09-0524 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00000524 -
Property Address:
54055 AVENIDA JUAREZ
APN:
774-193-015-3 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2000
Applicant-
Architect or Engineer:
ti /p
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenalty 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: C200-38 License No.: 374657
DatJS'�0( nuactor.
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construcfthe 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 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:
LQPERMIT
Owner:
ARGLEBEN DENNIS G
54055 AVENIDA JUAREZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/28/09
MAY ,9.8
Contractor: / 1
DANCY HVACR, MIKE x/41
81171 ;AREOMA COR
INDIO, CA 92201
(760)775-0750
LiC. No.: 374657
N A
WORKER'S COMPENSATION DECLARATION
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:
CarrierAMPT Policy Number EXEMPT
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
L� l 37000 of the borCode, IIsshall forthwith comply with those provisions.
9.fe-".7 pplicant:
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of ;this to enter upon the above-mentioned property for
i-nspectio rposes. -
te: J S' ature (Applicant or Agent):
Application Number . . . . . 09-00000524
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 31.50
Plan Check Fee
7.88
Issue Date . . . .
Valuation . . . .
0
Expiration Date 11/24/09
Qty Unit Charge .Per
Extension
BASE
FEE
15.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 4 TON HP CONDENSER
----------------------------------------------------------------------------
Other Fees . . . . . ... . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total 31.50
.00 .00
31.50
Plan Check Total-' 7.88
.00 .00
7.88
Other Fee Total 1.00
.00 .00
1.00
Grand Total 40.38
.00 .00
40.38
LQYERMIT
✓ O Alternative Component Package Whod: (check ore) C D D (Alternative)
* Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1 R page 3) _
For Pac&W D Alternadve see Appendbr B Table 151-0 Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ft
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 151-0 ----(209'* X CFA) ftr
✓ O BWk ing 'type: (check ow or mote) Single Family Multifamily Addition Alteration
Of adding faaesbation fill out WS -4R, Feneatralion Maximum Allowed Area Worikaheet and see Section 8 3.2
for Additions and 8.3.3 for Alterations,)
Nutnbor of Stories: Number of Dwelling Unita:
Floor Conshuction 'type: SlabAUised Floor (code one or both)
Frrnrt Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North
and circle one).
y O $aUTAN'�' B�RAIF,A r iinnri ' jg�q�g} 1�
QUM Wml &QS lrnLQA2 v OPAOi,�.,.D, 00R6
Component
Type (Wall.
Roof, Floor,
Slab Edge,
Doors)
Frain
Type
(Wood or
M
Cavity Continuous
Insulation Insulation
R -Value R -Value
Assembly U -
factor (for wood.
metal Same and
mass
assemblies '
Joint
Appendix
IV
Reference
Roof Radiant Location
Barrier Comments
Installed (attic, garage,
Yes or No MAW. etc.
- y.1� a . «a .aw. • .b, t Y - cum 1 v -, walun IS uw unis Icr Ine u-Iactor cutmon. u -tactors can not exceed
Prescriptive vahm to show equivalence to R -values.
Reaidendal Coonphame Favus April 2005
FE�NE,,.STRATION PRQD_ TS_ U FACTOQ ANDSH"
,/13 FENESTRATION MA7CIMUM ALLOWED AREA WORKSHEET WS -4R must be included for New
Conduction, Additions and Alterations.
Fit--
oame/pos.
(Front, Lett,
Rear• Right,
Skylight)W
OrieD.
talion,.
N. S, E,
Area
U•fectotz
U -factor
3ource�
SHGC
SHGC° Sources
Exterior
Shading ne-7
✓box if WS -3R is
included
(3
E3
0
0
o_
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any
direction when dte pitch is less than 1:12. See § 151(f)3C end in Section 3.2.3 of the Residential Manual
2) End values in this column are either NFRC Rated value or from Standards default Table 116A.
3) Iufmte source either from NMC or Table 116A,
4) Enter values in this column from NFRC or from Standards Default Table 116E 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 Residemial Manual and see WS -3R to calculate Exterior Shading
devices.
7) See Section 3.2.4 in the Residential Manual.
MVAC SYSTEMS
Type and
Cooling Equipment -
Type and Capacity
(A/C, heat pump, evap,
and Location I Duct or Piping f Thermostat
Minimum
Efficiency Duct Location Duct
EER or EER) I (attic, etc.) R -Val.
Thermostat
Configuration
Configuration
split or uackao
Residential Compliance Forms
April 2003
i CERTIFICATEOF COWLL4NCE: RESIDENTIAL (Paye 3 of S) CF -1R
t'rolecr Title DXe
�
Al- -5
A signed CF -4R Farm trust
� m .
to the building department for each home for which the following. are
J 0 Altmnative to Sealed Ducts and Refrigerant Charge nXVs (See Package D Alternative Package Features for
l Project Climate Zone in the RM Appendix B Table 151-0, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
sealed as confumed through field verification and diagnostic testing in s000rdance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
stall meet tate nNM4aynts of Section_ 150(m) and duct insulation requirements of Package D.
Be" Ducts all climate zones er and certification and HERS rater field verification
G
TXVs, rawly acoesdble (climate zones 2 and 8.15 only)
Tank
Cam,
kaims)
99!WLw Left and certification and HERS Rater field verification r
C3
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification
J 0 Altmnative to Sealed Ducts and Refrigerant Charge nXVs (See Package D Alternative Package Features for
l Project Climate Zone in the RM Appendix B Table 151-0, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
sealed as confumed through field verification and diagnostic testing in s000rdance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
stall meet tate nNM4aynts of Section_ 150(m) and duct insulation requirements of Package D.
Symms servintt single dwelling unit$
Water Heater
T 1 Type
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water beater per
G
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Tank
Cam,
kaims)
not allowed.
Standby'
Loss 96
Check box when using Preapproved Alternative Water Heating table, Table 5.4 in Chapter 5 in the Residential
Manual. No water h=ft calculations are re and the stow Oom lies automaticall .
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
D
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
Symms servintt single dwelling unit$
Water Heater
T 1 Type
Distribution
Number
in System
�t
(kW or
Bad)
Tank
Cam,
kaims)
EDOF
Factor or
Thermal
Efficiency
Standby'
Loss 96
Tank
External
Insulation
R -Value
system ser"ne mWtW* dwen im unids
Water Heater
Type.
Distribution
Type
Number
in System
Rated
*W or
Bidtr
Tank
City
not.
Enemy
Factor or
Thermal
Efficie
Standby
Loss/o
Tank
External
Insulation
R Valla
r) ror smarr gas storage water treaters (rated inputs of less than or equal to 75,000 Btu/br), electric resistance, and
beat pump water heatem list Energy Factor. For large gas storage water beaters (rated input of greater than 75,000
Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instant meows gas water
heaters, list Rated Input and Thermal Efficiencies.
oe In 1su 11O (kitchen lines >_ 3/4 inches) All tot water pipes from the heating source to the kitchen fixtures
that ane 3/ inobas or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2
B.
atdendal Compliance Forms April 2005
CO„ 1�V �LIANG'E $TATEMI�NT `
This certificate of compliance lists the building features and specifications needed to comply with Title
24, Parts 1 and 6 of the California Code of Regulations, sad the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. The
undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge
and TX Vs, insulation installation quality, and building envelope sealing require installer testing and
certification and field verification by an approved HERS rater.
Desimer or Owner [Der Business and Professions Cow Darnment aflan Anithar
Naaae: \
Name:
TitldPum; /
/rm: �-i✓C S/ !�`�/��
Tidefrm:
Aaa,�aa:
aean�
ea 044 •
Telephone: ? 7 S "' Q 7 g a
Telephone:
LeOe a €i: 3 7 (o
oq
(el (date)
(:agnatutc) (data)
Enforcement Agency
Residential Compllwce Forms April 2005
Bin # :-
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta,-CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 1
l�
Project Address jQ ss V
gIVTGCvfR3<2--
Owner's Name: Ay ye S 4,VC49BEIV
A. P. Number:
Address: 5p05 -is- /�r//�lA4
Legal Description:
Contractor-. f/ � i
City, ST, Zip: 44
Telephone:
Address: ���rly� ��
Project Description: Zc P.4-5— 44 TQC
City, ST, Zip: �OA 9;2Za 1
Telephone: O
State Lic. #: 3 ? 5-7 rcityc. #: 017F-5'
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: 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: Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cities.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans ticked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
_
''' 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 FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 1) CF -4R
Project Address I Algleben, Dennis I
Builder / Installer
54-055 Avenida Juarez / La Quinta / CA / 92253
Mike Dancy HVAC
Builder / Installer Contact
Telephone
Plan Number / Permit Number
Mike Dancy
7607750750
HERS Rater
Telephone
Sample Group Number
Dave Bricker - CIHIEIEIRIS® ID #CCN99380828 ..
7605419025
2
Compliance Method (Prescri 've)
Climate Zone 15
Certifying Signature
IA6 A 15
Date
4_9
Sample House Number
Firm
HERS Provider
Energy Driven Solutions Inc.
CIHIEIEIRISO
Address
City/State/Zip
P.O. Box 6705
La Quinta /CA /92248
a.upics to; DuiLiwo .x, ri>r.xn rxuviLLK Am) KUILDnG DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
This house was: V Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I cern
tested compliance requirements as checked on this form. The HER S'11r ir
correct tape is used before a CF -4R may be released on every tested buildii
and signed CF -6R has been received for the sample `indtested buildings.
The installer has provided a'copy of CF -6R (Installation Certificate
❑ New Ducts are fully ducted (i.e., does not -use b ui Iding,,ccavities as -p
�7 �
❑ New ducts with cloth backed, rubber adhesive duct tape is -installed
adhesive duct tape to seal leaks at duct co enn ctionsk fl
the house identified on this form complies with the diagnostic
ck and verify that the new distribution system is fully ducted and
EIERS rater must not release the CF -4R until a properly completed
5rm returns in lieu of ducts).
W bands -are -used in combination with cloth backed, rubber
Residential Compliance Forms Generated by CIHIEIEIRISO http://www.CHEERS.org December 2005
8_ l
l INSTALLATION CERTIFICATE—AJ� �',C�'=,r��/J MaLe 3 of 12) CF -6R
Site Address
AWAt 1T'j� �a Permit Number
eP� �� — HT t/ (-) 9 -,-' �5��
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(x).
HVAC SYSTEMS:
Heating Equlpmene
Equip Type
heat um
CEC Certified M&.
Name and Model
Number
# of
Identical
Systems
Efficiency
(AFUE, etc.)
-- F -IR value
Duct
Location
attic, etc.
Duct or
Piping
R -value
Heating
Load .
Btulhr(Btu/hr)
Heating
Capacity
aft
e-
VPoon
C'ooffng Equlpment
Equip Type
k . heat
CfiC Certified Mfr.
Name and Model
Number
fi of
Identical
Systems
Efficiency
�
(SEERor EER)
ZCF-IR value)
Duct
Location
attic etc.
Duct
R-valueBtu/hr
Cooling
Load
Cooling
Capacity
MUM
aft
e-
VPoon
1. > symbol reads greater than or equal to what is i►xiicated on the CF -IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ ®I L 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 Efflciency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Effkiency Regulations or Part 6), where applicable.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Naive) OR Owner
'M I rt/
Signature:
Date:
Copies to: BUILDING DEPARTMENT, HERS RATER (IP APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms
April 2005
I INSTALLATION CERTIFICATE (Paan 4 ®f 12) CF -6R 1
Site Address AT Permit Number
INSTALLER COMPLL4NCE STATICMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ DTested at Final ✓ ® Tested at Rough -in
IN�LER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:
e at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing
wall am properly sealed.
13 If the house rough -in duct leakage test was conducted without an air handler 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 on new ducts.
✓ Mum LEAKAGE REDUCTION
Prmodnrv_e fns firaid nariReatien and Afie®nasfir teen of air qtr hudon system are available in RACM. Annend& RC4.3
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM ® 25 Pa)
Measured
Values
I
Enter Tested Leakage Flow in CFM:
B (�
Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured
2
If Fan Flow is Calculated as 400 cf n/ton x number of tons or as 21.7 cW(Whybr) x Heating
✓ ✓
ggEity in Thousands of Btu/hr, enter total calculated or measured fan Bow in CFM here:
3
Pass if Leakage Percentage < 60/6 for Final or < 4% at Rougb-in without air handle:
❑ Pass ❑ Fail
100 x
ALTERATIONS: Duct S anent and/or HVAC Equipment Change -Oat
Enter Tested Leakage Flow in CFM from Pro -Test of Existing Duct System Prior to Duct
4
System Alteration and/or Equipment Change -Out.
ZF
Enter Tested Izakage Flow in CFM from Final Test ofNew Dud System or Altered Duct
/
5
System for Duct System Alteration and/or Equipment e -Out.
>J (O
Enter Reduction in Leakage for Altered Duct System
6Line
# 4 Minus ine # 5 — Onl ifApplicable)a
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
Entire New Duct System - Pass if Leakage Percentage < 61/6 for Final.
❑ Pam ® Fail
8
f 100 x Line # 5 / Line # 2
TEST OR VERMCATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-
✓ ✓
Out Use one of the &PEMIM four Test or Verification Standards for compliance:
Pass if Leakage Percentage < 15% [100 x [ (Line # 5) ! (Line # 2)]]
lQ
Pass ❑ Fail
9
Pass if Leakage to Outside Percentage < 10% [100 x [_ _T (Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
10
Pass if Leakage Reduction Percentage > 60% [100 x ._._(Line # 6) ! (Line # 4)11
❑ pass ❑ Fail
l l
and Verification by Smoke Test and Visual Ins on
12
Pass if Seal' of all Accessible Leaks acid Verification b Smoke Test and Visual Inspection
❑Pass ❑Fail
Pass if Orae of lanes # 9 throu h # 12 ass
Pass ❑Fail
✓ ❑1, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance
credit 1, 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.
Copies tw BUILDING DEPARTMENT, HERS RATER OW APPLICABLE) BURJXKG OWNER AT OCCUPANCY
Residential Compliance Forms December 2005
INST;LATION CERTIFICATE Page 5 of 12) CF -6R
Site Address Permit Number
✓ ® THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verykation of thermostatic expansion valves are available in RACAY Appendix R1
✓ 13 REFRIGERANT CHARGE MEASUMEMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic P-mnaminn Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Char,Ee Measurement Procedure (outdoor air dry-bulb 551 and above):
Procedures for Determining Refrigerant ChaTe using the &andord 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 Tenmeratures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Access is provided for inspection. The procedure shall
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
consist of visual verification that the TXV is installed on
OF
✓
CWes
O No the system and installation of the specific equipment
Er, 13
shall be verified.
Yes is a Ms
I Pass I Fail
✓ 13 REFRIGERANT CHARGE MEASUMEMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic P-mnaminn Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Char,Ee Measurement Procedure (outdoor air dry-bulb 551 and above):
Procedures for Determining Refrigerant ChaTe using the &andord 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 Tenmeratures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperature (Treturn, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevapomtor, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
Superheat Chame 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
0-14': .e --# -.,..o o it daom.nln dirirrno rrOA;f is fnho"
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
April 2005