WOOD STOVE CHANGE-OUT APPLICATION FORM APPLICANT

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MONTEREY BAY UNIFIED
AIR POLLUTION CONTROL DISTRICT
2014-2015
WOOD STOVE CHANGE-OUT PROGRAM
Due to budgetary constraints, this year’s program is ONLY available to San Lorenzo Valley
(SLV) home owners, which includes the communities of Ben Lomond, Boulder Creek,
Brookdale, Felton, Mt. Hermon, Lompico and Zayante. The Monterey Bay Unified Air
Pollution Control District (MBUAPCD) will be sponsoring financial incentives for SLV home
owners to change-out their wood burning fireplace or older uncertified wood stove to a
cleaner alternative. Eligible alternatives include change-outs to stoves and fireplace inserts
operated by gas, propane, pellets or electric power.
The purpose of the Woodstove Change-Out Program (WSCOP) is to reduce emissions of
residential wood smoke. The MBUAPCD is focusing on SLV because this area experiences
frequent exceedances of the federal air quality standard for fine particulate matter.
Wintertime residential wood smoke is especially problematic in SLV because of frequent
winter inversions coupled with an abundance of residents who burn wood to heat their
homes.
See the WSCOP guidelines or contact MBUAPCD staff for more information about the
program. Call 831-647-9411 for questions regarding the process.
WOOD STOVE CHANGE-OUT
PROGRAM GUIDELINES
As part of the MBUAPCD’s continuing effort to protect public health by reducing wood
smoke pollution, the WSCOP is being offered to SLV residents in Santa Cruz County. The
discounts range from $1,000 up $2,500. Additional low income incentives will be
evaluated on a case by case basis.
In areas such as the SLV, the build-up of wintertime wood smoke can exceed federal health
based air quality standards. Wood smoke contains gases, toxics, and particulate matter
which can cause health effects including eye, nose, and throat irritation and respiratory
disease. Older stoves and fireplaces are major contributors since they produce more wood
smoke and consume more wood than high efficiency alternatives currently available.
If you would like to participate, please carefully read the WSCOP Eligibility and Program
Requirements and fill out the WSCOP Application Form. An Authorized Participating
Hearth Product Dealer (APHPD) will arrange to have your eligible change-out replacement
installed and will scrap the old wood stove or fireplace box at a recycling facility. A list of
APHPDs can be found on the MBUAPCD’s webpage.
Additional information is available at www.montereybaycleanair.org.
The Mission of the Monterey Bay Unified
Air Pollution Control District is to Protect
Public Health and the Environment
while balancing Economic and
Air Quality Considerations
VOUCHER DISCOUNTS
The voucher discounts are for the device and its installation. A portion of the discount will go towards
the Authorized Participating Hearth Products Dealer (APHPD) stove purchase and the remaining portion
will go to the participating installer.
Once your application is received, MBUAPCD staff will review the MBUAPCD Woodstove Change-Out
Application Form and verify the installation address to determine eligibility and discount. The applicable
discount will be applied to a Voucher of Pre-Qualification and mailed to you.
The APHPD will arrange a pre-installation visit with a certified installer. The certified installer will provide
MBUPACD with photo documentation to verify the old wood stove or fireplace for final eligibility to the
Woodstove Change-Out Program.
$1,000* Discount for property owners in the SLV changing out to a gas, propane, electric or pellet stove
or insert. Zip Codes: 95005 (Ben Lomond), 95006 (Boulder Creek), 95007 (Brookdale), 95018
(Felton/Lompico), and 95041 (Mt. Hermon).
$1,500* Additional discount for income qualified property owners in the SLV.
Subject to confirmation by Central Coast Energy Services (CCES).
* The combined $2,500 discount may not cover the full cost of the change-out, depending on the specifics of the project.
LOW INCOME ELIGIBILITY AND VERIFICATION
MBUAPCD provides income qualified applicants an additional discount to assist with their change-outs.
Income is verified through Central Coast Energy Services (CCES) Low Income Home Energy Assistance
Program (LIHEAP). All LIHEAP applications must be mailed to CCES. CCES will notify MBUAPCD if
applicant is eligible for additional discount.
Income guidelines are provided as a courtesy and may change at any time, please use the tables provided
by CCES on the LIHEAP Application.
Persons in Household
1
2
3
4
5
6
Maximum Monthly Incomes
$2,019
$2,641
$3,262
$3,883
$4,505
$5,126
Request an application by:
a. Calling CCES at 1-888-728-3637 or
b. Downloading application from
http://www.energyservices.org/apps/2013HEAPAppwithInst_Eng.pdf or
www.montereybaycleanair.org
WOOD STOVE CHANGE-OUT
ELIGIBILITY AND PROGRAM REQUIREMENTS
1.
This offer is only available to San Lorenzo Valley property owners in Santa Cruz County to changeout their wood burning fireplace or older uncertified wood stove to a cleaner alternative.
All addresses will be verified to determine eligibility and discount.
2.
The property owner must submit the Woodstove Change-Out Voucher Application Form.
Renters or property managers should coordinate change-outs with the property owner.
3.
The woodstove or open fireplace that will be changed-out must still be installed in the residence.
No discounts are available for change-outs which have been completed or purchased prior to the
Woodstove Change-Out Program start date. Existing EPA-certified wood stoves or inserts that are at
least 10 years old are eligible for discounts.
4.
Discounts will be distributed to applicants on a first come first serve basis who comply with all
MBUAPCD Eligibility and Program Requirements. Discounts will end when allocated funds are
depleted. The program is limited to one discount per household.
5.
Eligible alternatives include change-outs to stoves and fireplace inserts operated by gas, propane,
pellets or electric power.
6.
Fill out the MBUAPCD Woodstove Change-Out Voucher Application Form completely and return to
MBUAPCD. Once your application is received MBUAPCD staff will review the application form and
verify the installation address to determine eligibility and discount. The applicable discount will be
applied to a Pre-Qualification Voucher and mailed to you.
7.
The Pre-Qualification Voucher is only valid for 30 days. Provide the assigned Pre-Qualification
Voucher at an Authorized Participating Hearth Products Dealer (APHPD). The APHPD list is available
on the MBUAPCD’s webpage.
8.
All new devices must be installed by MBUAPCD participating installer. The APHPD will arrange a preinstallation site visit with an installer. The certified installer will provide the MBUAPCD with photo
documentation to verify the old wood stove or fireplace for final eligibility to the Woodstove
Change-Out Program. If eligible, the installer will take pictures of current woodstove/fireplace and
pictures once the new device is installed.
9.
The installer will properly dispose of the old woodstove or fireplace box. They will provide the
MBUAPCD with a Certificate of Disposal.
10.
All authorized change-outs must be completed by April 1, 2015.
WOOD STOVE CHANGE-OUT
APPLICATION FORM
APPLICANT INFORMATION: (Please Print)
Applicant (Property Owner) Name:
Phone:
Mailing Address City, Zip Code: (Where Change-Out will take place)
Cell Phone:
Mailing Address, City, Zip Code (If different than Change-Out address):
Email: ☐ Check if you would like to be added to the SLV events e-mail list
APPLICANT ACKNOWLEDGEMENT STATEMENT AND SIGNATURE:
1. Read the following Acknowledgement Statement, Sign, Print Name and Date. Property owner
must sign in the box below.
APPLICANT ACKNOWLEDGEMENT STATEMENT
I agree to hold harmless the Monterey Bay Unified Air Pollution Control District (MBUAPCD) and its
directors, employees, and agents from any and all loss, damage, or liability that arises out of or is in any
way connected with installation or use of the device purchased in connection with the MBUAPCD
2014-2015 Woodstove Change-Out Program.
I further pledge to operate the device according to the manufacturer’s instructions and to not burn
pressure treated wood, trash, plastic or any other materials specified in the device instruction manual.
Acceptance of this offer allows the APHPD or MBUAPCD staff to inspect the home during normal business
hours to verify compliance with the MBUAPCD Eligibility and Program Requirements.
I acknowledge that any false information on the Woodstove Change-Out Voucher Application Form will
forfeit the Change-Out.
My signature below acknowledges that I have read, understand, and agree to the Wood Stove ChangeOut Eligibility and Program Requirements.
Applicant’s Signature:
Date:
INFORMATION ON
EXISTING WOODSTOVE OR FIREPLACE
Existing EPA-certified wood stoves or inserts that are at least 10 years old are eligible for discounts.
1. Select type of wood burning device you currently have and would like to Change-Out.
2. Answer questions pertaining to device as best as possible.
☐ Woodstove
Approx. how old is your wood stove:
Is this your only source of installed heat? ☐Yes ☐No
Installed heat means a heat source permanently attached to your
home’s structure such as a furnace or baseboard heater.
Make:
Model:
☐ Fireplace
What type of fireplace do you have?
☐ Masonry ☐ Manufactured Metal Firebox
Is this your only source of installed heat? ☐Yes ☐No
Installed heat means a heat source permanently attached to your
home’s structure such as a furnace or baseboard heater.
Approximately how many cords of wood do you burn per year?
Approximately how much do you spend annually on wood?
INFORMATION ON
PROPOSED NEW STOVE OR INSERT
☐ I will be applying to the CCES LIHEAP program to verify my eligibility for the income
qualified discount.
Select the device that will replace your current woodstove or fireplace.
☐ Natural Gas Stove or Fireplace Insert
☐ Propane Stove or Fireplace Insert
☐ Pellet Stove or Fireplace Insert
☐ Electric Stove or Fireplace Insert
RETURN COMPLETED APPLICATION TO:
Monterey Bay Unified Air Pollution Control District
24580 Silver Cloud Court, Monterey, California 93940
OR
Fax to (831) 647-8501
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