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Print Form Small Generator Facility Interconnection Certificate of Completion Form Applicant Information Name Mailing Address City Telephone Daytime State Zip Code Evening Fax number Installer Check if owner-installed Final Electric Inspection and Applicant Signature The Small Generator Facility is complete and has been approved by the local electric inspector having jurisdiction. A signed copy of the electric inspector s form indicating final approval is attached. The Interconnection Customer acknowledges that the Small Generator Facility is not ready for operation until receipt of the final acceptance and approval by the Public Utility as provided below. Applicant Signature Check if copy of signed electric inspection form is attached Date Acceptance and Final Approval of Interconnection Installation The interconnection installation is approved and the Small Generator Facility is approved for operation under the terms and conditions of the Public Utilities Commission s rules found at ARSD chapter 20 10 36 and a duly signed and executed Interconnection Agreement. Public Utility waives Witness Test Initial If not waived date of successful Witness Test Yes Passed No Title Applicant has completed this form secured the necessary attachments and signatures and returned a copy to the Public Utility at the Public Utility s designated address. Applicant Signature Check if copy of signed electric inspection form is attached Date Acceptance and Final Approval of Interconnection Installation The interconnection installation is approved and the Small Generator Facility is approved for operation under the terms and conditions of the Public Utilities Commission s rules found at ARSD chapter 20 10 36 and a duly signed and executed Interconnection Agreement. Public Utility waives Witness Test Initial If not waived date of successful Witness Test Yes Passed No Title Applicant has completed this form secured the necessary attachments and signatures and returned a copy to the Public Utility at the Public Utility s designated address.

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  • installation
  • Completion
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