Subdivision or Industrial Connection

Development Site Location

The site location is the legal parcel of land in which you require Counties Energy to supply an electricity connection.
Site address*

Street Address

Street Address Line 2

CitySuburb

Postal / Zip Code
DP number (found on your title plan)*
Lot number*
Number of stages within this development
Will you require separate contracts for each stage?*

YesNo
Number of lots per stage*
Customer reference
Requester Information
Name of person completing this form*

First NameLast Name
Company name
Contact phone*

Area CodePhone Number
Email*
example@example.com
Details of Legal Owner of Site
Legal name(s) of property owner*

First NameLast Name
Contact phone*

Area CodePhone Number
Email
example@example.com
Point of Contact for this Project

Counties Energy requires a key person to make direct contact with in relation to any technical queries we may in relation to this project. This is generally the project manager or civil contractor.
Company name
Contact person*

First NameLast Name
Contact phone*

Area CodePhone Number
Email
example@example.com
Quote Payer

In this section, the billing details of the person(s) or entity responsible for paying the quote or capital contribution should be provided here, If already provided above then please select form the drop down list.
Quote payer
Full legal name

First NameLast Name
Contact phone
Please enter a valid phone number.
Email
example@example.com
Billing address*

Street Address

Street Address Line 2

CityRegion

Postal / Zip Code
Planning
Would you describe the sub-division as*

Possibly going aheadProbably going aheadDefinitely going ahead
Expected start date for civil works

DayMonthYear
Date
Desired start date of electrical work

DayMonthYear
Date
Anticipated usage of site*

ResidentialCommerial - Glass house shedIndustrialSchool/Educational facilityFarm/OrchardPump supplyStreetlight (please attach a plan)EV ChargerOther
How many ICPs are required?*
Is Builders Temporary Supply (BTS) required?*

YesNo
Services on site*

None green field siteGasTelecommunicationWaterSewerageNo known existing services
Please select any known hazards on the site*

Archaeological siteAsbestosLand fillSite of cultural significanceNo known hazardsOther
Number of phases*

1 (standard urban residential)2 (minimum requirement for rural connections)3
Capacity required per lot or single connection*

63amp (standard residential)100+ ampsOther
Ground condition
Communication

Communication is important to us. The ensure that Counties Energy keeps the right people informed throughout the design process please complete the following section:
If a designer needs further information, who should we call?
Who needs to be kept updated on the Job?

RequesterOwnerElectrician/Civil ContractorContract Payer
Do you require a letter of compliance when the network connection point is installed and livened?

YesNo
Site Plans

We must have an approved site plan submitted with this application, this must show any existing services that have been identified. These plans must have the subdivision proposed layout as well as any streetlight design plans.

Where possible please provide a CAD design.
Approved site plan (A3 PDF)*

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Approved CAD design*

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Approved street light plan

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File Upload 1

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Declaration

As the legal owner of the property or as an authorised agent for the owner I hereby apply for a new or updated point of supply to the Counties Energy electricity network.

I confirm that I am duly authorised to sign this application and confirm that the Owner agrees to be bound by the terms and conditions as stated by Counties Energy Limited and hereby accepts all charges in relation to this application.
Owner name or authorised agent*
Date*

DayMonthYear
Date
Should be Empty:

Development Site Location

Requester Information

Details of Legal Owner of Site

Point of Contact for this Project

Quote Payer

Planning

Communication

Site Plans

Declaration