0401-118 (SFD)INSPECTION RECORD
OPERATION DATE
INSPEECTOR
OPERATION
DATE
INSPECTOR
BUILDpNO APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_I
Forms & Footings
Ducts
Slab Grade
1
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
— f ..- y
Compressor
Insulation
S _ _ y
S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
a --W.
Drywall - Int. Lath
—
Final
Final
POOLS - SPAS
BLOCKWALL AP OVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
i
Underground Plbg. Test
i
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1% —
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS.
Final
UWity Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
1 7>_ ��/
INSTALLATION CERTIFICATE (Page 3 of 13)
CF-6R
50-.Os vza s
py
•L j Site Address Permit Number
� f
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM C3a 25 PA) Test Leakage (CFM)-
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Hearing 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) =
1r ❑
Pass if leakage fraction < 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
[,' THERNTOSTATIC EXPANSION VALVE (TXV)
pf Yes ❑ No Thermostatic Expansion Valve is installed and Access is - provided for inspection
Yes is a pass
'g ❑
❑ DUCT DESIGN
Pass Fail
ACCA Manual D Design calculations have been
1. ❑ Yes ❑ No
completed, Duct Design Is on the plans and duct installation
matches plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, ❑ ❑
verified fan flow matches design from CF-IR. Pass Fail
Measured Fan Flow=
Yes for both 1 and 2 is a Pass
❑ 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. ]
Tests Si ture, Date Installing Subcontractor (Co. Name) OR
Peribrmed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Cornpilanw Forms August2001
A-25
INSTALLATION CERTIFICATE (Page 3 of 13) CF-6R
SEte Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM)1eA
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) _ )R ❑
Pass if leakage fraction < 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 0 ❑
Pass Fail
r THERMOSTATIC EXPANSION VALVE (TXNj
;R Yes ❑ No Thermostatic Expansion Valve is installed and Access is -provided for inspection
Yes is a pass '�' ❑
❑ DUCT DESIGN Pass Fail
ACCA Manual D Design calculations have been
1. ❑ Yes ❑ No completed, Duct Design Is on the plans and duct Installation
matches plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, ❑ ❑
verified fan flow matches design from CF-IR. Pass Fail
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑ 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. ]
i15/_�24/
Tesu S ature, Date
Performed
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms
Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name)
August 2001
A-25
0
INSTALLATION CERTIFICATE (Page 3 of 13) CI'-6R
SIte Address � - Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM Q 25 PA) Test Leakage (CF'M)1%
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 BtAr, enter calculated value here
If fan flow Is measured, enter measured value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) _
p
Pass if leakage fraction < 0.06
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFK
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections
❑
Pass Fail
F�THERMOSTATIC EXPANSION VALVE (TXV)
—
2f Yes ❑ No Thermostatic Expansion Valve is installed and Access is -provided for inspection
--
Yes is a pass
,;.W o
❑ DUCT DESIGN
Pass Fail
ACCA Manual D Design calculations have been
1. ❑ Yes ❑ No
completed, Duct Design Is on the plans and duct installation
matches plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF-11L
Pass Fail
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑ 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 ]
8 O
Tests $ � Date Installing Subcommctor (Co. Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August2001
A-25
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