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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 S P C G l A(.T 1 Po L 1 t E a S PHONE#: `boo --1'1 o -'1St <br /> PLANT LOCATION: W cyo T2 FAX#: <br /> MAILING ADDRESS: 2'1 (o 5 VimA J <br /> CITY: iv.)2r 4ft STATE o ZIP .ate t <br /> TYPE OF STRUCTURE: 5-re E L <br /> TYPE OF BLDG USE: I A A',du FACT•-)12-1 N G / ,o F F i c. ES <br /> SUPERVISING ELECTRICIAN: oA,A-11-1A'v tAA l�('E1ZCa'�12 ( (o'5'S Lj S') <br /> CONTACT PHONE#: 5 01,. '1 ►o - 2 t("AS" <br /> DATE NAME LICENSE#/TYPE EXPIRATION DATE• <br /> I2Z 1 ZT �oNA-1-1.4F1" I4AM(5E2Csi12 SPE12v1Sat t" I ) 2022 <br /> colali`1S <br /> 224 L I L.AndC L (.."-nA fv4 1 rc M i o I 1 ! L Z I <br /> SIGNATURE OWNER/SUPERVISOR: DATE: '/, I Zz /Z <br /> I UNDERSTAND THAT THE MASTER RMIT SPECTION FEE IS S67.25+12% STATE <br /> SURCHARGE/HOUR PORTAL-TO-PO TAL,(MINIMUM ONE HOUR FOR A TOTAL OF S75.32). <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 /> /Usersjonnvkristinhamberger Downloads License Electrical Log.doc 4/18 <br />