Ill. Admin. Code tit. 83, pt. 467, app A - Certificate of Completion

Certificate of Completion

(To be completed and returned to the EDC when installation is complete

and final electric inspector approval has been obtained[1])

Interconnection Customer Information

Name: ____________________________________________________

Mailing Address: ____________________________________________

City: ____________________ State: _________ Zip Code: __________

Telephone (Primary): ________________ (Alternate): _______________

Facsimile Number: _______________ E-Mail Address: ______________

Installer Check if owner-installed

Name: ____________________________________________________

Mailing Address: ____________________________________________

City: __________________ State: ___________ Zip Code: __________

Telephone (Primary): ________________ (Alternate): _______________

Facsimile Number: ________________ E-Mail Address: _____________

Final Electric Inspection and Interconnection Customer Signature

The distributed generation 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 it shall not operate the distributed generation facility until receipt of the final acceptance and approval by the EDC as provided below.

Signed: _________________________ Date: _______________________

(Signature of interconnection customer)

Printed Name: _________________________

Check if copy of signed electric inspection form is attached

Check if copy of as-built documents is attached

................................................................................................................................

Acceptance and Final Approval for Interconnection (for EDC use only)

The interconnection agreement is approved and the distributed generation facility is approved for interconnected operation upon the signing and return of this Certificate of Completion by EDC:

Electric Distribution Company waives Witness Test?? (Initial) Yes No

If not waived, date of successful Witness

Test: ____________________________ Passed: (Initial) ______

EDC Signature: __________________________________ Date: ________

Printed Name: ___________________________________ Title: __________

^[1] Prior to interconnected operation, the interconnection customer is required to complete this form and return it to the EDC. Use contact information provided on the EDC's web page for generator interconnection to obtain mailing address/fax number/e-mail address.

Notes

Ill. Admin. Code tit. 83, pt. 467, app A