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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 />lam p erformingworkonapropectylowno¢oooupy. <br />I am a registered builder OR ) the authorized representative SIGNATURE OF APPLICANT'. <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other_ <br />i ha~,e read and agree to the terms stated on the reverse side of SATE; <br />this document. <br /> <br />'OWNDAfE:ER: 07/3(,/91 f'ilVlE: 13:55:56 <br />SITUS ADDRES~A I ~', FAY CONSTRUCT ON TYPE: , OCCUPANCY <br /> <br />RESIDEN¥'iAL <br /> <br /> 9717 BATES ROAO <br />use 4¢¢rC~&CJ.E <br /> <br /> CONTRACT CITY <br /> <br />· OR - <br /> MAR.[ G'~ L,'O~N 'I Y <br /> <br />UGB <br /> <br /> i OCCUPANT LOAD. <br /> <br /> NO OF 8EI)R0C)MS <br />NO <br /> <br /> 9694 MiLL CREEK ROAD SE <br /> Aufvr:¢VtLLE. 97325 <br /> PHONE: 749%2840 <br />LOT:BLOCK: <br /> <br /> SiI.ENUMBER: 13093 <br />SECTON TOWNSHIP: RANyALUATiON:,ZONE MAP. <br /> <br />WIDTH: <br /> <br />DEPTH AREA UNITS: RREG LOT CORNER <br /> ~1 85 ~iN EFU 48 <br /> <br />~YPE: ELECTRICAL <br /> <br />CON'I'RAC'rOR, NO. <br />LICENSE NO: <br />BATES, FAY <br />9694 MiLL CREEK RCA0 SE <br />AUf4~VILLE 97325 <br />PHONE: '749~2840 <br /> <br />PERMI'I' OR APPLiCATiON NO: ~4113 <br /> <br /> SUPERVISING ELEC'rRtCIAN/NUMB~R <br /> <br /> ITEM <br />SERViCE~FEEDER 100 ANPS OR LESS <br />ELECTRICAL S'T'ATE SURCHARGE <br /> <br />QUANTIT'Y AMOUNT <br /> $35.00 <br /> <br /> TOTAL AaSE, SSEO FEES $36.75 <br /> .PREVIOUS RECEIPTS $0.00 <br /> 'f'h iS RECEt P'¥ $35,75 <br /> <br /> BAL~CE ~E $0.00 <br /> <br /> PAYEE: 8A'f'E~ FAY RECEIPT NO: ~5987 <br /> RECEIVED BY: D~2 TYPE: CA CHECK ~: 0 <br /> <br /> THIS iS A VALID P~II ~ THiS PE~IT.~PlR~,180 ~ F~ IT~ I~E ~TE. iF <br />~ST~CTI~ C~ FOR A PERIOD OF 380 ~, OR iD ~T~CTI~ FAI~ TO ~EEI' ALL <br />~[R~TS OF STATE ~ ~D ~RI~ ~NTY ~I~ING ~D Z~ING ORDiN~C~, THiS PE~IT <br />~ALL B~E NULL ~O ~ZD. <br /> <br />REMARKS: 100 AMP SERV R 3252 ~N <br />DONALD E, NOODLEY, MARION COUNTY BUILDING OFFICIAL / BY ~ <br /> <br />FORM # MC 1~-~6 REV, 4/t~J0 OF FICE COPY <br /> <br /> <br />