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HomeMy WebLinkAboutPermit Electrical 2009-2-16 Request to Energize an Electrical Installation Jurisdiction address: 1;1!;-,'llt~li~;!j[TI1;;r~'![\;4~~%18EI;')UESmINGl.Sl!JP.EBMISINGiEl!JECm8101~NiiN~0.KMA;I;10N~~~'~~tii:tr4l!'~~WW,\I#~il Name of supervising electrician: Ucrll'f' ~ {'':'''J7rkP Date ofrequest: d 11"/ Or I Supervising electrician's license number: 4 'lr Cf S Date installation was completed: :l / /(J oC{ I . " Electlical permit no.: If a temporary pei'lI1it is posted at [he job site, please i/;clude a copy of il with lhis form. ~1;:,~ii1.ii!lj~1Jt~,~,i;';\11':!i~~rii~EMR~0MING~lEI.!EQT:BI~'.tiL!'i.i"GONill8l\Gif:08iill NF,,0BMl\mI0Nwlf~~1k~~ii:;i,JJli'J\\'l\\Wr}j~ Nameofelectncalcontr)l3tor r:. d- 5 [/ecir/c ~c... . Licenseno.:drJ-J/.jC-- I BUSiness adchess r ~ f{~);r / V ~d- . / I City C;1'70M~/I) Slate tJ(( ZIP 77'177 I Phone: t,'II- .J;;)7Y3k- Pax :;V/- d'173' E-inail:, I l;:fu"";i'iJ:;;~'\i'J!'l~iiJ;F'??ll'i!~\\,~~~<if~l'wWi\t:';i"GllJSjT0ME8!'1.INI;.0.BM'AmI0N~/fll'\mlJn;,m_~1\r~~I~~[~\tit:",Wgl Customer's name: CXH7d i ~Ik, s ". I CuslOmer's address: l' ~75(J,7; 1"; () / ~ ~ I City '5tJrit1ljh~jJ .. StateOC !];IP, C(7Y.7cg Address of i,{stalIatidn if differ~nt thai'; customer's address: City: State: ZIP: 1'''j''''''!l7>>''7'ci\'''"''''<''''''JY-"r''''^'''IN S"E""'ING'F'^"'1"'ur.> DI",V1"IN' "0"M'^:T'I"'N""""""''''-''''''''~'"''w",'''''''"",'" ',,'," I . ~~~:::~:;":~;~'lf';~~~~:~{<;j+yv~~~;;;;;-1f1:/l ~.. ~?~\~;~:~::1~",~m$Z~;:7i3 'I Cily: ~r-j;/: Slate: ZIP: I -.. ., - I '::~,;?r.5;:TreY;j~~w';\}~?~irfiz~i4i1lg~~R E€.E I~I N G-~~E L:EGffiR HI::~qilH ~lffnYii11 N~0HM~ifl(9:r'J~~"mlf~iMrfi~&~~t~~Wtf(*,ic~~J~,rlf75,S~'~~' Name of electric utility receiving ~'eguest: .S' /(~ Phone:,~ '---" ,- " I City: ( State: ZIP: ". I 1~";!!&1L~;~)]a~~~m~:Mj8t1'i:jft'lBEAS_0Ni1F,Q8\\l8EGl.l!JESjf,f~~'~~&i\,,;~y;:1 A. Restoring electrical sen,'i~'that was.interrupted. or disconnected because of either a: o Service change or ncontrollablc evJnt: s"uch as fIre, flood, ~r severe 'weather; , . or ...... B. Electrical service at a remote location needs to be: . o Initialized 0 Restored 1~1'ft;~i~J!I!j~'~);JWl'j"ilITf'tNi~fi':We0MRl!JEmI.0Nu'INSJlI8l!temI0NS,!\'~t:.l@.l[SIGN~'11l!JR El~~~~"lIfiI~~;(;~~f)j,f!".'J~1 Supervising electrician Electrical contractor Plc"ase note - After sending thi~ form to the electric Please note - By close of business on the first business utility named above, you must send a copy of lhis form to: day, following energizing of a completed installation in (I) the electrical contraclOr, (2) ti,e customer, and (3) the' response to the above request, you must: (1) notify the inspecting aUlhority ~ (L'. .' authority having jurisdiction that the installation has been \'--. ""'f"),- n , . "'_ /( _/1IJ energized, and (2) request that the authority illspeclthe ,\ )~ ':~ . \,;l. d 10 (/1 completed installation. I Supervising electriCian's si~nature. Date - Address: rt~ DEPARTMENT OF :>'J!l CONSUMER ,,~ >:' ..BUSINESS IIlIi \ySERVICES 440.0948.COM (9/0S/COM