Custom water efficiency incentive application 
	
                 
            												
                    
			Looking for ways to save water and money at your business, restaurant, commercial, or multi-family property? The Portland Water Bureau has a custom water efficiency rebate program that will pay for half of your approved water efficiency project costs up to a maximum of $5,000. 
Applying for the rebate is easy but you'll need a few things before you start:  
Make sure you have discussed your project with Portland water efficiency staff and received approval. Your City of Portland sewer, stormwater, water account details. Equipment upgrade details or outline of process improvement. Project budget details including estimated water savings. Copies of receipts for equipment purchased and proof of recycling for equipment that was replaced.  A copy of your most recent bill would be helpful, let us know if you need one.  
If you get stuck, get in touch:  503-823-4527 or conserve@portlandoregon.gov
There are known accessibility issues with this fillable web form. Several of the issues impact screen reader users, such as form error messages not being detectable to screen readers. We are actively working with the software developer GovOS to resolve these issues. If you need assistance completing this form, please contact us by phone or email at 503-823-4527 (Oregon Relay Service 711) or conserve@portlandoregon.gov . 
The City of Portland is committed to providing meaningful access. To request translation, interpretation, modifications, accommodations, or other auxiliary aids or services, contact 503-823-4527, Relay: 711. 
Traducción e Interpretación  |  Biên Dịch và Thông Dịch  |  口笔译服务  |  अनुवादन तथा व्याख्या  |  Устный и письменный перевод  |  Turjumaad iyo Fasiraad  |  Письмовий і усний переклад  |  Traducere și interpretariat  |  Chiaku me Awewen Kapas  |  Translation and Interpretation: 503-823-4527  |  portland.gov/water/access  
 
 
            												
                    
			
About your business 
	
                
            												
                    City of Portland sewer, stormwater, water account number  
			
            												
                    Name of organization or business entity  
			
            												
                    Customer type  
			Choose One Not-for-profit Small business (< 20 employees) Restaurant School Multi-family Church Other (describe below) 
            												
                    Customer type - Other  
			
            												
                    Describe your business or operation. Include the type of service or product provided, number of employees, and hours of operation.  
			
	
                
            												
            												
                    E-mail  
			
            												
                    Phone Number  
			
            												
                    Property (project) address 
					
		
                 
            												
            												
                    
			
About your project 
	
                
            												
                    Describe the project details. Include the model numbers of equipment you plan to replace, as well as model numbers of the new equipment you've chosen. If you don't have model numbers, please explain why.  
			
	
                
            												
                    Estimate when you'll complete your project.  
			
            												
                    Calculate the estimated annual water savings in Ccf (1 Ccf = 100 cubic feet, which equals 748 gallons) Please enter numbers only, no letters!  
			
            												
                    
			
Expenses - project equipment, materials, and supplies 
	
                
            												
                    
			Please list in the entry below any equipment, materials, labor, and supplies needed to complete the project.  Include equipment model numbers when applicable. You only need to make entries for items applicable to your project. If you have project related expense entries beyond what is available in the form, please email conserve@portlandoregon.gov  with the additional details. 
You will enter professional services (outside of labor) in the next section. This is where you will enter items like permits and recycling fees.
Please also include total cost of all equipment, materials, and supplies. 
 
            												
                    List of equipment, materials, labor, and supplies  
			
	
                
            												
                    Total cost of all equipment, materials and supplies  
			
            												
                    
			
Expenses - professional services 
	
                
            												
                    Description of professional services (outside of labor) including all permits and recycling fees.  
			
	
                
            												
                    Total cost of all professional services  
			
            												
                    
			
Summary - total project costs 
	
                
            												
            												
                    
			
Savings and Payback 
	
                
            												
            												
            												
                    Enter your Extra-Strength Sewer Charge rate which is in dollars per Ccf. Please do not add any letters or symbols such as “$” or “Ccf”. You can use a period that is part of the rate (ex: 5.33). The ESSC rate was provided to you by staff during project pre-approval.  
			
            												
            												
            												
            												
                    
			While using the upload tool below to attach your receipts, please remember to push the blue 'Upload' button after you have selected or drag and dropped your receipt files into the 'Selected Files' list. 
The document upload feature may not work well for some assistive technologies.
If you can’t upload documents directly into this form, you may also email them to conserve@portlandoregon.gov . Call 503-823-4527 for help.
 
            												
                    Please upload scan or photo files of any applicable equipment purchase and recycling receipts 
			
	
                 
            												
                    
			
Rebate agreement 
	
                
            												
                    
			
We, the Portland Water Bureau may deny any application that does not meet the commercial rebate program’s eligibility and project requirements. 
We reserve the right to alter or cease this program at any time. 
We are not responsible for the quality of the equipment purchased and we do not warranty any part of the project, including equipment, and the installation of said equipment. 
We do not guarantee lower water bills because of participation in the commercial rebate program. 
We are not responsible for any damage that may occur to the applicant’s property as a result of removing the old equipment or installing the new equipment under this program. 
The undersigned agrees to hold harmless the City of Portland and the Portland Water Bureau from and against all loss, damage, expense, and liability resulting from or otherwise relating to the purchase, installation, use, or removal of equipment. 
  
            												
                    Signature of property owner or owner's representative.