Fillable L2 and DCFC Make Ready Program Application (Central Hudson)

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L2 and DCFC Make Ready Program Application (Central Hudson)

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L2 and DCFC Make Ready
Program Application
Refer to the Additional Documents Section of this application for further documentation required for the L2 and DCFC Make-Ready Program.
Please complete application and email with all required documentation to: EVMakeReady@cenhud.com
Project Number (Completed by Central Hudson) _____________________________
Job Number (Completed by Central Hudson) _____________________________
Would you also like to apply for the DCFC Per-Plug Incentive Program? o Yes
o No
o I am only interested in EV supply equipment electrical service and am not applying for incentives under the DC Fast Charger
Per-Plug Incentive Program and/or the Make-Ready Incentive Program. (Check box to opt-out)
Customer Information
Customer Name Central Hudson Account No.
Primary Contact Name
Work Phone Cell Phone Email
Address 1
Address 2
City State Zip
Participant Information (Please complete if the Participant is any entity other than customer listed above. The Participant is
the entity receiving program incentives. For details, see Participant Guide link on page 3.)
Participant Name
Primary Contact Name
Work Phone Cell Phone Email
Address 1
Address 2
City State Zip
Site Owner/Developer Information (Please complete if entity is other than Customer or Participant listed above.)
Site Owner/Developer Name
Primary Contact Name
Work Phone Cell Phone Email
Address 1
Address 2
City State Zip
L2 and DCFC Make Ready
Program Application
Project/Site Description
Address of Proposed L2 or DCFC Station (If different than Customer, Participant, or Site Owner/Developer information):
Same as: o Customer o Participant o Site Owner/Developer If existing location, list account number:
Address 1
Address 2
City State Zip
Type of facility:
o Multi-Unit Dwelling
o College/University
o Medical
o Other Commercial or Industrial o Retailo Office
o Other (Please specify):
______________________________________________________________________________________________________________________________
Are chargers intended or available for public use? o Yes
Is proposed site located in an economic justice community?
o I
No
Yes
o No
o Do Not Know
Type
Manufacturer
and Model
Number
of
Stations
Number
of
Plugs
Plug Type
(SAE J
Plug,
CCS,
CHAdeMO,
Other)
Charging
Output
per Plug
(kW)
Number of Plugs
Capable of
Simultaneous
Charging and
Output per Plug
kW)
Level 2
DCFC
o NoHave you previously requested a new service or service upgrade for this location? o Yes
If Yes, please provide the Job # for this location:
Are you requesting as part of this application a new service or service upgrade for this location? o Yes o No
If yes, please describe the necessary service requirements including single or multi-phase, voltage and/or transformer ratings:
_____________________________________________________________________________________________________________
_________________
Demand management software or hardware? o Yes o No If Yes, please briefly describe (i.e. Uses Open ADR):
_____________________________________________________________________________________________________________
_________________
Will EV supply equipment be bi-directional at present, in the future, or exclusively load? (List one)
_____________________________________________________________________________________________________________
_________________
Any co-located distributed generation or energy storage? o Yes
o No
Other notes regarding project description:
_____________________________________________________________________________________________________________
_________________
Contractor Information
Contractor Name
Has contractor completed an Approved Contractor Application? o Yes o No
If No, contractor must complete an Approved Contractor Application at the Joint Utilities of New York website.
Primary Contact Name (If not previously provided)
Work Phone Cell Phone Email
L2 and DCFC Make Ready
Program Application
10/20
Cost Information
Will futureproofing work
be performed at this site?
o Yes o No
Total futureproofing costs:
$
Number of additional ports supported by
futureproofing:
Total customer side electrical
infrastructure cost:
$
Total utility side costs (if known):
$
Total project cost excluding futureproofing
and charging equipment:
$
Additional Documentation (Required) L2 and DCFC Make-Ready Program
1. Quotes or invoices for customer side make ready
• Please show separately the total cost for cable, conduit and trenching/ restoration inclusive of material and labor and the total
length in linear feet.
• Please show separately the total costs for other electrical infrastructure such as panels and breakers inclusive of material and
labor and the electrical rating of such equipment.
• Please show separately costs for all non-electrical infrastructure costs such as bollards, signage, striping and mounting bases
and/ or hardware. These items are not eligible for make-ready incentives.
• Please show separately incremental costs for futureproofing (If any) including additional cable and conduit or upsizing of cable
and conduit and trenching backfill and restoration related to futureproofing inclusive of material and labor.
• Please show separately incremental costs for futureproofing (If any) for other electrical infrastructure such as panels and
breakers inclusive of material and labor.
2. Site plan with location of chargers including distance from existing or new services
3. Satellite image of site and location of chargers
4. Charger Specification Sheets
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L2 and DCFC Make Ready Program Application (Central Hudson)

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Completed 9 June 2021

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