Correspondence
PGE-PSC SERVICE COED r-riot ~VQ 1
Cis. ~1. 2COg 7:07~M.C~C17
I C_? . loci
-%,y! juCa,t w znerpize an Electrical Installation
jurisdiction address:
RQdUESTIN SUPERVISING ELECTRICIAN INl i RMAT ON
Name of supervising electrician: Date of requeyC 1~ l
SuprMsitig electrician's license number: Date install ii ion was completed: lj 1/XI U,-'
Electrical permit no.: a(~-2 0 rrjU,~41 Jtja renrpora y permit is posted or tha Job sir,, please include a copy of it WO (his forflu
EMPLOYING ELECTRICAL. CONT GTOR INFER ATIO
Name of electrical contractor, N 5 i' L t ~1c Cam' License no,: 5 CL
Business address: l C~ ~ ? 3,1
_
City;. stet: W. c~-?
Phone: Fax: E-mail:
Sob • 931- ►i °l CUSTOMER INFORMATION.
Customer's name:
Customer's address: SS~Z 4 ~YL
City: 7 r Stah.: 6,P ZIP: 5PZZ
ro. -
Address of installation if different than oaawmer's address:
City; Stott: 71p:
_ INSPECTING AUTHORITY INFORMATION
Authorityhaving jurisdiction to inspect: - - Phone: -
Address:
City. _ State._ ZCP.
RE ETVIN_o, _ELECTRIC UTILITY. INFORMATION'
Name of tleetrio utility receiving request Phone: -
Addresa:
City: State; ZIP'
REASON FOR• REQUEST
A. Restoring electrical service that was interrupted or disoonneoted because of either a:
Service change or ❑ Uncontrollable event, such as fire, flood, or severe weather;
or
B, Electrical service at a remote location needato be:
]'Initialized Q Restoted _
COMPLETION (MSTRUMONS 'A -ORE
Stapervisiug electrician Qlectrlcal contractor
T,Icase note After sending this fomi to rite electric Please note By elax.e of business on the first business
trtility neared above, you must send a copy of this form to: day, following eneroz;ng of a completed installation in
(1) the elegy ieal contractor, (2) customer, and (3) the response to the above request, you atasr. (1) notify the
ut prctinj authority. - / authority having jurisd:ation that the installation has been
energized, and (2) rtquEst that the authority inspect the
- conVIeted instaallahoC„
Mrviftn ■tec ici■n' rapture Date
SR N
440-049•COM (WOKOM