Energy Efficiency Design Summary Form - City Of London
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1
2Energy Efficiency Design Summary
(Building Code Part 9, Residential)
This form is used by a designer to demonstrate that the energy efficiency design of a house complies with the building code
For use by Principal Authority
Application No:
Model/Certification Number
A. Project Information
Building number, street name
Unit number
Lot/Con
Municipality
Postal code
Reg. Plan number / other description
B. Compliance Option
[indicate the building code compliance option being employed in this house design]
SB-12 Prescriptive
: A B C D E F G H I J K L M
Table 2.1.1.10.
(circle one)
or
(Additions)
.
prescriptive trade-offs used (Specify 2.1.1.2
or 2.1.1.3. sentences being employed):
* Attach energy performance calculations using an approved software
SB-12 Performance*
[SB-12 - 2.1.2.]
* Attach Builder Option Package [BOP] form
Energy Star®*
[SB-12 - 2.1.3.]
* House must be evaluated by NRCan advisor and meet a rating of 80
EnerGuide 80® *
C. Project Design Conditions
Climatic Zone (SB-1):
Heating Equipment Efficiency
Space Heating Fuel Source
□
□
□
□
□
≥ 90% AFUE
Zone 1 (< 5000 degree days)
Gas
Propane
Solid Fuel
□
□
□
□
□
≥ 78% < 90% AFUE
Zone 2 (≥ 5000 degree days)
Oil
Electric
Earth Energy
Ratio of Windows, Skylights & Glass (W, S & G) to Wall Area
Other Building Conditions
□
□
□
2
Area of walls =
m
ICF Basement
Walkout Basement
Log/Post&Beam
_____
=
W, S & G %
□
□
2
Area of W, S & G =
m
ICF Above Grade
Slab-on-ground
D. Building Specifications
[provide values and ratings of the energy efficiency components proposed, or attach Energy Star BOP form]
Building Component
RSI / R values
Building Component
Efficiency Ratings
Thermal Insulation
Windows & Doors
2
Provide U-Value in W/m
.K, or ER rating
Ceiling with Attic Space
Windows/Sliding Glass Doors
Ceiling without Attic Space
Skylights/Glazed Roofs
Exposed Floor
Mechanicals
Walls Above Grade
Heating Equip
.(AFUE or condensing type)
o
HRV Efficiency
Basement Walls
(SRE% at 0
C)
DHW Heater
Slab
(EF)
(all >600mm below grade)
DWHR (
Slab
(edge only ≤600mm below grade)
CSA B55.1 Efficiency)
Slab
(all ≤600mm below grade, or heated)
E. Performance Design Verification
[complete applicable sections if SB-12 Performance, Energy Star or EnerGuide80 options used]
SB-12 Performance:
The annual energy consumption using Subsection 2.1.1. SB-12 Package__________ is__________Gj
(1 Gj =1000Mj)
The annual energy consumption of this house as designed is__________Gj
The software used to simulate the annual energy use of the building is:______________________________________
The building is being designed using an air leakage of ______ air changes per hour @50Pa.
Energy Star: Submit the BOP form with Energy Advisor’s certification on completion.
Energy Star and EnerGuide80:
Evaluator/Advisor/Rater Name:
Evaluator/Advisor/Rater Licence #:
F. House Designer
[name & BCIN, if applicable, of person providing information herein to substantiate that design meets the building code]
Name
BCIN
Signature
Form authorized by OHBA, OBOA, LMCBO. Revised November 27, 2013
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