Lighting Equipment Worksheet - Focus on Energy

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MultifaMily EnErgy SavingS PrograM ligHting EQuiPMEnt WorKSHEEt THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY. This application expires December 31, 2013. Return signed, completed application with accompanying worksheet(s) and itemized invoice postmarked within 60 calendar days of project installation, but no later than December 31, 2013, unless an earlier date is specified by <strong>Focus</strong> on Energy. <strong>Focus</strong> on Energy incentives are subject to change. Please visit focusonenergy.com/multifamily to ensure you are using the most current form. This worksheet must be accompanied by a completed Prescriptive Incentive Application. Questions: Call 866.486.0832 4' LINEAR FLOURESCENT – HIGH PERFORMANCE T8 (HPT8) OR REDUCED WATTAGE T8 (RWT8) SYSTEMS Replace 4' T12 or upgrade standard T8 system with a 4' High Performance T8 (HPT8) OR 4' Reduced Wattage T8 (RWT8) system. Lamps and ballast must meet the guidelines below or system will not qualify for ANY incentive. Please call with any eligibility or product qualification questions prior to initiating project. n All components (ballasts and lamps) must be CEE listed. “High Performance T8” and “Reduced Wattage T8” qualified product lists posted at focusonenergy.com/business/lighting.aspx. n Parking garage fixtures must operate 24 hrs/day to qualify. If fixture is in operation less than 24 hrs/day, call to verify eligibility. HPT8 SYSTEM REQUIREMENTS: n High Performance T8 systems must contain high lumen, long life F32T8 lamps and be listed on CEE High Performance T8 list. n Must be paired with LOW Ballast Factor Range ballast from the CEE “High Performance T8” list only. RWT8 SYSTEM REQUIREMENTS: n Reduced Wattage T8 systems must contain 25W or 28W T8 (straight or U shaped) lamps and be listed on CEE Reduced Wattage T8 list. n Qualified lamps (above) must be paired with either a NORMAL OR LOW Ballast Factor Range electronic ballast from the CEE “High Performance T8” OR “Reduced Wattage T8” qualified product lists. n This incentive cannot be combined with the Reduced Wattage T8 lamp only incentive on page 1. <strong>Equipment</strong> Replaced/Upgrade 4' 1 Lamp T12 or Standard T8 System 4’ 2 Lamp T12 or Standard T8 System 4' 3 Lamp T12 or Standard T8 System 4' 4 Lamp T12 or Standard T8 System Specifications and Required Information Incentive 32W HPT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed NORMAL Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model# ______________________ Ballast Model# ______________________ RWT8 System RWT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ 32W HPT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed NORMAL Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed LOW Ballast Factor Range Ballast. Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ 32W HPT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed NORMAL Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ 32W HPT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed NORMAL Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ RWT8 System RWT8 System with CEE listed LOW Ballast Factor Range Ballast Lamp type: (check one) q 4' 25W T8 q 4' 28W T8 Lamp Model#______________________ Ballast Model#______________________ $15/Fixture $20/Fixture $25/Fixture $15/Fixture $20/Fixture $25/Fixture $25/Fixture $30/Fixture $35/Fixture $25/Fixture $30/Fixture $35/Fixture Installation Type and Quantity q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ Total MM_MESP_lighting_012913 4 of 7
MultifaMily EnErgy SavingS PrograM ligHting EQuiPMEnt WorKSHEEt THIS APPLICATION IS FOR EXISTING BUILDINGS ONLY. This application expires December 31, 2013. Return signed, completed application with accompanying worksheet(s) and itemized invoice postmarked within 60 calendar days of project installation, but no later than December 31, 2013, unless an earlier date is specified by <strong>Focus</strong> on Energy. <strong>Focus</strong> on Energy incentives are subject to change. Please visit focusonenergy.com/multifamily to ensure you are using the most current form. This worksheet must be accompanied by a completed Prescriptive Incentive Application. Questions: Call 866.486.0832 DELAMPING Incentive – PERMANENTLY REDUCE THE NUMBER OF 4' FLOURESCENT LAMPS IN UPGRADED FIXTURES n This offer is in addition to the 4’ linear fluorescent measures shown on page 4 where the number of fixtures is staying the same pre- and post-retrofit, but one or more lamps are permanently removed from the fixture. n Overall wattage in each fixture must be reduced and must include system upgrade to HPT8 or RWT8 as listed above. Removal of lamps in non-operational fixtures does not qualify. n <strong>Focus</strong> on Energy reserves the right to complete a pre-inspection prior to issuing a reservation code. Reservation Code is required before project begins to qualify. n Call 866.486.0832 to speak with a program representative to begin the reservation code process. Reservation Code__________________________ Quantity of Lamps in Existing Fixture REPLACE OR RETROFIT 8' T12 FIXTURES WITH 4' HPT8 OR RWT8 SYSTEMS n Replace or retrofit standard 8 foot T12 systems with 4' High Performance T8 (HPT8) or Reduced Wattage T8 (RWT8) systems in configurations described below. Please read carefully. If fixture configuration is not one for one replacement or differs from line items, please call 866.486.0832 to verify eligibility. n All components (ballasts and lamps) must be CEE listed. “High Performance T8” OR “Reduced Wattage T8” qualified product lists posted at focusonenergy.com/business/lighting.aspx. n LOW ballast factor ballast used to replace 8' HO or VHO systems requires a customer sign off on the light level, see below. <strong>Equipment</strong> Replaced/Upgraded 8' 1 Lamp T12 Replaced with 2 Lamp 4' T8 System 8' 2 Lamp T12 Replaced with 4 Lamp 4' T8 System 8' 1 Lamp T12HO Replaced with 2 Lamp 4' T8 S ystem 8' 2 Lamp T12HO Replaced with 4 Lamp 4' T8 System Existing Fixture Type q T12 Lamp q T8 Lamp q HPT8 Lamp q T12 Lamp q T8 Lamp q HPT8 Lamp 8' 2 Lamp T12VHO Replaced with 4 Lamp 4' T8 System Quantity of Lamps in Replacement Fixture Replacement System Type q RWT8 q HPT8 q RWT8 q HPT8 Quantity of Fixtures Upgraded Specification and Required Information Incentive CEE listed NORMAL Ballast Factor Range Ballast with: q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed LOW Ballast Factor Range Ballast with: q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed NORMAL Ballast Factor Range Ballast with: q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed LOW Ballast Factor Range Ballast with: q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed Ballast (check one Ballast Factor Range): q HIGH q NORMAL q LOW LAMP: (check one) q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed Ballast (check one Ballast Factor Range): q HIGH q NORMAL q LOW LAMP: (check one) q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ CEE listed Ballast (check one Ballast Factor Range): q HIGH q NORMAL q LOW LAMP: (check one) q HPT8 32W q RWT8 28W q RWT8 25W Lamp Model#______________________ Ballast Model#______________________ LIGHT LEVEL CERTIFICATION (For replacing 8' T12 with low ballast factor T8) I agree that the low ballast factor ballast lighting is adequate without the need for additional task lighting. Customer Signature: Customer Name (Print): Date: Total Number of Lamps Removed per Fixture $30/Fixture $35/Fixture $30/Fixture $35/Fixture $30/Fixture $40/Fixture $45/Fixture Installation Type and Quantity Incentive Total $1/ Lamp removed $1/ Lamp removed q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ q 24/7 Parking Garage:__________ q Common Area :___________ q In Unit :___________ Total MM_MESP_lighting_012913 5 of 7
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