Large Interconnection Request Application Form

(Greater than 10 MVA)

Name:

Company:

Mailing Address:

City:

State:

Zip Code:

Telephone (Primary):

(Alternate):

Facsimile Number:

E-Mail Address:

Alternative or Designated Representative Contact Information

Name:

Company:

Mailing Address:

City:

State:

Zip Code:

Telephone (Primary):

(Alternate):

Facsimile Number:

E-Mail Address:

Distributed Generation Facility Information

Project Name:

Facility Address:

City:

County:

State:

Zip Code:

Electric Distribution Company (EDC) serving Facility site:

Electric Supplier (if different from EDC):

Account Number of Facility site (existing EDC customers):

Inverter Manufacturer:

Model:

Equipment Contractor (if known):

Name:

Mailing Address:

City:

State:

Zip Code:

Telephone (Primary):

(Alternate):

Facsimile Number:

E-Mail Address:

Electrical Contractor (if known):

Name:

Mailing Address:

City:

State:

Zip Code:

Telephone (Primary):

(Alternate):

Facsimile Number:

E-Mail Address:

License number:

Existing Electric Service Information for Customer Facility Where Generator Will Be Interconnected

Check here if there is no existing electric service at the site

Capacity:			(Amps)			Voltage:	(Volts)
Type of Service:	Single Phase					Three Phase
(If customer-provided) Three Phase Transformer, Indicate Type:
Primary Winding		Wye		Delta
Secondary Winding		Wye		Delta
Transformer Size:					Impedance:
Point of Interconnection − Brief Description and Address of the Distributed Generation
Location:

Intent of Generation (check all that apply):

Offset Load (Unit will operate in parallel, but will not export power to EDC)

Back-up Generation (Units that temporarily operate in parallel with the electric distribution system for more than 100 milliseconds)

Qualified Facility ("QF") under PURPA

Other, please describe:

Note: Backup units that do not operate in parallel for more than 100 milliseconds do not need an interconnection agreement.

Generator & Prime Mover Information

ENERGY SOURCE (Hydro, Wind, Solar, Process Byproduct, Biomass, Oil, Natural Gas, Coal, etc.):
ENERGY CONVERTER TYPE (Wind Turbine, Photovoltaic Cell, Fuel Cell, Steam Turbine, etc.):
GENERATOR SIZE: kW or kVA	NUMBER OF UNITS:	TOTAL CAPACITY: kW or kVA
GENERATOR TYPE (Check one): Induction Inverter Synchronous Other 3515March 1, 2010

Distributed Generation Facility Information

Estimated Commissioning Test Date: _________________________________

Note: Provide the following information to the extent known. The EDC will contact you for additional information that may be needed after reviewing the application.

List interconnection components/systems to be used in the distributed generation facility.

Component/System		NRTL Providing Label & Listing
1.
2.
3.
4.
5.

Please provide copies of manufacturer brochures or technical specifications

Energy Production Equipment/Inverter Information:

Synchronous

Induction

Inverter

Other

Rating:

kVA

Rated Voltage:

Volts

Rated Current:

Amps

System Type Tested (Total System):

Yes

No; attach product literature

For Synchronous Machines:

Manufacturer (when available):

Model No. (when available):

Version No. (when available):

Submit copies of the Saturation Curve and the Vee Curve

Salient

Non-Salient

Rated RPM:

Field Amperes:

at rated generator

voltage and current and

% PF over-excited

Type of Exciter:

Output Power of Exciter:

Type of Voltage Regulator:

Locked Rotor

Synchronous Speed:

RPM

Winding Connection:

Min. Operating Freq:

Generator Connection:

Delta

Wye

Wye Grounded

Direct-axis Synchronous Reactance:

(Xd)

ohms

Direct-axis Transient Reactance:

(X'd)

ohms

Direct-axis Sub-transient Reactance:

(X''d)

ohms

Negative Sequence Reactance:

ohms

Zero Sequence Reactance:

ohms

Neutral Impedance or Grounding Resister (if any):

ohms

For Induction Machines:

Manufacturer:

Model No.:

Version No.:

Locked Rotor Current:

Amps

Rotor Resistance (Rr):

ohms

Exciting Current:

Amps

Rotor Reactance (Xr):

ohms

Reactive Power Required:

Magnetizing Reactance (Xm):

ohms

VARs (No Load)

Stator Resistance (Rs):

ohms

VARs (Full Load)

Stator Reactance (Xs):

ohms

Short Circuit Reactance (X"d):

ohms

Phases:

Single Three Phase

Frame Size:

Design Letter:

Temp. Rise:

°C.

Reverse Power Relay Information

Additional Information for Inverter-Based Facilities

Inverter Information:

Manufacturer:

Model:

Type:

Forced Commutated

Line Commutated

Rated Output:

Watts

Volts

Efficiency:

Power Factor:

Inverter UL 1741 Listed:

Yes

DC Source / Prime Mover:

Rating:	kW	Rating:				kVA
Rated Voltage:			Volts
Open Circuit Voltage (if applicable):							Volts
Rated Current:				Amps
Short Circuit Current (if applicable):					Amps

Dedicated Transformer (applicant owned):

Rating:

MVA

Voltage Ratio:

Fixed Tap Setting:

Winding connections:

Impedance:

% based on transformer rating

Capacitor Banks:

Type:
Size:			MVAR

Other Facility Information:

One Line Diagram attached: Yes

Plot Plan attached: Yes

Comments or additional information:

Customer Signature

I hereby certify that all of the information provided in this Interconnection Request Application Form is true.

Applicant Signature:
Title:			Date:

An application fee must be submitted before the application can be processed. The application fee is $15,000 for all Large (>10 MVA) Distributed Generation Facilities. Of the total application fee, $5,000 is nonrefundable, while the EDC shall apply the remaining $10,000 toward any subsequent studies related to this application.

EDC Acknowledgement

Receipt of the application and fee is acknowledged. This acknowledgement does not preclude the requirement to furnish additional information by the applicant if requested by the EDC when it is necessary for the EDC's review under these procedures. When this interconnection request is deemed complete by the EDC, the EDC shall notify the interconnection customer in writing.

EDC Signature:		Date:
Printed Name:	Title:

Manufacturer:

Relay Type:

Model Number:

Reverse Power Setting:

Reverse Power Time Delay (if any):