Commonwealth Solar Hot Water

Commercial Feasibility Study Application

BUILDING APPLICANT

Company Name
Contact Name / Contact Title
Contact Email / Contact Phone
Installation Address: Street
City / State / Zip Code

Please describe the nature of the Applicant’s business or organization:

BUILDING OWNER: (please only fill out if different from above, e.g. in cases of long-term lease agreements):

Company Name
Contact Name / Contact Title
Contact Email / Contact Phone
Address: Street
City / State / Zip Code

PRIMARY CONSULTANT:

Company Name
Contact Name / Contact Title
Contact Email / Contact Phone
Address: Street
City / State / Zip Code

SECONDARY CONSULTANT (if applicable):

Company Name
Contact Name / Contact Title
Contact Email / Contact Phone
Address: Street
City / State / Zip Code

Please select Payee (the entity the check should be sent to):

PRIMARY CONSULTANT BUILDING APPLICANT BUILDING OWNER
Please summarize the primary consultant’s prior experience with solar thermal systems in commercial applications:

BUILDING PROFILE

Sector: Commercial Multi-Family (5 units or greater)

Tax Status: Public Non-Profit Commercial (non-exempt)

Number of Buildings
Number of Units Served (if applicable)
Total Number of Users Served by the Water Heating System
Electric Utility (required)
Gas Utility (if applicable)
Oil/Propane Supplier (if applicable)

Roof deck type: Concrete Steel Wood Reinforced Wood

EXISTING WATER HEATING SYSTEM (before installation of solar hot water system):

Natural Gas Propane Oil Electric Other

Direct Fired Tankless Direct Fired Hot Water Tank Indirect Fired Tankless Indirect Fired Hot Water Tank

Existing Boiler or Hot Water Heater Capacity (kBtu/hr)
Current Total Hot Water Consumption (Gallons per day) Please provide an explanation of how this estimate was calculated.
Hot Water Temperature Required (⁰F)
Current Estimated Annual Fuel Consumption for Hot Water Load (specify units: therms, gallons, or kWh)

Is there a clear area of at least 100 sq ft available in your facility to install necessary solar storage, pumps, and controls?

No Yes Other

Notes:

PROPOSED SOLAR HOT WATER SYSTEM

Use: Domestic Water Heating Space Heating Combination Process Uncertain

Collector Racking Type: Roof Mount Ground Mount Uncertain

Provide a brief description of the proposed solar hot water system:

CAPITAL IMPROVEMENTS

Do you plan to make any capital improvements in 2014 or 2015? (E.g. Roof or heating system replacement)

Describe any other renovations planned that could offer significant reductions in energy expenses:

PROPOSED FEASIBILITY STUDY BUDGET

Budget Form

I. Contractors/Consultants / Total Cost
Firm, Consultant name, and title / Description of Work (include rates and hours)
$
$
Structural Engineer / $
Meter Hot Water Load / $
$
$
Subtotal / $
II. Other Direct Costs (list by type)
$
$
Subtotal / $
Total Cost Summary
Total Project Costs / $
Total MassCEC Grant Request / $
Total Cost Share / $
Cost Share as a Percentage of Project Cost
(For Private Entities the Minimum Required is 25%;
5% For Public/Non-Profit Entities)
MassCEC Grant Request as a Percentage of Project Cost

REQUIRED BACKUP DOCUMENTATION

Please attach the following required pieces of backup documentation:

1.  Signed Participant’s Agreement: Please submit signed Feasibility Study Participant’s Agreement.

2.  Electric Bill: Please submit a copy of the electric bill with the rate code listed. The address on the bill should match the address listed for the Building Applicant.

3.  Bill for Hot Water Fuel (Electric, Oil, Propane, etc.): Please submit one full year (preferably two) of the fuel bill used to heat the targeted hot water load.

4.  Aerial Photo: Please submit a Google or Bing Map aerial photo of the building.

5.  Signed W-9 from Grantee: Please email the signed W-9 directly to .

Please submit this application and backup documents 1-4 to . Completed applications will be considered in the order they are received. Incomplete applications will be rejected and removed from the queue.

Updated 2/18/2014 4