Fillable Form 2: N O 1 L C HVAC (Owatonna Public Utilities)

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Form 2: N O 1 L C HVAC (Owatonna Public Utilities)

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CTRI
C HVAC & W
A
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1 of 6
By typing my first and last names in the CUSTOMER SIGNATURE BOX below, I am signing this document and certify:
o
I have completely filled out Sections A and C
o
I have read, understand, and agree to the terms and conditions – Section B, #1
o
I have attached all support materials – Section B, #3-6
o
All equipment has been installed at the address listed in Section A
CUSTOMER SIGNATURE BOX__________________________________________________ Date_____________
SECTION A. CUSTOMER INFORMATION (please print)
Step 1:
Customer Name Account Number
Installation Address City State Zip Code
Mailing Address (if different from installation address) City State Zip Code
o
Home
o
Cell
o
Other:
Contact Phone Number (with area code) E-mail Address
Step 2:
o
Please apply rebate to my account.
o
Please send me a rebate check.
Rebates $75 and under will be applied to your account. If a box is not checked a bill credit will automatically be issued.
Step 3:
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 _______________________________________________
Step 4:
I am a: My building type is: I am a: My home/business is heated by: My water heating is:
o
Residential Customer
o
Single Family
o
Owner/Occupant
o
Electric
o
Electric
o
Commercial Customer
o
Multi- Family
o
Owner/Non-Occupant
o
Gas
o
Gas
buildings with 2 or more units
o
Renter
o
Don’t Know
o
Don’t Know
Allow 6-8 weeks
for processing.
Missing or incorrect
information will
increase the
processing time.
OFFICE USE ONLY o Gas o Electric o Water Total Rebate Amount:
Date Received__________________ Date Processed___________________
$
Appliance/Equipment ____________________________________________
ID____________________ Verified By____________________ FILE NAME:__________________________
MN
MS
MN
MS
SECTION C. CONTRACTOR/RETAILER INFORMATION (please print)
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
Contractor’s/Retailer’s Name Contact Person Phone Number (with area code)
Installer’s Name (write SELF if customer installed)
Type of Appliance/Equipment Installed
SECTION B. REBATE APPLICATION CHECKLIST
Use this checklist to complete the steps to receive your rebates:
o 1. Read the following terms and conditions to determine if you are eligible for a rebate:
• Only one service address per application.
• Rebates are intended for customers, not contractors or builders.
• The Utility reserves the right to apply rebates to past due accounts. Rebates $75 and under will be applied to your account. Rebates
will not exceed the purchase price.
• Energy-efficient equipment must be connected to an electric service supplied by Austin Utilities, Owatonna Public Utilities, or Rochester
Public Utilities and is subject to inspection.
• Purchase and install
NEW
products. Reconditioned, refurbished, or second-hand equipment is not eligible for a rebate.
•
Equipment installations must meet our Minimum Efficiency Requirements to qualify for a rebate. Air-Conditioning, Heating, and Refrigeration
Institute (AHRI) and ENERGY STAR
®
standards are used. The Utility reserves the right to reject any rebate application submitted as a
result of work performed by a contractor who has failed to adhere to the terms and conditions established for the rebate program.
Contractors must be licensed if applicable.
• Due to limited funding, this rebate offer can be withdrawn at any time without notice. Applications will be processed on a first-come,
first-served basis. All applications from this year’s purchases (2021) must be received by March 31, 2022.
• Rebates can only be offered on equipment that is installed while funding is in effect. In the event our program is discontinued due to
depleted funds, we will not provide a rebate for items installed between the discontinued date and the end of that year.
o 2. Complete the application, making sure to fill out all required sections in detail. Allow 6-8 weeks for processing. Missing or incorrect
information will increase the processing time.
o 3.
Include a final, detailed copy of the original sales receipt, invoice, or picking slip showing the customer name, date of sale, manufacturer
name,
model number, size, and date of installation. All HVAC equipment must have serial and model numbers listed on the invoice.
o 4. For FURNACE FAN MOTOR REPLACEMENTS rebates, applicant must also include documentation that the replacement motor is an
Electronically Commutated Motor (ECM) or equivalent.
o 5. Sign the application.
o 6.
Information contained in this rebate application may be shared with the Minnesota Department of Commerce and our co-op partners.
o 7. Mail completed forms 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 55060-0800 Rochester, MN 55906-2813
507-433-8886 507-451-2480 507-280-1500
www.austinutilities.com www.owatonnautilities.com www.rpu.org
or email: rebates@austinutilities.com or email: rebates@owatonnautilities.com or email: rebates@rpu.org
2 of 6
When purchasing any type of appliance or equipment, look for the ENERGY STAR
®
or ENERGY STAR
®
Most Efficient logos!
3 of 6
2021 ELECTRIC HVAC & WATER HEATING EQUIPMENT
C
ENTRAL OR MINI-SPLIT AIR CONDITIONERS
MINIMUM EFFICIENCY REQUIREMENTS: SEER 14.5; Must be AHRI Certified. SEER=Seasonal Energy Efficiency Rating
REBATE: see chart below AHRI=Air-Conditioning, Heating, and Refrigeration Institute – www.ahridirectory.org
Project Type:
o
Retrofit
o
New Installation
Equipment Type:
o
Central Air Conditioner
o
Mini-Split Air Conditioner
Outdoor Unit Model #: Manufacturer’s Name:
AHRI Certified Reference #:
Required – please include copy of AHRI Certificate.
Indoor Unit Model #: Manufacturer’s Name:
Rated Efficiency (SEER by AHRI): Cooling Capacity (Tons):
Number of Units Installed: Date of Installation:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit ___________ SEER
COOLING CAPACITY 14.5 15.0 16.0 17.0 18.0 19.0 20.0 21.0 22.0+
20,000 BTU/hr or less $100 $120 $140 $160 $180 $200 $220 $240
Over 20,000 BTU/hr $200 $220 $240 $260 $280 $300 $320 $340
20,000 BTU/hr or less – Rebate Formula: $100 + [(Rated SEER – 14.5) x $20]
Over 20,000 BTU/hr – Rebate Formula: $200 + [(Rated SEER – 14.5) x $20]
see
formulas
below
OFFICE USE ONLY
Rebate Total: $_____________________
FURNACE FAN MOTORS
RETROFIT EXISTING FURNACE FAN MOTOR. NOT FOR NEW FURNACE INSTALLATIONS.
MINIMUM EFFICIENCY REQUIREMENTS: Must be Electronically Commutated Motor (ECM) or equivalent; documentation required.
REBATE: $50
Manufacturer’s Name: Motor Model #:
Number of Units Installed: Date of Installation:
Do you have a central air conditioner?
o
YES (EXISTING)
o
YES (NEW)
o
NO
o
UNKNOWN
Have you attached the required documentation showing the
retrofit motor is an Electronically Commutated Motor (ECM) or equivalent?
o
YES
OFFICE USE ONLY
Rebate Total: $_____________________
ECM
CIR
CULA
TOR
PUMPS
MINIMUM E
FFICIE
NCY RE
QUIRE
ME
N
TS
:
Mu
s
t b
e
a n
e
w E
le
c
tr
on
ic
ally Commu
tate
d
Motor (E
CM),
DC b
r
u
s
h
le
s
s
,
or
p
e
rman
e
n
t magn
e
t s
tyle
.
Mu
s
t b
e
>
1/50 H
P an
d
<
1 H
P
(n
o gre
ate
r th
an
750 Watts
).
Mu
s
t b
e
c
ap
ab
le
of
variab
le
s
p
e
e
d
op
e
ration
an
d
mu
s
t in
c
lu
d
e
in
te
gr
ate
d
c
on
tr
ols
th
at au
tomatic
ally mod
u
late
f
low b
as
e
d
on
d
e
man
d
.
R
EBATES: <
100 W
at
t
s
=
$50 |
100-499 W
at
t
s
=
$200 |
500-750 W
at
t
s
=
$600 (al
l
reb
at
es
no
t
t
o
exc
eed
50% o
f c
o
s
t
)
H
P
=H
orse
po
w
e
r
P
ro
j
ect Typ
e:
o
Re
t
rofit
o
New Inst
a
lla
t
ion
C
ircu
lato
r P
u
m
p
Typ
e:
o
Boiler
o
Dom
est
ic Hot
W
a
ter
S
iz
e (
W
a
t
t
s)
^
:
Ma
nufa
ct
urer’s Na
m
e:
Mod
el #:
ECM Circula
t
or Cost
:
Number of Units Installed:
Date of Installation:
^Mot
or
W
a
tt
age = R
a
te
d HP x 746
OFFICE USE ONLY
Rebate Total: $___________________________
4 of 6
QUALIFYING EFFICIENCIES AND REBATE CHART
PROJECT
TYPE
EXISTING HEATING
FUEL/TYPE
ASHP SYSTEM
COOLING CAPACITY
ASHP
MINIMUM SEER
ASHP
MINIMUM HSPF
ASHP MINIMUM
COP AT 5º F
BASE
REBATE
EFFICIENCY
BONUS REBATE
3
New Construction/
No Previous
Heating Equipment/
Replace Failed
Heating Equipment
Any
< 20,000 15.5
8.5 NA $800 $10
10.0 1.75 $1,000 $10
20,000–65,000 15.5
8.5 NA $1,600 $10
10.0 1.75 $2,000 $10
Replace Working
Heating Equipment
Electric
Heat
< 20,000 15.5
8.5 NA $900 $10
10.0 1.75 $1,100 $10
20,000–65,000 15.5
8.5 NA $1,800 $10
10.0 1.75 $2,200 $10
Air Source
Heat Pump
< 20,000 15.5
8.5 NA $125 $10
10.0 1.75 $250 $10
20,000–65,000 15.5
8.5 NA $250 $10
10.0 1.75 $500 $10
Through-
the-Wall
Heat Pump
< 20,000 15.5
8.5 NA $200 $10
10.0 1.75 $350 $10
20,000–65,000 15.5
8.5 NA $400 $10
10.0 1.75 $700 $10
Natural Gas/
Other
< 20,000 15.5 7.7 NA $100 $10
20,000–65,000 15.5 7.7 NA $200 $10
OFFICE USE ONLY
Rebate Total: $__________________________
REBATE CALCULATION:
A B C D E
Base Rebate from Chart
SEER
by AHRI
Column B –
15.5 Minimum SEER
Column C
x $10
Total Rebate
(Column A + Column D)
$ $ $
$ $ $
AIR SOURCE OR MINI SPLIT HEAT PUMPS SEER=Seasonal Energy Efficiency Rating
MINIMUM EFFICIENCY REQUIREMENTS: See chart to the right. Must be AHRI Certified. HSPF=Heating Seasonal Performance Factor
REBATE: Base Rebate + $10 per Ton per EER over Minimum Efficiency Requirement
COP=Coefficient of Performance
Based on existing heating fuel/type. See chart below.
AHRI=Air-Conditioning, Heating, and Refrigeration Institute
Maximum Rebate not to exceed 50% of equipment cost.
www.ahridirectory.org
Project Type:
o
Retrofit
o
New Installation
Equipment Type:
o
Air Source Heat Pump
o
Mini-Split Heat Pump
Cooling Capacity:
o
< 20,000 Btuh
o
20,000–65,000 Btuh
Manufacturer’s Name: Indoor Unit Model #: Outdoor Unit Model #:
Cooling Capacity (Btuh): Heating Capacity (Btuh): Rated Efficiency (SEER by AHRI):
EER: HSPF: AHRI Certified Ref #: COP at 5º F* (if ≥10 HSPF)
1
:
Required – please include
copy of AHRI Certificate.
Date of Installation: # of Units Installed:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
EXISTING EQUIPMENT: Heating Type:
o
Electric Heat
o
Air Source Heat Pump
o
Through-the-Wall Heat Pump
o
Natural Gas/Other
o
No Previous Unit
Cooling Type:
o
Central AC
o
Air Source Heat Pump
o
Through-the-Wall Heat Pump
o
Room AC
o
No Previous Unit
Water Heater Type:
o
Natural Gas
o
Electric
o
Heat Pump
1
ASHPs with an HSPF
≥10 must also meet the minimum COP requirement to be eligible for the corresponding Base Rebate.
Otherwise, the Base Rebate for the 8.5 minimum HSPF unit will be offered.
2
Total Rebate is per ASHP system and is limited to 50% of equipment cost
.
3
Efficiency Bonus Rebate provides an additional incentive for efficiencies above 15.5 SEER
.
* If AHRI certificate does not verify COP at 5º F,
use NEEP's Cold Climate Air Source Heat Pump
qualifying list to obtain those ratings. Go to
ashp.neep.org and select "End User/Consumer”.
2021 ELECTRIC HVAC & WATER HEATING EQUIPMENT
5 of 6
G
ROUND SOURCE HEAT PUMPS
M
INIMUM EFFICIENCY REQUIREMENTS: Water-to-Air Heat Pumps: EER greater than or equal to 17.1 and COP greater than or equal to 3.6 (must also be AHRI Certified and a 2-stage unit)
Water-to-Water Heat Pumps: EER greater than or equal to 16.1 and COP greater than or equal to 3.1 (must also be AHRI Certified)
REBATE: $200 per Ton + $20 per Ton per EER over Minimum Efficiency Requirement + $250 per desuperheater
NOTE: MULTI-STAGE UNITS MAY MEET MINIMUM EFFICIENCY REQUIREMENTS BASED ON THE FOLLOWING: AHRI=Air-Conditioning, Heating, and
• AVERAGE EER = (highest rated capacity EER + lowest rated capacity EER) / 2 Refrigeration Institute – www.ahridirectory.org
• AVERAGE COP = (highest rated capacity COP + lowest rated capacity COP) / 2 EER=Energy Efficiency Rating
FOR MULTI-STAGE UNITS, REBATE CALCULATION WILL BE BASED ON FULL LOAD TONS AND AVERAGE EER. COP=Coefficient of Performance
Project Type:
o
Retrofit
o
New Installation
CHOOSE ONE:
o
Water-to-Air Heat Pump: The 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 13256-1 cooling conditions of 77°F entering water temp. and 80.6°F dry
bulb/66.2°F wet bulb entering air temperature (ground loop heat pump).
o
Water-to-Water Heat Pump:
The 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).
(For additional units, please list and attach separate sheet.)
Manufacturer’s Name: Model #:
Full Load EER by AHRI: Average EER (multi-stage units):
Full Load COP by AHRI: Average COP (multi-stage units):
AHRI Certified Reference #: Size or Capacity (Full Load Tons by AHRI):
Required – please include copy of AHRI Certificate.
Number of Units Installed: Date of Installation: Desuperheater?:
o
Yes
o
No
Total Cost of Project: (materials, labor, etc.) __________________________________________ Loop Type:
o
Horizontal
o
Vertical
o
Slinky
Water Heating:
o
Electric
o
Gas Size of Water Heater in Gallons: ______________________ Supplemental Heat Installed:
o
No
o
Yes: kW_________________
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
OFFICE USE ONLY
Rebate Total: $______________________ Savings: __________kWh ___________kW
REBATE CALCULATION:
A B C D E F G H I J
Full Load
Tons
by AHRI
Column A
x $200
EER
1
Minimum
EER
2
Column C –
Column D
Column E
x $20
Column F
x Column A
Qty of
Desuperheaters
Column H
x $250
Total Rebate
(Column B + Column G + Column I)
$ $ $ $ $
$ $ $ $ $
1
For single stage units use Full Load EER by AHRI
For multi-stage units use Average EER
2
Minimum EER for Water-to-Air is 17.1
Minimum EER for Water-to-Water is 16.1
2021 ELECTRIC HVAC & WATER HEATING EQUIPMENT
6 of 6
PLEASE PRINT ON RECYCLED PAPER 0121
ROOM AIR CONDITIONERS
MINIMUM EFFICIENCY REQUIREMENTS: ENERGY STAR
®
LABEL
REBATE: $25 (no recycling of working unit)
BONUS RECYCLE REBATE: not to exceed $15 or actual cost (with proof of charge for recycling of working unit
)
MUST INCLUDE RECYCLE RECEIPT FOR BONUS RECYCLE REBATE
Manufacturer’s Name: Model #:
MUST SHOW PROOF OF MODEL # TO QUALIFY FOR REBATE
Rated Efficiency (CEER): Size or Capacity (Btu/hr output):
Number of Units Installed: Date of Installation:
DOES THE UNIT HAVE A LOUVERED SIDE? o NO o YES
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
IF PURCHASED TO REPLACE A
WORKING UNIT, WAS THE UNIT RECYCLED? o NO
o YES (Must include recycle receipt for rebate.)
IF YES, what was the recycling cost: ________________________
OFFICE USE ONLY
Rebate Total: $_____________________
2021 ELECTRIC HVAC & WATER HEATING EQUIPMENT
HEAT PUMP WATER HEATERS – ENERGY STAR
®
Must replace an existing electric storage tank water heater or be installed in a new home. Heat pump water heaters that replace gas, propane,
or other non-electric water heaters are not eligible. Electric instantaneous (tankless) water heaters do not qualify.
REBATES FOR HOMES WITH ELECTRIC HEAT (not to exceed 50% of cost): $270 for 20-55 gallon heat pump
$60 for >55 gallon heat pump
REBATES FOR HOMES WITH NATURAL GAS HEAT (not to exceed 50% of cost): $400 for 20-55 gallon heat pump
$90 for >55 gallon heat pump
ENERGY STAR
®
qualified product list: www.energystar.gov/productfinder/product/certfiied-water-heaters/
Project Type:
o
Retrofit
o
New Installation
Manufacturer’s Name: Model #:
Size in Gallons: Rated Uniform Energy Factor (from ENERGY STAR
®
qualified product list):
Number of Units Installed: Date of Installation: Water Heater Cost:
Why was this purchased? To replace:
o
no previous unit
o
failed unit
o
working unit
Primary method to HEAT your home:
o
Electric
o
Natural Gas/Other
Considerations:
• Work with a licensed plumber to determine if a heat pump water heater is right for your home.
• For a heat pump water heater to run efficiently, the space should generally stay above 40 degrees Fahrenheit year round.
• Since heat pumps remove heat from the ambient air, there must be a considerable amount of air available in the space. Most manufacturers recommend
a minimum of 750 cubic feet, which means closets (even those with louvered doors) are usually not appropriate locations for heat pump water heaters.
• Recommended clearances should be followed to ensure adequate air circulation.
• Visit www.energystar.gov/products/hot-water-heater-replacement-guide
to learn more.
OFFICE USE ONLY
Rebate Total: $_______________________
SMART THERMOSTATS – ENERGY STAR
®
Only available to systems that control electric heating or control electric heating and air conditioning systems.
ELECTRIC HEATING ONLY REBATE (not to exceed 50% of cost): $90 Electric Heat
ELECTRIC HEATING AND AIR CONDITIONING REBATES (not to exceed 50% of cost): $100 Electric Heat
$50 Heat Pump
ENERGY STAR
®
qualified product list: www.energystar.gov/productfinder/product/certfiied-water-heaters/
Manufacturer’s Name: Model #:
Number of Units Installed (limit 1): Date of Installation: Smart Thermostat Cost:
What type of heating system
does the smart thermostat control?:
o
Air Source Heat Pump
o
Ground Source Heat Pump
o
Electric Heat
o
Natural Gas/Other
Heating System Manufacturer’s Name: Model #:
Does the smart thermostat control air conditioning?:
o
YES
o
NO
OFFICE USE ONLY
Rebate Total: $_______________________
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Form 2: N O 1 L C HVAC (Owatonna Public Utilities)

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Completed 8 June 2021

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