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MARION COUNTY B~LDING INSPECTION <br /> SENA~-OR B[.'OG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4;30 P.M,- 8:00 A,M, <br /> <br />I am performing work on a property ] own or occupy. <br />I am a registered builder OR the authorized representative <br /> of a registered builder. <br />The work will be performed by a registered builder. <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> °w~E: 11/17/89 TIME: 8-'40: l?a TAX LOT: <br /> <br />S~TDS Aoo~E~TTE~, HAL :~0NST~utYI~N ~YPE: <br /> <br /> CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESIDENTIAL <br /> <br /> CONTRACT CITY: ~ cGB: OCCUPANT LOAD; <br />105 FOR~T STREET ; <br /> <br /> DETROIT NO <br /> <br /> PHONE.- , SiTE NUIV~ER: 1134 <br />LOT: 8LOCK: i gEC'~ION': TOWNSHIP'. R^~UATiON: ZONE: <br /> <br />:DEPTH: ;AREA: 1 :UNITS: 10 IRREG, LOT: 5E CORNER: <br /> <br />105 <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO_ 40298 <br />LICENSE NO= <br />GRISWOLD ELECTRIC <br />22856 JENNIE RD <br />LYONS, OREGON 97358 <br />PHONE: 859-2214 <br /> <br />PERMIT OR APPLICATION NO: 20218 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> ~4ARK S GR[SWOLD <br /> <br /> ITEM <br />ELEC HEAT INSTALL-EXISTING RESIDENCE <br />SERV CHANGE ONLY-EXISTING RESIDENCE <br /> FLEET SURCHARGE -ZONE ? <br /> ELECTRICAL STATE SURCHAROE <br /> <br />QUANTITY AMOUNT <br />1 $30.00 <br />1 <br /> ¢8.96 <br /> 3.00 <br /> <br /> TOTAL ASSESSED FEES $71.95 <br /> PREVIOUS RECEIPTS $0- 00 <br /> THIS RECEIPT $? 1.96 <br /> <br /> BALANCE DUE $0.00 <br /> <br />PAYEE: GRI,?CNOLD ELECTRIC RECEIPT NO: 21549 <br />RECEIVED BY: PR TYPE: OK CHECK ~t: 201 <br /> <br />* THIS IS A VALID PERMIT * THIS PERMIT EXPIRES 180 DAYS' FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEA,.~ FOR A PERIOD OF 180 DAYS, OR IF CONS'T'RUCTION FAILS TO MEET ALL <br />REQUIREMI~ITS OF STATE LAWS AND MARION COJNTY BUILDING AND ZONING ORDINANCES, THIS PERt4iT <br />~rlALL BECOD1E NULL AND VOID. <br /> <br />REr4ARKS: HEAT INSTALLATION, SERVOHG R'~BS?8 <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL /BY <br /> <br />¢OR~ * MC 1:,!,,~ ~*V ~/,~ OFFICE COPY <br /> <br /> <br />