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Distributed Generation Application
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Section 1 - Applicant Contact Information
Name
*
Phone Number
*
Address
*
City
*
State
*
Zip Code
*
Electric Service Account #
Section 2 - Consulting Engineer or Contractor Contact Information
Name
Phone Number
Address
City
State
Zip Code
Email Address
Section 3 - Generating Facility/Inverter Information
Generator Type
Fuel Cell Hydro
Photovoltaic
Wind
Other
Specify Other
Manufacturer
Model Name & Number
kW Rating
*
kVA Rating
Interconnection Voltage
Disconnect Switch Manufacturer / Model #
Disconnect Switch Rating
THD
Maximum Fault Current
External Disconnect
*
-- Select One --
Yes
No
If Yes, Location
Will the system export power?
*
-- Select One --
Yes
No
Rated Frequency
Section 4 - One-Line Diagram & Additional Information
One Line Diagram
*
Product Literature
Electrical Permit
Note: One-line diagram must include all major equipment including, but not limited to, generators, inverters, circuit breakers, and protective relays.
Section 5 - Existing Electric Service
Main Panel Ampere Rating
Main Panel Voltage Rating
Service Character
-- Select One --
Single Phase
Three Phase
Section 6 - Distributed Generation Installation Information
Estimated In-Service Date
Estimated In-Service Date
Estimated Interconnection Date
Estimated Interconnection Date
Printed Name of Applicant
Date
Date
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