Electrical Battery Permit Application

ELECTRICAL BATTERY PERMIT APPLICATION

Recitals

WHEREAS, the Applicant seeks authorization to install, modify, or operate a stationary electrical energy storage system (battery system) at the proposed site in accordance with applicable electrical, fire, and building codes; and

WHEREAS, the Issuing Authority requires documented system specifications, plans, safety features, and payment of applicable fees prior to issuance of a permit to ensure public safety and code compliance; and

WHEREAS, the Applicant agrees to comply with all permit conditions, inspection requirements, and any revocation procedures set forth by the Issuing Authority;

Applicant Information

Site & Property Information

Battery System Details

Manufacturer:    Model(s):

Chemistry (check all applicable): Li-ion Lead‑acid Flow Other:

Total Energy Capacity (kWh):    Total Continuous Power (kW):

Number of Battery Units:    Nominal Voltage:

Inverter/PCS Manufacturer & Model:

Installation Location: Indoor Outdoor    Mounting:

Fire Suppression Provided: Yes No    Ventilation Provided: Yes No

Attachments & Plans

The Applicant certifies that the following documents are submitted with this application (check all that apply):

Site plan showing battery location and clearances Electrical single-line diagram Battery and inverter specification sheets Mounting and structural details Fire safety / suppression drawings

Scope of Work

Payment Terms

Permit Fee Amount (USD):

Payment Schedule:

Late Payment Penalty:

Fees are non-refundable unless expressly authorized by the Issuing Authority in writing. Failure to pay required fees may result in denial or suspension of permit processing.

Term and Termination

Permit Start Date:    Permit Expiration Date:

Notice Period for Termination or Suspension (days):

The Issuing Authority may revoke, suspend, or modify the permit for failure to comply with code requirements, permit conditions, or false statements. The Applicant must commence and complete work in accordance with the time limits specified or obtain an extension in writing.

Certifications, Insurance & Inspections

The Applicant hereby certifies under penalty of perjury that the information provided herein is true and correct. Prior to issuance, the Applicant shall furnish proof of insurance and any required indemnity agreements as required by the Issuing Authority. All installations are subject to inspection and approval; no system shall be placed into service without final inspection and written acceptance.

Confidentiality

Information submitted in this application will be treated as public records to the extent required by law. To the extent that any attachments contain proprietary technical details, the Applicant shall clearly mark such material as confidential. The Issuing Authority will make reasonable efforts to protect legitimately proprietary information, but makes no guarantee of confidentiality where disclosure is required by law.

Governing Law

This application and any permit issued in reliance on it shall be governed by the laws and regulations of the jurisdiction in which the installation is situated. Governing jurisdiction:

Entire Agreement

This application, together with approved plans, specifications, and permit conditions, constitutes the entire agreement between the Applicant and the Issuing Authority with respect to the matters contained herein and supersedes all prior communications, representations, or agreements, whether oral or written.

Applicant Attestation

By signing below, the Applicant declares that the information provided on this application and all attachments is accurate and complete. The Applicant agrees to comply with all applicable codes, regulations, inspection requirements, and permit conditions. The Applicant understands that intentional misrepresentation is a violation punishable by law and may result in denial or revocation of the permit.

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