Load Interconnection Request Form (LIRF)

LIRF ID #(ATC use only):
Date Submitted (by LDC):
Date Received (by ATC):
Revision: / 0

INSTRUCTIONS:

  1. Complete the LIRF in its entirety. Include proposed one-line for all projects affecting existing substations.
  2. ATC will update the T-D queue and assign a LIRF ID Number and a Date Received whena complete LIRFissubmitted if the LIRF is considered public information.
  3. Please submit the LIRF to:

Substation Name:Project Type*:

Requested In-Service Date:LDC Expected Construction Start Date:

Can project be listed on T-D Queue Yes No- Confidential

Project is due to an un-forecasted load addition of MW and MVAR.

*If the project type is a transformer replacement, indicate ifsuch a project will include a high voltage protection device replacementas well. If a more detailed description of project type is necessary, provide in the Statement of Need.

REQUESTER INFORMATION

Requester: / Phone: / Email:
Company
Address:
City: / State: / Zip:
Contact: / Phone: / Email:

LOAD INTERCONNECTION INFORMATION

Location (attach a drawing or a map):
State: / City:
Will the distribution work require a LDC Certificate of Authority filing or CPCN filing with the PSCW? / Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
Total distributionconnected generation (DCG) at the interconnection point: Existing: MW Proposed Additional: MW
Is this new or modified DCG subject to state regulatoryinterconnection requirements? Select one (Yes / No)NoYes IfYes, attach regulatory application.
ATC response required by to accommodate DCG regulatory requirements:
Will a Portable Substation be required as part of this proposed project? Select one (Yes / No)NoYes
PROJECTCHARACTERISTICS (Answer the following):
1)Will the proposed work require wiring changes to ATC owned protective systems?Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
2)Will the proposed work require setting changes to ATC owned protective relays? Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
3)Will the proposed work require that ATC complete a companion project at other stations? Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
4)Will the proposed work require modeling in the ATC short circuit case? Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
5)Does this project require ATC to make any drawing updates? Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
6)Are there any devices (esp. large motors) that may produce harmonic currents or voltage flicker/imbalance?Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
If yes, please describe:
7)Is there bridging capability of the new (or existing) load?Select one (Yes/No/ Uncertain)Uncertain at this timeYesNo
If yes, please describe:

CAUTION: For each submittal please retrieve the most current version of this form from

For questions please contact ATC Interconnection Services at

Last Revised: 1/01/16Page 1of 3

Load Interconnection Request Form (LIRF)

LIRF ID #(ATC use only):
Revision:

TRANSFORMER SPECIFICATIONS

High Side: Voltage: 69115138dual winding kV Winding Type: deltagrounded wyeungrounded wye Low Side: Voltage: kV Winding Type: grounded wyedeltaungrounded wye
Normal/Emergency ratings (MVA): / Nameplate impedance:
Capacitor banks MVAR & switching (timer, voltage):
Ultimate number of transformers at site (within next 10 years:

STATEMENT OF NEED FOR PROJECT

Include any information or report on the best-value alternative rationale. Attach additional sheets as needed.

JUSTIFICATION OF DISTRIBUTION PROJECT
SCOPE OF DISTRIBUTION PROJECT

CAUTION: For each submittal please retrieve the most current version of this form from

For questions please contact ATC Interconnection Services at

Last Revised: 1/01/16Page 1of 3

Load Interconnection Request Form (LIRF)

LIRF ID #(ATC use only):
Revision:

10-YEAR LOAD PROJECTION

Substation Name:

If the 10-year load forecast for the affected substation(s) has (have) changed since the most recently submitted 10-year load forecast, please complete the following tables. (Hint: Double click on the table to copy and paste your information).

Loads unchanged from the most recently submitted 10-year load forecast.

Loads changed fromthe most recently submitted 10-year load forecast.

If loads have changed:

-Indicate which season the peak load occurs.

-Forecast the peak load in the table below.

Indicate all substation load forecasts that would be affected by the proposed project.

CAUTION: For each submittal please retrieve the most current version of this form from

For questions please contact ATC Interconnection Services at

Last Revised: 1/01/16Page 1of 3

CAUTION: For each submittal please retrieve the most current version of this form from

For questions please contact ATC Interconnection Services at

Last Revised: 1/01/16Page 1of 3