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LICENSE ELECTRICAL LOG • <br /> MARION COUNTY DEPARTMENT OF PUBLIC WORKS <br /> • BUILDING INSPECTION DIVISION <br /> 5155 SILVERTON RD NE <br /> SALEM,OREGON 97305 <br /> PHONE#(503)588-5147 <br /> FAX#(503)588-7948 <br /> MASTER ELECTRICAL PERMIT <br /> LICENSE LOG <br /> PLANT NAME / j 4 PHONE#:9) 3 ' Y 3/ SI? <br /> PLANT LOCATION: 3 S , ''net l�J� /7 FAX#: <br /> MAILING ADDRESS: �/' <br /> CITY: W& AIjw l� STATE Y.. ZIP 7 ( <br /> TYPE OF STRUCTURE: /iR e ? S f /4-124.43 <br /> TYPE OF BLDG USE: f"G 9 /"ld C't Ss I`''� <br /> SUPERVISING gig*"io (/�+/}TI2l ' -If ✓ <br /> i) <br /> el' <br /> CONTACT PHONE#: " 3 1 S`' <br /> DATE NAME LICENSE#/TYPE EXPIRATION DATE <br /> Priel Sig 1/66 Ps to o z .2 <br /> - 7a 56 LP) E /d 01 202,3 <br /> Sf 6 & Z. P15z is/o, /zo z3 <br /> V /6/2/ hNLIS VtOtivu s4/4/ i / s 1010,1zo2,3 <br /> 341-24-- neci4 7114 i_ 141 a. I 2073 <br /> 3 /lb 4-- 0)Acl< Gouvto 6 _8' . Lrh' (c/ 1/ 20 Z3 <br /> SIGNATURE OWNER/SUPERVISOR: DATE: 34/2.f <br /> I UNDERSTAND THAT THE MASTER PERMIT INSPECTION FEEDS$67.25+12%STATE <br /> SURCHARGE/HOUR PORTAL-TO-PORTAL,(MINIMUM ONE HOUR FOR A TOTAL OF$75.32). <br /> • PAYABLE PRIOR TO THE RELEASE OF THE INSPECTION REPORT.(OAR 918-309-0100.) <br /> Complete this form and return it to Building Inspection Division. The Electrical Inspector will contact you to schedule a <br /> date and time for your inspection. <br /> C:\Users\pstump\AppData\Local\Microsoft\Windows\lNetCache\Content.Outlook\WPCVNLKQ\License Electrical Log.doc 4/18 <br />