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2. Section 1 - Applicant Contact Information
4. Name*
5. Phone Number*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Email Address*
14. Electric Service Account #
16. Section 2 - Consulting Engineer or Contractor Contact Information
18. Name
19. Phone Number
21. Address
23. City
24. State
25. Zip Code
27. Email Address
29. Section 3 - Generating Facility/Inverter Information
31. Generator Type

    1. Fuel Cell Hydro
    2. Photovoltaic

    1. Wind
    2. Other
32. Specify Other
34. Manufacturer
35. Model Name & Number
37. kW Rating*
38. kVA Rating
40. Interconnection Voltage
41. Disconnect Switch Manufacturer / Model #
43. Disconnect Switch Rating
44. THD
45. Maximum Fault Current
47. External Disconnect*
    -- Select One --YesNo
48. If Yes, Location
50. Will the system export power back to the electrical grid?*
    -- Select One --YesNo
51. Rated Frequency
53. Section 4 - One-Line Diagram & Additional Information
55. One Line Diagram*
56. Product Literature
57. Electrical Permit
59. Note: One-line diagram must include all major equipment including, but not limited to, generators, inverters, circuit breakers, and protective relays.
61. Section 5 - Existing Electric Service
63. Main Panel Ampere Rating
64. Main Panel Voltage Rating
65. Service Character
    -- Select One --Single PhaseThree Phase
67. Section 6 - Distributed Generation Installation Information
69. Estimated In-Service Date
    Estimated In-Service Date
70. Estimated Interconnection Date
    Estimated Interconnection Date
72. Printed Name of Applicant
73. Date
    Date
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75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field