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Customer Information: EXISTING CUSTOMER

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ELECTRIC SERVICE REQUEST FORM- SERVICE UPGRADE
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054 Fax: 1-800-882-0322 Email: cfny@nationalgrid.com
Please fill out all necessary information completely and legibly.
ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED
Customer Information: CURRENT ACCOUNT # ___________________________________
Customer Name: Last 4 of SSN, Customer #, or Tax ID*:
Phone:
Mailing Address:
*Last 4 of SSN, Customer #, or Tax ID is required if any meters are being added
Service Address:
House #: Street:
Town/City: State: Zip: Meter #:
Contractor Information: *PLEASE CHECK YOUR PREFERRED METHOD OF CONTACT
Company:
Contact Name: Phone:
Email: Fax:
Mailing Address:
Select one of the below options:
An appointment will be required for National Grid to do the Disconnect Reconnect
The contractor is a member of the National Grid Connects program and will be doing the Disconnect Reconnect IN an
authorized municipality
The contractor is a member of the National Grid Connects program and will be doing the Disconnect Reconnect OUTSIDE
an authorized municipality (must completed the disconnect reconnect section of this form)
The contractor is not a member of the National Grid Connects program and is requesting to do the Disconnect Reconnect
(must complete the disconnect reconnect section of this form)
Service Order Information: ALL THAT APPLY
RESIDENTIAL
COMMERCIAL
Upgrade existing service Relocate existing service Add Meter Remove Meter
Please provide a brief description of the work being performed:
Service Characteristics:
Overhead: Underground: URD:
Amps: Before After Voltage: / Single Phase: 3-Phase:
KW: Before After Primary: Secondary:
ELECTRIC SERVICE REQUEST FORM- SERVICE UPGRADE
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054 Fax: 1-800-882-0322 Email: cfny@nationalgrid.com
Please fill out all necessary information completely and legibly.
ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED
How many existing meters currently? Are you adding any meters?* Y N If so how many?
Are you removing any meters? Y N If so how many?
What is the meter socket attached to: House Pedestal Meter pole
* If meters are being added, please include additional documentation indicating appropriate labeling for units/apartments.
Is a site visit needed? Yes: No:
Do you need to meet with a designer on site to discuss the job details? Yes: No:
Are the meters outside? Yes: No:
Do any of the meters need to be exchanged? Yes: No:
Will the meter(s) be moving? Yes: No:
If so, how many feet are the meter(s) moving?
Does the meter socket have a 4ft clearance on the front and side of the meter? Yes: No:
Is the meter face mounted between 3 ½ and 5 ½ ft from finished grade? Yes: No:
Is there a 3 ft clearance away from any gas regulating vents? Yes: No:
Is the point of attachment relocating? Yes: No:
If so, how many feet is the point of attachment moving?
Does the point of attachment have a minimum of a 3 ft clearance, in any direction, from
windows, doors, fire escapes, porches, or similar locations?
Yes: No:
Can the point of attachment be reached by ladder? Yes: No:
Does the service drop have a minimum of 13 ½ ft and no higher than 25ft above finish grade? Yes: No:
Is there a minimum of 17 ½ ft of clearance over streets and parking areas subject to truck
traffic?
Yes: No:
Do the service conductors pass over a roof? Yes: No:
Has the service wire been spliced more then 2 times? Yes: No:
Is the service triplex? Yes: No:
Does the service drop cross over any properties other then the house it serves? Yes: No:
Does the service drop cross over a swimming pool? Yes: No:
Is the pole that the service is fed from on the same side of the street as the house? Yes: No:
What is the approximate length of the service going from pole to house?
Is electric heat being added? If there is existing electric heat select No. Yes: No:
If you are a member of the Ngrid Connects Program, will you be using National Grid
connectors for this job?
Yes: No:
ELECTRIC SERVICE REQUEST FORM- SERVICE UPGRADE
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054 Fax: 1-800-882-0322 Email: cfny@nationalgrid.com
Please fill out all necessary information completely and legibly.
ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED
Disconnect Reconnect Form
This section need to be completed if:
- The contractor is a member of the National Grid Connects program and will be doing the Disconnect Reconnect
OUTSIDE an authorized municipality
OR
- The contractor is not a member of the National Grid Connects program and is requesting to the Disconnect
Reconnect
Customer Name:
Contractor Name:
License Number:
Contractor Phone Number:
I am requesting the following service:
Contractor disconnects and National Grid Reconnects- 12 business days notice required
Contractor disconnects, reconnects and resets meter- 5 business days notice required
Scheduled Completion Date: _______________________
All of the following conditions exist and I assume the responsibility of a correct meter and service location and that
the installation meets the requirements of National Grid ESB 750.
1. Overhead, residential service, 200A or less.
2. Same point of attachment.
3. Meter box to be located outside, accessible to meter reading and protected from physical damage.
4. Point of attachment is accessible from the ground with ladder and is able to withstand 500 lbs. pull.
5. Service drop maintains minimum clearances per the NEC and National Grid ESB 750 — available at
www.nationalgridus.com/electricspecifications
By signing this form, the owner and contractor (a) acknowledge they have read and understand the disconnect
reconnect customer instructions; (b) acknowledge that they are not relying upon National Grid with regard to the
means, methods, practices, or any aspect of the work; (c) attest that the person performing the electrical work is
NEC- qualified; and (d) agree to indemnify and hold National Grid harmless for any loss or injury to person or
property arising out of the work of the owner, contractor, or their agents, employees or contractors. The Owner and
Electrician assume all risk resulting from performing their own disconnect /reconnect.
Contractor Signature: ______________________________________________________ Date: __________________
Customer Signature: ______________________________________________________ Date: __________________
ELECTRIC SERVICE REQUEST FORM- SERVICE UPGRADE
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054 Fax: 1-800-882-0322 Email: cfny@nationalgrid.com
Please fill out all necessary information completely and legibly.
ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED
Disconnect/Reconnect Form — Customer/Electrician Instructions (cont.)
This policy does not permit the customer to have an un-metered service. The meter shall be re- installed in the new (or
existing) meter socket prior to carrying load.
The customer or their contractor may not begin work without a returned signed copy of the Disconnect/Reconnect
form from the Company. It is the expectation of the Company that work will be completed within two weeks of the
application date.
Homeowners and others have the right to work on electrical equipment in those jurisdictions where electrician licenses
are not required. In doing so, they assume personal responsibility for their knowledge, ability and safety. Persons
performing residential electrical work under this policy shall be required to attest in writing they are NEC qualified.
The term NEC-qualified person(s) shall be used in all documents relating to this policy and understood to mean
qualified person(s) as defined in the current edition of the NEC as — “One who has skills and knowledge related to the
construction and operation of the electrical equipment and installations and has received safety training on the hazards
involved”.
Procedure:
1. Fill out the Disconnect/Reconnect form completely and return it to the email address or fax number on the form.
Note - incomplete forms shall be returned to the customer.
2. Wait for the Company to return the Disconnect/Reconnect form with a work order number. The returned form
constitutes written permission from the Company to temporarily remove the meter to modify the service entrance.
3. When ready to commence their work, the NEC-qualified person will cut the service entrance conductors on the
customer’s side of the service connection. See attached Figure 1.
4. The seal on the meter can then be broken, and the meter removed and secured.
5. Once the service is de-energized, work may begin on the customer-owned premises wiring and equipment.
6. Sufficient length shall be left on the individual service entrance conductors to allow them to reach the existing
service connection and create a sufficient drip loop according to ESB 750.
7. Upon completion of their other work, the person shall make temporary connections to the remaining piece of each
service conductor utilizing Anderson LC-51-C-XB or LC-52-C-XB connectors or equivalent parallel groove connector,
insulated with Anderson PTC 51 or 52 or equivalent plastic cover or black electrical tape.
8. Following the electrical inspection, the person shall install the meter in the new channel and secure it with a nylon
wire tie. See attached Figure 1.
9. Once the inspection is called into the National Grid VRU system, National Grid shall make the permanent
connections to the new service entrance conductors. The connectors shall be left at the work site for retrieval by the
owner or their contractor.
ELECTRIC SERVICE REQUEST FORM- SERVICE UPGRADE
CUSTOMER FULFILLMENT: Phone: 1-800-260-0054 Fax: 1-800-882-0322 Email: cfny@nationalgrid.com
Please fill out all necessary information completely and legibly.
ANY INCOMPLETE ORDERS WILL NOT BE PROCESSED
Disconnect/Reconnect Form — Customer Electrician Instructions (cont.)
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Customer Information: EXISTING CUSTOMER

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Completed 9 December 2020

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