Design & Construction Specifications - Town of Kernersville

Subdivision Utility Information SheetAddendum 1Complete and submit to the Public Works Department during the project design phase.Subdivision: _________________________ Phase: _____Section:_____Owner(s): ___________________________________________________________Project Manager/Key Contact: ___________________________________________Address: ___________________________________________________________Office #: ___________ Fax #: ____________ Emergency #: _________________Home#: ___________ Mobile #: _________ Pager #: __________Designing Engineer: ___________________________________________________Office #: ___________ Fax #: ____________Utilities that will be installed in subdivision:Check the boxes that apply and a "?" mark in the blank if you do not know the information requested.Q Power Company: ______________ Electrical Engineer: ________________Q Gas Company: ___PNG_______ Contact: ________________________Q Water Contractor: ______________ Contact: ________________________Q Sewer Contractor: ______________ Contact: ________________________Q Phone Company: ______________ Contact: ________________________Q Cable Company: _Time Warner___ Contact: ________________________Q Street Lighting - (Standard Wood Poles with HPS fixtures)There is no charge for standard wood pole lighting.Q Street Lighting - (Decorative Poles and fixtures)See Decorative Street Lighting Procedures for decorative information. Developer is responsible for allcoordination of utilities including street light wiring.Roadway Contractor: __________________________________________________Office #: ___________ Fax #: ____________ Emergency #: ___________________Reproducible Form