City of Columbiana Electric: Service Application
App. #
Date:
Address of service:
Lot/Unit/Suite # :
Name:
Phone # :
Customer Account #:
Service Details
New:
Revamp:
Size of service in AMPS:
Vo
ltage Required :
Connection type:
Overhead
Underground
Est. URD Length
Electrical Contractor:
State ID #:
Phone #:
Date Requesting Service: ___________________________
Signature:_______________________________________ Date: ________________
****NEW 2020 Muilty dwelling meter socket must be identified/ labeled by a permanent affixed label durable to the environment. No
exceptions!****
Notes:
Completed by:
Reading:
Office Use Only
Total Amount Due:
Meter Fee:
Footage Cost:
1/0 O.H.-$3.45ft 3/0 O.H. $4.62ft
1/0 URD- $6.00ft 3/0 URD- $10.00ft
Footage of Extension:
Service Costs
Bar Code:
Meter #:
Date of Service:
If service is URD please fill in estimated
footage
Commercial Meters Required:
**********Forms must be return to Utility Office or emailed to dsturgeon@columbianaohio.gov before service can be given**********
Permit No.
All services that are a Revamp or New must be inspected by : Central Inspection or State of Ohio, Upon release from inspection agent service's will be energized
Phase:
click to sign
signature
click to edit
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