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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: 888-7904 <br /> <br /> t e,m performing work on a property I Own or occupy, ~ ~ /J~.<J~,~ ~/<~[~,/C~"'-~;?~_ ~ ' - ' ' - ~ ~ <br /> I am a registered builder OR ( ) the authorized representative SIGNATUR~ OF A~PLICANT: <br /> Of a ¢eDistered builder, <br /> The work will be performed by a registered builder, <br /> Other,, , <br /> I have read and agree to the terms stated on the reverse side of DATE'. <br /> <br />DAI'E~ 12/15/~4 TIME: i2:49;~6 <br />'~OBE...O, ~OBERT & GAlL 75;3g~-930 RESIDENTIAL <br /> <br /> 8734~ . ~SHAW SQUARE RD SE ~'6~COP~N~ LO~O: <br /> <br /> ! SUBDIVISION; <br /> <br /> ~iTE NUNaEE~ 94-03784 <br /> <br />~ ~ 14 ' 8S 2W ~ AR <br /> <br />TYPE: ELECTRICAL <br /> <br />CONI'I~ACTOR~ NO,, <br />LICENSE NO: <br />Mark S Griswold <br />22856 Jem~ie Rd <br />Lyonsv 97358-000~ <br />PHONE: 8.~9 ~214 <br /> <br />PERMIT OR APPLICATION NO: &82~B <br /> <br /> SUPERVISING ELECTRICIAN/NIJMBER <br /> <br /> ITEM <br />SERVICE/FEEDER LESS I'HAN 200 AMPS <br />BRANCH CIRCSIT~ WITH SERVICE OR FEEDER <br />ELECTRICAL STATE SORCHARGE: <br /> <br />QiJANITTY <br /> 1 <br /> 20 <br /> <br />AMOLJNT <br /> $50.00 <br /> $40,, 00 <br /> $4.50 <br /> <br /> TOTAL ASSESSED FEES $94.50 <br /> , PRE1/IOUS RECE l PTS $0.00 <br /> THIS.RECEIpT $94.58 <br /> <br /> B~L~NCE DUE $0.00 <br />PAYEE: Hark S Griswold ' <br /> RECEIPT NO: 62878 <br />RECEIVED BY: mb :~YPE: GK CHECK %: 1772 <br /> <br /> ~ THIS l$ A VALID PERMIT * :THIS PERHIT:EXPIRES:18~ DAYS. FROH 'rTS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD oF".lgl!i DAYS~ :OR iD:: CONSIRUCTION FAILS TO HEET ALL <br />REQUIREMENTS OF STATE LA~S ;AND: MARION:' COUNTY BUIIZDINF.-. AND ZONING ORDINANCES, THIS PERMIT <br /> <br /> REHARKS: SERV/29/CIR <br /> <br /> PONAL9 E~ WOODLEY,~ H~RIQN COUNTY BUILDING:OFFICIAL / B~ <br /> <br />OFFICE COPY <br /> <br /> <br />