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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on s property I own or occupy, <br />lamaregistered builderOR( ) the authorized representative <br />of a registered builder, <br />The work will be gerformed by a registered builder. <br />Other <br /> <br />DATE: 01/14/9;5 TIME: 11:40:56 <br /> <br />DUNCAN, JANES E & OOROTHY Y <br /> <br />SIGNATURE OF APPLICANTL <br /> <br />TAX LOT'. <br /> 61~83-000 <br /> <br />RESIDENTIAL <br /> <br /> 9055 W STAYTON RD SE 'bONT'RACT~iTY OGBi <br /> AUMSVILLE OR 97525 'MARION COUNTY NO <br /> <br />U$~ OF BUtLDtNG: <br />MAiLiNG ADDRESS: SUBDIVISION; <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEOROOMS: <br /> <br />SAME <br /> <br />PHONE: 749-1545 <br /> <br />SITE NUMBER: 93-00175 <br />VALUATION: <br /> <br />~S 2~ EFU 62 <br />4.98 AC YES NO <br /> <br />TYPE: ELECTRICAL PERMIT OR APPLICATION NO= <br /> <br />44640 <br /> <br />CONTRACTOR, NO. <br />LICENSE NO: <br />OUNCAN, JAMES E & OOROTHY Y <br />SAME <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br />PHONE: 749-1545 <br /> <br /> ITEM <br />MANUFACTURED NONE SERVICE/FEEOER <br />ELECTRICAL STATE SURCHARGE <br /> <br />QUANTITY AMOUNT <br /> 1 $40.00 <br /> $2.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$42.00 <br />$42.00 <br /> $0.00 <br /> <br />BALANCE DUE $0.00 ; <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: P8 ................................. TYPE: CHECK ~: 0 <br /> <br />* THIS IS A VALID PERHIT * THiS PERMIT EXPIRES 180 DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION CEASES FOR A PERIOD OF 180 DAYS, OR IF CONSTRUCTION FALLS TO MEET ALL <br />REGUIREMENTS OF STATE LAWS AND M&RION COUNTY BUILDING AND ZONING ORDINANCES, THIS PERMIT <br />SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: REPLACE EXISTING SERVICE <br /> <br />DONALD E. WOOOLEY, MARION COUNTY BUILDING OFFICIAL / 8Y ~_~_ <br /> <br /> OFFICE COPY <br />FOAM Cf MC 15-56 REV. 4/90 <br /> <br /> <br />