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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 0"/Gr G/�Y 7(/�'L_ 6,�✓G 7�r©/ /� PHONE#: 53 '7 J Q/q � / 7 <br /> PLANT LOCATION: 2 63 D /V Al2. y FAX#: <br /> MAILING ADDRESS: 2.6 30 /'/z `' <br /> CITY: IAItyz ,mac f^-- STATE # g ZIP q 70 7 <br /> TYPE OF STRUCTURE: (,O✓v--- -0 <br /> TYPE OF BLDG USE: <br /> SUPERVISING ELECTRICIAN: //44# g <br /> CONTACT PHONE#: I'3?3 q 511 91 <br /> DATE NAME LICENSE#/TYPE EXPIRATION DATE <br /> • tylq*SkI..145 .- 331-0 <br /> /4 y i z3 0/1, <br /> Le m i lcctot le_ 6(o7b to/ 1 <br /> t�;4.4,6J I tio671.g.4/4 1 +f__ io — <br /> Det.,-;5 TA91A Z-33$A1 006 14-A- / <br /> C — <br /> SIGNATURE OWNER/SUPERVISOR: DATE: / 7�/2f <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:\Master Permits\License Electrical Log.doc 4/18 <br />