Residential New Construction Service Change Application

Service request*
Is the construction request due to house fire/demolish?*

YesNo
Primary applicant
Primary applicant or business*

First NameLast Name
Current address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone number*
Email address*
Co-applicant name

First NameLast Name
Contact name (if different from billing)
Contact phone number
Please enter a valid phone number.
Contact email
example@example.com
Billing address (if different from the above address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number
Please enter a valid phone number.
Email
example@example.com
Location information
Address of new service*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of building

HomeGaragePole buildingBarnMobile homeTownhouseOther
Legal description
Plat name
Lot
Block
Section
Township number
Range number
County*
Parcel ID
Service type (for new services please select overhead or underground). For service changes please only select service change options.*
If doing a service change, please briefly describe what you are doing.
Installation type (if temporary is chosen, an additional charge will apply)*

PermanentTemporary
If temporary, please select location of temporary service.*

5 feet from transformer5 feet from permanent service locationOther
Attach a site ready photo with the following showing in the photo: A. Address, B. UK1 or transformer, C. Meter socket *

Cancelof
If temporary, please upload a copy of the electrical permit. (If the permit is pulled by anyone other than a licensed electrician, we also require a copy of an inspection report showing it has passed inspection).*

Cancelof
Service size (amps)*
For services over 200 amps, you must complete the Electric Service & Load Information Form. Note: form must be filled out by a licensed electrician.
Are there any non-standard loads such as a motor larger than 7.5 HP?

YesNo
If yes, please explain
Meter socket location (when you are facing the front of the house from the street)*

On houseOn garageRight sideLeft sideFrontOther
Feet from corner (preferred meter location is on the same side of house as electric stub and within 15' of closest corner). If it is not, additional charges will apply. If unsure of electric stub, please call Connexus at 763.323.4214.
Feet from corner*
Date meter socket will be installed

MonthDayYear
Date
Date foundation will be backfilled

MonthDayYear
Date
Building area (sq. ft.)
Upload your site ready photo (jpg format only)

Cancelof
Buried private facilities/obstacles (please check for any buried private facilities)

WellYard lightingSewer lateralElectric fenceSepticSteep hillSprinkler systemDrain tiles/down spoutsUnderground tank/fuel linesCustom underground wiringTreesRetaining wallWetlands/creeksOther (future decks, additions, structures, fencing, pools)
Please Note: Connexus Energy and/or its agents are not responsible for damage to your facilities that are not properly marked before our work begins.
1. All buried private facilities (such as well, septic, drain tiles, irrigation systems, underground fencing, tanks, consumer-owned electric or gas lines, etc.) located on this property must be clearly marked at the job site by the customer.
2. To avoid delays, please make sure your lot is graded to within 4" of final grade, and the 10' pathway for our trench is clear of all obstructions (dumpsters, building materials, trees, stumps, etc.). Connexus is not responsible for restoring, to it's original condition, the lawn, yard, land, etc., which will be disturbed during installation.
3. Preferred meter location is on the same side of house as electric stub and within 15' of closest corner. If it is not, additional charges will apply. If unsure of location of electric stub, please call Connexus at 763.323.4214.
4. Meter socket must be attached and inspection must be complete prior to service installation. If not, services will not be installed and additional charges will apply.
5. Winter construction charges are effective from November 1 through April 1. To avoid these charges, work requests must meet all of Connexus Energy's requirements prior to November 1.
Type name*

First NameLast Name
Today's date*

MonthDayYear
Date
By submitting this application, I acknowledge I have read and understand the Conditions of Service. I also understand that my service will not be scheduled until I have met all of the necessary requirements, provided an approved electrical permit or state/local inspection card to Connexus, and Connexus has applied for and received all necessary permits.
Please verify that you are human*
Should be Empty: