State of New Mexico - Energy, Minerals and Natural ...
|State of New Mexico - Energy, Minerals and Natural Resources Department | |
|1220 S. St. Francis Dr., Santa Fe, NM 87505 (505) 476-3310 |Project No. |
|Geothermal Ground-Coupled Heat Pump System Certification Application (FORM 1) | |
|Geothermal Ground-Coupled Heat Pump Tax Credit - 3.3.32 and 3.4.19 New Mexico Administrative Code (NMAC) |For department use only |
| |Form version date: 9/15/10 |
|Taxpayer Information * indicates required information |
|* Name | |* Social | |
| | |Security Number | |
| | |or Corporate Number |(Will be kept confidential) |
|* Mailing | |
|Address (Address, City, Zip | |
|Code) | |
|* Telephone | |Email | |
|Contractor Information |
|* Name | |* License | |
| | |No. | |
|* Mailing | |* License | |
|Address | |Classification | |
|* Telephone | |Email | |
| Geothermal Ground-Coupled Heat Pump System (System) Information |
|* Project Location | |* County | |
|* Residential System | |* Commercial System | |
|(please check one) | |(please check one) | |
|* System | |* System |$ |
|Description | |Cost | |
|Applicant Agreement |
|The applicant named above and signing this statement agrees that all information provided in this application package is true and correct to the best of the|
|applicant’s knowledge. The applicant has read the certification requirements of 3.3.32 or 3.4.19 NMAC. The applicant understands that there are annual |
|aggregate state tax credit limits in place for these systems and that the department must certify the system documented in this application package before |
|the applicant is eligible for a state tax credit. Furthermore, the applicant agrees to: |
|make any changes the department requires to the system for compliance with 3.3.32 or 3.4.19 NMAC; |
|operate the system for a minimum of five years after department certification or, if the residential, business, or agricultural enterprise where the system |
|is located is sold or transferred to another party within five years after the department’s certification of the system, the sale or transfer agreement |
|shall require the system’s continued operation or maintenance for energy production for no less than the balance of the five-year period remaining; |
|provide for the system’s regular maintenance for a minimum of five years with the applicant’s own resources or through a contractor; and |
|allow the division or its authorized representative to inspect the system that is described in the application package, from the application package’s |
|submittal to three years after the department has certified the system, upon the division providing a minimum of five days notice to the applicant. |
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|* Taxpayer Signature |* Date |
|System |Optional: taxpayer may indicate interest in the following no-cost monitoring options for the system, if these options are |
|Monitoring |made available, to assist with evaluation of state-wide tax credit benefits (select all that apply): |
|Options |add energy monitoring equipment to the system |
| |analysis of system performance and operation |
| |analysis of taxpayer utility bill records. |
|Checklist - System Certification Application |
| |
|Please review the following list to make sure you have provided all attachments required in the application package. For assistance on system certification|
|requirements, see the Geothermal Ground-Coupled Heat Pump Tax Credit rules, 3.3.32 and 3.4.19 NMAC, and other information available through the website at |
|, or contact the Energy, Minerals and Natural Resources Department (EMNRD) at (505) 476-3310. |
|Geothermal Ground-Coupled Heat Pump Systems |
|3.3.32 and 3.4.19 NMAC - Required attachments |
| |Copy of a current property tax bill to the taxpayer for the residence, business, or agricultural enterprise where the system is located. |
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| |Copy of invoice(s) of itemized equipment and labor costs for the system. |
| |Copy of the system’s design schematic and technical specifications. |
| |Photographic record of the system after installation is completed. |
| |Documentation of the manufacturer’s listed coefficient of performance and efficiency ratio for the ground-coupled heat pump unit(s) |
| |Copies of Manufacturer or supplier of system components and their model numbers |
| |Contractor or Installer documentation of IGSHPA ‘Accredited Installer Workshop’ Certification |
| |Documentation of the total geothermal ground-coupled heat pump system size |
| |Completed Geothermal Ground-Coupled Heat Pump System Installation Form |
| |Taxpayer and Contractor Statement of Understanding (3rd page of Geothermal Ground-Coupled Heat Pump System Installation Form) |
| |Copy of the written final inspection approval from the building code authority or, if inspection approval cannot be obtained, the applicant shall |
| |provide the necessary information on the system installation form in place of obtaining the inspection approval. |
|Help - Application Package Submittal |
|General Information |
|Submit the application package to EMNRD after the system is completely installed and operating. |
|Copies are adequate for any documents submitted to EMNRD in the application package. |
|Use the “Geothermal Ground-Coupled Heat Pump System Certification Application” form as the first page of the application package. |
|Taxpayers are encouraged to submit application packages in a timely manner. |
|Mail applications to the attention of “ECMD Geothermal Ground-Coupled Heat Pump Tax Credit Administrator” or email to EMNRD as directed at |
| . ECMD is EMNRD Energy Conservation and Management Division. |
|Taxpayer Information |
|Provide contact information so that EMNRD may communicate with you about your application. The email address is not required but, if available, would |
|expedite communication. |
|The Social Security Number is required and is important in EMNRD’s reporting to the New Mexico Taxation and Revenue Department on taxpayer eligibility for the|
|tax credit. It will be filed as confidential information. |
|Contractor Information |
|Provide contact information so that EMNRD may communicate with the contractor, if needed. The Email address is not required but, if available, would expedite|
|communication. |
|The contractor license number and classification is required so that EMNRD may verify licensing of the contractor. |
|If the system is homeowner installed, select the box and leave the contractor information blank. |
|Geothermal Ground-Coupled Heat Pump System Information |
|Provide the location of the system by either the address, which could be the same as the taxpayer mailing address, or a brief description of the physical |
|location if an address is not available, to enable EMNRD to locate the system for inspection purposes. Also provide the county where the system is located. |
|Please indicate whether the tax credit application is for a residential or commercial system. |
|Provide a brief description of the system, such as describing the open or closed system, vertical or horizontal application, or lake or pond applications. |
|Provide the system’s complete net installation cost, including equipment, materials and labor, excluding the items listed in 3.3.32.13 NMAC, which should |
|agree with the total amount shown on an attached invoice that itemizes components and labor charges of the installed system. |
|Applicant Agreement |
|Sign and date the application form, which includes taxpayer agreement regarding truthfulness of the information provided, knowledge of the 3.3.32 or 3.4.19 |
|NMAC rules governing system certification, annual aggregate tax credit limits, system maintenance, and EMNRD inspection of the system. |
|Attachments |
|Property Tax Bill: provide a current property tax bill to prove that the taxpayer owning the system also owns the home, facility, or land where the system is |
|located. |
|Invoice: provide a contractor’s invoice (or homeowner-generated invoice for homeowner-installed systems) to document the complete cost of the installed |
|system. See 3.3.32.13 NMAC, for costs that are not allowed. |
|Taxpayer and Contractor Statement of Understanding: provide Taxpayer and Contractor Statement of Understanding signed by the contractor and the owner of the |
|system. If the system is installed by the homeowner, the statement does not need to be included. |
|Design: provide a schematic of the system installation, including specifications, component model numbers, and other information specific to its type, as |
|required. Additional attachments may be included if information cannot be shown entirely on the schematic. |
|Photographs: provide up to four photographs that show the system’s: 1) general site location and 2) above ground system components. |
|System Installation Form: provide a copy of this form completed with signatures from the contractor (if contractor installed) and the building code authority.|
|Use Alternative System Installation Approval only if building code authority approval cannot be obtained. Taxpayer may provide signatures on two separate |
|identical forms. |
|Final Inspection Approval: provide copy of building code authority’s written approval document for code compliance. |
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