Appendix E - New Construction Application.pdf

New Construction Application

Owner

Date:___________ Owner:_________________________________________________________________________________

Mailing Address:__________________________________________________________________________________________

Phone:_________________________ Owner E-mail:______________________________________________________

Project

Project Description:________________________________________________________________________________________

Project Location:____________________________________________________________ Town:_________________________

Contractor:______________________________________ Contractor Email:_________________________________________

Contractor Phone:________________________________ Contractor Contact Name:___________________________________

Commercial / Residential

Residential: □ Domestic Only: □ Pool: □ Peak Dom. GPM: ____________

Commercial: □ Fire Only: □ Pressure Tank/Booster: □ Peak Irrig. GPM: ____________

Industrial: □ Combined: □ Fire Protection GPM: ____________

Irrigation: □ Peak Total GPM: ____________

Service Installation │ Private Fire Protection

Service Size:________ Directional Drill: YES □ NO □ │ Sprinkler System Dry Sprinkler System YES □ NO □

Exist Service: YES □ NO □ │ None □ Private Hydrant(s) YES □ NO □

Existing Well: YES □ NO □ │ NFPA 13 □ Number of Hydrant’s: __________

Plans Submitted: YES □ NO □ │ NFPA 13R □

│ NFPA 13D □

Backflow Prevention │ Meter Set Information

Hazard Device Required: YES □ NO □ │ Meter Size: _________

Low □ Non-Testable Dual Check □ │ Meter Pit Required: YES □ NO □

Moderate □ Testable DCVA □ │ Located In Crawl Space: YES □ NO □

High □ RPZ □ │ Accessible to all Users: YES □ NO □

I have received a copy of the Terms and Condition of Service. I authorize Maine Water to enter the premises and access the property to inspect the main/service installation, normal maintenance and reading of the water meter, evaluate, require backflow prevention devices, and evaluate potential usage. I further understand that all paperwork and estimated cost is to be paid in advance and any adjustments will be made upon completion of work.

Owner/Applicant:________________________________ Date:___________

Business Name

Requirements Between Application And Activation

□ New Construction Application

□ Ability to Serve Letter: If required, 5 days in advance.

□ Project Plan review: Plans must be submitted in paper and electronic forms and may be up for review for

30 days

□ Fire Department Review: Letter signing off of review process.

□ Planning Board Review: Letter signing off of review process.

□ New Water Service/ Water Main Ext Agreement: Needs to be completed before work may start.

□ Payment: Deposit to be completed before work may start.

□ Sub-Division / Shoreland Form: Needs to be completed before work may start.

□ Inspection Scheduling: At least 5 days in advance of tapping/installation.

□ Flush / Pressure Test of new installation: Schedule at least 5 days in advance.

□ Water Sample: If required, schedule 5 days in advance. Provide passing results to MWC.

□ Service Activation: Contact Customer Service at least 5 days in advance.

Maine Water Use Only

Closest Hydrant:_________ Static Pressure (psi)________ Size Of Existing Main:______ Type:________

Main Extension:__________ Private/Public:___________ Private Hydrant:___________

Estimated Fees:

Inspection:________ Jobbing:_______ Inventory:________ Labor:________ TOTAL:_________