10260 SW GREENBURG ROAD STE 1150-3 ,
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ARCHITECTURE
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10300 5W UREENBURG RD
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PORT LAND , OR 97 ? 2 ;1
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T ���i7�iI7 I ! G"i �AN CITY OF T1GA
aJ, �� SNE Fri I 1 �4►�TI TI O� I`� APproved............................................................ C 1 � IT ON �hG
Cond
11"O I all For only he work ras described In:
N0. fUp 93
See letter to:Follow.............................................. .(
I — _ -� - fedi eJ,�I� Sr��.I�Vi►��n 'f s R Attach.............................................. .[ 1
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DRAWN BY. :,CALF'.
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CHECKED hF.'D BY. DATE I —
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1 DATABASE JOB Ntl.
( 10260 SW Greenburg FioacJ
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1 of 1Suite 1150
DRU."NG NO.
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If this police nl�Ile.u's clearer than the
document, the d0cumellt is of marginal quality. 3/4/97
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CITY CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Grogan 97223 6199 (603)639.1171
CA-1Pf Lf iLl-t►(_ GI A
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OCCUPPNCY
t XXXX PERMIT 0. . . . . s BUP93 ••00211:)
DATE ISSUED: 04/30/93
31 TE ADDRESS. . . a 10260 SW ORCEIABORG RIJ W3 t 1512) PARCEL: 1 S 135AB--03400
>UBDIV1CS1ON. . . . a TOWN OF' METZGE:.R ZONINGi C;-F+
Lx L.CII_K. . . . . . . . . . s LOT. . . . . . . . . . . . . 114 !
CLASS OF WORK. &AL T'
T YPE OF USE. . . e COM
OCCUPANCY GRP. a B.'
OCCUPANCY LOAD a 4C,
TENANT NAME. . . s F-IANGN N, VIUNTER, K I BBE<E~
Remarks: J nallt lmprt Delete, Arld int pRrtitionz for offices, star r3e., etr-.
MELVIN MARK BROKgRAGE:
1OP20 SW GREENBURG #450
f iGORD OR 97223
13hone #:
Conti-actorc -- ._..__________...________.._.__.._.•.__._M
MFI.VIN MARK CONSTRUCTION
I Cc.20 5W GRE:ENDURO RD
AbTE #150
T'IE3ARD OR 97223
Phone #: 452-•5900
Reg #. . s 64721
I.lccupmricy of the abovLj refe-rernce!d building ick hereby given, and certifies
x,:iea compliance with the 5t?ate OF Oregon Seer.:ialty Codes For ttiv group,
n/cc upanCyxnd Use u17dor whlr_ii the refer-Paced permit wa�a iga�Secf.
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FIRE DEPARTME NT A�LING I 'E'C:TOR
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FOOT IN COINGP 1 CUOUS PI-ACE
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INS,B�ECTION NOTICE
City or Tigard Building Depwrtsent
13125 SM Ifal.l Blvd.. Tigard, Oregon 97223
Inspection Line (Rec-O••Phone): 639-4175 Busirese Phpne: 639-417
1nspection:
��___
looting Plbg. Underelab Mech. Rouoh-in Apps:/84w1k
Pound. Plb,;. Top Out Gas Line lI ?
Post/Beam Struct. San. Sewer Framing
t Pos`./Blom Mech. Rain Drain Insulation -Plumb, PW
Plbg. Underrloor Water Li9e, / Gyp. Bd. -Mech.
Date Requested: r v Ties: _�AN PM r
Addrese: h (f C 1 Q_4 /l .' c �L leroit f f
Builder:
THR FOLLOWING CORRECTIONS ARE REQUIRED:
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y,. Inspector: Dater
APPROVRD DISAPPROVED APPROVED SUBJECT TO ABOVE
J C111 For Reinsp, ,
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�(IN � TUALATIN VALLEY FIRE & RESCUE
ANIS }
BEAVER_ f0N FIRE DEPARTMENT _
FIRE MARSHALS OFFICE -- I
(503) 526-2464 POSTED
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OCCUPANT _ ��X11 4e'
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CONTRACTOR BLDG. PERMIT Q
PROJECT NAME }} PLAN REVIEW �k
LOCATION t} U .o
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JURISDICTION: 1= Be. 2= Du. 3= F,Cle"4]j(� Ti5= Tu. 6= Sh. 7= Wi. 8= CC 9= WC 0= P,C
COVER t INAL SPECIAL FOLLOW-UP/REINSPECTION ATTEMPTED FINAL
❑ Framing ❑ Separation Walls ❑ Sprinkler. System
❑ Shaft ❑ Fire Dampers (Overhead{Underground) 4
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❑ Alarm System ❑ Hood' ConferenceExtug Systems ❑
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❑ Ceiling Cover ❑ Other
❑ Spray Booth _— --
Date: - {1 Inspector: 40 �J o (�
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INSPECTION NOTICE +�
t City of Tigard Building Dep+**ilsent ~`�
13125 SW Ball Blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-Phone): 639-44175� �Business Phone: 639-4171
Inspection:
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Footing Plbg. Underalab Mech. Rough--in Appr/Sdwlk
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Pound. Plbg. Top Out Cas Line NAL-
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Poet/Roam Struct. San. Sewer Framing -Bldg,
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor. Water Line Gyp. Bd. -Mach.
Date Requested: Time: _ AM PM
Permit
i Builder: - —
1 TBE FOLLOWING CORRECTIONS ARE REQUIRED:
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i Inspector: ✓A _ D�tef_,>� ,_-r
APPROVED DISAPPROVED APPROVED SUB:IRCT TO ABOVE
_—Cal 1 For Reinnp.
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NZ SPECfION NOTICE
City of Tigard fissilaing Depa.rtAent
13125 841 Hall Blvd. Tigard, Oregon 97221
Inspection Linn (Rec-O-Phone): 639-4175// Business Pill o e: 639-4171
/
Inspections —
pootinq lbg. Underslah Mech. R h-in Appr./Sdwlk d
Pound. Plbq. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
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Post/Beam Hoch. Rain Dratn Insulation -Plumb. i
Plbg. Underfloor Wat r Li Gyp. Bd. -Meeh.
Unto Requested:—_ / �T +i _._AM PN -
Address: 4'C, _ / 'Permit h —60��
Builder:— �2- Z O �.
THr, FOLLOWING CORRECTIONS ARE P.EQUIRFD:
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Inenector: Date.
i1PPROVED DISAPPROVED APFROVED SUBJECT TO ABOVE
Call For Reinep.
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TUALATIN VALLEY FIRE & RESCUE
AND
BEAVERTON FIRE DEPARTMENT •
4755 S.W. Griffith Drive • 11.0. Box 4755 • Beav,rton, O t 97076• (503) 526-2469• FAX 526-2538
March 31, 1993 e
Egad Knodell
Melvin Mark Brokerage Company
10220 S.W. Greenburg Rd. , Suite 150
Tigard, Oregon 97223
Re: Hansen, Hunter, Kibbe
10260 S.N. Greenburg Rd. , Saite 1150
5989A-292•-023
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Dear Mr. Knodell:
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This is a Fire and Life Safety Plan Review and is based on
the 1991 editions of the Uniform Fire Code (UFC) and those
sections of the Uniform Building Code (UBC) and Uniform
Mechanical Code (UMC) specifically referencing the fire
department, and other local ordinances and regulations.
1.
This review covers the tenant modification to the above
noted occupancy. The plans as submitted are conditionally
approved for construction, subject to the following:
If this building is protected by an autoraltic fire
protection or roquired fire or smoke detection system, not
addressed en these plans, contact this office before
proceeding. Demolition, new construction, or changes in
HVAC could alter, or eliminate protection fro-,i these life
safety systems. If a sprinkler system is involved, not
less than 3 set's of plans for the .installation shall be
' submitted to this office for approval prior_ to
installation or alteration.
A fire extinguisher having a minimum rating of 2AIOB:C
must be placed in an accessible location within plain
view. UFC Sec. 10. 301 (a)
Approval of submitted plans is not an approval 3f
omissions or oversights by this office or of nen.-
compliance with any applicable regulations of local
government.
i.
F
-worklnR- imnke Detectors Save Lives
1
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Brad Knodell
j March 31, 1993
Page 2 •
If you desire a conference regarding this plan review or
if you have questions, please feel free to contact re at
(503) 526-2454
Sincerely,
Bradley W naam ker
Deputy Fire Marshal
BNW:kw
cc: Tigard Building Department ✓
Mills Architecture, P.C.
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TT1�.4CITYOFTIFARDCrFYOFRD
CQMMUN rrY DEVELOPMENT DEPARTMENT oReooa
r 3 t 25 Sw wu Blvd. P.O.Bou 23307,Tigwd,aeon 97 (603)er3a4t 75 '
PL.UI BINU F'LRI91 T
G,E RMI '! -k#. . . . . . . : F'I_.Mo ::� Olj''I is
Ca,2i9•-4171 DATE ISSUED: 1'43/&2/93
SITE: AUDRL-t'iU. . . t 11&:-' 0 OW GRFI:Nh11JRG RD IkG 1. :I :J Li PARCEL:
SUED IV161ON, . , » TOWN OF MEI
'ZGER ZONING,
L:LASS D' WOPK. . :(-40' GARBPLIE. DI',J i(ai.- i. , MOBILE 143ME:. SPACES. : e�
-i YPE. OF USE. . . . tC OM WASHING MAC: I. , » . „ BACKFLOW PRE VNTRr;. .
OCCUPANCY U!4". . t132 FLOOR DRAINEi. . . . . . . .. TRAA:S. .. . . . . . . . . . . . . .
STORIES. . . . . . . 12' WOTER HE(4TERS. . . . . . % 1 CATCH BASINS. . . . . . . .
FIXTURES-- I..r=tC.ihI1JRY TRAYS. . . . . . . SF RAdfV Df+Alhi.J. , . . . ,.
r
SINKS. . . . . . . . . . : i URINALS. . . . , . . . . . . . .. GRi_.ASL--'" TRAPS. . . . . . . .
LAVAToRZES. . . . . n O FHE R F I VVU17ES. . . . . : 1
TUI.{/3HUWE:-RF3— . . : SEWER 1-INE i ft ) . . . .
WA rE P C:I_OG 'T u. . : WAT Eli L.I PJE: (f t)
D I IGHWASHE RS. . . . RAIN DRA i N t f t) . . . . s W .
L ewarrk%t Tenant i+npr,: Delete, .add int partitiun3 fo.v- of- ices, stat-age, etr...
MELVIN MARK ElRORLKEaG type amut.ant by data t,er_pt 4`
102E0 SW ORfc:EhIBURG #4511.1 PRMT $ 30. 00 PL.L 03/22/93 - 1
PL GR $ T. 50 PL-L ID 3/2-1c./t3;3 -
TIOARD OR 9-,c 3 `.ii»'C*T $ 1. 50 PLL 03122193 - f
(.CI art r`2C'r Ur,t .._......_.... _......._. ._ ._................._._._. _ _. .._...,..__...._._....
POWL.'R tL"LUMPING C0
VIO BOX 23144
T'ICARD OR 97261 _..._._._ _.....__..__..... ...._. ._.__..._ __.__.___.._.... ...
Phone 34. 017.) 'TOTAL.
Reg #. , a 5C_';a i 8
RLUU i RLD I NGPILC;TI ONS _- ...._...._
This perait is issued subject to the regulations contained in the Rol.tyh-•i.n Insp
Tigard Municipal Code, State of Ore. Specialty (odes and all other V`LM/Urrder^f Ioor^
applicable laws. All wo•:k will be done in accordance with 'lop-o k.it T n s p
approved plans. This perm t wi:: expire if work is not started Dr'•i n k i n g F o l.rn t zti
within 188 daysof issuance, or if work is suspended for more F"inr+l :napec:tiotr
than 180 days.
F'wr`mittet, SJ an Att.rre :
CaII for inspec_tiun - E,39-4175
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E RC_i�E:IPT OF PP'v M[- -IT RFCE iP"r NO. :"9:3•-8Lg4+t�F56 i
f.;I1'Y JF' 'f Ii?�aR17
CHECK OMOUNT 39. 00
NAME a POWER PLUMBING CO. C•Nlgl.i AMOUNT C 0. (AO
ADDRESS s P. 0. BOX x.3144 PAYMENT DATE 03/82/9.:3 �
!iljFtU I V T 4i[fllV t �
"f:1.C3p1�0, CI F2 972-8t
V.oURPFJSC" OF i='AYMCNI AMOUNT PP.)11.) r-'1.1RI:,O iE' OF: PAYMENT VIMOUN-C VIA 1 D �
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c it_UMR I NC, E-E�tni :30. 00 PLAN CHECK FE 7• 50 I
':3T. PUII_D PER
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10260 ROAD, 91150 �
t-'LUMR I N(-.; F- -14M I T #PLM9:3--04 40
TOT61 '4MC'll_iNT PAID _ _ _.> ;39. 014)
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INSPEOTION NOTICEOil
City of Tigard Building Department
13125 SM Ball Blcd. Tigard, O, n 9722,3 l 1+i��
on Line Rec-O-Phone): 639-405 Busineep ` 6391171
inspect
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C�FI��'S ny•� ( ,•
Inspection:
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg• Top Out Gee Line FINAL:
poet/Beam struct. San. Sewer Framing -Bldg.
post/Ream Mech. Rain Drain
IneulatJon -plumb.
plrg. Underfloor Water. Line � GYP•
Bd. --Mach.
- ---'C�--y'.
PM
Date R9quenteds
^ Timet AM _
Permit 1: — Ii
Addreen:_�_ �-7
Builder:_
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THE FOLLOWING CORRECTIONS ARE REQUIRED: j
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" Inspector
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APPROVED DISAPPROVED ^_ APPROVED SUFIECT TO ABOVE
g call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SM Ball Blvd. Tigard, Oregon 9:223
Inspection Line (Rec-O-Phone): 639-4175 Rueiness Phone: 639-4171
Inspection:
-.-- --- — —`
Footing Plbg. Underelab Mrch. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
Poet/Beam Str,n t. Sar-. Sewer S;9 ) -Bldg.
Poet/Beam M! i, Rain Drain Insu ataon -Plumb.
P1.:-;. Underfloor water Line G' yp• Bd• > -Mech. -
C_�----__'
Date R.equneteds �L 1 �__Tisnes AH �PM
�I SO moo 3
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Addrear:
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builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
t
Inepe:tor: Dates
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APPROVED —_ DISAPPROVED —_ APPROVED SUBJECT TO TBOVE
Call For Reinsp.
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INSPECTION NOTICE fi
City of Tigard Buitd.inq I:eptrtnent f'
13125 SW Ball Blvd. Tigard, Oregon 97223
4
:napection Line (Rec-O-Phone.): 639-4175 d-ininess Phone: 639-4171
-nspection•
_ 6
Footing Plbg. Underalab Hach. Rough-in Appr/Sdwlk
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Found. 11bg. Top Out Gas Line 1 FINAL: p
lost/Beam Struct. San. Sewer Framing J -Bldg.
Post/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water LineG Gyp. Bd. ( -Mach.
Data Requested: �``� / % Tis {—� AM PM
I � �
Address:-/ Permit
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Builder: �
THE FOLLOWING CORRECTIONS ARE REQUIRED•
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In-peCtOr:_�—� --_—__ Uat92
APPROVED DiSAPPROVFD APPROVED SUBJECT TO ABOVE
f Call For Reinap.
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IN vq \ TUALATIN VALALEY NDFIRE & RESCUE
BEAVERTON FIRE DEPARTMENT
FIRE MARSHALS OFFICE
(503) 526-2469 POSTED
&RESG��
OCCUPANT ' '
CONTRACTOR _ _BLDG. PERMIT ik
i
PROJECT NAME Y PLAN REVIEW 4t
LOCATION
JURISDICTION: I. Be. 2= Du, 3= Ii.C.( 4= Ti.,,6= Tu. 6= Sh. 7= Wi . 8= CC 9= WC 0= MC tl
COVER FINAL SPECIAL FOLLOW-UP/REINSPECTION ATTEMPTED rINAL
1
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Framing ❑ Separation Walls ❑ Sprinkler System �
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❑ Shaft ❑ Fire Dampers (Overhead/Underground) E
❑ Alarm System ❑ Hood Extng Systems Ll Conference l
❑ Spray Booth ❑ Ceiling C(,,ler ❑ Other
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Date' } ' ,� Inspector:
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t� INBP$CTION NOTICE
BVI City of Tigard RULIdiM DsParts—t ��
13125 8R Hall Blvd. Tigard, OL'eW- 97223 C
Inspection Lino (Roc-O-Phone)s 639-4175 Business Phone: 639-4171
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Inspections_
Footing Plbg. Under■lab Mach. Rough-in hppr/sdwlk
Yound. Plbg. Top Out Gas Line FINAL:
Post/Beam Stru-t. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Rd. -Koch. X
Date Requested: _ Times AM (QPM
Addre■■:
Z (� Permit tt� " Cso3 s
Builder+* &5a
THE FoLLOWINa OORRECTIONS ARE REQUIRED:
— —
A
Inspectors _ Datet
PROVED �SWOVED APPROV[U SUBJECT TO ABOVE
^all For P®inep. I
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CITYOFTIFARD
CfTYOF YI(riiARD
COMMUNITY DEVELOPMENT DEPARTMENT ORICK ty BUILDING PERMIT
13125 SWFWI8W. P.O.®am23M.Towd,Or"m 07229(603)&10-4176
�— _�.---- -------- x,35-4171 � ISSUED: 0,3115/93
SITE ADDRE.S"i. . . I I WE6+0 SW GREENF:IURG ST N:S l i 50 PARC EL.r 1 S 135AV-034rZ1,1'
SUBDIVISION. . . . r TOWN OF METZ(sER ZONINGe C—P
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .. 14
REISSUE: F"LI:rOh2 iaF2C:AS _._....__._.__.__ EXTERIOR WALL CONSFRUCTION— 4
CLASS OF WORK. r ALT F I RST. . . . r s f 114% S r E t W.1
TYPE: OF USE. . . i CUM SLCUND. . . r y t PRET F'ECT OPENINGS?---------
-
1`YPE: CIF CUNE'T. I E:FR THIRD. . . . 14960 f Ni S; E: W I
OCCUPANCY ORP. I B21 T O"f'AL—___.,_ r 4')6'A s t ROOF CONS Tr A FIRE RET? t''r
OCCUPANCY LOAD-46 BASLME NT. s s f AREA SEP. RATED I t.
S TO R. r 1;.? va. r 1'70 r t GARAGE. . . r s F OGCU SEP. RATED i �
LASMT'?•14 ME=Z Z?.N RF-OD S TBAC"Kr_____._.__._ REQU I REI)._—..._-........
FLOOR LOAD. . . . +50 ps f I. r-:FT i f t; RGHT I f t FIR SPKL t Y SIVIUK DET. . r Y
DWELLING UNITSr FRN'I t ft RFr4RI tt FIR ALFtMtY HNDILP HCL:r'Y
BEDRMS r BATN(S r IMP SURFACE: PR() C.ORR r Y PARKING:
VALUE::. +i+a 7600121
Remarks : lenAnt Impr^I Delete, acini int partitions for, offices, ytor,age, ett~_
Ownevs r--LES
MELVIN MARK BROKERAGE tvpe Amount by date rec.pt
10220 SW GPE''ENBURG #454' PRI, $ 367. 00 J'LH 03/02/93 9:3—•237311.
PLCK 11 238. 55 J'LH 03/02/93 93-2373l I
TIGARD OR 9 223 L-PCl' $ 18. 35 JLH 03/02/93 93—•237311.
Phone #:
C•ontract or r
WE'LV I N MAI:'iK CONSTRUCTION
1OP20 SW GREENBURG RD
SUITE ##150
T IGARD OR 9*7223
Phone #r 452-•-5900 623. 90 1OT'AL
Reg #. . I 647x:1 '
R0-.UrU 1 RE.0 1 NSPEL:.T 1 O1\1b
This permit is issued suoject .o the regulations contained in the Ft-aming InsFa
Tigard Municipal Code, State of Ore, Specialty Codes and all other In SLI I at i carr I n s p
applicable laws. All work will be done in accordance with Gyp board Insp
approved plans. 1his permit will expire if work is not started S�isp C:ei Ing Insp
within 18@ days of iFsuance, or if work is suspended for more F i n l Inspectionthan 180 days.
1 e t"m it t e e G i y n a t
i s si.red By .
Call for inspection — 6.39--4175
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CITY OF TIGARD
OREGON
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March 11, 1993
Brad Knodell
Melvin Mark Brokerage Company
10220 SW Greenburg Road, Suite 150
Tigard, OR 97223
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I Project: Hansen, Hunter, Kibbe, BUP93-0039 ;.
! 10260 SW Greenberg Rd. Suite 1150
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Dear Mr. Knodell:
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The revised plans for this project were reviewed for conformity with !
S applicable codes and are conditionally approved as revised. Please have
plans for changes to the automatic sprinkler and mechanical systems
€ submitted for review.
We see no area in whizh construction might interfere with the operation of �
the above-ceiling smoke detector system. If such work should be necessary,
please inform us.
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You may get the required permit for the project at your convenience. If you
have questions, or ii we may be of assistance, please contact us.
a
Sincerel
1 Jim Jaqua(/
(�Plane Examiner �?
FAX (503)684-7297
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13125 SW Nall Blvd., Tigard, OR 97223 (.503) 639-4171 TDD (503) 684-2772 - —
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13125swand
PLNCK/RECT #
CITY OF TIGARD qTm > C�
COMMUNMF DE "LOPMENT DEPARTMENT vm
("3)MA171 DATE ISS"UED _
•
JOB ADDRESS:
��`� TAX MAP/LOT —
USE ** PW> �,-S E .*
SUB: LOT: LANG
VALUATION: — 7��0O�
OWNER SPC NO S �
NAME; `����vy IfJl1,� 1 _ REISSUE OF:
ADDRESS: LAST REISSUE: _
FLOOD PLAIN/
PHONE: _ _ _, SENSITIVE LAND: _--
CONTRACTOR APPROVALS RE UIR 0
NAME: _ gELTG' �� U€C►�L-MSN� PLANNING: _
ADDRESS: _ — _ ENGINEERING:
FIRE DEPT: -
PHONE: OTHER: ,NO —
CONTR. BOARD #: EXP DATE:
ITEMS RMU-19ER
SUBCONTRACTORS: PLUMB: _ _ LIST/SUBCONTRACTORS:
MECH: —.-- BUS TAX: _
ARCH/ENG►NEER CALCULATIONS:
NAME: _M I Lr-S Lae- TRUSS DETAILS:
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ADDRESS: 1 -1-1 / ILIA OTHER: j
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PHONE:
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PROPOSED BLDG. USE: _( M,Wt
COMMENTS: _ w5n�1
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PLICANT SMRATURE v
�— Date Received:
Received By: _j�:__ -.�- —_ �--_-. - d �
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PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE""
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees.
}} 10-431 01 Mechanical Permit Fees
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10 i�
-230 01 State Building Tax (5x)
Building
Plumbing _
Mechanical
10-433 00 Plans Check Fee —
Bisilding
Plumbing
Mechanical
10-230 06 Fire _
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-0'. i;ommercial 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
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52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
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(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) _
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TOTAL ( � r
nm/3587P.WPF
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cjTY OF IIC:;ARry RE11-TP''T CW. AYME.N1 R .Cf:yr NU. a9,Z-137. 11.
C HI.:CY AMOUNT s 6 3. 90
NAME s MEL.V IN MARK SPUKe.RAGE CASH AMOUN I' a 111. 00
01)DRF", t DAYMENT DATE. t 03iQ ' r,
l,kU,"ADIVISION �
I i-fURPE_I'-jf OF PF'#VICENT AMOUNT PAID PURFiClSE OF r-,AYMI"NT AMOUNT PAID
BU I I._D I NC 6>RM 367. 00 PL.AIv CHw LK FE 238. 55
r. TA I t_rJ PF•.p 16. 351
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10:'_60 W CiPE*NBURG Ira, SUITE #1130
HANSEN, I-IUriTER, KIE+BEE"
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Tn7AL AMUUNT' F,A I U AjH2 3. 90
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