Ducted Heat Pump Rebate Application

PTCS® Air Source Heat Pump Form

All sections must be filled out, signed, and dated by a PTCS® Certified Technician at the time of installation. A copy of the completed form must be promptly submitted to the utility and homeowner in accordance with utility policy.

Household Information

Jefferson County PUD Customer Name(Required)
Available on PUD bill or in Smart Hub App
Mobile or home phone
Installation Address(Required)
Needs to be the same as PUD customer's service address.
MM slash DD slash YYYY

SITE INFORMATION

Site Built Home Foundation Type
Site Built Home Type
Super Good Cents?
Energy Star®?
Heating System Being Replaced(Required)
Duct Sealing?

NEW HEAT PUMP EQUIPMENT INFORMATION

Inverter Driven Heat Pump?

Bonneville Power Administration standards are 9.0 HSPF, 14 SEER. Check with utility regarding equipment eligibility if below these standards.

EXTERNAL STATIC PRESSURE TEST

Check unit operating at full capacity unless conditions do not permit. Attach additional sheets as needed if test must be re-run.

1. Record expected CFM/ton based on fan wiring board settings

2. Measure return static pressure

3. Measure supply plenum static pressure

4. Calculate external static pressure: add values in #2 and #3 together, ignoring the minus sign and absolute value.

1a. Testing Mode Used
Inits (Use same units for all tests).

NOTE:

An External Static Pressure of 200 Pa (0.8 inches H²O) or more in Step 4 can result in extreme fan energy use and early fan failure.

TRUEFLOW TEST

Use the Technical Resources section at https://www.bpa.gov to determine acceptable performance, unless using alternative method.


1. Measure Normal Supply Operating Pressure (NSOP) [A]

2. Check TrueFlow plate size and units

3. Note TrueFlow plate location

4. Measure Supply Pressure with TrueFlow plate in (TFSOP) [B]

5. Calculate Correction Factor [C]

6. Measure plate pressure

7. Enter Raw Flow CFM from tables [D]

8. Calculate Corrected Flow (CFM=CF × [D])

9. Calculate CFM/ton

2a. Plate Size
2b. Units (Use same units for all tests)
3. Filter Location
Or calculate √([A]/[B])
Is flow at or above 350 CFM/Ton?

REFRIGERANT CHARGE INFORMATION/TESTING

Does indoor unit have an ECM blower?
Mode unit tested in:
Stage/Capacity Tested
Refrigerant Adjusted?

PERFORMANCE CHECK

Run unit for at least 15 minutes in compressor-only mode before taking.
Use the Technical Resources section at https://www.pba.gov to determine acceptable performance, unless using alternative method.

Heating Mode (65°F or lower)

Expected Temp Split from table acceptable?

Cooling Mode (Higher than 65°F)

Sub Cooling [A] - [B] is acceptable?

Alternative Method

Alternative Method Acceptable?

CONTROLS

Compressor Low Ambient Lockout Control (LAL) setting
(For ALL systems, single and multi-stage compressors)
Auxiliary (strip) heat lockout
Single Capacity Compressor Systems
Confirm discharge air temp is either installed or disabled
Multiple Capacity Compressor Systems
If the discharge air sensor control is used to control auxiliary heat, confirm it is set to no higher than 85°F or,
If staging thermostat is set warmer that 85°F, confirm resistance heat cannot operate at temperatures above 35°F

INSTALLER INFO AND SIGNATURE

if different than Installation company name.
Mailing Address for Check(Required)
Is the installation PTCS Certified?(Required)
PTCS® Tech's Name
Drop files here or
Accepted file types: jpg, jpeg, gif, png, pdf, heic, doc, docx, Max. file size: 128 MB.

    PRIVACY ACT STATEMENT Basic authority for collecting this information is authorized by 16 U.S.C. §§ 832 et. seq., and 838 et. seq., pursuant to Bonneville Power Administration’s Conservation Program system of records established in 46 FR 31700. This information is primarily intended to further, but is incidental to the performance of, BPA’s overall Energy Efficiency Program, the objective of which is to acquire energy resources through energy efficiency, to determine what cost-effective conservation and direct application renewable resources measures should be installed or adopted under different circumstances, and to provide incentives for the installation of such measures. Other routine issues of this information include: aggregation into a public database on energy efficiency; furnished to authorized personnel for installation/repair of equipment; aggregated into a database for program publicity; and in some instances information regarding buildings will be made available to subsequent purchasers of the buildings. Your disclosure of the requested information is voluntary; however failure to provide requested information means that it will not be possible for you to participate in this BPA Energy Efficiency program.

    With my signature below, I certify that I meet all of the above rebate requirements and that the information I have provided is accurate and complete.

    Clear Signature
    This field is for validation purposes and should be left unchanged.