Aerial View of Griggs

ELECTRICAL SERVICE APPLICATION

Customer Information 
Type of Service:   
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

Temporary Service
Is Temporary Service needed for your project? 
Voltage Requirement:     Load in Amps:  
Temporary Billing 
Name of person responsible for Temporary Billing (if different from person signing contract):
First Name:    Middle Initial:    Last Name:  
Mailing Address: 
City:       State:        Zip: 
Phone:      Fax:      Email Address:  
Permanent Service
Type of Service:     Meter: 
Main Switch Size in Amps:    Size/Number of Cables: 
Existing:    Voltage:         Phase:          Wire: 
New:    Voltage:         Phase:          Wire:  
 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