30A-053 ELECTRIC COC 300-053-0ol
M.D.P.U.No. 1468
Canceling M.D.P.U.No. 1320
Sheet 104 of 170
STANDARDS FOR INTERCONNECTION OF DISTRIBUTED GENERATION
ATTACHMENT 2
Certificate of Completion for Simplified Process Interconnections
Installation Information: L] Check if owner-installed
Interconnecting Customer Name(print): ALDEN BOURNE
Contact Person:
Mailing Address: 56 LIBERTY ST
City: FLORENCE State: MA Zip Code: 01062-2714
Telephone(Daytime): (917) 816-2437 (Evening):
Facsimile Number: E-Mail Address: acbourne@gmall.com
Address of Facility(if different from above):
56 LIBERTY ST FLORENCE MA 01062
Electrical Contractor's Name(if appropriate): PV SQUARED
Mailing Address: 311 WELLS ST. SUITE B
City: GREENFIELD State: MA Zip Code: 01301
Telephone(Daytime): 413-772-8788 (Evening):
Facsimile Number: E-Mail Address: interconnection@pvsquared.coop
License number: 3877 Al
Date of approval to install Facility granted by the Company: 3.14.2023
Application ID number: 00505981
Inspection:
The system has been installed and inspected in compliance with the local Building/Electrical
Code of
Ax)r Ake ��
(City/County)
Si ed(Local trical Wiring Inspector,or attach signed electrical inspection):
Name(printed): U`n cvn- IN a to
Date: c- /q- 2 3
License# 'yb (,c(R,
Exhibit A
M.D.P.U. No. 1468
Canceling M.D.P.U. No. 1320
Sheet 105 of 170
STANDARDS FOR INTERCONNECTION OF DISTRIBUTED GENERATION
As a condition of interconnection you are required to send/fax a copy of this form along with a
copy of the signed electrical permit to(insert Company's name below):
Name:
Company: NATIONAL GRID
Mail 1: ATTN: DISTRIBUTED GENERATION
Mail 2: 40 SYLVAN RD
City, State ZIP: WALTHAM, MA 02451
Fax No.: DISTRIBUTED.GENERATION@NATIONALGRID.COM
Exhibit A