07-2252 (MECH)r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00002252
Property Address:
76890 AVENIDA FERNANDO
APN:
658-240-024- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4000
Applicant:
T4'yl 4 4 Q"
Architect or Engineer:
t) ( A -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class:C)^20-C10 LicenseNo.: 286936
Date: r —01 /1,actor. &40
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
,following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the .
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
anyapplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( — 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale.If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ I I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
'CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERN11T
Owner:
RODEN ROBERT
76890 AVENIDA FERNANDO
LA QUINTA, CA 92253
Contractor:
CAVANAUGH ELECTRIC & AIR
83231 HIGHWAY 111
INDIO, CA 92201
(760)347-3608
Lic. No.: 286936
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
V
Date: 8/07/07
arl�y F ..w
F11l9 i4 � UllasB'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of.the following declarations:
I have and will maintain a certificate of consent to self -insure. for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ENDURANCE WC Policy Number WEN0014468-01
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code,
I/sshhafll forthwith comply with those provisions.
ate:cant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
,of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. '
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and count rdinances and state laws relating to building construction, and hereby authorize, representatives
of this co y t/)e�n/iter upon the above-mentioned pro/pee/r/S/ fforr in s ect oses,,
Q,44 �v r Si ture (Applicant or Agent):� `v!/�
Application Number. . . . . . 07-00002252
Permit MECHANICAL
Additional desc .
Permit Fee 51.00
Plan Check Fee
12.75
•Issue Date
Valuation . . .
.
0
Expiration Date 2/03/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 9.0000 EA MECH
FURNACE <=100K
18.00
2.00 9.0000 EA MECH
B/C <=3HP/100K BTU
18.00
-
--------------------------------------
Special Notes and Comments
------------------------
--------
-----
REPLACE 2 5 TON ROOFTOP AIR
CONDITIONING AND HEATING UNITS
Fee summary 'Charged
-- - - - - - - - - - - - - - ------ - - - - ----
Paid Credited
-- - - - - ------ _- - - ----
Due
-- - ----
Permit Fee Total 51.00
.00 .00
-
51.00
Plan Check Total .12.75
.00 .00
12.75
Grand'Total 63.75
.00 00
63.75
c
LQPERMIT
I
Bi" #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495. Calle Tampico
La Quinta, CA 92253 - (760) 777.-7012
Building Permit Application and Tracking Sheet
Permit .#
„G A-,•
o� -'/
Project Address: 76 -•.- 0 90 fi!/e . Ferhanc%
Owner's Name: B06 Roden/
A. P. Number:
Address: �6 — �9� 1/� • �E'i/')anciQ
Legal Description:
Contractor: Ca UaH2G{ rl -ZeC f r1C'
City, ST, Zip:
Telephone: ] — m
Address: S 3 =� / /-���/, / /
Project Description:
City, ST, Zip: Z nQ�/ o C� 9�aol
�e La Com.. ' 2 5- y^/ rooAk
Telephone: 76o —5qrl=3608/�
/' COyIG7G7� Dy1 c�h a�l�7
State Lic. # : a06.934
city- tic.. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
s ,� ®
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
mo
Estimated Value of Project: S 4- 660 --
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING .
PERMTT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading,plan
2nd Review, ready for corrections!issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page i of 4) CF -IR
Poh Rz)de/x1 9-3-07
Project Title Date
76 - R96 Ave, �Pry� ��G% L a Qaa;V � �
Project Address13uildin Permit #a v�yla�/ !-: �L� 'z-frl� g
Documentation Author TelephonePlan Check / Date
S
Field Check /Date
Compliance Method (Prescriptive) Climate Zone Enforcement Agency Use only
✓ O Alternative Component Package Method: (check one) C D' D (Alternative)
Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ft2 Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA)' ft
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA) g
O Building Type: (check one or more). Single Family Multifamily Addition Alteration
(If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations.)
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or.both)
Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True
North and circle one).
✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-15)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall, Frame
Roof, Floor, Type
Slab Edge, (Wood
Doors) or Metal)
Cavity
Insulation .
R -Value
Assembly U -
factor (for Joint
Continuous wood, metal Appendix
Insulation frame and mass IV
R -Value assemblies t Reference
Roof Radiani
Barrier Location/Comments
Installed (attic, garage,
Yes or No typical, etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and 1VA, which is the basis for the U -factor criterion. U -factors can not
exceed prescriptive value to show equivalence to R -values.
Residential Compliance Forms March 2005
CERTIFICATK OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -1R
Rob _RaG%,l1 9-5-07
Project Title Date
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -411 —must be included for New Construction,
Additions and Alterations:
Fenestration
#/Type/Pos.
(Front, Left, Orien-
Rear, Right, tation, Area
Skylight) NSE Wt(ft)
Exterior
Shading/Overhangs b'
U -factor SHGC ✓ box if WS -3R is
U-factor2 Source SHGC4 Sources included
Distribution
Type and Location Duct or Piping Thermostat Configuration
ducts attic etc. R -Value Type, (split or package)
c a e
❑
❑
El
El
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any direction
when the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual
2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A.
3) Indicate source either from NFRC or Table I I6A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R.
5) Indicate source either from NFRC or Table 116B.
6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices.
7) See Section 3.2.4 in the Residential Manual.
HVAC SYSTEMS
Heating Equipment
Type and Capacity
furnace heat wn • boiler etc.
Minimum
Efficiency
AFLJE or HSPF
Distribution
Type and Location Duct or Piping Thermostat Configuration
ducts attic etc. R -Value Type, (split or package)
c a e
Cooling 9quipment Minimum
Type and Capacity Efficiency Duct Location Duct Thermostat
A/C heat pump, eve . coolie SEER or EER attic etc. R -Value Type
Configuration
(split or package)
'.4i
c a e
Residential Compliance Forms March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -IR
,Qob R e- 3-6-)7
Project Title Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF4R Form must be provided to the building department for each home for which the following. are
reauired.
❑ IAlternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
1( sealed as confirmed through field verification.and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
sOaces shall rneet therequiretnents of Section 1-50(m) and duct Itisulation requirements of Package D.
WATER HEATING SYSTEMS
Rated Enemy
Input, Tank Factor or
Distribution Number (kW or Capacity Thermal
Type in System Bm/hr) (gaeons Efficiency
❑
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.)
❑
TXVs, readily accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verification required.)
0
Refrigerant Charge (climate zones 2 and 8-15 oddly) (Installer testing and certification and HERS Rater field
verification required.)
❑ IAlternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
1( sealed as confirmed through field verification.and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
sOaces shall rneet therequiretnents of Section 1-50(m) and duct Itisulation requirements of Package D.
WATER HEATING SYSTEMS
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Rated Enemy
Input, Tank Factor or
Distribution Number (kW or Capacity Thermal
Type in System Bm/hr) (gaeons Efficiency
Tank
External
Standby Insulation
Loss % R -Value
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
❑
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
not allowed.
❑
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heating calculations are required, and the system complies automatically.
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
❑
Alternative Water Heating table. In this•case, the Performance Method must be used and must be included in the
submittal.
❑
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
units
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Rated Enemy
Input, Tank Factor or
Distribution Number (kW or Capacity Thermal
Type in System Bm/hr) (gaeons Efficiency
Tank
External
Standby Insulation
Loss % R -Value
Enemy
Factor orExternal
Thermal
Efficiency
Tank
Standby'Insulation
Loss % R -Value
System serving multiple dwelling units
Water Heater Distribution
Type Type
Rated
Input'
Number (kW or
in System Btu/hr(gall
Tank
Capacity
ons
Enemy
Factor orExternal
Thermal
Efficiency
Tank
Standby'Insulation
Loss % R -Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat
pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
BhVhr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B.
Residential Compliance Forms March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -1R
Project Title Date
SPECIAL. FEATURES NOT REOMING HERS VERIFICATION (add extra sheets if necessary)
Indicate which special features are part of this project. The list below only represents special features relevant to the
nrescrintive method..
✓
Feature
Required Forms if applicable)
Description
❑
Metal Framed Walls
CF -1R
Refrigerant Charge
❑
Radiant Barriers
CF -1R
CF -6R part 6 of 12
❑
Exterior Shades
WS -4R
❑
Cool Roof
N/A; Attach CRRC Label to
Forms.
Hydronic Heating
Performance Calculation
FODedicated
System
Required; Attach Run to Forms.
Combined Hydronic System
Performance Calculation
Required; Attach Run to Forms.
Performance Calculation
❑
Gas Cooling
Required.
❑
Buried Ducts
N/A; Indicate on building plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
❑
Performance Calculation and
Dwelling Unit
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
Serving Multiple Dwellings
attach Run to Forms.
El
Non-NAECA Large Water
CF -1R
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach Run to Forms
See Table 5-13 or use
❑
Instantaneous Gas Water Heater
Performance Calculation and
attach Run to Forms
See Table 5-13 or use
❑
Solar Water Heating System
Performance Calculation and
attach Run to Forms
Performance Calculation and
❑
Wood Stove Boiler
attach Run to Forms
SPECIAL FEATURES REOURUNG HERS RATER VERIFICATION
(add extra sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need
verification.
✓
Feature
Required Forms if applicable) Description
Duct SealingCF-6R
art 4 of 12
❑
E❑
Refrigerant Charge
CF -6R art 5 of 12
❑
Thermostatic Expansion Valve
CF -6R part 6 of 12
Residential Compliance Forms March 2005
INSTALLATION CERTIFICATE
17tn - R190 AVB, --eri9arlaD / /4 .0 L-1 IWAA
Site Address
3 of 12) CF -6R
Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion'of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
i
(A'UE. etc.)
(2CF-IR value
Duct
Location
attic etc.
Duct or
Piping
R -value
Heating
Load
Btu/fv
Heating
Capacity
BwAu
C ays-«r
.4&1
Cooling Equipment
Equip Type
.(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
(SEER or EER)
2CF-1R value)
Duct
Location
attic etc.
Duct
R -value
Cooling
Load
tw?v
Cooling
Capacity
Btu/hr
C ays-«r
.4&1
1. > symbol reads greater than or equal to what is indicated on the CF -1R value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
- I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy
Eficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Signature, Date Installing Subcontractor (Co. Name)
OR General Contractor (Co. Name) OR Owner
COPY TO: Building Department
HERS Rater (if applicable)
Building Owner at Occupancy
Residential Compliance Forms March 2005
INSTALLATION CERTIFICATE
Site Address
4 of 12) CF -6R
Permit Number
INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE
Copies to: Builder, HERS Rater, Building Owner at Occupancy and Building Department
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ OTested at Final ✓ Nested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
17 Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior
finishing wall are properly sealed.
❑ If the house rough -in duct leakage test was conducted without an air handier installed, inspect the connection points
between the air handler and the supply and return plenums to verify that the connection points are properly sealed:
❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used
✓ ❑ DUCT LEAKAGE REDUCTION
Procedures /or field verificatinn and diagnostic testing of air distribution systems are available In RACM. ADDendix RC4.3
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM Qa 25 Pa) Measured
Values
I
Enter Tested Leakage Flow in CFM:
2
Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ Cl Measured
If Fan Flow is Calculated as 400 cf Vton x number of tons or as 21.7 c&n/(kBtu/hr) x Heating
Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: coo
✓ ✓
3
Pass if Leakage Percentages 6% for Final or:9 4% at Rough -in:
100 x ine # 1 / ine # 2
❑Pass Fail
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
Alteration and/or Equipment Change -Out.
43-7System
5
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
S stem for Duct System Alteration and/or Equipment Chan a -Out.
6
Enter Reduction in Leakage for Altered Duct System
f ine # 4 Minus ine # 5 —(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
8
Entire New Duct System - Pass if Leakage Percentage:5 6% for Final or:5 4% at Rough -in
f 100 x Line # S / Line # 2
❑ Pass ❑ Fail
"PEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out •
Use one of the following four Test or Verification Standards for compliance:
�/ ✓
9
Pass if Leakage Percentage:5 15% [100 x [ _,__��(Line # 5) / 0,010 (Line # 2)]]2 Z
❑ Pass ®'Fail
10
Pass if Leakage to Outside Percentage 5 10% [100 x [(Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
11
Pass if Leakage Reduction Percentage z 60% [100 x r_(Line # 6) / (Line # 4)]]
and Verification by Smoke Test and Visual Inspection
❑ pass ❑ Fail
] 2
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
O Pass ❑ Fail
Pass If One of Lines # 9 through # 12 pass
❑ Pass ail
✓ ❑ I, the undersigned, verify that the above' diagnostic test results
were performed in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly
installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in
Section 150 (m) of the 2005 Building Energy Efficiency Standards,
Si tore Date Installing Subcontractor (Co. Name) OR
Z 11"11 /MLPI L a 13 &7 General Contractor (Co. Name) 0,3V,3Y0,UCb C1 eC�rl�
Residential Compliance Forms March 2005
INSTALLATION CERTIFICATE
Site Address
(Page 5 of 12) CF -6R
Permit Number
✓ ❑ THERMOSTATIC EXPANSION VALVE (TXV)
Ptoeedures for field verifieation of thermostatic expansion valves are available in RACM,, Appendix RI.
✓ ✓
Access is provided for inspection. The procedure shall
OF
,� consist of visual verification that the TXV is installed on
✓ a Yes ❑ No the system and installation of the specific equipment
E✓ ❑
shall be verified.
OF
Yds is a pass I
Pass I Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
TFArninc'ta'fir Pvnancinii Vakli-i
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btuft
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55T and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temneratures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry=bulb temperature (Tretum, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
u erheat Charge Method Calculations for Refrigerant Charge
Actual Superheat = Tsuction, db — Tevaporator, sat OF
Target Superheat (from Table RD -2) OF
Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF
Temperature Split Method Calculations for Adequate Airflow
.Split Methnd Cnlrulatinn is not necessnry ifAdeauate Air/Inw credit is taken
Actual Temperature Split = T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
OF
Actual Temperature Split Target Temperature Split (System passes if between -
OF
3°F and +3°F or, upon remeasurement, if between -3°F and -100°F
Residential Compliance Forms March 2005
INSTALLATION CERTIFICATE
-- 990
Site Address
6 of 12) CF -6R
Permit Number
Standard Charge Measurement Summary:
System shall pass both refrigerant charge and adequate airflow calculation criteria from the same
measurements. If corrective actions were taken, both criteria must be remeasured and recalculated.
✓ ❑ Yes ❑ No I System Passes
Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55 °F)
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer
verification shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is 55 OF or above, installer
shall use the Standard Charge Measure Procedure:
Procedures for Determining Refrigerant Charge using the Alternate Method are available in RACM, Appendix RD3.
Weigh -In Charging Method for Refrigerant Charge
Actual liquid line length: ft
Manufacturer's Standard liquid line length: ft
Difference (Actual — Standard): I 1 ft
Manufacturer's correction (ounces per foot) x difference in length = ounces
(+ = add) (- = remove)
Aeasured Airflow Method for Adequate Airflow Verification available in RACM,, Appendix RD2.6
Calculated Airflow: Cooling Capacity (Btu/hr) X 0.033 (cfin/Btu-hr) = CFM
Measured Airflow is CFM (Measured airflow must be greater than the calculated airflow).
Alternate Charge Measurement Summary:
System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective
actions were taken both criteria must be remeasured and recalculated.
v'0 Yes 1 O No IS stem Passes
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Signature, Date !
COPY TO: Building Department
HERS Rater (if applicable)
Building Owner at Occupancy
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Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
Residential Compliance Forms March 2005