HomeMy WebLinkAboutMiscellaneous Electrical 2010-4-26
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Request to Energize an Electrical Installation
Jurisdiction address: COPY.r,
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REQUESTlNG;SUPERVISING' ELECTRICIAN INFORMATION<.;litii';'.l:"'.,' cD,:'"
Name of supervising electrician: Tim Mi tchem Date ofrequest: I '.llD
Supervising electrician's license number: 4145s Date installation was completed: '12(,,1/0
Electrical permit no.:UtnJiJIO~ 00;;1, lfa temporary permit is posted at the job site, please include a copy o/it with this/orm.
EMPLOYINGi.ElECTRICAt;:CONTRACTORiINFORMATION'.....".!;i~;;{;;~;,c':.;;";,: .
Name of electrical contractor: Western states Electrical Constructi<imnse no.: c88
Business address: PO Box 847 - 235 NE Iron Mtn. Rd
City: Newport State: OR ZIP: 97365
Phone: 5417.6<;. R067 Fax: 541-265- 7652 E-mail: wsec@actionnet.net
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A. Restoring electrical service tpat was interrupted or disconnected because of either a:
o Service change or ).&t, Uncontrollable event, such as fire, flood, or severe weather;
or
B. Electrical service at a remote location needs to be:
o Initialized 0 Restored
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Supervising electrician Electrical contractor
Please note - After sending this form to the electric Please note - By close of business on the first business
utility named above, you must send a copy of this form to: day, following energizing of a completed installation in
(1) the electrical contractor, (2) the customer, and (3) the response to the above request, you must: (1) notify the
inspecting authority. authority having jurisdiction that the installation has been
.~, /.-/ energized, and (2) request that the authority inspect the
7? t-t#V~ completed installation.
Supervising electrician's signature Date .
ri DEPARTMENT OF
1";0 CONSUMER
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440.0948.COM (9/08/COM
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