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,....,.� COMMERCIA�- + �' ��'`� - < < i <br /> �U� t1EW SERVICE QUESTIONNAIR x AGREEMENT <br /> �� <br /> -- Err,21.��-----"_� <br /> .�, <br /> — .:� (' � . .. _ ,�� , ,. <br /> Cu::;o.�er Name_�=-;,_ v F,lessage ( � <br /> (�cGa�naMc rOr�Cr„.��:.G"=J Hor�e I } <br /> Wo�KPhoner_.��--—,-"""__' � � , _ •;• <br /> Sen•ice Address �� �� � '.---�� � �' `�' � � � c ? <br /> (HOUSE NU7l.E�P Af'iD S7AEETAODRE,.S LI+YJS�a ,z'°CO�t) <br /> V <br /> M3iii� Ad�ress ?�o�,a ( ) <br /> ArcnitecUSurv2yor __.� � �� i/r.� � •� . •s� <br /> ,:, •: <br /> =/.-� - . , Enail L < <br /> ElectrcalEngineerorContrecto�,� " " ��X,� � � �,�;_, Messa e <br /> V.'orkPhene (�t��. � ,c (; ,. <br /> � Emai! <br /> Projecl Cocrdirztor� *'� �" ' FAX ( Cellular( 1 <br /> Work F'hone �f? � � "7`I� �>`" � roximate date ser�ice wi11 be required: ^,--- <br /> �'Vhat ic, exGected dzte to put pr�ject to bid.� APA <br /> i; Graoes 8 S;akes Form �igned?�J Ye= ,,� No <br /> (7his �afc;n attes;i;�g that prop'�ty come�locstions zr,G fin2t grade ct Fldt is cSTABLISHEU.) <br /> h ❑ Letter of Guarantee ❑ Pe�formance Bond <br /> T��e�f f�nzncing ❑ �a� s <br /> ����_�___ � r rma�inn mun� u� <br /> In order co proce�d with the 2�gineenng and deterrr'inatlon of cr;arges, cne ����������n ����-• � - <br /> providec: <br /> 1. Are ihree ;3) complete ccpi�ss of the s�te plan (inciudin5 water, sev+er an�d Np rm) att2ched? [] Yes No <br /> 2, Is e 1eg21 description of the propery attached? � Yes ❑ Nv <br /> �. 3. Is a complete electrica! riser diagram aitached? <br /> �LK�Msa.;i�j ✓ti;ti ix rno��.r <br /> �..4. IS Sh(; CI951�e`� tTiEteCl'lg IOC3:10!l ;ene locatior per struct�re; attached? % eSU � <br /> 5. Is the PUD Ccntract Card filled ou;, signed ard retarned to the PUD? � Yes� No __ <br /> i <br /> ' ELECTfl CA4INFORMATION ' <br /> 1 Eiect;icai Service Entr2nce 5izz: ❑ 200 a�rp 400 amp ��zmp <br /> � (�Ov�>.rhead � Underground �Voltage �✓"% ! � � � �,! Phase -5 <br /> ' Service en'.rance wire sizes:�f Phase ,�°;b �i�c�N�Al-Totsl number of conduc'ors per phase: � � <br /> �J Neutrei .� L- Total nurnbe'oiconductcrs: � ��-•�^ � �'� � ` ' <br /> Largest motor: Fr=Guency of start: <br /> Type cf Heat: ❑ Electcic ❑ Gas ❑ Wood ❑ Other <br /> Tyoe of Cooli�c�: � Elect^c ❑ Ga� C ���e ❑ Other <br /> Type c` 9usines:.: _____ Bui(ding sq. ft.: .____ <br /> - VOLTAGE PYASE <br /> Tot�l Electrcal Load: EXIS i kW N� k�N � ----� <br /> Lighting _____ t,W ----- kW / ----- <br /> Hea,in9 ----- ----' kW � <br /> AirConditioning ____ kW ----- -- <br /> � ---- <br /> Motors ----- k�N ----- k'N / <br /> Water Heating -- kW +� <br /> kW <br /> -,._ kN ----- kW / -- ----- <br /> Misc. �---- ----- k��,� � <br /> TOTAL,: --�-- kW -- •-- ----- <br /> �; is understood thet if addi;ional �vork i; required o'tne PUD, due to customer rev sions of the electricat loao <br /> and/or v0ltage requirements oc othar in`ormation as supplied cr reauested on thls 'rcrm. the addi!lo�al costs <br /> shall be bome by the cus:ome�. The PUP provides for installed load, not future load. �oved by the <br /> Prior to energizing tn sarvice�pUD s:ancards 2nd senice requiremen±s must be met and aFp <br /> PUD. � ( Date 7 �3 07 <br /> ;;.,•x��:(�'-.• <br /> CuStoner .. <br /> ` J' --• - - - '--- - Cv5 3�i.^.'+0 a��VO'.J Wc9T :�: E5, c6 r�CN <br /> _.. _._...;��.` - - � _ <br />