Lighting Installation Application - Trico Electric Co-Op

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Date*

Trico Member Status*

New Trico Member

Existing Trico Member

Customer Number

Billing Account Information

Name*

First Last

Social Security

Day Phone

Business Phone

Home Phone

Fax

Owner, Agent, or Contractor Information

I am the:

Owner

Agent

Contractor

Email Address

Agent or Contractor Name

First Last

Leave blank if you are the owner

Phone

Mailing/Billing Address

Street Address Address Line 2 City State ZIP Code

Service Address

Same as Mailing/Billing Address

Subdivision (if any)

Unit

Block

Lot

Location of Lights:

Township

Range

Section

Technical Information

Will the light be in public road right of way?

Yes (Road Permit for light & pole may be required)

No (Outdoor Lighting Permit will be required)

Type of service you want **

Outdoor Light(s) (Private Use)

Street Light(s) (Government Use)

Requested Wattage

Quantity

* The design of your light(s) will be based on the Rate Tariffs and Rules, Regulations, and Line Extension Policies of Trico and must factor if existing facilities are capable and able of supplying your service requirement, plus responsibilities of the Cooperative and the Applicant, together with system plans of the Cooperative, to determine the most cost effective design, in the Cooperative’s opinion.

Service Charges

OL1 – Outdoor Lighting Service Charges:

Cooperative Owned, Operated, and Maintained Lighting
All rates are per/light, per/pole, and per/month based on OL1 Tariff and 120/240Volt-Single Phase Service

Rate for Light Only:

$11.47 + tax/fees - 6000 Lumen LED (approximately 100w equivalent)

Rate for Standard Pole(s) for Light(s), When Required:

$10.43 + tax/fees – 30’ to 35’ Wood Pole

No Additional Charges:

The Outdoor and Street Lighting Service Charges do not include any additional charges that shall apply as per Trico’s Rules, Regulations, and Line Extension Policy approved by the Arizona Corporation Commission. Trico no longer installs lighting on poles with primary facilities/equipment.

SL1 - Street Lighting Service Charges:

Customer Owned and Cooperative Maintained Street lighting (Governmental Entities Only)
All rates are per/light, per/pole, and per/month based on SL1 Tariff and 120/240Volt-Single-Phase Service

Rate for Light Only:

$10.76 + tax/fees - 6000 Lumen LED (approximately 100w equivalent)

Rate For Pole Only:

$1.32 + tax/fees – Approved Wood Pole
$3.48 + tax/fees – 28' Metal Pole
$4.15 + tax/fees – 20'-30' Metal Pole
$4.15 + tax/fees – 30'-40' Metal Pole

Additional Comments

Agreement to Accept Service

I have read and understand the requirements and my responsibilities regarding the Lighting Service I am requesting. I understand the Authority Having Jurisdiction for my property may require me to submit a lighting plan of my existing and proposed lighting needs for their approval and compliance with applicable lighting ordinances. I realize that Trico may not be able to complete my installation if I fail to submit an approved lighting plan from said inspection agency to Trico.

Member's Signature*