2. 
4. Electric Service Application
6. Service Address*
8. Owner Name*
10. Billing Address*
12. Phone#
13. Cell#
14. Email Address
16. Electrician/Service Installer
18. Contact Name
20. Mailing Address
22. Installer Phone#
23. Installer Cell#
24. Installer Email Address
28. Service Information
30. Service Address Classification*

    1. Residential

    1. Commercial

    1. Industrial

    (New commercial and Industrial services will require a site plan)
32. Voltage*

    1. 120/240 Volt, Single Phase
    2. Three Phase (see note 7)
    3. Other
33. Amperage
35. If other please describe
37. Contact the Borough's Electric Division (717.738.9236) for Service Location.
39. Service Entrance*

    1. New*
    2. Overhead
    3. Underground
    4. Upgrade

    1. Temporary (Req'd Fee- $125 plus permit & Insp. fees)
    2. Relocated
    3. Remove meter/Service (Req'd Fee- $125)
    4. Meter Test (Req'd Residential Fee- $50)

    *For new service connections the owner needs to contact the Ephrata Borough Business Office (717.738.9222) at least 1 week prior to occupancy to have the utility account placed in the owner's name. Please be prepared to provide the required information to the Borough- home and work phone numbers, social security#, etc.
41. What is the type of heat (Electric, Oil, Propane, etc.)
42. Estimated date service will be required
    Estimated date service will be required
44. Description of proposed work
46. List of any special/unusual electrical equipment needs from the utility
48. Size and number of service conductors (if applicable)
50. 1. All electric service facilities of the customer shall be installed and maintained in accordance with the Electrical Code adopted by the Borough. The Borough will not connect electric service or facilities to a structure or building (or major alteration of a structure or building), which has new wiring unless the installation has been inspected and approved by the municipal electrical inspector.
52. 2. The Borough reserves the right to reject any application for service for any reason, including but not limited to those instances where such service is not available under a standard rate schedule or where such service would otherwise require excessive service or installation costs or where such service may adversely affect the level of service to other customers.
54. 3. Electric will only be furnished by the Borough if the applicant complies with all the provisions of Chapter 165 of the Code of the Borough of Ephrata and the customer agrees to accept and comply with all rules, regulations, rate schedules, terms, conditions, and provisions of the same chapter.
56. 4. No person or organization shall occupy any dwelling or building within the Borough unless electric service is furnished in accordance with the Borough's standard requirements for electric service.
58. 5. Electric service is provided solely through the Borough's electric meters to the customer for use on customer owned or rented/leased premises. No customer may resell any electric service provided by the Borough or install any unauthorized metering system.
60. 6. Whenever, in the judgement of the Electric Division, the customer's installation has become dangerous or defective, or whenever, in the judgement of the Electric Division, the customer's service wires have been altered, tampered with or otherwise interfered with by the customer, the Borough reserves the right to disconnect the electric service.
62. 7. Three phase may be available. Individual requirements should be discussed early with the Borough Electric Division and will be handled on a case-by-case basis. Please contact the Borough for three phase voltage types, requirements, and availability at 717.738.9236.
64. 8. Each applicant for electric service involving special facilities or equipment must complete and execute an agreement identifying all special requirements of the applicant's installation or use of electricity and agreeing to comply with the conditions of service and such other requirements as may be deemed by the Borough Electric Division to be reasonably necessary for safe and efficient electric service.
68. Complete this section for New Services, Upgrades, Temporary Services, and Relocations. Allow a minimum of five (5) working days for permit to be issued.
70. Total Cost of Electrical Work
71. Anticipated Start date
    Anticipated Start date
72. Anticipate Finish Date
    Anticipate Finish Date
74. If Residential Work

    1. Single-Family
    2. Two-Family
75. Approximate number of electrical inspections needed
79. The applicant certifies that all information in this application is correct and the work will be completed in accordance with the approved construction documents and PA Act 45 (Uniform Construction Code) where applicable. Issuance of a permit and approval of construction documents shall not be construed as authority to violate, cancel or set aside any provisions of the codes or ordinances of the Municipality or any other governing body. The applicant certifies he/she understands all the applicable codes, ordinances and regulations.
81. Application for a permit shall be made by the owner or lessee of the building or structure, or agent of either, or by the registered design professional employed in connection with the proposed work.
83. I certify that the code administrator or the code administrator's authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the codes(s) applicable to such permit.
85. Name*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
86. Date*
    Date
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit Submit and Print

* indicates a required field