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FORMS FLORIDA BUILDING CODE,ENERGY CONSERVATION FORM 402-2010 Residential Building Thermal Envelope Approach ALL CLIMATE ZONES Seope:Compliance with Section 402 of the Florlda Building Code,EnergyConservation,shall be demonstrated bythe use ot Form 402 for single-and multiple-family residences of three stones or less in height,additions to existing res(dential buildings,renovations to ewst�ng residential buildings,new heating cooling and water heating systems in epsting bwldings as i applicable.To comply,a building must meet or exceed all of the energy efflciency requirements on Table'402A and all appiicable mandatory requirements summarized in Table 402B o{ttiis ' form.If a building does not comply wfth this method or Alternate Form 402,it may stili comply under Section 405 oi theFlorida Building Code,EnergyConservation. PROJECTNAME: A1142�('SD , Lo'�� ScL BUILDER: a ry��rKr�^ �YIC• AND ADDRESS: �j9�Cp �RiC�e, pERMITTWG/� /� I� I_ II MQ,�S�i(, �CA.kS OFFICE: l..l Ol""Ze y� (��'lil�5 , OWNER: �yr��eY SD PERMIT NO.: � JURISDICTION NO.: General Instructions: 1.New construction which fncorporates any of the following features cannot comply using this method:glass areas in excess oi 20 pe�cent of conditioned floor area,electric resistance heat and afr handlers located in atties.Additions s 600 sq.ft.,renovations and equipment changeouts may comply hy this method with exseptinns given. 2.Fill In ail the applicable spaces of the`To Be Installed"column on Table 402A with the iniormation requested.All"To Be Installed"values must be equal to or more efficient than the requfred levels. 3.Complete page 1 based on the"To Be Installed"column fnformation. 4.Read the requirements ot Table 402B and check each 6ox to Indicate your intent to comply with all applicable ftems. 5.Read,sign and date the"Prepared By"certification statement at the bottom of page 1.The owner or owners agent must aiso sign and date the form. Please Print CK 1. New construction,addition,or existing building 1, � �, 2. Single-family detached or multiple-family attached 2, 5 n 3. If multipfe-family-No.of units covered by this submission g, - 4. Is this a worst case?(yes/no) 4. !�� 5. Conditioned floor area(sq.ft.) g,�,��{�C�1 6. Glass type and area: a U-factoc 6a. .�OJ'r b.SHGC 6b. t,�,D c.Glass azea 6c. �i0' sq.ft. 7. Percentage of glass to floor area � ''l ,�o 8. Fioor type,area or perimeter,and insulation: a.Slab-on-grade(R-value) 8a.R- lin.ft. b.Wood,raised(R-value) 8b.R- I 3 �4 g _sq.ft. c.Wood,common(R-value) 8c.R= Sq.ft. d.Concrete,raised(R-value) 8d.R= sq.ft. e.Concrete,common(R-value) Se.R- sq.ft. 9. Wall type,area and insulation: a.Exterior: 1. Masonry(InsulaGon R-value) 9a-1. R= sq.ft. 2. Wood frame(Insulation R-value) 9a-2. Fi=�_ �sq.ft. b.Adjacent: 1. Masonry(Insu]ationR-value) 9b-1. R= sq.ft. 2. Wood frame(Insulation R Value) 9b-2. R=� a 3a sq.ft. 10. Ceiling type,area and insulation: a.Under attic(Insulation R-value) b.Single assembly(Insulation R-value) 10a.R= sq.ft. 110b.R= c � �_sq.�Y. 71. Air distribution system:Duct insulation,location,Qn a Duct location,insulation 11 a. R= _� DDY' b.AHiJ]ocation 11 b. - N A c.Qn,Test report attached(<0.03;yes/no) 11c.Test re ort attached? Yes No 12. Cooiing system: a.�,Pe 12a.Type: ��cc�. /FlG b.E�ciency 12b.SEER/EER• l3 '13. Heating system: 13a.Type: ��K� �FL��r�� a Type 13b.HSPF/COP/AFUE: 7.7 b.Efficiency 14. HVAC sizing calculation:attached 14. Yes Jo 15. Hot water system: �/� �.�,pe 15a.Type: b.Efficiency 15b.EF• I hereby certlfy that the pla and specfflcations covered 6y the calculatfon are in compliance v�th the Florlda Review of plans and specifications covered by this calcuiation Indicates compliance with ffie Flarfda Energy Code. Energy Code.Betore constructlon fs compJete tl'�bullding will be inspected tor compliance fn accordance with Section 553.0,F . PREPARED BY: DATE: a 'z� I� � CODE OFFICIAI. I hereby certify thzt this bufld in compliance with the Rorida Energy Code: � OWNER AGENT: DATE: DATE: C.4 2010 FLORIDA BUILDING CODE-ENERGY CONSERVATION