Report Feb. 27. 2015 4: 15PM PGE TCC QUAD A No. 6837 P. 1/1
, Y Request to Energlize.an Electrical Installation
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_ REQUESTING SUPERVISING ELE TRICIAN INFORMATION
Name of supervising electrician: "r , o . Date of request: A /7i in -
Supervising electrician's license number. / Date installation was completed: a 4,ril L5--
Electrical permit no.: a,e 7-1 y x 'gilt a temporary permit is posted at the job site,please include a copy of it with(Wpm
EMPLOYING ELECTRICAL CONTRACTOR INFORMATION
Name of electrical contractor: /t'iUf[.�1jt .t/—r/�/ �— License no-:
Business address:- Po. 5< l a 37
City os..;Ak1J1) state: 6 A_. ZIP: 7 9.
Phone:5-03 -9131-irev( . Fax..O3-,23s"--4 300 E-mail: erc A _ 470 r i• , co
CUSTOMER INFORMATION
Customer's name: , ., ,T,4 AoLlEEJ&—
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Customer's address: 7•foo , a.) d -.tin e- / v
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City: ' r'./9-,2D state; (2A_ ZIP: J. 3
Address of installation if different than customer's address:
City: State: ZIP:
INSPECTING AUTHORITY.INFORMATION
Authority having jurisdiction to inspect:; f/4 ) Phone:Tj 3-7/ 2 4 3
Address: / 3 1 . (-0 ail_ r.
City: .1—'76 frith State: o,e ZIP: 5 7��3
' RECEIVING ELECTRIC UTILITY INFORMATION
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Name of electric utility receiving request: 1O' 15_ Phone: - -
Address; - .
City: -14 ter 'IL.", Std: el__ ZIP:
REASON FOR REQUEST •
A. Restoring electrical service that was interrupted or disconnected because of either a:
0 Service change or El Uncontrollable event,such as Ere,flood,or severe weather;
or -
B, Electrical service at a remote 1 tion needs to be: ,
❑Initialized Cored __
COMPLETION INSTRUCTIONS AND SIGNATURE
Supervising electrician Electrical contractor
Note:After sending this fora►to the electric utility Note;By close of business nn 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
(1)the electrical contractor,(2)the custo er,and request,you must:(1)notify the authority having jurisdiction
(3)the insp authority. that the installation has been energized,and(2)request that the
V -a?j c authority inspect the completed installation.
e electrl ti's signattue We Electric utility
Note:Please consider notifying the inspecting authority
identified in this request when an installation is energized -
before inspection.
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