Overhead Electric Protection Notification Form

Project Site

Customer Name/Property Owner:

Customer Cell Phone:

Customer Email Address:

Street Address:

City/Town:

Zip Code:

Property Meter #:

Nearest Pole #:

Contractor Information

Contractor Name:

Contractor Phone #:

Contractor Email Address:

Project Information

Will there be any construction equipment that will come within 20 feet of a Central Hudson Wire? Yes No

Type of Wire: Primary Secondary Unknown

Do the wires run from the pole to the house? Yes No

Do the wires run from pole to pole along the roadway? Yes No Unknown

Do the wires run from a utility-owned pole to a customer-owned pole? Yes No Unknown

Project Description

Describe the type of work, activity or operation to be performed. Explain the reason for proximity to Central Hudson’s electric facilities and submit copies of any documents including permits, drawing designs, surveys or site plans for the project which include details and dimensions.

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Overhead Electric Protection Notification Form

Project Site

Contractor Information

Project Information

Project Description