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1 <br /> LICENSE ELECTRICAL LOG <br /> IP <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 ✓1 IC`7+� Pa <br /> ►�.s PHONE#: <br /> s <br /> PLANT LOCATION: U :0v,f, (Vol"\) k k FAX#: <br /> MAILING ADDRESS: /,3 Z$n, k_ , 1 riw.,1 e <br /> CITY: rule v Pt-t" STATE Of ZIP <br /> Ii <br /> TYPE OF STRUCTURE: 4 <br /> TYPE OF BLDG USE: ?c>I lil <br /> l <br /> SUPERVISING ELECTRICIAN: 41, I <br /> ti <br /> CONTACT PHONE#: s "•.P2 5-3 "2c ' -2y d 1 ii# <br /> 0 DATE NAME LICENSE#/TYPE EXPIRATION DATE <br /> t. <br /> le <br /> E <br /> li <br /> RI <br /> Fi <br /> I? <br /> II <br /> SIGNATURE OWNER/SUPERV.ISO • --- '"`"" <br /> ': '' DATE: "1 6P .,21 V; <br /> I UNDERSTAND THAT THE MASTER PERMIT INSPECTION FEE IS$67.25+12%STATE l' <br /> SURCHARGE/HOUR PORTAL-TO-PORTAL,(MINIMUM ONE HOUR FOR A TOTAL OF S75.32). I <br /> PAYABLE PRIOR TO THE RELEASE OF THE INSPECTION REPORT.(OAR 91.8-309-01.00.) i <br /> sComplete 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 /> P <br /> C:Wse slauroraprodmaintlAppData\Local\Microsoft\Windows\lNetCache\Contem.Outlook\CMO35NLM\License Electrical t og.doc 4/18 x{ <br /> i <br />