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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 & i3 ; L I L LC PHONE#: <br /> PLANT LOCATION: 317a4140A(C>(5) FAX#: <br /> MAILING ADDRESS: Z3 '5 k) • b esC U te.6 (U f r G� �j <br /> CITY: 'T tO STATE O r'`�3 orb zrP J 731�3 <br /> TYPE OF STRUCTURE: (OMI Crete w W I I <br /> TYPE OF BLDG USE: C1 0 Strt of ( a✓_u &c-TrJ!j <br /> SUPERVISING ELECTRICIAN: P.e ? til. <br /> PHONE#: 2'T S <br /> CONTACT97 1 -9 1 5 - <br /> DATE NAME LICENSE#/TYPE EXPIRATION DATE <br /> • 25-2-1 [ cL (AIi57wva/1 z19/9 -P3 JC) /i/2 ' 3 <br /> i_z5-21 G7 ST444<ter Si10 - Pc J 0 I s JZô23 <br /> -.Z5 -2- 1 1)2.1'cto-_Diyjeo, 259 VI -3- J o f i /2O2 <br /> i - 2 5-2-1 bi lion Pharstud i 277.6,2-3 j o l i j 20 2- 1 <br /> J -25 -2t 2)re;ir boibti (0779-/ME 1 O f 1 17623 <br /> -25-Z1 Teca 01„, L/031 -L.M E 10/ 112Cz3 <br /> SIGNATURE OWNER/SUPERVISOR e: DATE: /- as -Z. <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 /> 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 /> G:1Master Permits\License Electrical Log.doc 4/18 <br />