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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 H~GH STREET NE <br /> SALEM, ORFG~.N 97301 <br /> <br /> PHONE: .588-5147 8;00 - 4:;]0 <br /> 24 HOUR CODE-A-PHONE: .588~7904 <br /> <br />I ~lr'h performing work On a property ] owf~ Or o6cupy. <br />I 8m a (eOistered builder OR the authorized representative <br /> o aregietered bu der, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms state¢ on the reverse side of <br />this document. <br /> <br />owe:rE; ol/oe/91 <br /> BELDEN, BEN <br /> <br />TIME: 1.4:57:57 <br /> <br />T~ LOT: ,CATEGORY <br />CONSTRUCTION ~YPE. OCCUPANCY' <br /> <br />R£SI DFJ'41' IAL <br /> <br /> 12015 BELDEN OR <br /> AUf~VILLE OR <br /> <br />USE OF BUILDING: <br /> <br />~7~25 <br /> <br />CONTRACT CITY' i UGS <br />MARION CO&iN TY NO <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF REf)ROOMS <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISION; <br /> <br />SA~E <br /> <br />PHONE: <br /> <br /> SITE NUMBER.+ ?706 <br /> VALUA'r I ON: <br /> <br />AREA 24 UNrTS 9~ RRSG LOT: 2~CORNER: <br /> 89. AC . NO : NO <br /> <br />TYPE: ELE~I'RiCAL <br /> <br />CONTRACTOR, NO. 10875 <br />LICENeE NO: <br />CHERRY CITY ELEC <br />PO BOX 12.568 <br />SALET~ ORE 97309-0568 <br />PHONE: 399-?609 <br /> <br />PE~ll' OR APPLiCATiON NO*. 29545 <br /> <br /> ~UPERViStNG ELET~'f R I C 1AN/NU~3ER <br /> JON J WOLF <br /> <br /> ITEN <br />SE,.RV.,.,.t, CE/FEEDER 10.1~ 'rD 400 /~4PS <br />ELECTRICAJ- STATE ~URCHAR~E <br /> <br />r4LIAN T i l'y <br /> 1 <br /> <br /> AC4OUN T <br /> $60.00 <br /> $3.00 <br /> TOTAL A~S~ED FEE~ $63.00 <br /> PREVIOUS RECEIPTS $33.84 <br /> THIS ~EIPT $29.16 <br /> <br /> BA~CE ~E $0.00 <br /> <br /> PAYEE: ~ER~ CITY ELEC RECEIPT NO~ <br /> R~EtVED BY: ~2 TYPE~ CK ~¢K ~: 20631 <br /> <br /> ~ ~[S I8 A V~[D PE~IT ~ THIS ~tT ~[~ 180 ~ F~ IT8 I~E <br />~ST~CT[~ C~ ~ A ~R[~ t:80 ~,; ~;[E ~T~Ti~ FA[~ TO ~Ef ALL <br />R~I~T8 ~ STATE ~ ~D ~R[~ ~ BMILDi~ ~D Z~I~ ORD[N~C~, TH[¢ ~IT <br /> <br />REI~RK~: SERVICE CHANGE R~3094/R~5668 ~., <br />DONALD E, WOODLE¥, NARJ;ON COUNTY BUILDING OFFICIAL / 8Y ................................................................ _~.. <br /> <br />~ORM ~ ~c ~E-~ R~V, ,,,/'~ OF FICE COPY <br /> <br /> <br />