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.o' •,. Request to Energize an Electrical Installation
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<br /> Name of supervising electrician: \ i A. CA A f1. " Date of request: r V,/ Z
<br /> Supervising electrician's license r: ,5 /9/ S Date installation was completed: 1 /I V 0�
<br /> Electrical permit no.: - J j G t Cf2I j ted at the job srte,plea
<br /> : � se include a copy of it with this form,
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<br /> Name of electrical con ctor: of-- 'S . ' .e.�-- 1G License no.: _ q C j
<br /> Business address: Al ao ..11P. i. 1 •
<br /> City: Z A/1' he-Li..'q rr�� State: .01 ZIP: t 2
<br /> Phone r� U, U1"f Fax"_� i -02 E-mail: v�c -t
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<br /> Customer's name: •
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<br /> Customer's address: r ,
<br /> City: S d.,�. State: )� ZIP: # r7 _4
<br /> Address of installation if different than customer's address:
<br /> City:
<br /> • State: LIP:
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<br /> Authority having jurisdiction to inspect: VA soon Phoneme - _ {
<br /> Address 7��wj .it),- C ., : _ , T—
<br /> City' -_.....S.CA Leirsn . • ... State:'i_1042ZIF
<br /> Name of electric
<br /> ' 1 utilityreCei ' request: Phone 1
<br /> Address:
<br /> City: eh3 ;, _ State: �+�� ZIP: t„�'"1
<br /> ,-, `x c " '3:PA'Sou; N. tt1 i' ..:.ax�w.tis.' +w +O t n y a y
<br /> A. Restoring electrical service that was interrupted or disconnected ecause of either a:•
<br /> 01-8t2tvice change or ❑ Uncontrollable event,such as fire, ood,or severe weather;
<br /> Or
<br /> B. Electrical service at a remote location needs to be:
<br /> Lys ❑Initialized ❑Restored
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<br /> Supervising electrician Electrical contractor
<br /> Note:After sending this form to the electric utility Note:By close of business on the first business day following i
<br /> named above,you must send a copy of this form to: energizing of a completed installation in response to the above
<br /> (1)the lectrical contractor, (2)the customer, and request,you must: (1)notify the authority having jurisdiction
<br /> (3j ot/ttin auth•j that the installation has been energized,and(2)
<br /> // request that the
<br /> — I t if, authority inspect;he completed installation.
<br /> Supervising electrician's signature !Date Electric utility
<br /> Note:Please consider notifying the inspecting authority
<br /> identified in this request when an installation is energized
<br /> before inspection.
<br /> ---- - tUgaii
<br /> 440-0948-COM(10/08/COM
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