HomeMy WebLinkAboutPermit Miscellaneous 2009-1-26
~ ..._. :....:;;..;1.Z;\~1.,1.~1..._..;",,:.__'1~ ~..,_..."........:....;"'..,.:..t"~...__.. .' ~'" ~...,' .:".
,.....',- .;.... -,
_ ..t"~" ....;t. '''-1-: ,"...."
""..-."- ,".,~'
Request to Energize an E~~ctrical Installation
c,q .\\lp
1~:~~="~:c:~~UbSh~~R~I~~~1Err~ICI~~iINE0R~~;~I:~=::t~;~~~~
Supervising electrician's license number: t..J 7 )., J 5 Date installation was completed: I /:+, (o 01.
. . f ...., I
Electncal permit no.: 1/ a temporary permit is posted at the job si~e, please !'}clude a copy of it with this form.
'"-IJ'\~fI\"'1!;~~\~~~~JliiEMBI!0~GIl!El!EC.mRleAI!r'qQNmR~CTl0R~IN~CilRMAffiICilN!iltt'!Il~1::!'~';;J1ill:J'i'~,i,'lli
Name ofelectncal cOY'factor:h (') V Y Y-I J J hyO :) ::,~;:.. < l':1cense no,: j j(P LJ Y- &
Busines.s,a9dress: f/O Ox (oQ7, '."",-
City, W 11 J}..,"y.....; }}'f I -' State:() Y'f ,- ZIP: nLJ It I I
Phone: Pax: E-mail:
~F~1rs;':~=:::
Address ofi~stahation if different than customer's address:
City: State: ZIP: I
~~o/g:;r/~~r1!1~:f::~~3
~1~WR.~7~-.,a::::~1S
'~"'!!i!fIml!':'1Nl1l~~li'",""':~li$-""";-SitY"d0BAiWRl:wS'':'Nil!''''''Ril!RE'''U:ES'''~1:l;-:<''''11:,I_';"''!'''!:IAlli!llo!l1fi!,i~!,\t\jl1>~174~''"1:l;1i\,ii+i';,,'
_~~"",;;q;j.'2YNll0'k1;,~?"~rmit~Sk~.1fz'\1;&\:ffimh"\3A~~**1f, .J;i!:.\.':ri:I,. >.",fi~ ,.h, . ,~, .., ;'J1l'b&d~LJ.W,"~_:;;'=t~gi{!;';',b";A>"X,_"".:ii;gI.;}_G'1:,j~!lli"~,,,*;;w,<o%
A. Restoring electrical servic~at was interrupted or disconnected because of either a:
o Service change or . Uncontrollable event, such as fire, flood, or severe weather;
or .-
B. Electrical service at a remote location needs to be:
o Initialized 0 Restored /
'~"7d~~"'''MI'T'''':?,\'_&''''Il!IIJii\l~'''-''''M'''"IEiFI'''N' {"IN S"RU' -'''I'''N'S''''A'N' b"S'IGNiA'''lI RE"'""{"'"''E'''''''''''i''''~",''''' ""
~ii~~~&.ooB;X3i2:s@i[?Uf~}~ ". - i;ib~~_\ZI, J;$~. 1: -9 ' {fl,. )'),' - ;~iJ; ,Q, ,:f//tr:\.. ~px . '., '.. I:'\'I{ , . " i[:~?iflli?,;l~N:ir-:~.~i0~\-<;Z'f~~~;~'t1!1~&l
, Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(I) the electrical cOl!tractor, (2) the customer, and request, you must: (1) notify the authority having jurisdiction
(3) the inspecting authority, that the installation has been energized, and (2) request that the
, authority inspect the completed installation,
pervisipg e,ectriciaf3S ignalur~, Dale Electric utility ,
-~' l/- '\ I 1J ~ Note: Please consider notifying the inspecting authority
, ' \ f\ I d-..LP I identifIed in this request when an installation is energized
V \i , before mspectlOn,
rt D~~Jsym€~
'", &SE~Vlt~~
440,0948,COM (I0/08/COM,