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APPLICrrT t-W CERTIFICATE FOR PAYMENT <br /> COST: CITY OF SAINT ANTHONY 106: HOUSE DEMOLITION APPLICATION NO: 1 Page: 1 <br /> 3301 SILVER LAKE ROAD 2538 KENZIE-TERRACE PERIOD ENDING : 11/25/96 <br /> INVOICE NUMBER: 19010 <br /> SAINT ANTHONY, NN •55418 SAINT ANTHONY, MN <br /> FROM: BELAIR BUILOE_RS;'INC. ARCHITECT:' CONTRACT NO: <br /> 2200 OLD HWY 8'', CONTRACT DATE: 10/18196 <br /> NEW BRIGHTON, MN 55112 JOB 1: 6302 <br /> JOB DESCRIPTION: <br /> ------------------------------------------------------- <br /> CHANGE ORDERS <br /> -----------------------------------------------------I <br /> I I' ADDITIONS I DEDUCTIONS I 1. ORIGINAL CONTRACT AMOUNT.......................... ; 5,867.00 <br /> = I•. I _. I 2. Ne,t Change by Change Orders.. .... ; .00 <br /> PREVIOUS TOTAL I .00 I .00 I 3. CONTRACT SUM TO DATE (line 1 +J- 2)............... ; 5,867.00 <br /> -----------------------------------------------------I <br /> -----CURRENT----- I I I 4. TOTAL COMPLETED 6 STORED TO DATE.................. ; 5,867.00 <br /> I-----------------------I I I 5. RETAINAGE .008 OF WORK •COMPLETEO................ ; .00 <br /> Number Date I I I .008 OF STORED MATERIAL <br /> I-----------------------I I I 6. TOTAL EARNED LESS RETAINAGE ...................... ; 5,867.00 <br /> 7. LESS PREVIOUS CERTIFICATES FOR PAYNENT............ ; .00 <br /> I I I I <br /> 8. CURRENT PAYMENT DUE........................... . ; 5,867.00 <br /> 9. BALANCE TO FINISH, INCLUDING RETAINAGE............ ; .00 <br /> ----------------------------------------------------- <br /> TOTALS TO DATE I .00 I- .00 <br /> -----------------------------------------------------I . <br /> NET AMOUNT I .00 <br /> ----------------------------------------------------=------------------------------------------------------------------------------ <br /> The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by <br /> this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the <br /> Contractor for Work for which previous Certifiecates for Payment were issued and payments received from the Owner, and that current <br /> payment shown herein is now due. <br /> CONTRACTOR: BELAIR BUILDERS, -INC. <br /> BY: Date: <br /> State of: Minnes to <br /> County of: Ramsey <br /> Subscribed- and sworn to before <br /> me this day of / Q U STACY A. SJAAHEIM <br /> >. .. <br /> Notary Pu ,. NOTARY PUBLIC-MINNESOTA <br /> blic: a� y RAMSEY COUNTY <br /> My Commission ez�� %'"°';.�:r�• My Ccmm issionEzpues Jan.31.2000 <br /> _ <br /> ARCHITECT'S CERTIFICATE FOR PAYMENT <br /> In accordance with.the Contract Documents, Based on on-site observations and the data comprising this application, the Architect <br /> certifies to the Owner that to the best of the Architect's knowledge, informatlon and and belief the Work has progressed as <br /> indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the <br /> NT CERTIFIED. <br /> A OUNT CERTIFIED BY: AMOUNT:; DATE: <br /> ®Pnni•d on regelod paper - <br />