Instructions: Complete this form and submit it to Erik Boyer, ebboyer@bpa.gov. For questions please contact Erik Boyer at 509.822.4586. Incentive only available for retrofits and does not apply to new construction. BUSINESS AND SITE INFORMATION Utility Name Utility Address State Zip Utility Contact Phone # Facility Name Facility Address State Zip Facility Contact Phone # Email Contractor Name Contractor Address State Zip Contractor Contact Phone # Email Total Building square footage being served by HRV +VCHP system sq. ft. Building hours of operation hrs EXISTING EQUIPMENT INFORMATION Yes The building has electricity use data available for the previous year. No (If project is not eligible for incentives) “No”, Office Retail Grocery Lodging Building type (select one) Warehouse Food Service Hospital School Residential Care Assembly (describe): Name of building area(s) not served by HRV + VCHP (e.g. lobby) Existing HVAC Heat Source: Electric Resistance Heat Pump Cooling Capacity (tons): system Optional Additional Description and Ventilation Strategy (e.g. how many RTU’s retrofit, etc.): description: NEW EQUIPMENT INFORMATION VCHP manufacturer (s) VCHP model number (s) HRV manufacturer (s) HRV number (s) Describe new system, including ventilation strategy (e.g. rates and the control logic): New Ventilation system description Cooling Capacity (tons): Yes VCHP is a split-system heat pump with an inverter-driven outdoor compressor. No (If project is not eligible for incentives) “No”, Yes VCHP has inverter-driven or indoor blowers. No (If project is not eligible for incentives) “No”, The HRV meets the following a sensible effectiveness of 85% or greater, Yes has variable-speed blowers, No (If project is not eligible for incentives) “No”, integrated DCV, has economizer capabilities. INSTALLER INFORMATION Company Name Total Installed Cost (before rebate) including equipment, labor, permit and tax By signing this form, I confirm that the information is correct to the best of my knowledge. Installer Signature Date
Instructions: Complete this form and submit it to Erik Boyer, ebboyer@bpa.gov. For questions please contact Erik Boyer at 509.822.4586. Incentive only available for retrofits and does not apply to new construction. BUSINESS AND SITE INFORMATION Utility Name Utility Address State Zip Utility Contact Phone # Facility Name Facility Address State Zip Facility Contact Phone # Email Contractor Name Contractor Address State Zip Contractor Contact Phone # Email Total Building square footage being served by HRV +VCHP system sq. ft. Building hours of operation hrs EXISTING EQUIPMENT INFORMATION The building has electricity use data available for the previous year. Yes No (If “No”, project is not eligible for incentives) Building type (select one) Office Retail Grocery Lodging Warehouse Food Service Hospital School Residential Care Assembly (describe): Name of building area(s) not served by HRV + VCHP (e.g. lobby) Existing HVAC system description: Heat Source: Electric Resistance Heat Pump Cooling Capacity (tons): Optional Additional Description and Ventilation Strategy (e.g. how many RTU’s retrofit, etc.): NEW EQUIPMENT INFORMATION VCHP manufacturer (s) VCHP model number (s) HRV manufacturer (s) HRV number (s) New Ventilation system description Describe new system, including ventilation strategy (e.g. rates and the control logic): Cooling Capacity (tons): VCHP is a split-system heat pump with an inverter-driven outdoor compressor. Yes No (If “No”, project is not eligible for incentives) VCHP has inverter-driven or indoor blowers. Yes No (If “No”, project is not eligible for incentives) The HRV meets the following a sensible effectiveness of 85% or greater, has variable-speed blowers, integrated DCV, has economizer capabilities. Yes No (If “No”, project is not eligible for incentives) INSTALLER INFORMATION Company Name Total Installed Cost (before rebate) including equipment, labor, permit and tax By signing this form, I confirm that the information is correct to the best of my knowledge. Installer Signature Date