Fillable COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

Fill Online, Printable, Fillable, Blank COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities) Form

Use Fill to complete blank online OWATONNA PUBLIC UTILITIES pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

On average this form takes 61 minutes to complete

The COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities) form is 4 pages long and contains:

  • 3 signatures
  • 23 check-boxes
  • 222 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Owatonna Public Utilities forms online.

BROWSE OWATONNA PUBLIC UTILITIES FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION
SECTION A. CUSTOMER INFORMATION (please print)
Account Name Doing Business As (if different from Account Name)
Installation Address City State Zip Code
Mailing Address (if different from above) (rebate check will be mailed here) City State Zip Code
Account Number
o
Send us a rebate check.
o
Apply rebate to our account.
(Rebates $75 and under will be applied to your account. If a box is not checked a bill credit will automatically be issued.)
Type of Business:
o
Church
o
Government
o
Grocery
o
Health
o
Industrial
o
Lodging
o
Multi-family
o
Office
o
Restaurant
o
Retail
o
School
o
Other___________________________
How did you hear about CONSERVE & SAVE
®
?
o
Billboard
o
Chamber of Commerce
o
Contractor
o
Newspaper
o
Radio
o
Retailer/Vendor
o
Social Media
o
TV
o
Utility Newsletter
o
Utility Representative
o
Utility Web Site
o
Other_________________________
SECTION B. CONTACT INFORMATION (please print)/CUSTOMER SIGNATURE
ATTENTION:
ALL INVOICES OR RECEIPTS AND ALL SPECIFICATION SHEETS MUST BE INCLUDED WITH
YOUR FULLY-COMPLETED AND SIGNED APPLICATION OR APPLICATION WILL BE RETURNED.
( )
Contact Name (rebate check will be mailed to contact) Daytime Phone Number
Email
I certify that all the information in the application (including any associated worksheets) is correct to the best of my knowledge. I have read and
agree to the Terms and Conditions on the back of this application booklet. I understand that if any equipment in conjunction with this application
is
ordered, purchased, or installed before approval from The Utility is received, the proposed project may not qualify for a rebate.
Customer’s Signature Date
o
Check here if you DO NOT give us permission to use your business name in advertising our CONSERVE & SAVE
®
programs.
SECTION C. CONTRACTOR/VENDOR INFORMATION (please print)
Company Name Contact Name
Address City State Zip Code
( )
Daytime Phone Number Email
TEAMING UP TO SAVE YOU MONEYTTETEATEAMTEAMITEAMINTEAMINGTEAMING TEAMING UTEAMING UPTEAMING UP TEAMING UP TTEAMING UP TOTEAMING UP TO TEAMING UP TO STEAMING UP TO SATEAMING UP TO SAVTEAMING UP TO SAV ETEAMING UP TO SAV E TEAMING UP TO SAVE YTEAMING UP TO SAVE YOTEAMING UP TO SAVE YOUTEAMING UP TO SAVE YOU TEAMING UP TO SAVE YOU MTEAMING UP TO SAVE YOU MOTEAMING UP TO SAVE YOU MONTEAMING UP TO SAVE YOU MONETEAMING UP TO SAVE YOU MONEY
OFFICE USE ONLY Date Received:____________________
Inspected (Date & Initials): Pre:__________________ Post:___________________
Approval & Date:_____________________________________
Internal Account Number:_____________________________
TOTAL REBATE:
$
MN
MN
MN
MS
click to sign
signature
click to edit
TABLE 1 – Existing Cooling Equipment Types
Code Equipment Description
UT-1 Rooftop/Packages AC: Less than or equal to 65,000 BTU/hour (5.4 Tons)
UT-2 Rooftop/Packages AC: 65,001 – 134,999 BTU/hour (5.4 – 11.2 Tons)
UT-3 Rooftop/Packages AC: 135,000 – 239,999 BTU/hour (11.2 – 20 Tons)
UT-4 Rooftop/Packages AC: 240,000 – 759,999 BTU/hour (20 – 63.3 Tons)
UT-4 Rooftop/Packages AC: 760,000 BTU/hour and greater (63.3+ Tons)
PTAC Packaged Terminal Units (all sizes)
PTHP Packaged Terminal Heat Pump Units (all sizes)
*Efficiency Ratings by AHRI (www.ahridirectory.org):
AFUE = Annual Fuel Usage Efficiency
COP = Coefficient of Performance
EER = Energy Efficiency Rating (low speed)
HSPF = Heating Seasonal Performance Factor
SEER = Seasonal Energy Efficiency Rating
SECTION D. REBATE INFORMATION – GROUND SOURCE HEAT PUMPS
Project Type:
o
RETROFIT
o
NEW CONSTRUCTION
EXISTING (OLD) SYSTEM (if applicable):
COOLING HEATING
Code Size of Unit Rated Efficiency Equipment Type Rated Input Rated Efficiency
(Table 1) (Tons) (enter value, then check (Furnace, Boiler, etc.) (BTU’s) (enter value, then check
SEER* or EER*) HSPF* or AFUE*)
1.
o SEER o HSPF
o EER o AFUE
2.
o SEER o HSPF
o EER o AFUE
3.
o SEER o HSPF
o EER o AFUE
4.
o SEER o HSPF
o EER o AFUE
5.
o SEER o HSPF
o EER o AFUE
6.
o SEER o HSPF
o EER o AFUE
7.
o SEER o HSPF
o EER o AFUE
2
TABLE 2 – Qualifying Efficiencies and Rebate Schedule – Ground Source Heat Pumps (GSHP)
Code Qualifying Equipment Minimum Efficiency Base Rebate ($/Ton) EER Bonus Rebate** ($/Ton)
CL-W2A-20 Closed-Loop Water-to-Air GSHP 17.1 EER and 3.6 COP $200 $20
CL-W2W-20 Closed-Loop Water-to-Water GSHP 16.1 EER and 3.1 COP $200 $20
OL-W2A-20 Open-Loop Water-to-Air GSHP 21.1 EER and 4.1 COP $200 $20
OL-W2W-20 Open-Loop Water-to-Water GSHP 20.1 EER and 3.5 COP $200 $20
DGX-20 Direct Exchange GSHP 16.0 EER and 3.6 COP $200 $20
**EER Bonus Rebate provides an additional incentive for each 1.0 EER above the Minimum Efficiency.
^Total Rebate not to exceed $400/ton.
3
TABLE 3 – GUIDELINES FOR COOLING AND HEATING HOURS
Business Type Cooling Hours Heating Hours
Convenience Store 986 1,546
Education – Community College 785 1,616
Education – Primary 408 1,916
Education – Secondary 563 2,098
Health/Medical – Clinic 865 1,830
Health/Medical – Hospital 1,298 2,054
Lodging 754 1,934
Manufacturing 589 1,144
Office – Low Rise 446 1,610
Office – Mid Rise 651 1,793
Office – High Rise 1,263 1,760
Other/Miscellaneous 729 1,739
Restaurant 652 1,530
Retail – Large Department Store 686 1,444
Retail – Strip Mall 574 1,393
Warehouse 409 1,533
NEW SYSTEM:
Date Installed: ____________________________ Project Cost: (materials and labor) ________________________
Loop Type:
o
Horizontal
o
Vertical
o
Slinky
o
Other _______________________
Total Cooling Capacity: ___________________ BTU’s Total Heating Capacity: ___________________ BTU’s Supplemental Heat Installed:
o
No
o
Yes kW ______________
Desuperheater Installed?
o
Yes
o
No Water Heating:
o
Electric
o
Gas Size of Water Heater in Gallons: ___________
GROUND SOURCE HEAT PUMPS:
A B C D E F G H I J K L M N O
Code Manufacturer Model Size Qty. Annual Annual AHRI Minimum Rated Rated Rated Base EER Bonus Total
(Table 2) Name Number (Tons) Cooling Heating Reference EER EER COP HSPF Rebate Rebate** Rebate^
Hours Hours Number*
(Table 2) (D x E (J – I) x (M + N)
(Table 3) (Table 3) x $200) (D x E x $20)
1.
$ $ $
2. $ $ $
3. $ $ $
4. $ $ $
5. $ $ $
DESUPERHEATER REBATE: Qty: _________________ X $250 $
TOTAL REBATE AMOUNT $
* Qualifying Water-to-Air Ground Source Heat Pump efficiency ratings are determined using the Air Conditioning, Heating, and
Refrigeration Institute’s (AHRI) directory, which may be found at www.ahridirectory.org. EER rating is at AHRI/ISO 13256-1 cooling
conditions of 77°F entering water temperature and 80.6°F dry bulb/66.2°F wet bulb entering air temperature (ground loop heat pump).
A copy of the manufacturer’s applicable unit rating must accompany this application.
Qualifying Water-to-Water Ground Source Heat Pump efficiency ratings are determined using the Air-Conditioning, Heating, and
Refrigeration Institute’s (AHRI) directory, which may be found at www.ahridirectory.org. EER rating is at ISO 13256-2 cooling conditions
of 77°F entering water temp. and 53.6°F leaving water temperature (ground loop heat pump).
A copy of the manufacturer’s applicable unit rating must accompany this application.
Qualifying Direct Exchange Ground Source Heat Pumps must be rated in accordance with the AHRI 870 rating conditions.
Please include manufacturer’s specification sheets verifying this information.
4
GROUND SOURCE HEAT PUMP SYSTEMS – INSTALLATION CHECKLIST
THE CONTRACTOR MUST COMPLETE THE FOLLOWING ITEMS
AND REVIEW THIS CHECKLIST IN THE PRESENCE OF THE OWNER!
o
1. The heat pump unit(s) is(are) resting on a one piece, sound absorbing pad that completely supports the base of the
unit(s), or is suspended with recommended hangers and fittings that completely isolate noise and vibrations from any
living areas.
o
2. The size, location, and configuration of the complete heat pump system is as promised in the purchase agreement.
o
3. All major components of the heat pump system have been identified and their functions explained.
o
4. The unit(s) has(have) been operated in both the heating and cooling modes to demonstrate the soundness of
normal operation. The contractor also agrees to check the outdoor loop for proper operation, i.e. system loop has been
purged and pressurized per manufacturer’s specifications.
o
5. Air temperatures in both heating and cooling have been demonstrated and fall within manufacturer’s specifications.
o
6. All heating and cooling thermostat functions have been explained.
o
7. If auxiliary heat exists, the reason for auxiliary heat and when it is needed has been discussed.
o
8. Unit(s) run times at various temperatures have been discussed.
o
9. Filter maintenance has been explained and demonstrated.
o
10. All fault lights have been explained [thermostat and unit(s)] - when and how to reset unit in case of an emergency.
o
11. Ductwork is installed in a neat and professional manner.
o
12. Ductwork is isolated from the heat pump unit(s) by flexible connectors, and the supply and return plenum is
internally insulated or constructed of fiberglass duct board.
o
13. Ductwork in unconditioned areas is sealed and insulated.
o
14. Airflow to each room is even and acceptable. (Unless conditions exist that are not correctable.)
o
15. All inside loop piping and piping from unit(s) to water heater is installed in a neat and professional manner and is fully
insulated.
o
16. Rough grade and backfill has been completed.
o
17. The owner has been given a copy of the "As Built Site Plan" for the loop.
o
18. All structural and cosmetic repairs have been completed.
o
19. Anticipated operating costs have been estimated and discussed.
o
20. Warranty coverage (standard and optional extended warranties) has been explained and warranty information turned
in to manufacturer.
o
21.
A second meter has been installed for RPU customers who choose to participate in the High Efficiency HVAC
Rate program. (For more information, visit www.rpu.org or contact an RPU Commercial Account Representative.)
o
22. All work areas have been left clean and tidy.
THE ABOVE ITEMS HAVE BEEN COMPLETED, REVIEWED, ARE UNDERSTOOD, AND AGREED TO. Note exceptions here:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Owner Signature: ___________________________________________________________________ Date: ___________________
Contractor Signature: _______________________________________________________________ Date: ___________________
click to sign
signature
click to edit
click to sign
signature
click to edit
5
SECTION E. TERMS AND CONDITIONS
1. ELIGIBILITY
Rebates are available to non-residential electric customers of Austin Utilities, Owatonna Public Utilities, and Rochester Public Utilities (herein
r
eferred to as The Utility). All products must be in use in facilities in The Utility service territory.
2. APPLICATION
Program is offered January 1 through December 31 of the respective calendar year. Due to limited funding, this rebate offer can be changed
or withdrawn at any time without notice and is available on a first-come, first-serve basis. The entire rebate application must be
read and filled out completely or application will be returned.
3. INSPECTION AND VERIFICATION
The Utility reserves the right to inspect the customer’s facility through on-site visits before and after new equipment installation to verify rebate
e
ligibility. The Utility reminds you to follow all local permitting and building code ordinances.
4. INSTALLATION AND REBATE AMOUNTS
Qualifying energy-efficient equipment installed and operational within six (6) months of the date of purchase are eligible for rebate. Additional
time may be granted subject to the Utility’s pre-approval. In no case will the rebate paid by The Utility exceed the purchase price of the equip-
ment. The maximum rebate amount is $100,000 per customer location per technology per year.
5. INVOICE AND PAYMENT
Following inspection and verification (see #3) and completed installation, the customer must notify The Utility and submit original invoices spec-
ifying the quantity
and price of all materials purchased, the date ordered, installation costs, and applicable taxes. After satisfactory review of
the application and invoices, a rebate check or bill credit will be issued to the customer. Vendors or contractors are not eligible to receive their
customer’s rebate. Please allow 6-10 weeks from the date of application submission for delivery of rebate check or bill credit. The Utility
reserves the right to apply the rebate to past due accounts.
6. EQUIPMENT ELIGIBILITY REQUIREMENTS
Equipment must be new. Eligible high-efficiency heat pumps must meet or exceed The Utility’s minimum efficiency requirements as identified in
Tables 2, 4, and 6 according to its qualifying equipment description/category.
Qualifying Water-to-Air Ground Source Heat Pump efficiency ratings are determined using the Air Conditioning, Heating, and
Refrigeration Institute’s (AHRI) directory, which may be found at www.ahridirectory.org. EER rating is at AHRI/ISO 13256-1 cooling condi-
tions of 77°F entering water temperature
and 80.6°F dry bulb/66.2°F wet bulb entering air temperature (ground loop heat pump). A copy
of the manufacturer’s applicable unit rating must accompany
this application.
Qualifying Water-to-Water Ground Source Heat Pump efficiency ratings are verified using manufacturer specifications which clearly
demonstrate the
Entering Water Temperature (EWT), Gallons Per Minute (GPM) water flow, and the associated EER rating. EER rating is at
AHRI/ISO 13256-2 cooling conditions
of 77°F entering water temperature and 53.6°F leaving water temperature (ground loop heat pump).
Please include manufacturer’s specification sheets verifying this information.
Qualifying Direct Exchange Ground Source Heat Pumps must be rated in accordance with the AHRI 870 rating conditions. Please include
manufacturer’s
specification sheets verifying this information.
7. TAX INFORMATION
The Utility will not be responsible for any tax liability imposed as a result of the rebate payment(s). Customers are advised to consult their tax
advisors for details.
8. DISCLAIMER
The Utility does not guarantee that the implementation of energy-efficient measures or use of the equipment purchased or installed pursuant
to this program will result in energy or cost savings. The Utility makes no warranties, expressed or implied, with respect to any equipment pur-
chased or installed including, but not limited to, any warrant of merchantability or fitness for purpose. In no event shall The Utility be liable for
any incidental or consequential damages. Customers are solely responsible for the proper disposal of existing equipment. Consult the
Minnesota Pollution Control Agency (MPCA) office for details at 800.657.3864.
9. ENDORSEMENT
The Utility does not endorse any particular vendor, manufacturer, product, or system in promoting this rebate program. Listing a vendor or
product does not constitute an endorsement, nor does it imply that unlisted vendors or products are deficient or defective in any way.
10.PRIVACY
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners and
also may be used in our advertising efforts with your permission as granted in Section B of this rebate application.
RETURN COMPLETED APPLICATION AND REQUIRED DOCUMENTATION TO YOUR UTILITY PROVIDER:
Austin Utilities Owatonna Public Utilities Rochester Public Utilities
Attn: Rebate Processing Attn: Rebate Processing Attn: Rebate Processing
1908 14th St NE PO Box 800 4000 E River Rd NE
Austin, MN 55912-4904 Owatonna, MN 55060 Rochester, MN 55906-2813
507.433.8886 507.451.2480 507.280.1500
www.austinutilities.com www.owatonnautilities.com www.rpu.org
PLEASE PRINT ON RECYCLED PAPER 0120fillable
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

COMMERCIAL GROUND SOURCE HEAT PUMPS REBATE APPLICATION (Owatonna Public Utilities)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 8 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document