HomeMy WebLinkAboutAlaska Commercial Building Energy Audit Program Application 01-01-2019-A
Alaska Commercial Building Energy Audit Program Application
Building Information
Building Owner: ____________________________________________
Building Owner must be small for-profit business owner, including Alaska Native Corporations and electric utility
cooperatives.
NAICS Code: ______________________________
See link for codes: https://www.census.gov/cgi-bin/sssd/naics/naicsrch?chart=2017
Building Name: _______________________________________
(The street address can be used if no building name is used. )
Primary Building Use Category:
Accommodations services
Education - K-12
Education - University
Food service/drinking places
Hospital
Nursing home/residential care
Mall
Office
Other
Public assembly/house of worship
Public order and safety
Grocery store/food retail
Retail - non-food
Warehousing and wholesale
Briefly describe building use below (e.g. mixed office + retail):
___________________________________________________________
Commercial Building Physical Address: _____________________________________
City: ____________________________________
Year Built: _______________________________
Square Footage: __________________________
Please ensure accuracy by matching architectural drawings and/or tax records.
Average Number of Employees: ____________________________
If employee numbers fluctuate, please list the average.
Operating Hours per Week: _______________________________
Building HVAC Features: _________________________________
Air Conditioned? Yes No Unsure
Mechanical Ventilation System? Yes No Unsure
Annual Energy Cost: ____________________________________
Enter the total cost of electricity and heating fuel for a recent 12-month period.
Contact Information
Please enter the contact information for the primary contact (and optional secondary contact) for the
energy audit program. This could be the building owner, a facility manager, a representative from the
building management firm, or other contact designated by the building owner. Communications about
this program will be made to the individuals listed here.
Primary Contact Information
Contact Name: _________________________________________________
Relationship to Owner: __________________________________________
Company: _____________________________________________________
Phone: _______________________________________________________
Email: ________________________________________________________
Mailing Address: _______________________________________________
Secondary Contact (Optional)
Contact Name: _________________________________________________
Relationship to Owner: __________________________________________
Company: _____________________________________________________
Phone: _______________________________________________________
Email: ________________________________________________________
Mailing Address: _______________________________________________
2017 CBEA Program Participation Agreement
By submitting this signed application, the building owner commits to the following stipulations to participate in the
Commercial Building Energy Audit (CBEA) Program and receive a 75 percent subsidy from the Authority for an
ASHRAE Level I energy audit.
1. The building described in this CBEA application is a privately-owned commercial building in Alaska.
2. The building owner shall pay the Authority 25 percent of the cost of the ASHRAE Level I audit prior to the on -site
audit and no later than January 15, 2018. The cost of the ASHRAE Level I audit is based on the square footage of
the building as follows:
Square feet of
Building
25% paid to Authority
by Building Owner
75% subsidy paid by
the Authority
Total Audit Cost
Up to 3,000 sf $150 $450 $600
3,001 - 6,000 sf $225 $675 $900
6,001 - 10,000 sf $300 $900 $1,200
10,001 - 20,000 sf $400 $1,200 $1,600
Greater than 20,000
sf
$525 $1,575 $2,100
3. The building owner shall commit staff time to support the auditor during pre-meetings and walk-throughs; by
providing as-built records, two years of historic energy utility records, and similar documents as needed; and by
supporting the auditor in other related activities.
4. The building owner shall commit to making at least some of the recommended low- and no-cost improvements
within one year of receiving the energy audit report. The Authority will work with program participants as
requested to identify financing sources for implementation of recommended energy efficiency improvements.
5. The building owner shall participate in a follow-up survey one year after receiving the energy audit report. As
part of the survey, the building owner shall provide an update of the building’s energy use (utility bills), a list of the
energy efficiency measures implemented and date of implementation, investments made in improvements, and
program feedback.
6. The building owner shall permit the Authority and/or energy auditor to obtain energy usage records for the
calendar year following implementation of recomm ended energy efficiency measures.
7. If the building owner elects to receive an ASHRAE Level II energy audit from the certified energy auditor selected
by the Authority to conduct the ASHRAE Level I audit, the building owner agrees to the energy auditor p roviding an
electronic copy of the ASHRAE Level II audit report to the Authority.
8. The building owner shall allow public use of the building name and location in association with the building
energy use and/or energy savings data, through a written success story, or through a map interface of energy
efficiency measures implemented in Alaska, or similar public information about energy efficiency improvements
that have been implemented.
I have read and understand the 2017 Commercial Building Energy Audit Program Guidelines. I certify that I am the
building owner or authorized representative for the building listed above and that the information supplied on this
form is true and accurate to the greatest extent of my knowledge. If selected, I agree to adhere to and/or
implement the required commitments of building owners noted herein.
Printed Name: ____________________________ Signature: ____________________________ Date: _________
I am the: Building Owner Authorized Representative