New Commercial Electric Service

Applicant Information

Temporary Service

Owner's name and address or party responsible for temporary service billing

Name*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

Cell Phone*

E-mail Address

Permanent Service

Owner's name and address or party responsible for permanent service billing

Name

Mailing Address

Same as previous

Street Address Address Line 2 City State ZIP Code

Daytime Phone

Cell Phone

Project Description

Temporary Service?

No
Yes
Overhead
Underground

Date Desired

Permanent Service?

No
Yes
Overhead
Underground

Date Desired

Contractor Information

Name

Mailing Address

Same as previous

Street Address Address Line 2 City State ZIP Code

Daytime Phone

Cell Phone

Contact Information

Role

Name

Mailing Address

Same as previous

Street Address Address Line 2 City State ZIP Code

Daytime Phone

Cell Phone

Project Information

Parcel Number

(Example 2N 10 29AC 1400)

Street Address & City*

Same as previous

Street Address Address Line 2 City State ZIP Code

Additional Comments

Who Will Trench, Install, Conduit, And Backfill?

Applicant
Contractor

Contractor Name*

Contractor Cell Phone*

Electrical Load Information

Main Breaker Size*

Total Square Feet*

120/208, 3-Wire 1Ø
120/240, 3-Wire 1Ø
120/208Y, 4-wire, 3Ø
277/480Y; 4-wire, 3Ø
Other

Other Voltage

*See Link at Top of the Page for Load Data Sheet

Written or verbal authorization from the property owner is required if the applicant is a representative and not the legal property owner. Written authorization may be submitted by uploading a copy of the contract between applicant and property owner. Alternatively, the property owner may contact Tillamook PUD Engineering Department at 503-815-8629 to verbally authorize applicant’s request.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 200 MB, Max. files: 5.

Full Name (Customer's Electronic Signature)*

Do you consent to signing this document electronically?*

Yes
No

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Comments

This field is for validation purposes and should be left unchanged.

Additional Information

Customer Certification

Plan of Service and Load Requirements

Applicant Information

Temporary Service

Permanent Service

Project Description

Temporary Service?

Permanent Service?

Contractor Information

Contact Information

Project Information

Who Will Trench, Install, Conduit, And Backfill?

Electrical Load Information