Report Form 640S 2017
Completion Certification—Site Inspection r.,-,?
New Homes Program—Single Family
of of Oregon
To be completed by Verifier
CLEAResult is a Program Management Contractor for Energy Trust of Oregon,Inc.
Payment Information
Incentive Payee Company Name. I William Lyon Homes : Its this payment redirected?: IN°
Builder or Company: William Lyon Homes :. Redirect to Name:
Verifier Payee Company Name: Pertormanca Insulation and Energy - Redirect Payee Com
Affordable Housing No
Solar Ready Builder Incentive: 'Solar ReadyVentier
$fS4tnfaimeNGnY
Development River Terrace Rowshack Lot tE Axis ID: I I REM/Rate®ID:
.........
Street Line 2 Multi-Family No City Beaverton State: OR Zip: 97007
To coited asq.ft.): I 2,071 House Volume: I 23,392 Hg ype: Detached single fam
Numbtalernd of Stoionries:rea('3 Number of Bedrooms: '3 FoundousinationT Type Other/More Than Oneily(add comment)
Electric Provider: Portland General C-lectric " Gas Provider: NW Natural Gas.
Solar installed Solar Installer Name/Company:
Blue shaded fielde are required for EPS sheet
Varlwation 'Tye ; ',: ACtd8l Model Equipment petaib&:Notes f.
Slab Perimeter Insulation R- 15.0 Slab Under Insulation R-
Insulation Framed Floor R- 30.0 Secondary Framed Floor R- 59.0
Above Grade Wall Insulation R- 23.0 Below Grade Wall Insulation R-
Flat Ceiling Insulation R- 49.0 Vaulted Ceiling Insulation R-
Windows Windows U- 0.3 SHGC:10.3 Total window area: 1382.
Cooling Air Conditioning SEER: 0 Model#:
Primary Heating System Details AFUE: 92.1 :Brand Bryant
Type: Gas Furnace : HSPF: Model#: 9125D36040E17A-A
Heating Fuel: Gas SEER
Primary Heat
Source Comment: COP:
Location' Conditioned A Outdoor Unit(for heat pumps)
ECM: No Model#:
AHRI Certificate::7126235 #of Systems 11.
Gallons. 166 :Brand: AOSmi/h..:
Water Heater Type Heat Pump EF: 13.17 Model ft HPTU-66N 130
Water Heating Fuel Electric Location. Garage or ope AHRI Certificate:
u
Ducts and Duct Location Partial /o ducts inside ..::. .Duct Leakage(CFM)@ 50Pa: """'„ri •. '(''"EE'IEjjijjijjjjj jjjjjj..a I?
:......EEEEisi;::a., �€ E€.:�1Ei:iw...:.....t.••...:r.:3.
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa: 2.64
Ventilation Ventilation Type HRV/ERV Model:
Supply Side-:Air Cyder Airflow measured or why untestable? (Roof Termination.
AAllteeces
Refrigerator kWh/yr Model:
ENERGY STAR Diswasher kwh/yr 268: Model: FGID2466"1A
Percent High Efficacy Interior Lighting(%) 100% Thermostat
Showerhead 1.5 GPH I Showerwand 1.5 GPH I Showerhead 1.6 GPH I (Showerhead 1.75 GPH
Notest. .