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HomeMy WebLinkAboutPermit Electrical 2014-2-12 SPRINGFIELD, 225 Fifth St rt CITY OF SPRINGFIELD Springfield,OR 97477 c&i+ Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00304 www.springfield-or.gov permitcenter @springfield-or.gov • PROJECT STATUS: Issued ISSUED: 02/1212014 EXPIRES: 08/11/2014 STATUS DATE: 02/12/2014 APPLIED: 02/12/2014 SITE ADDRESS: 1000 CENTRAL BLVD,Springfield, OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1803021203600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Repair Service Mast from Storm Damage OWNER: YOSCO ANTHONY J JR Phone Number: ADDRESS: 1000 CENTRAL BLVD SPRINGFIELD OR 97477 L CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor ALAN JOHNSON CCB 78329 12/05/2014 541-344-6098 INSPECTIONS REQUIRED Inspections 4200 Reconnect Service 4500 Rough Electrical Rough Electric: Prior to Cover • 4999 Final Electrical Final Electric: When all electrical work is complete. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time,that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during • construction. Owner or Contractor Signature Date n off/ V I 2, f 5`-,r ' � T e`1 ct ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility NOTICE: Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- THIS PERMIT'SHALL EXPIRE IF THE WORK 0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR number for the Oregon Utility Notification ANY 180 DAY PERIOD. Center is 1-800-332-2344). Springfield Building Permit 2/12/2014 10:01:08AM Page 1 of 1 SPRINGFIELD CFIY OF SPRINGFIELD 225 Fifth St .(‘iR, , TRANSACTION RECEIPT Springfield.OR97477 OREGON 541-726-3753 • 811-S P R2014-00304 www.springfield-or_gov 1000 CENTRAL BLVD permitcenter @springfield-or.gov • RECEIPT NO: 2014000292 RECORD NO: 811-SPR2014-00304 DATE:02/12/2014 [DESCRIPTION; _ ^�ACCOUNT_CODE/TRANS CODE _:AMOUNT DUE Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.68 Technology fee (5%of permit total) 100-00000-425605 2099 4.45 TOTAL DUE: 104.13 ;_,PAYMENT TYPE_ PAYOR,_cASI-IER:JLARSON_ M_ _COMMENTS_.. , AMOUNT PAID Credit Card ALAN JOHNSON ---- _ - 104.13 052608 TOTAL PAID: 104.13 . P. 0 3 468.,?ay.o.aiiiiiaaides„-A _ t'74.C4',7: ,:':'-'..14;:;.. . ' IT7'15.;:k :VIN4C.4 -‘t: . - • . •• :.1.4.41;X:(<61;:.•-•• •.i-;'6,::Cet I tt:4 A ' Permit .Application H.1:*:-.sg‘diiikittiniktusaigiri[j ' . . Sratt4GFIlliti,,,,, • . ; c •C'i''..:4 ( t.r\ 4 S 11RINC Fin.41), ()RE(;ON 15ertilli i1O': gli zot 4 clq,•3:c$1... • . ., ,. . : ,.._ • r • • :.•,...';.,1..t,,2,2.51•Inli.S.Ort.4.6Ralilteld•,•"014 97477 t P31(5411726-3753*FAx(54 1)726.3659 ''.; .21./.. f;.:',Kr•7-,:];.f'.... - .• ;,.. ;;,;.;-crik-s•,;;i•).;;;.., ,..9.4-#4,9 .!ik:.•0;1 f•• l• /i •••;•4!.:,:••;?1,,,..i,:iT;; .:c:;.;";,'.;;;;;;;$:.{7;. . , ;;'!;4;V. daitil . rtizir.:..,,,i::,...r.tr.„,.4,.: r•lt,',.:: :1;!::.!.. ,,,:.:,:.s.,:.,,,.,.',,. , . . '.. .:s.Lizi-- • : .-,,--t—L,..-!„,....2-, „.,..• ' • • .;.;,,,,..„...,,,,,,,...,,,,c: ::::i. • - , , :14,,,zri:::::;:-f7-;.,..,,,., ..;,.•,.; .„..,..,.....?.. ,?,„,,,,i.,,,r,,,,.... • - • •:„,4.r:r;,:,;.., : • This tie.., it istis-,041 tinder OAR 918-309-0000..Perm its are nontransferable.Pe:rt,i5ttit41pin.1.;1414'no.t.sintled, 'ritillqn2t1,0,V.?i,:: . • days of if work is Suspended for 180 days .vier.l.c•t:r.,,.:•'.•: ::..•';'..3.42):4•:•$;;;.-;:*Jii ...!:;:... • • 1 .;;;"';;;: •--4•;:..4.',.:•. ......—_—_.7.... iis, • ---••• .2 ..,. _,.,..H. , , ,t. ,,,.0.,„, ,, ..:T,;<1•:1.:.2. ,...LOtal, GOVERNMENT APPROVAL .: -:••••,:•;s•FEE:AOHEOULE. . .• ,' ....4.n...;.,•:Ii.4,. - . ::.• :.' ' ,•Zrenalg:apOvatye:tier12 Dyes 0 No ----7:tilitTI .7,,, . .Coil"..J 1 Attryt ?I: , Number of insre5e10117 per itcrd(-/C'zi:: arl' • cji..: !! ji.f:*0 .':';. •<:... ' --.-• ''::.:.11 .4'•::''.`;.:,' ...dATEO.O.RY OF CONSTRUCTION _ Reardeatiai,pill!`iiiiII:Ae;ipalke;,Miieik: ' • •,•• •!:.c.,:•V::4.'!,;;H:.i . •,,..•- •'.:,- •' 10,ReSik‘ntial:.:„. ' . ,overnment 0 Commercial -:+''-rt,4'.'&-::„1„... : '• 1,000 sq.R.oil4ki,(4,,Y,..;if,'V.,;:i.:.;,-:;; ;;',4 : . $147.$0'... ;4•,,Icl-s,':::,;'; ;,.;: .. JOB SITE;INF RMATION_AN9 LOCATION , , , . ,A ,,. , • - ,7.77.7'7F.:?,.1.1q;"/?. 7,; .' ........._,-....- F,aeb additional sp,o',iit.Ot.Porti3Orq:, .. • s 7,46(1. Lob 6 'C'AA >.'(''''1 coo 4-- -1-11c-) ,.•...:, ,49.:sire......ctress.':'::.y.,t_ ". thereof .... ',k-,i.-:^•;,,'„'Iv'ce';'.;!;`?:4',"..S.: ' • ' . ' • • ..'"..Y'''''./* -",.. • . — --, _ ;:th'''..i;biSi'''j •i, ' ••• - S te. 0 a,.. I ZIP.ant/Di_ I irnued energy(2 .4.-., _._1.,... . . $ 30.00...: ..s„$.■.:1,g;',!".i 5:..-. . R6terae4:i3:;e',.::?:;. 1,,.,...:..... Teddot: Each -.. RI - - mai arfa'a.rigaf.hFat°riletlar'... ,..:31 beSAIPT(ON OF W ORK - dwallia%sar'iaaOce40 '. tbtr ;!!. ::.i;.:.;,), •i:,:':' Services or l'!orlp .s.t;;.,,rrorinip:4fflingt•Tc,Ap.Feict2riavi ,<.5::.,i;.: :f.;C.X .4. • Vt.:00.4\?;;.?q.".5gr 0 f 4. 1,.. VA C-- ,t_4t(316"- .:;...:"..■.....:.:' "'-''' r•-• . .2' • 7.0. __„;4 _, i ,Q.e... Ltbistr., .. 201 to 400 an114X2)•:(:;1::2f.i:c11C1C1,7J,/,:4 $.104.ik Y•i:';;;•.,:1,'Ci.,•: •,' ' 2c°cimPs cr le:ikOF:.: t;fil7±.-1,:.,VN.: ' / • 51,4109; :::S.•);;VZ•i:..1:c.. •:: 7. . •.''• ''sr..''Y 1.''••'''''''PiititiERTY. OWNER ■..}. - • , ',.- ..?i'l.... •'Narriii2.:‘,':',, To'cii qc .5 e. 0 401 10 600 isps(2). -•-•<4fr,tt.•,-•-•,••1,,7..,,. :.:--.7. .--7-. - -. . • .o,-„‘Thr..,,,,..7.:,, m,, . 174,b,?, i'li.,iiital. :,.:.,.... • 601 to 1009 ati10k(?)1: stli,:'6: :.'.'' • $22 5' c1.1, : ',. .Aciairesi; ;!.•.'.,• Hi ;•,;r3,5..h..;41/44,-..,, State • over1.00o amid,4 v.altY(2)i:CIA 1-!.cti''' ;• . : 'P164'. •■ 'A.0y.:::'1';•. 1.7'. •• ....A: i:•./11'.1: I : LlY: ..... ----- - Far, - - tscconnccronly(2)ze..-.....h.;..„ $ 139.09 ...; !.n.;;4.0r., .,:-...... P11911C:::::?:?':1!••'?..::.-.:1:'.: -4 ......-•71,:-H–t.17.7t:i•0. - ... .: t. .:.li..-..-.lc.;-;;0.,t •v;,.. Temporary servjces offeadeys;!,scalt•ilq ..clterptIcat:ly pErifit;.re,, "..,. ..).,,7• — - . ..... :.,...:.c.Tiis triSation.i4ging made on residential or farm properly 200 amps or la3 0 ! •,,: og $.1..,.-.±:t..:.., -,............. . . •:.' " "nwne d by-nit(sr 4-tut:IIhi*of my'immediate family. This 20110 400 art.1114'.(2)enit5.4fiXfAik 4..0000 °rt y IS not ndended for sal;exchange,lease,orient.OAR 47$1-540(I,),and479...;560(1). 401 to 600 amps(2) F :',.; 7:1' ' •$143,56 , l'S.,;,.'''Ir7,Y1r''',!:4;:',•.:' ii4(i. '. . . t' . urnps.."or N I.... d aitse'S41:vidilnifenaeis•a4666 fogv6 H-'• ..j. y'''.P:'.''.'::' CONTRACTOR INSTALLATION Brunel'eireidti:,101,'Oenfilr. aiss oh pe panel a.Fee for brial(;!isitilti•tiiiitisikiic.liadeof a service bf4e44i.t#:4),:k •,,, , tatiAmeas.riame: .0...t1 • L cc:Tv)CO . .• . . .. r 1.7 q of 3 .Each braneb eirdi111,1.'n''3':.41: -'' :I.-Aciidie .,...,2443 1 '.14chsvrtei„5 :St"ap: 1 -4" , . oilia7! t,44' -1•:.',.., b Fee for taine.Keiredlei:Sittsilkiigii4of sitserylee .,, ... j, .. . . • -,•-• •' t•;•I!8A 1 Ma • $ so:k .3i:14:c-:c3).:!,,:. First branch cittcyt(2) ...,..4 .,,1,..f,,,t:.±.,mug •: " 1'PtaimiCill . - - .. so- ; Fax - - Se...... i Each additldnal badich clituit . , $ 6.61:: 14-ir.' ,.;.a.;:. ;:' : • • IF anti FS .k pit-. mo.'t 1 i tomA- C CEli e?,5.', li.all.,.")e ,.... BCD licene no 20 -4 pc, mistellan,&.fc”7#1tEciElt:/c -.......-•.,- : . . ---,..-:;,1t,•:elt,,,, signiiiwsulioniippe1.1.5pps.c no.: 11 I 55 Mich pump or Irclaation nirelgy..,;;tim , $.00,00 , z,.t,/,„ •.,---,.. ..3. .---,,Nc•Irk,,,,-i. . . $ 89.00 it$..r.',V!, .,.':".• Each sign or otaliue lialltipi1,442). ..,it.a: , • • • ir ' .'.' • ' ;::•••,' *,i4440?:pi'sigi?..}ng's apt-visor 24 a-,-x 42 k kt 5 c2±-2 ---7---- --, ,•,., ..,„,,•'...r.:%f 1 '::.., ‘.o .. '• ...,. -;:.1!..t.....1 ::-;-..; ' .,.r.,. iri- energy-0er panel! $ sa.0 Stganture of,surp,in g. per v ism Signal crctiit or aU , ..1-1 ,,. '3:1•;•Sit:'i .;;;::,'• . __._...,.. --..... — .....- Each additleaal.14i11ctia‘ajf.(2,i4;:, ::•$4044.. 011A?fl.,',::', ..+4". ..C.2 . . .. •-• T9 .14PPLIJ4T".;-08 (A) Enter subft:410f ab.3lic,teeS:r!..'ir...1;:. .... • ..4-,,r,,,,t,c1.1:,■,;.. ;..:2-.: ',!..;',,,; ..,.4:..,,313,;',\,..14.. .', . . • .;;-',Ci.-;tki:''.. X:;1•:/r.i..,, (mininiamilekediFee11 #;91),.,! - .;- .- . '. ',„'ttit v,r.:..7W'if: .;•1'.-- :•:,..,f.".f:?).:::; i7t4.:::!:11;4);,-;/;:72. ,.t.-.7:•1.• (B)Eotcr 12$4'ikii;hkrie(.12 x IA))'1,51').* .' , .. :.' ;.$1..?..,, .'f,;:,'-..:,-::•••:,'',.f-i;:fc”ft, ,..,•1-.:Itf:':,?..!..:0:': ---.7,',. - . - ..,!, 7,!-,;;,/;•.;.:, ,„ ..: ;. ,:, ':,:';::•.; ;.+:•;ti,,1,•■)A1,;:',"):'.e.'..?- , ,- C.:.........,,••. (C)Trciinbl*Fcc fkiIII9C VP‘4.;,:c.41..c.,; ' -.• •• .!... .f'd. ,. ..., _.-• • TOTAL ten ar451suicsrgos(A0#9140 9.: .,•.:, 440,,-,i4t4,06,3k‘p.fct .,,.,.•,:, -...:::,,,,•;:‘,14?:::;,„.,,..:,:i:•:,,,,,,,i , .,‘,,•:,:......,•,‘,0;,:,.,,,,k,,:a, I-:..,,y,, : : i.:.,'''-•4; '4,-',•-.S1;14/,•••:k. • 4,,;3k;c'it.i4;. •.,:„.• (.....:\.:•:,'& :.••f;;k •irrPk•:::'‘.1•Ci••! •;:'"...- :J;:.X.",:.;;:.)1fi."').1`,•;.;,:-;..r.'::.1...,, • '.. •?,. ,•:::Y!':';;.1-.;'..i.■,.Ol.'.,.;-.;;.7:•;.; , • . ! 1.):',':•?:::&: t..,00:;;:..-;.:.. .•: ...7.-:,',..• :!../.1‘;0.;) ;! :' .• . • • ?;....:? . ..J 5 •T. '.!:.;.:''.........:'; 4•"•;.'.••:,.-'. :( ; • Jig,: : • • t: '...Al...:cSr.'y 1 i•:- ' • ';..-.atti,;11,■.1,:.',. A .:..:• '.:;i!.-,,...''' :'s•-■.'1 ...• FED- 11-14 TUE 10 :47 PM Al 's Electric P. 04 541 1-q 99.92 •-i'i-,,,,-7,-,it•I'":' .''' ..11 ..1 ''..,r/..!.1,!1:'''.. . • :;..1..,::-(,),.t4;;',.::.-rk:l?:;:l-..l.'i... ... . • .- '. -. '1.Th,;•:-ag..Y,..— : .r.:. :;:c.:-;-“,..:,....,,-,..:•!,..!... • • , .1::':&::,.:0.,::y"s•.., • :.•-,60.r: •±.,11,..,:. ...,'„pt:k!. :.... .. • ':.,..4-..4to.,;,,tcA-.,•.:::1: .0,::•."i,...fiisiTi-,::::::•.::;::-.9:,.... • • .:'...:,-;:si..,:,41s-Ic's:, ' ..:-,A.7.1., .•);4•••••• -i.:tx.i.1..,>:•., ..:2A.wri,....tr-#.;..■44.1:z::,&';',..:!.:it.,'' 1•;:•!:. ":1W,•it:49T4VF:WiSC,t3gWkrE a ESTINGISLIRERVI$ING".:ELECIFtltarNitiE51111,AATI:12,N:?-^ feZA, _7, . , ,..,•..,.._ : •;-• .. *,::iect c,•:1;.-7.,. • f Naine. of suPeOiligelectrician: (Tact k ,j, ),4,-,,,6 a 4--._ . .: .-"..;',?;7 bate'of reqUet: t /1:7/-'40.1,1-;SD",..,::: :..,..::: .I'j , license --.(1,7- . -fl'r..,91.:":,.:‘,.....' . - • --tr,tryl*---,tix ...-•• Date ir4tailaticiii ifra,s ooMpleted: _12, //o/cdVW? Supervfrisinge).ccpacian s l number: 3 r c 5 ._.._ . . •,':, •Eletic-al PerMii'116.: 11 a temporary permit is posted at thethlsf4plyggiql i_0.0.copyof it 14?ipA,LOyolyzeir:i4, 1... • . ::7:1-glei74.-ht.:YR-v-. 44-24::EMPLOYINO CCEETRICAL CONY RA CT.P.KkilS.FMIzkrAJVHFAIST4itt,1#2Ak'711,., :-_-d• ., 'Naiiie,..c?f el*.t,ri.Cii/1'Othitra at or: 0.42 r..e.,..-cyc • • :;:;;PMT,;:ii.A1A4Efaii:5:: : 8. :;,..4:;13Fl_i'OCY,'. . ..‘ . . , ...i. :31:Tti-e:,, , , ,:c,:;::-;tY ;J:i'%:,F,' Pastrie$4s aridi .' , , 2-G 3( i—rEs* vei_,. -6 .,, .-t.u.,iy.;;;;J,. tv.::.:___.5..i-- -_,.._.. r .;$4,'..ii...i.tt..,. V.'.. „..g.,tii,..q:f.,6.'yht•:q.li,)::c:zi.,. zw z , 7.7, ...Cryy:if'- :s.:- :41-‘... '''-,)- rilctt&. irt•-1/41;;I:',,Ny 074 Fax: - - E.-rriAllii,.:,;:,:.:i.d.mvs..;,..ti,. .„?.. ,. , ;4,.,.., ,,.;,-:-,..., -1---.--41 - : --41±...t.f7-f:':-;:;;, ,:::•:',1...:,.1.77,7S: 3_...::,:ii?,::'4'fIg'W;4:itEal-.Thli.4541-111.E-j.:3:3,`CUSTOIVIER*2.INFOIIMAHT.ICIN. P'.±-if7,i-. ':?....&a2:t] ,7:111'13.-at-fittw'j'ttr-r4kr.“1-4.7.LI:,HILA- ,: ...-..1 (7,41imic;er'd 7.14,4: . Ici,"-8 16_7,--T.......- c.. iL-' . ;;;.:; .` '' ,-• --irl.'t:.."l ii ,-;1-1.S."111.11p F'$1.fiqdre....,:titil . i cot c Cfrt ff.:c . ... i.;..:: :4):...;',,•;.: 0;:";V. . - ..'61;.:1:1:.."‘J,,tk,y,.:,•:,,,,•:. ,..:.. . . ,}..: ::....f.:Ity •;•:.::-.:t,;• :.4).1-s.i c .-., - • , ...-'11:'???,.t*-..;. qirrift;i:!! t •:y.:::: .&a, . f.,i.co lie -:C " '4'::Iti4:- '' •' ' 7' !■•'-'''''l'.1-€7'7‘t.,•:%;"''':•• A.liiiTe; Of installaticin if different than customer's address: :. .4 ,.:.':;•.•t... ;.i-'i...-..',:'.i.:,r ':t':...',:1;':,ti.}.i•"':;,-:•f,;•;.;C;-.';,;6i.?:t.;1.;y-2i.5.;::1.-.4;:':,‘ii9t:i.:.'=,.,.;7-Y;:1.•:•.:;'t::•':;"'!"--,,.,,1.:.47ti-f2:1,,:.:-.-.'-',;!.:\. •.- . ......_ . L . :::: ...•V.L.:..Z:1C7::,,,L,,,C-7:?77,,t,',.Yr.:., . ' 2sitftA2LAY 2' 7 : , IN S P E C T I tatAUTH 0 RITTkINEOKMATIYi .'•,e..;s.i,.....t!3:.t.a-L,;i1,l7q,j,,:,Cki-r;.'.2,44r.?:2`,::2-7,94.0t2,,±.44,•;7:-1f!.;:S;9(.4:::,..-,:;!•r,.::.. 1 Atufflorit5;hiYuahuri sdicti on to inspect: C.,+ o *-Poi :;•.•EEEEE;•?,:c.,E::E:E.7,:,::,..4,...E.Pb bile: - :L';..)1,..,t-1:1.;.',!&.:;• •.-:, ..:4...1.:.r..<:.'11.,E;.:.).--7.,- .:. , -• . 7.r...,::,2.4,,,i7::‘,;F„,..,...,•;,,, ..' ,::;.:.`,...`NT,:l.“H-S';:?.e•,,,..,',.',-,•:•'!.•• • • • ,,,,,,i,-4....e•vc1 :.: 'i'.:‘• ' Address' .:-.?..--'''„Y.',' " -•4!-rf _,-.,1.---4.kt 'oii,. .i .,. '-y7- ,7Lic.2.:- .,‘. ,t,..-.4:i i,6. .a.=-Jc"tit-fil?yi:rgi'i:-.v...1• - ,SX :teEZE:ii '.; te_2-.V,:;4?:;cQ5. :, 2 , (:r142:4;. ;22,1;,.. . ,. : -'.I4,-1 ''....... ii-...y..-,app, 477:-ft-oerre425.422/St*:?.;71,.?....;;;;.-; '• :fd.., ;:p,,,,;1.-4:,7,D.;.‘4,,:-.:7,-,1;6,`:•pcX;,....,._kcilti;r4;-il,f4c,..ii R c E NI N.Q:;;EEECTRIC. 01-1 Lira!N FOlt ActOr4.;sh4--..:',64 -.,irks--Jiiir-e :j.,,4;!-:27::ifikrif..!..,,. „ ‘,.;., . e of-el ec-tho utility receiving request; SPRINGFIELD UTILITY BOARS ‘, ..:;:',;,',.;,,,,,,,,,,,,,,,,,,,,,,,, 5417Z6Ø Adiar. :,•1001MAUN1 STREET ,.... 1.....7.:(..,?At.,‘,-(71-,,,-:... . . ... . •:4,!,? r4....!,:, :4 .-:it:4:r: '" *-, i4". __;H.' '..-D--, :zi',;-,:?.iT4:t City :..SPRINGFIELD :;1§tid?:I0R00.1'9,4Zi_ ::::9747.7.h.'..;;; ',;., •::-' •. . -c-- 1. . cfritri±i3O.;:*... . ,..•....,:.."-Fick,-7_,-.74:1-....4,:••,4'S,i,..-[,,.',:k4;17,..up-riA•7-1-it.-.::'.*:-....-.7-1,4:?..V.REASOW,.E.0R:.t.F.i.EQUE11 ;79..7:47-Thll,.,4 21-'dit12:iletsteik?;!--t. r—,., !,-erm.. r u -..(, ., ...• - :..., I 4,:f.t),,Restoring eleCtrical service that was interrupted or disconnected because}p,r4. itk,‘A-::63#41z....,'Ii.,:, . .: . ‘. .:,:,uo''':‘.,- "; -. .4,•'erii,i',.*•: ',,,,.- ‘.....l.'::....:-.:.),-;.-•--;..:•:211.?,';• .- . •••• ,- 1 ...,..,...!....i Service onfinge oi. x Uncontrollable event, such as fire, flood, or seyefe1,1,e.thei..,1., .., • --.i;.:.::: fiOn-4;., -'.. . . ........; I.!, ..:.1 or ....:'.1 7.1: • .. .ri.'fr',V!;:i..44"ew.i..:' •••••:;10,- ,,.. ::1,1•;:. ii.n.,';;:....g 1 ecHtric;a1 service:tice at a remote location needs.to bc: . :. .',•,...,-...-•,2','';':'...:Y,-L' • ,.,,,!4 ::!.... ,-1:..:g i. •. ..- ./7--1,:'IV..•'‘'',i•led'.?tt.' • ' ,-!: ••:1:::'''':"....'t InialiZ'ea.: IA Restored :-...l.,,..:;t:....::ik;1*-1-1i,..i.'y ,...,A,r. ,,,i.:.i.. _...L . :-.21:, 4.A,74.uii. e,..:::,.;:,. . 1 -..iti-c#X.-"e.A:,..m;I:jkilik74i:tjwatt)M P.ft ET:10 NaNSTRUCTIONSAN b3SIONABLIK, ..vviwe.:r9,22.'N3:74:49:4f:p11-"iii;,. . "•?:=(•S ',.r. 07---.77.1t.Z.•,';'•"' ''''''''`:`'';‘-:c••ne-- - 5" - • .... 7,r•Z+ •,' P 'kff";.1.;r4i'7:F:';•: :''' ::•1: itt.':.pe'iv is.ui'' ieieeirician Electrical contr4torH;i:; •:::'..!;'-',:d•:,2• :‘!. .' .....!...' 11:10t,,Y.-• . . - •....ii.....:::.....,! ilL..1:4.-• - - • ,' ?•••1 -ALO. : :;-• ,,!,,,...■ •.,Note' After i49-.efinglhi a form to the electric utility Note: By close of b4sktess on the.fusLbustness daYi pi oW m„, Yri4n.'eriabineeSiciiii•mast send a copy of this form to energizing of a cOnipl etecimte9PArpkp.?;response to 11-15 ,p::„... ,..4,.. .'E. l.•i .(i)t.i.le'acit4i1 Cent/actor, (2)the customer, and request,you .•::.,..,:.::.:::.,.:1 1•,::.,,,''..,4 :,,!i"4:.'f';.,1.: c \ ,., . inu.q.q5.40ktl# 0 i.W‘caYin$*4. ..14i1 (i (3) teipS•ect41: .uaorty that the installati6n154 ieeireneg.441:44(2)feci Ia: th i i • 3 /0 P-1 authority inspectthHee.:49'.Mp1elecl Ins- tacllation: •-:•:•filVt+T±2.,,T;.7..; .. --Tr-F.. .....,...k,..7..,- .. ...: ,p, ,...i ; eorict,iiiis signature Pate Electric utility .,. ,,:41)...,,.,;.. ...i),,ki!;.i.;•,. /.:.!.S...t.F.,,,T1?, .."'''...-t :1....,-;'.:,:. ••- • : ;:,.. .Y,• Note: Please coas,ther'nOliMi:—id?e.... 1.13e,Cirli3Oi#11is=ifiC17:j ,4, :.1.),:' •y E,..c. i • •.:mt•i :,'•••,,E,E:2.. .:.i.!..;"..,..ElE:;.• • ..- -".- •"' '' 11 .i...6ii istefierklid P.V.'t identified in this its,Liic75,fri.1M...41..9?,?p ...,.,..,1,,,:4,;;;,14..:. .. 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