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May 10 015 08: 17a David Hegarty 1 2095996043 p. 4 <br /> CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING(Page 1 of 7) CF4R <br /> Project Time <br /> a - O 5- / S <br /> J Date f 1 <br /> S 7 Tl u�Z n <br /> oject A dress� , B ame C, <br /> B Contact Telephone ' �— Plan Num <br /> U ' <br /> Telephone Sample Group Number <br /> G� <br /> Certtfym Date Sample-, umber <br /> Firm: HERS Provider <br /> StreetAddreas: (840 IQ City/sw&Zip: <br /> Copies to: Builder,HERS Provider <br /> .HERS RATER C9WLL4NCE STATEMENT <br /> The house was: J2-/Tested ❑ Approved as part of sample testing,but was not tested <br /> As the FIRS rater providing diagnostic testing and field verification)I certify that the houses identified on this form comply <br /> wie diagnostic tested compliance requirements as checked on this form. <br /> The installer has provided a copy of CF-6R(Installation Certificate. <br /> Distribution system is fully ducted(i-e.,does not use building cavities as plenums or platform reruns in lieu of ducts) <br /> Where cloth backed,rubber adhesive duct tape is installed,mastic and drawbands are used in combination with cloth <br /> backed,rubber adhesive duct tape to seal leaks at duct connections. <br /> MO UKUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT <br /> Duct Diagnostic Leakage Testing Results(Maximum 6%Duct Leakage) <br /> Duct Pressurization Test Results(CFM @ 25 Pa) Measurod <br /> values <br /> Test Leakage Flow in CFM <br /> If fan flow is calculated as 400cfmiton x number of tons enter calculated <br /> value here <br /> Iffan flow is measured enter measured value here <br /> Leakage Percentage(100 z Test Leakage/Fan Flow) <br /> Check Box for Pass or Fail(Pass=bye or less) ❑ <br /> l Pass Fail <br /> ❑THERMOSTATIC EXPANSION VALVE(TXV) 114 <br /> z <br /> ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is <br /> provided for inspection ❑ ❑ <br /> Yes is a pass Pass Fail <br /> ❑ MIPIIINIUM REQU REMENTS FOR DUCT DESIGN COMPLIANCE CREDIT <br /> 1" ❑Yes ❑No ACCA Mammal D Design requirements have been met(rater has <br /> verified that actual installation matches values in CF-IR and <br /> design on plan. <br /> 2. ❑Yes ❑No TXV is installed or Fan flow has been verified. If no TXv, <br /> verified fan flow thatches design from CF-i R <br /> Measured Fan Flow= <br /> Yes for both I and 2 is a Pass Pass Fail <br /> Compliance Forms August 2001 <br /> A-16 <br /> I <br /> I <br /> I <br /> I <br />