Illinois Administrative Code › Title 83 - PUBLIC UTILITIES › Part 467 - ELECTRIC INTERCONNECTION OF LARGE DISTRIBUTED ENERGY RESOURCES FACILITIES › Appendix B - Application

Current through Register Vol. 48, No. 28, July 12, 2024
Large Interconnection Request Application
				Form
(Greater than 10 MVA)
Applicant Contact
				Information
Name: _____________________________________________________
Company: __________________________________________________
Mailing Address:
				_____________________________________________
City: ____________________ State: _________ Zip Code:
				___________
Telephone (Primary): ______________ (Alternate):
				__________________
Facsimile Number: _____________ E-Mail Address:
				_________________
Alternative or Designated Representative Contact
				Information
Name: ____________________________________________________
Company: _________________________________________________
Mailing Address: ____________________________________________
City: __________________ State: _________ Zip Code:
				____________
Telephone (Primary): ______________ (Alternate):
				_________________
Facsimile Number: _______________ E-Mail Address:
				______________
Distributed Energy Resources Facility
				Information
Project Name: _____________________________________________
Facility Address: ___________________________________________
City: _______ County: _______ State: _______ Zip Code:
				___________
Electric Distribution Company (EDC) serving Facility site:
				_____________
Electric Supplier (if different from EDC):
				__________________________
Account Number of Facility site (existing EDC customers):
				____________
Inverter Manufacturer: ________________ Model:
				__________________
Equipment Contractor (if
				known):
Name: ___________________________________________________
Mailing Address: ___________________________________________
City: __________________ State: _________ Zip Code:
				____________
Telephone (Primary): _______________ (Alternate):
				________________
Facsimile Number: _____________ E-Mail Address:
				________________
Electrical Contractor (if
				known):
Name: ___________________________________________________
Mailing Address: ___________________________________________
City: __________________ State: _________ Zip Code:
				____________
Telephone (Primary): ______________ (Alternate):
				_________________
Facsimile Number: ______________ E-Mail Address:
				_______________
License number: _________________
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Intent of Generation (check all that
				apply):
Offset Load (Unit will operate in parallel, but will not
				export power to EDC)
Back-up Generation (Units that temporarily operate in
				parallel with the electric distribution system for more than 100
				milliseconds)
Qualified Facility ("QF") under PURPA
Other, please describe:
				_________________________________
Note: Backup units that do not operate in parallel for more than 100
				milliseconds do not need an interconnection agreement.
Generator & Prime Mover
				Information
ENERGY SOURCE (Hydro, Wind, Solar, Process Byproduct,
						  Biomass, Oil, Natural Gas, Coal, etc.):
ENERGY CONVERTER TYPE (Wind Turbine, Photovoltaic Cell, Fuel
						  Cell, Steam Turbine, etc.):
NAMEPLATE CAPACITY:
kW or kVA
NUMBER OF UNITS:
TOTAL EXPORT CAPACITY:
kW or kVA
GENERATOR TYPE (Check one):
InductionInverterSynchronous
						  Other
Distributed Energy Resources Facility
				Information
Estimated Commissioning Test Date:
__________________
Note: Provide the following information to the extent known.
				The EDC will contact you for additional information that may be needed after
				reviewing the application.
List interconnection components/systems to be used in the
				distributed energy resources facility.
Component/SystemNRTL Providing
				Label & Listing
1. _______________________________________________________
2. _______________________________________________________
3. _______________________________________________________
4. _______________________________________________________
5. _______________________________________________________
Please provide copies of manufacturer brochures
				or technical specifications
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Capacitor Banks:
Type: ___________________________________________________
Size: ___________________ MVAR
Other Facility Information:
One Line Diagram attached: Yes
Plot Plan attached: Yes
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Customer Signature
I hereby certify that all of the information provided in this
				Interconnection Request Application Form is true.
Applicant Signature: ________________________________________
Title: ______________________ Date: _________________________
An application fee must be submitted before the application can be
				processed. The application fee is $15,000 for all Large (>10 MVA) Distributed
				Energy Resources Facilities. Of the total application fee, $5,000 is nonrefundable,
				while the EDC shall apply the remaining $10,000 toward any subsequent studies
				related to this application.
EDC Acknowledgement
Receipt of the application and fee is acknowledged. This
				acknowledgement does not preclude the requirement to furnish additional information
				by the applicant if requested by the EDC when it is necessary for the EDC's review
				under these procedures. When this interconnection request is deemed complete by the
				EDC, the EDC shall notify the interconnection customer in writing.
EDC Signature: _________________ Date:
				_______________________
Printed Name: ________________ Title:
				_________________________