Tier I Interconnection Application

This form is only available for certified, inverter-based Distributed Energy Resources (DERs) no larger than 20kW.

The Interconnection Application is to be filled out completely by the applicant or as noted in each section of the application. Section that are noted with * are required to be filled out along with bolded items.

Checklist for Submission to Area EPS Operator

The items below shall be included with submittal of the Interconnection Application to the Area EPS Operator. Failure to include all items will deem the Interconnection Application incomplete.

(Yes) Non-Refundable Processing Fee

(Yes) One-Line diagram

Please see Area EPS Operator’s Technical Requirement for more details.

(Yes) Site Diagram showing DER system layout (See Technic(Seeal Requirements for more details

Possible Additional Documentation (See Technical Requirements for more details)

Schematic drawings for all protection and control circuits, relay current circuits, relay potentialcircuits, and alarm/monitoring circuits (if applicable).
Documentation that describes and details the operation of protection and control schemes (if applicable).
Inverter Specification Sheet(s).

Interconnection Customer/Owner *

Full Name

(match name of electric service account, if applicable):

Account Number:

Meter Number:

Mailing Address:

Email:

Phone:

Application Agent *

Is the Customer using an Application Agent for this application?

Yes

If internconnection Customer is not using an Applicant Agent, please continue to next section.

Application Agent:

Company Name:

Email:

Phone:

DER Location *

Is the proposed DER system to be located at the Interconnection Customer’s mailing address:

Yes

If yes, please continue to the next section.

If No, will the proposed DER system be interconnected to an existing electric service?

Yes

Please provide the address of GPS Coordinates:

If not an existing service, please state the proposed service entrance size (amps):

General *

Application is for a new DER

Aggregate DER namplate rating of all generation and storage types (kW AC):

Application is for a Capacity Addition to an existing DER

Capacity of existing DER (kW AC):

Capacity proposed to be added (kW AC):

Application is for a Material Modification to an existing DER

If Material Modifcation to existing facility, please describe:

Distributed Energy Resource will be used for what reason? (Check all that apply):

To only supply power to the Interconnection Customer

To only supply power to the Area EPS

To supply power to the Interconnection Customer and the Area EPS

Distributed Energy Resource Information *

Phase configuration of Distributed Energy Resource(s):

Single -Phase

Three-Phase

Solar Photovoltaics

Size (k@ AC):

Storage

Size (k@ AC):

Wind

Size (k@ AC):

Other

Size (k@ AC):

Please specify other:

Inverter Interconnected System Information – non ESS (if applicable) *

Aggregate Inverter Rating (kW AC):

Numbers of Total Inverters:

Phase configuration of inverter(s):

Single-Phase

Three-Phase

Voltage of Inverter(s):

Inverter Manufacturer:

1. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

2. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

3. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

4. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

Energy Storage System Information (if applicable)

ESS Inverter Energy Rating (kWh AC):

ESS Inverter Capacity Rating (kW AC):

How will the ESS be used? Select all Use Cases that apply.

Outage Protection/Backup Power

Time-of-Use Energy Management

Demand Reduction

Increased Self-Consumption

No Export

Other

Please specify other:

What Operating Modes will be used? Select all Operating Modes that apply.

Import Only

Export Only

No Exchange

Unrestricted Exchange

If Export Only is Checked, select all that apply.

ESS Export is Allowed

Solar Export is Allowed

Limited Export is Allowed (please specify export limit amount in kW):

export limit amount in kW

Is the ESS recharging limited to certain times of the day and/or after a power outage?

Yes

If Yes, please explain:

If the ESS shares an inverter that is listed in the previous section, please skip the rest of this section.

Aggregate ESS Inverter Rating (kW AC):

Numbers of Total Inverters:

Phase configuration of ESS inverter(s):

Single-Phase

Three-Phase

Other

Voltage of ESS Inverter(s):

ESS Inverter Manufacturer:

1. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

2. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

3. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

4. Model No.

Certification

UL 1741

UL 1741-SA

UL 1741-SB

Inverter Rating (kW AC):

Number of Units of this Model:

Additional Documentation

Please see the Area EPS Operator’s Technical Requirement for required information that need to be on the oneline and site diagram and for example application documentation.

Please see the Interconnection Process for additional requirements related to Site Control and insurance documentation.

Acknowledgements – Must be completed by Interconnection Customer *

Initials

Application Signature – Must be completed by Interconnection Customer *

Member Printed Name:

Date:

Signature

Sign above

BY SIGNING, THE CUSTOMER ACKNOWLEDGES THAT THEY HAVE READ THIS AGREEMENT AND AGREE TO BE BOUND BY ITS TERMS