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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE * Room 132 · Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br /> ;I ECTRICAL ~ERHIT <br />iHtTE~I~ : ~21/96 111~ Iqi]~ltZT ~ ; 96~4587 <br /> ~ R~id~. addition/alt~att~ ~A~ ~ I~D <br /> ; R-3 I~ · ~/21/1~6 <br /> <br />~ORK DESC = ~ SERV; 2-C~R FOR MECH. SHED <br /> <br /> SITE ADDRESS : CITY= ~RION COUNTY <br /> 1B~91 LEVERMAH RD SE AM <br /> <br />CROSS STREET = HY 22 E,AN EXIT, LEFT ON MILL CK, LEFT 0~; LEVERMAH <br />PARCEL NUNBER = 564~5-0~ <br /> <br />OWNER NAME <br /> <br />APPLICANT <br /> NAME <br /> ADDRESS <br /> <br />PHONE <br /> <br />COHTRACTOR <br /> PHONE <br /> <br />GRAY,ROGER & REBECCA <br /> <br />GRAY,ROGER & REBECCA <br />IBB91LEVERMAN ROAD SE <br />AUMSVILLE, OR <br /> <br />747-4B37 <br /> <br />GRAY.ROGER & REBECCA <br />749-4037 <br /> <br />ELECTRICIAN <br /> PHONE <br /> <br />97325 <br /> <br />SUPV ELEC : <br /> PHONE : <br /> <br /> OCCB= <br />CONTRACTOR LICENSE: <br />SUPERVISOR LICENSE= <br /> <br />Units Description Fee <br /> 5ervxce/feeders up to 2B~ amps <br /> 2 Branch circuits 4.00 <br /> 1 State surcharge 2.70 <br /> I Refund .00 <br /> <br /> Assessed fees : 56.70 <br /> Adjustments : <br /> Total fees : 56.70 <br />PAYEEI GRAY, ROGER & REBECCA ~o~al paxments: 56.70 <br /> <br />THI~S PERi,IT IS I~TR~I~ ~ £XPIRES 1~.. I)~IY$ ~ I~UE ~TE IF IJORK HAS <br /> <br /> OR IF CONIITRUCTIOR CE~S FOR A PERIQI OF 11~ 9AYe. Oil IF MORK <br /> L] REQUIREiIENT8 I]F STATE Lkl~ ItARItlll COUNTY ORIIIIAIICEli. UPON <br />tJRITTEN RL~RIEST~ ~ SlX I~NTH EXTFJ~ION HAY~E <br />SIGNATURE OF APPLICANT: ~-~'..- z. <br /> <br />DOHDALD E WOODLEY, MARION COUNTY BUILDINBG oFFIcIAL / BY <br /> <br /> <br />