Ames Electric Department

Hubbell Skycap Application

Application For Suburbanaire Streetlight Retrofit Program
City of Ames, Iowa

Address __________________________________________________________________

Name ____________________________________________________________________

Phone Number ___________________________

    I hereby certify that I am the property owner of the above address and request the existing suburbanaire fixture located on or adjacent* to my property be retrofit with a "skycap" type fixture.

Signature ______________________________________________

Date __________________________________________________

It is recommended the applicant consult with any neighboring property owners who may be impacted by the retrofit request.

Please check one of the following:

I have (  ) consulted my neighbors impacted by this lighting change.

I have not (  ) consulted with my neighbors impacted by this lighting change.

    * An adjacent fixture is defined as any fixture located within 100 feet of a property's street side corner.