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CARRP COMMUNITY AUDIT RETROFIT REBATE PROGRAM FINAL APPLICATION (A multi-jurisdiction rebate program with limited funding) Jurisdiction:

(Please circle)

Sun Valley Camas County Fairfield Ketchum Hailey

Blaine County


Name of Applicant: _______________________________________________________________________________________________ Property Address: _____________________________________________ City:________________ State:__________ Zip:______________ Mailing Address For Rebate (if different then above): ___________________________________________________ City:____________ State:_______ Zip:______________ Home Phone: (

) _______ - ________Cell: (

) _________-___________ Email Address:_______________________

Property Owner Consent: By signature hereon, the property owner acknowledges that City and County officials and/or employees may, in the performance of their functions, enter upon the property to inspect and/or other standard activities in the course of processing this application. The undersigned will, at any time, with 24 hrs of notice, allow an agent of the Building, Planning and Zoning Departments to inspect the improvements. Completion Declaration: The undersigned certifies that (s)he has implemented the improvements as proposed and in accordance with the CARRP program guidelines and (s)he is aware improvements are subject to random inspection. Improvements that are not implemented as proposed on this application shall be required to return the rebate money within 30 days or be subject to legal action. Disclaimer: The undersigned certifies that (s)he is aware that energy retrofits involving building envelope sealing could negatively affect indoor air quality and (s)he is aware a post-improvement blower door test should be conducted to ensure ASHTO standard 6.2.2. “Ventilation for Acceptable Indoor Air Quality.” has been met. Property Owner’s Signature: ____________________________________________________________________Date: __________ / __________ /

Rebate requested: Audit $_____Materials $______Total$___________(cannot exceed a percent of total cost up to $2000 ) AUDIT BPI ___ RESNET____ Total cost of audit: $________________Audit rebate requested? Y ___ N____ Blower Door Test: Air Exchanges per Hour (ACH) @ 50 CFM___________ Total Duct Leakage Test :_____________CFM; Duct Leakage Ratio (Cubic Feet Per Minute (CFM)/Surface Area):____________ *(if applicable) Auditor name and cell phone number and “Auditor Certification Number” or proof of BPI or RESNET certification __________________________________ (copy of original receipt). Date of Audit:________________ What were the recommended energy audit prioritized improvements; in order? Please circle the improvements implemented. 1.__________________________________________________________ 2.______________________________________________ 3.__________________________________________________________ 4.______________________________________________ 5.__________________________________________________________ 6.______________________________________________ 7.__________________________________________________________ 8.______________________________________________ IMPROVMENTS Total amount of material costs associated with improvements:$________ (original receipts attached) What recommended energy retrofits, as outlined above were implemented; please circle the above recommended improvements that were implemented. What were the annual kWhs, BTUs, carbon, and $ savings associated with the improvements implemented: _____________________________________ ____________________________________________________________________________________________________________________________ If a building department or state permit was required for the retrofit please provide the state or jurisdiction permit number (#): ____________________ *Program information and requirements are subject to change. Rebates are offered until funding is exhausted; please check with the Building Department in your jurisdiction to determine the current funding level. Before purchasing a product, check with your Building Department to reserve a rebate and/or ensure rebates are available, and to confirm product eligibility and program requirements. Products purchased must meet efficiency criteria as established by your local jurisdiction, CARRP and Department of Energy. Following approval of your application, payment will be mailed to you within 60 business days. 08_13_10

ELIGIBLE MATERIALS AND SUBMITTAL CHECKLIST ATTACHMENT A Rebates will be limited to NEPA excluded activities, as listed below, which have also been recommended by the Certified Energy Audit Materials HVAC Systems: Gas furnace models: > 90% AFUE rating Oil furnace models: > 83% AFUE rating Mastic (Duct Sealing) Duct insulation Lighting: Energy Star CFLs ENERGY STAR qualified LED recessed down lights Insulation: Grade I installation Insulation shall be professionally installed. Ceiling instillations may be installed up to R-50; must increase R-Value by R-10 or greater. Ceiling insulation over unconditioned space, such as garages, does not qualify for the rebate unless it is part of the thermal envelope for the whole structure. Wall insulation meets the recommended Energy STAR insulation levels for retrofitting existing wood-framed buildings for Zone 6. Appliances: Gas Hot Water Heaters – ENERGY STAR Tank-less water heaters – ENERGY STAR Refrigerators – ENERGY STAR Clothes Washers – ENERGY STAR Dishwasher – ENERGY STAR Electric Hot Water – ENERGY STAR Windows and Doors: Residential Windows, Doors, and Skylights meeting the ENERGY STAR criteria for Northern Climates. Minimum double pane low e .35 U-factor for windows. Shower/Facet Upgrades: EPA Water Sense certified products or products that use 20% less water than the current federal standard

Submittals / Verifications (check box if submitted) Copy of HVAC Permit Original Receipts (not required for mastic or duct insulation)

Product info and packaging

Original Receipts

Weather Sealing Products: Caulk Foam Weather Stripping

Product info and packaging

Original Receipts


Product info and packaging

Attic Insulation Field Worksheet (signed by installer)

Original Receipt

Original Receipts

Original Receipt or copy of receipt with OER Redemption Form

UPC or Picture of UPC

UPC or Picture of UPC

Original Receipts

Pictures of Installation if building permit not required.

AUDIT SUBMITAL CHECKLIST Check Box if Item has been submitted




1. Blower Door Test Results: Air Exchanges Per Hour (ACH) @ 50 CFM_______________________

2. Total Duct Leakage Test: ____________CFM; Duct Leakage Ratio (Cubic Feet Per Minute(CFM)/Surface Area):_____________ *(if applicable)

3. Prioritized list of energy improvements included in audit with estimated paybacks: a. Project Carbon Savings? b. Project kWhs Savings? c. Projected BTU savings?

4. Auditor Certification Number or Proof of Auditor Certification:



Detailed Inputs Worksheet– includes lighting and appliance analysis.

BPI Audit Inputs:



Assessment R-values for the various structural elements i.e. walls, ceilings, stem walls, basements, crawl space, etc.


Assessment of the U-factor for windows and door.


Lighting analysis and assessment of the existing appliances .i.e. annual kWh for existing washer/dryer, refrigerator, hot water, and dishwasher.


Jurisdiction: (Please circle) Sun Valley Camas County Fairfield Ketchum Hailey Blaine County Bellevue If a building department or state perm...