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Andrew J. Ginther, Mayor
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> Nicholas J. Bankston> Lourdes Barroso de Padilla > Mitchell J. Brown > Rob Dorans > Shayla Favor > Shannon G. Hardin> Emmanuel V. Remy
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ELECTRICAL SERVICE APPLICATION Customer Information Type of Service: (Select) Residential Commercial Industrial Name of person responsible for signing the Electric Service Contract:First Name: Middle Initial: Last Name: Title of Person Responsible: Company Name: Mailing Address: City: State: Zip: Phone: Fax: Email Address:
ELECTRICAL SERVICE APPLICATION
Type of Service: (Select) Residential Commercial Industrial Name of person responsible for signing the Electric Service Contract:First Name: Middle Initial: Last Name: Title of Person Responsible: Company Name: Mailing Address: City: State: Zip: Phone: Fax: Email Address:
Service Address:
Project Name: Address: City: State: Zip: Contractor Information: General Contractor Company Name: Name: Mailing Address: City: State: Zip: Phone: Fax: Email Address: Electrical Contractor Company Name: Name: Mailing Address: City: State: Zip: Phone: Fax: Email Address:
SERVICE SPECIFICATION AND LOAD REQUIREMENTS
Is Temporary Service needed for your project? Not Required Overhead Underground Voltage Requirement: Load in Amps:
First Name: Middle Initial: Last Name: Mailing Address: City: State: Zip: Phone: Fax: Email Address:
LOAD INFORMATION Existing New Single-Phase (KW) Three-Phase (KW) Single-Phase (KW) Three-Phase (KW) Comfort Heat Kitchen Equipment Lighting Air Conditioning Motors Water Heater Other: TOTAL CONNECTED Largest single-phase load connected: KW Starting Amps (LRA) for largest motor: Amps How often is the largest motor started per day? times per day Starting Amps for any other motors (5 HP and up) that are started coincidentally with the largest motor: LRA LRA LRA LRA