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CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF-IR
Project
Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF-4R Form must be provided to the building department for each home for which the following. are
required.
❑
Sealed Ducts all climate zones Installer testis and certification and HERS rater field verification re uired.
❑
TXVs, readily accessible (climate zones 2 and 8-15 only)
Installer testing and certification and HERS Rater field verification uircd
❑
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification i- uired)
OR
EDITAlternative to Sealed Ducts and Refrigerant Charge frXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM. Appendix B Table 15I-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
aces shall meet the requirements of Section 15 m and duct insulation reQuirements of Package D.
wA t L+ K UJtSA'F1fq[x SY&I'ILMS
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 Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heating calculations are requirerequir4 and the system complies aulomaticafl .
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
d Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple T
units
Systems serving sin a dwellin units
Rated Enemy Tank
Input Tank Factor or External
Water Heater [Distribution: Number (kW or Capacity Thermal Standby' Insulation
T e/Fuel Type T in System sW/hO (saltons) Efficiency Loss (OM R-Value
serving multiple dwelline units
Rated Enemy Tank
Input Tank Factor or External
Water Heater Distribution Number kw or Capacity Thermal Standby' Insulation
T e Type in System Zulhr (gallons) Efficiency Loss (%) 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.
PigC Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the ki€rhen fixtures that are 3/a
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 (j) 2 B.
Residential Compliance Forms March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL Maize I of 4) CF-1R
Project Title
Project Addres•. fo 1-4lC k 1 "� V) �p � Q A C, 1'
Documentation Author
Compliance Method (Prescriptive)
✓ ❑ Alternative Component Package Method: (check one)
Climate Zone
Date
Building Permit /I
Plan Check / Date
Field Check / Date
Enforcement Agency Use Only
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) W Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C — (5% X CFA) � fe
Maximum Allowed Total Fenestration Products Per Table 151-13 or 15I-C -.-- (20% X CFA) g
✓ 0 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). L.
✓ ❑ RADIANT BARRIER(required in climate zones 2 4.8-15
OPAQUE SURFACES INCLUDING OPA UE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors
Frame
Type
(Wood
or Metal)
Cavity
Insulation
R-Value
Continuous
Insulation
R Value
Assembly U-
factor (for
wood, metal
frame and mass
assemblies)
Joint
Appendix
IV
Reference
Roof Radiant
Barrier
Installed
Yes or No
Location/Comments
(attic, garage,
ical' etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U-factor criterion. U-faclors can not
exceed prescriptive value to show equivalence to R values.
Residential Compliance Forms March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Passe 4 of 4) CF-IR
Project
Date
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION add extra sheets if nee
Indicate which special features are part of this project. The list below only represents special features relevant to the
prescriptive method.
1 I
Feature
Reguired Forms if appheablo
Descri Lion
❑
Metal Framed Walls
CF-1R
❑
Radiant Barriers
CF-1R
❑
Exterior Shades
WS-4R
❑
Cool Roof
N/A; Attach CRRC Label to
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
S stem
R uired; 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 buildin plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-I3 or use
❑
Dwelling Unit
Performance Calculation and
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
_ _
Serving Multiple Dwelline
attach Run to Forms.
❑
Non-NAECA Large Water
CF-1R
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
attach Ripn 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
SPECIAL FEATURES REQUMING HERS RATER VERIFICATION
(add exL�a sheets if necrssarv) Indicate to the HERS Rater which credits are part of this project and need
verification
{
Feature
Required Forms if a licable
Desert tion
❑
Duct Scaling
CF-6R part 4 of 12
❑
Rcfri erant Charge
CF-6R part 5 of 12
❑
Thermostatic Expansion Valve
CF-611 part 6 of 12
Residential Compliance Forms March 2005
�....._. ., Buildirlg usgety Division
N PHnrlt i/ P-®. Boy 1584, 78-495 Calle Tampico
a Quints, Cf , 92253 - (7 60) 777-70 F 2
3 -75 Ruilding Permit Appiicadon and Tracking Sheet
rProjt:cl Addrem: n
--- �'l wtter Nt»e:L&) l j 4 I IUYY)M1
A. P. Number: R '
t+d _ +V , I
4
Leku! 17csttiplinst: ..^ City, ST. 7_ip:
Telephone: a—�`— '` r •:cN.
Address: 't j C C� l�%s.� /] .�� J` ProjcctDcscription:
City, ST,
— —zipA,—e>L,
z 'zw C})—Tlrn r!er '-iaiL,'
Telephone
Stole Lio. d : 3;19D (•Q
Ardi., Ergr., Desiper.
Address:
Cirv, ST. Zip:
1 Telephone: tt`-`ktia ''' ice` Cturstrur3io Type:
r`, r�
'�=._ .-.� T'r�s� ill -- OCCUPMCV:Stale Lic.
Projrcitvn: ii`f circleonc): e:: Add'n fiberHcp::ir t7 rto
iJanx: of Conlari Person.f 5q. PI-: R 5lnries 4 UnIL: T
!; 'fcleplteno nt Contact Pt•nrn: - � _ .,-y PstinuIled 1r21ue0fPinj-::
APPLICAt1' : DO 140T WRITE BELOW TifiS L[lE_ � —
I
t SuLmltralRcc'd
Plan Cacc& suWaitted
3trsitare�i, reedy forccrrectio�:s
C:31ed Carit2aFerson
?Teas picked up —
flan Sets
Sircelarul C;nla.
Tnuq Coles.
Hood plain pl :n
Gn,ding plan
SnlrrOnTatter List
Grant Dccd
11.0_4. Approval
1N IIOIISE:-
Plsaalag Approval
Poly. Ms. Appr
. Schaal ?~'sex
1
I
Plans resubmittea '
" Review, ready for corredio,idssue — Y
Called Contaci Person
Plnns pidted up
Plans resu€ rahled
Review,rme dyfor eorreednnsFusae
Called Contact Parson
IIMe of permit issue
PERAIrr IMU
Rem
Plna CLeckDepasit
Anoun,
NOR C6cck BalanCC
Construction
Mt!CI +oica1
Uzurical
Plum6c,:g
Grading
Developer Impact Fee
AIP-P.
Total Permit FeL `