Energy Upgrade CaliforniaTM Incentive Application Form · Energy Upgrade CaliforniaTM Incentive Application Form How to Apply 1.Review the Energy Upgrade California program application

Energy Upgrade CaliforniaTM

Incentive Application Form

How to Apply1. Review the Energy Upgrade California program

application and eligibility requirements.

2. Have the participating contractor install eligible energy-efficiency measures at your home.

3. Complete, sign and mail the incentive Application package together with supporting documents.

4. All information will be kept confidential unless the customer signs the Optional Release in section 1.2: Authorization to Release Customer Information. Participants are NOT required to sign the Optional Release in order to be eligible

Required Document ChecklistThe Application and all supporting documents must be included in your Application package. Please follow the checklist below to ensure proper handling of your incentive request.

Basic and Advanced Packages: Application (applicant must submit all pages of

the Application). Original signed application must be mailed to: Southern California Gas Company

Energy Upgrade California 9240 Firestone Blvd., ML:SCERC1 Downey, CA 90241

The following pages require signatures:

• Customer signed Terms and Conditions (page 2)

• Customer signed Payment Release Authorization (Page 4) if authorizing Southern California Gas Company (SoCalGas®) to pay the incentive to another entity (e.g., participating contractor)

• Contractor signatures (Basic Package: page 6, Advanced Package: page 15)

• BPI analyst signatures (Basic Package: page 8, Advanced Package: page 15)

Job Reporting Template (JRT-Excel File)

Supporting Documents (contractor’s invoice, products receipts, building permits as applicable, etc.) for all energy-efficiency measures installed at your home

Approved modeling simulation software files (BLD file; Econ-2: .pdf files—Advanced projects only)

Air Conditioning sizing document (Advanced projects with new air conditioning only)

Retain a copy of all submitted forms and required documents (including receipts and home improvement contracts) for your records.

Submittal options:

Electronically to: [email protected] FAX: 818-325-3137Mail to: Energy Upgrade California ICF International 14724 Ventura Blvd., #1001 Sherman Oaks, CA 91403

Southern California Gas Company’s Energy Upgrade California Incentive Application Form (07/2011a) 1

Terms and Conditions1. I understand that the Incentive Application Form is accepted on a first-

come, first-served basis while funding is available or until discontinued by the California Public Utilities Commission (CPUC). This Program will end December 31, 2012 or earlier if all allocated funds are depleted before that date. Qualified energy-efficiency measures are eligible for incentives if the corresponding incentive application is received by SoCalGas no later than sixty (60) days from the date of Confirmation of Incentive Reservation. SoCalGas will accept applications until December 17, 2012.

2. I am a property owner of a detached single family residence with an active meter(s) served by SoCalGas. I understand that I am only eligible to receive incentives that correspond directly to the type of service (e.g. natural gas) for which my detached single family residence currently receives service from SoCalGas. Detached single family residence must be fully constructed. New construction does not qualify.

3. Proof of property ownership from owner, and a copy of a recent SoCalGas bill from tenant are required when owner has purchased and installed measure in a rental home. Name and address shown on proof of ownership must match name and install address listed on the application form, and address shown on the SoCalGas bill must match the install address listed on the application form.

4. I certify that the qualified energy-efficiency measures were purchased and completely installed between January 1, 2010 and December 31, 2012. These energy-efficiency measures are for use in my detached single family residence.

5. I have submitted the following required documents establishing proof of installation for the energy-efficiency measures applied for in this Application: a) paid itemized sales receipt(s); b) building permits per local jurisdiction; c) paid contractor invoice; or paid Home Improvement Contract (HIC), with manufacturer name(s), model number(s), and any other required documentation.

6. I certify that all energy-efficiency measures were purchased new and I understand that the following energy-efficiency measures do not qualify: used, rebuilt, resale, rented, won as prizes, provided by insurance companies, or new parts installed in existing measures.

7. I understand incentives will only be paid for energy-efficiency measures that meet the program specifications described on the Incentives Energy-Efficiency Measures Forms and related specifications sheets.

8. I understand that under certain circumstances incentives may be taxable and, if greater than $600, may be reported to the IRS unless I am exempt from reporting. SoCalGas may report my incentive payment to me on IRS Form 1099 unless I have checked corporation or exempt from reporting tax status. I understand that I should consult my tax advisor concerning the taxability of incentives. SoCalGas is not responsible for any taxes that may be imposed as a result of my receipt of this rebate.

9. I understand incentives cannot exceed the combination of purchase price and installation cost.

10. I understand the qualified energy-efficiency measures have been installed by a participating contractor in the Basic Package or the Advanced Package.

11. I understand and agree that the choice of the energy-efficiency measures, selection of participating contractor, manufacturer, or dealer, purchase of materials, work performed, and the payment thereof, are my sole responsibilities and that SoCalGas has not any liability whatsoever concerning the quality, safety or installation of the energy-efficiency measures. I waive any and all claims against SOCALGAS, their respective parent companies, their respective directors, officers, employees and authorized agents, and will indemnify SoCalGas for any claims arising out of or relating to the installation and/or use of energy-efficiency measures referred to in this Application. I ALSO UNDERSTAND THAT SOCALGAS MAKES NO WARRANTY, WHETHER EXPRESSED OR IMPLIED, INCLUDING, WITHOUT LIMITATION, THE IMPLIED WARRANTY OF MERCHANTIBILITY FOR ANY PARTICULAR PURPOSE, USE, OR APPLICATION OF THE MEASURES REGARDING MANUFACTURERS, DEALERS, MATERIALS, AND WORKMANSHIP. Without limiting the generality of the foregoing, SoCalGas shall not be liable for any type of damages, whether direct, indirect, incidental, consequential, exemplary, reliance, punitive or special damages, including damages for loss of use, regardless of the form of action, whether in contract, indemnity, warranty, strict liability or tort, including negligence of any kind.

12. I am responsible for meeting all program requirements and complying with my state/county/city governments, property owner and/or homeowner’s association requirements (if any) in my area regarding local conditions, restrictions, codes, ordinances, rules, and regulations pertaining to all installations. I further understand that it is my sole responsibility to ensure all incentivized measures are installed as per all manufacturers’ specifications.

13. I agree that SoCalGas has not any liability whatsoever concerning the quality, safety or installation of the energy-efficiency measures, including its fitness, workmanship, or any other matter.

14. I agree to allow SoCalGas’ quality assurance team or their respective representatives and/or California Public Utilities Commissions (CPUC) representatives’ reasonable access to verify the installed measures. I agree to this inspection to be eligible to participate in the program and receive an incentive for the qualified measures. I understand that this inspection is for the purpose of determining that the installed measures meet all program(s) requirements.

15. I understand SoCalGas is not responsible for items lost, stolen or destroyed in transit or during installation or inspection of energy-efficiency measures.

16. I understand that the incentives amount provided by SoCalGas is NOT GUARANTEED and it may change based on a number of factors including, but not limited to, the verification of the modeling simulation performed by SoCalGas.

17. I understand that I cannot receive energy-efficiency incentives for the same measures, or for the replacement for the measure installed from more than one California Investor-Owned Utility or other third party programs offering rebates, financing, and other incentives funded with CPUC Public Goods Charge funds.

18. I UNDERSTAND THAT SOCALGAS WILL KEEP MY CUSTOMER INFORMATION CONFIDENTIAL UNLESS I ELECT TO SIGN THE OPTIONAL RELEASE FORM.


I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE TERMS AND CONDITIONS. I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND CORRECT AND THE ENERGY-EFFICIENCY MEASURES FOR WHICH I AM REQUESTING AN INCENTIVE MEET THE REQUIREMENTS LISTED ON THE ENERGY-EFFICIENCY MEASURES FORMS AND SPECIFICATION SHEETS AND HAVE BEEN COMPLETELY INSTALLED.

X _________________________________________________ __________________

SoCalGas Account Holder Signature Date (Month/Day/Year)

X _________________________________________________ __________________

Property Owner Signature Date (Month/Day/Year)

This program is funded by California utility customers and administered by Southern California Gas Company, under the auspices of the California Public Utilities Commission.

By checking this box, I confirm that I have

used a licensed contractor, as appropriate and

followed applicable permitting requirements

for this installation.

APPLICATION FORM

Section 1.1: Required Customer InformationCustomer Information

First and Last Name (as it appears on SoCalGas bill) Property Address

SoCalGas Service Account Number City, State, Zip

Incentive Applicant First and Last Name Mailing Address (if different from property address)

Email address City, State, Zip

Telephone Number Alternate Telephone Number

For Property Owner if Property Owner is Not Residing at the Address

Property Owner First and Last Name (if different from customer) Telephone Number

Mailing Address Alternate Telephone Number

City, State, ZIP Email Address

Prime Contractor Information

EUCA Contractor ID# Contractor Business Name

Contractor Contact Name

Telephone Number

Email Address

Make Incentive Check Payable to

Payee Federal Tax ID or SSN Mailing Address

Payee (Print Name) City, State, ZIP

Job Data

Total Gross Project Cost (not including any incentives):

Work-hours for retrofit:

Did you finance any portion of this project?


Payment Release Authorization

(DO NOT SIGN UNTIL PROJECT HAS BEEN COMPLETED TO YOUR SATISFACTION)

PROPERTY OWNER UNDERSTANDS AND AGREES THAT BY SIGNING THIS PAGE, I AM AUTHORIZING THIS PAYMENT ON MY INCENTIVE TO THE THIRD PARTY NAMED ABOVE, AND THAT I WILL NOT BE RECEIVING THE INCENTIVE CHECK FROM SOCALGAS. I ALSO UNDERSTAND THAT MY RELEASE OF THE PAYMENT TO A THIRD PARTY DOES NOT EXEMPT ME FROM THE PROGRAM REQUIREMENTS OUTLINED IN THE APPLICATION PACKAGE INCLUDING THE REQUIREMENT TO USE A CONTRACTOR WITH A CSLB LICENSE. BY AUTHORIZING THIS PAYMENT RELEASE, I HEREBY CERTIFY THE THIRD PARTY HAS A CSLB LICENSE, IS THE INSTALLER OF THE ENERGY-EFFICIENCY MEASURES FOR WHICH I AM REQUESTING AN INCENTIVE, AND HAS INSTALLED THE ENERGY-EFFICIENCY MEASURES TO MY SATISFACTION.

X ________________________________________________ _______________________________________________ ___________________

Signature Please Print Name Date (Month/Day/Year)

Section 1.2: Authorization to Release Customer InformationThis Release is Completely Optional. As a convenience to the Customer, SoCalGas is working with the County of Los Angeles (“County”) and other local governments to coordinate CPUC-funded programs with County and other local government-funded programs. With Customer’s approval, SoCalGas will provide County and other local governments and their respective representatives and contractors with the customer information described below to enable Customer to be eligible for American Recovery and Reinvestment Act (ARRA) and other energy-efficiency funds. If signed the Customer’s information will no longer remain confidential. This release is NOT required to participate in SoCalGas’ Energy Upgrade California program.

I, [print name of Customer], hereby authorize (“Authorization”) SoCalGas to release the following to County and other local governments and their respective representatives and contractors:

1. My customer information,

2. My property information,

3. My data regarding energy-efficiency measures that I have installed or plan to install through the program including estimated kWh savings, estimated kW reduction, estimated therm savings, and estimated percent improvement in energy performance as documented in my Energy Upgrade California Application (the “Application”), and

4. My utility billing records for the 12 months prior to the date below, and the 12 months after the Date of Post Installation and Inspections Performed as specified in the Basic and Advanced Package Post Installation Test and Inspections Section of the Application.

I hereby release, hold harmless, and indemnify SoCalGas from any liability, claims, demands, causes of action, damages, or expenses resulting from: 1) any release of information pursuant to this Authorization; 2) the unauthorized use of this information; and 3) any actions taken pursuant to this Authorization.

X _________________________________________________ __________________

SoCalGas Account Holder Signature Date (Month/Day/Year)

You may qualify for SoCalGas’ Energy Savings Assistance Program, and/or SoCalGas’ California Alternate Rates for Energy (CARE) program.

Please call 1-800-331-7593 for SoCalGas’ Energy Savings Assistance Program information, 1-800-427-2200 for CARE information, or visit our website at socalgas.com/residential/assistance.


2.0 BASIC PACKAGE MEASURES INSTALLEDA. ADDED ATTIC INSULATION

Attic insulation is eligible only if the pre-retrofit insulation level is R-11 or less and the final insulation level must be at least R-30 unless a higher level is specified by local jurisdiction.

Type of Material Installed:Mineral Fiber: Batts Loose FillMineral Cellular: Vermiculite PerliteCellulose: Loose FillRigid: Fiberglass Polyisocyanurate

R-Values Quantity AddedAdded: R - Sq. Ft.:

Final: R -

B. DUCT TEST AND SEAL (Installed)Perform duct test and seal.

At the end of job (CFM25): _______________________________________________________________________

Duct Leakage to Outside at end of job (supply+return), percentage of full flow: ______________________

Method used to calculate duct leakage is: _________________________________________________________

New Duct Insulation Level after job: ______________________________________________________________

C. AIR SEALINGSeal infiltration gaps throughout the attic/home per BPI standards. Install weather stripping as needed to reduce uncontrolled air infiltration.

House Infiltration at start of job (reading at the beginning of air sealing CFM50): ___________________

House Infiltration after job (reading at the end of air sealing CFM50): ______________________________

Attic Air Sealing: Wire Penetration Kneewalls Attic Access Drop Soffits Chimney Flues Pipe Penetration Attic Stairs Pocket Doors Recessed Lights Cantilevers Other

Methods: Spray Foam Caulking Mastic Gaskets

D. INSULATION OF DOMESTIC HOT WATER PIPESWrap first five feet of visible inlet/outlet pipes extending from hot water heater.

Number of feet installed:

E. LOW-FLOW SHOWERHEAD WITH THERMOSTATIC-ACTIVATED FLOW RESTRICTION VALVE OR THERMOSTATIC-ACTIVATED FLOW RESTRICTION VALVE DEVICEInstall a low-flow showerhead with thermostatic-activated flow restriction valve. If showerhead is already a low-flow showerhead or if customer would like to keep existing showerhead, install thermostatic-activated restriction valve device.

Low-Flow Showerhead with Thermostatic-Activated Flow Restriction Valve

Qty.:

Thermostatic-Activated Flow Restriction Valve Device

Qty.:


Contractor Statement and Signature:I attest that all of the information entered above is correct to the best of my knowledge. I agree to complete any items noted above for follow-up corrective action, and an additional Pre-Installation Tests, Post-Installation Tests and Inspections form that verifies the successful completion of those items and records required follow-up or inspections.

___________________________________________________ X ______________________________________________ _____________________

Contractor Name Contractor Signature Date (Month/Day/Year)

REQUIRED: Basic Package Pre Installation Tests and Inspection on page 7 and Basic Package Post Installation and Inspection on page 8 must be completed in order to receive incentives for completed project. These tests must be performed by a certified BPI Building Analyst.


2.1 BASIC PACKAGE PRE-INSTALLATION TESTS AND INSPECTIONS

Date of Post Installation Test and Inspections Performed: ______________________________________ (Month/Day/Year)

Distribution System Air Flow (required if ducts are sealed as part of project) and Leakage Test

Methods Used: Pressure Matching (w/ Duct Blaster) Duct Leakage Test Duct Blaster CFM25

Duct Pressurization result at start of job (CFM25):

Duct Leakage to Outside at start of job (supply+return), percentage of flow:

Blower Door Test and Ventilation Compliance

Blower Method used to Determine Building Leakage: Building Infiltration (CFM50):

Worst Case Test ResultsNatural Condition Test Results

(if Failed Worst Case)

Spillage Draft (Pa)Flue CO (ppm)


Flue Inspection

Action Required*

Heating System 1

Heating System 2*

DHW System 1

DHW System 2*

Other*

LocationCO

Ambient (ppm)

Base Pressure

Worst Case Pressure

Final Net CAZ

Depressurization

Limit for CAZ

ResultAction

Required*

CAZ 1List of CAZ 1 Appliances:


Gas Leak Testing: No Leaks Detected Leaks Detected as Noted:

Kitchen Other** Action Required:

Ambient CO (ppm)

Fuel* CO (ppm) Vent Out? Action Required:

Oven

Range

Other Appliance:

Fuel* Gas Properly Vented Gas Improperly Vented Action Required:

Dryer Vent

* As needed, list additional systems/zones/actions in the notes section; identify other systems/fuel types in NOTES section.

NOTES:


2.2 BASIC PACKAGE POST INSTALLATION TESTS AND INSPECTIONS




Duct Pressurization result at start of job (CFM25):

Duct Leakage to Outside at start of job (supply+return), percentage of flow:


Blower Method used to Determine Building Leakage: Building Infiltration (CFM50):





Flue Inspection

Action Required*

Heating System 1

Heating System 2*

DHW System 1

DHW System 2*

Other*

LocationCO

Ambient (ppm)

Base Pressure

Worst Case Pressure

Final Net CAZ

Depressurization

Limit for CAZ

ResultAction

Required*





Ambient CO (ppm)


Oven

Range

Other Appliance:


Dryer Vent


NOTES:

BPI Analyst Statement and Signature:I attest that all of the information entered above is correct to the best of my knowledge. I agree to submit an additional Pre-Installation Tests, Post-Installation Tests and Inspections form that verifies the successful completion of those items and records required follow-up tests or inspections.

___________________________________________________ X _________________________________________________ __________________

BPI Analyst Name (Please Print) BPI Analyst Signature Date (Month/Day/Year)

___________________________________________________

BPI Analyst Certification Number


3.1 ADVANCED PACKAGE MEASURES INSTALLEDA. AIR SEALING

Seal infiltration gaps throughout the attic/home per BPI standards. Install weather stripping as needed to reduce uncontrolled air infiltration.

House Infiltration at start of job (reading at the beginning of air sealing CFM50):

House Infiltration after job (reading at the end of air sealing CFM50):

Attic Air Sealing: Wire Penetration Kneewalls Attic Access Drop Soffits Chimney Flues Pipe Penetration Attic Stairs Pocket Doors Recessed Lights Cantilevers Other

Methods: Spray Foam Caulking Mastic Gaskets

B. ADDED ATTIC INSULATIONAttic insulation is eligible only if the final insulation level is at least R-30.

Mineral Fiber: Batts Loose FillMineral Cellular: Vermiculite PerliteCellulose: Loose FillRigid: Fiberglass Polyisocyanurate


Final: R -

C. WALL INSULATION Wall insulation is eligible as long as existing walls are not currently insulated and are between conditioned living area and unconditioned area. Garages and other non-living areas do not qualify. The installed insulation must achieve a minimum of R-13.



Final: R -

D. FLOOR INSULATION:Floor insulation is eligible as long as existing floors are not currently insulated and are between conditioned living area and unconditioned area. The installed insulation must achieve a minimum of R-19.



Final: R -


E. INSULATION OF DOMESTIC HOT WATER PIPES Wrap first five feet of cold water inlet pipe and all exposed and accessible hot water piping from hot water heater.

Number of feet installed:

F. DUCT TEST AND SEAL (Installed)Perform duct test and seal.

At the end of job (CFM25):

Duct Leakage to Outside at end of job (supply+return), percentage of full flow:

Post retrofit Duct Insulation R-Level:

G. LOW-FLOW SHOWERHEAD WITH THERMOSTATIC-ACTIVATED FLOW RESTRICTION VALVE OR THERMOSTATIC-ACTIVATED FLOW RESTRICTION VALVE DEVICEInstall a low-flow showerhead with thermostatic-activated flow restriction valve. If showerhead is already a low-flow showerhead or if customer would like to keep existing showerhead, install thermostatic-activated restriction valve device.

Low-Flow Showerhead with Thermostatic-Activated Flow Restriction Valve

Qty.: Location:

Thermostatic-Activated Flow Restriction Valve Device

Qty.: Location:

H. HEATING, VENTILATING AND AIR CONDITIONING (HVAC) REPLACEMENTS

CENTRAL AC AND FURNACE

System Documentation and Owner EducationCopies of this report and OEM manuals left with owner? Yes NoDemonstrated system for owner? Yes No

Electrical RequirementsMeets ACCA QI 4.3? Yes No

System ControlsMeets ACCA QI 4.6? Yes No

DesignType of installation: Replacement New system–existing homeArea of zone served by unit: sq.ft. # of units in home: Heat gain method: Manual J v8Duct design method: Manual D NoneEquipment specification method: Manual S

Previous equipmentAC Equipment Total capacity: BTUh ARI EER/SEER:

Furnace Equipment Gross capacity: BTUh Net capacity: BTUh

AC EquipmentSystem Type: Package Split Other:

Package Unit Manufacturer: Model Number:

Serial Number:


CondenserManufacturer: Model Number:

Serial Number:

Evaporator

Manufacturer: Model Number:

Serial Number:

Latent Capacity: BTUh ARI EER/SEER:

Sensible Capacity: BTUh ARI Ref#:

Total Capacity: BTUh

Furnace EquipmentManufacturer: Model Number:

Serial Number: AFUE:

Gross capacity: BTUh Net capacity: BTUh

Fuel Type: Gas Oil Propane Other:

Sealed combustion? Yes No

Fan Motor Type: Fixed Speed (e.g. PSC) Variable (e.g. ECM/ICM) Other:

Speed Setting If fixed Low Med/Low Med Med/High High CFM (at 0.5 IWC):

If variable Fan set for CFM

CENTRAL AC and HEAT PUMP

System Documentation and Owner EducationCopies of this report and OEM manuals left with owner? Yes No

Demonstrated system for owner? Yes No

Electrical RequirementsMeets ACCA QI 4.3? Yes No

System ControlsMeets ACCA QI 4.6? Yes No

DesignType of installation: Replacement New system–existing home

Area of zone served by unit: sq.ft. # of units in home:

Heat gain method: Manual J v8Duct design method: Manual D NoneEquipment specification method: Manual S

Latent Heat Gain: BTUh Sensible Heat Gain: BTUh

Total Heat Gain: BTUh Design Airflow: CFM

Evap. Fan Design Static Pressure: IWC


Previous Equipment – for replacements only

Cooling Total Capacity: BTUh ARI EER/SEER:

Heating HSPF:

At 17°F Capacity: BTUh COP:


EquipmentSystem Type: Package Split Other: ______________________________________________________

Package Unit Manufacturer: __________________________________ Model Number: _________________________________

Serial Number: _________________________________

CondenserManufacturer: __________________________________ Model Number: _________________________________

Serial Number: _________________________________

Evaporator Manufacturer: __________________________________ Model Number: _________________________________

Serial Number: _________________________________

Fan Motor Type: Fixed Speed (e.g., PSC) Variable (e.g., ECM/ICM) Other: _____________________

Speed Setting If fixed Low Med/Low Med Med/High High CFM (at0.5 IWC): ________

If variable Fan set for ___________CFM

Cooling Latent Capacity: BTUh ARI EER/SEER:

Sensible Capacity: BTUh ARI Ref#:

Total Capacity: BTUh

HeatingHSPF:



I. NEW WATER HEATERSFuel type (gas/electric/other non-solar)

Manufacturer Name: ______________________________________________________________________________

Model Number: ___________________________________________________________________________________

Energy Factor (EF): _______________________________________________________________________________

Gallons: __________________________________________________________________________________________

J. ENERGY STAR® LABELED INTERIOR HARDWIRED FLUORESCENT FIXTURES(≥ 22 watts. Please see Measures Specifications on page 16 for qualifications details)


Model Number: ___________________________________________________________________________________

Quantity: ________________________________________________________________________________________

Locations:________________________________________________________________________________________


K. ENERGY STAR LABELED EXTERIOR HARDWIRED FLUORESCENT FIXTURES(13 - 27 watts. Please see Measures Specifications on page 16 for qualifications details)


Model Number: ___________________________________________________________________________________

Quantity: ________________________________________________________________________________________

Locations:________________________________________________________________________________________

L. HIGH PERFORMANCE DUAL-PANE WINDOWS (U-factor of 0.35 or less and Solar Heat Gain Coefficient of 0.32 or less. Please see Measures Specification on pages 14 and 15 for more details)


Model Number: ___________________________________________________________________________________

Quantity of Windows Replaced: _____________________________________________________________________

Square Ft.: _______________________________________________________________________________________

M. COOL ROOF: (See Measures Specification on page 16 for more details)


Square Ft.: _______________________________________________________________________________________

N. RADIANT BARRIER


Square Ft.: _______________________________________________________________________________________

ADVANCED PACKAGE PERCENT ENERGY SAVINGS AND INCENTIVE TIERS

Energy Savings: % kWh: kW: Therms:

Energy Savings Incentive Amount

10% - 14% $400

15% - 19% $480

20% - 24% $640

25% - 29% $800

30% - 34% $960

35% - 39% $1,120

40% + $1,280

Advanced Package Total Incentives $

REQUIRED: Advanced Package Post Installation Tests and Inspection on page 14 must be completed in order to receive incentives for completed projects.


3.2 ADVANCED PACKAGE POST INSTALLATION TESTS AND INSPECTIONS







Flue Inspection

Action Required*

Heating System 1

Heating System 2*

DHW System 1

DHW System 2*

Other*

LocationCO

Ambient (ppm)

Base Pressure

Worst Case Pressure

Final Net CAZ

Depressurization

Limit for CAZ

ResultAction

Required*





Ambient CO (ppm)


Oven

Range

Other Appliance:


Dryer Vent


NOTES:



Duct Test Result:

Airflow Test Result: CFM Pass or Fail? If fail, action to be taken:

Contractor and BPI Analyst Signature Page Immediately Following


Contractor Statement and Signature:I attest that all of the information entered above is correct to the best of my knowledge. I agree to complete any items noted above for follow-up corrective action, and will submit an additional Post-Installation Tests and Inspections form that verifies the successful completion of those items and records required follow-up tests or inspections.

___________________________________________________ X _________________________________________________ __________________

Contractor Name (Please Print) Contractor Signature Date (Month/Day/Year)

BPI Analyst Statement and Signature:I attest that all of the information entered above is correct to the best of my knowledge. I agree to submit an additional Pre-Installation Tests, Post-Installation Tests and Inspections form that verifies the successful completion of those items and records required follow-up tests or inspections.

___________________________________________________ X _________________________________________________ __________________

BPI Analyst Name (Please Print) BPI Analyst Signature Date (Month/Day/Year)

___________________________________________________

BPI Analyst Certification Number


Basic Package Minimum Specifications A. Air Sealing

Seal air infiltration gaps throughout the attic/home per BPI standards. Install weather stripping as needed to reduce uncontrolled air infiltration.

B. Attic InsulationAttic insulation is eligible only if the pre-retrofit insulation level is R-11 or less. The final insulation level must be at least R-30 unless a higher level is specified by local jurisdiction.

C. Insulation of Domestic Hot Water PipesInstall insulation on all visible hot water pipes from domestic hot water.

D. Duct Test and SealFinal leakage rate cannot exceed 15 percent of airflow based on 400 CFM per ton or 21.7 CFM per kbtu output for heat only systems.

E. Low-Flow Showerhead with Thermostatic-Activated Flow Restriction Valve or Thermostatic-Activated Flow Restriction Valve DeviceInstall a low-flow showerhead with thermostatic-activated flow restriction valve. If showerhead is already a low-flow showerhead or if customer would like to keep existing showerhead, install thermostatic-activated flow restriction valve device.


Advanced Package Minimum Specifications A. Air Sealing

Seal air infiltration gaps throughout the attic/home per BPI standards.

B. Attic InsulationAttic insulation must be at least R-30 or better.

C. Wall InsulationThe installed insulation must achieve a minimum of R-13.

D. Floor InsulationThe installed insulation must achieve a minimum of R-19.

E. Insulation of Domestic Hot Water PipesInstall insulation on all visible hot water pipes from domestic hot water.

F. Duct Test and SealFinal leakage rate cannot exceed 15percent of airflow based on 400 CFM per ton or 21.7 CFM per kbtu output for heat only systems.

G. Low-Flow Showerhead with Thermostatic Valve or Thermostatic Valve DeviceInstall low-flow showerhead with thermostatic-activated flow restriction valve or thermostatic-activated flow restriction valve device

H. Heating and Cooling Natural Gas Furnace

Strongly recommend an Annual Fuel UtilizationEfficiency (AFUE) of 92 percent

Split Central ACSEER 13

Packaged Central Air ConditionerSEER 13

Split Heat PumpSEER 13 EER – HSPF 7.7

Packaged Heat Pump

SEER 13 EER – HSPF 7.7

I. New Water Heaters

High-Efficiency gas storage Water HeatersHigh-efficiency storage gas water heaters must have an Energy Factor (EF) of 0.62 or greater. The water heater must be 30 gallons or greater. Look

for the EF rating on the water heater specification sheet or on the packaging box; it does not always appear on the water heater label itself.

Tankless Water HeaterTankless water heaters must be replacing a conventional tank-type water heater. Tankless water heater must have an Energy Factor (EF) of 0.82 or higher. Look for the EF rating on the water heater specification sheet or on the packaging box; it does not always appear on the water heater label itself.

Efficient Electric Storage Water HeaterEnergy Factor of .93 or greater, 30 gallons minimum. Replace an existing electric water heater. Look for the EF rating on the water heater specification sheet or on the packaging box; it does not always appear on the water heater label itself. Tankless water heaters do not qualify. Replacing a gas water heater with an electric unit does not qualify.

J. ENERGY STAR Labeled Interior Hardwired Fluorescent FixturesTo qualify, must replace an existing hardwired incandescent fixture that is rated ≥ 100 watts. ENERGY STAR CFL must be included in fixture. Closets and storage spaces do not qualify for rebate.

K. ENERGY STAR Labeled Exterior Hardwired Fluorescent FixturesTo qualify, must replace an existing incandescent fixture that is rated ≥ 60 watts in common area (e.g. walkways, carport/garage, porch lights)

L. High Performance Dual-Pane WindowsHigh Performance Dual-Pane Windows are eligible provided they have a U-factor of 0.35 or less and a Solar Heat Gain Coefficient (SHGC) of 0.32 or less. U-factor is a measure of the solar energy coming through the window. Windows with a SHGC of 0.4 or less are referred to as spectrally selective low E glass. Both of these numbers can be found on the National Fenestration Rating Council (NFRC) label or on the manufacturer’s order confirmation sheet. Garages and other non-living areas do not qualify unless they are conditioned.

You must submit with your Application, either:

1. A NFRC label for each window with the U-factor and SHGC values on each label. The dimensions for each window must also be submitted. Illegible labels will not be accepted.


OR

2. The manufacturer’s order confirmation which may be provided by your contractor. This sheet must be on the window manufacturer’s letterhead and have the specific U-factor and SHGC value listed for each window or series of windows along with the dimensions for each window.

OR

3. A Home Improvement Contract or paid invoice from your contractor which provides the dimensions, SHGC and U-factor for each window purchased and installed.

M. Cool RoofRoofing materials meet or exceed 1) the Aged Solar Reflectance and Aged Thermal Emittance levels or 2) the Solar Reflectance Index (SRI) ratings specified below along with rated by the Cool Roof Rating Council (CRRC).

Type Aged Solar Reflectance

Aged Thermal Emittance

Solar Reflectance Index (SRI)

Low Slope (excluding CZ 13)

≥ 0.55 ≥ 0.75 ≥ 64

Steep Slope: Level 1

≥ 0.35 ≥ 0.75 ≥ 36

Steep Slope: Level 2

≥ 0.25 ≥ 0.75 ≥ 23

N. Radiant BarrierFollow manufacturer installation requirements. Equipment/Materials must meet or exceed all applicable local, state, and federal standards.
