Network Connection Application Form - Ergon Energy · Network onnection Application Form Ergon Energy orporation Limited A N 50 087 646 062 Form PW000101F101 Ver 13 Work Request Number:_____

Network Connection Application Form

Ergon Energy Corporation Limited ABN 50 087 646 062

Work Request Number:________________

Network Connection

Application Form

Privacy Notice

Ergon Energy is collecting information on this Network Connection Application form for the purpose of assessing your Network Connection Application. This

may include the collection of your personal information. Your personal information will not be disclosed to any external third parties without your consent,

unless authorised or required by law. If you wish to apply for access to this information or make a privacy complaint, you may contact the Right to

Information & Privacy Officer on (07) 3851 6000, or visit ergon.com.au to obtain access application and privacy complaint forms. If you have provided

personal information of another individual, please ensure that you advise the person about this privacy statement. Our privacy policy is available at

ergon.com.au.




DO YOU HAVE THE RIGHT APPLICATION?

a new connection to Ergon Energy’s network

a connection alteration (for example upgrading to 3 phase, upgrade to a service line, change from overhead to underground or relocation of a point of attachment etc.)

This Application is for:

This Application does not apply for:

HOW TO COMPLETE THE APPLICATION (* Denotes mandatory field)

A Connection Applicant & Customer details* All Applicants

B Project description* All Applicants

C Property and Installation details* All Applicants

D Residential (Domestic) Connections Complete this section if your project is for a Residential Property with a

single connection point (e.g. House, House with Granny Flat, House and Staff

Quarters etc.)

E Other Connection Types Complete this section if your project is for any of the following:

► Multi-occupancy dwelling;

► Farms;

► Commercial property;

► Pumps;

► Industrial property;

F Non Domestic Equipment and Pump Information Complete this section for all non-domestic equipment and pumps if installed

on the property

G Project Sketch* All Applicants —excluding point of attachment and service line upgrade

applicants

Once completed, please

submit this form to

Ergon Energy

Email

[email protected] 13 74 66

General Enquiries

PO BOX 308, Rockhampton Qld 4700

Postal

a subdivision. For these connections you will need to complete the Network Connection Subdivision/Street Lighting Application Form.

street lighting or public lighting. For these connections you will need to complete the Network Connection Subdivision/Street Lighting Application Form.

the removal of an unmetered supply device. For these applications you will need to complete a Request for the Abolishment of Supply and Removal of Ergon Energy Electrical Assets Form.

an unmetered supply device to be mounted on an Ergon Energy pole such as a CCTV. For these connections you will need to complete a Network Connection of Watchman Lights and Pole Mounted Unmetered Supply Devices Application Form.

an unmetered supply device that is not mounted an Ergon Energy pole. For these connections you will need to complete an Application for Network Connection of an Unmetered Supply Device Form.

a load that exceeds 1500 kVA/1.5 MVA or where power usage is typically above 4 GWh per annum at a single site or generation over 30 kVA. For these connections go to www.ergon.com.au/network/connections/major-business-connections/major-connections.

the connection of a Micro Embedded Generating (micro EG) Unit to an existing supply on the Ergon Energy Network. Please complete the Application for Network Connection of a Micro Embedded Generating (micro EG) Unit 30 kVA and Under form. For these connections go to www.ergon.com.au/network/contractors-and-industry/solar-pv-installers/ies-network-connection-form.

Form PW000101F101 Ver13

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Section A - Connection Applicant details (all applicants must complete this section)

Name (incl. business name if applicable):

Contact Number:

Email Address:

Postal Address:

Property Owner’s details (must be completed if different from the Applicant):

Name (Business Trading name if applicable):

Contact Number:

Email Address:

Address:

Electrical Contractor/Consultant details

Name

Office Phone Number: Mobile Number:

Select Preferred Contact details

Applicant: Property Owner: Electrical Contractor: Other: (please provide details below)

Contact Method: Phone: Email:

Best contact time: AM: (when?) e.g. between 8am-12pm PM: (when?) e.g. between 12pm-5pm No Preference:

Contact Name:

Contact Number: Email Address:

APPLICANT DECLARATION

I understand that this connection application is for the provision of a connection service, being a new connection, or the alteration of an existing connection, to Ergon Energy’s network. Please note that our connection offer to you will include itemised connection charges payable by you where relevant.

I acknowledge that if the connection service is not a basic connection service, or if I elect to negotiate the terms of the connection contract (please refer to Ergon Energy’s website for details), I will enter into a negotiated connection contract and Ergon Energy will invoice me (the applicant) where relevant for the costs of processing this connection application and preparing a negotiated connection offer . I declare that all of the information provided in this connection application is true and correct to the best of my knowledge, and that Ergon Energy will prepare a connection offer based on information contained herein. If I am acting on behalf of a customer, I declare that I have the authority to act on their behalf.

Signed by Applicant: Date (dd/mm/yy)

Full Name (please print)

Position (Company, Business or Government Entity)

Please select the box/s that best describes your needs

Certain connection services (that is, those that do not require augmentation to Ergon Energy’s distribution system) are defined as basic connection services (please refer to Ergon Energy’s website for details of these basic connection services and the relevant process). Before a connection service can be classified as a basic connection service, Ergon Energy will need to confirm whether there is available capacity in the relevant area. If you believe that your connection service may (subject to confirmation or available capacity) be a basic connection service, please select one of the following: you are requesting an expedited connection (meaning that if it is a basic connection service, the connection contract will come into effect upon the date your application was received by Ergon Energy) and you are happy for this connection contract to be on the terms of the relevant model standing offer (please refer to Ergon Energy’s website for details); or you would prefer that Ergon Energy send you a hard copy of the connection offer in the form of the relevant model standing offer for your review, signature and return within 45 business days for the connection contract to come into effect. This option attracts a fee of $86.00 (GST Inclusive); or you would prefer to negotiate the terms of the connection contract with Ergon Energy. If your connection service is not a basic connection service, you will need to negotiate the terms of the connection contract with Ergon Energy.

new connection to Ergon Energy’s Network move overhead to underground

upgrade to supply connection alteration

I want to negotiate the terms and conditions of the Model Standing Offer other

Form PW000101F101 Ver 13

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Section B - Please provide a description of your project (all applicants to complete this section)

E.g. New Connection, installing three phase air conditioner or addition of a pump to the back of my rural property


Nearest Ergon Energy Pole or Pillar detail?

Ergon Energy Poles: A series of individual numbers nailed to a pole or On a long aluminium strip mounted vertically

Ergon Energy Pillars: A yellow label with a series of 5 to 6 digits

Pole No.: Pillar No.:

Where total load is more than 80A, on any one phase, please supply either a detailed load breakdown or maximum demand calculations provided by a

licensed electrical contractor and attach it to this form

Load to meet your requirements

Please provide the Amps required for the connection

Single Phase Amps

Existing

Additional

Total

Multi Phase Amps (A) Amps (B) Amps (C)

Existing

Additional

Total

Section C - Property and Installation Details (all applicants to complete this section)

Street Name:

Suburb: Post Code:

Lot/s: RP/SP: Unit No.: Street No.:

Is your property part of a newly constructed subdivision? Yes No Existing Network Supply Type: Overhead Underground

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Is network supply currently available to your property? Yes No

Overhead (where the existing network is overhead, please complete this section)

Are both adjacent homes currently connected to the network? Yes No

Is there a Pole Installed on the boundary of the property? Yes No

Underground (where the existing network is underground, please complete this section)

Is there a Pillar Box Installed on the boundary of the property? Yes No




Section D - Residential (Domestic) Connection

Please complete if your project is for a residential property with a single connection point, excluding a residential development.

(e.g. House, House with a Granny Flat, House and staff quarters etc.)

How many rooms will the dwelling have?

Please provide details of your planned installation (please select and provide relevant details where required):

Select Installation Type New Existing Select Installation Type New Existing

Swimming Pool Electric Oven

Electric Hotplates Dishwasher

Select Hot Water System New Existing Select Hot Water System New Existing

Electric Heat Pump

Solar with Electric Booster

Refrigerator/s and Freezers New Existing Total Capacity in Litres

Single Refrigerator (populate number)

Refrigerator/Freezer Combination (populate number)

Stand alone Freezer (populate number)

Air conditioners New Existing kW BTUs

Living Areas

Bedrooms

Yes No

Is there any existing equipment that is non-domestic (e.g. Kilns, commercial ovens etc.). If yes, please provide details in Section F Part 1

Section E – Other Connection Types (select all that apply and provide information requested)

Multiple-occupancy development:

Number of units, dwellings, tenancies: __________

Please also complete Section F Part 1

Commercial:

What Type?


Industrial:

What Type?


Farm:

What Type?


Pump:

Please complete Section F Part 2


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Pressure Pump/s (please provide details in Section F Part 2)




SECTION F (Part 1) Non - Domestic Equipment (excluding pumps)

Complete the table below for equipment such as welders, air compressors, lathes, kilns, commercial ovens etc. If preferred, attach a load breakdown as provided by a licenced contractor or consultant.

No. Equipment Description How

Many?

Size

(kW)

No. of

Phases

(N) New or

(E) Existing Type of Starter

Daily

Usage

(hours)

No. of

starts per

hour

Average Annual

Usage (days)

Motors running simultaneously

(e.g. 1 & 4)

1

2

3

4

5

6

7

8

9

10

SECTION F (Part 2) Pump Information

Complete the table below for any new or existing pumps on your property

Pump

No. Proposed Start Method Size (kW) Running Current Start-up Current Starts per day

(N) New or

(E) Existing

Daily Usage

(hours)

Average Annual Usage

(days)

1

2

3

4

5

6

7

8

9

10


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SECTION G Project Sketch

Please provide a detailed sketch in black or blue ink in the space provided below or attach one to this application.

What to include in your sketch:

The sketch should include details of any relevant existing objects, for example, a row of trees, existing buildings, dams, creeks etc., that you consider may have an impact on an extension (if required) of the electricity network to, onto, or through your property. The detail and accuracy of the information you supply will assist Ergon Energy to locate your property on, or nearest to the existing electricity distribution system.

Please include in your sketch the following:

Property Location Property Location Buildings (existing and new)

North Point (N,S,E and W) Road Names Any other buildings/structures connected to the supply

Distance to nearest electricity pole or pillar Trees or Dams

Refer to the example below as a guide for your sketch


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Documents

Network Connection Application Form - Ergon Energy · Network onnection Application Form Ergon Energy orporation Limited A N 50 087 646 062 Form PW000101F101 Ver 13 Work Request Number:_____