Ductless Heat Pump (DHP) and Ducted Mini-Split ...
Please Return This Form To:
Eugene Water & Electric Board
Customer Solutions Department
PO Box 10148 Eugene, OR 97401
ems.answers@
(541) 685-7303
Ductless Heat Pump (DHP) and Ducted Mini-Split Installation Form
All sections must be filled out by the installer at the time of installation. A copy of this completed form and the purchase receipt or
invoice must be promptly submitted to the homeowner¡¯s utility in accordance with utility policy.
NEW EQUIPMENT INFORMATION
DHP Information
The DHP installed is on the Qualified Products List
available at:
Space 1
(Note: For multihead systems, the outdoor unit must
be listed on the Qualified Products List)
Yes
No (If ¡°No¡±, project is
not eligible for incentives)
Space 2
Space 3
Yes
No (If ¡°No¡±, project is not
eligible for incentives)
Yes
No (If ¡°No¡±, project is
not eligible for incentives)
Manufacturer
Model
Serial Number
AHRI Certified Reference Number
HSPF Rating
Outdoor unit heating capacity (Btuh at 47¡ãF)
Select what you are Installing
(Select One)
Single Indoor Head DHP
Single Ducted Mini-Split (not whole
home centrally ducted)
Eligible Building Types (Select One)
Eligible Existing Heating
System Being Replaced
(Select One)
Existing Single Family Existing
Manufactured
Electric Forced Air
New Single Family (in all states except WA)
Electric Zonal
New Manufactured
Gas or Oil
1
Small Commercial Bldg < 20,000 sq.ft.
Multi Indoor Head DHPs
Multiple Indoor Ducted Mini-Splits
(not whole home centrally ducted)
Combination DHP/Ducted Mini-Split
Existing Single Family
Small Commercial Bldg ( ................
................
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