National Grid
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MA Complex Application Exhibit C Manuel German Application
Contact Information
Date Prepared
*
Interconnecting Customer
*
Contact Person
*
Mailing Address
*
City
*
State
*
Zip Code
*
Telephone (Daytime)
*
Facsimile Number
*
Telephone (Evening)
E-Mail Address
*
Ownership Information (include % ownership by any electric utility)
*
Site Control
*
Select
Yes
No
Confidentiality Statement
I agree to allow information regarding the processing of my application (without my name and address) to be reviewed by the Massachusetts DG Working Group.
Group Study Agreement
I agree to share my contact information and project details with other parties involved in a Group Study.
Host Retail Customer Contact Information
Retail Customer
Contact Person
E-Mail Address
Telephone
Landowner Information
Landowner Name
Landowner Email
Landowner Telephone
Landowner Mailing Address
Alternative Contact Information
Company Name
Contact Person
Mailing Address
City
State
Zip Code
Telephone (Daytime)
Telephone (Evening)
Facsimile Number
Email
Electrical Contractor Contact Information
Name
E-Mail Address
Mailing Address
City
State
Zip Code
Telephone
Facility Information
Address of Facility
*
City
*
State
*
Zip Code
*
Single Parcel
*
Select
Yes
No
Existing Generation Capacity
On Current Account
On Same Legal Parcel of Land
In Same Building/Structure
Application Number(s) for Existing Generation
Electric Service Company
*
Account Number
*
Meter Number
*
Work Request Number
MTC ID
System Design Capacity
Nominal kWAC
*
Nominal kVA
*
Maximum kWAC
*
Maximum kVA
*
DC-STC Rating (kWDC)
*
Prime Mover and Energy Source
Prime Mover
*
Select
Photovoltaic
Reciprocating Engine
Fuel Cell
Turbine
Other
Other Prime Mover (if applicable)
Energy Source
*
Select
Solar
Wind
Hydro
Diesel
Natural Gas
Fuel Oil
Other
Other Energy Source (if applicable)
IEEE 1547.1 (UL 1741) Listed?
*
Select
Yes
No
Generating Unit Types
Manufacturer
*
Model Name and Number
*
Quantity
*
Nominal kW
*
Nominal kVA
*
Nominal AC Volts
*
Maximum kW
*
Maximum kVA
*
Maximum AC Volts
*
Phase
*
Select
Single
Three Phase
Remove
Add Generating Unit
Other Facility Details
Air Quality Permit Required?
*
Select
Yes
No
Not Sure
Applied for Air Quality Permit?
Select
Yes
No
Planning to Export Power?
*
Select
Yes
No
Cogeneration Facility?
*
Select
Yes
No
Applying for MA SMART?
*
Select
Yes
No
Standalone System?
*
Select
Yes
No
Anticipated Export Power Purchaser
Export Form
*
Select
Simultaneous Purchase/Sale
Net Purchase Sale
Net Metering
Other
Other Export Form (if applicable)
Estimated Install Date
*
Estimated In-Service Date
*
Submit Application