Instructions: Complete this form and submit it to the serving electric utility. with bold outlines indicate BPA requirements. BUSINESS AND SITE INFORMATION Business Name Address, City State Zip BUILDING INFORMATION New building: Is heated by heat pump Heat pump application (select one) Existing building: Existing heat pump will be upgraded to more efficient heat pump Yes Yes The building has 50,000 square feet No (If project is No (If project is “No”, “No”, The building is electrically heated or less conditioned building area not eligible for not eligible for incentives) incentives) Office Retail Grocery Lodging Building type (select one) Warehouse Food Service Hospital School Residential Care Assembly Other (describe): Name of building area(s) served by heat pump(s) (e.g. lobby) NEW EQUIPMENT INFORMATION Retrofit Information Heat Heat Heat Heat Heat Heat Pump 1 Pump 2 Pump 3 Pump 4 Pump 5 Pump 6 Heat Pump manufacturer Heat Pump model number Tons Yes Yes Yes Yes Yes Yes No (If No (If No (If No (If No (If No (If “No”, “No”, “No”, “No”, “No”, “No”, The heat pump is an air to air heat project is not project is not project is not project is not project is not project is not pump system, 20 tons or less eligible for eligible for eligible for eligible for eligible for eligible for incentives) incentives) incentives) incentives) incentives) incentives) Yes Yes Yes Yes Yes Yes No (If No (If No (If No (If No (If No (If “No”, “No”, “No”, “No”, “No”, “No”, The heat pump meets BPA Heat project is not project is not project is not project is not project is not project is not Pump and VRF Specifications* eligible for eligible for eligible for eligible for eligible for eligible for incentives) incentives) incentives) incentives) incentives) incentives) *The BPA Heat Pump and VRF Specification is available in the IM Document Library on bpa.gov. 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 the serving electric utility. with bold outlines indicate BPA requirements. BUSINESS AND SITE INFORMATION Business Name Address, City State Zip BUILDING INFORMATION Heat pump application (select one) New building: Is heated by heat pump Existing building: Existing heat pump will be upgraded to more efficient heat pump The building has 50,000 square feet or less conditioned building area Yes No (If “No”, project is not eligible for incentives) The building is electrically heated 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 Other (describe): Name of building area(s) served by heat pump(s) (e.g. lobby) NEW EQUIPMENT INFORMATION Retrofit Information Heat Pump 1 Heat Pump 2 Heat Pump 3 Heat Pump 4 Heat Pump 5 Heat Pump 6 Heat Pump manufacturer Heat Pump model number Tons The heat pump is an air to air heat pump system, 20 tons or less Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) The heat pump meets BPA Heat Pump and VRF Specifications* Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) Yes No (If “No”, project is not eligible for incentives) *The BPA Heat Pump and VRF Specification is available in the IM Document Library on bpa.gov. 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
Commercial_Heat_Pump_Upgrade_PIF_Apr2017.docx