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 1/22/2021 1:58:57 PM

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

TERMS & CONDITIONS

Read the Terms & Conditions.

The customer agrees that sponsoring utilities* may make agreements with Customers by electronic means, that such agreements have the same legal effects as agreements entered into on paper and that such electronic agreements are authentic and valid. Customer also agrees to receive Energy Design Assistance Program information in electronic form (e.g., by email). Please note that this information must be signed by both parties in order to be valid and approved.

I have read, understand and agree to the terms and conditions of the Energy Design Assistance Program Agreement.

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.