Residential Insulation Rebate Application Asterisks (*) indicate required fields.CUSTOMER INFORMATIONAccount Number* Are you the account holder?* Yes No Relationship to Customer (if not account holder)* Family Member Landlord Tenant Name* First Last Phone*Email* Installation Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a different mailing address?* My mailing address is the same as above I have a different mailing address Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code HOME INFORMATIONResidence Type:* Site Built Home (Four-plex or less) Multi-Family Home (Five-plex or more) Manufactured Home Multi-Family Type:* Low Rise (5 or more units, 3 stories or less) Mid/High Rise (6 or more units, 4 stories or higher) Electric Heat Source:*Residence must have permanently installed electric heat system capable of heating entire dwelling to qualify. Baseboard Ceiling Cable Wall/Cadet Heat Pump Electric Forced Air Other Other Heat Source:* ENERGY EFFICIENT UPGRADESI plan to install:*(Check all that apply) Attic Insulation Floor Insulation Wall Insulation I plan to install:*(Check all that apply) Attic Insulation Floor Insulation I plan to install:*(Check all that apply) Attic Insulation Wall Insulation Installation Method* Contractor Installed Self Installed Attic InsulationPlease input any additional R-values into the Notes section at the bottom of this form.Existing R-Value*Final R-Value (proposed)*Area (sq ft)*Floor InsulationPlease input any additional R-values into the Notes section at the bottom of this form.Existing R-Value*Final R-Value (proposed)*Area (sq ft)*Wall InsulationPlease input any additional R-values into the Notes section at the bottom of this form.Existing R-Value*Final R-Value*Area (sq ft)*REBATE PROGRAM GUIDELINES Please click the button below to find current rebate amounts. This will open a new tab. Rebate Amounts Rebate(s) will not exceed 100% of the installed job cost. Rebate(s) for self-installed energy efficient upgrades will not exceed 100% of the cost of materials. All energy efficient upgrades must be installed according to Clatskanie PUD (CPUD) specifications. If you would like information about CPUD specifications, please email rebates@esgroupllc.com to receive the information. Wall insulation: In-progress photographs required before, during & after insulation installation. After Installation: All final paperwork must be submitted before the rebate will be finalized. Verification of insulation is required. Upon receipt of the final paperwork, the project will either be added to the final inspection list, pictures of the insulation with a ruler inserted into the newly installed insulation must be submitted with the final paperwork, or contractor notes with pictures and final paperwork will suffice for the final inspection. Before Installation: Clatskanie PUD must receive verification of the existing insulation before insulation is installed. The verification can be by pictures with a ruler inserted into the existing insulation, an on-site audit of the insulation, or contractor notes & pictures. All energy efficient upgrades must be installed according to Clatskanie PUD (CPUD) specifications. If you would like information about CPUD specifications, please email rebates@esgroupllc.com to receive the information. Wall insulation: In-progress photographs required before, during & after insulation installation. After Installation: All final paperwork must be submitted before the rebate will be finalized. Verification of insulation is required. Upon receipt of the final paperwork, the project will either be added to the final inspection list, pictures of the insulation with a ruler inserted into the newly installed insulation must be submitted with the final paperwork, or contractor notes with pictures and final paperwork will suffice for the final inspection. Before Installation: Clatskanie PUD must receive verification of the existing insulation before insulation is installed. The verification can be by pictures with a ruler inserted into the existing insulation, an on-site audit of the insulation, or contractor notes & pictures. All energy efficient upgrades must be installed according to Clatskanie PUD (CPUD) specifications. After Installation: All final paperwork must be submitted before the rebate will be finalized. Verification of insulation is required. Upon receipt of the final paperwork, the project will either be added to the final inspection list, pictures of the insulation with a ruler inserted into the newly installed insulation must be submitted with the final paperwork, or contractor notes with pictures and final paperwork will suffice for the final inspection. UPLOAD YOUR FINAL DOCUMENTSRebate(s) will be paid when Clatskanie PUD has received the following required documents: Contractor installed: copies of contractor final invoice(s) noting R-value of existing insulation, R-value of final insulation, and square footage of added insulation. The date of the installation and invoice date must be on or after October 1, 2019. Include in-progress wall photos, if applicable. Self-installed: copies of purchase receipt(s) noting R-value of existing insulation, R-value of final insulation, and square footage of added insulation. The date of the installation and invoice date must be on or after October 1, 2019. Include wall photos, if applicable. Completed Residential Insulation Rebate Application (this application form) The following documents are required before final inspection of the new insulation: Contractor installed: copies of contractor final invoice(s) noting R-value of existing insulation, R-value of final insulation and square footage of added insulation. The date of the installation and invoice date must be on or after October 1, 2019. Final pictures of the project have been submitted or an on-site inspection taken place. Self-installed: copies of purchase receipt(s) noting R-value of existing insulation, R-value of final insulation and square footage of added insulation. The date of the installation and invoice date must be on or after October 1, 2019. Final pictures of the project have been submitted or an on-site inspection has taken place. Completed Residential Insulation Rebate Application (this application form) * Drop files here or Select files Max. file size: 20 MB. Application NotesPlease insert any notes that you would like us to review with your application.SUBMIT YOUR APPLICATIONTerms and Conditions*By clicking "submit," the applicant acknowledges the following: Rebate offer(s) may be changed or discontinued at any time by Clatskanie PUD (CPUD). CPUD disclaims any warranty, whether expressed or implied, regarding the energy efficient upgrade(s) listed on this application for any materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. I understand that the energy efficient upgrade(s) must be installed to CPUD specifications, and certify that I, or my contractor, have reviewed the specifications prior to beginning work. When selecting a contractor, I understand that it is the homeowner’s responsibility to request proof of insurance and licensing that meets the statutes and rules of the Oregon Construction Contractors Board. CPUD strongly recommends validating qualifications before work begins. I understand the above and certify that I am a customer of CPUD, that the energy efficient upgrade(s) are installed at the address indicated and that this address is within the CPUD service territory. I agree Allow 4 to 6 weeks after final inspection and receipt of all required documentation for rebate processing. Call 1-888-883-9879 to learn about additional energy efficiency programs.