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Central Electric Cooperative, Inc.
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Home Energy Audit Form
Home Energy Audit Form
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Home Energy Audit & Weatherization Request Form
Member Name
*
First
Last
Service Address
*
Street Address
Address Line 2
City
State
Oregon
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
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Maine
Maryland
Massachusetts
Michigan
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North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Mailing Address
*
Same as service address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Phone
*
Email
*
Have you completed a previous site inspection and are applying for insulation or air sealing incentives?
*
Yes
No
You have completed a previous site inspection and would like to apply for insulation or air sealing incentives.
Select the date of your previous CEC site inspection
*
MM slash DD slash YYYY
Select the energy efficiency improvements you have made to your home.
*
Ceiling Insulation
Floor Insulation
Wall Insulation
Air Sealing (pre and post blower door results on required CEC contractor form)
Date of Installation
*
MM slash DD slash YYYY
File Upload
*
Drop files here or
Select files
Accepted file types: jpg, gif, pdf, png, Max. file size: 30 MB, Max. files: 10.
Please upload a copy of documentation showing the quantity, description of product installed, purchase date and price, your receipt or other. For air sealing, please upload required CEC contractor form.
Installation Checklist
Follow the manufacturer's installation instructions and the CEC Weatherization Program Specifications exactly. Failure to do so will result in disqualification from the program, may void the manufacturer's warranty and may result in lower than expected energy savings.
I certify that the following installation items are complete and accurate:
*
Insulation and/or air sealing installed to manufacturer's recommendations
Insulation and/or air sealing installed CEC Program Specifications
Homeowner understands the safety instructions
I understand CEC recommends a carbon monoxide detector installed in the home
Electronic Member Signature
The CEC member, by executing this agreement, waives any and all claims against CEC that may arise from the installations of said improvements. CEC will not supervise the installation of said improvements, nor warrant the adequacy of said installation upon their completion. The CEC member assumes all of the usual responsibilities with hiring a private contractor. The CEC member acknowledges that CEC will approve the job for payment only after it has been determined that the job meets BPA/CEC specifications and/or standards. The CEC member acknowledges that they have received written instructions and understands that these instructions must be followed. The CEC member understands that if these instructions are not followed, CEC is under no obligation to grant or dispurse program funds. The CEC member understands that this program is funded by the Bonneville Power Administration (BPA) and is subject to change without notice.
By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information.
*
I certify the above information is true and correct and I am the person submitting this form.
By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information.
Type Full Name
*
You have not completed a previous site inspection and would like to request one.
Home Type
*
Site Built
Manufactured
Year Built
The site built home must have been built before 1992. The Oregon Building Code required site-built homes built in and after 1992 to be weatherized at the time of construction.
Water Heating System Type
*
Electric Resistance Tank Water Heater
Electric Heat Pump Water Heater
Electric Tankless
Heating System Type
*
The home must be heated electrically as the primary heat source to qualify.
Heat Pump
Ductless Heat Pump
Electric Furnace
Electric Resistance (baseboard, wall heat, plug in electric heaters)
Electric Hydronic
Combustion Appliance
*
Fireplace/Woodstove
Pellet Stove
None
Home Square Footage
*
Please enter a number from
1
to
10000
.
Consent
*
I agree to the privacy policy in the link below:
CEC Privacy Policy
Email
This field is for validation purposes and should be left unchanged.
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Rate Schedules
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Call 811 Before You Dig
Portable Generator Safety
Power Outage Tips
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Call 811 Before You Dig
Backup Generator FAQ
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Power Surges FAQ
Protecting Against Phone Scams
Public Safety Power Shutoff (PSPS)
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