Get Critical Care Customer Form - CenterPoint Energy

Key map Scope of Proposed work ex. Pipeline Utility Paving Private Development etc. 1000 minimum fee 4 hours 250 250 for each additional hour of field work. Horizontal locate and depth of cover Minimum fee due with request form. Fee payable to CenterPoint Energy Houston. Revised 2. 2. 11 CenterPoint Energy Houston Facility Location Request Form In order to have existing gas or electric facilities located for your project area you must fill out the following request form and send it in with a vicinity sketch to the following address Surveying Right of Way th 1111 Louisiana 7 floor Houston Texas 77002 Questions Call Mark Kouwe at 713-207-6380 or Harold Frank at 713-207-5458 Date Requesting Firm Name Contact Person s Name Return address Phone number - Fax number - E-mail If you are a Consultant for whom are you requesting the work i.e. Municipality City State County or Private Entity Project Title Limits including key map page number. Key map Scope of Proposed work ex. Pipeline Utility Paving Private Development etc* 1000 minimum fee 4 hours 250 250 for each additional hour of field work. Horizontal locate and depth of cover Minimum fee due with request form* Fee payable to CenterPoint Energy Houston. I certify that the information provided is accurate and I realize that the cost of this request may exceed the minimum fee and that I will be responsible for any additional cost at the rate described above. By my signature below I do hereby acknowledge and agree that this facility location service performed by CenterPoint Energy CNP or its contracted personnel at my request does in no way give consent or approval for me my contracted personnel or related clients to place improvements of any kind whatsoever above below on or adjoining CNP s facilities. In the event plans are made to cross over under or run within CNP s facilities easements or rights of way I agree to provide CNP a full set of plans depicting/outlining the scope of said plans. I further agree that I will not move forward with said plans prior to receiving a formal Consent to Encroach and/or a Letter of No Objection from CNP Surveying and Right of Way Department. Signature of Requestor If this form is not completed correctly your request for locating may be delayed until we receive the pertinent information*. Horizontal locate and depth of cover Minimum fee due with request form* Fee payable to CenterPoint Energy Houston. I certify that the information provided is accurate and I realize that the cost of this request may exceed the minimum fee and that I will be responsible for any additional cost at the rate described above. I certify that the information provided is accurate and I realize that the cost of this request may exceed the minimum fee and that I will be responsible for any additional cost at the rate described above. By my signature below I do hereby acknowledge and agree that this facility location service performed by CenterPoint Energy CNP or its contracted personnel at my request does in no way give consent or approval for me my contracted personnel or related clients to place improvements of any kind whatsoever above below on or adjoining CNP s facilities..