Subdivision Backbone Application Packet Dear Applicant: Thank you for contacting Kootenai Electric Cooperative and inquiring about a new electric service. We have provided the following checklist to assist you in providing the correct documentation we require to process your application. When you have all the required documents (Items 1-6), you are now ready to submit the application. Application packet contents include: 1. $250.00 Non-refundable Engineering and Mapping Fee We accept cash, check, VISA or MasterCard 2. Completed Subdivision Request for Backbone Form Enclosed in packet on next page 3. Excavation Settlement Liability Release Enclosed in packet 4. Copy of one of the following legal descriptions: Recorded Warranty Deed Schedule A of Final Title Insurance Policy Quit Claim Deed Please attach to the enclosed easement; this will be used as Exhibit A. 5. Easement Corporate Easement for Idaho enclosed in packet. Additional easements are available at www.kec.com or call 208.765.1200. All legal property owners need to sign this document exactly as it appears on the legal description. We have a Notary available. 6. Detailed map and directions to the property Use attached grid When all requirements are completed above (Items 1-6), we will process the application and schedule an engineer to meet with you or your designated representative on-site, as well as schedule a construction time-line.
OFFICE USE ONLY SO#: WO#: SUB: DIST: CYCLE: Subdivision Request for Backbone Form Applicant Information Applicant: Developer Name Address SSN# (last 4) or Tax ID# Primary Phone Alternate Phone Email/Fax Co-Applicant: Owner Name Address SSN# (last 4) or Tax ID# Primary Phone Alternate Phone Email/Fax Engineering Firm: Contact Person: Name Primary Phone Alternate Phone Email/Fax Plat of Project Included: Electronic (auto-cad format preferred) Paper Subdivision Backbone Information Development Location: Street City State Zip Type of Service Requested: Overhead Underground 277/480 3-phase 120/208 3-phase 120/240 1-phase *Note: Overhead may be required for service entrance if existing line to serve development is overhead on opposite side of road. Service Information: Check all that apply Manufactured Home Site Built Min sq. ft: Max sq. ft: Number of Lots: Front Setback Distance: Side Setback Distance: Natural gas in subdivision: Yes No Power needed at subdivision entrances: Yes No Street Lights Quantity: Street lights owned by: HOA KEC Town & Country Cobra Head Street lights billed to: HOA City
Pumps Sewer Pumps: Yes No Quantity HP 1-PHASE 3-PHASE Water Pumps: Yes No Quantity HP 1-PHASE 3-PHASE Location of all pumps must be marked on plat Motor - start calculations Pre-Construction Meeting Date: Water and Sewer State Date: Ditch for Power Line Start Date: Excavation/Dirt Work State Date: Road Crossing Start Date: Street Paving Start Date: Trenching, Backfilling and Compaction to be provided by the developer Estimated Date for First Temporary Service: Main Line Trench Start Date: Water Dept.: Contact: Phone: Please Read Before Signing - by signing, you agree to the following terms The engineering and mapping fee is good for one hundred twenty (120) days from the date of the service order. Upon expiration, the service order will be closed and the applicant must re-apply. The cost quote is valid for one hundred twenty (120) days from the date issued. Upon expiration, the service order will be closed and the applicant must re-apply. Once all fees are paid, the applicant has one hundred twenty (120) days to complete construction or the Cooperative will update costs to those in effect at that time. All electrical services need to comply with the requirements of the KEC Electric Service Handbook, current KEC policies and procedures and all state electrical codes. To the best of Applicant s knowledge, information and belief, the information set forth within this application packet, including but not limited to the contribution in aid of construction option, is true, accurate and correct. In the event any such information is later deemed to be inaccurate or incorrect, KEC reserves the right to recover the full amount of any resulting increase in costs and/or damages from the Applicant and Applicant agrees to pay the same. Applicant Signature: Date: Co-Applicant Signature: Date: All signatures are required before application can be processed.
Excavation Settlement Liability Release Kootenai Electric Cooperative (KEC) wishes to make the installation of its electrical service to both residential and commercial customers as smooth and trouble free as possible. While KEC attempts to compact its trenches; anytime soil is excavated or disturbed there is some potential for settlement. KEC can not, and does not warrant utility trenches excavated for the purpose of installing underground power lines against settlement. By exercising this release, the undersigned acknowledges that Kootenai Electric does not warrant its utility trenches against settlement and is holding Kootenai Electric Cooperative harmless for any and all surface replacement(s) and/or repair(s) caused by or related to the settlement of the soil in the utility trench. Such repairs and the cost of said repairs shall remain the sole responsibility of the undersigned party for the installation of electrical power and any associated excavation at the following address: The undersigned acknowledges full acceptance of and sole liability and responsibility to pay and satisfy any/all costs, claims and/or damages should trench settlement result in any damages including, but not limited to, any cracks, dips, compaction, erosion or other excavation settlement related issues. By signing below, I attest that I am authorized to execute this release for the electrical service located at the address listed above and hereby agree to indemnify, defend and hold Kootenai Electric Cooperative, Inc., harmless from any and all damages associated with trench settlement issues at this service address, including claims from any and all third parties, including future owners of this service address. Signed: Title: Date:
KNOWN ALL MEN BY THESE PRESENTS, that the undersigned,, a corporation organized and existing under the laws of the state of for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, does hereby grant unto Kootenai Electric Cooperative, Inc., an Idaho nonprofit corporation (hereinafter referred to as the Cooperative ) whose mailing address is 2451 W. Dakota Ave. Hayden, Idaho, 83835, and to its successors or assigns, an easement and the right to enter upon the undersigned s real property situated in the County of, State of, Township, Range, Section, and more particularly described as follows: (SEE ATTACHED EXHIBIT A ) This easement shall in all events provide the Cooperative the right to construct, operate and maintain an electric transmission and/or distribution line and/or system on or under the above-described real property and/or in, upon or under all streets, roads or highways abutting said real property; to inspect and make such repairs, changes, alterations, improvements, removals from, substitutions and additions to its facilities as Cooperative may from time to time deem advisable, including, by way of example and not by way of limitation, the right to increase or decrease the number of conduits, wires, cables, hand holes, manholes, connection boxes, transformers and transformer enclosures; to cut, trim and control the growth by machinery or otherwise of trees and shrubbery located within fifteen (15) feet of the center of said line or system, or that may interfere with or threaten to endanger the operation and maintenance of said line or system (including any control of the growth or other vegetation in the right of way which may incidentally and necessarily result from the means of control employed); to keep the easement clear of all buildings, structures, or other obstructions; and to license, permit or otherwise agree to the joint use or occupancy of the lines, systems or, if any of said system is placed underground, of the trench and related underground facilities, by any other person, association or corporation. The undersigned agrees that all of the Cooperative s poles, wires and all other equipment and facilities of any nature whatsoever, including but not limited to any main service entrance equipment, installed in, upon or under the above described real property shall remain as the Cooperative s sole property. All of such property shall be removable at the sole option of the Cooperative without the giving of any advance notice. The undersigned covenants that it is the owner of the above-described real property and that said real property is free and clear of encumbrances and liens of any nature whatsoever which would in any way frustrate or interfere with the easement rights granted to the Cooperative herein. ID CORPORATE ELECTRIC LINE RIGHT OF WAY EASEMENT - 1
Dated this day of, 20. X By: Its: STATE OF IDAHO ) : ss. County of ) On this day of, 20, before me personally appeared, who by me being personally sworn, declared that (s)he is the of, that (s)he signed the foregoing document in his/her duly authorized capacity for the uses and purposes therein mentioned. GIVEN UNDER MY HAND AND OFFICIAL SEAL the day and year in this certificate first written above. (SEAL) Notary Public Residing At: My Commission Expires: Revised October 27, 2014 ID CORPORATE ELECTRIC LINE RIGHT OF WAY EASEMENT - 2
Site Drawing Worksheet Please use the space below to provide a drawing of your construction site. Show existing and proposed structures, landmarks, roads, nearest neighbors, house site, driveway, powerlines, etc. NOTES: