37-065-002 Massachusetts Electric Company&Nantucket Electric Company(d/b/a National Grid) 37- 6S- DO 2 M.D.P.U. 1320
Certificate of Completion for Simplified Process Interconnections
Installation Information: ❑ Check if owner-installed
Interconnecting Customer: Donald Sailer Contact Person: Interconnection Admin
Mailing Address: 102 Black Birch Trail,
City: Northampton State: MA Zip Code: 01062
Telephone (Daytime): 888.765.2489 (Evening):
Facsimile Number: E-Mail Address: rsylvia@tesla.com
Address of Facility(if different from above):
102 Black Birch Trail, Northampton, MA 01062, US
Electrical Contractor's Name (if appropriate): Tesla Energy Operations, Inc.
Mailing Address: 240 Balardvale St.
City: Wilmington State: MA Zip Code: 01887
Telephone (Daytime): 508-241-1493 (Evening):
Facsimile Number: E-Mail Address: rsylvia@tesla.com (of 202-1
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License number: 22812-A I 7
Date of approval to install Facility granted by National Grid:
Application ID number:
Inspection:
The system has been installed and inspected in compliance with the local Building/Electrical Code of
(City/County): r
G4, a Signed(LoccElect • iring Inspector, or attach signed electrical inspection):
2 I,
Name (printed): \ 0 Cr-tt2 ►u w Date: q -
License #: V0
As a condition of interconnection you are required to send/e-mail a copy of this form along with a copy of the
signed electrical permit to National Grid:
National Grid
Attn: Distributed Generation
40 Sylvan Rd
Waltham, MA 02451
E-mail: distributed.generation@nationalgrid.com
Massachusetts: http://www.nationalgridus.com/masselectric/home/energyeff/distributed_generation.asp
Nantucket: http://www.nationalgridus.com/nantucket/home/energyeff/distributed_generation.asp Page 1 of 1