INTERCONNECTION REQUEST(APPLICATION)

INTERCONNECTION REQUEST
(APPLICATION)

Record Type Name

Processing Fee

A non-refundable processing fee of $100 must be paid before this Application is considered complete.

Are you submitting at a location with existing electric service or is this for a new build?

Are you the Member or a Contractor?

Who will pay the Interconnection Application fee?

This will determine who will receive an email with a link to pay the required fee.

Interconnection Member Information

Jackson EMC Billing Account #

First Name

Last Name

Primary Phone

Secondary Phone

Street

City

State Abbreviation

Zip Code

Contractor Information

Company Name

First Name

Last Name

Primary Phone

Secondary Phone

Street

City

State Abbreviation

Zip Code

Distributed Generation Facility Information

Installation Location

The location where the Generator (or Panel) will be installed.

Prime Mover Other Details

Energy Source Other Details

System Design Capacity (Total Panel DC Capacity)

(kW)

Generator or Panel

Generator (or Panel) Manufacturer

Generator (or Panel) Model

Generator (or Panel) Certifying Entity

IEEE or UL certification

Nameplate Rating

(AC Volts)

Nameplate Rating

(kW)

Inverter

Inverter Manufacturer

Inverter Model

Inverter Certifying Entity

IEEE or UL certification

Phase

Nameplate Rating

(kW)

Battery

Battery Manufacturer

Battery Certifying Entity

IEEE or UL certification

Battery Energy

(kWh)

Battery Power

(kW)

Disconnect Switch

Disconnect Switch Manufacturer

Disconnect Switch Model

Disconnect Switch Certifying Entity

IEEE or UL certification

Disconnect Switch Rating

(AC Amps)

Attach Supporting Documents

Please attach a detailed one-line diagram of the proposed Distributed Generation Facility

Please attach a major equipment specifications (generators, transformers, inverters, circuit breakers, protective relays, disconnect switches, etc)

Please attach any other applicable drawings or documents necessary to for the proper design of the interconnection

Estimated Installation Date:

Estimated In-Service Date:

Terms and Conditions

I hereby certify that, to the best of my knowledge, the information provided in this

Application is true. I agree to provide any further information required during the

Interconnection Application Process and to install and operate the interconnecting

equipment according to the Terms and Conditions as outlined in Jackson Electric

Membership Corporation’s Distribution Interconnection Procedure.

Accept Terms and Conditions

Solar	Wind
Hydro	Diesel
Natural Gas	Fuel Oil
Battery	Other