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Electrical Safety Inspection Report <br />1 <br />Planning & Development <br />Building & Permit Services <br />Date <br />In ,1 15 out <br />City of Eugene <br />99 W. 10th Ave. <br />Eugene, OR 97401 <br />(541) 682-5086 Information <br />(541) 682-5593 Fax <br />(541) 682-5119 TDD <br />In out <br />~-~i~3~ <br />lPernfit# <br />Travel P 5 P-7/ f7 Office <br />/ S i77 <br />Business Name Cf"/ Phone Number <br />Business Address Af/Clr'~,r" <br />Inspection Address <br />An inspection of the electrical equipment installed on the premises named herein revealed the following listed <br />defects: <br />L' J <br />2 <br />3. <br />4. <br />6. <br />7. <br />8. <br />The special inspection fee is $88.00/hour + 101a state surcharge ± 7% admin. fee portal to portal (minimum one hour) <br />Electrical Inspector Total Hours <br />Company Staff Date <br />VMS10N PDaaPWICFORIASrIV ArAp.v ka sW* kwpscS- ENO <br />I <br />