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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 />I am performing work on a property I o¢~n or occupy <br /> <br /> OAf F"; U5/13/92~ l IMF-.;: <br />OWNSF{ <br /> ~LAYOFcN, BRUCE <br />SITUS ADDRESS <br /> <br />TAX LOT CATEGORY <br />56456.-000 <br /> <br />RESiDENTZAL <br /> <br /> 11432 5IEiNKAMP RD SE OON¥~AC~clTY' UGS <br />AtJFC~V 1LLE OH 9?325 <br /> ~ARi ON COUN1Y NO <br /> <br />OCCUPANT LOAD <br /> <br />PHONE: 749-19?0 <br /> <br />LOT <br /> <br />W~DTN <br /> <br /> BLOCK SECTION TOWNSHIP RANGE <br /> <br /> 92 85 <br /> DE PTli AREA UNITS iRR~G ~GT <br />2;95 449 130685. ~F <br /> <br />SI'IF_ NUMBER; 92-0'~112 <br /> VALUAT iON: <br /> ZdNE <br /> <br /> NO NO <br /> <br />lYRE,; 6LECIRICAL PER,liT OR APPLiCATiON NO: <br /> <br />CON f RAC FOR, NO. 65444 <br />L. ICENBF_ NO: <br /> Co~nect:"fons E'lect:r"fc Thc <br />PO Box 7136 <br />~'lern, 97303-0000 <br />PHONE: ~¢63-3651 <br /> <br />SUPERVISING ELEC f R ICiAN/NUfV~BER <br /> <br /> ifEM QUANTITY <br />8RANC~ CIRCUIt, NI~HC~Jf SERVICE OR FEEDER - l~f' CIRCUI't ] <br />BRANCH CIRCUIf, WiTHOUI SERVICE OR FEEDBR - EACH ADDITIONAL 2 <br />ELECfRiCAL SfAIE SURCHARGE <br /> <br />YHIS RECEIR~ <br /> <br />BALANCE <br /> <br /> A~OUN! <br /> $s5.oo <br /> $4.o0 <br /> $1.95 <br /> <br /> $0.0o <br /> $40.95 <br /> <br /> $o.00 <br /> <br />41990 <br /> <br /> PAYbE: ConneCt;ffons E'lec~A"ffc inc RECEiPl NO: <br /> _,~.~ [YP~: CK C'HECK ~: <br /> <br />~ THIS JS A VALiD~E~~ TH1S PE~1f ~PIRB 180 DAYS F~ ZTS Z~E ~TE. 1F <br />~ST~CTI~ C~ FOR A PER~OB OF ~80 DA~, OR ~F ~8~BC"ft~ FAI~ TO ~EET ALL <br />R~R~TS O~ STATE ~ ~D ~R~ ~NTY BU~LO]NG ~O Z~NG ORDZN~CES, THiS PE~tT <br />~ALL BEdE NULL ~D ~iD. <br /> <br />RbMARK,.~: 3/CiR <br /> <br />DONALD E. WOODLEY, MARIDN COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15,56 REV 4/90 <br /> <br /> <br />