Interconnection Customer Signature Sample Clauses
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 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 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: Telephone (Day): Fax: (Evening): Location of the Generating Facility (if different from above) Address City: County: State: Zip: Name: Company: E-Mail Address: Address: City: State: Zip: Telephone (Day): Fax: (Evening): 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): Signature: Print Name: Date: As a condition of interconnection, you are required to send/email/fax a copy of this form along with a copy of the signed electrical permit to (insert Utility information below): Utility Name: Attention: E-Mail Address: Address: City: Fax: State: Zip: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW. Utility Signature: Title: Date:
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 10kW and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Title: Date: (For ISO and Connecting Transmission Owner use only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting an Inverter-Based Small Generating Facility No Larger than 10kW and return of the Certificate of Completion. Connecting Transmission Owner Signature: Title: Date: Connecting Transmission Owner waives inspection/witness test Yes No ISO Signature: Title: Date: Is the Small Generating Facility owner-installed? Yes No Interconnection Customer: Contact Person: Address: Location of the Small Generating Facility (if different from above): City: State: Zip Code: Telephone:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 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 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 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 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: ELECTRONICALLY FILED - 2019 April 22 5:05 PM - SCPSC - Docket # 2019-130-E - Page 60 of 115 Interconnection Request ID number: Utility waives inspection/witness test? Yes No ELECTRONICALLY FILED - 2019 April 22 5:05 PM - SCPSC - Docket # 2019-130-E - Page 61 of 115 Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kw and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date:
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 10kW and to return the Certificate of Completion when the Small Generating Facility has been installed. I further agree to relinquish my claims to any REC that will be generated with my equipment as part of this agreement.
Interconnection Customer 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 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Inspector Signature: Permit # (if required): 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 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Is the Generating Facility owner-installed? Yes No Interconnection Customer (must be utility billing customer) Name: Contact Person: Address: Name: Address: City: State: Zip: Telephone (Day): Fax: (Evening): E-Mail Address: License Number: Date Approval to Install Generating Facility granted by the Utility: Interconnection Request ID Number: The Generating Facility has been installed and inspected in compliance with the local building/electrical code of Attach signed electrical inspection and a signed electrical permit. 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: Greenville Utilities Commission Electric Engineering Office ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇ P.O. Box 1847 Greenville, North Carolina ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ (fax) I hereby certify that, to the best of my knowledge, the Generating Facility listed above has been installed in accordance with the Greenville Utilities Commission Interconnection Procedures for Certified Inverter-Based, Single-Phase Generators No Larger than 20 kW and the Greenville Utilities Commission Terms and Conditions for Interconnecting a Certified Inverter-Based, Single-Phase Generating Facility No Larger than 20 kW. Signature: Date: Energizing the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW. Utility Signature: Title: Date:
Interconnection Customer Signature. I hereby certify that, to the best of my knowledge, the information provided in this Interconnection Request Application Form is true. I agree to abide by the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return the Certificate of Completion when the Generating Facility has been installed. Signed: Title: Date: Print Full Name Company Name Title With Company E-Mail Address Mailing Address: City: State: Zip: County: Telephone (Day): (Evening): Fax: Interconnection of the Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW and return of the Certificate of Completion. Utility Signature: Title: Date: Interconnection Request ID number: Utility waives inspection/witness test? Yes No for Interconnecting a Certified Inverter-Based Generating Facility No Larger than 20 kW Is the Generating Facility owner-installed? Yes No Interconnection Customer Name: Contact Person: E-Mail Address: Address: City: State: Zip: County:
Interconnection Customer 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 an Inverter-Based Generating Facility No Larger than 20 KW for residential customers and no larger than 100 KW for non- residential customers and return the Certificate of Completion when the Small Generating Facility has been installed. Signed: Date: _ Title: _ **************************************************************************************************************** Contingent Approval to Interconnect the Small Generating Facility (For City of Concord Use Only) Interconnection of the Small Generating Facility is approved contingent upon the Terms and Conditions for Interconnecting an Inverter-Based Generating Facility No Larger than 20 KW for residential customers and no larger than 100 KW for non-residential customers and return of the Certificate of Completion. City of Concord Electric Systems Director Signature: Date _ Application ID Number: _ City of Concord waive inspection /witness test? □ Yes □ No Please complete the form, sign, and mail this form and applicable processing fee to: City of Concord Electrical Engineer P.O. Box 308 Concord, North Carolina 28026-0308 (▇▇▇) ▇▇▇-▇▇▇▇ INTERCONNECTION CUSTOMER ☐ Check if Owner-Installed Interconnecting Customer: Contact Person: Mailing Address: City: State: Zip: Telephone (Day): (Evening): Fax: E-Mail Address: Address: City: State: Zip: ******************************************************************************************* Name: Mailing Address: City: State: Zip: Telephone (Day): (Evening): Fax: E-Mail Address: License Number: Date Approval to Install System granted to City of Concord: Application ID Number: ******************************************************************************************* The system have been installed and inspected in compliance with the local Building/Electrical Code of: (Appropriate Governmental Authority) Signed (Local Electrical Wiring Inspector, or attach signed electrical inspection): Signature: Name (Printed): 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: City of Concord Attn: Electrical Engineer P.O. Box 308 Concord, North Carolina ▇▇▇▇▇-▇▇▇▇ Phone: (▇▇▇) ▇▇▇-▇▇▇▇ Fax: (▇▇▇) ▇▇▇-▇▇▇▇ ************...
Interconnection Customer Signature. I hereby certify that all of the information provided in this application request form is true. Signature: Date: Printed Name: Title: An application fee is required before the application can be processed. Please verify that the appropriate fee is included with the application. [ ] [ ] Application fee included Yes No Amount: Receipt of the application fee is acknowledged and the interconnection request is complete. EDC Signature: Date: Printed Name: Title: Small Generator Facility Interconnection Certificate of Completion Form1 Name: Mailing Address: City: State: Zip Code: Telephone (Daytime): (Evening): Facsimile (FAX) Number: Email Address: Name: Mailing Address: City: _State: Zip Code: Telephone (Daytime): (Evening): Facsimile (FAX) Number: Email Address: