GENERATOR INTERCONNECTION APPLICATION
Category 1
For All Inverter-Based Projects with Aggregate Generator Output 20 kW or Less
ELECTRIC UTILITY CONTACT INFORMATION
Consumers Energy
Interconnection Coordinator
1945 West Parnall Road (Room P14-205)
Jackson, MI 49201
(517)788-1432
Interconnection E-mail: customer_generation@cmsenergy.com
CUSTOMER / ACCOUNT INFORMATION
Electric Utility Customer Information (As shown on utility bill)
Customer Mailing Address
Customer Name (Last, First Middle)
Customer Phone Number
Customer E-mail Address (Optional)
(
)
Electric Service Account Number
Electric Service Meter Number
GENERATION SYSTEM SITE INFORMATION
Physical Site Service Address (If Not Billing Address)
Attached Site Plan
Attached Electrical One-Line Drawing
Page #
Page #
GENERATION SYSTEM MANUFACTURER INFORMATION
System Type (Solar, Wind, Biomass Methane Digester, etc.)
Generator Type (Inverter, Induction, Synchronous)
Total Generator(s) Nameplate DC Rating (Solar Only)
Total Generator(s) Nameplate AC Rating
kW
kW
A.C. Operating Voltage
Wiring Configuration (Single Phase, Three Phase)
Expected Annual Output in Kilowatt Hours
Is the Inverter tested to IEEE 1547.1?
kWh/year
Yes
No
Not Applicable
INVERTER BASED SYSTEMS
Manufacturer
Model (Name/Number)
Inverter Power Rating (kW)
kW
INDUCTION AND SYNCHRONOUS BASED SYSTEMS
Manufacturer
Form 1219 4-2013
Model Name
Model Number
Page 1 of 4
INSTALLATION INFORMATION
Project Single Point of Contact: (Electric Utility Customer, Developer or Other)
Name
Company (If Applicable)
Phone Number
(
E-mail Address
)
Requested In Service Date
Licensed Contractor (Name of Firm or Self)
Contractor Name (Last, First, MI)
Contractor Phone Number
(
Contractor E-mail
)
CUSTOMER AND CONTRACTOR SIGNATURES AND FEES
Attached $75 Interconnection Application Fee
Check #
Money Order #
Sign and Return Completed Application with Application Fee to Electric Utility Contact
To the best of my knowledge, all the information provided in this application form is complete and correct.
Customer Signature
Date
Contractor Signature (if applicable)
Date
Note: Refer to the applicable “Michigan Electric Utility Generator Interconnection Requirements” for a detailed explanation of the
Interconnection Process and Technical Requirements.
Form 1219 4-2013
Page 2 of 4
SAMPLE SITE PLAN – PROVIDED FOR REFERENCE ONLY
SITE PLAN
Applicant
Address
City/Town
Signature
30’– 0”
100.00’
Property Line
BUILDING SETBACK
LINES
20’– 0”
20’ – 0”
Sample on-site
generator location
150.00’
GARAGE
Visible
Break
Inverter
24’
24’-0”
Home
Service
Panel
Metering
To
Utility
150.00’
HOUSE
25’– 0”
29’– 0”
36’
N 59º 48’ 00” WEST
STREET
Weblink to State of Michigan / Plats:
http://www.cis.state.mi.us/platmaps/sr_subs.asp
Note: Legible hand drawn site plans are acceptable.
Form 1219 4-2013
Page 3 of 4
SAMPLE ONE-LINE DRAWING
SITE PLAN
Applicant
Address
City/Town
Signature
Customer
2 Pole
xx Amp
Located: House Service Panel
Breaker #:a
in/out
Customer
2 Pole
xx Amp
Located: House Service Panel
Breaker #:Main
Utility Installed Meter
Customer /
Contractor /
Developer Installed Enclosure(s)
Visible Break
AC Disconnect
Located External to Building
Lockable, Taggable, Accessible to Utility
GEN
Inverter / Generator
Manufacturer: XYZ Corp
Make: AAA
Model: 2000aa
Voltage: 240VAC
Connection: 240 Phase to Phase
Note: This One-Line Drawing is a general drawing for Net Metering customer.
Legible hand drawn one-line drawings are acceptable.
Form 1219 4-2013
Page 4 of 4