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^ m W P B - 2 7 7 H T aF p S S J S . OF AMERICA ON BOARD BUDGET BUREAU NO. 1 2 -E l 1 3 6 -6 APPROVAL EXPIRES JUNE 5 , 1 *4 5 5< DAT E OF APP L I CAT 1 ON 6 . FOR VPB USE ONLY u i i l i i t A r r L U , A i i u n r u n a u i i i u k i i i i u B E G IN C O N S T R U C T IO N , P R E F E R E N C E R A T I N G S , A N D O T H E R P U R P O S E S OWU S E R I A L NO. 7 . A P P L IC A N T 'S REFERENCE NO. TO: War Production Board, Washington 25, D. C. ATTN: O ffice o f War U tilitie s 8 , I S APPLICATION FOR A N E C E S S IT Y C E R T IF IC A T E \ FORM WPB - 3 lrO 7) BEING F I L E D {S ee in s tru c tion a l WITH T H I S FORM? NAME D YES ? NO AND ADDRESS >' OF APPLICANT ( S t r e e t , C i t y , Z o n e , | 9 . T Y P E OF U T I L I T Y ? E LEC TR IC ? NATURAL GAS ? STEAM HEATING ? D ? WATER MFD. GAS COMMUNICATIONS State) 10. T H I S APPLICATION I S : ? I N I T I A L ? AMENDMENT ? RESU BM IS SIO N INSTRUCTIONS - Submit original and two ( 2) copies ot this form. Only two sets of supporting papers are required. If a Necessity Certificate under Section 124 (f) of the Internal Revenue Code is being requested in connection with this application, attach application for Necessity Certificate (Form VPB-3467)’, and submit one additional copy of WPB-2774 and supporting data. If WPB-2774 is required to be fi3®!£with a builder's application under L-41, transmit to the builder. 11. 1F AMENDMENT OR R E S U B M IS S IO N , FU RN ISH FOR ORIG IN AL A P P LIC A TIO N : FORM NO. S E R I A L NO. DATE S U B M IT TE D SECTION I - IDENTIFICATION AND DESC RIPTIVE DATA 12. PROd E C f ~ S T A T U S (Estimated - not binding 1. B R I E F D ESC R IP TIO N AND LOCATION OF CONSTRUCTION OR IN S T A L L A TIO N on applicant INCLUDING NAME OF CUSTOMER, I F ANY STARTIN G DATE FOR CONSTRUCTION DATE SCHEDULED FOR COMPLETION PERCENT NOW COMPLETED” 13- ESTIMATED COST I F AMENDMENT, BY AMENDMENT F U R N ISH ONLY DOLLAR VALUE ADDED ITEM- (a) GROSS COST (bl NET COST1 (Cl MATERI AL 2 . NOT TO BE FILLED IN BY COMMUNICATIONS UTILITIES LABOR XXX I F PROPOSAL I S TO SERVE A CUSTOMER, G IV E : w a i s i u a u r cua i UMtK ' a o k d u i l u l k a n r r u u n u n UNUtK l - h -l r u n P ERMIS SIO N TO BEGIN CONSTRUCTION: 1— | CUSTOMER S T A T E S ,— , S U B M IT TE D WITH .— . P REVIO U SLY OTHER COSTS XXX '— 1 NOT REQUIRED 1— j T H I S FORM S U B M IT T E D TO TAL XXX F L - 41 APPLICATION WAS PREVIOUSLY SUBMITTED, STATE DATE RETURNED BY WPB ? YES ? NO I F RETURNED - WPB S E R I A L NO. *Groaa coat leaa coat o f material removed from p la n t • Not to be f i l l e d in by communicat iona (b) S T A T U S OF CUSTOMER’ S CONSTRUCTION Operators 1— ) UNDER O COMPLETED n N0________ 4 . TO BE FILLED IN ONLY BY GAS UTILITIES 5 T ART ED CONSTRUCTION CONSTRUCT ION 3 . W IL L T H E CONSTRUCTION OR OPERATION OF T H I S PROJECT REQUIR E THAT MORE THAN 25 PEOPLE BE ADDED TO YOUR PAYROLL OR USED BY CONTRAC- - TORS ON T H E . JOB ? j - , ^ NQ IN CONNECTION WITH T H I S A P P L IC A T IO N , I S A CUSTOMER’ S APPLICATION TO WPB REQUIRED FOR A S P E C IF I C EXEMPTION FROM T H E R E S T R IC T IO N S OF ORDER U -7 OR L - 1 7 4 ? I F Y E S , S T A T E NUMBER OF PEOPLE TO BE ADDED TO PAYROLL OR USED BY CONTRACTORS. MAXIMUM AVERAGE ? YES ? NO CERTIFICATION - T H E UNDERSIGNED HEREBY C E R TIF IE S THAT HE IS THE APPLICANT OR THAT HE IS AUTHORIZED TO EXECUTE T H IS APPLICATION ON BEHALF OF THE APPLICANT; THAT THE QUANTITIES SPEC IFIED ARE NOT GREATER NOR THE REQUIRED DELIVERY DATE(S) EARLIER THAN NECESSARY FOR COMPLETION ON TIM E OF T H IS CONSTRUCTION; AND THAT THE FACTS HEREIN SET FORTH, OR APPENDED, ARE TRUE AND CORRECT TO THE BEST OF H IS KNOWLEDGE AND A B IL IT Y . BY__________________________________________________________ _________________________ ______________ SIGNATURE OF AUTHORIZED OFFIC AL T I T L E DATE SECT ION 3 5 (A) OF T H E U N ITE D S T A T E S CRIMINAL CODE, 18 U . S . C . SEC. 8 0 , MAKES I T A CRIM IN AL OFFENSE TO MAKE A W I L L F U L L Y FA LSE STATEM EN T OR R E P R E S E N T AT ION TO ANY DEPARTMENT OR AGENCY OF TH E U N ITE D S T A T E S AS TO ANY MATTER W IT H IN I T S J U R IS D IC T IO N . GPO— War Board 13990A— p. 1