Hamilton County Residential Energy Code Compliance Certificate Form
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1
2Hamilton County Residential Energy Code Compliance Certificate
HOUSE ADDRESS: __________________________________________________________________________________
___
: ___________________________________________________________________
BUILDER/DESIGN PROFESSIONAL NAME
:__________________________________________________
____
:_________________________
COMPANY
PHONE
EMAIL: ____________
_________________________________________________________________________________
ENVELOPE SUMMARY (To be completed by Builder or Design Professional.)
FLAT CEILING/ATTIC
__________R-VALUE
WINDOWS:
SLOPED/VAULTED CEILING
__________R-VALUE
__________SHGC
__________U-FACTOR
ATTIC KNEEWALL
__________R-VALUE
EXTERIOR WALL
__________R-VALUE
SKYLIGHT:
ABOVE GRADE MASS WALL
__________R-VALUE
__________SHGC
__________U-FACTOR
BASEMENT STUD WALL
__________R-VALUE
BASEMENT (CONTINUOUS)
__________R-VALUE
OPAQUE DOOR (<50% Glazed):
CRAWLSPACE STUD WALL
__________R-VALUE
__________SHGC
__________U-FACTOR
CRAWLSPACE (CONTINUOUS)
__________R-VALUE
FLOOR
__________R-VALUE
OTHER INSULATION COMMENTS:
CANTILEVERED FLOOR
__________R-VALUE
FOUNDATION SLAB
__________R-VALUE
________________________________________________
MECHANICAL SUMMARY (To be completed by HVAC Contractor.)
: __________
NUMBER OF HEATING AND COOLING SYSTEMS
(choose one)
GAS: ________AFUE
AIR-SOURCE HEAT PUMP:_____HSPF
OTHER
HEATING SYSTEM 1 TYPE
______________________________________________
COOLING SYSTEM 1 TYPE (Standard DX, Heat Pump, Geothermal, Etc.)
: ___________________
SEER
EER
OTHER
COOLING SYSTEM 1 EFFICIENCY
(choose one)
GAS: ________AFUE
AIR-SOURCE HEAT PUMP:_____HSPF
OTHER
HEATING SYSTEM 2 TYPE
______________________________________________
COOLING SYSTEM 2 TYPE (Standard DX, Heat Pump, Geothermal, Etc.)
: ___________________
SEER
EER
OTHER
COOLING SYSTEM 2 EFFICIENCY
: ___________________Ef
:
GAS
ELEC
OTHER
WATER HEATER ENERGY FACTOR
FUEL TYPE
FIELD TESTING (To be completed by a qualified Third-Party Verifier)
BUILDING ENVELOPE TIGHTNESS:
3
: __________ CFM
: _______________ ft
FAN FLOW AT 50 PASCALS
TOTAL CONDITIONED VOLUME
50
ACH
= CFM
x 60 / Volume = _______________ ACH
(must be less than 7 ACH
)
50
50
50
50
DUCT TIGHTNESS TESTING:
2
SYSTEM
METHOD* (PCO, PCT, RIT)
CFM
AREA SERVED (ft
)
TEST RESULTS**
COMMENTS
25
1
2
* PCO (Post Construction Leakage to Outdoors) 8% max; PCT (Post Construction Total Leakage) 12% max; RIT (Rough-in w/Air
Handler installed) 6% max
2
** CFM
per 100 ft
of Conditioned Floor Area = CFM
x 100 / Conditioned Floor Area Served
25
25
BUILDING ENVELOPE TIGHTNESS / DUCT TIGHTNESS TEST CONDUCTED BY:
:________________________________________
__
___
________
__
NAME
SIGNATURE:
:____________________________________________ ____
_
HERS
BPI
DET
COMPANY
QUALIFICATION:
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