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Additional Information

Provide a copy of the following documents

Load Data Sheet
Legal description of property or copy of last recorded deed.
County assessor’s parcel map indicating home site(s), easements, and rights-of-way.
Detailed plot plan.

Customer Certification:

I certify that the information provided on this form is accurate and complete to the best of my knowledge; and that I own, lease, or have a contract to purchase the property or premises referenced in this request for service or I have been authorized by the owner or lessee to complete this request on their behalf.

Temporary Service
Owner's name and address or party responsible for temporary service billing
Name*
Street*
City*	State*	Zip*
Daytime Phone*
Cell Phone*
Email Address*	Permanent Service
Owner's name and address of party responsible for permanent service billing
Same As Above
Name
Street
City	State	Zip
Daytime Phone
Cell Phone

Temporary Service?

Overhead
Underground

Date Desired

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Permanent Service?

Overhead
Underground

Date Desired

Open the calendar popup.

Name*
Street
City	State	Zip
Daytime Phone*
Cell Phone

Same As Above
Role
Name
Street
City	State	Zip
Daytime Phone
Cell Phone

Street Address & City (OR Assessor's Parcel Number)*
Directions to Project (Cross Street, Mile Post, etc) *
Who Will Trench, Install, Conduit, and Backfill?
Applicant
Contractor	Contractor Name*	Contractor Cell Phone*

Main Breaker Size (in amps)*
Total Square Feet*
Voltage 120/208, 3-Wire 1Ø 120/240, 3-Wire 1Ø 120/208Y, 4-wire, 3Ø 277/480Y; 4-wire, 3Ø Other
Other Voltage

© Tillamook People's Utility District
PO Box 433, 1115 Pacific Ave. Tillamook, OR 97141-0433
800.422.2535, or locally 503.842.2535