No Permit No (MECH)CERTIFICATE OF
nLIJ AND DIAL
TIC TESTING
Project Title h j
Da LC
Project Ad ress 10— iJ
Builder N me
9ulluer Cnrogm
NcR, Rater.
rtifying Signature
D to
Firm;^ —
Street Address:
Copies to Builder, HERS Provider
HERS RATER COMPLIANCe STATEMENT
Plan Number
Semple Group Number
Sample Mouse Number
HERS Provider; J.-G_q-�SSDGIATYf _
Clty/State/Zip: Jp 'Z 23�L
.4R
The house was; X Tested 0 Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verlflcativn, I certify that the houses Identified on this form
comply with the diagnostic tested compliance requirements as checked on this form,
7oistribution system is fully ducted (i.e., does not use building cavities 'as plenums or platform returns in lieu
of ducts)
,YWhere cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands 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
Duct Diagnostic Leakage Teating Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM @ 25 Pa) Measured
values
Test Leakage Flow In CFM
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here
If fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _, 1 o
Check Box for Pass or Fail (Pass=6% or less) —
1Z"J THERMOSTATIC EXPANSION VALVEify,XV or Commission approved a uivalcnt
C!J Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Yes Is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values In
CF-1 R and design on plan.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF-1 R.
Measured Fan Flow
Yes for both 1 and 2 is a Pass
ass Fail
97 a
Pass Fail
Pass Faii