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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 performing work on a property i own or occupy, <br />lam a registeredbuildorOR( ) the authorized representative <br />of a registered builder. <br />The work will be por¢ormed by a registered builder. <br />Other. <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE: <br /> <br />OWNER; ~)ATI'."_': 04/04174 <br />SITUS AOr;~l~[!~¢~I*'¥ LARRY <br /> <br />TAX LOT CATEGORY. <br />OONSTggOT,ON 'Y.E , A L <br /> <br /> 775~J ~UHSV]LLF HWY SE <br /> AUMSVILL E OR ~7325 <br />USE OF BUILDINO'. <br /> <br />CONTRACT CIT~ UGB OCCUPANT LOAD: <br />..... HARION COUNTY NO <br /> <br />:W~CTH: <br /> <br />SAME <br /> <br />PHONE; <br /> <br /> SITE NUMBER: <br /> VALUATION: <br />SECTION TOWNSHIP; RANGE: ZONE; MAP'. <br /> · ~,, 6 ....... AC- ......... NO NO <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 8~964 <br />LICENSE <br />Joh~ A <br />10764 Hill Cre~k Rd <br />Ai,msvil]e~ .97~25-0008 <br />PHOHE: 749-2971 <br /> <br />PERMIT ORiAPPLICATION NO: 539§4 <br /> <br /> SUPERVISING ELECI'RICIAN/NIJHBER <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br /> t 'f' E H <br />SF-.RVICE/FIi:'EDER LESS THAN 280 AMPS <br />BRANCH CIRCUIT~ WITH SERVICE OR FEEDER <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY <br /> 1 <br /> 4 <br /> <br />AHOUNT <br /> <br /> $2.90 <br /> <br />$60.90 <br /> $0.00 <br />$60.90 ~ <br /> <br /> ~ALANCE ~UE $0.00 <br /> PAYEE: ,John A Spe~AA[~ ~ j : ,REC~i~I:'~ NU~ 584~8 <br /> RECE~VE~ BY: NB i TYPE: CE CHECK ~: 1426 <br /> <br /> * THIS IS A VALI~ PERMIT* THIS PER~IT EXPIRES 180 DAYS FROM ITS iSSUE DATE. IF <br />CONSTRUCTION CEASES FUR A PERIOD OF 18B DAYS~ OR IF CONSTRUCTION FALLS TO MEET ALL <br />REQUIRENENTS OF STATE LAWS ANDi MARIONCOBNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SWALL BECOME NULL AN~ VOID. <br /> <br />kEHARKS,, SERV~ 4/CT, R <br /> <br />~)OI,tAL,,D )ii;,, WOODI...k']Y,~ MAR3'OH COLI)-ITY BU3;L,,I)ING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV, 4/~0 <br /> <br /> <br />