Certificate of Completion Form

Project Developer / Engineer or Electrician (Primary Contact Person)

Name (First and Last)

Company

Mailing Street Address

City

State

Zip Code

Email (primary contact)

Phone Number

Member / Owner Information

Member Name (First and Last)

Member Account #

Facility Street Address

Facility City

Facility State

Facility Zip Code

Member Email

Member Phone

Installation and Inspection Information

Is installation complete?

YesNo

Date of Completion

Has system passed final inspection by AHJ?

YesNo

Date of Inspection

Please attach a copy of the approved final inspection

Interconnection Agreement

Please attach a copy of the completed interconnection agreement

Connector Information

Record Type Name

Not Needed After Refactor is Completed

Record Type ID