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MARION COUNTY B~JLD4,NG INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />The work will be performed by 8 registered builder, <br />Other <br /> <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br />¢'~N~,.: Ol/0S79o <br /> <br /> SITUS AD0~~ER <br /> <br />TIME= 10:47:48 !~XXt. b~i <br /> 8ONST~U6'FION TYPE; <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESIDENTIAL. <br /> <br /> ' CONTRACT Cl~Y: : dGB: iOCCUPANT LOAC: <br /> 5510 NINB~OR ISLAND RD -- 2 <br />KEIZER OR 97303 ' <br /> BUILD{NC; <br /> <br />SANE <br /> <br />PHONE: 390-3696 <br />LOT: ! BLOCK: <br /> <br />SITE NU~LIDER: 9146 <br /> NlQ N~ <br /> <br />TYPE: ELECTRICAL <br /> <br />CONTRACTOR, NO. 4492? <br />LICENSE NO: <br />QUANTUM ELECTRIC <br />1474 35TH AVE NN <br />SALEM, OREGON 97304 <br />PHONE: 262-4191 <br /> <br />PERMIT OR APPLICATION NO: 21097 <br /> <br /> SUPERVISING ELECTRICIAN/NUMBER <br /> DEAN GROZA <br /> <br /> ITEM <br />ONE NEN BRANCH CIRCUIT;ALTER OR EXTEND <br />FLEET SURCHARGE -ZONE 2 <br />ELECTRICAL. STATE .~¢JRCHARGE <br /> <br />QUANTZTY ANOUNT <br /> 1 $20.00 <br /> $2_56 <br /> $1.oo <br /> <br /> TOTAEASSESSED FEES $23.55 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $22.55 <br /> <br /> BALANCE DUE $0.00 <br /> PAYEE: OUANTUM ELECTRIC : RECEIPT NO: 22371 <br /> RECEIVEDBY: PR .............. ___ ___ TYPE: OK CHECK ~: 4156 <br />* THIS IS A VALID PEI;~IT * :THIS PERlVI[TEXPIRE~180 DAYSFROM ITS ISSUE DATE. IF <br />C(~ISTRUCTION 8FE~T~AATEF~ A PERIOD OF- 180,DAYS. OR tF, CON.-N-WRUCTION FAILS TO MEET ALL <br />REQUIREMENTS LA~ AND MARION COUNTY BUILDING AND ZONING ORDINANCES, THIS PE~IT <br />~HALL BEC~E NULL AND VOID. <br /> <br />REI',IARKS: 1-CIR R~6704 <br /> <br />DONALD E. KOODLEY, MARION COUNTY BUILDING OFFICIAL <br /> <br />FORM # MC 15 5b F~EV 6/a7 OFFICE COPY <br /> <br /> <br />