Equipment Installation Contractor. Check if owner-installed: ( ) Name: Mailing Address: City: State: Zip Code: Contact Person (If other than Above): Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: The undersigned asserts that the Equipment has been installed in accordance with Part 1 of the Interconnection Application/Agreement as well as all applicable codes and regulations. Signed: Date: Printed Name: Title: Electrical Contractor: (if Different from Equipment Installation Contractor) Name: Mailing Address: City: State: Zip Code: Contact Person (If other than Above): Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: The undersigned asserts that the Equipment has been installed in accordance with Part 1 of the Interconnection Application/Agreement as well as all applicable codes and regulations. Signed: Date: Printed Name: Title: Electrical Inspection1: The system has been installed and inspected in compliance with the provisions of the National Electrical Code and other applicable codes and standards as well as the local Building/Electrical Code of: (Appropriate Governmental Authority) By: Date: Customer-Generator Signature2: The Customer-Generator Facility is complete and ready for interconnected operation in accordance with all of the provisions of the Interconnection Application/Agreement. The Customer-Generator acknowledges that it shall not operate the Facility until receipt of Final Acceptance (below), or as otherwise provided for by regulation. Signed: Date: Printed Name: Title: Final Acceptance to Interconnect Small Generator Facility (for Use by EDC Only) The requirements for interconnection are complete and interconnection of the Customer- Generator Facility is accepted upon signature and return of this Certificate of Completion or by notification by electronic mail or other acceptable means by the EDC. Electric Distribution Company waives Witness Test? (Initial) Yes ( ) No ( ) If no, Successful Witness Test Date: Passed: (Initial) ( ) EDC Signature: Date: Printed Name: Title: 1 Completion of local inspections may be designated on inspection forms used by local inspecting authorities.
Equipment Installation Contractor. Check if owner-installed: () Name: Mailing Address: City: State: Zip Code: Contact Person (If other than Above): Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: The undersigned asserts that the Equipment has been installed in accordance with Part 1 of the Interconnection Application/Agreement as well as all applicable codes and regulations. Signed: Date: Printed Name: Title:
Equipment Installation Contractor. Check if owner-installed: ( ) Name: Mailing Address: City: State: Zip Code: Contact Person (If different than above): Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: The undersigned asserts that the Equipment has been installed in accordance with Part 1 of the Interconnection Application/Agreement as well as all applicable codes and regulations. Signed: Date: Printed Name: Title: Electrical Contractor: (if Different from Equipment Installation Contractor) Name: Mailing Address: City: State: Zip Code: Contact Person (If different than above): Telephone (Daytime): (Evening): Fax Number: E-Mail Address: The undersigned asserts that the Equipment has been installed in accordance with Part 1 of the Interconnection Application/Agreement as well as all applicable codes and regulations. Signed: Date: Printed Name: Title:
