Is the Generating Facility installed, tested and ready for operation? Yes ______ No ______

Customer:____________________________________________________________________________

Contact Person:________________________________________________________________________   

Address:  _____________________________________________________________________________

Location of the Generating Facility (if different from above):

_____________________________________________________________________________________

City: ____________________________________ State: _______________________ Zip: ____________

Telephone (Day):__________________________ (Evening): ____________________________________

Fax: _____________________________________E-Mail Address: _______________________________

 

Electrician/Service Company:

Name:________________________________________________________________________________   

Address:  _____________________________________________________________________________

City: ____________________________________ State: _______________________ Zip: ____________

Telephone (Day):__________________________ (Evening): ____________________________________

Fax: _____________________________________E-Mail Address: _______________________________

License number: _______________________________________________________________________           

Date Approval to Install Facility granted by the City:___________________________________________

Application ID number: _______________________________________

 

Inspection:

The Generating Facility has been installed and inspected in compliance with the local building and electrical codes 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:

Name:___________________________________________________________ 

Company: ________________________________________________________

Address: _________________________________________________________

               City, State ZIP:  ____________________________________________________        

               Fax: _____________________________________________________________         

 

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Approval to Energize the Generating Facility

Energizing the Generating Facility is approved:

City Signature: _____________________________________________________

Title: ________________________________ Date:________________________