Applicant Information Applicant Name First Last Applicant Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Applicant Email Applicant Phone Primary Type - Type -HomeOfficeCell Phone Ext: Applicant Phone Secondary Type - Type -HomeOfficeCell Phone Ext: Other Contact Info Electrician Info Electrician Name First Last Suffix Electrician Phone Electrician Email Contractor Info Contractor Name First Last Contractor Phone Contractor Email Site Location Street Address Subdivision Lot, Block, Filing Account Number Meter Number Existing Service Rating Existing Meter Location Service Requested New Service Rating More Indicate the amperage, the size of the main disconnect/breaker rating Secondary Voltage 120/240-1 phase 3 Wire 120/208- 3 single phase 4 Wire wy 120/208-1 Phase 3 Wire 277/480-3 Phase 4 Wire wye Size of Entrance Conduit(s) and Quantity Size of Entrance Conductor(s) (AL or CU) Distance from the transformer to the meter More Enter the distance from the transformer to the meter, if known Meter Location Pedestal House (shall be on gabled end front 1/3 of building) Pole (must have approval by area superintendent) Other Are all property corners clearly staked and labeled at the site? Yes No Type of Building Square footage of the building Electric Load Information Type of Heat Electric Furance Electric Baseboard or Cove Heating Electric Boiler Natural Gas or Propane Heat Pump Backup Resistance Heat KW of Electric Heat KW of Electric Water Heater Type of Water Heater Electric Gas On-Demand Lighting Load Hot Tub Sauna Major Loads Largest Motor Starting or Locked Rotor Current Variable Speed Drive - Starting current same as full load Yes No Written Description Site Sketch Attach a copy of the site sketch.One file only.20 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, svg. Please indicate on the site sketch the structure site to include gables on the building, roads, driveways, sidewalks, and proposed meter location(s). I agree that all electrical construction on the project will meet MPEI requirements as specified in the Electric Service Construction Standards. I agree to pay the non-refundable $600.00 engineering deposit which will be applied toward the cost of the job, site visit, staking, design, contracts, etc. for a period fo one year from the date of receipt. Processing the application will not begin until all required information is provided. ELECTRONIC SIGNATURE (REQUIRED) Sign above CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
