Fillable Application for Underground Utility Extensions to a New (Central Hudson)

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Application for Underground Utility Extensions to a New (Central Hudson)

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Application for Underground Utility Extensions to a New Residential Subdivision
Applicant Name: _______________________________________________________
(As it is to appear on Contract)
Address: _________________________________________________________
_________________________________________________________
Contact Person: _______________________________________________________
Telephone: ______________________ Fax No: _________________________
Cell Phone: ______________________ Email: ___________________________
Name of Subdivision: __________________________________________________
Subdivision Location: __________________________________________________
Total Number of Approved Dwelling Units Proposed in Subdivision: ____________
Type of Residential Subdivision:
( ) Single Family Home ( ) Multi-Family Buildings
Construction Schedule:
Date Service Required Number of Dwelling Units to Be Completed
& Ready For Service.
Phase 1 _______ ___________________________________
Phase 2 _______ ___________________________________
Phase 3 _______ ___________________________________
Type Use (check one or more)
( ) Electric or ( ) Natural Gas: Space Heating ( ) Electric or ( ) Natural Gas: Cooking
( ) Electric or ( ) Natural Gas: Water Heating ( ) Electric or ( ) Natural Gas: Fireplaces
( ) Electric or ( ) Natural Gas: Dryers ( ) Central Air Conditioning
( ) Natural Gas Generator ( ) Other (Specify) __________
Attached is an approved map of the subdivision described above. I hereby make application to Central Hudson Gas
& Electric Corporation for the supply of underground electric service to this subdivision. Service supplied under
this application will be taken and paid for by the applicant in accordance with the rules and regulations, and at the
rates, contained in the Company’s tariffs and schedules as filed from time to time with the Public Service
Commission of the State of New York.
This application will remain in effect until canceled by the applicant. However, failure to commence construction of
the above subdivision within 18 months of the date the application is received by Central Hudson Gas & Electric
Corporation will also result in the cancellation of this application.
___________ ___________________________ __________________________________________
Date Applicant’s Signature Print Name/Title
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signature
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REQUIREMENTS FOR NEW SUBDIVISION
How many lots in this subdivision? _______What are the size of the lots? ____________
If multi family, what type? Apartments, condominiums or townhouses-and are they separately
metered?
________________________________________________________________________
If multi family, how many floors and will elevators be needed? _________________
Does this subdivision have final approval? ________
Will this be done in phases or all at once? ___________________________________
Will there be a pump station? ______________ What is the load? _________________
Single Phase or Three Phase service? _______________
Will there be a sewer lift station? ________________What is the load? ______________
Single Phase or Three Phase service? ________________
Is there a backup generator needed for water or sewer? ______What is the load?_______
What is the road width? __________ Is there a requirement from the Town or City on where the
utilities need to be placed along the shoulder? _______________________
Are there any easements? _______ Drainage? _______Snow? ________Sight? ________
Any others? ____________
Are there town sewer and/or water? __________________________________________
Is there a preference to which side of the road utilities should be placed based on sewer and
water main location? __________________
Is there any rock to take into consideration when trenching? __________
When will the road be cut in? _____________________
Will it be a private or public road? _____________________
Will there be curbs? __________
Will there be sidewalks? _________
Will there be guardrails installed anywhere? ____________________________
Are there stream or water crossings to take into consideration? ______________
Where? _______________
Are there any restrictions from DEC because of waterways? __________________
Where? _______________
Are there any special conditions that that have to be met per the Local Highway Superintendent?
_______________________________________________________________________
Are there grade or slope concerns anywhere at the site? ____________________
Will the utilities have to cross drainage pipes of any kind? _________________
What is the square footage of the houses/condos/apts. being built? __________________
What is the electric (kW) load for each house? ___________________
Will solar be installed as part of the project? _______ If yes, please provide details
_______________________________________________________________________
What is the gas (btu) load, if applicable, for each house? ______________________
Will there be central air conditioning? ___________
Will there be natural gas fireplaces? ______________
Will there be EV (electric vehicle) charging stations? ______________
Is there a requirement by the town for street lighting? _________________________
If Central Hudson is lead agency, are you interested in the excavation of the distribution trench
(at our tariff price)? _____________________
Please provide the closest CH pole # to the entrance of subdivision_________________
Please provide the closest intersecting road and the closest street address (residential) to the
entrance of subdivision________________
Are there any particular requests you have for us in preparing the layout? _____________
________________________________________________________________________
________________________________________________________________________
The utility layout/design may take up to 8 weeks to complete. There will be a charge to
redo the layout, based on current Estimating charges, if it is due to information not
supplied to Central Hudson at the time of completing this form.
Completed By _____________________________________
Date ________________________
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Application for Underground Utility Extensions to a New (Central Hudson)

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Completed 9 June 2021

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