PON 1050 Incentive Application Form Attachment C
I
NCENTIVE APPLICATION FORM
Name of Eligible Installer:________________________________________ NYSERDA Installer Number: ________________Name of Company: ____________________________________________Owner Name: _________________________________________________ Owner Phone Number: _______________________Installation Address: ______________________________________________________________________________________City: ______________________________________ State: ______________ Zip: _______________________Mailing Address (if different from Installation address): _____________________________________________________________________________________ City: _________________________________ State: ________________ Zip:____________Owner Email: _________________________________________ Utility Service Territory: ______________________________Expected Date of Installation ____________________________ Expected Date of Interconnection: _____________________Please attach proof of payment by customer into Renewable Portfolio Standard (as shown on utility bill or letter from utility)Building or Customer type Check all that apply:
___New Construction ___Existing Home –––Commercial ___Single Family Res. ___2-4 FamilyResidential ___Mutifamily ___Agricultural ___Industrial ___Educational ___Not-for-Profit ___Municipality/Government ___Other________________
Required System Documentation - Each Incentive Application must include as attachments: site map, shading analysis, three-lineelectrical drawing, and utility bill.
PV Panel Manufacturer: Model: Number of Panels:PV Panel Manufacturer: Model: Number of Panels:Inverter Manufacturer: Model: Number of Inverters:Inverter Manufacturer: Model: Number of Inverters:
Inverter Efficiency: __________________ Orientation:_____________________ Tilt: _______________________Total System Production kW (DC at STC): _______________________ Total System Production AC: __________________Customer’s Annual Electric usage (kWh): _________________Expected Annual kWh Produced by system: __________Annual Electrical Offset Associated with the PV System:_______ %(Must not be greater than 110%)Total Cost Before Incentive: ________________ Incentive Total: _________________Incentive Calculation: __________________________________________________________Estimated Annual losses from shading: ___________ kWh: ______________%Estimated Annual losses from orientation, tilt, etc: ____________ kWh ___________ %
Estimated Annual losses from shading & orientation: _______________ kWh ______________ %
Does total square footage of PV array exceed 4,000 square feet: ___Yes ___No ______________square ft.If Batteries are Part of this System, What is their Capacity: ______________________________________
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