Application for Interconnection of Customer Owned Generation

Company

This field is for validation purposes and should be left unchanged.

Customer Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone Number - Day(Required)

Phone Number - Evening

Fax

Email Address(Required)

DES Electric Service Account Number

Contact (If different than Customer)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone Number - Day

Phone Number - Evening

Fax

Email Address

Owner of System (If different than Customer)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone Number - Day

Phone Number - Evening

Fax

Email Address

Electrical Contractor

As applicable

Company

Mailing Address

Street Address Address Line 2 City State ZIP Code

Phone Number - Day

Phone Number - Evening

Fax

Email Address

Contractor's License #

City/County/State

Generating Facility Information

Location (if different from above)

Distributor(Required)

Account Number(Required)

Inverter Manufacturer(Required)

Model(Required)

Nameplate Rating

kW(Required)

kVA(Required)

AC Volts(Required)

Single Phase(Required)

Three Phase(Required)

System Design Capacity

If other please describe

kW(Required)

kVA(Required)

Energy Source - check all that apply(Required)

Solar

Wind

Renewable

Renewable with Battery Backup

Whole Home Generator

Portable Generator

EV Battery Charger

Other

If other, please describe.

Estimated Installation Date(Required)

Estimated In-Service Date(Required)

Equipment Type

Certifying Entity

Additional Information - Single Line Diagram

In addition to the items listed above, please attach a detailed one-line diagram of the proposed facility, all applicable elementary diagrams, major equipment (generators, transformers, inverters, circuit breakers, protective relays, batteries, number and location of PV panels, etc.), specifications, test reports, etc., and any other applicable drawings or documents necessary for the proper design of the interconnection. Also describe the address or grid coordinates of the facility.

File Upload(Required)

Drop files here or

Max. file size: 300 MB.

Name

First Last

Title

Date(Required)