Laserfiche WebLink
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 /> �j LICENSE LOG <br /> PLANT NAME �c� v i' a A) v c d ,i"- ,/5��;�Xi�i S PHONE#: S v� - 2 V - <br /> / <br /> PLANT LOCATION: / 41 } / '��' , FAX#: s'`>3 — 7 Y$ ' 41,r <br /> MAILING ADDRESS: /" . 0` d <br /> CITY: /9 U S //.G L 6' STATE C5-4-# ZIP 7 7 2 Z .s <br /> TYPE OF STRUCTURE: 'v 0 6 / <br /> TYPE OF BLDG USE: /94,4/KA G T a ' "� L' �G�� /•� 'G/� C <br /> SUPERVISING ELECTRICIAN: o Ltti/ a , /..10 a, y __ <br /> CONTACT PHONE#: ✓ C'3 2 5'9 - `7/ V' , Z S-Z <br /> • <br /> #/ <br /> PATE NAME LICENSE TYPE EXPIRATION DATE <br /> !_SZ / 06,<.t % O.Aigavoi-A ei.S"' / S /o- /- Zo22 <br /> I - S- 2( M, rr /h, /9..p,« Z Z/" /v- /- ZD z / <br /> 1 - S - 2 / 71a0 Edt 2.(2- / ffT /o - /-ZcZ / <br /> - 5- Z / s 4,4' 4‘SLS-.T' <br /> / _ s - Z1 g , c- a//1"_ ��?A/A1 s / S-, 624 /e> -/ - <br /> /�-ppsGH14-/7 /�70,,/,/1.,�,i. /2-6 73 J />—/ L a Z / <br /> SIGNATURE OWNER/SUPERVISOR DATE: / - S1— LaZ / <br /> I UNDERSTAND THAT THE MASTER PERMIT INSPECTION FEE IS$67.25+12%STATE <br /> SURCHARGE/HOUR PORTAL-TO-PORTAL,(MINIMUM ONE HOUR FOR A TOTAL OF$75.32). <br /> 41, <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 /> rz.t.t(.ww D..mifolT;r.., Flrr.irol I no an,4/1 R <br />