Professional Documents
Culture Documents
) N N/A
89!9!
:P/;<
;
Plans and,or s%ecifications %rovide all information *ith
*hich com%liance can -e determined for the
*uilding en&elo(e and delineate and document
*here e5ce%tions to the standard are claimed9
89!9!= >989!
:P/!<
;
Plans= s%ecifications= and,or calculations %rovide all
information *ith *hich com%liance can -e
determined for the mechanical s+stems and
e,ui(ment and delineate and document *here
e5ce%tions to the standard are claimed9
89!9!= ?989;
:P/@<
;
Plans= s%ecifications= and,or calculations %rovide all
information *ith *hich com%liance can -e
determined for the ser&ice 'ater heating s+stems
and e,ui(ment and delineate and document *here
e5ce%tions to the standard are claimed9
89!9!=
A989;9
;=
A989;9
!
:P/8<
;
Plans= s%ecifications= and,or calculations %rovide all
information *ith *hich com%liance can -e
determined for the lighting and electrical s+stems
and e,ui(ment and delineate and document *here
e5ce%tions to the standard are claimed9 Information
%rovided should include interior and e5terior lighting
%o*er calculations= *attage of -ul-s and -allasts=
transformers and control devices9
>9?9!98
:P/B<
Detailed instructions for 36AC s#stems commissioning
included on the %lans or s%ecifications for CBD=DDD ft
!
9
A989;9;
:P/><
!
eeder connectors siEed in accordance *ith a%%roved
%lans9
A989;9!
:P/?<
!
Branch circuits siEed for ma5imum dro% of @F9
Additional Comments,Assum%tions:
1
.se Comments,Assum%tions to document code reGuirements that %ass due to e5ce%tions= and s%ecif# the e5ce%tion9 Also use
Comments,Assum%tions to document multi%le values o-served for a given code reGuirement= such as multi%le eGui%ment efficiencies9
H,!8,!D;D Page
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ -ooting / -oundation Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
B9B9@9@
:);<
!
Belo*(grade *all insulation /(value9 /(
B9A9;9!
:)!<
!
Belo*(grade *all insulation installed %er
manufacturerIs instructions9
B9B9@9B
:)@<
!
"la- edge insulation /(value9 /(
.nheated .nheated
3eated 3eated
B9A9;9!
:)8<
!
"la- edge insulation installed %er manufacturerIs
instructions9
B9B9@9B
:)B<
!
"la- edge insulation de%th,length9 ft
B9A9;9?
:)><
B9A9;9?9@
:)?<
Insulation in contact *ith the ground has JD9@F
*ater a-sor%tion rate %er A"'0 C!?!9
>9@9!=
>98989;=
>98989!
:)A<
>9B9A9!=
?989@
:);D<
B989@9!
:/!<
@
Doors meet ma5imum air lea&age reGuirements9 cfm, ft
!
B989@9!
:/@<
@
enestration and doors la-eled for air lea&age9
B989@98
:/8<
@
6esti-ules installed %er a%%roved %lans9
B9B9@9;
:/B<
B9A9;9!
:/><
B9B989!9;=
B9B989!9!
:/?<
B9B989@a
:/A<
B9B98989!
:/;;<
B9A9!9;
:/;!<
!
enestration %roducts rated in accordance *ith
N/C9
B9A9!9!
:/;@<
B9A9!9@=
B9B9@9>
:/;8<
!
.(factor of o%aGue doors associated *ith the
-uilding thermal envelo%e meets reGuirements9
.(
"*inging "*inging
Nons*inging Nons*inging
Additional Comments,Assum%tions:
H,!8,!D;D Page
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ %lum*ing Rough!In Ins(ection
Com(lies
Comments/Assum(tions ) N N/A
?989@
:P2;<
"
Pi%ing for recirculating and non(recirculating service hot(
*ater s#stems insulated9
?98989;
:P2!<
@
C
'em%erature controls installed on service *ater heating
s#stems (J;!D L to ma5 tem% for intended use)9
?98989!
:P2@<
?989>
:P28<
@
3eat tra%s Installed on non(circulating storage *ater
tan&s9
Additional Comments,Assum%tions:
H,!8,!D;D Page
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ 0echanical Rough!In Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
>989;98=
>989;9B
:0E;<
!
36AC eGui%ment efficienc# verified9 Non(NAECA
36AC eGui%ment la-eled as meeting HD9;9
Efficienc#:
>989;9B9!
:0E!<
@
P'AC and P'3P *ith sleeves ;> in -# 8! in9
la-eled Mfor re%lacement onl#N9
>989@989;
:0E@<
@
"tair and elevator shaft vents have motoriEed
dam%ers that automaticall# close9
>989@989!=
>989@989@=
>989@9898
:0E8<
@
)utdoor air and e5haust s#stems have motoriEed
dam%ers that automaticall# shut *hen not in use
and meet ma5imum lea&age rates9 Chec& gravit#
dam%ers *here allo*ed9
>989@989B
:0EB<
@
C
6entilation fans KD9?B h% have automatic controls
to shut off fan *hen not reGuired9
>989@9H
:0E><
>98989;9;
:0E?<
1
Insulation e5%osed to *eather %rotected from
damage9 Insulation outside of the conditioned
s%ace and associated *ith cooling s#stems is
va%or retardant9
>98989;9!
:0EA<
!
36AC ducts and %lenums insulated9 /(
>98989;9@
:0EH<
!
36AC %i%ing insulation thic&ness9 in9
>98989!9;
:0E;D<
!
Ducts and %lenums sealed -ased on static
%ressure and location9
>98989!9!
:0E;;<
@
C
Duct*or& o%erating K@ in9 *ater column reGuires
air lea&age testing9
>9B9;=
>9B9;9;9;=
>9B9;9;9!=
>9B9;9;9@=
>9B9;9@
:0E;!<
>9B9;9;98
:0E;@<
!
/eturn air and outdoor air dam%ers meet
minimum air lea&age reGuirements9
>9B9;9;9B
:0E;8<
H,!8,!D;D Page
90.!"00#
Section $ 0echanical Rough!In Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
>9B9;9@
:0E;B<
C
economiEer control and heating s#stem im%act9
>9B9;98
:0E;><
>9B9!9;
:0E;?<
;
Zone controls can limit simultaneous heating and
cooling and seGuence heating and cooling to
each Eone9
>9B9!9!9@
:0E;A<
!
C
3#dronic heat %um% s#stems connected to a
common *ater loo% meet heat re4ection and heat
addition reGuirements9
>9B9!9@
:0E;H<
@
C
Dehumidification controls %rovided to %revent
reheating= recooling= mi5ing of hot and cold
airstreams or concurrent heating and cooling of
the same airstream9
>9B9!98
:0E!D<
@
C
1ater economiEer s%ecified on h#dronic cooling
and humidification s#stems designed to maintain
inside humidit# at K @B L de*%oint if an
economiEer is reGuired9
>9B9@9;9!
:0E!;<
!
36AC fan motors not larger than the first
availa-le motor siEe greater than the -h%9
-h%:
>9B9@9!9;
:0E!!<
!
C
6A6 fan motors C;D h% to -e driven -#
mechanical or electrical varia-le s%eed drive= or
have a vane(a5ial fan *ith varia-le %itch -lades=
or have controls or devices to limit fan motor
demand to O@DF of design *attage at BDF
design air volume at static %ressure of ;,@ total
rated static %ressure of the fan9
6"D
6ane a5ial
fan
)ther
>9B9@9!9!
:0E!@<
!
C
6A6 fans have static %ressure sensors %ositioned
so set%oint J;,@ total design %ressure9
>9B9@9!9@
:0E!8<
!
C
/eset static %ressure set%oint for DDC controlled
6A6 -o5es re%orting to central controller -ased
on the Eones reGuiring the most %ressure9
>9B989;
:0E!B<
@
C
36AC %um%ing s#stems K;D h% designed for
varia-le fluid flo*9
>9B989!
:0E!><
@
C
/educe flo* in %um%ing s#stems K;D h%9 to
multi%le chillers or -oilers *hen others are shut
do*n9
>9B989@
:0E!?<
@
C
'em%erature reset -# re%resentative -uilding
loads in %um%ing s#stems K;D h% for chiller and
-oiler s#stems K @DD=DDD Btu,h9
>9B9898
:0E!A<
@
C
'*o(%osition automatic valve interloc&ed to shut
off *ater flo* *hen h#dronic heat %um% *ith
%um%ing s#stem K;D h% is off9
>9B9B9!
:0E!H<
@
C
an s#stems *ith motors C?9B h% associated *ith
heat re4ection eGui%ment to have ca%a-ilit# to
o%erate at !,@ of full(s%eed and auto s%eed
controls to control the leaving fluid tem% or
condensing tem%,%ressure of heat re4ection
device9
>9B9>9;
:0E@D<
H,!8,!D;D Page
90.!"00#
Section $ 0echanical Rough!In Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
>9B9>9!=
>9B9>9!9;=
>9B9>9!9!
:0E@;<
@
C
Condenser heat recover# s#stem that can heat
*ater to AB L or %rovide >DF of %ea& heat
re4ection is installed for %reheating of service hot
*ater in !8,? facilit#= *ater cooled s#stems re4ect
K> 00Btu= "31 load C; 00Btu9
>9B9?9;
:0E@!<
!
Pitchen hoods KBP cfm have ma&e u% air
CBDF of e5haust air volume9
>9B9?9!
:0E@@<
C
ume hoods e5haust s#stems C;B=DDD cfm have
6A6 hood e5haust and su%%l# s#stems= direct
ma&e(u% air or heat recover#9
>9B9A9;
:0E@8<
@
.nenclosed s%aces that are heated use onl#
radiant heat9
>9B9H
:0E@B<
C
3ot gas -#%ass limited to:
J!8D &Btu,h Q BDF
K!8D &Btu,h Q !BF
?989!
:0E@><
!
C
"ervice *ater heating eGui%ment meets efficienc#
reGuirements9
?9B9;
:0E@?<
!
C
Com-ined s%ace and *ater heating s#stem not
allo*ed unless stand-# loss less than calculated
ma5imum9 A3$ has a%%roved or com-ined
connected load O;BD PBtu,h9
?9B9!
:0E@A<
!
C
"ervice *ater heating eGui%ment used for s%ace
heating com%lies *ith the service *ater heating
eGui%ment reGuirements9
Additional Comments,Assum%tions:
H,!8,!D;D Page
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ Rough!In Electrical Ins(ection
Com(lies
Comments/Assum(tions ) N N/A
H989;9;
:E2;<
!
Automatic lighting control to shut off all -uilding lighting
installed in -uildings KB=DDD ft
!
9
H989;9!
:E2!<
!
Inde%endent lighting control installed %er a%%roved
lighting %lans and all manual control readil# accessi-le
and visi-le to occu%ants9
H989;9@
:E2@<
!
Automatic lighting controls for e5terior lighting installed9
H989;98
:E28<
6erif# se%arate lighting control devices for s%ecific
uses installed %er a%%roved lighting %lans9
H989!
:E2B<
@
Ballasted one and three lam% fi5tures *ith K@D 1,lam%
have t*o lam% tandem *ired -allasts *hen K! fi5tures
in same s%ace on same control9
H989@
:E2><
E5it signs do not e5ceed B *atts %er face9
H9898
:E2?<
E5terior grounds lighting over ;DD 1 %rovides
K>D m,1 unless on motion sensor or fi5ture is e5em%t
from sco%e of code or from e5ternal 2PD9
H9>9!
:E2A<
Additional interior lighting %o*er allo*ed for s%ecial
functions %er the a%%roved lighting %lans and is
automaticall# controlled and se%arated from general
lighting9
;D989;
:E2H<
!
Electric motors meet reGuirements *here a%%lica-le9
Additional Comments,Assum%tions:
H,!8,!D;D Page
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ Insulation Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
B989@9;
:IN;<
;
All sources of air lea&age in the -uilding
thermal envelo%e are sealed= caul&ed=
gas&eted or *eather stri%%ed to minimiEe air
lea&age9
B9B9@9;
:IN!<
/oof insulation /(value9 /(
B9A9;9!=
B9A9;9@
:IN@<
/oof insulation installed %er manufacturerIs
instructions9 Blo*n or %oured loose(fill
insulation is installed onl# *here the roof slo%e
is J@ in ;!9
B9B9@9;
:IN8<
1
"&#light cur-s insulated to the level of roofs
*ith insulation a-ove dec& or /(B9
/(
B9B9@9;9;
:INB<
@
3igh(al-edo roofs meet solar reflectance of
D9?D and thermal emittance of D9?B or "/I of
A!9
"/:
"/I:
B9B9@9!
:IN><
A-ove(grade *all insulation /(value9 /(
0ass 0ass
0etal 0etal
"teel "teel
1ood 1ood
B9A9;9@
:IN?<
A-ove(grade *all insulation installed %er
manufacturerIs instructions9
B9B9@98
:INA<
!
loor insulation /(value9 /(
0ass 0ass
"teel "teel
1ood 1ood
B9A9;9@
:INH<
!
loor insulation installed %er manufacturerIs
instructions9
B9A9;9;
:IN;D<
"
Building envelo%e insulation is la-eled *ith /(
value or insulation certificate %roviding /(
value and other relevant data9
B9A9;98
:IN;;<
!
Eaves are -affled to deflect air to a-ove the
insulation9
B9A9;9B
:IN;!<
!
Insulation is installed in su-stantial contact *ith
the inside surface se%arating conditioned
s%ace from unconditional s%ace9
B9A9;9>
:IN;@<
!
/ecessed eGui%ment installed in -uilding
envelo%e assem-lies does not com%ress the
ad4acent insulation9
B9A9;9?
:IN;8<
!
E5terior insulation is %rotected from damage
*ith a %rotective material9
B9A9;9?9;
:IN;B<
!
Attics and mechanical rooms have insulation
%rotected *here ad4acent to attic or eGui%ment
access9
H,!8,!D;D Page
90.!"00#
Section $ Insulation Ins(ection
.eri/ied
.alue
Com(lies
Comments/Assum(tions ) N N/A
B9A9;9?9!
:IN;><
!
oundation vents do not interfere *ith
insulation9
B9A9;9A
:IN;?<
@
Insulation intended to meet the roof insulation
reGuirements not installed on to% of a
sus%ended ceiling9
Additional Comments,Assum%tions:
H,!8,!D;D Page ;D
General building information only required if different than above Building ID:
Date: Name of Evaluator(s):
Building Contact: Name: Phone: Email:
Building Name & Address: Conditioned loor Area: ft
!
Com%liance A%%roach (chec& all that a%%l#): Prescri%tive 'rade()ff Performance
Com%liance "oft*are (if used): +reen,A-ove(Code Program:
90.!"00#
Section $ -inal Ins(ection
Com(lies
Comments/Assum(tions ) N N/A
B989@9@
:I;<
1eatherseals installed on all loading doc& cargo doors
in Climate Zones 8(A9
>989@9;9;
:I!<
!
3eating and cooling to each Eone is controlled -# a
thermostat control9
>989@9;9!=
>989@9!=
>989@9@=
>989@9@9;=
>989@9@9!
:I@<
!
'em%erature controls have the follo*ing features: dead
-and controls= set%oint overla% restrictions= off(hour
controls= automatic shutdo*n= set-ac& controls9
>989@9@9@
:I8<
!
"#stems *ith air ca%acit# K;D=DDD cfm include o%timum
start controls9
>989@9B
:IB<
@
3eat %um% controls %revent su%%lemental electric
resistance heat from coming on *hen not needed9
>989@9?
:I><
@
C
1hen humidification and dehumidification is %rovided to
a Eone simultaneous o%eration is not %ossi-le9
>9?9!9;
:I?<
1
urnish 36AC Mas(-uiltN dra*ings su-mitted *ithin HD
da#s of s#stem acce%tance9
>9?9!9!
:IA<
1
urnish )&0 manual for 36AC s#stems9
>9?9!9@
:H<
C
An air and,or h#dronic s#stem -alancing re%ort is
%rovided for 36AC s#stems serving Eones KB=DDD ft
!
of
conditioned area9
>9?9!98
:ID<
C
6erif# 36AC control s#stems have -een tested to
ensure %ro%er o%eration= cali-ration and ad4ustment of
controls9
?98989@
:I;;<
@
Pu-lic lavator# faucet *ater tem%erature not greater
than ;;D
o
9
?989898
:I;!<
@
Controls are installed that limit the o%eration of a
recirculation %um% installed to maintain tem%erature of a
storage tan&9
?989B9;
:I;@<
@
C
Pool heaters are eGui%%ed *ith on,off s*itch and no
continuous -urning %ilot light9
?989B9!
:I;8<
!
C
Pool covers are %rovided for heated %ools and %ools
heated to KHDR have a cover K/(;!9
?989B9@
:I;B<
@
C
'ime s*itches are installed on all %ool heaters and
%um%s9
A9?9;
:I;><
1
urnished as(-uilt dra*ings for electric %o*er s#stems9
A9?9!
:I;?<
1
urnished )&0 manual for electrical %o*er s#stems
and eGui%ment9
H9;9@
:IA<
Installed lam%s and fi5tures are consistent *ith *hat is
sho*n on the a%%roved lighting %lans9
H,!8,!D;D Page ;;
Additional Comments,Assum%tions:
E&aluator Assessment
Please %rovide a general descri%tion of *hat *as discovered during the onsite evaluation= and a %rofessional estimate of
*hat #ou feel the com%liance rating should -e= regardless of the individual metrics scored a-ove9 Include #our
assessment of the most im%actful energ# reGuirements for this %articular -uilding9
2E)
;
3igh Im%act ('ier ;)
!
0edium Im%act ('ier !)
@
2o* Im%act ('ier @) C Com%le5 0echanical
H,!8,!D;D Page ;!