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07-2492 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO .:y LA QUINTA, CALIFORNIA 92253 Application Number: 07-00002492 Property Address: 54065 AVENIDA HERRERA APN: 774-213-028-4 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 2687 Tay/ 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: ctSEPa -------------------------------------- LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class:__/1C20-C10 se No.: 286936. Date: �V _"0 7,Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Caw 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).: (_) 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 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.). ( ) 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: CARUSO RESIDENCE 54065 AVENIDA HERRERA LA QUINTA, CA 92253 ( Contractor: CAVANAUGH ELECTRIC & AIR COND ,,,�83231 HIGHWAY 111 INDIO, CA 92201 60)347-3608 c. No.: 286936 0 VOICE (760)777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/10/07 WORKER'S COMPENSATION DECLARATION hereby affir under penalty of perjury one of the following declarations: have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier ENDURANCE WC Policy Number WEN0014468-01 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor /C/no/die�1,omply with those provisions. Datei�� Applicant: J%�-{�_ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES: APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this scounty ,..tto) enter upon the above-mentioned propert forriinspecti roses. Date:/ / UZ/ ! Signature (Applicant or Agent):�/J� Application Number . . . . . 07-00002492 Permit . . . MECHANICAL Additional desc ... Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 2687 Expiration Date 3/08/08 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Special Notes and Comments FURNACE CHANGE OUT REPLACE EXISTING HEAT PUMP AIR HANDLER & CONDENSER Fee summary Charged Paid Credited ---------- Due ------------------------------------- Permit Fee Total 24.00 .00 ---------- .00 24.00 Plan Check Total 6.00 .00 .00 6.00 Grand Total . 30.00 .00 .00. 30.00 LQPERMIT Bin # City of La Quinta. Building a Safety Division " P.O. Box 1504, 78-495 Calle Tampico t,a Quinta, CA 92253 - (760) 777-7012 ..Building Permit Application and Tracking Sheet Permit .# Project Address:. e Owner's Name: eTU #1 . CC^ S C7 A. P. Number: Address: sy- S"- Ave . Ae l ef Legal Description: City, ST, Zip: Lal C_e, Contractor: �' _ te �.� C Telephon 'e Address: --�'. L Project Description: Fin G Cbcqo e-oot - City, Teldphone: State Lic. # : Z City Lip. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type:. Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo . Name of Contact Person: Sq. Ft:: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: 2 e APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan CheckDeposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs.. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading. plan 2"Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed. Plans picked up S.M.T. H.O.A. Approval ' Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees ✓ O Alternative Component Package Method: (check one) C D D (Alternative) Package C and Package D choices reOui(e 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. 15I -C --- (5% X CFA) ft, Maximum Allowed Total Fenestration Products Per Tables 151-B or 151-C ----(20% X CFA) fe ❑ Building Type: (check one or more) Single Family Multifamily Addition Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations) Number of Stories: Number of Dwelling Units; .Floor Construction Type; Slab/Raised Floor: (circle one or both). Front Orientation: , North / South / East / West /All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2.4..8-M 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 1 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 TVA, 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 CERTIFICATE OF COMPLLANCE: RESIDENTIAL (Page 2 of 5) C&M Project Twe %^D Date 9- S— 07 FENESTRATION PRODUCTS - U- FACTOR AND SHGC ✓ ❑ FENESTRATION MAXWJM ALLOWED AREA WORKSHEET WS4R -must be included for New Construction, Additions and Alterations. Fenestration Vrype/Pos. (Front, Left, Rear, Right, Skylight) Orien- tation, N,, S, E, W1 Exterior Shading/Overhangsb•' Area U -factor SHGC ✓ box if WS -3R is ft U -factor' Source' SHGC" Sources included 13 13 13 1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west .or tiltod in any direction when the pitch is less than'1:12. See §151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 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 ftrmace heat Pump,boiler, etc. Minimum. Efficiency . AFUE or HSP Distribution Type and Location Duct or Piping Thermostat Configuration ducts attic etc. R -Value Type s lit or acka e L Cooling Equipment Type and Capacity Minimum (A/C, heat pump, evap. Efficiency. Duct Location Duct Thermostat cooling) SEER or EER attic etc. R -Value Type Configuration (split or package) FAN Co/L .3 AHIc- R- 4- Residential Compliance Forms April 200' CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of CF -1R Project title a A C'�/` !.t S o Date SEALED DUCTS and s (or Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for which the following. are ❑ 1 Sealed Ducts all climate zones(Installer testing and certification and HERS rater field verification required.) d TXVs, readily accessible (climate zones 2 and 8-15 only) (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 Alternative to Sealed Ducts and Refrigerant Charge f1XVs (See Package D Alternative Package Features for Project Climate Zone in the RM Appendix B Table 1.51-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 re uirements of Section 150(ml and duct insulation requirements of Package D. WATER HEATING SYSTEMS Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. ❑ Check box when using Freapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water beating 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 C3 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 Svstems•servinu single dwelling units Rated input, Water Heater Distribution Number (kW or Type/Fuel Type Type in System BMW) Tank Capacity (gallons) Energy Factor' or Thermal Efficiency Standby' Loss % Tank External Insulation R -Value Svstem serving multinle dwelling unitt Input' RatedI. Water Heater Distribution Number (kw or Type Type in system'Bt,/hr Tank Capacity (gallons)Efficienc Enerfy Factor or Thermal Standby Loss % Tank External Insulation R -Value 1) For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 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 % 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 200: CERTIFICATE OF COMPLIANCE: RESIDENTJA.L Proiect ?Elle 7�w.t ' C..,-S?1'z 50 (Page 4 of'5) CF -IR Date 9 — 5— B 7. SPECIAL FEATURES NOT REOUIRING 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 nrncrtrinfive mefhnd add extra sheets if necess Indicate to the HERS Rater which credits are part of this project and need verification. ✓ I Feature Required Forms (if applicable) I Description CF -6R part 5 Valve CF -6R part 6 Residential Compliance Forms April 2005 ✓ Feature Re ulred Forms applicable) Description ❑ Metal Framed Walls CF -1R ❑ Radiant Barriers CF -IR ❑ Exterior Shades WS -411 NIA; Attach CRRC Label to ❑ Cool Roof Forms. ❑ Dedicated Hydroriic Heating Performance Calculation System Required;.Attach Run to Forms. 13Combined Hydronic System Performance Calculation Required; Attach Rua to Forms. ❑ Gas Cooling Performance Calculation Required. ❑ Buried Ducts NIA; Indicate on.buildin Inns. ❑ Kitchen Pipe Insulation See Section 5.6.2 Distribution I.Systenis in Residential Manual. Multiple Water Heaters Per See Table 5-13 or use ❑ Dwelling Unit Performance Calculation and attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Serving Multiple Dwellings attach Run to Forms. ❑ Non-NAECA Large Water CF -IR 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 Sec Table 3-13 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 necess Indicate to the HERS Rater which credits are part of this project and need verification. ✓ I Feature Required Forms (if applicable) I Description CF -6R part 5 Valve CF -6R part 6 Residential Compliance Forms April 2005 VV i 1/tVVV Vr.vi ran o0bono.uvU0 ocnno onn u.1cou - nv nun n -V INSTALLATION CERTIFICATE (Page 3 of 12) CF -6 Sit* Addross , Permit Number ullv An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (711+ ' 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(&). HVAC SYSTEMS: i Heating Equipment CDC Certtt'fe4 Mir, q of , Duet poet' of Hawing Equip 'Typo _ Name and Model [dentias) i�t niciency E. oto.) . I.boation Piping I Loud Cooling Equipment �2gVaY1 � [f!G- Signatur i Date: g — 07 Equip Type CEC Certified Mfr. Name turd Model # of Eftlalency t Idonbeol (86t?R or EVA). Duct Location Cooling Duct load Cooling) Capoolry heat um Number systems ZCF•IRvalue ic.4tC,) -value tliAr Btu/f,r FAIV Coil .4V%� 12o/ . 1 1-3 q ¢ 66k 649K 1. > symbol reads greater than or equal to what Is Indicated on the CF -I R.Vaim Include both SEER and ERR If compllpnce credit for high EER air conditioner is claimed. 1311, the undersigned, vcrify that equipment listed above Is: 1) Is the nctual equipment Installed, 2) equivalent to or more efflolont than that spaoified in the oartifloate of compliance (Fornt CF-IIQ submitted for compliance with the Energy 4BINency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate roquirtments for manufhctured devices (from the Appliance Ffileienry Regulations or Part 6). where applicable, Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner �2gVaY1 � [f!G- Signatur i Date: g — 07 Copies to -.BUILDING DEPARTMEPW HERS RATER (IF APPLICA E) BUTLDTN(: OWNER AT OCCUPANCY Residential Compliance !~bans Apri/2005 i t OCT 04,2005 08:99 SEARS HOME I MP 8585869098 Page 4 vol I Icvvv vi.va ran VJVJVVVVVV Vim••••`• "••^ "-"-•' w INSTALLATION CIEIRTIFICATE -age 4 of 12 CF -6R Site Address Permit Number 4 -- �� 5 �v� �r r� Lh Ql 111V 1 ��- � INSTALLER COMPLIANCE STATENZNT FOR DULY' LEAKAGE INSTAF,M COMPLIANCE STATEMENT The building was: ✓ Mated at Final --"C3 Tested st Rough -In INSTALLER VISUAL. INSPECTION AT FINAL CONSTRUCTION $TAGS: 17 Remove at least one supply and one retum regiater, and verify that the spaces between thq register boot and the interior finishing wall are properly sealed. 13 If the house rough -in duct leakage test was conduawd without an air handler insiaMcd, inspect the connection points between the air handler and tho supply and return plenums to verity that the connection points are properly sealed. O Inspect all Joints to cnsure that no cloth backed rubber adbesive duct tape is used ✓ C3DUCT LEAKAGE REDUCTION ✓ ❑I, the undersigned, verify that the above diagnostic test results were pentrmed In confvtmanoe with the roquircmcats for compliance credit. 1, the undcrsigncd, also certIfy that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements speoiRed in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Nurse) OR Ciencral L C a G' Contractor (Co. Name) OR Owner �a i1 auq/r GGl i l G '° Signatvro: Date:5P-5-07 Copies tet BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 OCT 04,2005 08:45 SEARS HOME I MP 8585869098 Page 5 vo/ „/tvvv vi.v4 rAA 000ao0avoo ocmno onn vicau • Ml. Ain Wlvvcivir ✓ C'7 THERMOSTATIC EXPANSION VALVE (TXV) Proeedm'eiforfleld veriJioarlon ofthermaaadc arpwWon valves are avallabla In RCM—Appendix Rl. Access is provided for inspection. The procedure shall consist of visual verification that the TXV Is Installed on Yos C] No the system and installation of the specific equipment LBO' Q . shell be voriflad. ,eyes is a_pass I Pass I Fait I. O REFRIGERANT CHARGE MEASUREMENT . Voriflcation fbr Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic expansion Valves Outdoor Unh Serial # Location Outdobr Unit Make Outdoor Unit Model Cooling Capaoi BttrThr Date of Verificstion Date of Refrigerant Gauge Calibtmtion (must be checked monthly) Date of Thermocouple Calibration (must be chocked monthly) 5tgndsrd!Qhgme Measu_mment Prgcadury (outdoor air dry-bulb ST and ve): Procedures for Derermininq Refrigerant Charge using the Slandard Melhod are aWrIaNs In RACM, Appendix RD2. Note: The system should be installed and charged In accordance with the manufacturer's specifleatlons befbro starting this procedure. AAGAmicAA Twmnwrnfi,ree Supely (evaporator leaving) air dry-bulb temperature (Tsupply, db) "P Return (evepomtor entering) air dry-bulb temperature (i'return, db) OF Return (evaporator entering) air wet -bulb temperature (Treturn, !Lb °I' Evaporator saturation temperature (Tevaporator, sat °F Suction line temperature (Tsuetion, db) °F Condenser (ent¢ring) air dry-bulb temperature (Tcondenser, db) °F >u erheat Charize Method Calculations for Refrigerant Ch Actual Superheat - Tsuetlon, db — Tevaporator, sat OF Target Superheat (from Tibia RD -2) or Actual Suporhoat — Target Superheat (System passes If between -3 and +3.°F) OF Temperature Split Method Calculations for Adequate ALdlOw e_c. 1. — --....., Jl•Ad.......i. /t./r..,.. A"1410 !e �nhon Actual Tcm orature Split o T rcturn, db Tsupply, db "F Target Temperature Split from Tablo RD3) op Actual Temperature Split Target Temperature Split (System passes if behveon - OF 3°F and +3'F or, upon remeasuremant, if between -3°F and -100•F) ResldentW Compliance Forms 4prll 2005 OCT 04,2005 08:46 SEARS HOME I MP 8585869098 Page 6 Vo/ II/GVVV VI.Vt. I'/1,1 OJVNOOOVoo Jrnnv onil u1GOu ,1V n4.n YNSTAUATION CERTIFICATE a e 6. of 12 CF -6X2 Site Address Permit Number Standard Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criterls from the same j measurements. If corrective actions were taken, both criteria must be remeasured and recaloulated. ❑ Yes ❑ No System Passes --� Alternate .Charge Measurement Procedure (outdoor air dry-bulb below 55 7) Note: The system should be installed and charged In aeeardaace with the manufacturer's specifications and installer verification shall be documented on CF -611 before starting this procedure. If outdoor air dry-bulb is SS OF or above, installer shall use the Standard Charge Measure Procodure: Procedures for Deiermining 1'oigerant Charge using the Alternate Method are awillable in RA CM. Appendix RDS Actual liquid Jive length: Manufacturer's Standard liquid line length: ft Difference (Actual — Standard): ft Manufacturer's oorroction (ounces per foot) _ x fformce In length=_ounoes (+ a add) (- ,a remove) di I teas urcd Airflow Method fbr Adeguata Airflow Verification avallabla in R4 CA rlgPend& AQ,2-.6 _ Calculatod Airflow: Cooling Capacity (Btu/hr) X 0.033 (cfaila v -hr) _ CFM Measured Airflow is CFM (Maasurod alrflow must be greater -the calculated alrflow), Altemate Charge Measurament Summary. System shall pass both rofrdgamrit charge and adequate airflow calculation criteria from the same measurements.. If corrective actions woro taken both criteria must be remeasured and recalculated. v" I 0 Yes I ONO I S rrem Pisses Installing Subcontractor (Co. Name) OR General' (f -g Re _1r/e �^d �/G Contractor (Co. Name) OR Owner q C 7 Signature: RxaDate: . 9-5-07 Copies to: BUILDING DEPAR7M , HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Resldennal Compliance Forms it pril 2005 OCT 04,2005 08:47 SEARS HOME I MP 8585869098 Page 7 v 0 ' CheckMe!" Duct Data Entry. Form r �u� CALL 1-(877)-243-2553 roll l Free for Data Entry or Technical Help Customer ID# -- 7 Zip, Wyo/ Program Type: _v1ID Residential Q GWP Res/Comm Residential U Commercial ❑ Other _ Contractor. C';r V-rAtw/h /eel Tech I.D. 1913 AC Information: LI nitial Test C] Test After Repair Apt/Space/Suite # System # Customer Information: First & Last Name OR Company Attw Property Location: - Address� _54 -__L7f �� rl'eYfJ City /,a G?aIAE b+ State< ')4.._ Zip Phone( Mail -To Address (if different from job location): First & Last Name On Company_ Attn: Address City State _Y_ Zip _ Phone Notes Supply. Pressure measured at: ❑ Supply Plenum dearest Register INITIAL Combustion Safety Test Results:. U Passed U Failed LLAot Completed Combustion Safety Test Results. AFTER Sealing: Ll Passed L? Failed 2114ot Completed Method of Determining Air Flow: 0 Default Airflow Q' Duct Blaster U Flow Hood U TrueFlow Meter Leakage Test Device: a�'buct Blaster U Aeroseal AC; Not Legible Make: L7 Model-, ARa)! ' 48 �C�% ❑ Nominal Tons: O Duct Blaster Duct Leakage Measurements: Initial Test Final Test Duct Pressure: a 5 - Ring Number: U Open C71)<2 113 LJ Open E 1 112 U3 Fan Pressure: teakage Flow; TrueFlow�Air Handier Airflow. Measurements: Initial Testa Final Test Operating- Supply Pressure.- ressure:Test TestSupply. Pressure: Plate Number 14 20 14 = ': 20 Differentia( Pressure; Measured Flow:•° :. Duct Blaster Air.Haridler Airflow Measurements:; . Qperating Supply Press:- "; #1 #2 #1 #2 Test Supply Pressure: #I_- #2 #1 __ #2— Ring Number: EJ Open [1 1, U2 U3 CJ Open 01 02 U' 3 Duct Blaster Pressure: . Duct Blaster Flow: Ftowhood Airflow Measurements: - Total Flow Measured: INITIAL LEAKAGE TEST Initial Duct Leakage is: /.97_ cfm _ �� % of airflow Initial Duct Leakage is: ❑ High enough to qualify this system for the Duct Sealing incentive opportunity. Liffoo low to qualify this system for the Duct Sealing incentive opportunity. FINAL LEAKAGE TEST Final -Duct Leakage is: __ cfm % of airflow Final Duct Leakage is: L Low enough to qualify this system for the Duct Sealing incentive. U Not low enough to qualify this system for the Duct Sealing incentive. Additional sealing must be performed to qualify for the incentive. 02003 Proctor Engineering Group, Rev 04/04/05