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<br />PROJECl NAME'T"" :
<br />AND ADDRESS: -':
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<br />- --. --- -- ,-",-"-.'"..'-'
<br />OWNF-R: .
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<br />: u ;,;.~' 0
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<br />" "'fl<'
<br />
<br />BUILOF:R:
<br />'PERMii"ftNG 'i
<br />Of:FIC~ :
<br />
<br />PEI~MIT N J.
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<br />..",.,....,......."..IIii..
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<br />1. New construction ':"'1ddith,n
<br />2. Single family detached or Multifamily attached
<br />3. If Mulllfamlly-,No. (If units covered by this submission
<br />4. Is this 8 worst casp.l (yo;! no)
<br />5. Condilloned floor lire!) (:q. ft.)
<br />6. Predominant elJW! (vp.l"lnng (ft.)
<br />7. Glass type And fir..:':
<br />a. Clem qlw;s
<br />b, Tint. fillTlo( rni;:n :Cf4~en
<br />8. Floor tYflP. Amt IrIr.;t!'~Ul)r:
<br />;1, ~;t;'lh,c'l1pr,:'dl' (11'1;->1110 + perimeter)
<br />b WlJod. rni<", , I Fl,/ '1lw! .. sq. ft.)
<br />c, r;nncr.,to r li:;,'rj:l''1alue)
<br />9. Net Wi'J1I typf!' , men "ldPlsulatlon:
<br />B, Exterlo..: ( . H',~rf~te block (Insulation R-value)
<br />\, i onrllrame (Insulation R-vallJEl)
<br />,. r-1P.fJI frame (Insulation R-value)
<br />I ('p (In!";ulatlon R-value)
<br />(l'h"!I: ____H.__ _.. .
<br />b. J\dj<l':;I"IlI: ( 'll\cr"te block (Insulatiol1 n, 'n',,! I!',
<br />:' I'J()~H1 frame (Insulation R.vaIIJEl)
<br />~ II~nl f'ame (Insulation R-value)
<br />I <'9 (In!~ulation R-value)
<br />10_ Celllnt;J type, area Imrlln1ulaUon: I
<br />
<br />~: ~~~~; :::€,~:~~~I~)'~~~I~~~~I~~~aIUe) , ,I ; 'il"'~l
<br />
<br />c. Radiant barrier Installed (yes I no) ~ I:! ...~
<br />11. Air dlfltrlbutlon Rystem:, : ' : t~ :I::~;,
<br />a. Ducts (Insulation -4- Location) : : ~~"f'
<br />b A. Ha dl r (L cat.o"')' .,.... " l~!.~""",
<br />. II" n e 0 I II "'I,$;.~~~~'~I(~,
<br />12. Cooling system: , ,"'j ~ j!ff'
<br />(Types: cen.llel-splll, cenlral.slnole pkg., room unit. PTAC" gas, non~~ " 0,' :>;.~.
<br />,1
<br />13. Heating system: i I
<br />
<br />1.,.,i~.'..."..
<br />2~" i.;,' l;';,~#
<br />3. :r.'-'-.. .":df~i-~~ll"; .. . '
<br />
<br />::\~ ... . Sq. n:
<br />
<br />8. '., '.' ,~. ft.
<br />(Slhgle Pane : Double Pane
<br />18." )'/9.1;' 1,. SQ. ft. ~_~_ sq. ft.
<br />7b. ,', sq_ ft. _______ sq. ft.
<br />
<br />81. R= 0
<br />8b. R=
<br />8e. Rs
<br />
<br />. _J..!t~_ t. ft.
<br />. _.______"- sq. ft.
<br />. _'__'_ sq. ft.
<br />
<br />.,'1
<br />
<br />91-i"'Rc I:.
<br />91.2 ;.::;Ra :"d' ,
<br />ga.3 v Rd 'ij,;~ll i,
<br />91.4 J . " R= ':. ,. :. . , ' .
<br />
<br />'_ ; ,sq. ft. .
<br />, :: I~'I sq. ft.:
<br />, " , '. I .-I iq. ft.
<br />., ft
<br />-..~~8q. .
<br />
<br />14.
<br />
<br />
<br />" : J
<br />.. ,....p' i .
<br />
<br />i-
<br />
<br />:~_L.-.-:Bq. ft,
<br />'~_;'sq. ft.
<br />\, n ~8q.ft.\
<br />...:......:.____ sq. ft.,
<br />
<br />'J.'" '
<br />
<br />(Types: elne" naturAl rFt~, f.ola', L.P. gas, none)
<br />15. Hot Water Credits:
<br />a, Heat RecovNY /HFII
<br />b, Df'dicated H':,'\I PUP1p(DHP)
<br />c, Solar
<br />16. ~WAC Credits
<br />(Use: C"-Ce>;lIng FHn, ('\,' e10S; Vf:'1(, PT-Programmable thermostat,
<br />HF-Whole house fRrl, M;~.MlIlti;'''ne)
<br />17. COMPLIANCE STAlUS: (PASS if As-Built PIs. are less than Base Pts.) .
<br />I
<br />a, Total As-Built poin1s b. Total Base points ;!
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<br />RevIew Of p...,. IOCUpec1ftca111)nt COvered by this calculltlcm
<br />111~'oat.~~no. ~Ith th'~lorld" Energy Cod.. a.fote
<br />==~~~,:thIS bU"dln~~~ ~~!nap'C"d,fot
<br />IUILbtNO . , ",c" '
<br />DA111
<br />
<br />OWNER AG,ENT:
<br />.....~__~.;i;; i_.__."
<br />
<br />DATE' jCJ- ~dl
<br />wfth the FlOrkl. Energy cod..'
<br />i
<br />DATE:
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