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STATE OF CALIFORNIA MECHANICAL SYSTEMS ,f: STATE OF CALIFORNIA CEC-NRCC-MCH-01-E Revised 05!15 CALIFORNIA ENERGY COMMISSION MECHANICAL SYSTEMS CERTIFICATE OF COMPLIANCENRCC-MCH-01-E CEC-NRCC-MCN-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION Mechanical Systems (Page 1 of 4 CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Project Name: Date Pre pared: ( g } ARCO NTI 1/11/16 Mechanical Systems {Page 3 of 4} Project Name: ARCO NTI Date Prepared: 1/11/15 ARCO A.MECHANICAL COMPLIANCE FORMS&WORKSHEETS(check box if worksheet is included) C.MECHANICAL HVAC ACCEPTANCE FORMS(check box for required forms) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms,refer to the 2013 Nonresidential Monual Test Performed By: Note:The Enforcement Agency may require all forms to be incorporated onto the building plans. Designer: YES NO Form/Worksheet# Title This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems.The designer is required to check the applicable boxes for all ❑ ❑ NRCC-MCH-01-E (Part 1 of 3) Certificate of Compliance, Declaration. Required on plans for all submittals. acceptance tests that apply and list all equipment that requires an acceptance test.All equipment of the same type that requires a test,list the equipment description and the number of systems. ❑ ❑ NRCC-MCH-01-E (Part 2 of 3) Certificate of Compliance, Required Acceptance Tests(MCH-02A to 11A). Required on plans for all submittals. Installing Contractor: ❑ ❑ NRCC-MCH-01-E (Part 3 of 3) Certificate of Compliance, Required Acceptance Tests(MCH-12A to 18A). Required on plans where applicable. The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing,each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. EJ ❑ NRCC-MCH-02-E (Part 1 of 2} Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans. The following tests require a ❑ ❑ NRCC-MCH-02-E(Part 2 of 2) Mechanical Wet Equipment Summary is required for all submittals with chilled water,hot water or condenser water Enforcement Agency systems. It is optional on plans. Plancheck—The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. ❑ ❑ NRCC-MCH-03-E Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. Itis Inspector-Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. optional on plans. Test Description MCH-12A MCH-13A MCH-14A MCH-15A MCH-16A MCH-17A MCH-18A ❑ ❑ NRCC-MCH-07-E (Part 1 of 2) Power Consumption of Fans. Required on plans where applicable Equipment #of Automatic Fault Requiring Tessin units Fault Detection& Distributed Energy Thermal Energy Supply Air ❑ ❑ NRCC-MCH-07-E(Part 2 of 2) !Power Consumption of Fans, Declaration. Required on plans where applicable q x g Detection& Condenser Water Diagnostics for DX Storage DX AC Storage(TES) Temperature Reset ELMS or Verification Diagnostics forAir& Units Systems Systems Controls Reset Controls Zone RTU-1 is Cat ❑ ❑ ❑ ❑ ❑ G HA RTU-2 ® 19 ❑ p ❑ ❑ ❑ X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11 13 0 11 El 1- ❑ ❑ ❑ ❑ ❑ ❑ ❑ G EN © ❑ ❑ 1 ❑ ❑ ❑ ❑ 18215 72ND AVENUE SOUTH KENT, WA 98032 (425)251-6222 (425)251-8782 FAX CIVIL ENGINEERING, LAND PLANNING, SURVEYING, ENVIRONMENTAL SERVICES NO. DATE REVISION DESCRIPTION CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 1.18.15 PERMIT SUBMITTAL CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 9 2 3 4 STATE.OF CALIFORNIA g ECHA�NICAL SYSTEMS STATE OF CALIFORNIA CEC-NRCC-MCH-01-E Revised 05!15 CALIFORNIA ENERGY COMMISSION y. MECHANICAL SYSTEMS CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E CEC-NRCC-MCN-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION 7 Mechanical Systems (Page 2 of 4) CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Project Name: ARCO Date Prepared: Mechanical Systems (Page 4 of 4) 1/11/16 Project Name: ARCO NTI Date Prepared: 1/11/16 B.MECHANICAL HVAC ACCEPTANCE FORMS(check box for required forms) ®0 Test Performed By: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Designer: 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. 4# SEAL - This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems.The designer is required to check the applicable boxes for ail Documentation Author Name: Documentation Author Signature: acceptance tests that apply and list all equipment that re requires an acceptance test.All equipment of the same type that requires a test,list the equipment descri tion and the number of systems. Gary Womack p pp Yq PYp qpX&M ®®®® ®® lL Company: Signature Date: 1/11!15 !j1 Installing Contractor: Abossein Engineering LLC y: The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. if more than one person has 4 Address: CEA/HERS Certification Identification(if applicable): � • ` responsibility for the acceptance testing,each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. 2100 112th Ave NE, Suite 201 y'� Enforcement Agency: City/State/Zip: Phone: Plancheck—The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. 425-462-9441 Inspector-Before occupant permit is granted all newly installed process s stems must be tested to ensure proper operations. RESPONSIBLE PERSON'S DECLARATION STATEMENT 981 I certify the following under penalty of perjury,under the laws of the State of California: sj' • �� Test Description MCH-02A MCH-03A MCH-04A MCH-05A MCH-06A MCH-07A MCN-OSA MCH-09A MCH-10A MCH-11A � �,' .�?/�•�' Demand Hydronic CA` 1_ The information provided on this Certificate of Compliance is true and correct. ® OF �g f #of Outdoor Single Zone Economizer Control Supply Fan Valve Leakage Supply Water System � Equipment Air Automatic 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible _ � Requiring Testing Distribution Demand Shed designer). Units Air Unitary Controls Ventilation VAV Test Temp.Reset Variable Flow or Verification Ducts (DCV) Control Control 3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. RTU-1 1 [ p ® ® 13 13 ❑ ❑ ❑ ❑ 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information po'dt ed on other applicable compliance documents, RTU-2 1 10 ® ® ® ❑ ❑ ❑ ❑ ❑ ❑ worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit a� of n. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit s)°1 2ed for the building,and,made available to the enforcement ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ agency for all applicable inspections. I understand that a completed signed co of this Certificate of Compliance is re o be included ocumentation the builder provides to the g Y AP P p g copy P q ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ building owner at occupancy. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Responsible Designer Name: Alex Abossein Responsiblegesigner5 atdre: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ company: Abossein Engineering LLC Date Si ed: /I1Ji ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ address: 2100 112th Ave NE,Suite 201 License: M26991 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ city/state/zip; Bellevue, WA 98004 Phone: 425-462-9441 DE ELOPMENT INF A71ON: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ARCO TI 3000 am/pm/ QSR FUEL CANOPY / 6 MPD's Sim ADDRESS:- ESCALON AVENUE @ HIGHWAY 120 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 ESCALON,CALIFORNIA CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 FACILITY TBD WMIGM W. Ata! Abossein of IP FMnk Engineering, M . L• L--• C. 17223 DRAIMNG TITLE: MECHANICAL - ELECTRICAL CIVIL - LEED MECHANKCAL FIRE PROTECTION T-24 FORMS 2100 112TH AVE. NE BELLEVUE, WA 98004 SHEET NO: PH: (425) 462-9441 FAX: (425) 462-9451 E—Mail: cserkeCkbossein.com www.obossein.com M0111113 ,ABOSSEIN #215064