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Central Electric Cooperative, Inc.
>
Weatherization Program Form
Weatherization Program Form
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Owner Name
*
First
Last
Installation Address
*
Street Address
Address Line 2
City
ZIP Code
Mailing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
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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
State
ZIP Code
Phone
Email
Type of Electric Heat
*
Furnace
Heat Pump
Zonal (Baseboard, Wall, Plug-in)
Year House Was Built
*
House Type
*
Site Built
Manufactured Home
What Weatherization Was Completed
*
Windows
Exterior Doors
Insulation
Whole Home Air Sealing (Please attach technician's supporting documentation)
Date of Installation
*
MM slash DD slash YYYY
Existing Window Type
*
Single Pane Wood Frame
Single Pane Metal Frame
Double Pane Metal Frame
How Many Windows Are Being Replaced?
*
How Many Exterior Doors Were Replaced?
*
Where Was Insulation Updated?
*
Ceiling Insulation
Floor Insulation
Wall Insulation
How Many Square Feet of Ceiling Insulation Was Updated?
*
What Was the existing R-Value of the Ceiling Insulation?
*
What is the Ending R-Value of the Ceiling Insulation?
How Many Square Feet of Floor Insulation Was Updated?
*
What Was the existing R-Value of the Floor Insulation?
*
What is the Ending R-Value of the Floor Insulation?
How Many Square Feet of Wall Insulation Was Updated?
*
What Was the existing R-Value of the Wall Insulation?
*
What is the Ending R-Value of the Wall Insulation?
Document Upload
*
Drop files here or
Select files
Max. file size: 30 MB.
Please upload a copy of documentation showing the size of each window, U-value of each window and door, window or door brand, model information showing, purchase date and price, your receipt or other. For Insulation the documentation must state square footage replaced and the new and existing R-value.
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:
*
Existing windows being replaced are single or double pane metal frame or single pane wood frame. Existing doors being replaced are un-insulated exterior doors.
I certify that the following installation items are complete and accurate:
*
Replacement windows are NFRC labeled with a maximum U-Value of 0.30; glass doors maximum U-Value of 0.35; exterior doors are pre-hung and meet Energy Star specifications. All replacements shall not increase in area except as required by egress.
I certify that the following installation items are complete and accurate:
*
Invoice, all NFRC U-Value labels (or other documentation representing U-Value) are submitted to CEC.
I certify that the following installation items are complete and accurate:
*
Replacement windows and doors are installed to manufacturer's recommendations and resident understand the safety instructions.
I certify that the following installation items are complete and accurate:
*
Replacement windows and doors are installed to CEC Program Specifications.
I certify that the following installation items are complete and accurate:
*
Any exposed wood, either existing or added, shall be finished with a sealer to prevent future warping, swelling or rotting.
I certify that the following installation items are complete and accurate:
*
After installation, windows and glass doors shall operate smoothly and properly. When close, the entire assembly shall provide a complete weather barrier for the entire opening.
I certify that the following installation items are complete and accurate:
*
There is an air-tight seal between replacement units and the rough opening.
I certify that the following installation items are complete and accurate:
*
If applicable, safety glass was installed to Oregon State building code requirements.
Electronic Member Signature
Rebate amounts and program requirements are subject to change or be discontinued at any time by Central Electric Cooperative (CEC). CEC disclaims any warranty, whether expressed or implied, regarding the equipment listed above and for materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. All locations and jobs are subject to inspection. Electricity usage, job information and all application data may be analyzed or shared to partnering third parties by participating in energy efficiency programs by CEC. Equipment and installation of the job must meet all program criteria to qualify for rebates. I understand the above and certify that the job is completed and operating at the location indicated.
Digital Signature
*
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.
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*
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*
I agree to the privacy policy.
CEC Privacy Policy
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Call 811 Before You Dig
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Call 811 Before You Dig
Backup Generator FAQ
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