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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am perform,n9 work on a property I own or Occupy, <br />lam a registeredbdlde OR( ) eau ho zed ep esen ave <br />ol a re¢is~ered builder, <br />The wo'rk will be gorformed by a registered builder. <br />Other .... <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE~ <br /> <br />OwN~J:~TE: 10/28/91 TIME: 15;59:23 TAX LOT; CATEGORY: <br />SITUS ADDRFS~~VE~GREEN CONSTRUCTION TYPE: OCCUPANCY: RES 10EN l [ AL <br /> <br /> CONTRACT CITY: U~B: OCCUPANT <br /> AU~SV~ LM~ OR 97325 <br /> <br />MAILING ADDRESS: SU BDIVI~ION: <br /> <br />PHONE <br /> <br /> SiTE NUMBER: <br /> RANGN!ALUA'f' 1ON: ZONE: <br /> <br />~ UNI'fS: t~E~. LOT: CORNER: <br /> <br />MAP: <br /> <br /> rYPb: kLE(}FRICAL PER~i'f OR APPLICATION NO: <br /> <br />~:. ~ ,~'~5~ IqS- NO_ ~7459 SUPERVI~ING <br />R & R Electrlc <br />Po Sox 52 <br />h_m~mr, 97392~0009 <br />PHONE: ?~3--2546 <br /> <br />SERViCE/FEEDER 101 TO 400 AMPS <br />ADDiTiONAL FEES <br />ELECTRICAL STATE SURCHARGE <br /> <br />PAYEE: R <br /> <br />TOTAL AS~E~EO FEES <br />PRE¥iOU~ RECEiP'r~ <br />THiS RECEI¢'I' <br /> <br />QUAN'f' i I'Y <br /> 1 <br /> '1 <br /> <br />RECEIPI' NO: <br /> <br /> AMOUN 1' <br /> $60, O0 <br /> $30. UU <br /> $4.s0 <br /> <br /> $94,50 <br /> $94_50 <br /> <br /> $0. O0 <br />:~8346 <br /> <br />RECEIVED BY: CL TYPE: CK CHECK ~: 9990 <br /> <br />$ THIS IS A VALID PEI~'VIiT * THIS PE~IT EXPIRES 180 DAYS FR~M ITS II~UE DATE. IF <br /> <br /> NULL ~D <br /> <br />REMARKS: 200 AMP SVC FOR PUMP, MPG SV C R~3030 <br /> <br />DONALD E. WOODLEY, MAR.ION COUNTY BUiLDiNG OP'F~C~AL / 8Y <br /> <br />FORM # MC 15-5~ R'EV. 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />