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Residential Electric Service Construction Application
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Member Information
Account Number
Have you been or are you currently a member of Beltrami Electric Cooperative?
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Yes
No
If yes, please list which account number you would like this billed to.
Member Name
Member Name
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Mailing Address
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Service_address
Service/Site Address
City/Town
State/Province
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Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Contact phone number(s) (List all)
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Contact phone number(s) (List all)
Contact phone number(s) (List all)
Type
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Home
Office
Cell
Phone
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Email Address
Joint Member Name
Joint Member Name
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Middle
Last
Social Security Number (Joint Member)
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Date of Birth (Joint Member)
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Joint Member Contact Phone Numbers
Use the green Plus (+) button to enter additional contact phone numbers.
Joint Member Contact Phone Numbers
Joint Member Contact Phone Numbers
Type
?
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Home
Office
Cell
Phone
Item weight
Joint Member Email Address
Service Construction Information
Preferred method of contact regarding this new service?
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Phone Call
Email
Type of Structure
?
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House
Mobile Home
Cabin
RV site
Other (Specify)
Is this within city limits?
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Yes
No
Unknown
If yes, select city:
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Bemidji
Blackduck
Cass Lake
Kelliher
Laporte
Tenstrike
Name of closest neighbor with power
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
Township, Section, Range and Parcel ID
?
Please enter the E-911 Address for the location (if assigned)
Enter the E-911 address if assigned
?
Heat Type (Select all that apply)
Electric
Propane/Natural Gas
Wood
Fuel oil
Unknown
Will you be installing electric off-peak heating?
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Yes
No
Unknown
Will you be installing an Electric on-demand water heater (10 kVA or larger)?
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Yes
No
Unknown
An electric on-demand water heater will affect the size and cost of the electric service needed at the location.
Upload Site Sketch
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
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 Electrician
?
Name of Electrical Contractor
?
Electrician contact phone number
I agree to the Construction
Terms and conditions
.
Electric Service Construction Terms & Conditions
It is the owner's responsibility to locate and expose their private lines before construction takes place. All markers need to be intact when construction happens. Any water lines buried deeper than 48 inches do not have to be exposed. 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 fences or sprinkler system lines.
It is the applicant's responsibility to obtain and clear right-of-way.
Applicants will pay for the cost of all permits and/or grant of easements required for this electric service and will help obtain any permits and/or easements necessary to construct the line.
This type of work will be done as construction crews are available. Emergencies, such as outages, maintenance, road moves, and other necessary line construction will have priority over construction of services.
All construction cost quotes are valid for the current construction season, January 1 to December 31, and do not include any membership fee or deposits that may be due.
Frost charges of an additional $7.00 per foot with a $500 minimum will be applied to all underground services installed between November 1 and May 1 of each year dependent on MnDOT road restrictions.
If the 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.
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.
Disconnection of a new service may be made after one year of continuous service. If a member requests disconnection prior to one continuous year of service, the current access charge for the remaining months of that year will be billed to the member via a lump sum on final bill.
Beltrami Electric is not responsible for restoration of property on a new construction site or requested service improvement.
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