Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Facility’s intended design: Sell All Net Meter If Net Metering, do you intend to keep your current retail rate schedule? Yes No Length of contract term and option under the Cogeneration & Small Power Producer Tariff: Term (Select One): Variable 5-year fixed 10-year fixed 15-year fixed Option (Select One): Option A Option B Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Utility: Interconnection Request ID Number: The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Signed (Local electrical wiring inspector, or attach signed electrical inspection): Print Name: Date: As a condition of interconnection, you are required to send/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility information below): Name: Company: Address: City: Fax: State: Zip: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 10 kW. Utility Signature: Title: Date:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Application is true. I agree to abide by the Terms and Conditions for Interconnecting an Inverter-Based Small Generating Facility No Larger than 10kW and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Title: Date: (For ISO and Connecting Transmission Owner use only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting an Inverter-Based Small Generating Facility No Larger than 10kW and return of the Certificate of Completion. Connecting Transmission Owner Signature: Title: Date: Connecting Transmission Owner waives inspection/witness test Yes No ISO Signature: Title: Date: Is the Small Generating Facility owner-installed? Yes No Interconnection Customer: Contact Person: Address: Location of the Small Generating Facility (if different from above): City: State: Zip Code: Telephone:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Full Name Company Name Title: Date: With Company
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: ELECTRONICALLY FILED - 2019 April 22 5:05 PM - SCPSC - Docket # 2019-130-E - Page 60 of 115 Interconnection Request ID number: Utility waives inspection/witness test? Yes No ELECTRONICALLY FILED - 2019 April 22 5:05 PM - SCPSC - Docket # 2019-130-E - Page 61 of 115 Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Application is true. I agree to abide by the Terms and Conditions for Interconnecting an Inverter-Based Small Generating Facility No Larger than 10kW and return the Certificate of Completion when the Small Generating Facility has been installed.
Interconnection Customer Signature. I certify that the information provided above is complete and correct to the best of my knowledge. I agree to the terms and conditions of the Interconnection Standards Revision 1 set forth by the Public Utility District #1 of Xxxxx County. I agree to the terms and conditions of the Net Metering Standards Revision 1 set forth by the Public Utility District #1 of Xxxxx County. I agree to allow the Public Utility District #1 of Xxxxx County to disclose personal information about my participation in the Washington State Renewable Energy Cost Recovery program to the Washington State University’s Energy Extension Program. I agree to allow the Public Utility District #1 of Xxxxx County to disclose certain information about my generation facilities to the installer of my system.
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Print Full Name Company Name Title With Company E-Mail Address Mailing Address: City: State: Zip: County: Telephone (Day): (Evening): Fax: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer Signature. I hereby certify that all of the information provided in this application request form is true. Signature: Date: Printed Name: Title: An application fee is required before the application can be processed. Please verify that the appropriate fee is included with the application. [ ] [ ] Application fee included Yes No Amount: Receipt of the application fee is acknowledged and the interconnection request is complete. EDC Signature: Date: Printed Name: Title: Small Generator Facility Interconnection Certificate of Completion Form1 Name: Mailing Address: City: State: Zip Code: Telephone (Daytime): (Evening): Facsimile (FAX) Number: Email Address: Name: Mailing Address: City: _State: Zip Code: Telephone (Daytime): (Evening): Facsimile (FAX) Number: Email Address:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request is true. I agree to abide by the Terms and Conditions for Interconnecting an Inverter-Based Generating Facility No Larger than 20 KW for residential customers and no larger than 100 KW for non- residential customers and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Date: _ Title: _ **************************************************************************************************************** Contingent Approval to Interconnect the Small Generating Facility (For City of Concord Use Only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting an Inverter-Based Generating Facility No Larger than 20 KW for residential customers and no larger than 100 KW for non-residential customers and return of the Certificate of Completion. City of Concord Electric Systems Director Signature: Date _ Application ID Number: _ City of Concord waive inspection /witness test? □ Yes □ No Please complete the form, sign, and mail this form and applicable processing fee to: City of Concord Electrical Engineer P.O. Box 308 Concord, North Carolina 28026-0308 (000) 000-0000 INTERCONNECTION CUSTOMER ☐ Check if Owner-Installed Interconnecting Customer: Contact Person: Mailing Address: City: State: Zip: Telephone (Day): (Evening): Fax: E-Mail Address: Address: City: State: Zip: ******************************************************************************************* Name: Mailing Address: City: State: Zip: Telephone (Day): (Evening): Fax: E-Mail Address: License Number: Date Approval to Install System granted to City of Concord: Application ID Number: ******************************************************************************************* The system have been installed and inspected in compliance with the local Building/Electrical Code of: (Appropriate Governmental Authority) Signed (Local Electrical Wiring Inspector, or attach signed electrical inspection): Signature: Name (Printed): Date: ******************************************************************************************* AS A CONDITION OF INTERCONNECTION YOU ARE REQUIRED TO SEND/FAX A COPY OF THIS FORM ALONG WITH A COPY OF THE SIGNED ELECTRICAL PERMIT TO: City of Concord Attn: Electrical Engineer P.O. Box 308 Concord, North Carolina 00000-0000 Phone: (000) 000-0000 Fax: (000) 000-0000 ************...
