Net Metering Application for Interconnecting a
Generating Facility No Larger than 25kW
This Application is considered complete when it
provides all applicable and correct information required below. Additional
information to evaluate the Application may be required.
Fees
An electrical permit and fee of $50 is required for system installation.
Interconnection
Customer
Name:
_______________________________________________________________________
Contact
Person: ________________________________________________________________
Address:
______________________________________________________________________
City:
____________________________________State:________ Zip: ____________________
Telephone
(Day): _____________________ (Evening):_________________________________
Fax:
_____________________________E-Mail Address: _______________________________
Contact
(if
different from Interconnection Customer)
Name:
_______________________________________________________________________
Address:
_____________________________________________________________________
City:
___________________________State: ________________ Zip: ____________________
Telephone
(Day): ________________________ (Evening): _____________________________
Fax:
___________________________E-Mail Address: ________________________________
Owner of
the facility (include % ownership by any electric Utility):
_______________________
Generating Facility Information
Location
(if different from above): _________________________________________________
Electric
Service Company: _______________________________________________________
Account
Number: ______________________________________________________________
Inverter
Manufacturer: ________________________Model _____________________________
Interconnection inverter
must be UL 1741 Listed. Is the inverter
UL1741 Listed? Yes __ No __
Attach
manufacturer’s cut-sheet showing UL1741 listing.
Nameplate
Rating: _________(kW) ________ (kVA) ________ (AC
Volts)
Single
Phase _______ Three Phase ___________
System
Design Capacity: _________ (kW) _______ (kVA)
Generation
type: Photovoltaic ___ Reciprocating Engine ___ Fuel Cell ___ Turbine __ Other ___
Energy
Source: Solar ___ Wind ___
Hydro ___ Diesel ___ Natural Gas ___ Fuel Oil ___
Other
(describe) _________________________________________________________________
Estimated
Installation Date: _____________
Estimated In-Service Date: ____________
Electrical schematic drawing must be
included. Link to drawing template. Include provisions and show the location
for the required lockable visible disconnect.
List
components of the Generating Facility equipment package that are currently
certified:
Equipment Type Certifying
Entity
1. ____________________ _________________________
2. ____________________ _________________________
3. ____________________ _________________________
4. ____________________ _________________________
5. ____________________ _________________________
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 25 kW and return the
Certificate of Completion when the Small Generating Facility has been
installed.
Signed:
___________________________________________________________________
Print
name: ________________________________________________________________
Title:
______________________________________ Date: ________________
---------------------------------------------------------------------------------------------------------------------
Contingent Approval to Interconnect
the Generating Facility
(For
Company use only)
Interconnection of the
Generating Facility is approved contingent upon the Terms and Conditions for
Interconnecting an Inverter-Based Generating Facility No Larger than 25kW.
Company
Signature: __________________________________________________
Print
name: ______________________________________
Title:
_____________________________ Date: ___________________
Application
ID number: __________________
Company
waives inspection/witness test? Yes
____No ____
Application 8-22-06