Fillable Smart Thermostat Project Information Form (CITY OF FOREST GROVE)

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Smart Thermostat Project Information Form (CITY OF FOREST GROVE)

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Smart Thermostat
Project Information Form
For Single Family, Multifamily and Manufactured Home Residential Customers
Smart Thermostats Project Information Form 6/10/2020 1
Instructions: Complete this form and submit it to the serving electric utility.
HOUSEHOLD INFORMATION
Customer Name
Installation Address (Street, City, State, Zip)
Customer Phone
Installation Date:
EXISTING EQUIPMENT INFORMATION
One Smart Thermostat per furnace or heat pump controlled w ith a limit of tw o per household.
Existing Equipment Information Thermostat 1 Thermostat 2
What heating system is the thermostat controlling?
Electric Forced Air Furnace
Air or Ground Source Heat
Pump
Electric Forced Air Furnace
Air or Water Source Heat
Pump
NEW EQUIPMENT INFORMATION
Information Thermostat 1 Thermostat 2
Thermostat manufacturer
Thermostat model
Thermostat serial number
Who installed the thermostat?
Homeowner
Contractor or Utility
Homeowner
Contractor or Utility
The installed thermostat must:
1. Be on the BPA Smart Thermostat Qualified Products List (
www.bpa.gov/EE/Policy/IManual/Pages/IM-
Document-Library.aspx)
2. Have occupancy detection set to on, and
3. If the thermostat controls a heat pump, be programmed to control a heat pump
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Smart Thermostat Project Information Form (CITY OF FOREST GROVE)

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Completed 13 February 2021

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