OFFICE USE ONLY
Rebate Total: $__________________________
Savings: _____________________________ccf
3
ATTIC AIR SEALING AND/OR RIM JOIST SEALING/INSULATION (Retrofit only)
MINIMUM EFFICIENCY REQUIREMENTS: All bypasses indicated by House Call audit must be addressed. Post-Installation Blower Door Verification required.
REBATE: CEE Participating Contractor Installed: Air Sealing: $200; Rim Joist Sealing/Insulation: $150
Sealing Type:
o
Air Sealing
o
Rim Joist Sealing/Insulation
o
Check here to signify that all bypasses identified in audit were sealed. If not, explain: _________________________________________________________
_____________________________________________________________________________________________________________________________________________
Describe any additional air sealing performed not identified by audit:
# of Stories: Date of Installation:
CEE PARTICIPATING CONTRACTOR VERIFICATION (Complete for any CEE Participating Contractor installed work.)
CEE Participating Contractors performing the work must have attended all Center for Energy and Environment (CEE)-required trainings and be a
certified insulation installer by the Building Performance Institute, conduct work in accordance with the CEE standards, and agree to the provisions of the
CEE Contractor Participation Agreement, including correcting any deficiencies found by CEE and completing a CEE-provided post-installation report.
Summary of work performed (check all that apply):
o
Attic Air Sealing
o
Attic Insulation
o
Wall Cavity Insulation
o
R5 Rigid Foam (added to outside of insulated walls)
The following section must be completed if attic air sealing, or wall cavity insulation work was performed:
Pre-installation blower door test: ___________CFM at ___________Pa Post-installation blower door test:___________CFM at ___________Pa
% blower door CFM reduction: ___________% If less than 25% reduction, please explain: ___________________________________________________________
Does house have an atmospherically-vented water heater, furnace, or boiler?
o
Yes
o
No
If Yes, initial below to confirm that the following tests were completed and the property owner was advised of any safety issues:
_____ Spillage evaluation for all atmospherically-vented gas appliances
_____ Worst-case negative pressure measurement for each combustion appliance zone
Signature of CEE Participating Contractor: ___________________________________________________________________ Date: __________________________
By signing, I certify that all of the values above are true and accurate and that all work was performed in accordance with the CONSERVE & SAVE
®
HOUSE CALL
Program Air Sealing and Insulation Contractor Requirements and Standards.
Contractor Name (printed): ________________________________________________ Contractor License #: _____________________________________________
ONLY CUSTOMERS WHO HAVE HAD A HOUSE CALL AUDIT PERFORMED MAY QUALIFY FOR THESE REBATES!
ATTIC INSULATION (Retrofit only)
MINIMUM EFFICIENCY REQUIREMENTS: Must add a minimum of R19 with an ending R value of 44 or greater. All attic bypasses must be sealed prior to adding insulation.
REBATE: CEE Participating Contractor Installed: $350 (Rebate is capped at 50% of cost.)
Installation Type:
o
Self-Installed
o
CEE Participating Contractor Installed (see top of this page)
Were all attic bypasses sealed?
o
Yes
o
No
Description of Insulation Improvements:
Manufacturer & Type of Insulation Added: Inches of Insulation Added:
Square feet covered: Date of Installation:
Initial R-Value: ___________ R-Value Added: ___________ Total Ending R-Value (Initial + Added): ____________
OFFICE USE ONLY
Rebate Total: $__________________________
Savings: _____________________________ccf
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