2013 masssave incentive request form

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Massachusetts Residential New Construction Program is sponsored by the following Program Administrators: Berkshire Gas, Cape Light Compact, Columbia Gas of Massachusetts, National Grid Gas & Electric, New England Gas, NSTAR Electric, NSTAR Gas, And Western Massachusetts Electric Company.

2013 Incentive Request Form* INCENTIVE RECIPIENT INFORMATION Contact: (must match application)

Company: (incentive check will be issued to)

Mailing Address: Street or PO Box, City, & Zip Code:

Phone:

Note: BUILDER, DESIGNER, or Homeowner can get the cash rebate

E-mail:

TAX ID or SS# (W-9 Form Required for Columbia Gas and New England Gas Incentives):

PROJECT INFORMATION Project Name:

Performance Path

Project Street Address, City, & Zip Code:

Choose a Heating Fuel Type:

Prescriptive Path

Natural Gas Master Metered

Electric Service Provider: Gas Service Provider:

Electric Master Metered

Natural Gas

Propane

Electric

Other

Permit Number:

Energy Code Type:(IECC 2006, IECC 2009 or MA Stretch Energy Code)

Number of Stories:

Total Number of Units Expected to Complete:

Oil

PRESCRIPTIVE PATH INCENTIVE SPECIFICATIONS Prescriptive Option I

Projects must meet the requirements of the Option I Prescriptive Measures List

Prescriptive Option II

Projects must meet the requirements of the Option II Prescriptive Measures List

REQUESTED PRESCRIPTIVE PATH PROGRAM INCENTIVES Total # Single-family Market Rate Units:

Total # Multi-family Market Rate Units:

Total # Single-family Affordable Rate Units:

Total # Multi-family Affordable Rate Units:

Total # Single-family Low Income Units:

Total # Multi-family Low Income Units:

Incentive Level

Prescriptive Option I

Prescriptive Option II

SINGLE-FAMILY Incentive Number of units

$1,250

$7,000

MULTI-FAMILY (2-99 units) Incentive Number of Units

$1,150

$4,000

MULTI-FAMILY (100-199 units) Incentive Number of Units

$850

$3,000

MULTI-FAMILY (200+) Incentive Number of Units

$550

$2,000

Total Prescriptive Path Program Incentives Requested * Incentives available to residential new construction less than three stories.

ENERGY STAR V3 (Awarded per Project) $25 Check if applicable. For 1st completion in Project

$25 Check if applicable. For 1st completion in Project

$25 Check if applicable. For 1st completion in Project

$25 Check if applicable. For 1st completion in Project

Total Dollar Amount Requested $

$

$

$ $


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