COMMERCIAL / INDUSTRIAL CUSTOMER INFORMATION SHEET
-10287005615940-87630COMMERCIAL / INDUSTRIAL CUSTOMER INFORMATION SHEETPlease complete this form and return to the Estimator assigned to your jobBusiness InformationBusiness / Customer Name: FORMTEXT ????? Request Number: FORMTEXT ?????Address: FORMTEXT ????? Person responsible for advance and contract billing (if different than monthly billing customer):Name: FORMTEXT ????? Address: FORMTEXT ????? Phone No.: FORMTEXT ?????E-mail Address: FORMTEXT ????? Fax No: FORMTEXT ????? Building Square Footage: : FORMTEXT ????? Note: breakdown into use (i.e.: office, warehouse)Hours of Operation (include days & hours): FORMTEXT ?????Service DescriptionDesired Secondary Voltage: FORMCHECKBOX 3 Phase 120/208v FORMCHECKBOX 3 Phase 277/480vNote: Not all voltages may be available FORMCHECKBOX 1 Phase 120/240v FORMCHECKBOX 1 Phase 120v Only FORMCHECKBOX Other FORMTEXT ?????Panel Size (in Amps): FORMTEXT ????? Total number of 3 Phase meters: ≤ 200 A FORMTEXT ????? > 200 A FORMTEXT ????? Total number of 1 Phase meters: ≤ 400 A FORMTEXT ????? > 400 A FORMTEXT ?????Nearest Pole or Equipment number: FORMTEXT ????? Type of Service Desired: FORMCHECKBOX Overhead FORMCHECKBOX UndergroundElectrical Contractor: FORMTEXT ????? Phone No.: FORMTEXT ????? Load List (attach additional sheets if necessary)DescriptionMotor starting codeNew Load to be addedLoad to be removedTotal Connected Load after changesUnitHVAC (name plate rating) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Refrigeration Equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Tons*Total (do not convert to kW) : FORMTEXT =Tons1+Tons2 00TonsExhaust Fans FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPGas/Fuel/Sump Pump FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPSmall Motors < 10 HP FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPAir Compressor FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPSwimming Pool FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPLarge Motors > 10 HP (not included above) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????HPTotal (do not convert to kW) : FORMTEXT =Horse1+Horse2+Horse3+Horse4+Horse5+Horse6 00HPElectric Heat FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWWater Heating FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWLighting FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWOutlets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWOffice Equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWKitchen Equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWComputers, Magnetic Power Supplies FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWMachinery FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWThermoplastic Injection Equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWElevators FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWBoiler FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWSnow Melting FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWSigns FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWX-Ray Equipment FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWWasher/Dryer FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWMiscellaneous FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWHeat Exchanger FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWHumidifier FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWFuture FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????kWFor PEV (plug-in electric vehicle) chargers see page 2.Total: FORMTEXT =watt1+watt2+watt3+watt4+watt5+watt6+watt7+watt8+watt9+watt10+watt11+watt12+watt13+watt14+watt15+watt16+watt17+watt18+watt19 00kW 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 SignatureDatePlug-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 SignatureDateAttach 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 mercial metering can have many restrictions that should be discussed with the estimator prior to the purchase and installation of your metering equipment. There are also restrictions regarding master metering. If your plans call for master metering, please discuss this with your estimator.Motors larger than 35hp three phase or 3hp single phase 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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