Interconnection Member Signature Sample Clauses

Interconnection Member 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: 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. Cooperative Representative Signature: Title: Date: Interconnection Request ID number: Cooperative waives inspection/witness test?  Yes  No Is the Generating Facility owner-installed? Yes No Name: Contact Person: Address: Location of the Generating Facility (if different from above) City: State: Zip: Telephone (Day): (Evening): Telephone (Cell): Fax: E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): (Evening): Telephone (Cell) Fax: E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Cooperative: Interconnection Request ID Number:

Interconnection Member 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 25 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: ……………………………………………………………………………………………………………………………. Contingent Approval to Interconnect the Generating Facility (For Cooperative use only) Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 25 kW and return of the Certificate of Completion. Cooperative Representative Signature: Title: Date: Interconnection Request ID number: Cooperative waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Name: Contact Person: Address: Location of the Generating Facility (if different from above) _ City: State: Zip: Telephone (Day): (Evening): Telephone (Cell): Fax: E-Mail Address: Name: Address: City: State: Zip: Telephone (Day): (Evening): Telephone (Cell) Fax: E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Cooperative: 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 the Cooperative (Information Below): Name: Xxxxxx Xxxxxxx Company: Surry-Yadkin Electric Membership Corporation Address: P.O. Box 305_ City: Dobson State: NC E-mail: xxxxxxxxxxxxx@xxxxx.xxx Zip: 27017 Fax: 000-000-0000 ……………………………………………………………………………………………………………………………. Approval to Energize the Generating Facility (For Cooperative use only) Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 25 kW. Cooperative Representative Signature: Title: Date: 1.0 Construction of the Facility The Interconnection Member (Member) may proceed to construct (including operational testing not to exceed two hours) the Generating Facility when the Cooperative approves the Interconnection Request and returns it to the Me...