APPLICATION
COLORADO
Application For Gas And Electric Services
Please photocopy both sides of this page for multiple use.
DATE
BCLCO@xcelenergy.com
PHONE: 1-800-628-2121 FAX: 1-800-628-2521
SERVICE ADDRESS (PLEASE PRINT)
House or Fire Number Full Street Name
City State Zip
Urban
Subdivision Name
__________________________
Lot Number _______________________________
Block Number _____________________________
County ___________________________________
Rural
County
____________________
Township
_________________
Range ____________________
Section ___________________
Direction to service location (Rural required)
________________________________________
________________________________________
________________________________________
________________________________________
Unincorporated Incorporated
Cross Street/Road
CONSTRUCTION INFORMATION (PLEASE PRINT)
Owner Information (Party to be billed during construction)
Owner/Builder Name
___________________________________
Mailing Address _________________________________________
City _____________________________State ____ Zip _________
Phone Number __________________________________________
Contact during construction _________________________________
Address _______________________________________________
City _____________________________State ____ Zip _________
Email _________________________________________________
Daytime phone __________________________________________
Fax __________________________________________________
Cell __________________________________________________
Contractor Information (include phone number)
Builder
_______________________________________________
Phone Number __________________________________________
Email _________________________________________________
Heating Contractor _____________________________________
Phone Number __________________________________________
Email _________________________________________________
Electrical Contractor ____________________________________
Phone Number __________________________________________
Email _________________________________________________
A & E Firm ____________________________________________
Phone Number __________________________________________
Email _________________________________________________
Required services: Electric Gas New Relocate Conversion Demolition
SERVICE INFORMATION (COMPLETE ALL SECTIONS)
Electric Service
overhead underground Service size (amps) ____________
Air conditioning tonnage: ____________ ton
single phase three phase Voltage ___________________
Is temporary electric service needed? Yes
single phase three phase at pole
at transformer pedestal other __________________
Date needed_______________ /_______________ /20_____
Foundation backll / To grade___________ /___________ /20 ______
Gas Service (For gas service, please ll out second page of application.)
Is this service being used for primary heat? Yes No
Total gas load (BTUs/hour):
_______________________________
Pressure 6 or 7 inch 2 lb Other __________________
Date needed ____________ /____________ /20_______
Foundation backll / To grade ___________ /_________ /20 _______
FACILITY INFORMATION (COMPLETE ALL SECTIONS)
Building Type
single home duplex multi-dwelling/no. of units _____________________ commercial bldg. mobile
Building Class
residential commercial farm
Building square footage
___________________________ Building setback from property line (feet) __________________________________
Electric Meter location preference (when you are facing the front of the house from the outside) on house
on garage
right side left side front other ___________ Feet from front corner __________________________________
Gas Meter location preference (when you are facing the front of the house from the outside) on house on garage
right side left side front other ___________ Feet from front corner __________________________________
For Commercial
Total motor load_________ HP _________ Largest HP _________ Code___________ BTU input ___________
See second page of form