Pre-Approval Submission Form
Project Details
Contractor Name
Contractor Phone
Please enter a valid phone number.
Contractor Email
example@example.com
Customer Name
First Name
Last Name
Customer MLP
*
Please Select
Belmont Light
Braintree Electric Light Department
Concord Municipal Light Plant
Hingham Municipal Lighting Plant
Middleborough Gas and Electric Department
Norwood Light Department
Reading Municipal Light Department
Wakefield Municipal Gas and Light Department
Wellesley Municipal Light Department
Customer Email
*
Used for rebate milestone updates & customer survey at end of rebate process. If your customer does not have one, please use your own.
Project address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contract total
Utility Authorization Number (UAN)
*
Please contact RMLD to obtain the UAN. You will need the Electrician License number to complete this. Call 781-942-6598
RMLD requires that all projects complete a Town Wiring Inspection upon completion. Please confirm that you understand this requirement.
*
Please Select
Yes, I understand.
No, I am not able to complete the required inspection.
WMGLD requires that all residents complete a home energy assessment through the MMWEC Muni HELPS program. In order to be eligible for a WMGLD rebate, your customer will need to have received an assessment within the last three years OR receive an assessment within one year of ASHP install, and will not receive their rebate until the assessment has been completed. Please confirm that you understand this requirement.
*
Please Select
Yes, I understand that my customer needs a home energy assessment.
No, my customer will not be able to complete the required home energy assessment.
MGED requires that all residents complete a home energy assessment through Energy New England (ENE) within the last 2 years BEFORE installation of their system. If this assessment is not completed beforehand, your customer will not be eligible for a rebate through MGED. The assessment can be scheduled at https://www.mged.com/MyEnergyXpert PLEASE CONFIRM THAT YOU UNDERSTAND THIS REQUIREMENT.
*
Please Select
Yes, I understand that my customer needs a home energy assessment.
No, my customer will not be able to complete the required home energy assessment.
HMLP requires that all projects complete a Town Wiring Inspection upon completion. Please confirm that you understand this requirement.
Please Select
Customer Interest
Customer's primary use for ASHPs
*
Please Select
Heating
Cooling
Both
Replacing or adding systems
*
Please Select
Replacing a heating system
Replacing a cooling system
Adding to the existing systems
Is the customer buying ASHPs to minimize use or stop using their existing heating system?
*
Please Select
Yes
No
ASHP System Size
System size
*
Est. design heating load for whole building
Total nominal heating BTUs of ASHPs being added
Total square footage of home
% of home square footage to be conditioned by ASHPs
Sizing
20,000
25,000
30,000
35,000
40,000
45,000
50,000
55,000
60,000
65,000
70,000
75,000
80,000
85,000
90,000
95,000
100,000
105,000
110,000
115,000
120,000
>120,000
7,000
9,000
12,000
15,000
18,000
24,000
30,000
36,000
42,000
48,000
54,000
60,000
66,000
72,000
78,000
84,000
90,000
96,000
102,000
108,000
114,000
120,000
>120,000
600
800
1000
1200
1400
1600
1800
2000
2300
2600
2900
3200
3600
4000
4500
5000
5500
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Copy of total nominal BTUs added
Copy of whole building design load
~% of design load covered by ASHPs
Supplemental 0-49%
Majority Replacement 50-75%
Full Replacement 76-100%
Did you complete a Manual J to estimate the heating load?
*
Please Select
Yes, block load calc
Yes, room by room load calc
No
Optional upload of Manual J report
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Home Details
Approximate year built
*
Please Select
Older than 1900
1900-1940
1941-1960
1961-1980
1981-2000
2001-2007
2008-2016
2017-2021
Existing systems
*
Heating fuel
Heating system type
DHW fuel
DHW type
Existing systems
Gas
Oil
Propane
Electricity
Wood
Hydronic boiler
Steam boiler
Furnace
Electric resistance
Wood stove
Other
Gas
Oil
Propane
Electricity
Indirect tank
Tankless coil
On-demand
Stand-alone tank
Heat pump DHW
Solar DHW
Building envelope
*
Floor R-Value
Wall R-Value
Ceiling R-Value
Air Infiltration
Average R-values
R-3
R-7
R-11
R-13
R-15
R-19
R-21
R-25
R-30
R-38
R-3
R-7
R-11
R-13
R-15
R-19
R-25
R-3
R-7
R-11
R-13
R-15
R-19
R-21
R-25
R-30
R-38
R-49
R-60
Very-tight
semi-tight
average
semi-loose
loose
Current annual heating fuel usage (therms, gallons, kWh)
*
If you don't have actual usage, you can estimate
Is fuel usage estimated?
Yes
ASHP System Design
How many systems (outdoor units) are being installed
*
Please Select
1
2
3
4
Distribution type
*
Please Select
Ductless
Ducted
Mix of ductless and ducted
Type of floor plan being conditioned by ASHPs
*
Please Select
Open floor plan with communicating rooms
Closed floor plan with isolated rooms (bedrooms, office)
Combination of an open and closed floor plan
Is the existing heating system being left operational?
*
Please Select
Yes
No
Heating Strategy
Which control strategy is being used to operate the existing system and the ASHPs? (if any)
*
Please Select
Integrated control
Existing zone shut off or disconnected
Existing system thermostat set lower than ASHP to stage equipment
Customer managed staging of equipment
No control strategy needed
What is the overall heating strategy for the existing system and ASHPs?
*
Please Select
ASHPs will be the first stage; Existing heating system will be the second stage back-up
ASHPs and the existing system will run at the same time and heat the same zone(s)
ASHPs and the existing system will run at the same time but heat different zones
At what outdoor temperature will the integrated control turn off the ASHP?
*
Please confirm all outdoor units will be mounted on stands at least 12" above the ground
*
Yes
System 1
If your system connects to more than 4 indoor units, input them in system 2. Indicate in the notes section they all belong to the same outdoor unit. You will need to select 2 outdoor units in "How many systems (outdoor units) are being installed."
Distribution type (S1)
Please Select
Ductless
Ducted
Mix of ductless and ducted
Outdoor unit (S1)
*
Manufacturer
Model number
Nominal size
# of indoor units
AHRI #
Outdoor unit
6,000
7,000
9,000
12,000
15,000
18,000
24,000
30,000
36,000
42,000
48,000
54,000
60,000
1
2
3
4
5
Ducted indoor unit model number(s) (S1)
Indoor units (S1)
Indoor unit model
Nominal size
Space/room conditioned
~Floor area of space/room
Unconditioned space above
Unconditioned space below
Indoor unit 1
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 2
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 3
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 4
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 5
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
System 2
Distribution type (S2)
Please Select
Ductless
Ducted
Mix of ductless and ducted
Outdoor unit (S2)
*
Manufacturer
Model number
Nominal size
# of indoor units
AHRI #
Outdoor unit
6,000
7,000
9,000
12,000
15,000
18,000
24,000
30,000
36,000
42,000
48,000
54,000
60,000
1
2
3
4
5
Ducted indoor unit model number(s) (S2)
Indoor units (S2)
Indoor unit model
Nominal size
Space/room conditioned
~Floor area of space/room
Unconditioned space above
Unconditioned space below
Indoor unit 1
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 2
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 3
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 4
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 5
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
System 3
Distribution type (S3)
Please Select
Ductless
Ducted
Mix of ductless and ducted
Outdoor unit (S3)
*
Manufacturer
Model number
Nominal size
# of indoor units
AHRI #
Outdoor unit
6,000
7,000
9,000
12,000
15,000
18,000
24,000
30,000
36,000
42,000
48,000
54,000
60,000
1
2
3
4
5
Ducted indoor unit model number(s) (S3)
Indoor units (S3)
Indoor unit model
Nominal size
Space/room conditioned
~Floor area of space/room
Unconditioned space above
Unconditioned space below
Indoor unit 1
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 2
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 3
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 4
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 5
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
System 4
Distribution type (S4)
Please Select
Ductless
Ducted
Mix of ductless and ducted
Outdoor unit (S4)
*
Manufacturer
Model number
Nominal size
# of indoor units
AHRI #
Outdoor unit
6,000
7,000
9,000
12,000
15,000
18,000
24,000
30,000
36,000
42,000
48,000
54,000
60,000
1
2
3
4
5
Ducted indoor unit model number(s) (S4)
Indoor units (S4)
Indoor unit model
Nominal size
Space/room conditioned
~Floor area of space/room
Unconditioned space above
Unconditioned space below
Indoor unit 1
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 2
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 3
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 4
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Indoor unit 5
6,000
7,000
9,000
12,000
15,000
18,000
20,000
24,000
30,000
36,000
42,000
48,000
entire floor
multiple rooms
bedroom
dining room
family room
living room
kitchen
office bathroom
laundry room
mudroom
sunroom
basement
50
100
150
200
250
300
350
400
500
600
800
1000
1200
1500
1800
2200
2600
3000
Please upload all spec sheets and AHRI certificates for selected outdoor equipment
*
Browse Files
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Choose a file
Specification sheets, "cut" sheets, or submittals are all acceptable provided they include power input data for the utility's engineers.
Cancel
of
Please upload all AHRI certificates for selected outdoor equipment
*
Browse Files
Drag and drop files here
Choose a file
Cancel
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Optional notes
Any specific design or sizing details that seem relevant or general feedback on the form and information requested
Ready to submit?
*
Yes
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