Net Metering Revision: 1 Revised: November 7, 2017 Net Metering Page 1 of 5
1 Net Metering This Application and Agreement is considered complete when it provides all applicable and correct information required and is signed below. Additional information to evaluate the Application may be required. 1.1 Processing Fee A non-refundable processing fee of $100 (25kW or less) or $500 (over 25kW) must accompany this Application. 1.2 Additional Documentation This application and agreement should be accompanied by the follow documents: One Line Diagram, including: o Energy Source o Inverter(s) o Disconnect switch o Production meter o Service/Net Meter o Connection to Service Panel Site Map Photovoltaic Panel Specification sheet (if applicable) Inverter specification sheet (if applicable) Turbine specification sheet (if applicable) IEEE 1547 or UL 1741 Certification 1.3 Interconnection and Net Meter Customer Information Account Number: Name: Service Address: Mailing Address: Telephone: Cellular: Email Address: Net Metering Page 2 of 5
1.4 Installer Information Company Name: Contact Person: Address: Telephone: Cellular: Email Address: 1.5 Generation Facility Information Energy Source (e.g. Solar, Wind, Hydro, Fuel Cell): Rated Output: kw Volts Amps Is the system: Single Phase Three Phase Does the system have battery back up? Yes No Does the system have a backup generator? Yes No Proposed Installation Date 1.6 Inverter Information (if applicable) Nameplate Ratings: kw Volts: Amps Number of Inverters: UL 1741 Listed Inverters? Yes No 1.7 Photovoltaic Panel Information (if applicable) Nameplate Ratings: W Volts: Amps Number of Modules: Modules made in Washington? Yes No 1.8 Other Generation (e.g. Wind, Hydro, Fuel Cell, Bio-Gas) Information (if applicable) Nameplate Ratings: kw Volts: Amps Operating Power Factor Net Metering Page 3 of 5
1.9 Interconnection Customer Signature I certify that the information provided above is complete and correct to the best of my knowledge. I agree to the terms and conditions of the Interconnection Standards Revision 1 set forth by the. I agree to the terms and conditions of the Net Metering Standards Revision 1 set forth by the Public Utility District #1 of Lewis County. I agree to allow the to disclose personal information about my participation in the Washington State Renewable Energy Cost Recovery program to the Washington State University s Energy Extension Program. I agree to allow the to disclose certain information about my generation facilities to the installer of my system. 1.10 Signatures By signing below the Customer-Generator certify, to the best of their knowledge, the information provided above is true and correct. In Witness Whereof, the Parties have caused this Application and Agreement to be executed by their duly authorized representatives as the date below. This final Application and Agreement is effective as of the last date set forth below. Customer-Generator: Signature: Print Name: Title: Date Signed: Net Metering Page 4 of 5
2 Customer Checklist for Utility Interconnection PUBLIC UTILITY DISTRICT NO.1 OF LEWIS COUNTY Submit the Application and Agreement for Interconnection and Net Metering to the Public Utility District #1 of Lewis County (Utility). Send application to Public Utility District No. 1 of Lewis County o Email to netmetering@lcpud.org o Mail to P.O. Box 330, Chehalis WA 98532 Receive written design approval from the Utility Pay application fee and production meter fee (if applicable) Get an electrical permit from Washington State L&I (360-896-2300). Follow the National Electric Code (NEC) as required. Complete the installation. Get inspections from a state electrical inspector Notify the Utility that the installation has passed inspection. Get inspection from the Utility Utility installs new bi-directional meter and/or production meter (if applicable). Start generating power Net Metering Page 5 of 5