Pre-Project Submission Form

Transcription

1 Pre-Project Submission Form INSTRUCTIONS: Please complete ALL required fields below. For Head Office Applications, complete a Pre Project Submission Form for each facility. Check each box below to confirm the required documentation is submitted to the LDC for each Facility as part of your Application prior to beginning your Project(s): Equipment cost estimates, quotes or proposals Cut sheets or detailed manufacturers data Proposed Project M&V Plan (if applicable) For Prescriptive Measures, one or more of the following worksheets: Lighting Eligible Measures Worksheet Agribusiness Eligible Measures Worksheet Unitary AC Eligible Measures Worksheet VFD Eligible Measures Worksheet Motors Eligible Measures Worksheet Multi Residential In suite Appliances Eligible Measures Worksheet Alternative Energy Measures for Space Cooling Eligible Measures Worksheet Synch Belt Eligible Measures Worksheet For Custom Measures, one or more of the following worksheets: Industrial Pump VSD Industrial Compressed Air Commercial Lighting Industrial Fan VSD Commercial HVAC Fan VSD Tool Commercial HVAC Pump VSD Tool Industrial Refrigeration Commercial Unitary AC Tool Custom Lighting Project Worksheet Custom Non Lighting Project Worksheet Page 1 of 6

2 1) The Project described herein is to be completed in the service area of the Lead LDC: Yes No 2) Social Housing Provider Election (optional): a) The Applicant is a Social Housing Provider that is applying for a Social Housing Adder: Yes No b) The Applicant is applying for an Advance Incentive: Yes No 3) Building where Eligible Measures will be installed: BUILDIING NAME (IF APPLICABLE) ADDRESS CITY PROVINCE POSTAL CODE LDC IS [LEAD LDC / SATELITE LDC] HST REGISTRANT # 4) Please check all building types that apply to your Project (required): Commercial Large Office Commercial Large Retail Commercial Food Retail Commercial Large Hotel Commercial Hospital Commercial Schools (K 12) Commercial Warehouse & Wholesale Commercial Small Office Commercial Small Retail Commercial Restaurant Commercial Other Hotel & Motel Commercial Long Term Care Commercial University & Colleges Commercial Religious Institutions Page 2 of 6

3 Commercial Other Please Specify: Multi Residential Rental Apartment Multi Residential Other Please Specify: Industrial / Manufacturing Iron & Steel Industrial / Manufacturing Petroleum / Plastic Industrial / Manufacturing Automotive Industrial / Manufacturing Food & Beverage Industrial / Manufacturing Strip Mall / Unit Government/ Publicly Owned Administrative Buildings Residential Condominium Multi Residential Social Housing Provider Industrial / Manufacturing Warehouse Industrial / Manufacturing Pulp & Paper Industrial / Manufacturing Mining Industrial / Manufacturing Cement & Non Metallic Mineral Industrial / Manufacturing Manufacturing Industrial / Manufacturing Other Please Specify: Government/ Publicly Owned Government Culture & Tourism Government/ Publicly Owned Emergency Services Government/ Publicly Owned Public Works Agricultural Cattle Farm Agricultural Greenhouse Agricultural Swine Government/ Publicly Owned Parks/Recreation Government/ Publicly Owned Other Please Specify: Agricultural Dairy Farm Agricultural Poultry Agricultural Other Please Specify: 5) Which of the following best describes this Project (required)? Planned replacement Efficiency upgrade Unexpected replacement New equipment for new process or expansion of operations 6) Building Characteristics (required): m 2 sq.ft. Page 3 of 6

4 Total Building / Floor Area Age of Building Number of Floors Existing Cooling System Existing Heating System Estimates Annual Consumption (kwh) (if known) Estimated Summer Peak Demand (kw) (if known) 7) Which type of project(s) is included in this Application (required)? Prescriptive Project Custom Project 8) Estimated or Actual Eligible Project Costs (required). Please refer to the Participant Agreement for a list of Eligible Costs: Total Eligible Costs For Prescriptive Projects: $ Total Eligible Costs For Custom Projects: $ 9) Participant Incentive amounts (required): Total Prescriptive Incentive being applied for: $ Total Custom Incentive being applied for: $ Total incentive being applied for that accounts for Social Housing Adder (if applicable): $ Amount of Advance Incentive amount being applied for (if applicable): $ Amount of total incentive being applied for that accounts for Multi-family Building Adder (if applicable): $ Page 4 of 6

5 10) Project Timeline (required): Estimated Project Start Date (mm/dd/yyyy) Estimated Project Completion Date (mm/dd/yyyy) 11) Have you received any other financial incentive(s) for this project through an LDC or any other public program (required)?: Yes No If yes, please specify the following: of Program: Funding Provider: Funding Amount ($): 12) Other comments (for example, special site requirements or conditions which Project Evaluators should be aware of, etc): By signing below, I certify that the information provided in this Appendix A is true and accurate. Applicant / Legal Company Authorized Signature Date Applicant / Legal Company Authorized Signature Date 13) Project Management (FOR LDC USE ONLY): Project Application Number: Approved Prescriptive Incentive Amount: $ Page 5 of 6

6 Approved Custom Incentive Amount: $ Approved Social Housing Provider Participant Advanced Payment: $ Approved Social Housing Provider Adder: $ Date Application Approved (mm/dd/yyyy): Advanced Project Evaluation Required? Yes No Date of Project Evaluation (mm/dd/yyyy): Comments LDC Authorized Signature Date LDC Authorized Signature Date Page 6 of 6