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PLANT NAME: <br /> <br />PLANT LOCATION: <br /> <br />MAILING ADDRESS: <br /> <br />CITY, ST, ZIP: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />285 CHURCH ST NE - ROOM 132 <br /> SALEM, OREGON 97301 <br /> PHONE # (503) 588-5147 <br /> <br /> FFt~ 1 8 <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />INDUSTRIAL PLANT ELECTRICAL INSPECTION <br /> LICENSE LOG <br /> <br />PHONE #: <br /> <br />SITE #: <br /> <br />P.a. B~ ¥~,:} <br /> <br />TYPE OF STRUCTURE: <br />TYPE OF BLDG USE: <br /> <br />SUPERVISING ELECTRICIAN: ~-~r,-u /... · G"a,~3 <br /> J <br />CONTACT PHONE #: (_5~3J -~,/e-jqoo <br /> <br />LICENSE LOG <br /> <br /> LICENSE # / TYPE <br /> 3qO~ <br /> <br /> 7?Z~,T' <br /> /~q 7':/,3" <br /> <br />DATE NAME <br /> <br />DATE <br /> <br />NAME <br /> <br />LICENSE # / TYPE <br /> <br />EXPIRATION DATE <br /> <br />I0-01-oI <br /> <br />l~-oI-oo <br /> <br />EXPIRATION DATE' <br /> <br />! UNDERSTAND THAT THE SPECIAL INSPECTION FEE IS $50.O01HOUR PORTAL-TO-PORT/iL, <br />(MINIMUM ONE HOUR), PAYABLE PRIOR TO THE RELEASE OF THE INSPECTION REPORT. <br />OAR 918-260-190 (4). <br />SIGNATURE OWNER/SUPERVISOR: ~ DATE: Z- <br /> ' / / <br /> <br />Complete this form and return to Building Inspection prior to inspection. Inspector will contact you to <br />schedule date and time of inspection. <br /> <br />LIC. LOG 12/98 <br /> <br /> <br />