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AF'r'LIC~TIOtv ANfl L'ERTIrICflTE ~D~ RAYMEMT ~.... <br />GAGE 1 <br />TO iOWNERI: MflRIUN CDUiVTY GRDJECT: 1+1RAICEN CO/SALEM/DEMO 4~'RLICATI~iV N0: ~ DNTE @7/19/97 <br />~ 1i~1~ HIGH SI. NE ^c~~b HIC~i 5T. <br />SALtM, t]R 9731Q~ <br />~t~OM iCONTRACTUR): STAfON C~IJSTRUCTION, INC. <br />~9394-8 Airport Road <br />Eugen'r„ DR 97402-4~94 <br />GHUNE #: t5411 4n1-1~54s <br />CNANGE URDER 5t1MM~iRY <br />I ADDITI(~Pf5 I DEDl~TIOPIS I <br />CHt~fGE ORDERS AF~ROVED IN i { I <br />GHtVIDUS MUNTHS RY OWNER I I I <br />1 I I <br />APGROVED THIS t40NTH I I I <br />{ f I <br />PfUpIBER i DATE A4~GkOt+EU I I I <br />{ 1 I - <br />f I I ! <br />I { I I <br />I 1 I I <br />1 f I f <br />I f I I <br />i i I I <br />I i I f <br />TC-7~1.5 i I I <br />I { I <br />i~T CHANGE 1 i 1 <br />9Y CHANGE DkDERS { I I <br />f ~ ~ <br />PERIDD T0: [~7/19/97 <br />SAtEM, DR 97310 <br />ARCiiITECT' S <br />VIA {ARCHITECT): PROJECT N~: <br />CQNTRACT FQR: <br />The undersigned Cc,ntractor certifies that ta the best of the <br />Contractor's knowledge, inforwation and belief the wark <br />cavered by this Application for ~ay~ent has been ca~pleted <br />in accordance with the Contract Docu~ents, that all a~ounts <br />have been paiti by the Contractor f~r wark for Nhich previous <br />Certifirates fnr Payeent were i5sued and pay~ents received <br />fra~ the Owner, and that current pay~ent shawn herein is now <br />due. <br />CONTRACTUR: _ <br />gY~_~~""~~~'~ I Date: ~~1~' 1~~ <br />~ - --- ------------- <br />CONTRACT DATE: <br />DRIGINAI CONTRACT 5UI4 518, ~79. ~@ <br />NET CHf~`iE BY Ct~E ORDERS <br />CONTRACT SIIM TO DATE 518, 579. @~ <br />TUTAL Ct~LETED f~ID 5TORED TO DATE .iJI~J~ J14. :d~ <br />RETAItJAGE: <br />5.0% af Co~pleted Wark 35@,514.~0 <br />5.0% of Stared Material <br />Total Retainage 17,Sc5.7s' <br />TDTAL EARNED LE5S RETAIP~IGE 'sscs988.7i <br />LESS PREVIDU5 CERTIFICATE5 [!F PAYMENT ~id7,~98.55 <br />CURRENT Si~ES TAX: <br />~.0~~ af Taxable Arount <br />Curzr~ent 5aIE5 Tax <br />CIJRRENT PAY~NT ~ <br />BAIf~lCE~ FINISH, INCI <br />~~~9~ ~ <br />125,b90.2C <br />I HAGE ~ ~~85, 590 <br />S> <br />~~r;~ <br />Y` „{ t.t CD <br />~ <br />C,a «, ~ ~ <br />L_ c „~ <br />~~~C..;:-'S.l <br />;~, v :~ -~ <br />~i • ~-"'i z `~~z <br />C:, 31_ =~ ~ iL <br />r crr z <br />LL.. ~" `. ~': CS <br />oC:?4=~ <br />c~. ~- .~ _n <br />~,~..~ <br />~~U~ <br />u <br />~ <br />~ <br />.;-,:;-.. <br />~` _ ,:iS9 <br />o<~~~~ <br />~~ pP <br />State of: ~~QO`Q~ County af ~--fl.stiR. <br />Subsrribed and saorn to before re this\~~~~day af~,~.;,l~i`j`1 <br />My Coe~iSSion expires: ~-~-'~-~~Z V <br />AhIOUNT CERTIFIED t <br />f~RCHITECT'S CERTIFICATE FQR GAYMENT <br />In accordance with the Cantract ~ocu~ents, based on on-site <br />nbservations and the data co~prising the abave applicatian <br />the flrchite~t ~ertifies to the Owner that to the best of the <br />Ar~hitect's knawledge, inforiatian and belief the Wark has <br />progre5sed as indicated, the quality of the Wark is in <br />accardance with the Contract Docueents, and the Gantractor <br />is entitled to paysent of the AMOUNT CERTIFIED. <br />ARCHITECT: ~i~c,c~ /,(~1,~ g~ , ~ <br />U ~ <br />By. ---------c~~~~~a~!"'~ Date: _~~Z~S~ <br />Thi~ Gertification is not negotiable. The AMDUNT CERTIFIED is <br />payable only to the Contractor na~ed herein. Issuance, pay~ent <br />and acceptance af payeent are without prejudice ta any rights <br />nf the ~wner or Can ctar under thi~ Contract. <br />~,_Ql!'~~-~~.N <br />/~ , '~ <br />~~~~~~7 <br />