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07-1697 (SFD)r. . T4hf 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 07-00001697 Owner: Property Address: 53435 FREMONT WY IRVING AZOFF APN: 767-200-998-90 -330762- 620 N. ALMONT.DRIVE Application description: DWELLING - -'SINGLE FAMILY DETACHED LOS ANGELES, CA 90069 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1351640 Contractor: Applicant: Architect or Engineer: BRADSHAW, MARK 46248 ROUDEL LN LA QUINTA, CA 92253 (760)347-4246 Lic. No.: 848057 LICENSE ONTRACTO R'S DECLARATION I hereby affirm under penalty of.perjury that 1 am ensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and rofessionals Code, and my License is in full force and effect. License Class: B License No.: 848057 Date: / 17Contractor: 'OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjur that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Busin ss 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).: (_) 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 construct the project (Sec. 7044, Business and Professions Code: The Cc th viuis'. Slate License Law dues not apply to an uwner 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 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 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 ISec. 3097, Civ. C.1. Lender's Name: _ Lender's Address: LQPERMIT WORKER'S COMPENSAI 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 performanceofthe work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner soZbme ecome subject to the workers' compensation laws of California, and agree that, if I shoulsubject to the workers' compensation provisions of Section 3700 of the Labor Codeforthwith those provisions. Date: 7 Applicant: WARNING: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,000). IN ADDITI N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/14/07 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrlctlons 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 1 have read this application and state that the above i ormation is correct. 1 agree to comply with all city and county ordinances and state laws relating to building co truction, and hereby authorize representatives of this county to enter upon the above-mentioned property for ' s/pection purposes. Date:6'�i Signature (Applicant or Age ntl: Application Number 07-00001697 _ ------ Structure Information 15',517SF DWELLING/V-NR/RES-3/CLASS A -FR ----- Other struct info . . . . . CODE EDITION 2001/2005 # BEDROOMS 7.00 FIRE SPRINKLERS NO GARAGE SQ FTG 2863.00 PATIO SQ FTG 2407.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 10081.00 ---------------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE 5660.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 4243..50 Plan Check Fee .. 2758.28 Issue Date . . . . Valuation . . . . 1351640 Expiration Date 5/12/08 Qty Unit Charge Per Extension BASE FEE 3539.50 352.00 2.0000 ---------------------------------------------------------------------------- THOU BLDG 1,000,001 - UP 704.00 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 634.84 Plan Check Fee 158.71 Issue Date . . . . Valuation 0 Expiration Date 5/12/08 Qty, Unit Charge Per Extension BASE FEE 15.00 15517.00 ..0350 ELEC NEW RES - 1 OR 2 FAMILY 543.10 3087.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 61.74 1.00 15.0000 ------------------------------------------------------------------------------ EA ELEC TEMPORARY POWER POLE 15.00 Permit GRADING PERMIT Additional desc ... Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/12/08 Qty Unit Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit . . . MECHANICAL Additional desc . LQPERMIT Application Number. . . . Permit . . . . . .. MECHANICAL Permit Fee . . . . 434.00 Issue Date . . . . Expiration Date . . 5/12/08 07-00001697 Plan Check Fee . . 108.50 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 9.0000 EA MECH FURNACE <=100K 108.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4..50' 2.00 9.0000 EA MECH B/C-<=3HP/100K BTU 18.00 10.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 165.00 18.00 6.5000 EA MECH VENT FAN 117.00 1.00 6.5000 EA ---------------------------------------------------------------------------- MECH EXHAUST HOOD 6.50 Permit . . . PLUMBING Additional desc. Permit Fee . . . . 468.00 Plan Check Fee 117.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/12/08 Qty Unit Charge Per Extension BASE FEE 15.00 54.00 6.0000 EA PLB FIXTURE 324.00 1.00 15.0000, EA PLB BUILDING SEWER 15.00 .9.00 6.0000 EA PLB ROOF DRAIN 54.00 2.00 7.5000 EA PLB WATER HEATER/VENT '15.00 1.00 3.0000 EA _ PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 24.00 .7500 EA PLB GAS PIPE >=5. 18.00 1.00 15.000.0 EA PLB GAS METER 15.00 -----------------------------------------------------=---------------------- Special Notes and Comments 15,517SF DWELLING/V=NR/CLASS A -FR. 224SF POOL BATH/1,408SF TOTAL GARAGE/1,455SF BASEMENT/2,407SF COVERED OR TERRANCES. .2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY. THIS PERMIT DOES NOT _INCLUDE BLOCKWALLS, POOL AND SPA, OR DRIVEWAY APPROACH. November 14, 2007 8:48:09 AM AORTEGA ---------=------------------------------------------------------------------ Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 2879.10 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY'REVIEW FEE 275.83 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE 30.00 LQPERMIT Application Number . . . . . 07-00001697 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . DIF LIBRARIES - RES 355.00 DIF,PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 135.16 DIF STREET MAINT FAC -RES 67.00 DIF.TRANSPORTATION - RES 1930.00 Fee summary ----------------- Charged ---------- Paid Credited -------------------- ---------- Due Permit Fee Total 5795.34 .00 .00 5795.34 Plan Check Total 3142.49 1250:00 .00 1892.49 Other Fee Total 7795.09 .00 .00 7795.09 Grand Total 16732.92 1250.00 .00 15482.92 LQPERMIT Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVELONEAMOUNT: LEVELTWOAMOUNT: MITIGATION AMOUNT: COMM/IND. AMOUNT: DATE: RECEIPT: CHECK #: INMALS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: ruing Azoff(Madison Club) Date: 11/13/07 Owner's Name: Irving Azoff Phone No. ( Project Address: 53435 Fremont Way, La Quinta, CA 92253 Project Description: Single Family Dwelling APN: 767-710-002 & 767-710-003 Tract #: Lot #'s: Type of Development: Residential XX Commercial Total Square Feet of Building Area: 15,324 sq. Ft. Industrial Certification of Applicant/Owners: The person signing certifies that t above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sipf on behalf of the owner/developer. Dated: ' 11/13/07 Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR THEOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Number of Sq.Ft. 15,324 sq. ft. Amount per Sq.Ft. $ 3.48 Amount Collected $ 53,327.52 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Support Services Certificate issued by: Leticia C. Torres, Facilities Analyst Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. L"r:c/mvdocs/devfees/certificate of compliance form tablesTO USE.doc 1/16/03 T JOB ADDRESS: 53-435 Fremont Way PERMIT: OWNERS: Irving & Shelli Azoff BUILDER: Bradshaw Construction Contractor State Contractor's License Workers Compensation Carrier LQ Business License Trade/Classification Company Name Class Lic. # Exp. Date Carrier Name Policy # Exp. Date License# Exp. Date Earthwork (C-12) Maco Equipment Rental, Inc. A 799087 9/30/2007 State Fund 461620507 4/1/2008 6732 2/29/2008 Concrete (C-8) Ajster Cement C-8 478301 8/31/2009 State Fund 046-0009928 1/1/2008 3356 4/30/2008 Framing (C-5) Anderson Development B 560720 3/31/2009 State Fund 0015439-2007 5/1/2008 2974 3/31/2008 Structural Steel (C-51) White Steel C-51, C-23 477294 8/31/2008 Redwood Fire & Casualty Ins. W6734339 7/22/2008 263 5/31/2008 Masonry(C-29) RAS Masonry C-29 678140 6/30/2008 State Fund 0008738-2007 1/1/2008 5347 9/30/2008 Plumbing (C-36) SSW Mechanical Con., Inc. C-36 736942 6/30/2009 Sea Bright Insurance BB1070845 3/31/2008 5098 3/31/2008 Lath/Plaster (C-35) Mike Keefe Drywall, Inc. C-9 B 610288 9/30/2008 State Fund 461760807 1/1/2008 2747 3/31/2008 Drywall (C-9) Mike Keefe Drywall, Inc. C-9 B 610288 9/30/2008 State Fund 461760807 1/1/2008 2747 3/31/2008 HVAC (C-20) Breeze Air Conditioning, Inc. C-20 416394 1/31/2008 Insurance Co. of the West WSD155761810 7/1/2008 843 4/30/2008 Electrical (C-10) Murdica Electric C10 464972 10/31/2008 Preferred Employers Ins. Co. WKN1200954 1/1/2008 5578 10/31 Roofing (C-39) Emerald Roofing, Inc. 770940 11/7/2007 State Fund 639-000108 11/7/2007 5978 6/30/2008 Sheet Metal (C-43) Valley.Wide Sheet Metal C-43 561154 3/31/2009 State Fund 046015678-06 10/25/2007 45 6/30/2008 Flooring (C-15) Carrillo's Tile C54 791332 2/28/2009 State Fund 1863372 1/1/2008 6833 8/31/2008 Glazing (C-17) Crescent Glass C-17 682150 12/31/2007 State Fund 1652911 11/1/2007 338 6/30/2008 Insulation (C-2) Paragon Schmid C-2 221517 9/30/2007 Travelers Property Casualty TC21UB122D025806 6/30/2008 1819 3/31/2008 Sewage Disposal (C-42) Burrtec Enviroment - Painting (C-33) Pat's Painting C-33 810059 6/30/2008 Lincoln General Ins. Co. CWC00029400 8/1/2008 4120 8/31/2008 Ceramic Tile (C-54) Carrillo's Tile C54 791332 2/28/2009 State Fund 1863372 1/1/2008 6833 8/31/2008 Cabinets (C-6) Sunvalley Cabinets C-6 855372 3/31/2009 First Comp Endurance WEN0012240-03 1/0/08 4712 2/29/2008 Fencing (C-13) RAS Masonry C-29 678140 6/30/2008 State Fund 0008738-2007 1/1/2008 5347 9/30/2008 Landscaping (C-27) Maco Equipment Rental, Inc. A 799087 9/30/2007 State Fund 461620507 4/1/2008 6732 2/29/2008 Pool(C-53) Western Pools B C-53 348768 1 12/31/2007 State Fund 1270996 2/1/2008 1151 5/31/2008 MERCADO ASSOCIATES STRUCTURAL ENGINEERS STRUCTURAL OBSERVATION REPORT FORM Date: 11 -Dec -07 Page No. 1 Of 1 FLOOR Project Address: ' 53435 Fremont Way, La`. Quinta, CA 92253 Structural Observer of Record: Lizandro Mercado Structural Observation Performed by: Joseph Posada Professional License: C 52303 Observed Structural Elements and Their Connections FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTIO N OBSERVATION LOCATION ❑Footing, Stem Walls ❑ Concrete ❑ Steel Moment Frame ❑ Concrete ❑ Mat Foundation ❑ Masonry ❑ Steel Braced Frame ❑ Steel Deck 5 Q (— . ww; t BQ 41, C%e ❑ Caisson, Piles, Grade Beams ❑ Wood ❑ Concrete Moment Frame ❑ Wood N -o plas o ew a pN ❑ Retaining Foundation Hillside Special Anchors ❑ Others ❑ Masonry Wall Frame ❑ Others Others g2 ❑ Others ° S 00 re 1`1 r c q NOTED DEFICIENCIES `J psi f� �O9?,OFESS/% �(a0 Pi1F9 FZ � o � a -' No. S4331 O o Exp. 6/30/09 k s � �gUCTO gTFOF CA1. 0 Date: Stamp of Structural Observer 24881 San Fernando Road, Suite 203 Santa Clarita, CA 91321 661 753-9295 Fax 661 753-9298 04 vevi+'--a oo C v► owes o ve kook S o a ( .40W a is wav s' N'sl�dLP J�-t o Inooks C4 walt Aawei.5 JMVJ a vd ✓�Saio 6--QS-@&%S4 (✓S JO Oe'v% 144 5 Q (— . ww; t BQ 41, C%e ai- sill. At N -o plas o ew a pN w.e o . ✓pow. 1 to �+$ �O9?,OFESS/% �(a0 Pi1F9 FZ � o � a -' No. S4331 O o Exp. 6/30/09 k s � �gUCTO gTFOF CA1. 0 Date: Stamp of Structural Observer 24881 San Fernando Road, Suite 203 Santa Clarita, CA 91321 661 753-9295 Fax 661 753-9298 .,F FIDELITY NAnONALTTTLECOMPANY SUBDIVISION DFPARTMEW 'WHEN RECORDED MAIL TO: Connie Concetto The Madison Club 80-349 Via Mirasol La Quinia, CA 92253 MAIL TAX STATEMENT TO: SAME AS ABOVE q10 COr�S �Qt4Cw�� DOCUMENT TRANSFER TAX $ —0—"This is a conveyance of an easement Computed on the consideration or value of property conveyed; OR 1�onsideration and value is less than $100.00, R & T 11911." DOC #2006-0077398 02/01/2006 08:00A Fee:13.00 Page 1 of 3 Recorded in Official Records County of Riverside Larry W. Ward Assessr, County Clerk & Recorder 111111111111111111111111111111111111111111111111111111 M S _ U PAGE I SIZE DA PCOR NOCOR SMF wsG A R L COPT LONG ( REFUND NLNG ExAM Computed on the consideration or value less liens or encumbrances th tim f al and a** 13 LIC] remarrung at e Signature of Declarant or Agent der g tax — Firm Name QUITCLAIM DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, EAST OF MADISON, LLC, a Delaware limited liability company ("Grantor"), hereby remises, releases and quitclaims the right to create future easements, created on the recordation of Tract Map 33076-2 (the "Map") recorded on November 29, 2005, in Book 393, P g 61 to 80;� inclusive, of Maps, in the Office -of -the -Riverside County Recorder, to Irving Azoff, Trustee of The Azoff Family Trust of,1997 ("rantees'), with respect to the real property located in the City of La Quints, County of Riverside, State of California, described as: See Legal Description attached hereto and incorporated herein as Exhibit "A". SUBJECT TO all matters of record including, without limitation, the easements created by the recordation of the Map. Provided, that the foregoing shall have no impact with respect to easements created or of record prior to the recordation of this quitclaim deed. Dated: I7' Z EAST OF MADISON, LLC, a Delaware limited liability company By: 120 Acre Partners, LLC, a Delaware limited liability company Its: Managing Member By: Discovery La Quinta Investors C, a Delaware limit ability mp y its Authorized resent e BY J L. Arenson Its: Authorized Representative RIVERSIDE,CA Document: QD 2006.77398 Page 1 of 3 Printed on 9/13/2007 10:30:54 AM Provided by Data Trace System STATE OF California ) ss. COUNTY OF Riverside ) �� On 2005, before me, the a notary public i0k— personally appeared Joseph L. Arenson, authorized representative of Discovery La Quinta Investors, Ltd., (whose identity was proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS MY HAND AND OFFICIAL SEAL. ^ / [SEAL] lgnature CONNIE CVmo COMM. # 1417229 NOTARY PUBUC - CAUFORNIA RIVERSIDE COUNTY MY Canmissan Was MW 11.2007 RIVERSIDE,CA Document: QD 2006.77398 Page 2 of 3 Printed on 9/13/2007 10:30:55 AM Provided by Data Trace System t EXHIBIT "A" Legal Description Lot 90 (the "Lot") of Tract No. 33076-2 as shown on Subdivision Map (the "Map") recorded on November 29 2005, in Book 393,x, Pages 6 81 0o 0ii cl� usive; of Maps, in the Office of the Riverside County Recorder. RIVERSIDE,CA Document: QD 2006.77398 Page 3 of 3 Printed on 9/13/2007 10:30:55 AM Provided by Data Trace System WHEN RECORDED MAIL TO. The Azoff Family Trust of 1997 1100 Glendon Ave., Ste. 2000 Los Angeles, CA 90024 ' DOCUMENT TRANSFER TAX $0 Computed on the consideration or value of property conveyed; OR DOC # 2007-0315420 05/11/2007 08:00A Fee:16.00 Page 1 of 4 Recorded in Official Records county -or Riverside Larry U. Uard Assessor, County Clerk 8 Recorder I 11111i 11111111111111111111111111111111111111 S R I U PAGE SIZE I DA MISC I LONG RFD I COPY 1 M A L 465 426 PCO NCOR SMF NCHG EXAM DO Computed on the consideration or value less liens or encumbrances remaining at the time of sale. /L. .0 j�o ✓l �iddw'u 4; e`- t�� II T 049 Signature of Declarant or Agent determining tax - Firm Name GRANT DEED FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Irving Azoff, Trustee of THE AZOFF FAMILY TRUST OF 1997, ("Grantor."), hereby GRANT(S) to Irving Azoff, Trustee of THE AZOFF FAMILY TRUST OF 1997, ("Grantee"), the real property located in the City. of La Quinta, County of Riverside, State of California, described as: Lot 89 and Lot 90, Tract 33076-2, The Madison Club, in the City of La Quinta, County of Riverside, State of California as shown by map on file in Book 393, Pages 61 to 80 of maps. THIS GRANT DEED REFLECTS PARCEL MERGER NO. v�7_ 4.W , AS APPROVED BY THE CITY OF LA QUINTA. Dated: 0 THE AZOFF FAMLY TRUST OF 1997 By: a(�A Irving Azoff, rus STATE OF CALIFORNIA ) CS COUNTY OF R+VE-ftS+DE LDS A^9 C40 ) � A A On &') l 5, x001 , before me, l�rl A, • Ni tIgl l , a notary public in and for said State, personally appeared Irving Azoff, to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS MY HAND AND OFFICIAL SEAL. �Z�► / /Ii APPROVED BY MMMUN11TY DFOALOP.btE1`'T DEPART%1j, 7ERESA A. NIC14011 BY DATE 3 �L L l a Commtsslon N 1479394 EXHIBIT D •el . •s Notary Pubtic - Calliomlo Los Angeles County CASE NO. P—( f' 07 - y 7g W Comm. Exphes Mar 29.2008 „ � 1 Recording Requested By and When Recorded Return to: EXHIBIT CERTIFICATE OF PARCEL MERGER NO. �2- 1-72 Existing Parcels Record Owners Assessor Parcel Numbers Irving Azoff, Trustee of the Azoff Family Trust of 1997 767-710-002 Irving Azoff, Trustee of the Azoff Family Trust of 100 767-710-003 Legal Description of Merged Parcel LOTS 89 AND 90 OF TRACT NO. 33076-2, CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN ON A MAP FILED IN BOOK 393, ,PAGES 61 THROUGH THROUGH - —JOF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. APRRNID BY COMMUNITY DIIELOP,MEU C.r.PAR,VZN; PREPARED BY ME OR UNDER MY DIRECTION:Z No. 7842 * Exp. 12/31/08 2 � o 7 s�9r DEAN J. SOULDIN, P..S. 7842 DATE F OF Cp,L�FO EXP. 12-31-08 EXHIBIT B . CERTIFICATE OF PARCEL MERGER N0. APPROVED BY COMMUNITY DNE ELONAE�ff CEPARTi► cAli BYlLL D.iTE T .- EXHIBIT LOT P CASE NO. PW a-1- q73 PER TR 33076-1 M.B. 3881157-70 GOLF COURSE LOT 89 33,522 SOFT. 0.770 ACRES 53-401 FREMONT WAY BOTH LOTS ARE VACANT AND THE STREET IMPROVEMENTS THAT FRONT THE LOTS HAVE NOT BEEN CONSTRUCTED LOT 90 / 34587 SOFT. 0.748 ACRES 53-435 FREMONT WAY LOT 01 LOT Q LOT 02 PER TR 3307'6-1 M.B. 388/87-70 GOLF COURSE Record Owner Irving Azoff, Trustee of the Azoff Family Trust of 1997 Address 53-401 and 53-435 Fremont Way, La Quinta, CA 92253 Map Prepared By RCE Consultants, Inc. Address 7595 Irvine Center Drive, Suite 130, Irvine, CA 92618 Scale 1' = 80' Assessor's Parcel Nos. 767-710-002 and 767-710-003 SCALE: f' 0 80' Recording Requested By and When Recorded Return to: IEXHIBIT B I CERTIFICATE OF PARCEL MERGER N0. aCxD . 7.'1,s -- ORIGINAL LOT LINE TO BE REMOVED (XXXX) INDICATES ,RECORD DATA PER, T �� TRACT NO. 33076-2 M.B. 393/6 80) INDICATES A 12' WIDE LANDSCAPE U AND DRAINAGE EASEMENT PER TRACT NO. 33076-2 M.B. 393/680 LOT P PER TR 33076-1 jv1.B, 38S/l;7-70 ►� I "I LOT 89 33,522 SQ.FT. 0.770 ACRES , 53-401 FREMONT WAY TRACT No. 3 45� QINDICATES A 22' MADE P.U.E., ELECTRICAL. 2 AND INGRESS/EGRESS EASEMENT PER TRACT NO. 33076-2. M.B. 393/61-80 QINDICATES A 40' WIDE INGRESS/EGRESS 3 AND LANDSCAPE EASEMENT PER INST. NO. 2006-0077396 O.R. QINDICATES A 40' WIDE INGRESS/EGRESS 4 AND LANDSCAPE EASEMENT PER INST. NO. 2006-0077400 O.R. 141 �V 0 0.` 33076-2 WI I I � 1 �^ 11 LOT QLOT 01 PER TR 3So 0-1 I: 38816 0 SCALE: 1' = 80' CURVE TABLE LOT '90 DELTA RADIUS LENGTH 32.587 SO.FT. 253'01'42" 42.00' 185.48' 0.748 ACRES 60'34'30" 42.00' 44.40' 53-435 FREMONT WAY 57'44'23" o. \17.02') 56`18'08' "42.00' rtiA M.H. SDS/B1-80 42.00' 57.48' 4 LOT QLOT 01 PER TR 3So 0-1 I: 38816 0 SCALE: 1' = 80' DEPARTMENT USE ONLY Record Owner Irving Azoff, Trustee of the'Azoff Family Trust of 1997 This Certificate of Parcel Merger No. is Address 53-401 and 53-435 Fremont Way, La Quints, CA 92253 hereby approved. Map Prepared By RCE Consultants, Inc. By Address 7595 Irvine Center Drive, Suite 130, Irvine, CA 92618 Title Area/District Date — r r CURVE TABLE DELTA RADIUS LENGTH 253'01'42" 42.00' 185.48' RVE 60'34'30" 42.00' 44.40' 57'44'23" 42.00' 42.33' 56`18'08' "42.00' 41. 7' (C-5)-_78'24'41' 42.00' 57.48' DEPARTMENT USE ONLY Record Owner Irving Azoff, Trustee of the'Azoff Family Trust of 1997 This Certificate of Parcel Merger No. is Address 53-401 and 53-435 Fremont Way, La Quints, CA 92253 hereby approved. Map Prepared By RCE Consultants, Inc. By Address 7595 Irvine Center Drive, Suite 130, Irvine, CA 92618 Title Area/District Date — r r Re Edit Ypeoi Zoom soots AmotaWrt Amk,' f—Im —41 kwa-VmLom Oq *9,6 to l", USE. 5j5 -4,5S 441' A5 lig go 02 so 101 1 },' 102 s "0 so im --A 10 107 r 108 104 "n 4p a0w as 04 bS as SS4 so ,,e,k AV' ? ,IW6011t 131114 ills 1� Ito lie fok-?h / lie 128 Vj I LIP In m aw a. CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 11/17/2006 Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works. Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed below are complete. Incomplete. applications or applications which cannot be processed will be returned to applicant. Date: 10 -VI -071 Developer. 13(2,AMV4A J .Cbtys- JUAC-Aots Tract No.: 31&or7 - 2. Tract. Name: tMA6aSpM C.i.LAS Lot No. (s): gq 4 qQ Address(s); S3 -43S' F'RErtia,rC' W15►•t The following are the requirements for Public Works Clearance to authorize issuance of a building permit from the Building & Safety Department: ❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4 AND #5 BELOW ❖ TRACT HOMES:. PROVIDE ITEMS #1, #2, #3, #4 (AS APPLICABLE) AND #6 BELOW COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1 #2 #3 AND #5 BELOW WALLS: PROVIDE ITEMS #7 -BELOW SIGNS: PROVIDE ITEMS #8 BELOW 1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad (maximum allowable deviation of .+/- 0.1 foot). Pad Elevation Certificates must be current (within 6 months -of current date). If a precise grading plan creates the pad for approval, please. withhold green sheet submittal until a Pad Elevation Certificate can be provided. 2. Attach geotechnical certification of grading plan compliance. Attach recorded final map showing proposedbuilding locations are legal lots. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan & agreement or provide alternative, & valid City approved PM10 plan set reference number or hard copy plan. PM 10 ,plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans &-are subject to additional requirements. �. Attach an approved precise. grading plan for the building location(s). AO flood zone developments will require an approved flood plain development plan. 6. Attach an approved rough grading plan for the building location(s). 7. Attach wall plan & related approved grading plan. 8. Attach sign layout/plan & related precise grading/landscape plan. - I have reviewed and confirmed the requirements listed .above as presented and find the improvements to be sufficiently com tete for construction of the posed buildings/structures/walls/signs on the subject lot(s). Pursuant o my in , s a ove proV c may be released for building permit issuance. Recommended by: Dated: 11 77 Public Works Distribution: ( reen Sheet to Building & Safety counter no {� ��LS� V E© (_) Green Sheet to Community Development H Declined for.approval for reason(s) as follow(s), please correct and resubmit OCT 2 9 2007 City of La Quinta - PM 10 Project Information (< 1 acre per Lot or Infill Project) Page 1 of 3 Form updated & effective 8/25/2005 Project Information Project Contractor: Project Phase 'g9ABS14A�„ S Ct*y kLC—�ot,� Project Phase (Check One): Project Name: A77- A LS (,Construction Project Tract Number: 33Q -(o- 2„ ❑ Demolition Lot Number(s): (9c)Anticipated Start Date: «-� o, Project Street Address: Anticipated Completion: t t - t - ug 53-W 3S ��Eiv►o�►T Total acres in active construction (< 1 acre per Lot): L[o . I o9 scn� Project Contact Please Note: Dust control is required, 24 hours a day, 7 days a week, Information . regardless of construction status. Person listed below is responsible for dust control during business and non- business hours. Name: A94f- -UADS4L&, 3 Title: Company Name: T&R,AOSMW Ct rAS--ri�oA Mailing Address: LM._z,IAg LAS City: State: �► Zip Code: 2253 Primary Telephone Number: 7 Lo_ -&%4-1-4L4(,, -Fax: "1c.o 04R-1 24 Hour Access/Emergency -7G0 1:1S--(Pgn) , Phone: Cell Phone: -7 PM 10 Certificate Number: ❖ Expanded PM10 plans for commercial and residential developments > 1 acre are required by the City of La Quinta. a .p PM ti 0 (< 1 acre per Lot or' Infill Project) Fugitive Dust Control Plan Paae 2 of 3 Plan updated & effective 8/25/2005 This plan shall take into account applicable SCAQMD Rule 403 regulations. Training may be obtained by contacting SCAQMD (Sharon Zamora - Phone: (909) 396-2183). This plan shall consist of the following action items: WATERING: Continuous watering is required to prevent dust and must occur a minimum of.4 times daily. Water shall be applied to dry soils to stop: • Visible dust emissions over 20% opacity • Visible dust emissions that travel over 100 feet. • Water'source 3/4 nch water meter at front (south) side of pad. ❖ EDUCATION: Responsible Dust Control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM 10 certificate number prior to construction activity. ❖ WEATHER MONITORING: Wind predictions shall be monitored. SIGNAGE: Use Coachella Valley Fugitive Dust Control Plan Handbook Construction Site Signage Guidelines. s• . TRAFFIC: Construction traffic shall not be allowed on the pad, unless absolutely necessary. If vehicles operate on pad, pad shall be kept firm and moist through hose watering or sprinklers. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. (15 mph maximum traffic speed). PARKING: Parking is not allowed on the pad. All vehicles must park on street (at designated areas only). TRACK OUT: Provide 24 hour street cleaning and track out system as approved -by City Public Works Inspector. (No dirt on public or private roads). 'Track out shall be cleaned up within one hour of incident. ❖ , DIRT PILES: Dirt piles shall be limited to 50 cubic yards and built per California Building Code grading requirements. Piles shall be kept moist.or covered with tarp material. Larger dirt. piles will require stockpile.or grading permit. ❖ FENCING: Provide PM 10 fencing at perimeter of public roads and where applicable. Wood slat fencing can be installed at rear .of. property .and return 20 feet on either side if HOA restrictions apply. Block walls can replace.PM10 fencing during the construction phase. ❖ EQUIPMENT: Extra hoses and sprinklers shall be maintained on site: EXCAVATION MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall be applied during excavation or grading operations also. ❖ DUMP TRUCKS: Open top dump trucks to be wet down, moist and tarped prior to leaving site INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required. 4 r 1 -5 City of La Quinta - Site Specific Construction Phase PM 10 Agreement Page 3 of 3 Agreement updated & effective 8/25/2005 The signature of the property owner (or authorized representative): ❖ Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to AQMD Rules 4Q3 and 403.1; ❖ Shall constitute and agreement to comply with all project conditions as identified in the approved dust control plan; The property owner (or authorized representative): ❖ Acknowledges that dust control is .required 24 hours a day,.7 days a week, throughout the period of project performance, regardless of project size or status; ❖ Shall ensure that each and every contractor/subcontractor and all other persons associated with the project shall be in continuous compliance with all requirements of the approved dust control plan; ❖ Shall take all necessary precautions to minimize dust, even if additional measures beyond, those listed in the dust control plan are necessary; Shall authorize representative of the.City/County to enter upon the above mentioned property for inspection and/or abatement purposes; and ❖ Shall hold harmless the City/County and its representatives from liability for any actions related to this dust control plan or any City/County initiated abatement activities. Signg6re of Property Owner or Authorized Representative Printed Name (=. k-1 -0'1 Title Date �3RA-Ds�� C.o �SrR�o� Company Sladden Engineering 77-725 Enfield Lane, Suite 100, Palm Desert, CA 92211 (760) 772-893 Fax (760) 772-3895 6782 Stanton Avc., Suite A, Buc au Park, CA 90621(714) 523-0952 Fax (714) 52371369 450 Egan Avcnuc, Beaumont, CA 92223 (951) 845-7743 Fax (951) 845-8863 15438 Cholamc Road, Suite A, Victoiville, CA 92392 (760)962.1868 Fax (760) %2-1878 May 2, 2007 Waldos Design 620 Almont Drive Los Angeles, California 90069 Subject: Geotechnical Update Project: Madison Club Lots 89-B, 90-B and 34A NEC Avenue 54 and Madison Street La Quinta, California Project No. 544-06696 06-09-951 CITY OF LAQUINTA BUILDING.& SAFETY DEPT, APPROVE® FOLOZ�_ TRUCTION DAT 1BY Ref:Grading Report prepared by Sladden Engineering dated March 2, 2006, Project No. 522-4810, Report No. 06-02-120. Geotechnical investigation Report prepared by Sladden Engineering dated January 28, 2005, Project No. 544-4810, Report No. 05-01-101. As requested, we have reviewed the referenced geotechnical reports as they relate to the design and construction of the proposed single family residences. The Madison Club development is located on the northeast corner of Avenue 54 and Madison Street in the City of La Quinta,. California. The referenced geotechnical reports include recommendations for:the design and construction of residential building foundations. Based upon our review of the referenced reports and our recent site observations, it is our opinion that the recommendations included in the above referenced reports remain applicable for the proposed residential development. ft,.Footings should extend at least .12 inches beneath lowest adjacent grade. Isolated square or, rectangular footings should be at least two feet square and continuous footings should be at least / 12 inches wide. Continuous footings may be designed using an allowable bearing value of 1500' pounds per square foot (psf) and. isolated pad footings may be designed using an allowable bearing pressure d�ps� Allowable increases of 250 psf for each additional 1 foot of width and 250 psf for eadt a'a ditional 6 inches -of -depth may be utilized if desired. The maximum allowable bearing pressure should be 2�b00,psf.�The allowable bearing pressures are applicable to dead and frequently applied live loads. The allowable bearing pressures may be increased by 1/3 to resist wind and seismic loading. JUN 1 2 2007 D 4 . /i\ ev, May 2, 2007 .-2- Project No. 544-06696 06-09-951 The recommendations made in the preceding paragraph are based on the assumption that all footings will be supported by properly compacted soil. Prior to the placement of the reinforcing steel and concrete, we recommend that the footing excavations be inspected in order to verify that they extend, into the firm compacted soil and arc frele of loose and disturbed materials. Settlements may result from the anticipated foundation loads. These estimated ultimate settlements are calculated to be a maximum of 1 inch when using the recommended bearing values. As a practical matter, differential settlements between footings can be assumed as one- half of the total settlement. These elastic settlements are.expected to occur during construction.. Resistance to lateral loads may be provided by a combination of friction acting at the base of the slabs or foundations and passive earth pressure along the sides of the foundations. A coefficient Of ,friction of between soil and concrete may be used for dead load forces only. A passive earth .pressure of 50 pounds per square foot; per foot of depth, may be used along the sides of footings which are poured against properly compacted native or approved import soil. Retaining walls may be required to accomplish the proposed construction. Cantilever retaining walls may be designed using-Iactive" pressures. Active pressures maybe estimated using an, equivalent fluid weight f 35 pcf, for native backfill soil with level free -draining backfill conditions. For walls that are remained, "at rest" pressures should be'utilized in design. At rest pressures maybe estimated using an equivalent fluid weight of555 pef. Walls should be provided with adequate drainage. The site was previously graded during the rough grading of the Madison Club project site. The rough grading included overexcavation of the native surface soil along with the placement of engineered fill material to construct the building pads. Because the lot has been previously graded, the remedial grading required at this time for the proposed residence should be minimal. The building areas should be cleared of surface vegetation, scarified and moisture conditioned prior to precise grading. The exposed surface should be compacted so that a minimum of 90 percent relative compaction is attained prior to fill placement. Any fill material should be placed in thin lifts at near optimum moisture content and compacted to at least 90 percent relative compaction. It should be noted that the site is located within a seismically active area of Southern California and it is likely that the proposed structures will experience strong ground shaking as a result of an earthquake event along one of the faults in the region during the expected life of the development. As a minimum; structures should be designed based upon Seismic.Zone 4 design criteria included in the Uniform Building Code (UBC). The potential for liquefaction or other geologic/seismic hazards occurring at the site is considered to be negligible. Sladden EnSineerirtg May 2, 2007 -3- Project No. 544-06696 06-09-951 We appreciate the opportunity to provide service to you on this project, if you have any questions regarding this letter or the referenced reports please contact the undersigned: Respectfully submitted, SLADDEN ENGINE ING QP��1=� Slpy • V. ANUF 4Z G� t Brett L. Ane No. C 05389 m Principal Engineer ; Exp. 9-30-2008 �� CIVIL SER/pct7FCA�� Copies: 4/Waldos Design > Sladden',Engineering May 2, 2007 -4 Project No. 544-06696 06-09-951 2001 CALIFORNIA BUILDING CODE SEISMIC DESIGN INFORMATION . The California Code of Regulations, Title 24 (2001 California Building Code) and 1997 Uniform Building Code, Chapter 16 of this code, contain substantial revisions and additions to earthquake engineering design criteria. Concepts contained in the code that will be relevant to construction of the proposed structures are summarized below. Ground shaking is expected to be the primary hazard most likely to affect the site, based upon proximity to significant faults capable of generating large earthquakes. Major fault zones considered to be most likely to create strong ground shaking at the site are listed below. Fault Zone Approximate Distance From Site Fault Type . (1997 UBC) San Andreas S.9 km A San Jacinto 30.9 km A Based on our field observations and understanding of local geologic conditions, the soil profile type judged applicable to this site is Sp, generally described as stiff or dense soil. The site is located within UBC Seismic Zone 4. The following table presents additional coefficients and factors relevant to seismic mitigation for new construction. Sladden Engineeiln Near -Source Near -Source Seismic Seismic Seismic Acceleration Velocity Coefficient Coefficient Source Factor, Na Factor, No C. C-1 San Andreas 1:04/ 1.29 0.44 N. 0.64 N, / San Jacinto 1.0 1.0 0.44 Na 0.64 M, Sladden Engineeiln 6lo-ILDING ' �61TY OF LA QUINTA ' & SAFETY DEPARTMENT IDF,777-7012 INSPECTION REQUEST LINE 0 777-7153 IRVI :G AZOFF W CONSTRUCTION tPermit`Number; 07-1697 ; POST'ON' JOB IN CONSPICUOUS PLACE INSPECTOR,MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 53-435 FREMONT WAY I5,517SF DWELLING-NR/CLASS A -FR. 224SF POOL BATH/1,408SF TOTAL GARAGE/1,455SF BASEMENT/2,407SF COVERED OR TERRANCES. 2001 CBC,•CMC, CPC, 2004 CF..C, 2005 ENERGY. THIS PERMIT DOES NOT INCLUDE BLOCKWALLS, POOL AND SPA, OR DRIVEWAY APPROACH TYPE OF INSPECTION DATE INSP. TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE v / U/G ELECTRICAL/ GROUNDING. FOOTINGS/STEEL • O CONCRETE SLAB DO NOT POUR QONCRETE UNTIL ABOVE SIGNER ROOF NAIL / PRE -ROOF OKAY TO WRAP IVilla O FRAMING COMBINATION I ROUGH ELECTRIC ROUGH PLUMBING ROUGH MECHANICAL INSULATION /COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. DRYWALL — . QS EXTERIOR LATH GAS TEST SEPTIC ABANDONMENT SEWER CONNECTION -a cec SEPTIC / GREASE INTERCEPTOR _ MASONRY INSPECTIONS FOOTINGS/ STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING U/G GAS U/G ELECTRICAL PRE -PLASTER (ALARMS/ BARRIERS FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT. y COMMUNITY DEVELOPMENT DEPT. 15 z � ZO mss. FINAL / JOB/COMPLETED _ . ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING �a 1 Certificate of Occupancy a� 0'T Building & Safety Department y This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 53-435 FREMONT WY Use classification: SINGLE FAMILY DWELLING Building Permit No.: 07-1697 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: IRVING AZOFF Address: 53-435 FREMONT WY City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: OCTOBER-22-09 Building Offici POST IN A CONSPICUOUS PLACE 1 , £ I CALIFORNIA ENERGY DESIGNS, INC. I CONSULTING ENGINEERS F.1 CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED F[[,'O !FOR NNSTRU ' NC I 2 0 0 7 DAT `IIBY (AW 4517 Angeles Crest Highway, La Canada Flintridge, California 91011-3202 (818) 790-6817 • (213)`681t&1'68 • (800)?" 426-5982 • Fax: (818)790-7540 E -Mail: calen.erg@pacbell.net TITLE 24 REPORT Title 24 Report for: AZOFF RESIDENCE THE MADISON CLUB, LOT 89-B, 90-B LA QUINTA, CA Project Designer: -WALDO'S DESIGNS 620 N. ALMONT DRIVE LOS ANGELES, CA 90069. (310) 278-1803 Report Prepared By: GABRIEL GAGNON California Energy Designs, Inc. 4517 Angeles Crest Hwy. La Canada Flintridge, CA 91011 (818) 790-6817 Job Number: 10253r 0 Date:`'"`� 10/18/2007 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. EnergyPro 4.3 by EnergySoft - Job Number: 10253r User Number: 1115 3 TABLE OF CONTENTS Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary Form WS -5R Residential Kitchen Lighting HVAC System Heating and Cooling Loads Summary Room Load Summary Room Heating Peak Loads Room Cooling Peak Loads 1 2 3 7 9 10 12 14 16 EnergyPro 4.3 by EnergySoft Job Number: 10253r User Number: 1115 � I � I Certificate Of Compliance : Residential (Part 1 of 4) CF -1 R A_Z_OFF giDFN(-F FIRST FI 0013 blew n9 -A6 1011812.OS27 Project Title Ei.EMADJ_S-aN-CL_UB,_I C)T AP -R, qn- IA UINTA FIRST Fi nnR FIRST FLOOR Date Project Address New Il9-A6 SECONDrzI n Building Permit # Cafifomia_E.aerg_y_Designsr lnc- New 09-a6 New- ng- (818) 790-6817 Naw D9 -A6 New- D9_A6 New D1 -A18 Documentation Author Telephone Plan Check/Date -Fn Lg-y lm 15 Field Check/Date Compliance Method Climate Zone TDV Standard Proposed Compliance kBtu/sf- r) Design Design Margin • Space Heating 1.89 1.63 0.26 Space Cooling 54.90 52.38 2.52 Fans 7.79 9.32 -1.54 Domestic Hot Water 1.58 0.88 0.69 Pumps 0.00 0.00 0.00 Totals '66.16 64.21 1.95 Percent Building Type: [X Single Family ❑ Multi Family Building Front Orientation: Fuel Type: Fenestration: ❑ Addition ❑ Existing + Add/Alt (E) 90 deg Natural Gas Area: 3,816 ft2 Avg. U: 0.34 Ratio: 24.9% Avg. SHGC: 0.33 BUILDING ZONE INFORMATION Zone Name 2.9% Total Conditioned Floor Area: Existing Floor Area: Raised Floor Area: Slab on Grade Area: Average Ceiling Height: Number of Dwelling Units: Number of Stories: # of Floor Area Volume Units Zone Type FMR R OOR 9 694 x 16,328 -0 61 CDnditicned SECOND R noR 5 630 96 3n0 0-37 C:nnr itinned OPAQUE SURFACES Insulation Act. Type Frame Area U -Fac. Cay. Cont. Azm. Tilt Wall- 1Nnod 1 iso fn.6.9_ -21 R-0 0 45_ q Wall Wood 358_ 0.069 R_21 R-nA --9.0- go Wall_ Wmtl__ 793 n-069 -B_21 R-0 _n135. A0 Wall wwrl 973 n nR9 R_91 R -n n 225)_ q0 Wali . Wand Q.2 0 069_ R-21 R-0 0 270 9D. Wall_ Wood _ Ran 00.62 R-21 _B=0.0_115_ 9.Q Roof- WDnd 3 666 0095 -38_-B=OA n Ball_ Wood 947 n 069 R-21 R-n_n 45 q0 \Nall_ Wood 324 -DM9- X21 R_0 0_ 9D30 Wa1L- Won -d- 299 0.062 R-91 R-0 0 19 qp Wall_ Wnori< 644 X069 R-21 R -n n -22510 ' Run Initiation Time: 1 EnergyPro 4.3 by EnergySoft User Number: 1115 15,324 ft2 n/a ft2 0 ft2 9,694 ft2 11.3 ft 1.00 Thermostat Vent Type Hgt. Area _-Se.tback- n/a _S.et4ack_ 8 n/a Gains Condition Y / N Status JA IV Reference Location / Comments Naw 09-A6 FIRST FI 0013 blew n9 -A6 FIRST El New 09-a6 New 09-A6 FIRST Fi nnR FIRST FLOOR New 09-A6 New na-As New 01 -AIR FIRST Fl nnR FIRST R nnR FIRST FI nOR New Il9-A6 SECONDrzI n New 09-A6 _SECONDLELOOB New 09-a6 New- ng- SEW.Kin n OOP SECO.NDm Ong Naw D9 -A6 New- D9_A6 New D1 -A18 SECOND FI nnR SF-COND Fl 00R SEC -OND -El OnR Job Number: 10253r 3of17 Certificate Of Compliance : Residential (Part 2 of 4) CF -1 R AZOFF RESIDENCE 10/18/2007 Project Title Date FENESTRATION SURFACES True Cond. Location/ # Type Area U -Factor' SHGCZ Azm. Tilt Stat. Glazing Type Comments _- -Wad-ow-Bight Right (NES 479 5 _0.34Q NFRC -o._33 NERG 45_ _90_ L1Lew Andersen ParmashiEld FIRSTF9ODR 2 Window Front (E) 42.0 0.340 NERC 0.33 NERC 90 90 New Andersen Permashield FIRST FLOOR 3' Window Front (SE) 286.8 0.340 NFRC 0_33 NERC 135 90 New Andersen Permashield FIRST FLOOR 4 Window Left (SW) 595.1 0.340 NFRC 0.33 NFRC 225 90 New Andersen Permashield FIRST FLOOR 5 Window Left (SW) 751.7 0.340 NFRC 0_33 NFRC 225 90 New Andersen Permashield FIRST FLOOR 6 Window Rear (W) 57.5 0.340 NFRC 0_33 NFRC 270 90 New Andersen Permashield FIRST FLOOR L Window Rear (NW) 419.8 0_340 NFRC 0_33 NFRC 315 90 New Andersen Permashield FIRST FLOOR 8 might Right (N) 35.0 0.340 NFRC 0.33 NFRC 0 0 New Andersen Permashield FIRST FLOOR 9 Window Right (NE) 113.3 0.340 FRC 0.33 NFRC 45 -3Q New Andersen Permashield S�Q0-ND FLOOR 10 Window Front-JZL Front -J 76.0 0.340 NFRC 0_33 NFRC 90 90 New Andersen Permashield-SECOND FLOOR 1 Window Front (SE) 80.6 0.340 NFRC 0_33 NFRC 135 90 New Andersen Permashield SECOND FLOOR 12 Window . Left (SW) 596.3 0.340 NFRC 0_33 NFRC 225 90 New Andersen Permashield • SECOND FLOOR 13 Window Rear--J-W- 46.0'0.34 NFRC -O-a3 MFR 270 qQ New Andersen Permashield SECOND FLOOR 14 Window Rear (NW) 236.3 0.340 NFRC 0.33 NFRC 315 90 New Andersen Permashield SECOND FLOOR 1. Indicate source either from NFRC or Table 116A. 2. Indicate source either from NFRC or Table 116B INTERIOR AND EXTERIOR SHADING # Exterior Shade Type SHGC Window Overhang Left Fin Right Fin Hgt. Wd. Len. Hgt. LExt. RExt. Dist. Len. Hgt. Dist. Len. Hgt. 1 Bug Screen 0.76 Cond. R -Val. JA IV Reference. 2 Bug Screen 0.76 0.98 0 26-A1 3 Bug Screen 0.76 . 0.98 2 26-A1 4 Bug Screen 0.76 5 Bug Screen 0.76 10.0 22.0 10.0 0.1 -8. 8.0 6 Bug Screen 0.76 7 Bug Screen 0.76 8 None 1.00 9 Bug Screen 0.76 10 Bug Screen 0.76 11 Bug Screen 0.76 12 Bug Screen 0.76 13 Bug Screen 0.76 14 Bug Screen 0.76 THERMAL MASS FOR HIGH MASS DESIGN Area Thick.Heat Inside Condition Location/ Type (sf) (in.) Cap.. Cond. R -Val. JA IV Reference. Status Comments Concrete, Heavyweight 3,980 3.50 28 0.98 0 26-A1 New FIRST FLOOR / Slab on Grade Concrete, Heavyweight 5,714 3.50 28 . 0.98 2 26-A1 New FIRST FLOOR / Slab on Grade PERIMETER LOSSES Insulation Condition Location/ Type Length R -Val. Location JA IV Reference Status Comments Slab Perimeter 252 None No Insulation 26-A1 New FIRST FLOOR Slab Perimeter 302 None No Insulation 26-A1 New FIRST FLOOR 4.3 User Number: 1115 Job Number: 10253r � I � I I Certificate Of Compliance : Residential (Part 3 of 4) CF -1 R_ AZOFF RESIDENCE 10/18/2007 Project Title Date HVAC SYSTEMS Heating Minimum Cooling Minimum Condition Thermostat Location Type Eff Type Eff Status Type - FIRST FLOOR Central Furnace 94% AFUE Split Air Conditioner 16.0 SEER New Setback SECOND FLOOR Central Furnace 94%, AFUE Split Air Conditioner 16.0 SEER New Setback COMPLIANCE STATEMENT 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, and 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 TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) HVAC DISTRIBUTION ' Title/Firm: Address: WALDO'S DESIGNS 620 N. ALMONT DRIVE LOS ANGELES, CA 90069 Duct (310) 278-1803 Lic. #: Duct Condition Ducts ' Location Heating Cooling Location R -Value Status Tested? FIRST FLOOR Ducted Ducted Attic 4.2 New No SECOND FLOOR Ducted Ducted Attic 4.2 New No ' Hydronic Piping Pipe Pipe Insul. System Name Length Diameter Thick. ' WATER HEATING SYSTEMS Rated Tank Energy Tank Insul. Water Heater # in Input Cap. Condition Factor Standby R -Value Name Type Distribution Syst. (Btu/hr) (gal) Status or RE Loss (%) Ext. 'System AMERICAN POLARIS PBG102- Larqe Gas All Pipes Ins 2 100,000 50 New 0.94 0.00% 0.0 1-0 ' Multi -Family Central Water Heating Details Hot Water Pump Hot Water Piping Length(ft) Add 1/2" Control # HP Type In Plenum Outside Buried Insulation REMARKS COMPLIANCE STATEMENT 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, and 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 TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) (date) Enforcement Agency Name: Title/Firm: Address: ' Telephone: 'k/ Documentation Author Name: GABRIEL GAGNON Title/Firm: California Energy Designs, Inc. Address: 4517 Pggeles �C, rest Hwy. Tele EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number. 10253r Paae:5 of 17 I Name: ' Title/Firm: Address: WALDO'S DESIGNS 620 N. ALMONT DRIVE LOS ANGELES, CA 90069 Telephone: (310) 278-1803 Lic. #: (date) Enforcement Agency Name: Title/Firm: Address: ' Telephone: 'k/ Documentation Author Name: GABRIEL GAGNON Title/Firm: California Energy Designs, Inc. Address: 4517 Pggeles �C, rest Hwy. Tele EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number. 10253r Paae:5 of 17 I Certificate Of Compliance : Residential (Part 4 of 4) CF -1 R AZOFF RESIDENCE 10/18/2007 Project Title Date Special Features and Modeling Assumptions The local enforcement agency should pay special attentionto the items specified in. this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Plan Field The DHW System "AMERICAN POLARIS PBG1 02-50T1 00" is a Large Gas water heater with Pilot Loss = 0 btuh. HIGH MASS Design - Verify Thermal Mass: 3980 sqft Exposed Slab Floor, 3.50" thick at FIRST FLOOR HIGH MASS Design - Verify Thermal Mass: 5714 sqft Covered Slab Floor, 3.50" thick at FIRST FLOOR HERS Required Verification Items in this section require field testing and/or verification by a certified home energy rater under the supervision of a CEC- approved hots provider using ctc approved testing anwor veritication metnods and must oe reported on the cr-art installation certificate. Plan Field The HVAC System "FIRST FLOOR" incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion Valve. The Cooling System "CARRIER 58MBAl00-20/25HNA60" includes credit for a 12.0 EER Condenser. A certified HERS rater must field verify the installation of the correct Condenser. The HVAC System "SECOND FLOOR" incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion Valve. The Cooling System "CARRIER 58MBA100-20/25HNA60" includes credit for a 12.0 EER Condenser. A certified HERS rater must field verify the installation of the correct Condenser. c 4.3 by EnergySoft User Number: 1115 4 Job Number: 10253r I I I I I I � I I I Mandatory Measures Summary: Residential (Page 1 of 2) MF -1R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (') below. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Check or initial applicable boxes or check NA if not applicable and included with the permit application documentation. N/A DESIGNER ENFORCE - MENT Building Envelope Measures ❑ ❑X ❑ § 150(a): Minimum R-19 in wood ceiling insulation or equivalent U -factor in metal frame ceiling. ❑ ❑x ❑ § 150(b): Loose fill insulation manufacturer's labeled R -Value: ❑ ❑ ❑ *§ 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -factor in metal frame walls (does not ❑ ❑X ❑ apply to exterior mass walls). ❑ ❑ ❑ *§ 150(d): Minimum R-13 raised floor insulation in framed Floors or equivalent U -factor. ❑ ❑ ❑ § 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. ❑ ❑X ❑ 1. Masonry and factory -built fireplaces have: ❑ ❑x ❑ a. closable metal or glass door covering the entire opening of the firebox ❑ ❑ ❑ b. outside air intake with damper and control, flue damper and control ❑ ❑ ❑ 2. No continuous burning gas pilot lights allowed. ❑ ❑ ❑ § 150(f): Air retarding wrap installed to comply with §151 meets requirements specified in the ACM Residential Manual. ❑ ❑ ❑ § 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. ❑ ❑ ❑ § 150(1): Slab edge insulation - water absorption rate for the insulation alone without facings no greater than 0.3%, water vapor ❑ ❑ ❑ permeance rate no greater than 2.0 permfinch. ❑ R ❑ § 118: Insulation specified or installed meets insulation installation quality standards. Indicate type and include ❑ ❑K ❑ CF -6R Form: ❑ IR ❑ § 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls. 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. ❑ ❑. ❑ 2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain ❑ ❑ ❑ Coefficient (SHGC), and infiltration certification. 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. ❑ ❑ ❑ Space Conditioning, Water Heating and Plumbing System Measures § 110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Energy Commission. ❑ ❑ ❑ § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. ❑ ❑X ❑ § 150(i): Setback thermostat on all applicable heating and/or cooling systems. ❑ ❑x ❑ § 1500): Water system pipe and tank insulation and cooling systems line insulation. 1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with insulation ❑ ❑ ❑ having an installed thermal resistance of R-12 or greater. 2. Back-up tanks for solar systems, unfired storage tanks, or other indirect hot water tanks have R-12 external ❑ ❑ ❑ insulation or R-16 internal insulation and indicated on the exterior of the tank showing the R -value. 3. The following piping is insulated according to Table 150-A/B or Equation 150-A Insulation Thickness: , 1. First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire ❑ R ❑ length of recirculating sections of hot water pipes shall be insulated to Table 150B. 2. Cooling system piping (suction, chilled water, or brine lines), piping insulated between heating source and ❑ IR ❑ indirect hot water tank shall be insulated to Table 150-B and Equation 150-A. 4. Steam hydronic heating systems or hot water systems > 15 psi, meet requirements of Table -123-A. ❑ ❑ ❑ 5. Insulation must be protected from damage, including that due to sunlight, moisture, equipment maintenance, ❑ ❑ ❑ and wind. 6. Insulation for chilled water piping and refrigerant suction piping includes a vapor retardant or is enclosed ❑ ❑ ❑ entirely in conditioned space. t 7. Solar water -heating systems/collectors are certified by the Solar Rating and Certification Corporation. ❑ ❑ ❑ EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number: 10253r , Page:7 of 17 Mandatory Measures Summary: Residential (Page 2 of 2) MF -1 R NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (') below. When this checklist.is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION Instructions: Check or initial applicable boxes when completed or check N/A if not ENFORCE - applicable. N/A I DESIGNER MENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) § 150(m): Ducts and Fans 1. All ducts and plenums installed, sealed and insulated to meet the requirements of the CMC Sections 601, 602, 603, 604, ❑ ❑ ❑ 605, and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minumum installed level of R4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than ❑ ❑ ❑ sealed sheet metal, duct board or Flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 3. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive ❑ ©_ ❑ duct tapes unless such tape is used in combination with mastic and draw bands. ❑ ® ❑ 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operating ❑ ❑ ❑ dampers. 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment ❑ ❑ ❑ maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ ❑ ❑ 7. Flexible ducts cannot have porous inner cores. § 114: Pool and Spa Heating Systems and Equipment 1. A thermal efficiency that complies with the Appliance Efficiency Regulations, on-off switch mounted outside of the ❑ ❑ ❑ heater, weatherproof operating instructions, no electric resistance heating and no pilot light. 2. System is installed with: ❑ ❑ ❑ a. At least 36" of pipe between filter and heater for future solar heating. b. Cover for outdoor pools or outdoor spas. ❑ ❑ ❑ 3. Pool system has directional inlets and a circulation pump time switch. ❑ ❑ ❑ § 115: Gas fired fan -type central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously ❑ © ❑ burning.pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) § 118 (i): Cool Roof material meets specified criteria ❑ ❑ ❑ Lighting Measures § 150(k)1: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID: contain only high efficacy lamps as outlined in Table ❑ ❑ ❑ 150-C, and do not contain a medium screw base socket (E24/E26). Ballasts for lamps 13 Watts or greater are electric and have an output frequency no less than 20 kHz. § 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, ❑ ❑ ❑ luminaire has factory installed HID ballast. § 150(k)2: Permanently installed luminaires in kitchens shall be high efficacy luminaires. Up to 50% of the Wattage, as determined ❑ X❑ ❑ in Section 130(c), of permanently installed luminaires in kitchens may be in luminaires that are not high efficacy luminaires, provided that these luminaires are controlled by switches separate from those controlling the high efficacy luminaires. § 150(k)3: Permanently installed luminaires in bathrooms, garages, laundry rooms, utility rooms shall be high efficacy luminaires. ❑ Q ❑ OR are controlled by an occupant sensor(s) certfied to comply with Section 119(d). § 150(k)4: Permanently installed luminaires located other than in kichens, bathrooms, garages, laundry rooms, and utility rooms shall be high efficacy luminaires (except closets less than 70 ft) OR are controlled by a dimmer switch OR are ❑ ❑ ❑ controlled by an occupant sensor that complies with Section 1'19(d) that does not turn on automatically or have an always on option. § 150(k)5: Luminaires that are recessed into. insulated ceilings are approved for zero clearance insulation cover (IC) and are ❑ ❑ ❑ certified to ASTM E283 and labeled as air tight (AT) to less than 2.0 CFM at 75 Pascals. § 150(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the ❑ ❑ ❑ same lot shall be high efficacy luminaires (not including lighting around swimming pools/water features or other Article 680 locations) OR are controlled by occupant sensors with integral photo control certified to comply with Section 119(d). § 150(k)7: Lighting for parking lots for 8 or more vehicles shall have lighting that complies with Sections 130, 132, and 147. ❑ ❑ ❑ Lighting for parking garages for 8 or more vehicles shall have lighting that complies with Section 130, 131, and 146. § 150(k)8: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more ❑ ❑ ❑ dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s) certified to comply with Section 119(d). EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number: 10253r Page:8 of 17 Residential Kitchen Lighting Worksheet WS -5R 'AZOFF RESIDENCE 10/18/2007 Project Title Date At least 50% of the total rated wattage of permanently installed luminaires in kitchens must be in luminaires that are high efficacy luminaires as defined in Table 150-0. Luminaires that are not high efficacy must be switched separately. Kitchen Lighting Schedule. Provide the following information for all luminaires to be installed in kitchens. rHigh Efficacy Luminaire Type High Efficacy? Watts Quantity Watts Other Watts 50w Low Voltage Halogen Yes 7 No Fx 55.0 x 4 = or 220 (1) 26w Compact Fluorescent Quad 2 Pin Yes X1 No 1 37.0 x 8 296 or ' (1) 14w Linear Fluorescent T5 Elec Yes X1 No 1 18.0 x 8 144 or Yes No x = or Yes No x = Yes No x or or ' Yes No x or YesNo x = or Yes No x = or Yes No x or ' Yes No x or Yes No x = or Yes No x = or Yes No x or ' Yes No x or Yes No x or Yes No x = or ' Yes No x = Yes No x or or Y sl I No I x ' or Total A: 440 B: 220 rCOMPLIES IF A >_ B YES GQ NO ❑ ' EnergyPro 4.3 by Energysoft User Number: 1115 Job Number: 10253r Page:9 of 17 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY PROJECT NAME DATE AZOFF RESIDENCE 10/18/2007 SYSTEM NAME _ FLOOR AREA FIRST FLOOR 9,694 Number of Systems 7 Heating System Output per System 94,000 Total Output (Stuh) 658,000 Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COIL COOLING PEAK COIL HTG. PEAK CFM I Sensible Latent I I CFM J Sensible 16,787 191,042 33,202 2,723 122,577 0 31,306 13,916 0 0 0 0 0 0 0 0 0 31,306 13,916 HVAC EQUIPMENT SELECTION 253,6531 33 202 50,4091 CARRIER 58MBA100-20/25HNA60 221,935 74,180 658,000 Total Adjusted System Output 221,935 74,180 658,000 '(Adjusted for Peak Design Conditions) TIME OF SYSTEM PEAK Aug 2 pm Jan 12 am EATING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Heating -Peak 26.0 OF 69.1 OF 69.10F 113.20F Supply Air Ducts Outside Air 0: 0 cfm 112.3 of Supply Fan Heating Coil 14000 cfm ROOMS 70.0 of 69.1 OF i 1, Return Air Ducts V DOLING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Cooling Peak 111.9 / 77.6 of 74.1 / 64.4 of 74.1 / 64.5 of 59.2 / 58.5 of e 4 Supply Air Ducts Outside Air y0; 0 cfm Supply Fan Cooling Coil 61.3 159.2 of 14000 cfm 64.0% R.H. ROOMS 74.1/64.4 of 72.0 63.7 OF. �% Return Air Ducts 4 EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number: 10253r Page:10 of 17 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY ' PROJECT NAME DATE AZOFF RESIDENCE 10/18/2007 SYSTEM NAME FLOOR AREA SECOND FLOOR 5,630 tENGINEERING CHECKS_ SYSTEM LOAD Number of Systems 4 Heating System Output per System 94,000 Total Output (Btuh) 376,000 Output (Btuh/sqft) 66.8 Cooling System Output per System 48,000 Total Output (Btuh) 192,000 Total Output (Tons) 16.0 Total Output (Btuh/sqft) 34.1 Total Output (sgft/Ton) 351.9 Air System CFM per System 2,000 Airflow (cfm) 8,000 Airflow (cfm/sgft) 1.42 Airflow (cfm[Ton) 500.0 Outside Air (%) 0.0 Outside Air (cfm/sqft) 0.00 Note: values above given at ARI conditions EATING SYSTEM PSYCHROMETRICS 26.0 OF 69.2 OF 69.2 OF Outside Air 0 cfm el ' 69.2 of DOLING SYS 111.9/77.6OF ' Outside Air 0 cfm '73.4/63.4 0 od ' Energypro 4.3 Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COIL COOLING PEAK 11COILHTG.PEAK CFM I Sensiblel Latent I I CFM I Sensible 5,758 75,067 13,114 1,326 60,047 0 12,301 6,817 0 0 a 0 01 0 0 0 0 12,301 6,817 99,6701 13,1141 73 681 HVAC EQUIPMENT SELECTION CARRIER 58MBA100-20/25HNA60 128,904 37,674 376,000 Total Adjusted System Output 128,904 37,674 376,000 (Adjusted for Peak Design Conditions) TIME OF SYSTEM PEAK Aug 2 pm Jan 12 am 113.40F Supply Fan Heating Coil 8000 cfm PSYCHROMETRICS (Airstream T 73.4 / 63.4 OF 73.4 / 63.50F Supply Air Ducts 112.6 OF ROOMS 70.0 OF Return Air Ducts I tratures at Ti 58.3/57.5OF Supply Fan Cooling Coil 8000 cfm User Number: 1115 lina Pea b, Keturn Air uucts 1 Job Number. 10253r Supply Air Ducts 59.7 / 58.1 OF 61.0% R.H. ROOMS 72.0/62.9OF 11 of 17 ROOM LOAD SUMMARY PROJECT NAME DATE AZOFF RESIDENCE 10/18/2007 SYSTEM NAME FLOOR AREA FIRST FLOOR 9,694 ROOM LOAD SUMMARY ROOM COOLING PEAK COIL COOLING PEAK COIL HTG. PEAK ZONE NAME ROOM NAME Mult. CFM SENSIBLE LATENT CFM SENSIBLE LATENT CFM SENSIBLE FIRST FLOOR FIRST FLOOR 1 16,787 191,042 33,202 16,787 191,042 33,202 2,723 122,577 PAGE TOTAL 1116,7871 191,042 331202 2,723 122,577 TOTAL 1 16,787 191,042 33,202 2,723 122,577 EnergyPro By EnergySoft User Number: User Job Number: 10253r Page: 12 of 17 -I 1� ROOM LOAD SUMMARY PROJECT NAME DATE AZOFF RESIDENCE 10/18/2007 SYSTEM NAME FLOOR AREA SECOND FLOOR 5,630 ROOM LOAD SUMMARY ROOM COOLING PEAK COIL COOLING PEAK COIL HTG. PEAK ZONE NAME ROOM NAME Mult. CFM SENSIBLE LATENT CFM SENSIBLE LATENT CFM SENSIBLE SECOND FLOOR SECOND FLOOR 1 5,758 75,067 13,114 5,758 75,067 13,114 1,326 60,047 a PAGE TOTAL 1 5,758 75,067 13,114 1,326 60,047 TOTAL 1 5,758 75,067 13,114 11326 60047 EnergyPro By EnergySoft User Number: User Job Number: 10253r Page: 13 of 17 ROOM HEATING PEAK LOADS Project Title Date AZOFF RESIDENCE 10/18/2007 Room Information Design Conditions Room Name FIRST FLOORTime of Peak Jan 12 am Floor Area 9,694 Outdoor Dry Bulb Temperature 26OF Indoor Dry Bulb Temperature 70 OF Conduction Area . U -Value OT of Btu/hr Items shown with an asterisk ('r) denote conduction through an interior surface to another room. Page Total: 74 354 Infiltration: 1.00 x 1.064 x 9 694 x 12.00 x 0.531 / 60] x = 48 223 chedule Air Sensible Area Ceiling Height ACH OT Fraction TOTAL HOURLY HEAT LOSS FOR ROOM 122,577 EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number. 10253r Page: 14 of 17 1.180.5 x X x X X X x X X x x X X x X x X X x X X X X x x x X X X X X x X X x X X X X 0.0690 x X X X X X x X X x X X X x x x X X x X x X X x x x X x X x X X X X x X X X X 44 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = 3,584 479.5 0.3400 441 7,173 358.0 0.0690 44 1,087 42.0 0.3400 44 628 723.2 0.0690 44 2,196 286.8 0.3400 44 4,291 973.2 0.0690 44 2,955 595.1 0.3400 44 8,903 751.7 0,3400 44 11,245 92.5 0.0690 44 281 57.5 0.3400 44= 830.2 0.0690 44 2,520 419.8 0.3400 44 6,280 3.666.0 0.0250 44= 4,033 35.0 0.3400 44c perimeter = 252.0 0.7300 44 8,094 _perimeier = 3 �0 44=P 700 Items shown with an asterisk ('r) denote conduction through an interior surface to another room. Page Total: 74 354 Infiltration: 1.00 x 1.064 x 9 694 x 12.00 x 0.531 / 60] x = 48 223 chedule Air Sensible Area Ceiling Height ACH OT Fraction TOTAL HOURLY HEAT LOSS FOR ROOM 122,577 EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number. 10253r Page: 14 of 17 ' ROOM HEATING PEAK LOADS ' Project Title Date AZOFF RESIDENCE 10/18/2007 Room Information Design Conditions 'Room Name SECOND FLOOR Time of Peak Jan 12 am Floor Area 5,630 Outdoor Dry Bulb Temperature 26°F Indoor Dry Bulb Temperature 70 OF tConduction Area U -Value OT OF Btu/hr 946.7 x x X X x X x X X X x X X X x X X x X X X X X x X X X X X X x x x X x X X X X 0.0690 x X X x x X x X X X x X X X x X X x X X x x x x X X x X x X X X x X x x x X x 44 = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = 2.874 113.3 0.3400 44 1,695 324.0 0.0690 44 984 76.0 0.3400 44 1137 299.4 0.0690 44 909 80.6 0.3400 44 1,206 693.7 0.0690 44 2.106 596.3 0.3400 44 8,921 104.0 0,0590 44 316 46.0 0.3400 44 68 763.7 0.0690 44= 236.3 0.3400 44 3,535 4.865.0 0.0250 44 5,352 ' Items shown with an asterisk ('f) denote conduction through an interior surface to another room. Page Total: 32 040 Infiltration: 1.00 1 x 1.064 x 5 630 x 10.00 x 0.638 / 6 ] x 44 = 28 006 chedule Air Sensible Area Ceiling Height ACH &T ' Fraction TOTAL HOURLY HEAT LOSS FOR ROOM 60,047 ' EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number: 10253r Page: 15 of 17 RESIDENTIAL ROOM COOLING LOAD SUMMARY Project Title Date AZOFF RESIDENCE 10/18/2007 Room Information Design Conditions Room Name: FIRST FLOOR Outdoor Dry Bulb Temperature: 1130F Floor Area: 9,694 sf Outdoor Web Bulb Temperature: 780F Indoor Dry Bulb Temperature: 72 of Outdoor Daily Range: 350F vNayuc oui faces R-21 Wall R-21 Wall R-38 Roof Attic Orientation Area . X X X X X x x x x x x x NE 1,180.5 E 358.0 SE 723.2 SW 973.2 W 92.5 NW 830.2 (N) 3,666.0 0.0690 33.0 211 0.0690 30.2 1,732 0.0250 56.0 5,132 286.8 Items shown with an asterisk (') denote conduction through an interior surface to another room. 1. Cooling Load Temperature Difference (CLTD) Fenestration ht U -Factor X X X X X X x x x x x. x CLTD 1 = = = = = = = = = = = = Btu/hr 0.0690 29.0 2,362 0.0690 33.0 815 0.0690 31.0 1,547 0.0690 31.0 2,082 0.0690 33.0 211 0.0690 30.2 1,732 0.0250 56.0 5,132 286.8 26.6 7,625 SW 0.0 19.0 595.1 26.6 15,822 SW' 751.7 19.0 0.0 26.6 14,275 W Page Total 13 881 Orientation Shaded Area X x x X x x x x X x GLF + + + + + + + + + + Unshaded Area X X x x X X X x x X- GLF = = = = = = = = _ Btu/hr NE 0.0 19.0 479.5 29.6 14,195 E 0.0 19.0 42.0 38.6 1,62 SE 0.0 19.0 286.8 26.6 7,625 SW 0.0 19.0 595.1 26.6 15,822 SW' 751.7 19.0 0.0 26.6 14,275 W 0.0x 19.0+ 57.5X 38.6= 2,219 (NW) 0.0 19.0 419.8 29.6 12,428 (Sky) 0.0 19.4 35.0 64.1 2,242 Page Total 70 426 Internal Gain Btu/hr Occu ants 60 x Occupants X 230 Btuh/occ. = 13,8001 E ui ment E 30 x Dwelling Units X 1,6001 Watts/sgft = 48,0001 Infiltration: 1.064 x 1.51 x 684.01 x 0 = 44 935 Air Sensible CFM ELA DT TOTAL HOURLY SENSIBLE HEAT GAIN FOR ROOM 191,0421 Latent Gain Btu/hr Occupants 60 X Occupants x 200 Btuh/occ. = 12,0 Infiltration: 4 769 X 1.51 x 684.01 x 0.00431 = 21 202 Air Latent CFM ELA n w ' TOTAL HOURLY LATENT HEAT GAIN FOR ROOM 33,202 EnergyPro 4.3 by EnergySoft User Number: 1115 Job Number: 10253r Page: 16 of 17 r� RESIDENTIAL ROOM COOLING LOAD SUMMARY Project Title Date AZOFF RESIDENCE 110/1812007 Room Information Design Conditions ' Room Name: SECOND FLOOR Outdoor Dry -Bulb Temperature: 1130F Floor Area: 5,630 sf Outdoor Web Bulb Temperature: 780F Indoor Dry Bulb Temperature: 72 of Outdoor Daily Range: 350F ■ Items shown with an asterisk (`) denote conduction through an interior surface to another room. Page Total 13 397 r 1. Cooling Load Temperature Difference (CLTD) Shaded Unshaded Fenestration Orientation ' Area GLF Area GLF Btu/hr 1 r 1 Orientation Area X X X X X X X x X x X x U -Factor X X X X X X X x X x X x CLTD = = = = = = = = = = = = Btulhr 29.6 NE 946.7 0.0690 29.0 1,894 E 324.0 0.0690 33.0 738 SE 299.4 0.0690 31.0 • 640 (SW) 693.7 0.0690 31.0 1,484 W 104.0 0.0690 33.0 237 NW 763.7 0.0690 30.2 1,593 (N) 4,865.0 0.0250 56.0 6,811 ■ Items shown with an asterisk (`) denote conduction through an interior surface to another room. Page Total 13 397 r 1. Cooling Load Temperature Difference (CLTD) Shaded Unshaded Fenestration Orientation ' Area GLF Area GLF Btu/hr 1 r 1 r• NE • 0.0 X x x x x x x x x x x 19.0 + + + + + + + + + + + 113.3 x x x x X X x x X x x 29.6 = = = = = = = = = = = 3,354 E 0.0 19.0 76.0 38.6 2,932 SE 0.0 19.0 80.6 26.6 2,143 (SW) -0.0 19.0 596.3 26.6 15,854 W 0.0 19.0 46.0 38.6 1,775 (NW) 0.0 19.0 236.3 29.6 6,995 r• Page Total 33,053 Internal Gain Btulhr rOccupants 4 x Occupants x 230 Btuh/occ. = E ui ment B1 X Dwelling Units x 1,600J Watts/sqft = 920 1,6001 Infiltration: 1.064 x 1.51 x 397.26 x 0 = 26.097 ' Air Sensible CFM ELA DT TOTAL HOURLY SENSIBLE HEAT GAIN FOR ROOM 75,067 . Latent Gain Btu/hr ' Occupants F 4� X Occupants X 200 Btuh/occ. , = 800 Infiltration: 4 769 x 1.51 X 397.26 x 0.00431 = 12 314 ' Air Latent CFM ELA pW TOTAL HOURLY LATENT HEAT GAIN FOR ROOM 13,114 rEnergyPro 4.3 by EnergySoft User Number. 1115 Job Number. 10253r Page: 17 of 17 r . CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 1p CF -4R Project Address [ Azoff Residence J Duct Pressurization Test Results (CFM @ 25 Pa) Builder / Installer 53-435 Fremont Way / La Quinta / CA / 92253 1 Bradshaw Construction Builder/ Installer Contact Telephone Plan Number / Permit Number Tom Bradshaw 7603474246 Azoff Residence HERS Rater Telephone Sample Group Number Michael Willeford - C[HJEJEJRJS@ ID 7604497248 0 #CCNMW263496 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. Compliance Method (Prescriptive) Climate Zone 15 Certifying Signatur Date Sample House Number TEST 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 v 1 Firm 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] HERS Provider MW Ratings 1 I Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection CJHJEJEJRJS@ Address 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection City/State/Zip 74315 Peppergrass Pass if One of Lines #9 through #12 Pass❑Pass Palm Desert /CA /92260 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT This house was: / Tested As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. V The installer has provided a copy of CF -6R (Installation Certificate). New Ducts are fully ducted (i.e., does not use building cavities, as plenums or platform returns in lieu of ducts). New ducts with cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ✓ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results System # I NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 47 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating / Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 3.9 ,/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail 1 I Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection " ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass❑Pass ❑ Fail Residential Compliance Forms Generated by CJHJE[EJR[S@ http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 2 of 19 CF -4R Project Address I Azoff Residence j 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 2 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 66 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating ✓ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 4.1 ,/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] . . 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line N2 ] ] Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail O Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection 12 ❑Pass ❑Fail ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass Pass if One of Lines #9 through #12 Pass O Pass ❑ Fail System # 3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM 70 2 Fan Flow: Calculated (Nominal: O Cooling O Heating V Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 4.3 ,/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail I I Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection - ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass ❑ Pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 10 CF -4R Project Address [ Azoff Residence ] 53-435 Fremont Way / La Quintad CA / 92253 Builder / Installer Bradshaw Construction System # 4 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 80 1 Enter Tested Leakage Flow in CFM 101 2 Fan Flow: Calculated (Nominal: O Cooling O Heating V Measured) Enter Total Fan Flow in CFM: ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 5.0 V Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. TEST 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 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ] 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). O Pass O Fail 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [, Line #5 / Line #2 ] ] ❑ Pass O Fail TEST OR VERIFICATION STANDARDS: For Altered Duct Systerim.and/or HVAC Equipment Change -Out Use one of the following four Test or Verification Standards fo.r Compliance . 9 Pass if Leakage Percentage < 15% [ 100 x [ Line #5'/ Line #2 O Pass ❑Fail 10 Pass if Leakage to Outside Percentage < 10%:[ 100;x [ Line #7 /!Line #2):] O Pass ❑Fail 1 I Pass if Leakage Reduction Percentage > 60% (.I OO z (Line #6 /.,Line #4 } } and Verification. by Smoke Test and Visual Inspection ❑ Pass O Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection O Pass O Fail Pass if One of Lines #9 through #12 Pass ❑Pass ❑Fail System # 5 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 80 2 Fan Flow: Calculated (Nominal: O Cooling O Heating ,/ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 4.0 ✓ Pass O Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] O Pass O Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] O Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ) and Verification by Smoke Test and Visual Inspection O Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑Pass ❑Fail Pass if One of Lines #9 through #12 Pass O Pass O Fail Residential Compliance Forms Generated by CIHIEJEJRJS© http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 4 of 19 CF -4R Project Address t Azoff Residence I 53435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 6 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM 84 2 2 Fan Flow: Calculated (Nominal: O Cooling O Heating ✓ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 5.3 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #I / Line #2 ] ] 4.2 Y/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ J 00 x [ Line #5 / Line #2 ] ] O Pass O Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] O Pass O Fail 10 Pass if Leakage to Outside Percentage < 10%'[ 100 x [ Line #7 / Line #2 ] ] O Pass O Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [.Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection O Pass O Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection 9 ❑ Pass O Fail Pass if One of Lines #9 through #12 Pass 10 O Pass O Fail System # 7 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 106 2 Fan Flow: Calculated (Nominal: O Cooling O Heating / Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 5.3 f Pass O Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] J ❑ Pass O Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] O Pass O Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass O Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass O Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass O Fail Pass if One of Lines #9 through #12 Pass ❑ Pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJS@ http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 5 of Ip CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 8 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 103 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating ✓ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 5.1 v/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 J ] ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 j ]- 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑Pass ❑Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x, [ Line #61 Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #9 through #I2 Pass ❑ Pass ❑ Fail System # 9 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM 94 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating V Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 J ] 4.7 ,/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass ❑ Pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 6 of 10 CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 10 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 89 2 Fan Flow: Calculated (Nominal: O Cooling O Heating / Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 4.4 ,/ Pass O Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 1Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). O Pass O Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] TEST 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 O Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ].and Verification by Smoke Test and Visual Inspection ❑ Pass O Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass 11 ❑ Pass O Fail System # 11 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 97 2 Fan Flow: Calculated (Nominal: ❑ Cooling O Heating ./ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] J 4.8 �/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] O Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] O Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ) ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass O Fail Pass if One of Lines #9 through #12 Pass ❑ Pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 7 of 10 CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 12 NEW CONSTRUCTION: Duct Pressurization Test Results ( FM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM — 91 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating / Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 4.5 �/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). TEST 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 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ] 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] J ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass ❑Pass ❑ Fail System # 13 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM 153 2 Fan Flow: Calculated (Nominal: ❑ Cooling ❑ Heating ,/ Measured) Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] 5.1 ,/ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leakage for Altered Duct System [ Line #4 Minus Line #5] (Only if Applicable). 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). 8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail TEST 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 < 15% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 Pass ❑ Pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 8 of 10 CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction ,/ THERMOSTATIC EXPANSION VALVE (TXV) Procedures forfield verification of thermostatic expansion valves are available in RACM, Appendix RI. System # 1 ,/ Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass ,/ pass ❑ Fail System # 2 Yes O No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass / pass ❑ Fail System # 3 ,/ Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass /Pass ❑ Fail System # 4 ,/ Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass �/ Pass ❑ Fail System # 5 ,/ Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass �/ pass ❑ Fail System # 6 " f Yes ❑ No I Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass �/ pass ❑ Fail System # 7 Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass �/ pass ❑ Fail System # 8 Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass f pass ❑ Fail System # 9 i V Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass / pass ❑ Fail System # 10 Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass,/ pass ❑ Fail System # I 1 ./ Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass I ,/ pass ❑Fail System # 12 j Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass ,/ pass ❑Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 9 of 1p CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA / 92253 Builder / Installer Bradshaw Construction System # 13 V Yes ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be -verified. Yes is a pass �/ pass ❑ Fail ,/ HIGH EER AIR CONDITIONER Procedures for verification are available in RACM, Appendix R1. System # 1 I ✓ Yes ❑ No EER Values of installed systems match the CF -1R 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 ,/ Yes ❑ No Time Delay Relay Verified (If Required) Yes to I and 2; and 3 (If Required) is a pass �/ pass ❑ Fail System # 2 f ,, Yes ❑ No EER Values of installed systems match the CF=IRC.; 2 ✓ Yes ❑ No For split system, indoor coil is -matched to outdoor. coil. - 3 3 V Yes ❑ No Time Delay Relay Verified (If_Required) Yes to l and 2-- and 3 (If Required) is a pass �/ pass ❑ Fail System # 3 Yes ❑ No EER Values of installed systems match the CF -IR 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 �/ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass I V pass ❑ Fail System # 4 I v/ Yes ❑ No EER Values of installed systems match the CF -IR 2 ,/ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 �/ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass I V pass ❑ Fail System # 5 I ,/ Yes ❑ No EER Values of installed systems match the CF -IR 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 V Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass I Y/ pass ❑ Fail System # 6 I ✓ Yes ❑ No EER Values of installed systems match the CF -IR 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 v1 Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass I V pass ❑Fail System # 7 I v/ Yes ❑ No EER Values of installed systems match the CF -IR 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 V Yes ❑ No Time Delay Relay Verified (If Required) Yes to I and 2; and 3 (If Required) is a pass �/ pass ❑ Fail Residential Compliance Forms Generated by CJHJEJEJRJSO http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 10 of 10) CF -4R Project Address I Azoff Residence I 53-435 Fremont Way / La Quinta / CA 192253 Builder / Installer Bradshaw Construction System # 8 I ✓ Yes O No EER Values of installed systems match the CF- I R 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 ✓ Yes O No Time Delay Relay Verified (If Required) Yes to I and 2; and 3 (If Required) is a pass f pass ❑ Fail System # 9 I ✓ Yes ❑ No EER Values of installed systems match the CF -I R 2 ✓ Yes ONO For split system, indoor coil is matched to outdoor coil 3 ✓ Yes ❑ No Time Delay Relay Verified (If Required) Yes to I and 2; and 3 (If Required) is a pass I V Pass O Fail System # 10 I / Yes O No EER Values of installed systems match the CF -I R 2 ✓ Yes ❑ No For split system, indoor coil is matched to:outdoor coil 3 ✓ Yes ONO Time Delay Relay Verified (If Required) Yes toil and 2; and 3 (If Required) is a pass �/ Pass O Fail System # 11 Yes O No EER Values of installed systems match the CF -IR' 2 For lits stem, indoor coil is.matched o ,/ Yes ❑ No P Y .matched: to outdoor coil .:`- 3 ✓ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass I v/ Pass O Fail System # 12 I ✓ Yes ONO EER Values of installed systems match the CF -IR 2 ✓ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 ,/ Yes O No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (If Required) is a pass �/ Pass O Fail System # 13 I ✓ Yes ❑ No EER Values of installed systems match the CF -IR 2 v/ Yes ❑ No For split system, indoor coil is matched to outdoor coil 3 ✓ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and 3 (if Required) is a pass �/ Pass O Fail Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 i ` � J INSTALLATION CERTIFICATE (Page 3 of 12) CR -6R . Site Address 5 3-41 '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(x). HVAC SYSTEMS: Heating Equipment Equip Type . CEC Certified Mfr. # of Efficiency t (AFUE, etc.) - Duct Duct or Heating Heating Name and Model Identical Location Piping Load Capacity k . hereat pump) Number Systems (>_CF -I R'1vaalluue) attic, etc. R -value (Btuthr (Btuthr kig7pV'P t ,, ,Number �NVox 9 �• F Pm id �li y 1417,500 SY,0 0 1 43 �1J7 1�= .� E" �A_N_, ? r V\hMV -SP l.e-> w -A c� 8.5 ASP:1P ATTIC H((s Z=4 _;L, 311 3`15 y 4 j50 cs L4 T o p,P1yS43 /'2- _ . - IA �P P T SPBo3i,HyS43 g• 65 HSPF RITtC w& ( =y. Zy, 300 _2�+fo0 'r�-5 � �� 1 t 1-3, a Cod' �I trs R'?_y t 3.,') So 857, 00 0 ? H i ZA --oocko -� I R -r -r- C . 9`a 00 0 9 U t000 Cooling Equipment Equip Type CEC Certified Mfr. # of Efficiency (SEER or EER) DuctDuct Cooling Cooling Name and Model Identical Location Duct Load Capacity (pkg. heat um Number Systems >_CF -IR value) attic, etc. R -value Btufl r (Btuthr 1 oFA-r y� Xh L46N N --)-x 9 / 6 .5K6rt- /4-M C � �4 410, 0 00 � ri r Soo 5 P LIT 5pe o i L.-&-9- N ., •� E A - 4-r PVA►v``P _ (._NNoX c� / to %b-fL ATTI C �. ant Lo Do Z/�,00�� SP ?Bo4 /'2- _ y , - IA KslE'T'PVAm L-EWNQx bS it=— R7rIC. �� b8o 3Y 600 Q L.i� P, �I S 3 / �I trs 1 1 i�P�' ter^ SQV_j - scO)c kP� ro0--4 I R -r -r- C -, 9`a 00 0 9 U t000 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. v" 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 Efficiency 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. . Installing Subcontractor (Co. Name) OR General p Contractor (Co. Name) OR Owner �j 12 �G Z SL A % R W wv 1 T� o -N l m C, Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE),. UILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE),. UILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address S3- Li 3(ZE M o -11 1 -WA- Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT,_ ❑ The building was: ✓ Tested at IR Final ✓ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: R -le move at least one supply and one return register, and verify that the spaces between the register boot and the interior Fai ishing wall are properly sealed. ER 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 verifi, that the connection points are properly sealed. enspect all joints to ensure that no cloth backed rubber adhesive duct tape is used l�1ew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platformssreturns in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION Prnrnflurec fnr field verification and (fluenoslic testing of air distribution systems are available in RACM• ADoendix RC4.3 NEW CONSTRUCTION: ✓ Duct Pressurization Test Results (CFM C 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x Heating L008 Capacity in Thousands.of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or 54% at Rough -in: % [B')Sass GI Fail 100 x Line # 1) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment -Change -Out F Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. - Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. r Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) - (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if' Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage s 6% for Final 11 Pass ❑Fail 8 100 x Line # 5) / Line # 2 TEST OR VERIFICATION STANDARDS: For Altered Duct System and%or HVAC Equiprnen-t Change- ✓ ✓ Out Use one of the following four. Test or Verifiention Standnrds for compliance: 9 Pass if Leakage Percentages 15% [100 x [ (Line # 5) / (Line 4.2)]] ❑ Pass ❑ Fail 10 Pass 'if Leakage to Outside Percentage:5 10% [100 x [ (Line # 7) / (Line # 2)]] 1:1 Pass ❑ Fail Pass if Leakage Reduction Percentage >- 60% [100 x # 6) / (Line,# 4)]] _(Line ❑Pass ❑ 1 I and Verification b Smoke Test and Visual Ins Inspection .Fail 12 Pass ifSeaiing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fai I Pass if One of -Lines #.9 throw h # 12 ass ❑Pass ❑ Fail 01, 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Own at Z A I®i I I J.I>y i N (� )NL. Signature: � . 0 _ Date: . ) / J /09 Copies to: -BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDINC OWNER AT OCCUPANCY. Residential Compliance Forms Seolember 2005 A. -I- INSTALLATION CERTIFICATE (Page 4 of'12) CF -6R Site Address 5-3 3 S` P` RE M 0 -Ni -I W P- Permit Number' INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAILAGE INSTALLER COMPLIANCE STAT.EMrNT��< The building was: ✓ OTested at Final -1 IP Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: CYflemove at least one supply and one return register, and verify that the spaces between the register boot and the interior "P ishing wall are properly sealed. I f the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handier and the supply and return plenums to verif , that the connection points are properly sealed. Vnspect all joints to ensure that no cloth backed rubber adhesive duct tape is used R- ew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platformsreturns in lieu of ducts . ✓ DUCT LEAKAGE REDUCTION Procedures for field veriTcalion and diagnostic lesling of a.ir rlislribulion syslenu are available in RACM, 'Appendix RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: 9 9 Me 10 .� Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x -Heating Capacity in Thousands.of Btu/hr, enter total calculated or measured fan flow in CFIA here: ✓ ✓ Pass if Leakage Percentages 6% for Final or _< 4% at Rough -in: 3 a5 ass ❑Fail 100 x Line # 1) / (Line # 2 ALTERATIONS: Duct System and/o i• HVAC Equipment -Change- 0 ut Wisrs W". Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. - uct5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct- 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage _5 6% for Final - 13 Pass ❑Fail 8 100 x Line # 5 / Line # 2 TEST 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: 4 Pass if Leakage Percentage!!:- 15% [ 100 x ( (Line # 5) / (Line # 2)]) ❑ Pass ❑ Fail 10 Pass if. Leakage to Outside Percentage S 10%[100x [ (Line # 7) / (Line # 2)]] ❑ Pans ❑ Fai1 Pass if Leakage R>_eduction Percentage 60% [100 x `_(Line # 6) / (Line ,# 4)]] ❑ Pass ❑ Fail 11 and Verification b y Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fai I Pass if One of Lincs #.9throu h # 12 ass ❑ Pass ❑ Fai I ✓ ❑l, 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner s Z9 A I Cooc) i I I J N i N G- NL , Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCS'. Residentiol Complionce Forms September 2001 143 INSTALLATION CERTIFICATE (Page 4 of'12) CF -6R Site Address Permit Number .53 -- Lf 3 S i- RE M o -N 1 ,W P- �- TN,gTA1 J,RR COMPLIANCE STATEMENT FOR DUCT LEAFAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ OR"Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: Cl-jemove at least one supply and one return register, and verify that the spaces between the register boot and the interior, fi ishing wall are properly sealed. ER If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between (lie air handier and the supply and return plenums to verify that the connection points are properly sealed, enspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ❑'qe, w Distribution system is fully ducted (i.e., does not use building cavities as -plenums or platforms returns in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION Prnreriure.r fnr field verification rind diaPiz ostic lestinP of air distribution systenzs nre avaRnble in RACM. ADDC11db: RC4.3 NEWCONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: 6 j ; S Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x -Heating D -p0 -0 Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ 3 Pass if Leakage Percentages 6% for Final or _< 4% at Rough -in: 3, ass ❑ Fail [100x[ Line # 1) / (Line # 2)11 ALTERATIONS: Duct System and/or* HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. . dt' uch5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct- 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #4) Minus (Line # 5) - Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final $ 100 x Line # 5) / Line # 2 ❑Pass ❑Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-. ✓ ✓ Out Use one of the following fourTest or Verification Standards for compliance: 9 Pass if Leakage Percentage <_ 15% [100 z ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside -Percentage S 10% [ 100 x [_(Line # 7) / (Line # 2)]] ❑ Pass ❑'Fail Pass if Leakage Reduction Percentage >_ 60% [100 x [_(Line # 6) / (Line W 4)]] I1 and Verification by Smoke Test and Visual Inspection ❑Pass ❑ .Fail Q Pass if Scaling of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of -Lines #.9 throuVi P 12 ass ❑Pass ❑ Fail ✓ LJ 1, 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner ] N (r ) NL Signature: f D Date: J I C) 1 Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residential Compliance Forms September 2005 *14 INSTALLATION' CERTIFICATE (Page 4 of 12) CF -6R Site Address 3 3 Si FIRE M 6 -Ni T A Permil Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT ��, The building was: -/ ❑Tested at Final ✓ IJ' "l ested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: Psi cmove at least one supply and one return register, and verify that the spaces between the register'boot and the interior fi ishing wall are properly sealed. 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. enspect all joints to ensure that no cloth backed rubber adhesive duct tape is used R -I ew Distribution system is fully ducted (i.e., does not use building cavities as -plenums or platforms returns in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION Procedures forfield verification and diagnostic lestinh of n.ir distribution systems nre available in RACM, Appen&x RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: b�`�'�-$ ° 0. Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 if Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x -Heating dL1D a c7 Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or 5 4 % at Rough -in: 3 O amass ❑ Fail (100X Line # l) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out t Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage 5 6% for Final ❑Pass ❑Fail 8 100 x Line # 5 / Line # 2)11 TEST 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 . -f- 15% [ 100 x [ (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage 5 10%[100x [ (Line # 7) / (Line #2)]] ❑ Pass ❑ Fai I Pass if Leakage Reduction Percentage >— 60% [100 x (Line # 6) / (Line # 4)]] 11 and Verification b'y Smoke Test and Visual Inspection ❑ Pass ❑ .Fail 12 Pass if Sealing of al! Accessible Leaks and Verification by Smoke Test and Visual Ins ection ❑ Pass ❑ Fail Pass if One ofLines #.9 throw h # 12 ass ❑ Pass ❑ Fail ✓ ❑ 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner I sm Z A ® I )MC, Signature: Date: /,0 / . Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms. I I September 2005 AY INSTALLATION' CERTIFICATE . (Page 4 o{' 12) CF -6R Site Address �- Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT oe- Tile building was: ✓ []Tested at Final ✓ D? "Nested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: p--�emove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. ER 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 plena ns to verifi' that the connection points are properly sealed. enspect all joints to ensure that no cloth backed rubber adhesive duct tape is used [v slew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ &DUCT LEAKAGE REDUCTION Procedures for field verification and din nostic lesting o air distribution sysfems nre available in RACM, A endia: RC4.3 N.EW CONSTRUCTION: Duct Pressurization Test Results (CFM C 25 Pa) Measured Values ' I Enter Tested Leakage Flow in CFM: r� L/ Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 efm/ton x number of tons or as 21..7 cfm/(kBtu/hr.) x -Heating ae pp Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFivl here: ✓ ✓ Pass if Leakage Percentages 6% for Final or _< 4% at Rougli-in: 3 r)O [B'1Sass 171 Fail .i 100 x Line # 1) / (Line # 2 , ALTERATIONS: Duct System and/or HVAC Equipment.Change-Out Enter Tested Leakage Flow in CFM from -Pre-Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. uct5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct- 5 System for Duct System Alteration and/or Equipment Chan e -Out. r Enter Reduction in Leakage for Altered Duct System 6 (Line #'4) Minus (Line # 5) - (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage:5 6% for Final El Pass ED Fail 8 100 x Line # 5 / Line # 2)11 TEST OR VERIFICATION STANDARDS: For Altered Duct System and%or HN/AC Equiprnen•t Change - Out Use one of the following four. Test or Verification Standards for compliance: 9 Pass if Leakage Percentages 15% [10 0 x [ (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage :5 10% [ 100 x [ (Line # 7) / (Line # 2)]] C3 Pass ❑'Fail Pass if Leakage Reduction Percentage >- 60% [100 x [__(Line # 6) / (Line # 4)]] 11 and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ .Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection -1 0 Pass ❑Fail Pass if One of -Lines # 9 throw h # 12 ass IMMMJMI ❑ Pass ❑ Fail ✓ OI, 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. Installing Subcontractor (Co. Name) OR General � ^, Contractor (Co. Name).OR Owner !' Z A (� l/t�N®i I I J N (r J NC_ , Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residential Complionce Forms - Sepfeniber 2005 01 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address Permit Number INSTALLER COMPMANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STAT.E[MENT,�_., The building was: Y' ❑Tested a(Final ✓ Ly'''1'ested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: R-emove at least one supply and one return register, and verify that the spaces between the register'boot and the interior, ishing wall are properly sealed. l I r 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. enspect all joints to ensure that no cloth backed rubber adliesive. duct tape is used .2-fqew Distribution system is full), ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ FDUCT LEAKAGE REDUCTION Proredures for field verilteation and Cliagnostie lesting of air distribution systems nre available in RACM, Aopendia: RC -4-3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM C 25 Pa) Measured " ' Values I Enter Tested Leakage Flow in CFM: 1-� O; ?fid Fan Flow: Calculated (Nominal: -'❑ Cooling ✓ [IHeating) or ✓ ❑ Measured 2 if Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21..7 cfm/(kBtu/hr) x'Heating P,00 p Capacity in Thousands.of Btu/hr, enter total calculated or measured fan flow -in CFM here: I✓ ✓ Pass if Leakage Percentages 6% for Final or 5 4% at Rough -in: 3 � So IR15ass ❑ Fail 100 x Line # l) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage :5 6% for Final ❑Pass ❑Fail 8 100 x Line # S / Line # 2 TEST OR VERIFICATION STANDARDS: For Altered Duct System and%or HVAC Equipment Change- ✓ ✓ Out Use one of the following fourTest or Verification Standards for compliance: 9 Pass if Leakage Percentage 5 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage _5 10% [ 100 x [_(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100x L(Line # 6) / (Line # 4)]] El Pass ❑ 11 and Verification by Smoke Test and Visual Inspection .Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #.9 through # 12 pass ❑ Pass ❑ Fail ✓ ❑ 1, (lie 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner I sL Z� A I � i i I N) N G- ) NL . Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Res•idenliol Complionce Forms September 2005 Ari INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT�� The building was: ✓ ❑Tested at Final v/Eb- "Nested al Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: P -f emove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. IP 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. P'Tnspect alljoints to ensure that no cloth backed rubber adhesive duct tape is used Rlrqew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ' ✓ DUCT LEAKAGE REDUCTION Procedures for field verij<cation and rlignostic testing of n.ir distribution systenis nre available in RACM, Appendix: RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM C 25 Pa) Ivfeasured 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 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x -Heating Zoo p Ca act , in Thousands.of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or _< 4% at Rough -in: 3 S' amass E) Fail 100 x Line # l) / (Line # 2 —3 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change-Out.low.' Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Chan e-OUt. r Enter Reduction in Leakage for Altered Duct System 6 (Line # 4) Minus (Line # 5) — (Only if Applicable) low - 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final ❑Pass ❑Fail 8100 x Line # 5 / LLine # 2 TEST 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 <_ 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10' Pass if Leakage to Outside Percentage _< 10% [ 100 x [_(Line # 7) / (Line # 2)]J ❑Pass ❑Fail Pass if Leakage Reduction Percentage >_60% [100 x f(Line # 6) / (Line # 4)]] ❑ Pass ❑ I 1 and Verification b Smoke Test and Visual Inspection 1 .Fail 12 Pass ifsealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection ❑ Pass ❑ Fail Pass if One of -Lines #.9 throw h # 12 pass 111j16=1 ❑ 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Zg A I ?, CO)4®i'I ION) N (T J NL , Signature: v D- __ Date: 1,o lo I 0 cl Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residenlial Compliance Forms Seplember 2005 F;j INSTALLATION CERTIFICATE (Page 4 of'12) CF -6R Site Address Permit Number S3- LJ 3S 1=RE 01� I WA INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKLAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ rested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: P-1�emove at least one supply and one return register, and verify that the spaces between the register boot and the interior lijiishing wall are properly sealed. 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. Vnspect all joints to ensure that no cloth backed rubber adhesive duct tape is used R'�lew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts), ✓ tJ DUCT LEAKAGE REDUCTION Procedure.- for field verification and diagnostic testing of air distribution svVenu nre availnbie in RA CM, Appendix: RC4 N -EW CONSTRUCTION: ✓ Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 if Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21..7 cfm/(kBtu/hr) x Heating �OdO Ca iaci , in Thousands of Btu/hr, enter total calculated or measured fan flow -in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or _< 4% at Rough -in: 3 ass El Fail [100x[ Line # l) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out F Enter Tested Leakage Flow in CFIA from Pre -Test of Existing Duct System Prior to Duct 4—System Alteration and/or Equipment Change -Out.. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duch S System for Duct System Alteration and/or Equipment Chan e-OUt. Entet Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) - (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage:5 6% for Final - ❑ Pass ❑ Fail 8 100 x Line # 5 / Line # 2)11 TEST OR VERIFICATION STANDARDS: For Altered Duct System and%or HN/AC Equipmenyt Change-. ✓ ✓ Out Use one of the following four Test or Verificntion Standards for compliance: 9 Pass if Leakage Percentages 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside -Percentage. s 10% [100 x [ (Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >- 60% [100 x (Line #6)/_ (Line,# 4)]] El Pass ❑ 11 and Verification by Smoke Test and Visual Inspection .Fail 12 Pass ifSealing of all Accessible.Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #. 9 tiirou ii #i 12 ass ❑ Pass ❑ Fail 111, 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owners Signature: Date: O Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) DUILDING OWNER AT OCCUPANC)'. Residential Compliance Forms I September 2005 9 INSTALLATION CERTIFICATE (Page 4 oi' 12) CF -6R Site Address Permit Number S3 3S` F e o� i W� INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STAT.GMENT,. The building was: ✓ ❑Tested at Final ✓ &** Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL'CDNSTRUCTION STAGE: R -remove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. Ile] f 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. enspeel all joints to ensure that no cloth backed rubber adhesive duct tape is used Hew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ &DUCT LEAKAGE REDUCTION Procedures forrield verification and diagnostic lesting o a.ir distribution systenis nre ovailable in RACM, Appendix RC4.3 REW CONSTRUCTION: Duct Pressurization Test ilesults (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x Heating Capacity in Thousands.of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or s 4% at Rough -in: amass ❑Fai l 100 x Line # 1) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment -Change -Out t Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to -Duct 4 System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct E- 5 System for Duct System Alteration and/or E ui ment Change -Out. . Enter Reduction in Leakage for Altered Duct System 6 (Line #'4) Minus (Line # 5)] —(Only if Applicable) -, 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final - ❑ Pass ❑ Fail 8 100 x Line # 5 / Line # 2 TEST 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 f5 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentages 10% [100 x [_(Line # 7) / (Line # 2)]] ❑ Pans ❑ Fail Pass if Leakage Reduction Percentage >t 60% [ 100 x _(Line # 6) / (Line # 4)]] p Pass ❑Fai I 1 I and Verification b Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection ❑ Pass ❑ Fai I Pass if One of -Lines #.9 through # 12 pass ❑ Pass ❑ Fail ✓ 1, the undersigned, verify that the above diagnostic lest 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. lnstallirtg Subcontractor (Co, Name) OR General Contractor (Co. Name) OR Ownert�"R�l Z� A I K CoJD mo N 1 N Cr I NL . Signature: j p_ _ I Date: 1,ololloq Copies to: BUILDING DEPARTMENT, HERS RATER (IFAPPLICABLE) BUILDING OWNER AT OCCUPANCY. Residentiol Compliance Forms September 2005 ,0 INSTALLATION CERTIFICATE (Page 4 of'12) CF -6R Site Address Permit Number S 3 -5t= RE 0) 1 (� A INSTALLER COMPLIANCE STATE MENTT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATE MENT,.� The building was: -/❑Tested at 0? Final ✓ "tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: remove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. I f 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. Vnspecl all joints to ensure that no cloth backed rubber adhesive duct tape is used P-IJew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returris in lieu of ducts). . ✓ DUCT LEAKAGE REDUCTION Procedures for field verification and dfa nostic testing of air distribution sys/enu• nre available in RACM, A en(Ex RC4.3 NEW CONSTRUCTION: ✓ Duci Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21..7 cfm/(kBtu/hr) x Heating /16o6, Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFIA here: ✓ ✓ Pass if Leakage Percentages 6% for Final or –5 4% at Rough -in: 3—So O [B'Isass ❑Fail 100 x Line # 1) / (Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment -Change -Out. = F' Enter Tested Leakage Flow in CFIA from -Pre-Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct S System for Duct System Alteration and/or Equipment Chan e -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) – (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage –< 6% for Final --10 8 100 x Line # 5) / Line # 2 Pass ❑Fail TEST 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 f: 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass 'if. Leakage to Outside Percentage :< 10% [ 100 x [_(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fait Pass if Leakage Reduction Percentage >– 60% [100 x (_(Line # 6) / (Line # 4)]] 11 and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ .Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines #.9 throw h # 12 pass ❑Pass ❑ Fail El 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 witli Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner s Z9 A i R, Co�®Fri J m N (f NL Signature: 17j D I Date: 1,o lo / O 7 Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residential Compliance Forms September 2005 INSTALLATION CERTIFICA'T'E . (Page 4 of 12) CF -6R Site Address Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ tom' "tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: C3-(emove at least one supply and one return register, and verify that the spaces between the register'boot and the interior fi ishing wall are properly sealed. If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handier and the supply and return plenums to verify that the connection points are properly sealed. Vnspect all joints to ensure that no cloth backed rubber adhesive duct tape is used R'fq'ew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION PrnrP/lnrPC fnr bald veriTirntinn rind dinpnn.ctir lesling ofnir r/i.rlribnlion syslenu nre available in RACM.'Annnndiy R('.1 ; NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM:Cl r' '° Fan Flow: Calculated'(Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x Heating Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFK4 here: ✓ ✓ Pass if Leakage Percentages 6% for Final or _< 4% at Rough -in: Q 3, /c a 91 ass ❑ Fail 100 x Line # 1) / (Line # 2) ALTERATIONS: Duct System and/or HVAC Equipment Change -Out =. Enter Tested Leakage Flow in CFIA from Pre -Test of Existing Duct System Prior to Duct 4—System Alteration and/or Equipment Change -Out.' uch5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct- 5 System for Duct System Alteration and/or Equipment Change -Out. Entet Reduction in Leakage for Altered Duct System 6 f (Line #-4) Minus (Line # 5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage s 6% for Final - ❑Pass ❑Fail 8 100 x Line # 5) / 'Line # 2)11 TEST OR VERIFICATION STANDARDS: For Altered Duct System and%or HNIAC Equipment Change - Out Use one of the following four.Test.or Verification Standards for compliance: g Pass if Leakage Percentage :5 15% [100 x [ (Line # 5) / (Line # 2)]) ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage s 10%[)00x [ (Line # 7) / (Line #2)]] ❑ Pass ❑'Fail Pass if Leakage Reduction Percentage >_ 60% [100 x (Line # 6) / (Line ,# 4))] 11 and Verification by Smoke Test and Visual Inspection ❑Pass ❑ .Fail 12 Pass ifSealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection❑ Pass ❑ Fail ., Pass if One of Lines #, 9 throw -1, # 12 pasl= ❑ Pass ❑ F a i I ✓ ❑l, 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. Installing Subcontractor (Co. Name) OR General � ^, Contractor (Co. Name) OR Owner-� Z� A I (� �N®1 I I J N 1 N (f )AC , Signature: D Date: /0/0//09 Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) DUILDINC OWNER AT OCCUPANCy. Residential Compliance Forms Seplember 2001 /A INSTALLATION CERTIFICATE . (Page 4 of 12) CF -6R Site Address Permit Number 5-3 L' 3 RE W A INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT,. The building was: ✓ ❑Tested at Final ✓ 1rJ' "Nested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: -lemove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. ER 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 plena ns to verify that the connection points are properly sealed. Vnspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ©'fgew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION Procedures for /teld verification and diaPnostic lestirro o%air distribution svrlenn are available in R4CM, Appendix: RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured "a ; Values' I Enter Tested Leakage Flow in CFM: 14-3 Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Ivleasured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x -Heating O Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final ors 4% at Rough -in: -13,S5 OR11ass ❑ Fail 100 x Line # l) / (Line # 2)]] ALTERATIONS: Duct System and/o i" HVAC Equipment Change -Out Enter Tested Leakage Flow in CFIv1 from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. - Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 (Line #'4) Minus (Line # 5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentages 6% for Final ❑ Pass ❑ Fail 8 100 x Line # 5) / Line # 2)11 TEST 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 Percentages 15% [100 x ( (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage _< 10%[100 x ( (Line # 7) / (Line # 2)]] C1Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x # 6) / (Line # 4)]] 11 _(Line and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ ,Fail 12 Pass ifSealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection ❑ Pass ❑ Fail Pass if One of Lincs #.9 throw h # 12 pass ❑ Pass ❑ Fail ✓ ❑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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner -Z—c- A I S CoND i i I o N 1 N (r J NL Signature: Date: ID,D / Za Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residential Compliance Forms September 2005 A /3 INSTALLATION CI;RTIFICATI; (Page 4 of 12) CF -6R Site Address 53 3S` rRE M 04,i —i WP - Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAI'AGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ trJ'-Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: R*d-emove at least one supply and one return register, and verify that the spaces between the register boot and the interior fi ishing wall are properly sealed. 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 plena ns to verify that the connection points are properly sealed. enspeci all joints to ensure that no cloth backed rubber adhesive duct tape is used R_�e'w Distribution system is fully ducted (i.e., does not use building cavities as plenuins or platforms returgs in lieu of ducts). ✓ DUCT LEAKAGE REDUCTION PrnrnlltlNdC lar field verification and dinenostic testing of air distribution systenis nre availnble in RACM, AoDen(Lx RC4.3 REW CONSTRUCTION: ✓ Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 2 L cfm/(kBtu/hr) x'Heating ,3a p o . Ca aci in Thousands.of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentages 6% for Final or -< 4% at Rough -in: 3 -SCD amass ❑Fail 100 x Line # t / (Line # 2 • ALTERATIONS: Duct System and/or HVAC Equipment -Change -but Enter Tested Leakage -Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or.Equipment Change -Out. - Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -01.1t. Enter Reduction in Leakage for Altered Duct System 6 (Line #-4) Minus (Line # 5) - (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final ❑ Pass ❑ Fail 8 100 x Line # 5) / Line # 2)11 TEST 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 <- 15% [100 x [ .(Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage:5 10%[100 x [_(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >- 60% [100 x [(Line # 6) / (Line # 4)]j El Pass ❑Fail 11 and Verification by Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of -Lines #.9 through # 12 pass ❑ Pass ❑ Fail El I, 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner-� -z-9 A I®Fri J N) N (Y ' NL . Signature: D _ Date; Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY. Residenlial Compliance Forms September 2005 0 INSTALLATION CERTIFICATE (Page 5 of 12) GF -6R Site Address 5 3-Lf35 FIZEly,QNi W Permit Number ✓ L'7. THERMOSTATIC EXPANSION VALVE (TXV) Procedures for f eld veri_ fication of thermostatic expansion. valves are available in RA CM, Appendix RI. ✓ ✓ Access is provided for inspection. The procedure shall Location consist of visual verification that the TXV is installed on Outdoor Unit Make OF �_!! ✓ 1�r es ❑ No the system and installation of the specific equipment El Cooling Capacity shall be verified. Btu/hr Date of Verification Yes is a ass 1.Pass I Fail OF ✓ E] REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Tretum, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator, sat) Suction line temperature (Tsuction, dbj Btu/hr Date of Verification Condenser (entering) air dry-bulb temperature (Tcondenser, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): )rocedures for Determining Refrigerant Charge using the Standard Method are available in R4 CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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) Suction line temperature (Tsuction, dbj OF OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, A — Tevaporator, sat OF Target Superheat (from Table RD72) OF Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow Split Method Calculation is not necessan; ifAdequate AirJloN, 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms April 2005 ),S� ;)- INSTALLA'T'ION CERTIFICATE (Page 5 of 12) CF - Site Address Permit Number ' ✓ L" I THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion, valves are available in RA CM Appendix RI. ✓ ✓ ✓ El 'REFRIGERANT CHARGE MEASUREMENT , Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make consist of visual verification that the TXV is installed on Outdoor Unit Model �� ✓ [Er es ❑ No the system .and installation of the specific equipment ❑ . Date of Verification Suction line temperature (Tsuction, db) sliall be verified. OF (must be checked monthly) Date of Thermocouple Calibration Yes is a ass' Pass I Fail ✓ El 'REFRIGERANT CHARGE MEASUREMENT , Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dr) -bulb 55°F and above): )rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 temperafure (Tretorn, wb) OF Evaporator saturation temperature (Tevaporator; sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RDr2) OF Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow S lit Method Calculation is not necessa>7, ifAde uate Air flow 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms April 2005 )§�3 INSTALLATION CERTIFICATE (Page 5 of 12) GF -6R Site Address S' 3-LI3S �FA�0I► WP- Permit Number ✓ LJ TH l; MOSTATIC RXPANSION IIALVE (TXV) Procedures, for f eld verification of thermostatic expansion. valves are available in RA CM, Appendix: RI. ✓ ✓ ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Return (evaporator entering) air dry-bulb temperature (Tretum, db) Outdoor Unit Make OF Outdoor Unit Model consist of visual verification that the TXV is installed on Cooling Capacity Evaporator saturation temperature (Tevaporator; sat). .�� V/L7Yes ❑ No the system and installation of the specific equipment IB-_" ❑ °F (must be checked monthly) Date of Thermocouple Calibration shall be verified. (must be checked monthly) Yes is a pass IPass Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Tretum, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat). Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration °F (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charize Measurement Procedure (outdoor air dry-bulb 55°F and above): )rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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) °F Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charee Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RD72) OF Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow Split Method Calculation is riot necessary ifAdequate Airflow 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Fonns April 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address S' 3-435 Em Lj Permit Number JI V V. ETHERMOSTATIC EXPANSION VALVE (TXV) Pi ocedures for f eld verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ ✓ ✓ ❑ 'REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatic Exnansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) consist of visual verification that the TXV is installed on OF Y/[� �� es ❑ No the system and installation of the specific equipment ❑ Evaporator saturation temperature (Tevaporator, sat) shall be verified. Date of Verification Suction line temperature (Tsuction, db) Yes is a pass Pass Fail ✓ ❑ 'REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatic Exnansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator, sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration °F (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .)rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured •Temoeratures 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 (Tevaporator, sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) °F Suoerheat Charge Method Calculations for Refrigerant Charee Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RDr2) OF Actual Superheat — Target Superheat. (System passes if between -5 and +57). OF Temperature Split Method Calculations for Adequate Airflow .Snlit Arfethnrl Calrulntinn k not nere.c.rnnr ifAdenunte Air•fTnw rr-nrlit is tnlran 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 - ' : 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F OF Residential Compliance Forms Apri12005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Permit Number 3,—L135 F)z,L� 0 NT W I'► �2 ✓ E THERMOSTATIC EXPANSION VALVE (TXV) Procedures.for f eld verification of thermostatic expansion valves are available in RACj1f Appendix RI. ✓ El REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Exnansion Valves ' Outdoor Unit Serial # Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) consist of visual verification that the TXV is installed on °F ✓ �� [r es 0 No the system and installation of the specific equipment ❑ Evaporator saturation temperature (Tevaporator, sat) shall be verified. Date of Verification Suction line temperature (Tsuction, db) Yes is a pass I Pass Fail ✓ El REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Exnansion Valves ' Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make °F Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator, sat) Btu Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charl4e Measurement Procedure (outdoor air dry-bulb 55°F and above): )rocedures for Determining Refrigerant Charge using the Standard Method are available in R,4 CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving).air dry-bulb. temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Treturn, .db) °F Return (evaporator entering) .air wet -bulb temperature (Tretorn, wb) OF Evaporator saturation temperature (Tevaporator, sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charee Actual Superheat = Tsuction, db — Tevaporator, sat °F Target Superheat (from Table RDr2) OF Actual Superheat'— Target Superheat (System passes if between 5 and +5'F) OF Temperature Split Method Calculations for Adequate Airflow Solif Method Calculation is not necessary ifAdeounte .4irflnw rrpdif is tnkvn 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F. of Residential Compliance Forms Apri12005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address 3—Ll35 P ermit Number ✓ L1. THERMOSTATIC EXPANSION VALVE (TXV) Procedures.for f eld verification of thermostatic expansion. valves are available in PZA CM, Appendix RI. ✓ ✓ ✓ ❑ 'REFRIGERANT CHARGI; MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) consist of visual verification that the TXV is installed on OF �.� V/[Er es ❑ No the system and installation of the specific equipment ❑ Evaporator saturation temperature (Tevaporator; sat) shall be verified. Date of Verification Suction line temperature (Tsuction, db) Yes is a pass I Pass Fail ✓ ❑ 'REFRIGERANT CHARGI; MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charye Measurement Procedure (outdoor air dry-bulb 55°F and above): ,irocedures for Determining Refrigerant Charge using the Standard Method are available in R4 CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 (Tevaporator; sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat 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 Method Calculation.is not necessary ifAdequate Airflow 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Fotms April 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address 5 3-435�oav� WI�- Permit Number ✓ ETH.ERMOSTATIC EXPANSION VALVE (TXV) procedures, for f eld verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ ✓ Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) consist of visual verification that the TXV is installed on OF Outdoor Unit Model �� ✓ 1JYes ❑ No the system and installation of the specific equipment Evaporator saturation temperature (Tevaporator; sat) ❑ Date of Verification shall be verified. Date of Refrigerant Gauge Calibration OF (must be checked monthly) Yes is a pass Pass I Fail ✓ 0 REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btullu Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .)rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 (Tevaporator; sat) °F Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat 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 Method Calculation is not necessary ifAdequate Au floN 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 37 and +3'F or, upon remeasurement, if between -3'F and -100°F Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page S of 12) GF -6R Site Address 3 - L13 S Permit Number ✓ B"THERMOSTATIC EXPANSION VALVE (TXV) Procedures_for f eld verification of thermostatic expansion valves are available in R4 CM, Appendix Rl. ✓ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatir. F.xnanSion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure. shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make consist of visual verification that the TXV is installed on Outdoor Unit Model ��!! ✓ Ey- es ❑ No the system and installation of the specific equipment Btulhr ❑ Suction line temperature (Tsuction, db) shall be verified. OF (must be checked monthly) Date of Thermocouple Calibration Yes is a pass Pass Fail ✓ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatir. F.xnanSion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btulhr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration °F (must be checked monthly) Standard CharjZe Measurement Procedure (outdoor air dry-bulb 55°F and above): .procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 (Tevaporator; sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) °F Superheat Charge Method Calculations for Refrigerant Charee Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RDr2) OF Actual Superheat— Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow .Snlit Uethnd Cnlrulntinn i.c not neca.c.cnry ifAdenunta Air/7nu, r•rndit is tnknn 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'- 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms Apri12005 INSTALLATION CERTIFICATE (Page 5 of 12) GF -6R Site Address Permit Number ✓ ETHERMOSTATIC EXPANSION VALVE (TXV) Procedures_for f eld verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ ✓ Access is provided for inspection, The procedure shall Location consist of visual verification that the TXV is installed on Outdoor Unit Make °F �.� V/[7 es ❑ No the system and installation of the specific equipment ❑ Cooling Capacity shall be verified. Btu/hr Date of Verification Yes is a pass I Pass I Fail °F ✓ ❑ 'REFRIGERANT CHARGI; MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make °F Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration °F (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .)rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving).air dry-bulb. temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Treturn, .db) °F Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporator; sat) OF Suction line temperature (Tsuction, db) °F Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charize 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 Method Calculation is not necessary ifAdequate Airflow 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 _ 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F OF Residential Compliance Forms April 2005 )*§k 6 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address S 3-435 -�O�i W/'► - Permit Number 1 ✓ B'THERMOSTATIC EXPANSION VALVE (TXV) Procedures_for f eld verification of thermostatic expansion, valves are available in RA CM, Appendix RI. ✓ ❑ 'REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatic Exnansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF consist of visual verification that the TXV is installed on ✓ L'JYes ❑ No the system and installation of the specific equipment ❑ Suction line temperature (Tsuction, db) . Date of Refrigerant Gauge Calibration shall be verified. (.must be checked monthly) Date of Thermocouple Calibration °F Yes is a pass Pass Fail ✓ ❑ 'REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermnstatic Exnansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) . Date of Refrigerant Gauge Calibration OF (.must be checked monthly) Date of Thermocouple Calibration °F (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .yrocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 (Tevaporator; sat) OF Suction line temperature (Tsuction, db) . OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) °F Superheat Charee Method Calculations for Refrieerant Charee Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RDr2) OF Actual Superheat — Target Superheat (System passes if between -5 and +5'F) OF Temperature Split Method Calculations for Adequate Airflow ,Snlit Afe[hnd Cnlrulnfinn k not norecsnry ifAdanvnfa Airtlnw rrorlif is intron 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -1007 of Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Peanit Number ✓ R THERMOSTATIC EXPANSION VALVE (TXV) Procedures.for f eld verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ ❑ 'REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF consist of visual verification that the TXV is installed -on ✓ t+� 1'es ❑ No the system and installation of the specific equipment ❑ Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration shall be verified. (must be checked monthly) Date of Thermocouple Calibration OF Yes 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 Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, .db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (T evaporator,' sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration °F (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .)rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures 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 (Tretum, wb) OF Evaporator saturation temperature (T evaporator,' sat) OF Suction line temperature (Tsuction, db) °F Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat 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 Method Calculation is not necessary ifAdequate Airflow 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F OF Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address 5 3- y 3 S �1Z.e� o W /�- Permit Number J ✓ B THERMOSTATIC EXPANSION VALVE (TXV) Procedures.for field verification of thermostatic expansion valves are available in RA CM, Appendix RI. Access is provided for inspection. The procedure shall Location consist of visual verification that the TXV is installed on Outdoor Unit Make OF ✓ LrT �' es ❑ No the system and installation of the specific equipment ❑ shall be -verified. Btu/hr Date of Verification Yes is a pass I Pass Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Tretorn, .db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporatorl sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): .)rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving).air dry-bulb. temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Tretorn, .db) OF Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporatorl sat) °F Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Suoerheat Charee Method Calculations for Refrigerant Charee 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 Method Calculation is not necessary ifAdequate Airflow 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms April 2005 )1�5 /3 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address -45 3—Ll35 -F-9�orj WR, Permit Number 'I ✓ EfJ THERMOSTATIC EXPANSION VALVE (TXV) Procedures.for field verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ 0 REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermostatic Expansion Valves Outdoor Unit Serial # Access is provided for inspection. The procedure shall Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) consist of visual verification that the TXV is installed on OF �� V/li es ❑ No the system and installation of the specific equipment ❑ Evaporator saturation temperature (Tevaporator; sat) shall be verified. Date of Verification Suction line temperature (Tsuction, db) Yes is a ass Pass F75il ✓ 0 REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems -without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator; sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): )rocedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving).air dry-bulb. temperature (Tsupply, db) °F Return (evaporator entering) air dry-bulb temperature (Treturn, db) OF Return _(.evaporator entering) air wet -bulb temperature (Tretorn, wb) °F Evaporator saturation temperature (Tevaporator; sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Suoerheat Charee Method Calculations for Refrigerant Charee 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 Airllow S lit Method Calculation is not necessaryffAde uate Airfloiv 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 - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RA CM, Appendix RE3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes Measured Fan Watt Dram: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ ✓ ❑ Yes ❑ No Measured fan watt draw is equal to'or lower than the fan watt drawdocumented in CF -1R 0 ❑ ❑ No Duct design exists on plans Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION PrnrBfl7/YB.0 fnr mpnmrina the nirflnw pre available in RACM Annendix RE,3.1. ✓Method For Airflow Measurement ✓ I []Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ No ❑ Yes ❑ No Duct design exists on plans ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1R. ❑ ❑ Yes to 1,-2, and 3; and Yes to either 4 or 5 is a pass Pass Fail Measured Airflow: ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass I Pass Fail ✓ .❑ MAXIMUM COOLING CAPACITY Procedures for determining maximum cooling load capacity are available in RA CM. Appendix RF3. Watts cfm/ton 1 ✓ I []Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV Duct leakage reduction credit verified 3 ✓ ❑ Yes ❑ No 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are:5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1R. ❑ ❑ Yes to 1,-2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓21HIGH EER AIR CONDITIONER Procedures or veri ication are. available in RA CM, A endix RI. I ✓ [3.'1'68 ❑ No EER values of installed systems match the CF -1R 2 ✓ [ides ❑ No For split system, indoor coil is matched to outdoor coil ✓ ✓ 3 9i'Yes ❑ No Time Delay Relay Verified (If Required) [a ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner TZ0&ZI= AI K CONo I TI 0--N I NC Signature: Date: D /Of d % Copies to:'BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix RE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow -Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan. Flow Using Plenum Pressure Matching ❑ Yes ❑ ✓ ❑Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ ❑ No Duct design exists on plans Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnredure.r for measuring the airflow are available in RACM ADDendix RE3.1. ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow -Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan. Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Dia ostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑ Yes ❑ No Duct design exists on plans ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical'in ut in the CF- I R. .❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a ass Pass Fail Measured Airflow: ✓ ✓ ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determining maximum cooling load caoacity are available in RA CM ADnendix RF3. Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF- lR and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical'in ut in the CF- I R. .❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a ass Pass Fail ✓21HIGH EER AIR CONDITIONER Procedures for verification are. available in RA CM, A endix RI. 1 ✓ C''es ❑, No EER values of installed systems match the CF -1R 2 ✓ 9?'7es ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ M'Yes ❑ No Time Delay Relay Verified (If Required) [✓] ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass I Fail Installing Subcontractor (Co. Name) OR -General Contractor (Co. Name) OR Owner f� �Zl= AIR �5>!�I Q I TI 0--N I ly Signature: Date: - /0/61 d Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 * 3 ,.INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address . Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix AE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2:2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ✓ ❑Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -IR ❑ ❑ Cooling capacities of installed systems are S to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnrp,-J7/YP.R fn?- mpnsurino the nirflnw nrp nvailahle in RACM ADnendix RE3.1. ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement Duct leakage reduction credit verified ❑ Yes ❑ No Duct design exists on plans ❑ No Cooling capacities of installed systems are S to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical in ut in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 of 5 is a pass Measured Airflow: Fail ✓ ❑Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for determining maximum cooling load capacity are available in RA CM, Appendix RF3. Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified,(see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are S to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical in ut in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 of 5 is a pass Pass Fail ✓2RIGH EER AIR CONDITIONER Procedures for verification are available in RACM, Appendix RI. 1 ✓ RrYes I❑ No EER values of installed systems match the CF -1R 2 ✓ l?es ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ 9�-Yes ❑ No Time Delay Relay Verified (If Required) ' [v] ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner T>ZAEZZE P',I C -OV -01 TI 7SN ly L 1 NC Signature: Date: - /()/61 d Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 1 INSTALLATION CERTIFICATE (Page 8 of. 12) CF -6R I Site Address Permit Number' ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix RE3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ✓ ✓ ✓ ❑Yes ❑ No Measured fan watt.draw is equal to or lower than the fan watt draw documented in CF -IR ❑ ❑ Cooling capacities of installed systems are 5 to maximum cooling capacity indicated on the Performances CF -1R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnredure.c for men.cvrina the airflow are available in RACM. ADDendU RL3.1. ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑ Yes ❑ No Duct design exists on plans Cooling capacities of installed systems are 5 to maximum cooling capacity indicated on the Performances CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF- I R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Measured Airflow: Fail ✓ ❑ Yes d No Measured airfiow'is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determining maximum cooling Inad capacity are available in RA CM Annendix RF3 Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are 5 to maximum cooling capacity indicated on the Performances CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF- I R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓01HIGH EER AIR CONDITIONER Procedures or verification are.available in RACM, Appendix RI. 1 ✓ C"1 Yds ❑ No EER values of installed systems match the CF -1R 2 ✓ lues ❑ No . Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ 5?Yes ❑ No Time Delay Relay Verified (If Required) [� ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner P's! (Z CO -N-0 0 ITI isle 11y NC Signature: Date: 1 d % Copies to. -'BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 * S INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix AE -3.2. ✓ Method For Fan Watt Draw Measurement TT ce—z- P'sI K CZN Q 1 TI DTIN- ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 UtilityRevenue Meter Measurement Diagnostic Fan Flow -Using Flow Capture Hood Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Dia ostic Fan Flow Using ✓ ❑Yes d No Measured fan watt.draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnredure.r in?- menxurinv the airflow are available in RACM Annendix RE3.1. ✓Method For Airflow Measurement TT ce—z- P'sI K CZN Q 1 TI DTIN- Signature: ❑ RE4.1.1 Diagnostic Fan Flow -Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Dia ostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑ No Duct design exists on plans Measured Airflow: ✓ ❑ Yes ❑ No Measured airflow'is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determinin maximum cooling load capacity are available in RA CM, Appendix RF3. 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified Watts cfm/ton 4 ✓ D Yes ❑ No Cooling capacities of installed systems are _< to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. If the cooling capacities of installed systems are > than maximum 5 ✓ D Yes ❑ No cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass I Fail ✓Q'(HIGH EER AIR CONDITIONER Procedures or veri ication are.available in RA CM, A endix RI. 1 ✓ ©'Yes ❑ No EER values of installed systems match the CF -1R 2 ✓ lames ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ❑ No Time Delay Relay Verified (If Required) [a ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail 'Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner TT ce—z- P'sI K CZN Q 1 TI DTIN- Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 RE INSTALLATION CERTIFICATE (Page 8 of. 12) CF -6R Site Address Permit Number 1 ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt dram) are available in RACM, Appendix RE -3.2. Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE4.1.1 Diagnostic Fan Flow -Using ❑ RE3.2.2 Utility Revenue Meter Measurement ❑ RE4.1.2 Measured Fan Watt Draw: Plenum Pressure Matching 3 ❑ RE4.1.3 Diagnostic Fan Flow Using ✓ ❑ Yes ❑ No Measured fan watt .draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prarpdure.c for mancvrina the nirilow are nvoilahle in RACM .Annendix RF -3-1 _ ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow -Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching 3 ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement 4 ❑ Yes ❑ No Duct design exists on plans Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be S to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Measured Airflow:. ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for determining maximum cooling load cavacity are available in RA CM. ADnendix RF3. Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) Refrigerant charge or TXV 2 ✓ ❑ Yes ❑ No 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be S to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail -,/2'HIGH EER AIR CONDITIONER Procedures or verification are.available in RA CM, A endix RI. 1 ✓ ©'rYes ❑ No EER values of installed systems match the CF -1R 2✓ lues ❑ No .Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ 9e ,Yes ❑ No Time Delay Relay Verified (If Required) [v] ❑ Yes to I and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner � i � '�ZCS hl (Z x,61!` 0 IT I ZJ-ly I Signature:ou") Date: j D /D/ p % Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of. 12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt dram) are available in RACM, Appendix RE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using ❑ RE3.2.2 Utility Revenue Meter Measurement ❑ RE4.1.2 Diagnostic Fan Flow Using Measured Fan Watt Draw: Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _< to maximum cooling capacity indicated on the Performance's CF- 1RR and RF -3. ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ✓ ❑Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ ✓ ❑ Yes Yes is a pass 1 Pass Fail ✓ ❑ ADEQUATE AIRTLOW VERIFICATION Procedures for measurine the airRom, are available in RA CM, Appendix RE3.1. -/'Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _< to maximum cooling capacity indicated on the Performance's CF- 1RR and RF -3. ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement 4 ❑ Yes ❑ No Duct design exists on plans 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ V cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical 'in ut in the CF -IR. •❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail Measured Airflow: ✓ ❑ Yes ❑ No Measured airflow'is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for dP.tPrminina maximum cnolinn load canacity are available in RAC -M- Annendix RF? Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _< to maximum cooling capacity indicated on the Performance's CF- 1RR and RF -3. 3 ✓ ❑ Yes ❑ No 4 ✓ ❑ Yes ❑ No 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ V cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical 'in ut in the CF -IR. •❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓CYHIGH EER AIR CONDITIONER Procedures for verification are. available in FA CM, A endix RI. 1 ✓ R* Yes ❑ No EER values of installed systems match the CF -1 R 2 ✓ lames ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ' C5'Yes ❑ No Time Delay Relay Verified (If Required) [] ❑ Yes to I and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner 1�'b" -Z-r . A l K CZKO I TI 6-N I ly NC Signature: Date: /0 /01 O cJ Copies to: BUILDING DEPARTMENT; HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 0 .INSTALLATION CERTIFICATE (Page 8 of.12) CF -.6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measurinn the air handler watt dram, are available in RA CM, Appendix: RE -3.2. ✓ Method For ran Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ✓ ✓ ✓ ❑ Yes ❑ No Measured fan watt.draw is equal to or lower than the fan watt draw documented in CF -IR ❑ ❑ ❑ No Duct design exists on plans Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION PrnCpll)/Yp.Q for rnpncvrina the nir/lnw nre nvnilnhle in RACM Annendix RE3.1. ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑Yes ❑ Yes ❑ No Duct design exists on plans ✓ . ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical'in ut in the CF -1R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail Measured Airflow: ✓ ❑Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determining maximum cooling load capacity are available in RA CM. Appendix RF3. Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 v/ ❑Yes ❑ No Cooling capacities of installed systems are _< to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. 5 ✓ . ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical'in ut in the CF -1R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓21HIGH EER AIR CONDITIONER Procedures or verification are. available in RA CM, Appendix RI. 1 ✓ ErYes ❑ No EER values of installed systems match the CF -1R R. 2 ✓ —OPes ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ Ui�'Yes ❑ No Time Delay Relay Verified (If Required) [v] ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner � "�� ij rz CO-NO IT) 6 -Ni Fy 1 NC - Signature: Date: 1 o /(51 O Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 00 .'INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix RE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood []Yes Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ ✓ ❑ Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ ❑ No Duct design exists on plans Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION PYnredurP.P for mea.curino the airflow are available in RACM ADDendix RE3.1. ✓Method For Airflow Measurement ✓ []Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood []Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ No ❑ Yes ❑ No Duct design exists on plans ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail Measured Airflow: ✓ ❑Yes ❑ No Measured airflow'is greater than the criteria in Table RE -2 ✓ ✓ is a ass ❑ Pass [IYes Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Prnredures fnr datermininv maximum rnnlino load caoacity are available in RA CM Annendix RF3_ Watts cfm/ton . 1 ✓ []Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ []Yes ❑ No Refrigerant charge or TXV Duct leakage reduction credit verified . 3 ✓ ❑ Yes ❑ No 4 ✓ 11 Yes ❑ No Cooling capacities of installed systems are _< to maximum cooling ca acity indicated on the Performance's CF -IR and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓CYHIGH EER AIR CONDITIONER Procedures for verification are.available in RA CM, Appendiz RI. 1 ✓ 18 Yes ❑ No EER values of installed systems match the CF -1 R 2 ✓ lues ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 1k'Yes ❑ No Time Delay Relay Verified (If Required) 2 ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner I< Ps,I K (✓6N 0 I TI OTIN ly NC Signature: 12"Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 *10 .INSTALLATION CERTIFICATE (Page 8 of. 12) CF -6R Site Address Permit Number ,i ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt dram) are available in RA CM, Appendix RE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE 3.2.-2 Utility Revenue Meter Measurement Diagnostic Fan Flow -Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes ✓ ✓ ✓ ❑Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CFAR ❑ ❑ Cooling capacities of installed systems are:5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnrarl —pv fn,- monciirina Iho nirilnw nre nvnilnhle in RACM .Annendix RF3_ l ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow -Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑ No Duct design exists on plans 4 ✓ ❑Yes ❑ No Cooling capacities of installed systems are:5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No. If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be 5 to electrical 'input in the CF -1 R. ❑ ❑ Measured Airflow: Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determining maximum cooling load capacity are available in RA CM ADoendix R.F'3. Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3. ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑Yes ❑ No Cooling capacities of installed systems are:5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No. If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be 5 to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓ HIGH EER AIR CONDITIONER Procedures or verification are.available in RA CM, A endix RI. 1 ✓ I R'Yes ❑ No EER values of installed systems match the CF -1 R 2 ✓ Crimes ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 0 -,yes ❑ No Time Delay Relay Verified (If Required) ❑ Yes to 'I and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner �ZAE'EZC- j K CO -►'01 TI D N ly L 1 NC - Signature: Date: 10 d eJ Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN V1�ATT DRAW Procedures for measuring the air handler watt draw are available in RA CM, Appendix RE -3.2. ✓ Method For Fan Watt Draw Measurement ✓ 1 ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using ❑ RE3.2.2 Utility Revenue Meter Measurement ❑ RE4.1.2 Diagnostic Fan Flow Using Measured Fan Watt Draw: Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _5 to mdximum cooling ca acity indicated on the Performance's CF -1R and RF -3. ❑ RE4.1.3 Diagnostic Fan Flow Using ✓ ✓ ✓ ❑ Yes. ❑ No Measured fan watt .draw is equal to or lower than the fan watt draw documented in CF -IR ❑ ❑ ✓ ❑ Yes Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnredure.r fnr men.curino the airflow are available in RACM ADDendix RE3.1. ✓Method For Airflow Measurement ✓ 1 ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _5 to mdximum cooling ca acity indicated on the Performance's CF -1R and RF -3. ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement 4 ❑ Yes ❑ No Duct design exists on plans 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ � j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail Measured Airflow: ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass I Pass Fail ✓ ❑ MAXIMUM COOLING .CAPACITY Procedures for determininv maximum cnnlinn load canacity are available in RACM Annendix RF3 Watts cfm/ton 1 ✓ 1 ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV Duct leakage reduction credit verified Cooling capacities of installed systems are _5 to mdximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 3 ✓ ❑ Yes ❑ No 4 ✓ ❑ Yes ❑ No 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ � j cooling capacity in the CF -1R, then the electrical input for the installed systems must be < to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓21HIGIH EER AIR CONDITIONER Pro ceduresor verification are. available in RA CM, A endix RI. I ✓ ©.'Yes 1 ❑ No EER values of installed systems match the CF -1R 2 ✓ M1es ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ . 3 ®''Yes ❑ No Time Delay Relay Verified (If Required) [►-�) ❑ Yes to 1 and 2; and 3 (If Required) is a Dass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner - Signature: Date: 9 /of d Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE.), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 */D_ INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handier wait draw are available in RA CM. ADDendix RE -3.2. ✓ Method For ran Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ ❑ RE3.2.2 Utility Revenue Meter Measurement Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes Measured Fan Watt Draw: RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ✓ ✓ ✓ Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ Cooling capacities of installed systems are:5 to maximum cooling capacity indicated on the Performance's CF -1•R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prnredures for measurinv the airflow are available in RACM ADDendix RE3.1. ✓Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ Yes ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ Yes ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes O No Duct design exists on plans ❑ No Cooling capacities of installed systems are:5 to maximum cooling capacity indicated on the Performance's CF -1•R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical'in ut in the CF -1R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Measured Airflow: Fail ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for determining maximum cooling load caDacity are available in RACM Annendix RF3 Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are:5 to maximum cooling capacity indicated on the Performance's CF -1•R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ �j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical'in ut in the CF -1R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓HIGH EER AIR CONDITIONER Procedures fior verification are.available in RA CM, A endix RI. 1 ✓ ©: 13 .INSTALLATION CERTIFICATE (Page 8 of.12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM, Appendix RE3.2. ✓ Method For Fan Watt Draw Measurement ✓ ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using ❑ RE3.2.2 Utility Revenue Meter Measurement ❑ RE4.1.2 Diagnostic Fan Flow Using Measured Fan Watt Draw: Refrigerant charge or TXV ❑ RE4.1.3 Diaostic Fan Flow Using Flow Grid Measurement ✓ ❑Yes ❑ No Measured fan watt draw is equal to or lower than the fan watt draw documented in CF -1R ❑ ❑ Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION PYaCed1/Ye.Q far measuring the airflow are available in RACM. ADDendLx RE3.1. -,/'Method For Airflow Measurement ✓ ❑ Yes ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching Refrigerant charge or TXV ❑ RE4.1.3 Diaostic Fan Flow Using Flow Grid Measurement Duct leakage reduction credit verified ❑ Yes ❑ No Duct design exists on plans ❑ No Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Measured Airflow: Fail ✓ ✓ ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in Table RE -2 Yes is a pass ❑ Pass ❑ Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for determining maximum cooling load caDacity are available in RACM ADnendix RFT Watts cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are 5 to maximum cooling ca acity indicated on the Performance's CF -1R and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ j cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical 'input in the CF -1 R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓2'HIGH EER AIR CONDITIONER Procedures or veri ication are available in RA CM, A endix RI. 1 ✓ 2"Yes ❑ No I EER values of installed systems match the CF -1R 2 ✓ lues ❑ No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ❑ No Time Delay Relay Verified (If Required) [� ❑ Yes to 1 and 2; and 3 (If Required) is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner 'F>`Q,5---ZE •ssI R CGNO IT jo- N IPA(, ) NC Signature: Date: • 10/61 e� Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005