[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-204514-113":3,"detail-sidebar-cat-1-id-113":71,"doc-detail-204514-id":105},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":64,"head_meta":66,"extra_data":68,"updated_unix":70},113,"id","formulir-isian-permohonan-izin-operasi-permit-application-for-power-supply-operation","FORMULIR ISIAN PERMOHONAN IZIN OPERASI - Permohonan Izin Operasi Penyediaan Tenaga Listrik","","Formulir ini digunakan untuk mengajukan Permohonan Izin Operasi dalam rangka penyediaan tenaga listrik untuk kepentingan sendiri dengan kapasitas pembangkit tenaga listrik di atas 500 kVA di wilayah Provinsi Banten. Dokumen meminta kelengkapan data administrasi, data teknis, serta data lingkungan seperti izin lingkungan dan Amdal/UKL-UPL. Di dalamnya terdapat bagian identitas pemohon, profil perusahaan, akta pendirian, NPWP, rincian mesin penggerak dan generator, jaringan transmisi/distribusi, sambungan listrik, jadwal pembangunan dan pengoperasian, tenaga ahli, hingga informasi energi primer serta lokasi instalasi. Disertai pernyataan tanggung jawab atas kebenaran data.",{"@graph":14,"@context":63},[15,34,50],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/id/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/id/template/formulir/","Formulir",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/id/template/formulir-isian-permohonan-izin-operasi-permit-application-for-power-supply-operation/204514/",4,{"url":32,"name":10,"@type":35,"author":36,"headline":10,"publisher":39,"fileFormat":42,"inLanguage":8,"description":12,"dateModified":43,"datePublished":44,"encodingFormat":42,"isAccessibleForFree":45,"interactionStatistic":46},"DigitalDocument",{"name":37,"@type":38},"Violet","Person",{"url":19,"name":40,"@type":41},"DocShare","Organization","application/pdf","2026-09-08","2026-09-05",true,{"@type":47,"interactionType":48,"userInteractionCount":22},"InteractionCounter",{"@type":49},"ViewAction",{"@type":51,"mainEntity":52},"FAQPage",[53,59],{"name":54,"@type":55,"acceptedAnswer":56},"Apa saja yang harus disertakan pada kelengkapan dokumen?","Question",{"text":57,"@type":58},"Kelengkapan mencakup Data Administrasi, Data Teknis, serta Data Lingkungan (termasuk izin lingkungan dan Amdal/UKL-UPL).","Answer",{"name":60,"@type":55,"acceptedAnswer":61},"Informasi teknis apa yang diminta untuk operasional instalasi?",{"text":62,"@type":58},"Formulir meminta rincian mesin penggerak dan generator, jaringan transmisi dan distribusi, sambungan listrik, serta jadwal pembangunan dan pengoperasian.","https://schema.org",{"og:url":32,"og:type":65,"og:title":10,"og:site_name":40,"og:description":12},"article",{"robots":67,"canonical":32},"index,follow",{"doc_id":69,"site_id":7},204514,1788573956,{"code":4,"msg":72,"data":73},"success",[74,78,81,85,89,93,97,101],{"id":75,"doc_module":22,"doc_module_name":25,"category_name":76,"show_sort_weight":4,"slug":77},178,"Faktur","faktur",{"id":79,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":4,"slug":80},192,"formulir-192",{"id":82,"doc_module":22,"doc_module_name":25,"category_name":83,"show_sort_weight":4,"slug":84},180,"Media Sosial","media-sosial",{"id":86,"doc_module":22,"doc_module_name":25,"category_name":87,"show_sort_weight":4,"slug":88},179,"Poster","poster",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":4,"slug":92},176,"Presentasi","presentasi",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":4,"slug":96},177,"Resume","resume",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":4,"slug":100},182,"Surat","surat-a95d00d3aaf04f3b854ecf140f00d385",{"id":102,"doc_module":22,"doc_module_name":25,"category_name":103,"show_sort_weight":4,"slug":104},183,"Umum","umum-07d1ff437201438088836b2b1ed3c90f",{"code":4,"msg":72,"data":106},{"doc_id":69,"user_id":107,"nickname":37,"user_avatar":108,"doc_module":22,"category_id":79,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":109,"file_id":110,"file_url":111,"file_type":112,"file_size":113,"view_count":22,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":114,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":115,"faqs":116,"seo_title":117,"seo_description":12,"update_tm":70,"read_time":26},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908",".......... , ... 20 ...  \nNomor :  \nLampiran :  \nHal : Permohonan Izin Operasi  \nYang terhormat, Gubernur Banten  \nCq. Kepala Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu Provinsi Banten  \nKawasan Pusat Pemerintahan Provinsi Banten (KP3B)  \nd/a. Jl. Syech Nawawi Albantani –Kota Serang, Provinsi Banten  \nDalam rangka usaha penyediaan tenaga listrik untuk kepentingan sendiri dengankapasitas pembangkit tenaga listrik di atas 500 kVA yang fasilitas instalasinya di wilayah Provinsi Banten, dengan ini kami mengajukan permohonan Izin Operasidengan kelengkapan dokumen :  \n1. Data Administrasi :  \na. Identitas Pemohon;  \nb. Profil Perusahaan;  \nc. Akta Pendirian Perusahaan; dan  \nd. Nomor Pokok Wajib Pajak;  \n2. Data Teknis:  \na. Lokasi instalasi termasuk tata letak (gambar situasi);  \nb. Diagram satu garis;  \nc. Jenis dan kapasitas instalasi penyediaan tenaga listrik;  \nd. Jadwal pembangunan;  \ne. Jadwal pengoperasian;  \n3. Data Lingkungan  \na. Izin Lingkungan  \nb. Amdal/UKL/UPL  \nDemikian permohonan kami, atas perhatian Bapak/Ibu*) Gubernur kami ucapkan terima kasih.  \n*) Sesuaikan dengan keperluan  \nHormat kami, Ttd, meterai dan stempel  \n(Nama Lengkap)  \nJabatan  \nFORMULIR ISIAN PERMOHONAN IZIN OPERASI  \nA. Data Administrasi  \n1. Nama Badan Usaha/Pemohon : ................... .........................................  \n2. Alamat Badan Usaha/Pemohon : ................. ...........................................  \n3. Telp./HP./Faks. : ............................. ...............................  \n4. Akta Pendirian (untuk badan usaha)/Keterangan Pemohon  \nNomor /Tanggal : ................................ ............................  \nNotaris : ....................................... .....................  \nAkta Perubahan (untuk badan usaha) : ............. ............................................... Nomor/Tanggal : ................................. ...........................  \nNotaris : ........................................ ....................  \n5. Nomor Pokok Wajib Pajak : ..................... .......................................  \nB. Data Teknis  \n1. Data Mesin Penggerak  \n\n| Data Mesin | Mesin No |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  | I | II | III | IV | dst |\n| Jenis (Air, Uap, Diesel, dst) |  |  |  |  |  |\n| Merk |  |  |  |  |  |\n| Type |  |  |  |  |  |\n| Buatan |  |  |  |  |  |\n| Negara/Tahun |  |  |  |  |  |\n| Daya (PK/HP) |  |  |  |  |  |\n\n2. Data Generator  \n\n| Generator | Generator No. |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  | I | II | III | IV | dst |\n| Merk |  |  |  |  |  |\n| Tipe |  |  |  |  |  |\n| Buatan Negara/Tahun |  |  |  |  |  |\n| Fasa |  |  |  |  |  |\n| Frekuensi |  |  |  |  |  |\n| kVA |  |  |  |  |  |\n| kW |  |  |  |  |  |\n| Volt |  |  |  |  |  |\n\n3. Jaringan Transmisi :  \na. Panjang Saluran : ......................... kms  \nb. Tegangan : .........................Volt  \n4. Jaringan Distribusi :  \na. Panjang Saluran : ......................... kms  \nb. Tegangan : .........................Volt  \n5. Sambungan listrik dari dan ke pihak lain : ada/tidak ada  \na. Dari badan usaha lain : ...................... ... ...................................  \nb. Daya Tersambung : .........................kVA  \n6. Jadwal Pembangunan /Pengoperasian Contoh (melampirkan jadwal) :  \n\n| Uraian Kegiatan | Pelaksanaan |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  | 20..... |  |  |  |  |  | 20......... |  |  |  |  |  | 20....... |  |  |  |  |\n| Studi Kelayakan |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| .............. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| ............. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Kontruksi |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Uji Laik Operasi |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| COD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\n7. Keterangan Tenaga Ah","cbCaiePj0BXvB0to","https://ap.wps.com/l/cbCaiePj0BXvB0to","pdf",87928,"Indonesian","# Lampiran\n## Permohonan Izin Operasi\n## Kelengkapan Dokumen\n### Data Administrasi\n### Data Teknis\n### Data Lingkungan\n### Lokasi\n## Pernyataan dan Tanda Tangan","[{\"question\":\"Apa saja yang harus disertakan pada kelengkapan dokumen?\",\"answer\":\"Kelengkapan mencakup Data Administrasi, Data Teknis, serta Data Lingkungan (termasuk izin lingkungan dan Amdal/UKL-UPL).\"},{\"question\":\"Informasi teknis apa yang diminta untuk operasional instalasi?\",\"answer\":\"Formulir meminta rincian mesin penggerak dan generator, jaringan transmisi dan distribusi, sambungan listrik, serta jadwal pembangunan dan pengoperasian.\"}]","FORMULIR ISIAN PERMOHONAN IZIN OPERASI - Permohonan Izin Operasi Penyediaan Tenaga Listrik | PDF"]