17652 Water Heater Plan Work Completion Form

Energy Right Program

17652

Energy Right Program

OMB: 3316-0019

Document [docx]
Download: docx | pdf


energy right® Program

Water Heater Plan Work Completion Form


OMB No. 3316-0019

Expires: MM/DD/YYYY



1.

Power Distributor:

     



2.

Work ID Number:

     

(Work ID Number is assigned by energy right Information System)


3.

Inspection Open Date:

     

(mm/dd/yyyy)


4.

Legal 911 Address of Property:



     


     


Street Address


City, State, Zip Code



5.

Structure:

Single Family

Multi-Family

Business


6.

Number of Dwellings/Businesses at this Address:

     



7.

Type System Replaced:

Electric Resistance

Fossil-Fuel

New Load

Other

     


8.

Enter Number of Water Heaters Invoiced For:


Standard Water Heaters

     




Advanced Water Heaters

     




Water Heaters for DLC Switch

     



9.

Total Storage Capacity:

     

(gallons)



For Distributor Records (Complete the following where required by distributor):

1.

Date Passed TVA Requirements:

     

(mm/dd/yyyy)


2.

Subdivision or Customer Name:

     



3.

Account (or Meter) Number:

     



4.

Total Heating Capacity:

     

(kW)


5.

Water Heater Brand 1:

     

Water Heater Brand 2:

     


6.

Retailer Name:

     



7.

Lifetime Warranty:

Yes

No



8.

Average Energy Factor Rating:

     



9.

Installed by:

     



10.

Inspector:

     



11.

Date Passed Local Standards:

     



12.

Incentive Paid:

$

     

Retained MVP:

$

     



13.

Natural Gas Available?

Yes

No



14.

Contractor Paid?

Yes

No



15.

Comments:

     


TVA 17652 [08-23-2011]

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleEnergy right® Program
AuthorEMPLOYEE OF TVA
File Modified0000-00-00
File Created2021-01-27

© 2024 OMB.report | Privacy Policy