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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 Roth's Stayton- PHONE#: 503-796-5999 <br /> PLANT LOCATION: 1770 Shaff Rd, Stayton, OR 97383 FAX#: <br /> MAILING ADDRESS: Same • <br /> CITY: STATE ZIP <br /> TYPE OF STRUCTURE: Framed Building <br /> TYPE OF BLDG USE: Retail and Office Space <br /> SUPERVISING ELECTRICIAN: Kevin Burdine 6136S <br /> CONTACT PHONE#: 503-566-5600 <br /> DATE NAME LICENSE#\TYPE EXPIRATION DATE• <br /> 3-30-20 Straus 4003S 10-1-21 <br /> Martinez 28791J 10-1-21 <br /> SIGNATURE OWNERISUPERVISOR: DATE: <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 /> • <br /> G:\Master PennitalLicense Electrical Logdoc 4/18 <br />