49-037 (3) 1.{/,-63"7- 0 of
Massachusetts Electric Company&Nantucket Electric Company(d/b/a National Grid) M.D.P.U. 1320
Certificate of Completion for Simplified Process Interconnections
Installation Information: ❑ Check if owner-installed
Interconnecting Customer: MICHAEL GROSS, SARA GROSS Contact Person: SARA GROSS
Mailing Address: 644 PARK HILL RD
City: FLORENCE State: MA Zip Code:01062
Telephone (Daytime): (413) 301-2277 (Evening):
Facsimile Number: E-Mail Address: SJmgross@comcaSt.net
Address of Facility (if different from above):
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): SAME
Facsimile Number: 413-772-8668 E-Mail Address: interconnection@pvsquared.coop
License number: A13764
Date of approval to install Facility granted by National Grid: 4/15/2022
Application ID number: 00423172
inspection:
The system has been installed and inspected in compliance with the local Building/Electrical Code of
(City/County):
Signed(Loc Electri 1 Wiring Inspector, or attach signed electrical inspection):
Name (printed): Re (r-e_rl wl 4 Lb Date: (i,',.) °I- ?-1-
License#: V 0 (1,(1
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(cOationalgrid.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