Residential Electric Service Construction Application

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Account Number

Have you been or are you currently a member of Beltrami Electric Cooperative?

If yes, please list which account number you would like this billed to.

Member Name

Enter name of primary member or business name, if applicable

Middle

Last

Enter full name of primary member on account

Date of Birth

Mailing Address

City/Town

State/Province

ZIP/Postal Code

Enter current mailing address here

Service/Site Address

City/Town

State/Province

ZIP/Postal Code

Use the green Plus (+) button to enter additional contact phone numbers.

Contact phone number(s) (List all)
Contact phone number(s) (List all) Type Phone

Email Address

Joint Member Name

Middle

Last

Date of Birth (Joint Member)

Use the green Plus (+) button to enter additional contact phone numbers.

Joint Member Contact Phone Numbers
	Joint Member Contact Phone Numbers Type Phone	Item weight

Joint Member Email Address

Service Construction Information

Preferred method of contact regarding this new service?

Type of Structure

Is this within city limits?

If yes, select city:

Name of closest neighbor with power

This will assist us in finding the location of the property on our map.

Township, Section, Range and Parcel ID

Enter the E-911 address if assigned

Heat Type (Select all that apply)

Will you be installing electric off-peak heating?

Will you be installing an Electric on-demand water heater (10 kVA or larger)?

An electric on-demand water heater will affect the size and cost of the electric service needed at the location.

Will you be installing an Electric Vehicle charger now or in the future?

An electric vehicle charger will affect the size and cost of the electric service needed at the location.

Upload Site Sketch

To facilitate the process of installing or changing your electric service, please complete the site sketch indicating placement of private facilities such as private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fences, sprinkler system lines, etc.

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, jpg.

Upload Copy of Warranty Deed

Upload Document

In order to complete an easement, Beltrami Electric Cooperative requires a copy of the property Warranty Deed or Reservation/Tribal Land assignment that includes the land owner's names and a legal description of the property. Right-of-way easements give Beltrami Electric Cooperative permission to install and maintain electrical equipment on your property.

One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, ppt, pptx, xls, xlsx, jpg.

Additional Notes/Comments

Contractor Information

Name of Contractor

If you have a contractor for this project, please fill in their contact information here.

Contractor's Phone Number

Contractor's Email Address

Name of Electrician

Name of Electrical Contractor

Electrician contact phone number

I agree to the Construction Terms and conditions.

Electric Service Construction Terms & Conditions

I understand that as the owner, it is my responsibility to locate and expose any private lines before construction takes place. I will leave all markers intact and will not move. I will expose any water lines buried deeper than 48 inches do not have to be exposed.
I understand that the cooperative is not responsible for damages to private lines such as cable TV, satellite, private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fencing, or sprinkler system lines.
I understand that it is my responsibility to obtain and the clear right-of-way for this project.
I will pay for the cost of all permits and/or grant any easements required for this electric service and will help obtain any permits and/or easements necessary to construct the line.
I understand that this type of work will be done as construction crews are available, and that emergencies, such as outages, maintenance, and other necessary line construction will have priority over construction of services.
I understand that all quotes for contribution in aid of construction charges are only valid for the current construction season ending Dec. 31, and do not include any membership fee or deposits that may be due.
I understand that winter construction charges will apply for any service constructed between Nov. 1 and May 1 of each year, and will be in addition to the standard service charges.
I understand that services are energized at the time of construction. Billing for the monthly access charge will begin once a new service has been built and will continue for a minimum of 12 months. The access charge will be billed according to the current rate structure regardless of any energy used.
I understand that if my service cannot be energized at the time of construction, a meter reconnect fee will apply at the current reconnect rate. Any work in addition to energizing that cannot be completed will be considered a Service Improvement or New Relocation of Facilities and subject to the current rates.
I understand that if I request a disconnection before one continuous year of service, I will be billed the current access charge for the remaining months of that year will be billed to the member via a lump sum on final bill.
I understand that Beltrami Electric is not responsible for the restoration of property on a new construction site or requested service improvement.

Name of person signing application

Application Signature

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Residential Electric Service Construction Application

Use the green Plus (+) button to enter additional contact phone numbers.

Use the green Plus (+) button to enter additional contact phone numbers.

To facilitate the process of installing or changing your electric service, please complete the site sketch indicating placement of private facilities such as private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fences, sprinkler system lines, etc.

I understand that as the owner, it is my responsibility to locate and expose any private lines before construction takes place. I will leave all markers intact and will not move. I will expose any water lines buried deeper than 48 inches do not have to be exposed.

I understand that the cooperative is not responsible for damages to private lines such as cable TV, satellite, private electrical, water, well, sewer, telephone, gas, lift station pump lines, underground dog fencing, or sprinkler system lines.

I understand that it is my responsibility to obtain and the clear right-of-way for this project.

I will pay for the cost of all permits and/or grant any easements required for this electric service and will help obtain any permits and/or easements necessary to construct the line.

I understand that this type of work will be done as construction crews are available, and that emergencies, such as outages, maintenance, and other necessary line construction will have priority over construction of services.

I understand that all quotes for contribution in aid of construction charges are only valid for the current construction season ending Dec. 31, and do not include any membership fee or deposits that may be due.

I understand that winter construction charges will apply for any service constructed between Nov. 1 and May 1 of each year, and will be in addition to the standard service charges.

I understand that if I request a disconnection before one continuous year of service, I will be billed the current access charge for the remaining months of that year will be billed to the member via a lump sum on final bill.

I understand that Beltrami Electric is not responsible for the restoration of property on a new construction site or requested service improvement.

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