone:
1(
i
Inspection:__,_
Sdwlk
Doting Plbg. Underalab Mech. Rough-in Appr/ i
ound.
Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain
Insulation -Plumb.
Water Line Gyp. d. -Mach.
plbg. Underfloor II
Tims�2 —_AH --PM
Date Requesteds�
' �L.G L 5.�--• Permit i s
Address$
Builders_
TME FOLLOWING COM 'IONS ARE REQUIRED: J_
i
i
Dater
:nepector -- ---_�-
APPROVED DISAPPROVED APPROVED SUBJRCT TO ABOVE
Call For Reinsp.
CITYOF TIGARD CSN - ""RD MASTER PERMIT
ium,
PERMTT #. . . . . . .
COMMUNW1 DEVELOPMENT DEPARTMENT
13126 SIN HN11 6W. P.O.NO 23397,TOW,OM90n 97223(SM)SM 4175
7 1
1;lTL, ADDRE;3S., 1,(4800 SW I-,EtqTON DR PARCEL: IRS112CS-A0147
SUBDIVISION. . . . : ASHFORD OAKS 3 ZONINGS: R-7
BLOCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . 9 147
BUILDING
RE I SSUE DWELLING UNITS: 1 BASEMENT— . . . . . t Qt s
CLASS OF WORK. :NEW BEDRMS:3 BATHS.-3 GARAGE. . . . . . . . . . :488 5
TYPE Or- USE. . . z SF FLOOR AREAS._..______.__.__..._ Rr-QUIRED SETBACKS----
VYF-`E OF CONST. -SN F I RST. . - - : 1007 s LEFT. . :5 ft RIGHT. :6 ft
OCCUPANCY GRP. :R13 SECOND. . . :603 f FRONr. :,�O ft REAR. . :30 ft
STORIES. . . . . . . ..2 TH I RD. . . . :0 of REQUIRED-_.___.___.__
HE I GHT. . . . . . . . :25 f 04 ALL . 1.810 SMOI f S -NE DETECTORS. :Y
f LLJOR LOAD. . . . :40 psf VALUE:. . . . . f s 9 2'1214 4 VARK I NG SPACES- - :0
R e miar-k S
PLUMBING
4IN5. -0 BACf/FLOW PREVNTRS. - :0
5 1 NKS. .� . . . . . . . . . 1. FLOOR D14'
L.OVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . .0
TUB/SHOWERS. . . . : LAUNDRY TRAYS. . . -0 CATCH BASINS. . . . . . . t
3
WATER CLOSETS. - :3 VEWER I INE (ft ) . :0 GREASE TRAPS. . . . . . . :0
D I Si IWASHE RS. . . . .. I 'ER Llt-,IE (ft ) . : 100 OTHF.-"R F'TXTIJPLG. . . . . ..0
BARBAGE DISE'. . . : 1 N DRAIN (ft ) . , O
WASH 11\I6 MAL",H. I GF RAIN DRAINS— FEES
MECHANICAL
rUEL TYPES---- - UNIT HTRS. . -.0 type amol.knt by j akt e v-e C P t
/GASC / VENTS . . . . . :0 T I F: s 1,380. 00 IJL.H 06/09/92
MAX INPUT:O BTU VENT PANS. . 14 D P R I 4• 4 Q)0 jL.H 06/09/92
FURN ( 101AK . . : I HOODS. . . . . . .. I BPLU $ 40. 00 JLH 14/2.3/91. 221095
TURN ) =100K . . :0 WLIODSTOVES. .0 1.a5PL $ call JLH 06/09/92 -
F-LDOR FURN. . . . CL.J DRYERS.: I 8PL-L. $ 1 t�. 00 JLH 06 09j9. ' -
SOIL/Cmp ( 3HP:0 OTHER UNITS:0 1, 0100. 00 JI-1-1 0(.i i 09 14 i2
GAS OUTLETS: I $ 500. 00 JLH 06/09/92
MPRT $ 139. 00 j 1..1-4 0C,/09/9"''
MLLVIN WAYMIRE MPLC $ 9. 75 JL+4 06/09/92
PO BOX 231164 M51-L'L 4 1.. 95 J I...H 166/09/95
PIP,R i $ 147. 50 J Lf 1 06/L49/91?
FIGA('4) OR 97'2'23 J. 138 J LH 0 UI/0 9/9
Plt-ione #- 6396 /4i�
contr-actor,:
MF-1 VIN WAYMIRE
I-IC) BOX 231164
TIGARD OR 97c".23
c:A-353. 18 TOTPL
itis ptreit is issued subject to the regulations contained in the REQUIRED INSPECTIONS
T;oard Municipal Code, State of Ore. Specialty Codes and all other Foot/ fol.tnd Insp Fit^pplmce .Cusp
apFlicabl# laws. All work will be done in accorda- -ith approved Post /Seam StIr-1-tc2t Gas Lin, Insp
plans. This per2it will expire if wo is T. Within 180 ,,_,ost/FkeAm Mechan Ine'tlstio,il Insp
days of issijance, or if work is s !P 19 Plm/undslab Insp Gyp Boat,d Insr
PLM/Under-floor Appr/(..';dwlF( It-,
I it Lee 1_ij,FITIAt kW MeCtIal)iCAl IVSD
Plumb 'lop UL1t Plumb F=inal
Bv , 44 Ft-Lamitirl Irli-,P B 1.111.0 i n tj
Call fore inspection 639-4175,
CITYOFTIFARD MY SEWER CONNEuriON
COMMUNITY DEVELOPMENT DEPARTMENT nsoN PERMIT
13125 SW Hell Bk-d P.O."MI.TWwd,Oregon 97 (5W)6304176 PERMIT #. . . . . . . 2 SWR92
639-4171. DATE ISGUED: 06/09/92
SITE ADDRESS— i 14800 SW KENTON OR PARCEL: 2S112CB-AO147
3UBD I V I S I ON. . . . : A13HFORD OAKS 3 ZONING: R--7
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 147
------------------------- -
TENANT NAME— — :
USA NO. . . . . . . . . . : FIXTURE UNITS— :
CLASS OF WORK. . . :NE.W DWELLING UNITS- . . l
TYPE OF USE. . . . . :SF NO. OF BU I LD I N(3b: I
INSTALL TYPE. . . . 1BUSWFR IMPERV SURFOCA-.'-
irter ---------I-------------------- FEES,
-it
.VIN WAYMIRE type m o 4..t n t by ri.- -P rE t
I-AOX 231164 PRMT 1300. 00 JLH 06/09/92
INSP $
TIGARD OR 97.223
i-lficme #. 639--6742
Contr-actor-
(-(JN7RACT0R NOT ON FILE
Phone #: 1935. 00 TOTAL
Reg
REQUIRED INSPECTIONS
This Applicant agrees to roapiv with all the rules and regulations Sewot- Insppcticin
of the Unified Sewage Agency, The persit expires 00 days frog
the date issued. The total aeount paid will be forfeited if the
Deroit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not lorated at the measuresent
given, the installer shall prospect 3 feet in all directions frog ------
the distance given. If not so locate th", I er shall ourchase
3 "Tap and Gide Sewer" Perpit literal.
F-,er-mittee
1sS'.Jed By , _._ ......
CAII for inspectioil 639-4175
Y.
PLUMBING pEltMIT MST91-0240
ITY OF TIGARD cily 10 PERMIT #. . .
c
COMMUNITY DEVELOPMENT DEPART �,i1on .
MENT
2M,TOW.Oregffl 91M(SM)6W4175
13126 SW Md'etvd'P.O.Bait PARCEL RS I 12CB *
KENTO�Ijph ZONINGs R-7
REr
_,lTE ADD AKS- 3
SUBDiVISION. . . . I ASHFORD 0 : 1
I
BLOVK. . . . . . . .
-
----------------
_rA j
cIff
GARFRVIE'61r61:'0j )'e' 'O .'l BACKFLO44 PREVNTR5%
WORK. - INEW MACH.
CLASS OF WASHING TRAPS. . . . . . . . . . .. . . . .Q.,
F USE... . . . -SF - 0 0
TYPE 0 I?A I N)'L . . � , CATCH BASINS. . . . . . .
. sR3 r i�Z(4t I CA PINS. . . . . .
OCCUPANCY GRP- AT&R SF RAIt-- OR
12 0 -17,
STORIES. . . . . . . . LAUNDRY TRAYS GREASL TwIPS. . . . . . .
F 'TURES--------__'____
�'INKS . . . . . . OTHER FIXTURES, . . . .
Rjp,� . . . . . 14
LpVATOSEWER LINE (ft) -
TUBISHOWERS. - 3 WATELINE (ft ) . . . .
WATER CLOSETS- RAINR 13 DRAIN (ft ) :0
14
SHERS- - 11
.,I
WA
�einark% 1 1 ). i
-!WNER: TIF $ 00 ILIA O6/09/')2
k 412- 00 JLH 06/0"'J
11EI-V I N WAYMIRE PF $
po BOX 831164 FPLC $ 40. 00 JLH 12/23/91
j�o &0 JI-H 06/Qiq/92
B5Pc $ . C.
15. 00 JLH
TIGARD OR 97223 BPLC 280. 00 ILIA 0')/92
Phone #j 639-6742 ssiDc 500. 00 JL.H 06/09"' P-
PARK qiei JI.-H '06/09/9
Pli.mbing MF -15 JLH 06/0c)/92
MPIX
M5PG 1. 95 JL.H 06/09/42
PRT $ 147- 50 Ti..H 06/09/92
Address P j1j.1 OC./09/92
t 7. 36
Z J,p
Reg REQUIRED INSPr_-c,,TiONS
is isstled subject to the reg_. tjfou"d Insp Appr/Sclw1k "-P
his permit Foo h A n i c,-:k I F
ontaiTied in the rigard MiAl-lic-1-T)al past/Beam struct Mec
and al I
ons of Ore. spr�rj . ltv Codes Mechon PI'Amb r'"kl
jA
r,ode, State r1j , work will be done post/Beam Bj.%ildinq Final
able S. Th i pim/undsl&b Inep Erosion CC)ntv-(-"
'they Applic A I)pw-oved Plan PLM/Uncierf I Dot"
&rcordance with
tri re i f wc),.,k is not started Mechanic,41 Insp
Viev"Mit will expire ice$ or if Wavk is PIUMI) Top
within 180 days of "suan
penFraming 1"P
ded for t han 180 days. Fireplmre 7nsr
Line tn%P
I n F.,I.(I i tiL),(, Inqp
Gyp soat'd Insp
0
01
X -7
M 0 639-41
for :t i an
C 0 n t r`act o r No t e s 3
k
CITY OF T I GARD - RECEIPT OF PAYMENT i?EGE.:I F T NO. :92-8.28245
CHECK AMOUNT a 4748. 18
I NAME t WAYM I RE, MEL c-A aH AMOUNT 0.lao
ADDRESSe s f Pf)YMtr:tlT DATE. c 06/09/92
s: a1JBDI V I SI1lN
1 ,r f4 jR ii`i
P1 JR1`OS71�= OF PAYMENT AMOUNT' PAID PURPOSE OF PAYMEN'i AMOUNT PAID
BUILDING PERM 41a. 071 PLUMBING PERM 147. 50
MECHANICAL PE 39. 00 ST. BUILD PER a"9• 93
1 PLAN CHECK FE. ;.--14. 75 SEWER USA 1900. 00
SEWER INSPECT ;31-5. 00 RESIDENTIAL TRAFFIC FEED 1Pew. 00
PARKS SDI "-00. 00 STORM DRAIN SDC 00
MASS TRANSIT TIF' FEES 100. 00
LOT 147 AISHFORD OAKS
i 14800 `14 KENTON VP
i! ,
` TOTPI.. (IMnLIN'i P-0 I U _ ._ 4748. 1A
f
Cl 1Y OF 'rlr,.)PRL) RECEIPT OF PAYMENT' RECEIPT Nn. 1X31--ea I fAc)5
CHECIA AMOUNT a 40. 00
NAME WAYMIRL, MELVIN b. , IAL.DR CASH AMOUNT 1 0. 00
ODDRESS P. O. PDX 231164 PAYMENT DATE 10/23/91
11GARD, OR SUBDIVISION
1)7 2;i?3-
Plit!i-tiOw (JF PAYMEN'l AMOUN T VIA 11) f-,UFPGSE OF POYMM' AMOUNT V11411)
(,-K FE 2--.55R 40. IAPI
PL. 111
TOTAL AMOUNT PAID 40. 00