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Correspondence No. 3977 P. 1/1 Feb. 14. 2014 3:46PM PGE TCC QUAD A Feb 14 2014 1 : 17RM Clackamas 503-632-2421 p. l o---!,-- request Ta r`nerglze an tlectrrcai insYaiiat,on . ' \'"r�• (JfX1,5 *I 13 ZC,ZI GmS I zZZ57zc; Z 2 Z 5 9 71 Name of supervising electrician: �'� � r._�i. '��ti;4'�s�`�'y P B S ems4- o �S 1 - Date of request a/tY/t q Supervising electrician's license number: SOLj I S Date installation was completed: /Pi/IL( - Electrical permit no.: Ile lemporary permit Is posted al the job SIMM, �, ;,.,,; _,�:., i - •�,. Y_ o i please Include a copy Olt with INC form. Name of electrical+con � � .t y °'• -,�_:`' ..t ;•�.;�� r r L � hx�� ,,�w�.,�1,.:��:ti. tractor: C Ia..cgo rv,e,,5 61 e.c ,.`1' . .. L ��- License no,; b o b C.. Easiness address: r x $I - � City: ;5b3 -6-� 1c _ State: ZIP;c{ 7 COL( Phone c7 Fax:50; •63.2 at./ ..1 E-mail; 4.::,,,77,-,',:!.,%;,.:::4-,t/,:',- ,)(cCe Qera�cvaM OSG1+L-vI C- m .•w's^ik'ti� � r t - - ,ad•".P 5",i• q . . •r+77;-.a �'h -.;ate _ •2 _ ;=gig ;,Customer's name: Ext21 Qc � �orl +Gy Customer's address: 1 6c1ct6 5 w 14 ve City: b,r& State: ©V.. ZIP: 9-72,..a r Address of installation if different than customer's address; ^`- City: r Stale: ZIP; V - ...r p T c,77�T E 0=' , i-l..:�.:.'�.�" �..;::, �*,,{: 1 F 0`Authori ry hav ing jurisdiction to ins pe ct: � ' ' b - ", k Phono:Set, .1t 4.31 Address: 1 ' 1a5 -1 \` .1+J City: 1ii �cc :�•, �. . _ � State: C ( ZIP: al—7 A 2:5 'ter.. . :..'. .• .._ ', R err• :.-4.41, 4 f ]!1 l 1� ..:::7177E+177' T�1••^ ♦ '-•,....,. ...;y_ Name of electric utility receiving request; 4 /'`'1lLi�. . ;"kr . ,:f G 4< � f:: Address; t rc (-11-i pc.l Phone:�aC} '1 - 5�S" r}City: ( pc- V�� —� State: O IZ ZIP: q 7 ,� I {C-1a,_ �i%7~y(ii.. ^''4 •.. '' •XIS. - Restorrng electrical service that was interrupted or disconnected because of either a: 'f'` 0 Service change or (Uncontrollable event,such as fire, flood,or severe weather; or 13, Electrical service at a remote location needs to be lL 0 Initialized ❑Restored 1 lii u 1 2 i AYU _ Supervising electrician .. - 1:` �'t"�°;_ 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 mug/send a copy of this form to: energizing of a completed installation in response to the above (1)the electrical contractor, (2)the customer,and request,you muse (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, Supervising eleetricbn'ssigmiture Oats Electric utility ....11-/-vi Note;Please consider notifying the inspecting authority .l identified in this request when an installation is energized before inspection, ST INN • � b '� �r *�� 1�o Se_ ~awe_\ W••• sR " E 1 11 O� D-0941.CoM(1O1OSICOM • `� Q ; S kabt-1 e-c\.. 1- e�-