Rebate Geo Resi
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Customer Rebate Application Form
2009 LIPA Residential Geothermal Program Important: Please read the attached instruction page thoroughly before submitting all forms (Keep a copy for your records)
Customer Information Customer Name: ________________________________________________________ Installation Address: ______________________________________________________ City: ____________________________________ State: ___________ Zip _________ Mailing Address (if different): _______________________________________________ City: ____________________________________ State: ___________ Zip _________ Daytime Telephone ( ) ____________________
LIPA Electric Account Number at Installation Address:
- - - Installation Date: ______/______/______ I would like my rebate: (check one): Credited to my LIPA electric account Sent to me as a check
Equipment Information Unit #1
Size (Tons): ________
EER Rating: ________________
Manufacturer: _________________________ Closed Loop Open Loop / Well
Unit #2
Size (Tons): ________
Closed Loop Open Loop / Well
Unit #3
Size (Tons): ________
Closed Loop Open Loop / Well
Size (Tons): ________
Manufacturer: _________________________ Closed Loop Open Loop / Well
Used for Space Heating Used for Water Heating
Serial No.: _______________________ Used for Space Heating Used for Water Heating
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Serial No.: _______________________
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Manufacturer: _________________________
Unit #4
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Manufacturer: _________________________
COP Rating: ________________ ARI Reference #_______________
Serial No.: _______________________ Used for Space Heating Used for Water Heating
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
Serial No.: _______________________ Used for Space Heating Used for Water Heating
I certify that I purchased the unit(s) described above, and on the enclosed invoice and / or contract, and that they were installed at the location indicated. I agree to the terms and conditions stated on this application (see eligibility requirements).
______________________________________________ Customer’s Signature
______ / ______ / ______ Date
Contractor Information Contractor Name: ________________________________________________ Contractor Daytime Telephone: _____________________ Address: ______________________________________ City: _____________________________ State: _________ Zip: __________ I certify that the system has been installed in accordance with ACCA Manual J version 8.0 calculations and that the calculation was performed using ACCA-approved software. I also certify that I installed the unit(s) described above, and on the enclosed invoice and / or contract, and that they were installed at the location indicated. I agree to the terms and conditions stated on this application (see eligibility requirements).
Print Contractor Name: _________________________________________ E-mail Address: ____________________________________ Optional
Contractor Signature: _______________________________________ Date: ______ / ______ / ______
Any Questions? Call LIPA’s Infoline at: 1-800-692-2626 or visit LIPA’s Web site for more information at www.lipower.org/Efficiency
Customer Rebate Application Form
2009 LIPA Residential Geothermal Program Instructions 1. 2.
Customer picks the contractor of their choice Customer, with the help of their contractor, chooses eligible equipment (See incentive chart and eligibility requirements below)
* Verify eligibility of the equipment and of the installation before signing a contract! Many rebate applications are denied because the equipment is not listed in the ARI directory, or one of the other eligibility requirements are not met 3. 4. 5. 6. 7. 8.
Contractor performs Manual J version 8 calculation Contractor installs properly sized qualifying equipment Customer completes Customer Information section of rebate application Contractor completes Equipment Information and Contractor Information sections of rebate application Both the contractor and customer sign the rebate application and keep a copy for their records Contractor (or customer) submits the rebate application and all required documentation (See eligibility requirements below) to LIPA at the following address: LIPA Residential Geothermal Program 25 Hub Drive Melville, NY 11747
Please Note: 2009 Rebate amounts are paid by the UNIT 2009 Residential Geothermal Customer Incentive EER
New Geothermal Installation
Replacement Geothermal Installation
>= 13.0 & < 16.0 >= 16.0 & < 19.0 >= 19.0
$700/unit $800/unit $1,000/unit
$200/unit $250/unit $350/unit
• Replacement refers to any installation where the previous equipment was a geothermal heat pump Eligibility Requirements for Residential Geothermal Incentives 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
11. 12. 13. 14. 15.
Units must be installed between January 1, 2009 and December 31, 2009 There must be a LIPA residential electric account at the installation site and it must be in the applicant’s name Qualifying units must be listed in the ARI directory at the time of installation (Visit www.aridirectory.org/ to verify equipment eligibility) Split systems must be installed with the matching pieces specified in the ARI directory at the time of installation These incentives apply to new and replacement total system installations performed during the term of this rebate program (The heat pump unit and air handler / fan coil must both be installed new. Partial system replacements do not qualify) All qualifying units installed at a residence must be documented on the same application (additional sheets may be attached if necessary) Replacement of systems less than five years old, that were rebated by LIPA, are not eligible for another rebate unless the EER level of the replacement unit is higher than the existing unit by at least 1 full EER level The Contractor must use an ACCA approved Manual J version 8 software package to perform the load calculation, and then size the unit(s) accordingly. (Visit http://www.acca.org/software/ for a current list of ACCA approved Manual J version 8 software) Rebate applications must be received within 60 days of installation and contain all required documentation a. Rebate Application Form b. ACCA approved Manual J V8 software load calculation printout c. Invoice or Contract must contain total cost (dollar amount), equipment make, model & serial number as well as customer name, installation address, and installation date d. Equipment Spec Sheet printout from the ARI On-Line Directory please indicate ARI Reference # on application LIPA reserves the right to inspect and test the equipment installation, and review the original contract in order to ensure compliance with program requirements. * Failure to allow LIPA access to the equipment, or original contract, will result in a denial of the rebate application LIPA is not responsible for lost mail LIPA is not responsible for any tax liability imposed as a result of rebate payments LIPA reserves the right to use the customer rebate to credit accounts in arrears Please allow up to 60 days for the delivery of the rebate check or bill credit LIPA reserves the right to modify or withdraw these incentives, and to adjust the eligibility requirements, at any time
Any Questions? Call LIPA’s Infoline at: 1-800-692-2626 or visit LIPA’s Web site for more information at www.lipower.org/Efficiency
2009 LIPA Residential Geothermal Program Important: Please read the attached instruction page thoroughly before submitting all forms (Keep a copy for your records)
Customer Information Customer Name: ________________________________________________________ Installation Address: ______________________________________________________ City: ____________________________________ State: ___________ Zip _________ Mailing Address (if different): _______________________________________________ City: ____________________________________ State: ___________ Zip _________ Daytime Telephone ( ) ____________________
LIPA Electric Account Number at Installation Address:
- - - Installation Date: ______/______/______ I would like my rebate: (check one): Credited to my LIPA electric account Sent to me as a check
Equipment Information Unit #1
Size (Tons): ________
EER Rating: ________________
Manufacturer: _________________________ Closed Loop Open Loop / Well
Unit #2
Size (Tons): ________
Closed Loop Open Loop / Well
Unit #3
Size (Tons): ________
Closed Loop Open Loop / Well
Size (Tons): ________
Manufacturer: _________________________ Closed Loop Open Loop / Well
Used for Space Heating Used for Water Heating
Serial No.: _______________________ Used for Space Heating Used for Water Heating
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Serial No.: _______________________
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Manufacturer: _________________________
Unit #4
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
EER Rating: ________________
Manufacturer: _________________________
COP Rating: ________________ ARI Reference #_______________
Serial No.: _______________________ Used for Space Heating Used for Water Heating
COP Rating: ________________ ARI Reference #_______________
Model No.: _______________________ New Home New ENERGY STAR Home New Install (existing home) Replacement Installation
Serial No.: _______________________ Used for Space Heating Used for Water Heating
I certify that I purchased the unit(s) described above, and on the enclosed invoice and / or contract, and that they were installed at the location indicated. I agree to the terms and conditions stated on this application (see eligibility requirements).
______________________________________________ Customer’s Signature
______ / ______ / ______ Date
Contractor Information Contractor Name: ________________________________________________ Contractor Daytime Telephone: _____________________ Address: ______________________________________ City: _____________________________ State: _________ Zip: __________ I certify that the system has been installed in accordance with ACCA Manual J version 8.0 calculations and that the calculation was performed using ACCA-approved software. I also certify that I installed the unit(s) described above, and on the enclosed invoice and / or contract, and that they were installed at the location indicated. I agree to the terms and conditions stated on this application (see eligibility requirements).
Print Contractor Name: _________________________________________ E-mail Address: ____________________________________ Optional
Contractor Signature: _______________________________________ Date: ______ / ______ / ______
Any Questions? Call LIPA’s Infoline at: 1-800-692-2626 or visit LIPA’s Web site for more information at www.lipower.org/Efficiency
Customer Rebate Application Form
2009 LIPA Residential Geothermal Program Instructions 1. 2.
Customer picks the contractor of their choice Customer, with the help of their contractor, chooses eligible equipment (See incentive chart and eligibility requirements below)
* Verify eligibility of the equipment and of the installation before signing a contract! Many rebate applications are denied because the equipment is not listed in the ARI directory, or one of the other eligibility requirements are not met 3. 4. 5. 6. 7. 8.
Contractor performs Manual J version 8 calculation Contractor installs properly sized qualifying equipment Customer completes Customer Information section of rebate application Contractor completes Equipment Information and Contractor Information sections of rebate application Both the contractor and customer sign the rebate application and keep a copy for their records Contractor (or customer) submits the rebate application and all required documentation (See eligibility requirements below) to LIPA at the following address: LIPA Residential Geothermal Program 25 Hub Drive Melville, NY 11747
Please Note: 2009 Rebate amounts are paid by the UNIT 2009 Residential Geothermal Customer Incentive EER
New Geothermal Installation
Replacement Geothermal Installation
>= 13.0 & < 16.0 >= 16.0 & < 19.0 >= 19.0
$700/unit $800/unit $1,000/unit
$200/unit $250/unit $350/unit
• Replacement refers to any installation where the previous equipment was a geothermal heat pump Eligibility Requirements for Residential Geothermal Incentives 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
11. 12. 13. 14. 15.
Units must be installed between January 1, 2009 and December 31, 2009 There must be a LIPA residential electric account at the installation site and it must be in the applicant’s name Qualifying units must be listed in the ARI directory at the time of installation (Visit www.aridirectory.org/ to verify equipment eligibility) Split systems must be installed with the matching pieces specified in the ARI directory at the time of installation These incentives apply to new and replacement total system installations performed during the term of this rebate program (The heat pump unit and air handler / fan coil must both be installed new. Partial system replacements do not qualify) All qualifying units installed at a residence must be documented on the same application (additional sheets may be attached if necessary) Replacement of systems less than five years old, that were rebated by LIPA, are not eligible for another rebate unless the EER level of the replacement unit is higher than the existing unit by at least 1 full EER level The Contractor must use an ACCA approved Manual J version 8 software package to perform the load calculation, and then size the unit(s) accordingly. (Visit http://www.acca.org/software/ for a current list of ACCA approved Manual J version 8 software) Rebate applications must be received within 60 days of installation and contain all required documentation a. Rebate Application Form b. ACCA approved Manual J V8 software load calculation printout c. Invoice or Contract must contain total cost (dollar amount), equipment make, model & serial number as well as customer name, installation address, and installation date d. Equipment Spec Sheet printout from the ARI On-Line Directory please indicate ARI Reference # on application LIPA reserves the right to inspect and test the equipment installation, and review the original contract in order to ensure compliance with program requirements. * Failure to allow LIPA access to the equipment, or original contract, will result in a denial of the rebate application LIPA is not responsible for lost mail LIPA is not responsible for any tax liability imposed as a result of rebate payments LIPA reserves the right to use the customer rebate to credit accounts in arrears Please allow up to 60 days for the delivery of the rebate check or bill credit LIPA reserves the right to modify or withdraw these incentives, and to adjust the eligibility requirements, at any time
Any Questions? Call LIPA’s Infoline at: 1-800-692-2626 or visit LIPA’s Web site for more information at www.lipower.org/Efficiency
