Public Buildings Enhanced Energy Efficiency Program

PBEEEP Project Application: State Of Minnesota Buildings

Introduction & Overview

The PBEEEP Project Application following this introduction is for the State Of Minnesota Public Buildings Enhanced Energy Efficiency Program (PBEEEP). To be eligible for the Program, the building and the Owner's (building owner/manager) project commitment must meet these minimum requirements:

• Owner makes a good faith commitment to implement measures through the Program for measures that pay back in three (3) years or less, subject to available financing.
• Owner is willing to commit 40-60 hours of senior building operations staff time to support the project. Necessary support will include providing building and equipment documentation, access to control systems, and access to portions of the building relevant to the Retrocommissioning/Recommissioning (RCx) and/or Retrofit process.
• Owner is willing to sign a release of energy bills for the last 12-24 months and through the program duration and to grant the chosen provider permission to update the Minnesota Benchmarking & Beyond (B3) database.
• Preferred candidate buildings will have at least 50,000 square feet of conditioned space; if the application is for a building having <50,000 square feet, the project will be considered for a separate small building screening process.

If the building meets these four program application requirements, building owners may apply for the Program by submitting the PBEEEP Project Application below.

Shortly after the application is submitted, the applicant will receive a confirmation email. Attached will be the first of the following documents, if not otherwise provided with the application, and the second of the following documents, if appropriate for the application submitted:

1. Utility Data Authorization Release Form
2. Department Of Administration/RECS Project Initiation Form (PIF), for those projects managed by RECS. (.doc, 185 kB)

To complete the application, the applicant must then:

1. Fax back the Utility Data Authorization Release Form, as described in the faxing instructions below, and
2. Reply to the confirmation email, attaching, if applicable, the Department Of Administration/RECS Project Initiation Form (PIF)

Application submission is strongly preferred via the PBEEEP Project Application below. The application may also be downloaded, completed, and submitted by one of the following methods:

PBEEEP Project Application

= Required Information

1. General Information

Agency Name:	Representative:	Representative Phone:
Administration Corrections Employment and Economic Development Historical Society Human Services Military Affairs Minnesota State Academies Minnesota State Colleges & Universities Natural Resources Perpich Center for the Arts Education Transportation University of Minnesota Veterans Affairs
Department/Division/Campus:		Representative Email:

Mailing Address:	City:	County:	ZIP:
		AitkinAnokaBeckerBeltramiBentonBig StoneBlue EarthBrownCarltonCarverCassChippewaChisagoClayClearwaterCookCottonwoodCrow WingDakotaDodgeDouglasFaribaultFillmoreFreebornGoodhueGrantHennepinHoustonHubbardIsantiItascaJacksonKanabecKandiyohiKittsonKoochichingLac Qui ParleLakeLake of the WoodsLe SueurLincolnLyonMahnomenMarshallMartinMcLeodMeekerMille LacsMorrisonMowerMurrayNicolletNoblesNormanOlmstedOtter TailPenningtonPinePipestonePolkPopeRamseyRed LakeRedwoodRenvilleRiceRockRoseauScottSherburneSibleyStearnsSteeleStevensSt. LouisSwiftToddTraverseWabashaWadenaWasecaWashingtonWatonwanWilkinWinonaWrightYellow Medicine

Site Access Restrictions and/or Special Considerations:

Does this site have any special requirements, such as access restrictions that the Provider should be aware of (i.e. Prison facility requiring guard escort while on-site)? Please describe:

Primary Provider:

Does the Agency site have an available Provider (contractor) that the Agency would like to have included in the RFP process for the Screening work? Yes - Please complete the information below for the Provider. No The Program will attempt to, as possible, accommodate the request. Please provide the contact information and a brief description of the Provider's background and experience at the site:

Name:	Email:	Phone:

Address:	City:	State:	ZIP:
		AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC DS TN TX UT VT VA WA WV WI WY

Background Description

Project Management
Are your agency's projects managed by RECS?
Yes -

Please do not complete Section 2; you will instead need to fill out the PIF form, which will be attached to your confirmation email after this application is submitted. Go to Section 3 to continue.

No - Please complete Section 2 to the extent applicable.

2. Other Funding Sources & Amounts

Screening and Investigation project phases will be initially funded through Department Of Administration technical assistance and federal stimulus funding using Providers from the State's Master List of Energy Engineering Firms. You may supplement this funding through other individual Agency funding sources. If your Agency has other funding sources that will be applied to the project, please list these.
	FY (YYYY or YYYY-YYYY)	Fund or Account	Agency or Financial Institution	Org	Appr	Amount ($)
1
2
3
4
5
6
7
8
9
10
Total estimated amount to be applied to project ($):

3. Agency's Internal Application

Does your Agency have an internal application that will also be used to track this project?
Yes -	Please provide your agency's assigned project number. PBEEEP will reference this number on project documents, as applicable, for convenience in tracing to your Agency's internal documentation processes. If a project number is not assigned at this time, please note that in the space below by writing "Not Yet Assigned." PBEEEP can retrieve this information once it has been established. Agency Project Number (APN):
No -	Continue the application with the next section.

Building Specific Information
Sites comprised of a single building can apply to PBEEEP by completing all sections of the application and then clicking the Submit & Quit button at the end. An Application Submission Summary will then be shown on the resulting page.

Sites comprised of multiple buildings can submit all buildings for consideration to PBEEEP under one application. To do so, complete all sections of the application for the first building and then click the Submit & Continue button at the end. For each additional building, return to this point in the form and complete sections 4-8 for that building. Submit each building except the last in the same way as the first. Submit the final building by clicking the Submit & Quit button. An Application Submission Summary will then be shown on the resulting page. Do not reload this page during this process.

4. Identification & Owner Contact Information

Building Name:	Building ID:

Building Address:	City:	ZIP:

Building Owner/Representative Name:	Title:

Email:	Phone:	Fax:

Primary Contact (if different):	Title:

Email:	Phone:	Fax:

5. Energy Usage

	Electricity	Natural Gas
Utility Provider
Estimated Annual Usage (last 12 months)	kWh	therms
Estimated Annual Cost (last 12 months)	$	$
Peak Summer Demand	kW
Number of Meters (total)
Is there on-site generation?
Yes - Please describe source at right. No
Has utility data for building/site been entered into a benchmarking application?
Yes - Please identify below. B3 Database Portfolio Manager (PM) Database No

6. Building Overview

Primary Use(s) (check all that apply):
Office	Public Service (Police, Fire, Community Center)
School/College	Correctional
Medical	Other - Please identify at right.

Gross Size (sq ft)	Occupancy (%)	Year Constructed	Total Annual Operation (hr)

7. HVAC System Overview

Primary Source for Cooling
Electric Gas Other - Please describe at right.
Cooling Equipment:
Chilled Water Plant Packaged Equipment Water Loop Heat Pump Other - Please describe at right.
Primary Source for Heating:
Electric Gas Other - Please describe at right.
Heating Equipment:
Hot Water Boiler Steam Boiler Packaged Equipment Other - Please describe at right.

8. Control System Overview

Indicate Type of Controls and Equipment Controlled:
Direct Digital Central Plan Zone Terminal Equipment Other - Please describe at right.
Pneumatic Central Plan Zone Terminal Equipment Other - Please describe at right.
Other Central Plan Zone Terminal Equipment Other - Please describe at right.
Are changes to the HVAC or control system currently funded or underway?
Yes - Please explain, indicating timeline No

9. PBEEEP Awareness

How did you hear about the PBEEEP? Where possible, please detail responses:
PBEEEP Event Utility Email	Other Event Web Article	Organization Contractor/Professional CEE

Applicant Confirmation

Please confirm that this PBEEEP Project Application is not being submitted by an automated program by solving this simple challenge. Doing so also helps digitize old books, newspapers, and other texts. Type the distorted words, separated by a space, into the input field. If the words displayed are indecipherable, either guess or click the refresh icon to the right of the input field to display new words. The words entered are verified when this application is submitted. Incorrect answers will not cause any loss of data from this application.

Computers have proven ineffective in solving this simple challenge, so if the answers are correct, it confirms with a great deal of accuracy that a person completed the application. This technique originated at Carnegie Mellon University.

Building Owner Certification
By submitting this application, I certify as the building owner or the owner's authorized representative that the information contained within this application is true and factual to the best of my knowledge. I also certify that I am interested in receiving a building screening to determine if this building qualifies for the Program's services.

Please print a copy of this application for your records and click one of the "Submit Application" buttons below.

Multiple-Building Applications

Submit, or append additional buildings to, the current application, and then continue defining additional buildings for this application.

If this is the initial submission of this application, please be sure that all non-building specific sections (1-3, and 9) are accurately completed. Since only building-specific information is needed when submitting additional buildings to an application, the sections noted can not be modified after the initial submission.

To conclude the application and view an Application Submission Summary, submit the last building to this application using the Submit Application & Quit button to the right.

Note that each building is saved when submitted. If the last building to an application has already been submitted, it is okay to simply close the browser. An Application Submission Summary will, of course, not be shown in that case.

Single-Building Applications & Summary

Submit, or append the final building to, the current application, and then quit. Additional buildings can not be added to this application after selecting this option. An Application Submission Summary will be shown on the next page.

Updated 2011-12-15 Thu 07:02