Southern California Edison Revised Cal. PUC Sheet No. 55698-E
Rosemead, California (U 338-E) Cancelling Revised Cal. PUC Sheet No. 51873-E
Sheet 1
(To be inserted by utility) Issued by (To be inserted by Cal. PUC)
Advice 3118-E Megan Scott-Kakures
Date Filed Oct 23, 2014
Decision Vice President Effective Nov 22, 2014
1C12 Resolution
APPLICATION AND CONTRACT FOR ELECTRIC SERVICE
FORM CSD-272
APPLICATION AND CONTRACT FOR ELECTRIC SERVICE
T
o Southern California Edison (SCE):
T
he undersigned Applicant hereby requests you to supply electric service and to deliver electric energy to and for the equipment hereinafter described, at the location shown on the reverse
side hereof, in accordance with the applicable rates and rules of SCE.
A
pplicant hereby agrees to the following:
1
. SCE has made available for inspection its applicable rates and rules. Applicant agrees to comply therewith, and with any changes or modifications thereof which may be authorized from
time to time by the Public Utilities Commission of the State of California.
2
. Applicant’s attention has been directed to the rate schedules applicable to the service herein described, and Applicant has elected to take and pay for service under Schedule
____________________ for a minimum period of ____________________ months.
3
. Applicant hereby grants to SCE a right of way for any electric lines which it may be necessary to build in, on, under or over applicant’s premises for the purposes of making delivery here-
under. Where Applicant requests facilities which are in addition to, or in substitution for, the standard facilities which SCE normally would install, the extra cost thereof shall be paid by
Applicant.
4. If an Applicant, per the assigned period(s) within the agreed upon Rate Schedule(s) and/or contract(s) materially increases or decreases his electric service requirements from those
i
nstalled hereunder and a change is made in the SCE’s facilities, settlement shall be made for the installation and removal cost of the facilities removed. A new agreement shall be
entered into providing for the modified service required by applicant.
5
. This contract shall at all times be subject to such changes or modifications by the Public Utilities Commission of the State of California as said Commission may, from time to time, direct
in the exercise of its jurisdiction.
EQUIPMENT TO BE SERVED PHASE K.V.A. K.W. H.P.
LIGHTING
POWER
Service Voltage _______________________________________ Connected Load ______________________ Est. Max. Demand _____________________________________________________
____________________________________________________ Corporate or Individual’s Name ________________________________________________________________________________
Dated _______________________________________________ D.B.A. ____________________________________________________________________________________________________
By ________________________________________________________ Title ___________________________________________
Witness _____________________________________________ Office of Origin _____________________________________________________________________________________________
Approved and accepted for Southern California Edison Company
____________________________________________________ By ________________________________________________________________________________________________________
District Manager
SCE CSD 272 REV 1/13 (CW) Printed on recycled paper
A
ZIP CODE
SERVICE ADDRESS STREET
NAME
CREDIT INFORMATION – FORM OF BUSINESS ORGANIZATION
P
ROPRIETORSHIP
CORPORATION
GENERALSOLE
P
ARTNERSHIP
CO-PARTNERSHIP OTHER
TYPE OF BUSINESS–PROCESSING, MFG., ETC.
CORPORATE OR INDIVIDUAL’S NAME
DBA NAME BUSINESS TELEPHONE NUMBER
PARTNERS OR CORPORATION OFFICERS
NAME ADDRESS TITLE
TELEPHONE
NUMBER
NAME ADDRESS TITLE
TELEPHONE
NUMBER
SERVICE ADDRESS STREET
SERVICE ADDRESS POST OFFICE
FORMER BUSINESS SERVICE ADDRESS
TELEPHONE
NUMBER
DATE WANTED
NEAREST CROSS STREETSCHEDULE
METER ORDER NO.
LOAD CHECK
LIGHT
POWER
NEW SET
HOURS OF OPERATION
SQUARE FOOTAGE (AS REQUIRED)
ADDITIONAL INFORMATION
ORDER TAKEN
AT B Y DAT E
APT NO.
SERVICE ADDRESS POST OFFICE
CA
ZIP CODE
MAILING ADDRESS
MAILING ADDRESS
OWNER OF PREMISES
ADDRESS
NAME
PROJECT NO.
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