Loading...
05-4886 (MECH)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/02/05 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 05-00004886 80076 HERMITAGE 762 -231 -014 - MECHANICAL LOW DENSITY RESIDENTIAI 3141 Architect or LICENSED CONTRACTOR'S DECLARATION I hereby.affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Clas . C20 License No.: 374937 Date:&--AContractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The• Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). . (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction' lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: WAYNE LARSON 80-076 HERMITAGE LA QUINTA, CA 92253 Contractor: PALM DESERT AIR CONDITIONING 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 Lic. No.: 374937 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 1795546 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: /Woo' Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes nulland void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned pro ert 'section purposes. Date:��z Signature (Applicant or Agent):\ Application Number . . . . . 05-00004886 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date 5/01/06 Qty Unit Charge Per Extension BASE FEE .15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00. 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 " ---------------------------------------------------------------------------- Special Notes and Comments REPLACE FURNACE & EVAP COIL/NEW R-8 A/C DUCTS Fee summary Charged Paid Credited 4 Due Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Grand Total 41.25 .00 .00 41.25 LQPERMIT Bin # City of La Quinta Building U Safety Division P'O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit Project Address: 8(j - 0 —7 Owner's Name: Lo mG A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: ��-�?y.� �- '�v{.yp� Telephone: Address: . q ogs ( B Project Description: City, ST, Zip..'�'?4, f t' G}22�1 iYk,E ��c�► '-d yi,n,Q Telephone: i(pvtC(p'?'I �.+t Cei1 State Lic. # : C240 i City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: r -- Telephone: x State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter6epai Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 31,41 ^o APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready foe corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°d Review, ready for correctionsfissue Electrical .Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Pians resubmitted Grading IN HOUSE:- '`" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Work Order Palm Desert Air Conditioning & Heating Company 42-081 Beacon Hill Palm Desert CA 92211 760-346-0677 FAX: 760-346-5200 95-3343831 ervice At: Customer # 2178 Bill To: Customer # 8254 Rating: LARS,ON, WAYNE 760-77.1-3900 LARSON, WAYNE �0 076 HERMITAGE 80-076 HERMITAGE QUINTA CA 92253'.: LA QUINTA CA 92253 Type: SEA Open Balance: ($341.00) Source: REFE I Payment Method: COLLECT, NET30 Zone: LQ Map: PGA Credit Limit: Skill: Tax: Installation Customer Directions 20X20XI;12Xl2XI-4 Instructions 10/31/05 SCHED. 11/01/05 2-5 PM. NEED TO PERFORM A PRE TEST & GET A PERMIT. KIMBERLY INSTALL ONE (1) LENNOX (3.0 TON) G60 TWO STAGE, 80% AFUE, GAS FURNACE WITH MATCHING COOLING COIL WITH ONE (1) ELECTROSTAITIC AIR FILTER. TXV FACTORY INSTALLED. TOTAL DUE: $3491.00 - $100.00 (MANUFAC) URER REBATE) - $250.00 (PDAC DISCOUN n 3441 00 :al REBATES: $15.00 (IID) 10/28/05 SCHED. 11/02/05 8-9 AM. PERFORM A POSTTEST. KIMBERLY Call Info Job Info Call No.: 120568 Booked by: KGALINDO Job No.: 120568 Taken: 10/28/05 4:06 PM Type: TECH Booked Date: 11/1/05 Class: REPLACEMENT Taken by: KGALINDO Scheduled: 11%2/05 8:OOAM Sched by: KGALINDO Type. IFCH Cust PO: . Pri Level: 5 Ld Src: SalesPerson: TYRUS Eq Age: LS Ref: Contact: JIM CARPENTER 333-2959 Equipment: Assignments Employee TaskCode Scheduled Time LIN 8:30:00 AM SCOTT 8:30:00 AM Equipment Warranties Type Sys Mfg Model # Serial # Age Type Parts Ends Labor Ends FAU LEN G40UH36AO70X 5803A77049 2 LOIYR-P 04/11/2004 Filters: Loc: SACH FAU PAYN 373CAV036035 3192AO6153 13 Filters: Loc: SACH CUAC LEN 13ACC-036-230-1 5804D48633, 1 LOIYR=P 10/27/2005 Filters: Loc: ROOF O l YR -L 10/27/2005 L l 0YR-COMP 10/27/2014 CUAC LEN 13ACC-036-230-1 5803J71361 1 LOIYR-P 10/27/2005 Filters: Loc: ROOF O 1 YR -L 10/27/2005 L l OYR-COMP 10/27/2014 Agreements Type Agr No Status Sold By Start End- Discount Last Visit Next Scheduled SEA 409865 Active 10/31/2005 10/31/2006 15 % SEA 10/28/2005 4/2006 SEA 407196 Terminated 03/31/2005 03/31/2006 15 % SEA CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 4) CF -IR Project Title Uc� Date 7 'Buildmg+Per_mgtt #�"j-$y'1 7 1h �" ,,qA• K l�;.���/bbr W� Project Address kle.: C/.� 3 -7'%/ _39,00paoj&ct �?lanCheyklDate'#`a�� f p Documentation Author Compliance Method (Prescriptive) Telephone cow -Woo ' 344,-0&-7-7 Climate Zone,'„ ryField�heck /Date "��� %�' z AF F- a �• rf s�" ;;,r , r' Enforoement3A eric":••Use Onl ' � �_. ✓ 0 Alternative ComponentPackage Method: (check one) C '� D D (Alternative) Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 GENERAL INFORMATION Total Conditioned Floor Area (CFA) ft Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) ft Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA) ft1 ✓ ❑ Building Type: (check one or more)—L/— Single Family Multifamily Addition Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: I Number of Dwelling Units: Floor Construction Type: S aised Floor (circle one or both) Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-151 OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type Cavity (Wood or Insulation Metal) R -Value Assembly U - factor (for wood, Continuous metal frame and Insulation mass R -Value assemblies Joint Appendix IV Reference Roof Radiant Barrier Installed Yes or No Location Comments (attic, garage, typical, etc. 1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -factor criterion. U -factors can not exceed prescriptive value to show equivalence to R -values. Residential Compliance Forms April 2005 FENESTRATION PRODUCTS — U -FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be included for New Construction, Additions and Alterations. Fenestration #/Type/Pos. (Front., Left, Orien- Rear, Right, tation, Area U -factor Skylight) N S, E W' i U-factorz Source SHGC° . Exterior Shading/Overhangs6 SHGC ✓ box if WS -3R is Sources included Distribution Type and Location Duct or Piping Thermostat Configuration ducts attic etc. R -Value T pe (split or package) E 1G -L t �r !L4r 13 1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in. any direction when the pitch is less'than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter valuesin this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R. 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. HVAC SYSTEMS Heating Equipment Type and Capacity fumace heat pump, boiler, etc. Minimum Efficiency AFUE or HSPF Distribution Type and Location Duct or Piping Thermostat Configuration ducts attic etc. R -Value T pe (split or package) E 1G -L t �r !L4r Cooling Equipment Type and Capacity Minimum (A/C, heat pump, evap: Efficiency Duct Location . Duct Thermostat Configuration cooling) SEER or EER attic, etc. R -Value Type (split or package) Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R Project Title I,(,G i.,..c aA4_ ✓_ Date SEALED DUCTS and TXVs (or Alternative Measures) � signed CF -4R Form must be provided to the building department for each home for which the following. are required. OR F- o Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Proiect Climate Zone in the RM Appendix B Table 151-C. Footnotes 7-14. OR For additions and alterations, duct systems that are not documented to have been previously ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.) ❑ TXVs, readily accessible (climate zones 2 and 8-15 only) Tank Capacity (gaeons Installer testing and certification and HERS Rater field verification required.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verification required.) OR F- o Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Proiect Climate Zone in the RM Appendix B Table 151-C. Footnotes 7-14. OR For additions and alterations, duct systems that are not documented to have been previously ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS Systems serving single dwelling units Water Heater Type/Fuel Type Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per ❑ dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is Tank Capacity (gaeons not allowed. ❑ Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automatically. Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the submittal. ❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple units Systems serving single dwelling units Water Heater Type/Fuel Type Distribution Type Number in System Rated Input' (kw or Btu/hr) Tank Capacity (gaeons Energy Factor' or Thermal Efficiency Standby Loss % Tank External Insulation R -Value 1 fir System serving multiple dwelling units Water Heater Distribution Type Type. Number. in System Rated Input' Tank (kw or Capacity Btu/tu aeons Energy Factor' orExternal Thermal Efficiency Standby' Loss % Tank Insulation R -Value 1 fir 1) For.small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump. water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are '/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B. Residential Compliance Forms April 2005 ala � SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary) Indicate which special features are part of this project. The list Below only represents special features relevant to the nr8crintive method. ✓ Feature Required Forms if applicable) Description ❑ Metal Framed Walls CF -1R CF -6R part 6 of 12 . ❑ Radiant Barriers CF -1R ❑ Exterior Shades WS -411 ❑ Cool Roof N/A; Attach CRRC Label to Forms. © Dedicated Hydronic Heating Performance Calculation System Required, Attach Run to Forms. ❑ Combined Hydronic System Performance Calculation Required; Attach Run to Forms. ❑ Gas Cooling Performance Calculation Required. ❑ Buried Ducts N/A; Indicate on building plans. ❑ Kitchen Pipe Insulation See Section 5.6.2 Distribution Systems in Residential Manual. Multiple Water Heaters Per See Table 5-13 or use ❑ Performance Calculation and Dwelling Unit attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Serving Multiple Dwellings attach Run to Forms. ❑ Non-NAECA Large Water CF -1R Heater See Table 5-13 or use ❑ Indirect Water Heater' Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Solar Water Heating System Performance Calculation and attach Run to Forms Wood Stove Boiler Performance Calculation and attach Run to Forms add extra sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need verification. ✓ Feature Required Forms if applicable) Description ❑ Duct Sealing CF -6R part 4 of 12 . ❑ Refri erant Charge CF -6R part 5 of 12 Cl Thermostatic Expansion Valve CF -6R part 6 of 12 . Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -1R Proiect Title Date COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts I 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. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using duct sealing and TXVs requires installer. testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business and Professions Code) Name: OA Tide/Finn: Address: -L 'o (9 1 Telephone: Documentation Author A Name: Title/Firm: G 11 At, OWb Address: �a1,w� ��• Ca• gzz�i Telephone: -200 - 54<o • 0(0 77 Lie. a: 3-7N 93-7 (f 2y (signature) - (date) (signature) (date) C2o 37•{9.3 Enforcement Agency Name: T7eio• Agency: Telephone: (signature / stamp) (date) Compliance Forms August 2001 A-4 INSTALLATION CERTIFICATE 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; however, use of this form to provide the information is optional.) 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(b). HVAC SYSTEMS: Heating Equipment Equip. # of Efficiency Duct Duct or Heating Heating Type (pkg. CEC Certified Mfr Name Identical (AFUE, etc.)' Location Piping Load Capacity e attic etc -value B r Btu/hr fooWOE LEO roc Cs &0UiF FWUE, 90 `7— cmU Cooling Equipment Equip: CEC Certified Compressor # of . Efficiency Duct Cooling Cooling Type (pkg. Unit Mfr Name and Identical (SEER, etc.)' • Location Duct Load Capacity 1. > reads greater than or equal to. 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 Pa 6), where applicable. Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner WATER HEATING SYSTEMS: Distribution IfRecir- #of Rated' Tank Effi- External Heater CEC Certified Mfr Type (Std, culation, Identical Input (kW Volume ciency' Standby' Insulation Type Nalne & Model Number Point -of -Use) Control Type Systems or Btu/hr) (gallons) (EF, RE) Loss (%) R -value' 2 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Recovery Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Recovery Efficiency and Rated Input 3. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111. I, the undersigned, verify that equipment listed above my signature is: 1) 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. Signature, Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Compliance Forms August 2001 A-23 INSTALLATION CERTIFICATE (Page 2 of 13) CF -6R Site Address SO- O'-lcvc Permit Number FENESTRATION/GLAZING: Total Quantity Product Product of Like Exterior Shading U -Factor' (5 SHGC' (5 # of Product Square Device or Comments/Location/ Manufacturer/Brand Name CF -IR value)' CF -IR values Panes (Optional) Feet Overhang Special Features (GROUP LIKE PRODUCTS) 1. 2. — 3. 4. — 5. _ 6. .7. - 9. 10. _ 11. 12. —_ 13. _ 14. _ 15. ' Manufactured fenestration products use the values from the product label. Field fabricated fenestration products use the default values from Section 116 of the Energy Efficiency Standards. 2 Installed U -Factor must be less than or equal to values -from CF -1R. Installed SHGC must be less than or equal to values from CF -1R, or a shading device (exterior or overhang) is installed as specified on the CF -IR. Alternatively, installed weighted average U -Factors for the total fenestration area are less than or equal to values from CF -IR. I, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual• fenestration product installed; 2) is equivalent to or has a lower U -Factor and lower SHGC than that specified in the certificate of compliance (Form CF -1R) .submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) the product meets or exceeds the appropriate requirements for manufactured devices (from Part 6), where applicable. Item #s Signature, Date (if applicable) Item #s Signature, Date (if applicable) Item #s Signature, Date (if applicable) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner OR Window Distributor Installing Subcontractor (Co. Name) OR - General Contractor (Co. Name) OR Owner OR Window Distributor Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner OR Window Distributor Compliance Forms August 2001 A-24 DUCT LEAKAGE AND DESIGN DIAGNOSTICS ❑ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) _ Pass if leakage fraction 5 0.06 ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes • ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑ TTHERMOSTATIC EXPANSION VALVE (TXV) O Yes ❑ No Thermostatic Expansion Valve is installed and Access is _ / ❑ provided for inspection Yes is a pass Pass Fail ❑ DUCT DESIGN 1 ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2• dyes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1R. Measured Fan Flow = 0 ❑ Yes for both 1 and 2 is a Pass Pass Fail 0 I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] `fit- �2• � `���'��-4" �,� r%'o�•� c2°'`� Tests Signature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy . Compliance Forms August 2001 A-25 INSTALLATION CERTIFICATE 4of1 CLD (_C4444— Site Address -0-2(, ^ ��P Permit Number REFRIGERANT CHARGE AND AIRFLOW MEASUREMENT CF -6R Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems. without Thermostatic Expansion Valves Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge and Airflow Measurement (outdoor air. dry-bulb 55 OF and above): 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 (Tretum, 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 1) OF Actual Superheat - Target Superheat OF (System passes if between -5 and +5°F) s Temperature Split Method Calculations for Adequate Airflow Actual Temperature Split = T return, db - Tsupply, db OF Target Temperature Split (from Table 2) OF Actual Temperature Split - Target Temperature Split OF (System passes if between -3°F and +3°F or, upon remeasurement, if between +3°F and -25°F) Standard Charge and Airflow Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. System Passes yes or no Compliance Forms August 2001' A-26 TNQT A T X. A TTl1N r1 1DTT1 1P A TF ra1-FRA—P7 Alternate Charge and Airflow Measurement (outdoor air dry-bulb below 55 °F): Weigh -In Charging Method for Refrigerant Charge Actual liquid line length:. Manufacturers Standard liquid line length: Difference (Actual — Standard): ft. R. ft. Manufacturers correction (ounces per foot) x difference in length = ounces (+ = add) (- = remove) Measured Airflow Method for Adequate Airflow Airflow criterion: Cooling Capacity X 0.032 = CFM Measured Airflow is CFM and passes since it is greater than the criterion. Alternate Charge and Airflow Measurement Summary: System charge shall be corrected and it shall also pass measured adequate airflow criterion. System Passes yes or no Compliance Forms August 2001 A-27 INSTALLATION CERTIFICATE (Page 6 of 13) CF -6R Site Address Permit Number Table K-1: Target Superheat (Suction Line Temperature - Evaporator Saturation Temperature) Compliance Forms August 2001 A-28 Return Air Wet -Bulb Temperature (°F) w. -b) 50 51 1 52 53 54 55 56 57 . 58 59 60 1 61 62 63 64 65 66 67 1 68 69 70 71 72 73 1 74 . 75 76 55 8.8 . 10.1 1 11.5 12.8 14.2 15.6 17.1 18.5 120.0 21.5' 23.1 11 24.6 26.2 27.81 29.4 31.0. 32.4 33.8 1 35.1 36.4 37.7 39.0 40.2 41.5 42.7 43.9 45.0 56 8.6 9.9 11.2 12.6 14.0 15.4 16.8 18.2 19.7 21.2 22.7 24.2 25.7 27.3. 28.9 30.5 31.8 33.2 34.6 35.9 37.2 38.5 39.7 41.0 42.2 43.4 44.6 57 8.3 9.6 11.0 12.3 13.7 15.1 • 16.5 17.9 19.4 20.8 22.3 23.8 25.3 26.8 28.3 29.9 31.3 32.6 34.0 35.3 36.7 38.0 39.2 40.5 41.7 43.0 44.2 58 7.9 9.3 10.6, 12.0 13.4 14.8 16.2. 17.6 19.0 20.4 21.9 23.3 24.8 26.3 27.8 29.3 30.7 32.1 33.5 34.8 36.1 37.5 38.7 40.0 41.3 42.5 43.7 7.5 8.9 10.2 11.6 13.0 14.4 15.8 17.2 18.6 20.0 21.4 22.9 24.3 25.7 27.2 28.7 30.1 31.5 32.9 34.3 35.6 36.9 38.3 39.5 40.8 42.1 43.3 59 60 7.0 .8.4 9.8 11.2 12.6 14.0 15.4 16.8 18.2 19.6 21.0 22.4 23.8 25.2 26.6 28.1 1129.6 31.0 32.4 33.7 35.1 36.4 37.8 39.1 40.4 141.6 42.9 61 6.5 7.9 9.3 10.7 12.1 13.5' 14.9 16.3 17.7 19.1 20.5 21.9 23.3 24.7 26.1 27.5. 29.0 30.4 31.8 33.2 34.6 35.9 37.3 38.6 39.9 41.2 42.4 62 6.0 7.4 8.8 10.2 11.7 13.1 14.5 15.9 17.3 18.7 20.1 21.4 22.8 24.2 25.5 27.0 28.4 29.9 31.3 32.7 34.1 35.4 36.8 38.1 39.4 40.7 42.0 5.3 6:8 8.3 9.7 11.1 12.6 14.0 15.4 16.8 18.2 •19.6 20.9 22.3 23.6 25.0 26.4 27.8 29.3 30.7 32.2 33.6 34.9 36.3 37.7 39.0 40.3 41.6 63 64 - 6.1' 7.6 9.1. 10.6 12.0 13.5 14.9 16.3. 17.7 19.0 20.4 21.7 23.1 24.4 25.8 27.3 28.7 30.2 31.6 33.0 34.4 35.8 37.2 38.5 39.9 41.2 65 5.4 7.0 8.5 10.0 11.5 12.9 1 14.3 1 15.8. 17.1 1 18.5 1 19.9 21.2 22.5 1 23.8 25.2 26.7 1 28.2 29.7 31.1 32.5 33.9 35.3 36.7 38.1 39.4 40.8 el 66 - 63 7.8 93 10.8 12.3 13.8 15,2 16.6 180 19.3 203 22.0 23.2 24.6 26.1 27.6 29.1 30.6 32.0 33.4 34.9 36.3 37.6 39.0 40.4 67 - 5.5 7.1 8.7 10.2 11.7 13.2 14.6 16.0 17.4 18.8 20.1 21.4 22.7 24.1 25.6 27.1 28.6 30.1 31.5 33.0. 34.4 35.8 37.2 38.6 39.9 - - - 6.3. 8.0 9.5. 11.1 12.6 14.0 15.5 16.8 18.2 19.5 20.8 22.1 23.5 25.0 26.5 28.0 29.5 31.0 32.5 33.9 35.3 36.8 38.1 39.5 68. Q 69 - - 5.5 7.2' .8.8 10.4 11.9 13.4 14.8 16.3 17.6 19.0 20.3 21.5 22.9 24.4 26.0 27.5 29.0 30.5 32.0 33.4 34.9 36.3 37.7 39.1 E 70 - 6.4 ' 8.1 9.7 11.2 12.7 14.2 15.7 17.0 18.4 19.7 20.9 22.3 23.9 25.4 27.0 28.5 30.0 31.5 33.0 34. 4 1.35.9 37.3 38.7 E 71 - - 5.6 7.3 8.9 10.5 12.1 13.6 15.0 16.4 17.8 19.1 20.3 21.7 23.3 24.9 26.4 28.0 29.5 31.0 32.5 34.0 35.4 36.9 38.3 72 - - - - 6.4 8.1 9.8 11.4 12.9 14.4 15.8 17.2 18.5 19.7 21.2 22.8 24.3 25.9 27.4 29.0 30.5 32.0 33.5 35.0 36.5 37.9 73 - 5.6 7.3 9.0 10.7 12.2 13.7 15.2 16.6 17.9 19.2 20.6 22.2 23.8 25.4 26.9 28.5 30.0 31.5 33.1 34.6 36.0 37.5 e 6.5 8.2 9.9 11.5 13.1 14.5 15.9 17.3 18.6 20.0 21.6 23.2 24.8 26.4 28.0 29.5 31.1 32.6 34.1 35.6 37.1 A 75 5.6 1 7.4 1 9.2 10.8 1 12.4 1 13.9 15.3 16.7 1 18.0 1 19.4 21.1 22.7 24.3 25.9 27.5 29.1 30.6 32.2 33.7 35.2 36.7 76 - - - - - - - 6.6 8.4 10.1 11.7 13.2 14.7 16.1 17.4 18.9 20.5 22.1 23.8 25.4 27.0 28.6 30.1 31.7 33.3 34.8 36.3 77 - - - - - 5.7 7.5 9.3 11.0 12.5 14.0 15.4 16.8 18.3 20.0 21.6 23.2 24.9 26.5 28.1 29.7 31.3 32.8 34.4 36.0 78 - - - - - - 6.7 8.5 10.2 11.8 13.4 14.8 16.2 17.7 19.4 21.1 22.7 24.4 26.0 27.6 29.2 30.8 32.4 34.0 35.6 79 c - - - - - - - - 5.9 7.7 9.5 11.1 12.7 14.2 15.6 17.1 18.8 20.5 22.2 23.8 25.5 27.1 28.8 30.4 32.0 33.6 35.2 U 6.9 8.7 10.4 12.0 13.5 15.0 16.6 18.3 20.0 21.7 23.3 25.0 26.7 28.3 29.9 31.6 33.2 '34.8 80 81 - - - - - - - - 6.0 7.9 9.7 11.3 12.9:.14:3 16.0 17.7 19.4 21.1 22.8 24.5 26.2 27.9 29.5 31.2 32.8 34.4 82 - - - - - - - 5.2 7.1 8.9 10.6 12.2 13.7 15.4 17.2 18.9 20.6 22.3 24.0 25.7 27.4 29.1 30.7 32.4 34.0 83 - - - - - - - - - - 6.3 8.2 9.9 11.6 13.1 14.9 16.6 18.4 20.1 21.8 23.5 25.2 26.9 28.6 30.3 32.0 33.7 84 - - - - - - - - - 5.5 7.4 9.2 10.9 12.5 14.3. 16.1 17.8 19.6 21.3 23.0 24.8 26.5 28.2 29.9 31.6 33.3 85 6.6 8.5 10.3 11.9 13.7 15.5 17.3 19.0 20.8 22.6 24.3 26.0 27.8 29.5 31.2 32.9 86 - - - - - - - 5.8 7.8 9.6 11.3 13.2. 15.0 16.7 18.5 20.3 22.1 23.8 25.6 27.3 29.1 30.8 32.6 5.0 7.0 8.9 10.6 12.6 14.4 16.2 18.0 19.8 21.6 23.4 25.1 26.9 28.7 30.4 32.2 88 - - - - - - - - - - - - 6.3 8.2 10.0 12.0 '13.9 15.7 17.5 19.3 21.1 22.9 24.7 26.5 28.3. 30.1 31.8 89 - - - - - - - - - - - 5.5 7.5 9.4 11.5 13.3 15.1 17.0 18.8 20.6 22.4 24.3 26.1 27.9 29.7 31.5 90 - - - - 6.8 8.8 10.9 12.8 14.6 16.5 18.3 20.1 22.0 23.8 25.6 27.5 29.3 31.1 Compliance Forms August 2001 A-28 INSTALLATION CERTIFICATE (Page 7 of 13j CF -6R . Site Address Permit Number Table K-1: Target Superheat (Suction Line Temperature - Evaporator Saturation Temperature) (continued) Compliance Forms August 2001 A-29 Return Air Wet -Bulb Temperature ff) rth n ab 50' 51 52 53 54 55 56 57 58 59 60 . 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 . 91 - - - - - - - - - - - - 6.1 8.1 10.3 12.2 14.1 15.9 17.8 19.7 21.5 23.4 25.2 27.1 28.9 30.8. 92 - - - - - - - - - - - - 5.4 7.5 9.8 11.7 13.5 15.4 17.3 19.2 21.1 22.9 24.8 26.7 28.5 30.4 93 - - - - - - - - - - - - - 6.8 9.2 11.1 13.0 14.9 16.8 18.7 20.6 22.5 24.4 26.3' 28.2 30.1 94 - - - - - - - - - - - - - .6.2 8.7 10.6 12.5 14.4 16.3 18.2 20.2 22.1 24.0 25.9 27.8 29.7 95 - - - - - 5.6 8.1 10.0 12.0 13.9 15.8 17.8 19.7 21.6 23.6 25.5 27.4 29.4 d 96 - - - - - - - - - - - - - - - - - - - - - - - - 7.5 7.0. 9.5 .8.9 11.4 10.9 13.4 12.9 15.3 14.9 17.3 16.8 19.2 18.8 21.2 20.8 23.2 22.7 25.1 24.7 27.1 26.7 29.0 28.7 97 98 - - - - - - - - - - - - - - - 6.4 8.4 10.4 12.4 14.4 16.4 18.3 20.3 22.3 24.3 26.3 283 99 - - - - - - - - - - - - - - 5.8 7.9 9.9 11.9 13.9 15.9 17.9 19.9 21.9 24.0 26.0 28.0 100 - - - - - - - -1 5.3 7.3 9.3 1 11.4 13.4 15.4 1 1751 19.5 21.5 123.6 25.6' 27.7 6.8 8.8 10.9 12.9 15.0 17.0 19.1 21.1 23.2 .25.3 27.3 102 103 e - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6.2 5.7 8.3 7.8 10.4 9.9 12.4 11.9 14.5 ' 14.0 16.6 16:1 18.6 18.2 20.7 20.3 22.8 22.4 24.9 24.5 27:0 26.7 e104 - - - - - - - - - - - - - - - - 5.2 7.2 9.3 11.5 13.6 .15.7 17.8 19.9 22.1 24.2 26.3 105 A E" - - 6.7 8.8 1 11.0 13.1 15.2 17.4 19.5 21.7 23.8 126.0 'a`- 106 - - - - - - - = - - - - - 6.2 8.3 10:5 12.6 14.8 17.0 19.1 21.3 23.5 25.7 107 d - - - - - - - - - - - 5.7 7.9 10.0 12.2 14.4 16.6 18.7 21.0 23.2 25.4 l08 - - - - - - - - - - - - - 5.2 7.4 9.5 11.7 13.9 16.1 18.4 20.6 22.8 25.1 109 U - - - - - - - - - - - - - - - 6.9 6.4 9.1 8.6 11.3 10.8 13.5 13.1 15.7 1 15.3 18.0 17.6 20.2 19.9 22.5 122.1 24.7 24.4 110 5.9 8.1 10.4 12.6 14.9 17.2 19.5 21.8 24.1 5.4 7.6 9.9 12.2 14.5 16.8 19.1 21.5 23.8 - 7.2 9.5 11.8 14.1 16.4 18.8 21.1 23.5 - 6.7 9.0 11.4 13.7 16.1 18.4 20.8 23.2 6.2 1 8.6 10.9 13.3 15.7 18.1 20.5 22.9 Compliance Forms August 2001 A-29 INSTALLATION CERTIFICATE (Page 8 of 13) CF -6R Site Address Permit Number Table K-2: Target Temperature Split (Return Dry -Bulb - Supply Dry -Bulb). Return Air Wet -Bulb (T) (T return, wb) 50 51 52 53 54- 55 56 57 58 .59 60 61 62 63. 64 65 66 67 68 69 70 71 72 73 74 75 76 70 20.9 20.7 20.6 20.4 20.1 19.9 19.5. 19.1 18.7 18.2 17.7 17.2 16.5 15.9 15.2 '14.4 13.7 12.8 11.9 11.0 10.0 9.0 7.9 6.8 5.7 4.5 3.2 71 21.4 21.3 21.1 20.9 20.7 20.4 20.1 19.7 19.3 18.8 18.3 17.7 17.1 16.4 15.7 15.0 14.2 13.4 12.5 11.5 10.6 9.5 8.5 7.4 6.2 5.0 3.8 0 '. 21.9 21.8 21.7 21.5 21.2 20.9 20.6 20.2 19.8 19.3 18.8 18.2 17.0 17.0 16.3 15.5 .14.7 13.9 13.0 12.1 11.1 10.1 9.0 7.9 6.8 5.6 4.3 72 22.5 22.4 22.2 22.0 21.8 21.5 .21.2 20.8 20.3 19.9 19.4 18.8 18.2 17.5 16.8 16.1 15.3 14.4 13.6 12.6 11.7 10.6 9.6 8.5 7.3 6.1 4.8 73 74 v 23.0 22.9 22.8 22.6 22.3 22.0 21.7 21.3 20.9 20.4 19.9 19.3 18.7 18.1 17.4 16.6 15.8 15.0 14.1 13.2 12.2 11.2 10.1 9.0 7.8 6.6 5.4 w a 23.6 23.5 23.3 23.1 22.9 22.6 22.2 21.9 21.4 21.0 20.4 19.9 19.3 18.6 17.9 17.2 .16.4 15.5 14.7 13.7 12.7 1.1.7 10.7 9.5 8.4 7.2 5.9 75 76 24.1 24.0 23.9 23.7 23.4 23.1 22.8 22.4 22.0 21.5 21.0 20.4 19.8 19.2 18.5 17.7 16.9 16.1 15.2 14.3 13.3 12.3 11.2 10.1 8.9 7.7 6.5 77 - 24.6 24.4 24.2 24.0 23.7 23.3 22.9 22:5 22.0 21.5 21.0 20.4 19.7 19.0 18.3 17.5 16.6 15.7 14.8 13.8 12.8 11.7 10.6 9.5 8.3 7.0 78 - - - 24.7 24.5 24.2 23.9 23.5 23.1 22.6 22.1 21.5 20.9 20.2 19.5 18.8 18.0 17.2 16.3 15.4 14.4 13.4 12.3 11.2 10.0 8.8 7.6 L A - - - - - 24.8 24.4 24.0 23.6 23.1 22.6 22.1 21.4 20.8 20.1 19.3 18.5 17.7 16.8 15.9 14.9 13.9 12.8 11.7 10.6 9.4 8.1 79 L Q - - - - - - 25.0 24.6 24.2 23.7 23.2 22.6 22.0 21.3 20.6 19.9 19.1 18.3 17.4 16.4 15.5 14.4 P3.4 12.3 11.1 9.9 8.7 80 i 81 - - - - - 25.1 24.7 24.2 23.7 23.1 22.5 21.9 21.2 20.4 19.6 18.8 17.9 17.0 16.0 15.0 13.9 12.8 11.7 10.4 9.2 82 - - - - -. - - - 25.2 24.8 24.2 23.7 23.1 22.4 21.7- 21.0 20.2 19.3 18.5 17.5 16.6 15.5 14.5 13.4 12.2 11.0 9.7 a - - - - - - - - - 25.3. 24.8 24.2 23.6 23.0 22.3 21.5 20.7 19.9 19.0 18.1 17:1 16.1 15.0 13.9 12.7 11.5 10.3 •83 - - - - - - - - 25.9 25.3 24.8 24.2 23.5 22.8 22.1 21.3 20.4 19.5 18.6 17.6 16.6 15.6 14.4 13.3 12.1 10.8 84 Compliance Forms August 2001 A-30 INSTALLA ION CERTIFICATE . (Page 9 of 13) CF -6R Site Add s gG —�?���'��P Permit Number DUCT LOCATION AND AREA REDUCTION DIAGNOSTICS ❑ DUCT IN CONDITIONED SPACE ❑. Yes ❑ No Duct in conditioned space criteria matches CF -1R . Yes is a Pass Pass Fail ❑ REDUCED DUCT SURFACE AREA Measured duct exterior surface area in the following unconditioned duct locations (square feet): Attics Crawlspaces Basements Other (e.g., garages, etc.) ❑ Yes ❑ No Duct surface area matches CF -1 R? ❑ ❑ Yes is a Pass Pass Fail ❑ I, the undersigned, verify that the duct surface area and duct locations claimed for duct surface area reductions and duct location improvements beyond those covered by default assumptions match those on the plans. [The builder•shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] Tests Signature, Date Performed COPY TO: Building Department HERS Provider ('if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) Compliance Forms August 2001 A-31 INSTALLATION CERTIFICATE (Page 10 of 13) CF -6R . Site Address 8() —(j-? (o Z 4 c 4- V Permit Number BUILDING ENVELOPE LEAKAGE DIAGNOSTIC ❑ ENVELOPE SEALING INFILTRATION REDUCTION Diagnostic Testing Results Building Envelope Leakage (CFM @ 50 Pa) as measured by Rater I. ❑ ❑ Is measured envelope leakage less than or equal to the required level from Yes No CF -1R? 2. ❑ ❑ Is Mechanical Ventilation shown as required on the CF -1R? Yes No 2a. ❑ ❑ If Mechanical Ventilation is required on the -CF -IR (Yes in line 2), has it Yes No been installed? 2b. ❑ ❑ Check this box yes if mechanical ventilation is required (Yes in line 2) Yes No and ventilation fan watts are no greater than shown on CF -1R. Measured Watts = 3. ❑ ❑ Check this box yes if measured building infiltration (CFM @ 50 Pa) is Yes No greater than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R (If this box is checked no, mechanical ventilation is required.) 4. ❑ ❑ Check this box yes if measured building infiltration (CFM @ 50 Pa) is less Yes No than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R, mechanical ventilation is installed and.house pressure is greater than minus 5 Pascal with all exhaust fans operating. Pass if: Pass Fail d: Yes in line 1 and line 3, or e. Yes in line 1 and line2, 2a, and 2b, or f. Yes in line land Yes in line 4. Otherwise fail. ❑ I, the undersigned, verify that the building envelope leakage meets the requirements claimed for building leakage reduction below default assumptions as used for compliance on the CF -1R. This is to certify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit.] Test Performed Signature Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 Testing Subcontractor (Co. Name) OR General Contractor (Co. Name) A-32 INSTALLATION CERTIFICATE Site Address 0 90-0__2(,, The following is an explanation of many of the input values required on this form: HVAC SYSTEMS Hentinu F.nuinment Tvne mutt he one of the following - 11 of 13) CF -6R Permit Number Furnace: Gas (including Liquefied Petroleum Gases) or oil -fired central furnace & space heater Boiler: Gas or oil -fired boiler PckgHeatPump: Packaged central heat pump SplitHeatPump: Split central heat pump RoomHeatPump: Room heat pump LgPkgHeatPump: Large packaged heat pump (z 65,000 Btu/hr output) Electric: Electric resistance heating (fixed HSPF = 3.413); radiant electric resistance. (fixed HSPF = 3.55) CombinedHydro: Reference water heater under water heating systems below CEC Certified Manufacturer Name & Model Number from applicable Commission approved appliance directory. ft.of Identical Systems is for those systems with the same efficiency, duct location, duct R -value and capacity. Efficiency from applicable Commission certified appliance directory. Duct (or Piping) Location is attic, crawl space, CVC crawl space, conditioned space, unconditioned space or none. Duct (or Piping) R -Value from Directory of Certified Insulation Materials and/or manufacturer's data. Heating/Cooling Load refer to Commission approved load calculation procedure. Heating/Cooling Capacity from the applicable Commission certified appliance directory. Note: location elevations over 2,000 ft above sea level require a derating of output capacity. (refer to manufacturer's literature). Cnnlinu F.mninnient Tvne musfhe one of the following- SplitAirCond: Split system air conditioner PckgAirCond: Packaged air conditioner Split Heat Pump: Split system heat pump PckgHeatPump: Packaged heat pump RoomHeatPump: Room heat pump LgPkgHeatPump: Large packaged heat pump (>_ 65,000 Btu/hr output). Substitute EER for SEER when SEER is not available RoomAirCond: Room air conditioner. Minimum SEER varies* LgPkgAirCond: Large packaged air conditioner (>_ 65,000 Btu/hr output). Substitute EER for SEER when SEER is not available EvapDirect: Direct evaporative cooling system. For compliance calculation purposes, fixed Values: SEER = 11.0; duct location = attic; duct insulation R -value = 4.2 EvapIndirect: Indirect evaporative cooling system. For compliance calculation purposes, fixed values: SEER = 13.0; duct location = attic; duct insulation R -value = 4.2 !Reter to. Energy Commission publication Appliance Efficiency Regulations, P400-92-029 Compliance Forms August 2001 A-33 INSTALLATION CERTIFICATE Site Address -074. �,`S(• The following is an explanation of many of the input values required on this form: WATER HEATING SYSTEMS Distribution Svstems Refer to Residential Manual for more details: 12 of 13) CF -6R Permit Number Standard: Standard — Supply pressure based system, no pumps Pipe Insulation: Pipe Insulation on all 3/4 -inch pipes POU/HWR: Point of Use/Hot Water Recovery System Recirc/NoControl: Recirculation loop with no controls Recirc/Timer: Recirculation loop with a timer Recirc/Temp: Recirculation. loop with temperature control Recirc/Time+Temp: Recirculation loop with a timer and temperature control Recirc/Demand: . Recirculation loop with demand control Water Heater Type Storage Gas, Oil or Electric Heat Pump Instantaneous Gas Instantaneous Electric Large Storage Gas Indirect Gas (Boiler) FENESTRATION/GLAZING Fenestration: Information Needed Energy Factor Recovery Efficiency Standby Loss Rated Input Yes No No No Yes No No No No Yes No No Yes No No No No Yes Yes Yes No Yes (AFUE) No Yes Fenestration: Windows, sliding glass doors, French doors, skylights, garden windows, and any door with more than one square foot of glass Operator Type: Slider, hinged, fixed U -Factor:. Installed U -Factor must be less than or equal to value from CF -1 R OR Installed weighted average U -Factor for the total fenestration area is less than orequal to value from CF -1R SHGC: Installed SHGC must be less than or equal to value from CF -1R OR Installed weighted SHGC for the total fenestration area is less than or equal to value from CF -1R OR An interior shading device, overhang, or exterior shading device is installed consistent with the CF -1R Shading Device: Include when the building complied using an exterior shading device: woven sunscreen, louvered sunscreen, low sun angle sunscreen, roll -down awning, roll -down blinds or slats (do not list bug screen), or an overhang (include depth in feet Compliance Forms August 2001 A-34 11 INSTALLATION CERTIFICATE Site Address ' 80 —O^hv 4-le�,--VLV 13of1 Permit Number CF -6R The following is an explanation of many of the input values required on the Diagnostic portion of this form (page 3 of 6): TYPE OF CREDIT Refer to Residential Manual Chapters 4 and 5 for more details: Reduced Duct Surface Area: Calculated as the outside area of the duct. Areas must be measured and verified by a HERS rater. Improved Duct Location: Supply duct located in other than attic, as verified by location of registers (does not require HERS rater verification). Catastrophic Leakage: Pressure pantest readings must be less than 1.5 Pascal at a house pressure of 25 Pascal. TXV: Access cover required to facilitate verification. Infiltration Reduction: Infiltration is measured without mechanical ventilation operating. Mechanical ventilation is required for very tight house construction when credits for infiltration reduction using diagnostic testing are being used for achieving compliance. These very tight houses are defined as those with SLA of less than 1.5. The compliance documentation (CF -1R) will contain the measured CFM target value from a blower door test at 50 Pascal pressure difference that represents this SLA of 1.5. Mechanical ventilation is also required if the builder chooses to design the building to use mechanical ventilation and claims a credit for infiltration below an SLA of 3.0. The compliance documentation (CF -1R) will contain the measured CFM target value that represents this 3.0 SLA. If the builder claims credit in a design for infiltration reduction that is at an SLA of 3.0 or higher, and the actual measured SLA is 1.5 or greater, then mechanical ventilation is not required. If the SLA in this case were below 1.5, then mitigation (such as mechanical ventilation) would be required. iance Forms August 2001 A-35