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Certificate of Completion for Simplified Process Interconnections
Installation Information:
Installed Owner—Interconnecting Customer
Interconnecting Customer Name print): Mary Garbauskas
Contact Person: Mary Garbauskas
Mailing Address: 69 Neptune Ln
City: S Yarmouth State: MA •
Zip Code: 02664
Telephone (Daytime): 518-598-7643 (Evening):
Facsimile Number:
E-Mail Address: mfgarbauskas@gmail.com
Address of Facility:
Address: 69 Neptune Ln
City:S Yarmouth State: MA
Zip Code: 02664
Electrical Contractor Company(if appropriate): Tesla Energy Operations Inc.
Contractor Name: Tesla Energy
Mailing Address: 12832 South Frontrunner Blvd.
City: Draper State: UT •
Zip Code:84020
Telephone (Daytime):8887652489
E-Mail Address: interconnection ry@tesla.com
License number: 2282 A
Date of approval to install Facility granted by the Company:
Application ID number: ESMASI-26766
Work Request number: 12855007
Inspection:
The system has been installed and inspected in compliance with the local Building/Electrical Code of
(City/County) Yar outh/ Signed(Local Electric Wiring Inspector,or attach signed electrical
inspection):
Signature :
Name(Printed): 6-UJr(�
Date: S� 3 I (2.-3
License# 2_.