Report (44 rwi ... Request to Energize an Electrical Installation RECE!VEJ)
r^?2 APR 2 7 2015
REOUEST4NGSUPERVISING ELECTRICIAN INFORMATION_ " . .- ..
Name of supervising electrician: Robert Bruene Date o,r,�`pp�t:(y1_ ,Ilio ,. .
Supervising electrician's license number: 52155 Date installation was eompittPI t'PEVSiOl�'
Electrical permit no.: ELC2 015-0 0 2 901f,temporary permit is posted at the joh site,please include a copy of it with this form.
EMPLOYING:ELECTRICAL.CONTRACTOR INFORMATION
Name of electrical contractor: Christenson Electric, Inc License no.: 26-340
Business address: 111 SW Columbia,Suite 480
City: Portland State: OR ZIP: 97201
Phone: 503 -419^3300 Fax: 503/r+/-4419- 3333 E-mail: bob.bruene@christenson.com
1:RMA7TON,E;F:. : ... M ..
Customer's name: Meadow Creek Apartments
Customer'sa.ddress: 12505 SW North Dakota, Unit 1708
City: Tigard State: OR .ZIP: 97223
Address of installation if different than customer's address:
City: State: ZIP:
.y - "INSPECTING.:AUTHORITY INFORMATION -
Authority having jurisdiction to inspect: City of Tigard Phone: 503 .71 X24 3 9
Address: 1312 5 SW Hall B lvd
City: Tiagrd State: OR ZIP: 97223
: • a RECEIMING:_ELECTRIC UTILITY INFORMATION _ _.
Name of electric utility receiving request: PGE Phone: 503 -736- 5771
Address: 121 SW Salmon St.
City: Portland State: OR ZIP: 97204
W ,. y"L,:'REAS!DI31, OIiE!QW S; . T.
A. Restoring electrical service that was interrupted or disconnected because of either a:
❑ Service change or [Uncontrollable event,such as fire,flood,or severe weather;
or
B. Electrical service at a remote location needs to be:
❑Initialized ❑Restored
COMPLETION INSTRUCTIONS AND SIGNATURE
Supervising electrician Electrical contractor
Note:p cr sending this form to the electric utility Note: By close of business on the first business day following
name ar, ve, 'u must send a copy of this form to: energizing of a completed installation in response to the above
(1)th; ectri•',] ontractor,(2)the customer,and request,you must (1)notify the authority having jurisdiction
(3)th:1- spec}n, authority. that the installation has been energized,and (2)request that the
I authority inspect the completed installation.
•
Supe ,ising ele 'deism's signature Date Electric utility
4-2 7_15 Note: Please consider notifying the inspecting authority
identified in this request when an installation is energized
pp before inspection.
eEUN�EM R
StKVIC�. S
440-0048-COM(10/(18/COM