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Elk River M <br />Municipal Utilities MR.My MI. <br />HEAT PUMPS <br />RESIDENTIAL REBATE APPLICATION <br />AIR SOURCE HEAT PUMP TUNE UP REBATE: Up to $75 / UNIT <br />(Must provide professional contractor invoice showing tune up activity performed) <br />Quantity Cooling Capacity (Tons) Unit Efficiency: SEER EER <br />Completed (check all that apply) ❑ Condenser Coil Cleaning & Filter Change ❑ Refrigerant Charge Correction & Air Flow Correction <br />Contractor Name Date of Service <br />CENTRAL AND DUCTLESS HEAT PUMPS <br />(Units 15.2 SEER2 & 7.8 HSPF2 or higher will qualify. Must be ENERGY STAR°certified) <br />Quantity Cooling Capacity (BTU/hour) Heating Capacity (BTU/hour) . <br />SEER2 EER2 HSPF2 <br />Manufacturer Name Model Number Date of Install <br />REBATE: $400 / UNIT <br />COLD CLIMATE HEAT PUMPS REBATE: $1,000 / UNIT <br />(Minimum 15.2 SEER2, 8.1 HSPF2, & COP >=1.75 at 5°F. Must be ENERGY STARecertified) <br />'Must meet Northeast Energy Efficiency Partnership (NEEP) efficiency specifications for cold climate models <br />Quantity Cooling Capacity (BTU/hour) <br />SEER2 HSPF2 <br />If the old system had a furnace, enter furnace capacity (BTU/hour) — <br />Manufacturer Name Model Number <br />GROUND SOURCE HEAT PUMPS <br />(Closed -loop system only. Must be ENERGY STAR®certified) <br />Cooling Capacity (BTU/hour) <br />FFP <br />Manufacturer Name <br />Heating Capacity (BTU/hour) <br />Heating Capacity (BTU/hour) <br />C'nP <br />Model Number <br />HEAT PUMP WATER HEATER <br />(Must have UEF of 2 or higher. Must be ENERGY STAR°certified) <br />Quantitv <br />Uniform Energy Factor (UEF) <br />Space Heating Type (select one) ❑ Electric <br />Manufacturer Name <br />Date of Install <br />REBATE: $600 / TON <br />Date of Install <br />REBATE: $400 / UNIT 50-79 gallon 1 $450 / UNIT < 80 gallon <br />New Unit Tank Size (gallons) <br />If greater than 55 gallons must be greater than 2.2 <br />❑ Gas Style <br />Model Number <br />Date of Install <br />106 <br />