2009 Eco Business Custom Systems Project Preapproval Application

2009 eco@business Custom Systems Project Preapproval Application

Please complete both pages of this application and attach copies of invoices.
Mail to: Electric or Gas Utility, eco@business Energy Efficiency
Call Utility phone number with questions about the program.
Customer Information

Utility account number (found on bill) ______

Service address______

City______State______ZIP ______

Company name on bill ______

Rebate check (if applicable) should be payable to______

Mailing address______

City______State______ZIP ______

Contact person ______Title______

Phone______E-mail address
Is company incorporated?  Yes  No

Customer Agreement (signature required before application is processed)

My signature indicates consent to and agreement with all program terms and conditions; and certifies that all information on this application is correct; and that the described new equipment or systems have not been purchased or installed at the indicated location. I understand that Utility reserves the right to pre-inspect the installation site and inspect and verify installation before and after issuing the rebate payment.

Customer signature______Date______

Facility Information(check one)

Office Lodging Grocery Convenience Store Church

Retail Warehouse School/College Multifamily Industrial/Manufacturing

Fast Food Restaurant Health Care______ Other______

Building size______sq.ft. (area)Do you:  own or  rent this building?

Year building was constructed:.

Facility Hours of Operation: (please circle a.m. or p.m.)Seasonal Operating Schedule (please check one)

Monday - Friday ______a.m./p.m. to ______a.m./p.m. Summer only (June - Sept.)  Year-round

Saturday a.m./p.m. to ______a.m./p.m.  Winter only (Oct. - May)  Other

Sunday ______a.m./p.m. to ______a.m./p.m.

Equipment Hours of Operation: (please circle a.m. or p.m.)

Monday - Friday ______a.m./p.m. to ______a.m./p.m.

Saturday a.m./p.m. to ______a.m./p.m.

Sunday ______a.m./p.m. to ______a.m./p.m.

Planned Energy Efficiency Project (please describe equipment/system to be replaced/upgraded and attach documentation)

This new custom equipment/system is:

Replacement  New Construction  New Installation

Project Specifier/Contractor Information (engineer; architect; mechanical/electrical contractor; dealer; etc.)

Specifier company name______

Address______

City______State______ZIP______Fax______

Contact person______Phone______E-mail address______

Specifier/Contractor Agreement

I certify that all equipment and installation information provided on this application is correct and accurate.Specifier/contractor signature Date

2009 eco@business Custom Systems Project Preapproval Application

Please complete both pages of this application.

Estimated Energy Savings (Calculations and documentation must be attached.)

ElectricityNatural Gas

Summer peak demand reduction______kWWinter peak demand reduction ______therms/day

Annual energy reduction______kWhAnnual usage reduction______therms

Annual energy cost savings $ ______Annual energy cost savings $______

Custom Equipment Project Information (Please use additional sheets if necessary.)

Please describe the existing equipment and/or system to be replaced/upgraded.

Manufacturer / Model # / Size / Efficiency Rating / Quantity / Equipment Cost / Installation Cost (Labor) / Equipment Life (Years)

Written description:

Please describe the proposed standard-efficiency equipment and/or system that would be installed.

Manufacturer / Model # / Size / Efficiency Rating / Quantity / Equipment Cost / Installation Cost (Labor) / Equipment Life (Years)

Written description:

Please describe the proposed high-efficiency equipment and/or system that would be installed.

Manufacturer / Model # / Size / Efficiency Rating / Quantity / Equipment Cost / Installation Cost (Labor) / Equipment Life (Years)

Written description:

Other Custom Systems Project Information (Please use additional sheets if necessary.)

Provide building or manufacturing systems or equipment information that does not fit into the tables above. Or, call Utilityto discuss your project and any information Utility might need to complete its review.

DISCLAIMER: Utility does not guarantee that the implementation of energy-efficient measurers or use of the equipment purchased or installed pursuant to this program will result in energy or cost savings. Utility makes no warranties, expressed or implied, with respect to any equipment purchases or installations, including, but not limited to, any warrant of merchantability or fitness for purpose. In no event shall Utility be liable for any incidental or consequential damages.