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Applicant Information
First Name
Last Name
Existing Customer:
Yes
No
If Existing Customer, is the additional construction at the same location?
Yes
No
911 Address
Street
City
State Abbreviation
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Subdivision
Block
Lot
Contact Information
Cell
Home
Email
Driver License
Contractor Information if Applicable
Contractor Name
Cell
Email
Nearest Location with Upshur Power
Name
Address
Approximate Distance from Nearest Location with Upshur Power
(50ft, 100ft, 200ft, etc.)
Direction from Nearest Location with
Upshur Power
(North, South, East, West)
Same side of road as Nearest Location with
Upshur Power
?
Yes
No
Approximate Distance from the road/highway
Can site be seen from the road/highway?
Yes
No
Does this property currently have power lines on or crossing it?
Yes
No
If NO, an easement will need to be obtained from your neighboring property owner in order to move forward with your new construction process.
Landmarks/Description of home:
Property Information
Type of Service:
House
Mobile Home
Business
Other
Other:
Sq. Ft.
Four Corners of House or Structure Pad Marked:
Yes
No
Meter Pole/Loop Marked:
Yes
No
(Keep in mind any future development of property such as driveways, swimming pools, porch, deck, etc.)
Structure in place:
Yes
No
Wired:
Yes
No
Will Call:
Yes
No
Temporary Service:
Overhead
Underground
Permanent Service:
Overhead
Underground
(Temp. service needs to be on the same side as the perm. service) (Customer is responsible for the wire from metering point to pedestal)
Is Property Accessible from the Road?
Yes
No
Gate?
Yes
No
Gate Code
Permission for Us to add an URECC Lock?
Yes
No
Load
Air Cond./Window Unit
Tons/BTU
Number of Air Cond. /Units
Heat Pump
Kw's
Water Heater
Electric
Gas
Size
Gallons?
How Many?
Tankless Water Heater
Yes
No
Electric
Gas
Voltage
Kilowatts
What size of service will permanent structure be:
100AMP
200AMP
320AMP
Three Phase Request:
What type of equipment
What size HP
Record Type Name
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