2. Section 1 - Applicant Contact Information
4. Name*
5. Phone Number*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Electric Service Account #
15. Section 2 - Consulting Engineer or Contractor Contact Information
17. Name
18. Phone Number
20. Address
22. City
23. State
24. Zip Code
26. Email Address
28. Section 3 - Generating Facility/Inverter Information
30. Generator Type

    1. Fuel Cell Hydro
    2. Photovoltaic

    1. Wind
    2. Other
31. Specify Other
33. Manufacturer
34. Model Name & Number
36. kW Rating*
37. kVA Rating
39. Interconnection Voltage
40. Disconnect Switch Manufacturer / Model #
42. Disconnect Switch Rating
43. THD
44. Maximum Fault Current
46. External Disconnect*
    -- Select One --YesNo
47. If Yes, Location
49. Will the system export power?*
    -- Select One --YesNo
50. Rated Frequency
52. Section 4 - One-Line Diagram & Additional Information
54. One Line Diagram*
55. Product Literature
56. Electrical Permit
58. Note: One-line diagram must include all major equipment including, but not limited to, generators, inverters, circuit breakers, and protective relays.
60. Section 5 - Existing Electric Service
62. Main Panel Ampere Rating
63. Main Panel Voltage Rating
64. Service Character
    -- Select One --Single PhaseThree Phase
66. Section 6 - Distributed Generation Installation Information
68. Estimated In-Service Date
    Estimated In-Service Date
69. Estimated Interconnection Date
    Estimated Interconnection Date
71. Printed Name of Applicant
72. Date
    Date
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74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field