Energy Design Assistance Application

Enter as much information that is known at this time; the rest can be entered later.
Fields marked with a red bar are required.
After entering information, click the “Submit” button at the bottom of the page to save your progress.
Once the information is submitted, you will receive a link via email that can be used to access the form again, or forwarded to others to complete more of the application.

Application

Energy Design Assistance

Created 7/23/2021 11:50:11 AM

Your Information

First Name:

Last Name:

Company Name:

E-mail:

Phone:

Project

Project Name:

Street Address:

City:

State:

ZIP:

BUSINESS CUSTOMER INFORMATION

Please ensure all contact information is correct, as all rebate checks will be sent to this address.

Company Name:

Billing Address:

City:

State:

ZIP:

Customer Contact

Name:

Phone:

E-mail:

Alternate Recipient

Name:

Address:

City:

State:

ZIP:

Phone:

E-mail:

Customer Utility Account Manager

CUSTOMER'S DESIGN TEAM INFORMATION

Please fill out the name, contact, phone and e-mail address for each of the following:

Architectural Firm

Name:

Contact:

Phone:

E-mail:

General Contractor

Name:

Contact:

Phone:

E-mail:

Mechanical Engineer

Name:

Contact:

Phone:

E-mail:

Electrical Engineer

Name:

Contact:

Phone:

E-mail:

Development Company

Name:

Contact:

Phone:

E-mail:

Other Design Team

Name:

Contact:

Phone:

E-mail:

CERTIFICATION INFORMATION

Are you planning on obtaining a green building certification (3rd party verification)?
YesNo

ENERGY DESIGN ASSISTANCE APPLICATION: SCREENING FORM

Schematic Design

Start Date:

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End Date:

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Notes on Schedule:

Design Development

Start Date:

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End Date:

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Notes on Schedule:

Architectural Construction Documents

Start Date:

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End Date:

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Notes on Schedule:

M/E Construction Documents

Start Date:

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End Date:

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Notes on Schedule:

Construction Schedule

Start Date:

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End Date:

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Notes on Schedule:

Design Process

Design/Bid Single PackageDesign/Bid Multiple Package (Fast Track)Design Build

Building Information

New Construction

Addition

Renovation

Does this square footage include multi-tenant/lease type spaces?
YesNo

Heating and Cooling

On-site Cooling System
District Cooling
On-site Heating System
District Heating
Other Heating\Cooling Systems

DESIGN CONSIDERATIONS OPTIONS

Willingness to Consider Energy Saving Alternatives

HVAC system alternatives:

YesNo

If yes, describe the alternative systems:

Orientation-building layout

YesNo

Wall/roof insulation:

YesNo

Glazing type-window design:

YesNo

Lighting design/controls:

YesNo

HVAC efficiency/controls:

YesNo

Demand response strategies:

YesNo

On-site renewables:

YesNo

Electric vehicle charging stations:

YesNo

Energy efficiency financing opportunities:

YesNo

Special considerations and other comments:

How did you hear about the Energy Design Assistance program?

select

Signature

Customer Authorized Signatory: Authorized signer (please type full name)

Date:

Design Team Authorized Signatory: Authorized signer (please type full name)

Date:

Note: Clicking the 'Submit' button will notify program administrators for further action, but does not finalize this application.
Upon submission you will receive an email confirmation that will include a link to allow you to make further modifications.