Full Text
WATER CONSERVATION REBATE APPLICATION FOR CITY OF MOSCOW WATER CUSTOMERS Rebates only valid on or after Feb 2, 2016 I Return application and supporting documents by Email: [EMAIL REDACTED] Fax: [PHONE REDACTED] Mail: Environmental Services Dept. I 201 N Main St I Moscow, ID 83843 1B1B1B1BCITY OF MOSCOW CUSTOMER INFORMATION 2B2B2B2BCITY OF MOSCOW REBATE SITE REQUEST Name: (must be legal owner, check will be made out to this name) Name: Street Address: Site Address: City, State, Zip: City, State, Zip: Phone Number: Phone Number: Email: Email: Account Number: Comments: Type of Building: (Select one) I Additional Info: (Fill in for fixture rebate) □ Single Family Total # of restrooms 13B13B13B13B□ Multi Family Total # of units 15B15B15B15B□ Commercial Total # of restrooms 17B17B17B17B□ Other Total # of restrooms TYPE OF REBATE Fixture Program # Fixture gpf = gallons per flush New Installation Date □ Existing Toilet Replacement (new toilet must be more efficient than existing toilet) Existing gpf Installed gpf □ New Construction Toilet Installation (Dual Flush or Ultra High Efficiency Toilet, 1.28 gpf or less) Installed gpf □ Low Volume Urinal (High Efficiency Urinal, 0.125 gpf or less) Existing gpf Installed gpf Lawn Replacement Program I Turn in form prior to starting removal process; pre-removal site inspection required. Total ft² Removed Removal Date Replacement Date □ Irrigated Lawn to Wisescape® (300 ft² or more, Staff pre/post inspection required) LEGAL OWNER/AGENT SIGNATURE By signing this application I certify the information provided is true to the best of my knowledge and I acknowledge that I am the legal owner/agent of the property for which the rebate is being requested. I understand the rebate will only be dispersed to me, the legal owner/agent, and not a property manager, tenant or any other party managing or living on the premises. I also acknowledge that the replacement / installation is in accordance with the rebate program. Legal Owner/Agent (signature) Date Legal Owner/Agent (printed) STAFF Staff Site Inspections: Irrigated Lawn to Wisescape® Pre-removal Inspection Proposed ft² Date Completion Inspection Completed Date Budget Code Number: Date Payment Authorized: Amount of Payment: 24B24B24B24BAuthorized Signatures: ---PAGE BREAK--- Water Conservation Rebate Application Page 2 of 2 Fixture Rebate Process: No site inspection by staff required I gpf = gallons per flush 1. Return completed application form with supporting documents by: Email: [EMAIL REDACTED], Fax: [PHONE REDACTED], or Mail: Environmental Services Dept. I 201 N Main St I Moscow, ID 83843 2. Required Supporting Documents Checklist: □ Existing Toilet Replacement: □ Dated receipt for new lower volume toilet. □ Documentation of new lower volume toilet’s gpf: can be stated as part of the professional installation receipt OR a copy of the toilet’s information literature. □ Receipt of professional installation of new lower volume toilet, if it was professionally installed. □ Documentation of existing toilet’s gpf: can be stated as part of the professional installation receipt OR for do-it- yourself installation, a picture of the existing toilet in the restroom and a picture of the existing toilet’s gpf stamp. □ Documentation of new toilet’s installation: can be stated as part of the professional installation receipt OR for do-it-yourself installation, a picture of the new toilet in the restroom. □ New Construction Installation: □ Dated receipt of the new low volume toilet to not exceed 1.28 gpf. □ Documentation of new toilet’s gpf: can be stated as part of the professional installation receipt OR a copy of the toilet’s information literature. □ Low Volume Urinal □ Dated receipt for new low volume urinal to not exceed 0.125 gpf. □ Documentation of the new low volume urinal’s gpf: can be stated as part of the professional installation receipt OR a copy of the urinal’s information literature. □ Receipt of professional installation of new low volume urinal, if it was professionally installed. □ For Existing Urinal Replacement, documentation of existing urinal’s gpf: can be stated as part of the professional installation receipt OR for do-it-yourself installation, a picture of the existing urinal in the restroom and a picture of the existing urinal’s gpf stamp. □ Documentation of new urinal’s installation: can be stated as part of the professional installation receipt OR for do-it-yourself installation, a picture of the new urinal in the restroom. 3. The completed and approved application will be submitted for rebate payment. Allow three weeks for check processing. Fixture Rebate Amounts: gpf = gallons per flush □ Existing Toilet Replacement: NO rebate available for replacing a broken toilet. □ Up to a $50 rebate is offered if your existing toilet is greater than 1.6 gpf and replaced with a 1.6 gpf toilet. □ Up to a $125 rebate is offered if your existing toilet is greater than 1.6 gpf and replaced with a 1.28 or less gpf toilet. □ Up to a $75 rebate is offered if your existing toilet is a 1.6 gpf and replaced with a 1.28 or less gpf High Efficiency Toilet or Ultra High Efficiency Toilet with a maximum of 0.8 gpf. □ New Construction Toilet Installation □ Up to a $75 rebate is offered for a 1.28 or less gpf Dual Flush High Efficiency Toilet or Ultra High Efficiency Toilet with a maximum of 0.8 gpf if installed during new construction. □ Low Volume Urinal □ Up to a $50 rebate is offered for replacement of OR a new installation of a High Efficiency Urinal with a maximum 0.125 gpf for commercial properties. Replacements must be more efficient than the existing; replacement maximum is 0.125 gpf. Irrigated Lawn to Wisescape® Rebate Process: Site inspection by staff required before removal process. 1. Return partially completed application form (total ft² removed, removal date or replacement date left blank) by: Email: [EMAIL REDACTED], Fax: [PHONE REDACTED], or Mail: Environmental Services Dept. I 201 N Main St I Moscow, ID 83843 2. Staff will contact you within five business days of receipt of your application and will set up a time to inspect the existing irrigated turf prior to any work being done. 3. Once the work is completed, email [EMAIL REDACTED] or call [PHONE REDACTED] to set up a time for a completion inspection. 4. The completed and approved application will be submitted for rebate payment. Allow three weeks for check processing. Lawn Replacement Rebate Amounts: □ Replace an existing area of lawn that is currently being irrigated and is 300 square feet or larger and receive $150 rebate. Questions: Kelli Cooper, Environmental Services Coordinator- Sustainability Programs, [EMAIL REDACTED] or [PHONE REDACTED]. Staff: 1. Completed applications to be approved and signed by Water Conservation and Sustainability Program Coordinator. 2. Water Department staff to issue a Request for Payment (RFP) and forward to the Finance Department. 3. Finance Department to issue a check to the legal owner of the property.