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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 own or occupy. <br /> 18maregistered builder OR( ) the authorized representative <br /> of 8 registered builder, <br /> The work will be performed by a registered builder· <br /> Other <br /> I have read and agreo to the terms stated on the roverse side of <br /> this document. <br /> <br />OWNERz <br /> PITTERLE, ELISE K CHAMPOE6 WINERY <br /> <br /> 10375 CHAMPOEG RD NE <br />AURORA OR 9?002 <br /> <br />c~O~RCIAL <br /> <br />OCCUPANCY~ <br /> <br />~.~Nc~'OuNTY: u~[i ;OCCUPANT LOAD: <br /> NO 0¢ BEDROOMS: <br /> <br /> SU BDIVISION~ <br /> <br />,i 10~69 CHAMPOEG RD <br /> AORORA~ OR 97002 <br /> PHONE: 678-].228 VALUATION: <br /> <br />LO'f': BLOCK: S~iC~i; ...... fS~D§R'il~i 'RANGE: ' ZOl~l~: MAP: <br /> ~ 4S 1W EFU 4 <br /> : <br /> <br /> TYPE". ELECTRICAL PERMIT OR A~LIcATIoH .0= 5.228 <br /> <br />CONTRA~TOR~ ldO. 42047 <br />LICENSE NO: <br />Clare~ce L Ke~agy <br />i~Z H~ 2nd <br />CaDby~ 9701~-0000 <br />PHONE: 2&3-8828 <br /> <br />SUPERVISING ELECTRICIAN/NUMBER <br /> <br /> ITEM QUANTITY AMOUNT <br />BRANCH CIRCUIT, WITHOUT SERVICE OR FEEDER - 1ST CIRCUIT 1 $35.00 ... <br />BRANCH CIRCUIT, WITHOUT SERVICE OR FEEDER EACH ADDITIONAL 2 $4.00 <br />ELECTRICAL STATE SURCHARGE $1.95 <br /> <br /> TOTAL A~SESSED FEES $40.95 <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT $40.95 <br /> BALANCE DUE $0.00 <br /> PAYEE: C].areDce L KeDagy RECEIPT NO: 52741 <br /> RECEIVED BY: DM2 TYPE: BK CHECK 8: 5256 <br /> <br />UUM~T[UCI/UN CEASES FOR A PERIOD'OF'186 DAYS~ OR iF COHSTRUCTIOH FAILS TO HEET ALL <br />REOUIREH£HTS OF STATE LA~S AHD HARIOH COUHTY BUILDING AHP ZOH~Hg ORDIHAHCES~ THIS PE~H~T · <br />SHALL BECOHE HULL AHD <br /> <br />REMARKS: 3 CIR <br /> <br />DONALD E. WOODL. EY~ MARION COUNTY BLIILDING OFFICIAL / BY <br /> <br />FORM # MC 15-58 REV. 4~0 OFFICE COPY <br /> <br /> <br />