COMMERCIAL / INDUSTRIAL CUSTOMER INFORMATION SHEET
-571502286000 RESIDENTIAL CUSTOMER INFORMATION SHEET Please complete this form and return to the Estimator assigned to your jobCustomer InformationCustomer’s Name: FORMTEXT ?????Phone No: FORMTEXT ????? Request Number: FORMTEXT ????? Address: FORMTEXT ?????E-mail address: FORMTEXT ????? Fax No: FORMTEXT ????? Total Square Footage: FORMTEXT ?????Built Out Square Footage: FORMTEXT ?????Unfinished Square Footage: FORMTEXT ?????Upstairs Square Footage: FORMTEXT ????? Main Floor Square Footage: FORMTEXT ?????Basement Square Footage: FORMTEXT ?????Service DescriptionDesired Secondary Voltage: FORMCHECKBOX 1 Phase 120/240 FORMCHECKBOX 3 Phase 120/208v FORMCHECKBOX Other: FORMTEXT ?????Note: Not all voltages may be availablePanel Size (in Amps): FORMTEXT ?????Panel Size (in Amps): FORMTEXT ?????Nearest Pole or Equipment number: FORMTEXT ????? Nearest Pole or Equipment number: FORMTEXT ????? Electrical Contractor: FORMTEXT ?????Phone No: FORMTEXT ?????Load List (attach additional sheets if necessary)DescriptionPhase (check correct one)Locked Rotor AmpsRunning Load AmpsLoad/Size (Tons*, HP, kW)UnitAir conditioner #1 (Largest) FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Air conditioner #2 FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Air conditioner #3 FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Air conditioner #4 FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Air conditioner #5 FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons** 12,000 BTUs per tonTotal connected Tons: FORMTEXT ?????Tons*Exhaust Fans FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????HPMotors (include motor codes) FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????HPLargest Motor (not included above) & code FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????HPTotal connected HP: FORMTEXT ?????HPForced Air Furnace FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWElectric Heat FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWElectric Water Heating FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWElectric Water Heating (on demand) FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWBoiler FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWHeat Exchanger FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWHumidifier FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWKitchen Equipment FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWElectric Range FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWDishwasher FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWMicrowave FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWWasher/Dryer FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWHot Tub/Spa FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWLighting FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWOutlets FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWComputers, Magnetic Power Supplies FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWOffice Equipment FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWSnow Melting FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWSwimming Pool FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWElevator FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWMiscellaneous FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWFuture FORMCHECKBOX 1? or FORMCHECKBOX 3 ? FORMTEXT ?????kWTotal connected kW: FORMTEXT ?????kW FORMTEXT ????? FORMTEXT ?????Customer Signature DateRevised 22Feb19Plug-in Electric Vehicle (PEV) Chargers:DescriptionNumber of charger unitsNameplate kW each chargerTotal kWManufacturer (ex: Chargepoint, Clipper Creek, Bosch, etc)ModelLevel 1 PEV Charger (120v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level1*kWone 00 FORMTEXT ????? FORMTEXT ?????Level 2 PEV Charger - J1772 (240v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level2*kWtwo 00 FORMTEXT ????? FORMTEXT ?????Level 2 PEV Charger – Tesla (240v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level3*kWthree 00 FORMTEXT ????? FORMTEXT ?????DC Fast Charger - CHAdeMO (480v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level4*kWfour 00 FORMTEXT ????? FORMTEXT ?????DC Fast Charger – CCS (480v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level5*kWfive 00 FORMTEXT ????? FORMTEXT ?????DC Fast Charger – Tesla (480v) FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level6*kWsix 00 FORMTEXT ????? FORMTEXT ?????DC Fast Charger – Dual – CHAdeMO/CCS FORMTEXT ????? FORMTEXT ????? FORMTEXT =Level7*kWseven 00 FORMTEXT ????? FORMTEXT ?????Total PEV Charger: FORMTEXT =(level1*kwone)+(level2*kwtwo)+(level3*kwthree)+(level4*kwfour)+(level5*kwfive)+(level6*kwsix)+(level7*kwseven) 00Installing solar panels?No ?Yes ?Total nameplate kW capacity = FORMTEXT ?????Annual kWhIf yes, list the estimated annual kWh production in alternating current: FORMTEXT ?????It is important to provide the most accurate information available, as it is used by the Estimator to design PacifiCorp’s facilities and determine the customer’s costs. Please sign and date this form before giving it to your estimator. FORMTEXT ????? FORMTEXT ????? Customer Signature DateAttach to page 1 to submit with building load request.Note: You may wish to consult a trained professional (electrician, engineer, etc.) prior to providing the information to your estimator.Install meter outdoors at a location acceptable to the Power Company. Locate the meter within 10 feet of the street side (front side) of the residence, on the side of the residence closest to the Power Company’s source.Motors larger than 3?-35hp or 1?-5hp will require approval by our engineering department prior to installation in order to determine the acceptable starting current.Additional comments: FORMTEXT ????? ................
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