APPLICATION FOR INTERCONNECTION AND PARALLEL OPERATION WITH THE
CITY OF COLUMBIANA ELECTRIC DISTRIBUTION SYSTEM
Return Completed Application to: City of Columbiana
Attn: Electric Superintendent
28 W. Friend Street
Columbiana, Oh. 44408
Customer’s Name: ________________________________________________________
Address: ________________________________________________________________
Contact Person: ___________________________________________________________
Telephone Number: _______________________________________________________
Service Point Address: _____________________________________________________
Information Prepared and Submitted By: _______________________________________
(Name and Address) _______________________________________________________
The following information shall be supplied by the Customer or Customer’s designated
representative. All applicable items must be accurately completed in order that the Customer’s
generating facilities may be effectively evaluated for interconnection with the City’s Electric
Distribution System.
GENERATOR
Number of Units: _________________________________________________________
Manufacturer: ____________________________________________________________
Type (Synchronous, Induction, or Inverter):____________________________________
Fuel Source Type (Solar, Natural Gas, Wind, etc.):_______________________________
Kilowatt Rating (95 F at location):____________________________________________
Kilovolt-Ampere Rating (95 F at location):_____________________________________
Power Factor: ____________________________________________________________
Voltage Rating: ___________________________________________________________
Ampere Rating: ___________________________________________________________
Number of Phases: ________________________________________________________
Frequency: _______________________________________________________________
Do you plan to export power: ______Yes _______No
If Yes, maximum amount expected: ___________________________________________
Expected Energizing and Start-up Date: ________________________________________
Normal Operation of Interconnection: (example: provide power to meet base load, demand
management, standby, back-up, other) (please describe) ____________________
Meter Fee $ _________. Checks may be made payable to the City of Columbiana.
One-line diagram attached: _______Yes
Have all necessary government permits and approvals been obtained for the project prior to this
application? _____Yes / {Note: Requires a Yes for an Application to be considered complete.}
Have the generator Manufacturer machine characteristics been supplied to the City? ____Yes
[Note: Requires a Yes for complete Application.]
Layout sketch showing lockable, “visible” disconnect device: _____Yes
DATE: ____________________
____________________________________
(Signature)
By: _________________________________
Title: _______________________________
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