HomeMy WebLinkAboutPermit Building 1988-1-28
".. "-- ....,~..
.. RESIDENTIAL"
APPLICATION/PERMIT
225 North 5th Street (,_
Springfield, Oregon 97477"
Building Div,ision'
726-3753
~'-
.y
.'
I'
Job Loc:::tion:
I
I
I
I
,
." {' ~'..., ......~. .~. . -.
..'
'''.-
Rcce:pt Ii
I/J YC; 7
SPRINGAELC
Assessor.: Map #
1120 FairviAw Drive #11. 5orin"field
Tc:r Lot #
Subdivision:
Clmer:
Judy Webster
xm~~
Add:res~:
City:
Springfield, OR
n"p'.'
n Addi ticn
I n Remo.:et
I f;:((!Ob;!2 Hom.
i
Phone: 747'-8690
zip, 97477
\I~O
\ I').
DilBcPibe f.'ork:
Wo&~/()r!e ,/
jJ11f r.J- t/ r
. I
-y
Siqr.ed:
Date:
c~
(-U-J?R
Date of Application
~:::::~=or/ )~AW~
((
I-2ft --7f va!ue;2-0, t(!;3
mO~~
I( I(
t:).(vYl/' /L? .
I. Plwr.binq '-
E!c.::'::-::~::!
Lise.;!
Expires
Phone
.1 t.:e~har.ic::l
,I Construction Lender _ .........._
.It is 'the respontJibiZity ot the permit holder to BeB that all inDpections are made at the proper tim~1 that ccch ~eBs is re"'':''':'':.?
from ths Btl'eetj and that the pcl"llTit ctrl'd is "Located at the front of the property.
.Eui~i~~ Divi=io~ approved pLan shatt remain on the BuiLding Sits at att times.
PROCEDU,'!E FOR INSPECTION R!OU!'ST:CALL 726-3769 (roccorderoJ state youro City designated job nur.:ber.. job aC.iztcss.. type of in:;pea:icn
raques~cd a~~ when you wi~Z be reaay 101" inspeotion.. Contractors or OWne~s ncme and phone number. Requests roeceived cefere 7:00 ~
:..~LZ be made th€ same dcy.. requests made a~ta' 7:'00 am will be 1riuie the n;:;;ct :.JO~kin.; day. JI
. Your City Deaigr.a.tcd Job Nwnber I(J: ~OQ ?vr-
-AT.!. N.;.':F!C:..~s ANn C{,Flg'(IU,:,s ,'fU~'!' E.~ ,ljcc.r::s::;_~!..r', 4!'.1US7'.':.':'.',"!' TO .'!~ ,'.:.1D.::: /'.7' .':0
~p.m~i",pd Tr.srJl!ctic11ff
o
o
o
FOOTING! FOUND.iTION: To be m:::de
after ~renches are excavated and
foPms are erected.. but prior to
pourir~ cencret..
UNDSRCROUHD PLUMBING, SEWER. W.1TER.
DRAIllAG2: To be made priolO to fil-
Zir.g tr6nchee.
D
o
UNDERFLOO.~ PLUl,!BI.'lG & NECHANICAL:
To be made prior to in3taZZation of
11001' insulation 01' decking.
POST AND BEAM: To be made prior to
instalZaricn of floor insklatior. 01'
cisckin;,
ROUCH PLlP..IBPlG. Er.ECTP.!CAL & MECH-
ANICAL: No :Jerk is to bc cOI:Bred
unriL these inspections have beer.
roode ar.d approved.
FIREPLA.CE: Prior to plecir.g feeing
mc.te:ri.ai..s and b€fore framing inspec-
tior..
FRA!~I!!C: f.1u.!Jt be requested afte1'
appl'ovaL of rough pLwr.bin(h dect1'i-
caZ .& mechanicaL. An roOfing
bracing ~ chimneys.. etc. nr~st be
,completod. No wo1'k is to be con-
... cealed until thiD inspection has
.b€~n made and app1'Oved.
D
[J
,~
~
=:J FI/IAL PLU!.tBI/IG
:=J FIliAL MEcHANICAL
=:J FINAL ELEC':'RICI..L
-=:J
o
u
lNSULATION/VAPOR BARRIER IHSP~CTIOII:
To be made after aLL insuZ~ti~n a~4
rcqu:'1'ed vapor ca1'1'iers are in place
Cut cefo1'cany Lath.. gypswn board or
LXlll covering is applied.. and before
any insulation is conceaLed.
DE,~,OLITIO;'.' OR ;~:OVE:; B!./.tLD~:,Y;S
~ Semi tary seJer capped =.t p~opert":1' Zir.e
=:J Septic tank p:...."?ed a":'ld fille~ tJith ~ra~e:
o
:J Pinal - f{hen ~V8 ite.":ls aZ"e CC.'11Vl8t€d
ar.d when d~clition is complete 01' 8t~c-
tU~e moved and premises clean~d up.
DRYWALL IllSPECTION: Tc be made
afte1' all drywall is in place..
but prior to any taping.
MASONRY: Steel. location.. bomt
beams.. g1'Outing 01' verticals in
accordance tJith V.B.C. Section
24105.
o
I Mobile Hemes
o
Afte1' installation is ... ~ Blocking and Sat-:lp
S l.., iJ PZwnbing connections
CURB & APPROACH AP.rKJN: Aftc:- .form?, ~ l1ELcctrical Ccnr:ection _ Blocking.. set-up
are crected bu.t prior to pOU1"1,.ng ')::> and plumbing connections nr..;st ce apprQve;;;
aona1'ete. before requesdng eZec:l'ical inspectio:-:
WOODSTO:'E:
ccmpZeud.
s:;wer and wa:e1'
D
D
:=J AcceBsor~:.. Bu.ilding
sk~rting.. decks..
o
o
:1
I
D
, All p1'o,iect eor:ditioYlD.. auch as the -:"YlstaZZation of street trees.. cO.'':7pLot;..;m of tile
requi1'cd Zandsccpir.g.. etc., must be satisfied before the BUILDING FINAL can be r3qu.est~d.
FINAL BUILDINC: The Final Building Inspection must be reque3ted alter the Pinal Plumbing
electrical.. and Nechar.iccZ Inspect;.ona nal)a been made and app1'ov~d.
~
~~s'!' ~CJ'!''! 11':1':1'
or :!
: JOB NO, rtfJ7J7L/ SOLAR ACCESS REQ,-
L-COG""
T,~'pe/cor.st :
Bedroorr:s:
I I Ener(7~ Sources
II fieat
Water l1r?atf.l!'
I I Rattf:o
II I Fircolaca
Waod::;tot:e
II
Oc~pancu Crou~:
: Zor.c:
I Lot Faces -
I
I P.L.
INorth
lEast
ISouth
IWcst
T:Jr>e
LOT TYPE
Interior
Corner
Panhandle
cut-de-sac
lLot Sq. 'Ftg.
l:: .,f lot C.7Veragc
1.i! of Stories
I, , ! " .' h'
1 ~o...a ..e..{j..
;
! Topography
~ethflr.ks
House--r caraae
Access,
-- Fees
VaZue
SQ,FTG
x
I!TE,'.!
!,I'k:in
I Cereae
,
,
!Cart:lcrt:
i
I .4cecssor~J
11
I
I
iSoDoc.
Building Value & Permit
This permit i~ aranted on the express condition that the s~id.const~ction
8hall~ in all respects, conform to the Ordinance adopted by the City of
Springfield, including the Zoning C'rdinance, reguz.ctil~g the . cons tructicn
and use of buildings, and m3Y be suspended orreuokec at cr.y time upon vie.
Lation of any provisions of said Ordir~nces.
I
I
I
I ~00. '79 I r'd.'}
,
I
TOTAL VALUE
I LlC/.UC)
1.5 =
I Plan Check
I Date Paid,
IReadpt #,
I Sig"-ed,
Building Permit
Fl!e:
State Su:rc:harge
Total Cha:"gss
/
CRARGE
NO.
FEE
: ITEM
; fL -tu:reB
Plumbing Permit
No pereon chall construct, install, a!ter or change ~ny ne~ cr e:isting
plumbing or drainage syste~ in whole or' in part, unless such person is the
legal possessor of a valid plumber'~ license, ezcept tr~t a pe;"son may do
plumbing ~ork to property which is owned, leased or operated by the appli-
cant.
,Residential (J bath)
I Sanitary Sewer
i
; Wete!"
I
I l' .00
u~.
1.~.7~:?1
i
?l:.u:-:b{.r.g Pert::"'~t
State Su:rcr.arge
Tota! CharGes
F'
I
I
I
I
I.
I
I
I
I
IS. eft) I
,7SI...~J
IS, 7<)1,
I
CHARGE
I NO.
, :TE::.!
Electrica I
Perm it
. _~es. Sa. fte.
IN.u/E:tend Circuits
Where State Lal.J requires tr.at the electrical work be 'done by an Electrical
Contractor, the electrical portion of this per.mit shall r~t be valid until
the tabel has been signed by the Electrical Contractor.
I
1-
; Tem;Jorar.y SeI"Vice
Electrical Permit
St::.te Su:rcharQe
Total Cha:rces
I
I
I
I
I
I
I
Z;S,'.! I NO, I Fr;'~
Furr..::!ce ETU'S I '1
, E:haust Hood I
Vent Fan I
i/:Jodsto:Je I
I
CHARCE
Mechanical
Permit
Pe.rmit IssuanC2
Me.:hanic::.l. Permit
State SUrchc:"t'ac
T('Jtal C'JurrOP.[J
,
-- ENCROACHMENT --
. I
Se~~ritv DZ~o3it
PUm Exc:mt.ner
uate
Stora{!e
I HAVE CAREFULLY EXA...fINED the completed appLication for per.mit, and do
hereby certify that aU i':':.fo:omation hereon is true and corrcct, an:i. I
further certify that any ar.d all work perfor:ned shall. be done in ac~or-
dance ~th the Ordinances of the City of Springfield, and th~ Lu~s of tho
. State of Oreg~n p~rtaining to the work described hcre~n, and that NO OCCU-
PANCY will be made of any structur2 without pa~is3ion of the Building Di-
vision. I further certify tha.t o':1.ly eontra.:tors m.d e:npz.,yees who are in
comptiance with ORS 701.05$ witt, be used on this proi~ct
Maintenan.:e
Permi t
I
I
I
I I
Nltf ~ I .'20 I-~":i
i :=<'5, O'D
I \.'7.5'
I
~t!.;)i
Total Charaas
.1
I
Cu:r:,C'~t
. Sid"",!k
'Pl!n::e
Electrlcal Label
XobiZe Home
...\1
~~::1-,J uJ~J
SJc...
/-$'-(Z
~fute
~-
.
:--OTAL AgIJU.'''T DUF: 4
~,~:lit_~~~~:~~_ -.-,_~..._
i:. .~,.' J. , . ," -:"'- .-...-~-..---------'...-- ..-..--~-w:.r-'~--~';~;(..:,
I, \-;:>{:'~' ,~:" AMERICAN .81 ' '
I~';I'" ~o '~'1 '
\ ~I:' ,," I, ",~'x,' " ' I !,..] C> .. ' I 1111 ~at~":""'~
:.t.-rr)U-J'~;>I;'II~:'II':"''':''C'' plr'bl l"J;..,rl-':\~~'\;tr41 ,.' ~ '" "~(...-e~,f} .
II .. \ ' , , . . It ~ " . '\ . l,t., , ,\l \~ 1L'err.'l0:,l\~ '"ultnqu~ .~p. ta~(''''f'Oll~~..'lllt..
: r;:,,~' ~ HI, b',,1 nil':" ^" ,'1~ ",:", ,,' :,'H'l"'}"."'lt') 'id'~ ""O.'.IJII1\11 Or~\~6 ~c~i?~rPr~r!t : :~~ft:j I'
Ii ~< '-'" ". -. ',:r' '~';%nh""':';":;:\" ",!;, ~:' P.URCHASE,CONTRACT':' CASHin:"~lr.nll"'i"'!.t~.,.~~ij.~q ,
I' ., 8ALESMAN~; __(___ lJ, r,,11 iJ\. . ~., . . .ll..,il'l'.,l ,...' :.':.",-, I.. a-"'i~j,ttl xn~ '(Ill. cd...~~7~~'~.r n
, t', ;l~'f'" illll:1O .t,;o', ''J!,...,~ ,,"',',,"'!'. ,~,:"", ",Ii '},a ,..,.. , "~?, VI' ;'":>!>.'" 'm'J.<l:l '" <1,.,,1 :leI .~ '.,,.11 Itllr.IOr,{~'\~".~;."'~"7.~.?B.\!JJ~.... ,~.
"I., { 't. . .... ....1\..1. " njp t ",("Il"'''' i.~!ln t;l 0'1' '" I ~ l.' " , ,'.1111 MIM. no hl"\~;t.1t vf~rno\i-1 jiHfJt:.,1 9l~1 Jtt~ti:~~c.~.... ,;.
, ." .. ^.' ~ ~ ,.. r. ~'I . "f' '., ,\ .,,', '1 I""t' "','I,I 11" "~1' Jrr11!o:1)2 p..:.~.n');.'!?1r.!n'br.~". .1 '
,; 1-., '...' ~ :: '011...f.. \ ~I"",' ,. ~ I ,.- l.1"l"',~';,' . .. ....\ . II '1,..:):1 :"tn'tIH{(;:sr.'l.1'" UtJtF1?".'!j: "J1t~':W".~". '.flO:C(;'~ll\1J> .
I' . " '," "o,;,.:Jlf '\'''''' I~ ('\.~"'I"" '".~ 'ft. .. ;'::;f1'J,;'llO', - t':'...rt~":5''t'il l>Il~ 'Q.':;1 ,il\\ .' 1i~":~1',
'," ", ," .'.. ,;:1,' ".'I:l .., :'f~"f';' TI ..,.' .' n"''l'~ fp.:r,tiStij
I ::0', 0""""'" ' ,," ':, "'." ,; on',.",""" 0>',"':'" ',1,\': ":," "I', ',', w~,-""." ,', ,Ir.l. ~;",1I'...1 ,.., .011 m'lIiJ..~~",li'.~,l!l!~;.l"'~ ~~~
I, I ~"'agrea(.) 10 'purchase and Amarlcan Moblla'.'Homa.,'lnc. "Sallar,' agree. 10' seli" pertY'deecrlbed' bel "on' t1i."Ie'irii.s~na'MiUIilliii\'8~.;i
,1:.""" .elforthbelow:""..,"..,.. .",' ..' ,'.',..' "..,.. ", '" :I"",' i.:.z:'''..,.!~.,..';,:.f,1~11~t<lS'!'"a''$I&r;m..'...."<i'~i,Y.'h'''';.D11
._ .._' ' j'" ,',~"I1.,.'......;"l1l'l.,l.,btl.4l~'~~t..
,'~. . V. MANUfACTURED ~. APPROXIMATE ~N _MANUfACTUREC . '.' . MOOEL' , .. 8EAlAL"o.' . - ... . '. : . .- . "~
1 " N~l._~~ 1....o".,l..1 VR'~ ":;'W10TH I LENGTH I,; '1,', ,r..l/l~,;O ll~.I~-i::~;US.!'Jl~f.X'$lr(~n)tl \'Wf1~l;:JOr.lO..'.'~~"'l
I ,..,~": U', :.,~ '....,.0:' fl<("" .. ,AA^~" ,"'J..IJIJf~,/) HuDNo"''''F'~,..'..~-_~"~t,''''I'l3:.'~:li:fk
\:1" ".'0.____. C2Q.. d--O ., ,,f}t'Y\lI\V'~jlItIl\Jl~l\"7"l"'l"]n' '"~I);'Mll"'h;tr.f;;<NRiIl\1n!..,,, :;"'JI,~',~~~:
! 'I" . ' ," ' .. , ' ' , '" I""'~ ".~,~ "'OJ"'" ., .._v." ,,- ,,,f!l,lilJPIOl;l ~ f
l" DELlVe~Yl''''''' PROPOSED, DATF',' i" ,,,, ,,' '. ..' ,',,!I.c:>p~T'9N;,......'" """"." 1" QI""'" ,,/..... ". J'iWiol,
"'I I jl I" . I .... t III . "',) , It, . ot' ,," "f " .' .' t I'" ';...!:.. \.' ~ .......'''-''1 lI,~""1'
"'~ .,... \.,' ...' '.~ , .i".....I',;I,;.....,..ti'.lr.;t~"(:.I'~,I'l/'l'~i""tI>:~!'Ji!:r;.~l...-..,pf\fti:1\1:;.t.n.I",.11<l1.ftM-",~
. , ':l;:~l':
.' TERMS.,.,f: !"~!o:'r1""~1 toi ~w'..iI fll~!Jl;It JlsJtnI~'.'i'-!1et r.(jfd li:02',' ,
~ _ .. ~ tl ~:~;Ii;ii:~":l,n 1(:1 rt;IS:'\110~')'9Vmq.Q~~~\I~<;' '. '.lOf
1, 'CASH PRICE" '" ~""l^~' ff.::l;''ll\rj 11\"'11'IKlIOl>lf~r.-$' ,.",'1.
2 OTHER CHARGES'! ~". ,.~",,,,t;~ :~3Itlf~1,,'~:h"l\'ll'lVO"'J.'" """.....,11\1:
...' . ;' , "V"":;''l'1~'~'''!~i''''''''''"::l'~h:~,.;l! ~,O!.."",\:
".' (a) Title and reglatmtlon'~ .'JI\.<:"!\''a'S ,.""','~' \ i;l'n)~' ~~1't.11"
, (b) ,Department 01 Cbmmllrce'P !JIlI$V",'"'' ""r.wt',IIj))!"lI:i~I.\lQGV~~
(c) Insurance ~Ih4""li_1ll'mS '1.,.,.O/)"I!:S';:!l)~~~
~(d) Trip pe'1Tllld.::""f~'1 "",t 1M "",~'S . Iii ..,..,1', .~~ilool. ~)lr,'
'..() ."t"''f~l". ~I Y.,1;,J.ln'1tY::l.,}()S.;....,...,.......'4.."':"'..I,,~\lmr~~,"'lt.Q
,~ e:.. ,..".,. ' :,', :." r.)Anlf<?~~:.'':f)fY.lZ.
~ (f) ,. .' ".t "~$I",, ,; ,1"1' :"ll1n:t1;"f':':"'p-~
, Tolal Other Charges ,),," tM "f"S ".I't """',' '\iiII....s!lb'7.1:5";",'
".. " ", 1'1\0 .:,tr..ii! ';tti.il,,~l~a?! tlJ!\l1:.l~. '~7
3. TOTAl: CONTRACT PRICE IQ m<1l1G1Q ,r.s "'i,v,~en'S ' il, '
.: " 'l ,~:.,: l'i ~".~~ ~,~;~II..leJ~lb~~ml..~il.I!p'~d'~t...-... .UJ~'~ .~,~
4. DOWN PAYMENT: '.. ~ : .' :.::,~" ',:: '. }~;::./r "';~!fi,J{~t,~,\r~~:~. .~
o Deposit'. ~l ~'~J,'1 ","'. ",,~..~H$~"~ 0 .:olIll~or~!!\\y'y
; , ;f.,l...tt tA.,ft"f'.. ~~\ -,n~~~J. f1, ,pO(1'..K"'!c';J~f~~;~ n
. AddltlonalCashb " ..,f.$~;'O.,~lir!\I,~;I~1
l"! ,''"If.'")I''.'~' 1'l'7ol"~" "",......~~,,~....~}t.,l!..~.~~"\l
, NetTrade-lnAllowance-;!) /.~",."!JIl'$r'~"l "', :~~'
., TOI~1 Dow~pay~~~i~,~1~~r~~:,.~~.'~n;1~~~[: '1' .~
1 It ,\",. I" ,,. ., ~l \,Il~~~:~~.' r.~Jll. t,,:,,~~ t:i,tl-!;1Qtl;1
-- 5, ,:~~IN.FULL,~J~H rr '\i~""'!''''ijS3-?~
.., ...,In .r..,
! REMARKSO;~n'\':\IH on.t::li'l't \01'. "'.~;;:\:;/
._....l,-i........."'- .. ." .,.."" .:;~.:
,I' I . ,. ';~. " h"~ ,hi( ~,.1l'}'t'I.!.1~~,~'..~~'(l~l\ lI,iJ&np.f.~I(,'(Q(l
< ",e~., hlbll u,l\...a,P,BrJ,!!!.!~~g~ee.!l",e~~O~!l. ilriJlti'VM' ;iitl.,
I, "',~i"~r\1f"' '~i'lfI"I''''''! t"iirit' 'r'to . eft
, . JJ.- "" ,,. '\I" 1'1, ..,,;~::r:-,n. ~, '~~' ..:!:~. "..~. ,Q
'-.,L/ J ~ h"\I~n'tH1r Pf!:"'r,~. .1 tt9'nu" '"9f1'1'1""OQ
I, - "' ~!1 ,,..,_ 'u'~",ftjl'.;..'U p.ntaJf10~
,.,.,. "T 1j
'll "
,I '
-j j :;:.,."
'j, ,,". INSURANCE: No I".uranee Is required by Seller In this Contreet,
:11'(~C ~but Buyer may purcnase tho followIng coverage. for the pDIk:y terms and
rl. ! ,..(. p"!"!'!urn.indlceted t~rough :>eller,. \~, '.' ,,:,,", ,",,, ", , . ..,.,
r . ,,,,~~. '. , ~ ,\" '.. ' . "'~ '1-. 'II., ',t' I. "...',:.j"
','I ;~,'.' 9 ~lra,.~J~u.ci,!t~,t:.:..-.~mosl,:,:", ~ '.\ ".$
t:,: ,"..1 ~l' ,,',," , .,' .,.:'" t" , '.',~ ..., ~" I "i I,," ,q'
~'" ",::t b Fire and TheU.comprehenslve L-- mos) . $
)j "- 'I'" '. '..., '1"/" "'.''; ," " ".'. 'hJlll "",","
t~ ,~: .!-OMoblleHomeowne":I.~mos). ~". .' : $~~
'~~ .'~_. ~ ,.,..lncI~a.IIa~I~~!~ ';, 'Il!',...} p.,'; " '~I I .,'1' ,..'... 'if: :~ '
11" ',' "O'~ . ;,~.,r" ... ;'(11" .,.,' to : "..! .'f' ' '.' " ',' . " 'I
:,. r. \ . ,~moa) S
.,.1...," ,". -'''. " '.' " .'
:.''f .~ "':(",' 0""1'" 1< l~a: I'. \ .,:'1",1 t"'l;' . ~ ~".' L::..:_"~~S)' ':. .$.., ,i.:
W~ ,.. .. " h
~i ,,;~;.t,' 0 PIeaae obtain thecover80ei'l,dlcated ebove:' , '..1;' ,I , ", I
,\'f-. ~~,;. ,hi' il>.;: I,ll II) :.'1. I~ 'j,;, ", ......~ ;o'!; (.J '~l'"'' .1 ,; 1,'l.I'H " '. j,;
b '~~ .N BUYER t., ." 'I "I r 11< ~ 'I ,': f~ ~ li \..,. \11." .1, I', .! DATE ...
~'~ 'i: .' -, ..' l ll~" .-"l~~:;
~,. "".~",f\""tl'V"'C~'~!<1.1~.",,~I~,,"""'I, ',..'i,':,' : "
:!~ ~~~::'::.:~~. '~t~:~~re'lt~~~rcha~. ~he' 'cove'~g~TElnd~ted 8~
~J,'~l ';'{!.t..~r... . from or throuoh Sel1er.~;,I-&,t ,....'..1"1 If :,'; ., 1'0 "." I" i'. " . ., I, ,.
; I j'-" ,. , "', ,~. " '{" ' . ~
'J "; .."1,' ....--.......,;~ ""lp.i': II "'. i:I'r. tI';('dif\ ''l 1.1[: ":' :.Ii",.,l ''.' I :.!\.I',' ,,; r i
'1 ; ;f' ".t1BUYER!l;" ,. ,..d' '.. ,,;".. " _DATE__~.~ ._.~L:!..
,i; , "', 'BUYtA'l f.j:~ ,<'\ 'II ,,:<111" Illl.', ".1. '" ~I DATE
<l ,;''-' :" 'J.).' .' '.,.', ~- ~c' .=,,:,,' -", t" ., .. ;', ' ,
~IJ ~1TOTAL COST OF INSURANCE'ORDEREO $'
r..l,'..Hft';'!~,'T. RADE'IN', -'" ' . . ,.
i' ~ ~ l.rt^.f.1L"".L
~lh; ii'~eii~."".~;'~"~~IM~keil PI",,,! "",1"" ,: ~e'" ",,'
"'1 '~. ..1.'\".:'''' ,,.,. ,'. "1,;..,,, .'..,'" -" , ;ti ,.
, ,'" ,'\ ..,., 't-jtl.~ "3(hOrf ~,1;.1t""1 (1/:' :., ~, , ' 'Ito " ..
: ,,:.::' Model Sial N"
: _ .", . {Yl..." ~ -.. .,.....~J 1 ~ "., I" ,'" f. - " .; to '" .
. ''"il I,.,.... ,- " '''''''\:H K._.4\ Ii r-''i: II" . . I , .
,:,~" Stale,tltled In " Serial No
:~~;"';:;; I ~~i~r~:i~';""::~:' . "I :.1';' .....'~
'.' ",- ~, , ,....~.." "'" '.. .
: " j~, ",', .
;,'.: ' ... \. . ,t":" ~.r., .' (I .t, .., , l~'t
" '..:' Balance Owed 0
:>'. i;dre:"'''' ,'" ~ / ., "''''''CIIY'';''':: :." ...,.,'
-, .'.'
Gross Trade
Additional E
~ :~.~,~t.
" "
t... ~ ;",tl!'.:'
'1
.!&"
,~:t~,
.{;,
J~'r.
.,..,1
.: ,'Tolalli e'ln Allowance
.
.1] . Less yoll <,,' .
..i ' ,;
;"..1 r < Ne rade.ln Allowance
$.;
'If:
1::'."",
.J ".
'- ,'j
"J J.'l
"
/
~
\
$ ..
, ,
~.
V $
-~
:"'<..' .,
"", ",'
~"~' .-
;-tl'>J.
.~.~
;"',i
,
~~.;::;'rE~~" SL
~-/:,.
/'
/..'
./
~...~ 'It, ';'-
;<,1.
:x/.s' ',,'
.'
._u.~~_j.""":._ -
..._,.....-~~,.-:....;,::~.;'
.,
,,~.' '"
.,."~~..:..:
:., , '- :....'
it
w- .
~~ : '~." '
t,
r~
(,.
J
'f
~.
,
~"
:'
..
t
\'1
;"-
f~.
iJ>.
,.
!~-
r;
f';
, '
,
"
,.
t
t
~.
~~.
~'
I;l'
f;
ff'
[:
r
,
,
>
r"
r
~.
1,\
l:,..:
\J \A~~
- ,.---.------, -'------_....-.._----~- ---.-.----.
,
SPf-)C E' "10 II
Vj(IYE'WAV
J 2. xSO
~'
....
~~
\~
)
(
)
(
)
(
)
\
)
(
J
w~dRr
,
i
i"-
II,)
I -
,
I
.
N10&IL E.
ffr,rrllE.
dg"'fL/Lj
,
.
---A
, '"
1\
I '__h' S IDliW/i1-k;
--,-,-.--.-.---- ~~ .
.fi,
.
v
:;
, .
. -
....IIi
.l
"
'"
, i
,
j;: ~