Interconnection Customer Information. Legal Name of the Interconnection Customer (or, if an individual, individual’s name) (must be a single individual or entity) Name of Interconnection Customer: Contact Person: Mailing Address: City: State: Zip: Facility Location (if different from above): Telephone : E-Mail Address: Additional Contact Information Contact Name: Title: Address: Telephone: E-Mail Address:
Interconnection Customer Information. Indicate Distributed Resource size: Up to 30kW 30-149kW 150 - 749kW 750- 1,999kW _lL_ 2,000kW and greater Application is for: X New Distributed Resource Facility Capacity addition to Existing Distributed Resource Facility Ifcapacity addition to existing facility, please describe: Xxxxx of 10 Legal Name of Interconnection Customer (or, ifan Individual, Individual's Name) Name: Xxxx Po wer LLC. Mailing Address: _P_ .o_ ._ _ Bo_ x_3_6_ 7______________ __ City: _A_lle_ _n_ __ _ _ _ State: __KY_ Zip: 41601 Generating Facility Location (ifdifferentfrom above): 000 Xxxxxx Xxxx Xxxxx Xxxxx Xx Xxxxxx KY 41214 Requested Point of Interconnection: If the requested point of interconnection is the same as an existing electric service, provide the electric service account number. Proposed In-Service Date: _611_120_ _18 _ 000-000-000 1 Evening: Telephone: Daytime: 000-000-0000 E-Mail Address: xxxxxxxxxxxxxxxxxxxxxxxxxxxx@xxxxx.xxx Fax: ---------- Alternative Contact Information (Ifdifferentfrom Interconnection Customer information above) Contact Name: -Le-e -Ba-zzl-e -- Title: Project Manager Mailing Address: 000 Xxxxxxxxx Xx City: Summerville Telephone: Daytime:000-000-0000 E-Mail Address: xxxxxxxxx@xxxxx.xxx State: _S_C__ Zip: 29483 Evening: 000-000-0000 Fax: ----- - -- Title: Project Leader Contact Name: P -aul Aiken -- - -- - Mailing Address:
Interconnection Customer Information. Legal Name of the Interconnection Customer (or, if an individual, individual’s name) (must be a single individual or entity) Name of Interconnection Customer: Contact Person: Mailing Address: City: State: Zip: Facility Location (if different from above): Telephone : E-Mail Address: Additional Contact Information Contact Name: Title: Address: Telephone: E-Mail Address: ED. Application Information Application is for: New Small Generating Facility Capacity addition to Existing Small Generating Facility If capacity addition to existing facility, please describe: Will the Small Generating Facility be used for any of the following? Net Metering? Yes No To Supply Power to the Interconnection Customer? Yes No To Supply Power to Others Through Wholesale Sales Over the New York State Transmission System or Distribution System? Yes No To Supply Power to a Host Load? Yes No For installations at locations with existing electric service to which the proposed Small Generating Facility will interconnect, provide: (Local Electric Service Provider) (Existing Account Number) Local Electric Service Provider Contact Name: Title: Address: Telephone: E-Mail Address: Project Name: Project Description: Requested Point of Interconnection: Coordinates (i.e., latitude and longitude) of the Proposed Point of Interconnection: Interconnection Customer’s Proposed Initial FeedbackIn-Service Date: Interconnection Customer’s Proposed Initial Synchronization Date: Interconnection Customer’s Proposed Commercial Operation Date: EF. Small Generating Facility Information Data apply only to the Small Generating Facility, not the AttachmentInterconnection Facilities.
Interconnection Customer Information. Name: Mailing Address: City: Telephone (Daytime): Facsimile Number: State: (Evening): E-Mail Address: Zip Code: Installer ☐ Check if owner-installed Name: Mailing Address: City: State: Zip Code: Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: Final Electric Inspection and Interconnection Customer Signature The distributed generation facility is complete and has been approved by the local electric inspector having jurisdiction. A signed copy of the electric inspector's form indicating final approval is attached. The interconnection customer acknowledges that it shall not operate the distributed generation facility until receipt of the final acceptance and approval by the EDC as provided below. Signed: Date: (Signature of interconnection customer) Printed Name: Check if copy of signed electric inspection form is attached Check if copy of as built documents is attached (projects larger than 25 kW only) ……………………………………………………………………………………………………
Interconnection Customer Information. Name: Facility Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address: Installer Check if owner-installed Name: Mailing Address: City: State: Zip Code: Telephone (Daytime): (Evening): Facsimile Number: E-Mail Address:
Interconnection Customer Information. Legal Namename of the Interconnection Customer (or, if an individual, individual’s name) If applying for a Utility’s customer program in conjunction with this request, the Legal name must be the same as the name shown on the Interconnection Customer’s account with the Utility. Name:
