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PTCS Duct Sealing Certification Form
All sections must be filled out by a PTCS-certified Technician at the time of installation,signed and dated. A copy of the
- completed form must be promptly submitted to the utility and homeowner in accordance with utility policy. Please
enter online at www.ptcsnw.com or fax to 877-848-4074. Questions?Call 800-941-3867 or email ResHVAC @bpa.gov.
Site Information (Please print dearly)
PTCS Tech Q Install Customer's
Tech q Name �V�i1; F'a. (O� Date Electric Utility
Customer (1 y Q Installation v750
W „�Ly c}
Name �QG:LwG LVf.��^ She Address' 7 O r I St
Site �^ 11 v Site p She Zip Customer
• City i'i1q, State ON Code' 1f223 Phone it ( 5o3 ) 60 - 61'(23
*If mailing address is different,record here(#,City,St,Zip):
Home Type(provide information for just one type,either a Site Built or Manufactured Home):
Site Built Home: ❑Existing to New Construction Manufactured Home: ❑Y 11 N
. Site Built Home Foundation Type: d of Sections for a Manufactured Home: Ell ❑2 ❑3
❑Crawl Space ❑Full Basement ❑Half Basement ❑Slab Super Good Cents? ❑Y ❑N
. Year Built: -2013 Heating System: ❑Elec.Furnace ❑Heat Pump 0 Gas Furnace Heated Area r�
Energy Star?❑Y N ❑Other: Gas Company(if applicable): (sq ft) Required 2 i 2
Are at least 50%of the ducts in unconditioned space?❑Y ❑ N it of supply registers li of returns
If more than 50%of the ducts ore in conditioned space,the home does not qualify for PTCS Duct sealing. -1 1
House Pressurization and Duct Blaster Tests
Do either of these special conditions apply? (check if"yes") Testing Equipment Used:
al Record Only-no duct sealing work done ❑Energy Conservatory ❑RetroTec
❑PTCS Certification ONLY-pretest leakage too low for BPA program ❑AeroSeal ❑Air Care❑Other:
House Pressu ed(Blower Door)to: D ct Blaster Location: Pressure Tae Sup Iytteglster Location:
ID+50Pa Other: D Pe mi Retum Grille ❑Other: f1 iy pfeeD�a(,�
Duct Leakage Test:TYPICAL DUCT BLASTER CFM READING with Duct Pressure at OPa and BBlowe/r Door @+50Pa.
08 Fan Pressure:Found using equipment;it is the fan pressure,not the house pressure.(Ex.Ring 1,78 Pa,364 CFM).
Definitions:(DB)=Duct Blaster (BD)=Blower Door (AH)=Air Handler (SW)=Single Wide (DW)=Doubie Wide (TW)=Triple Wide
New Construction Existing Home,New Ducts Existing Home,Existing Ducts Manufactured Home
Pre-test Ring ❑Open❑1 0 2 0 3 ❑Open 0 1 02 03
Not Applicable Not Applicable
(select one) ❑H ❑M ❑L ❑H ❑M ❑L
N 08 Fan Pressure Not Applicable Not Applicable Pa Pa ••
I--
I DBCFM Not Applicable Not Applicable CFM CFM
Pretest ❑a 250 CFM(>1667 sq ft) ❑2100 CFM,SW
Requirements Not Applicable Not Applicable ❑>15%of home's sq ft ❑z 150 CFM,OW
(BPA Only) ❑2 225 CFM,TW
Post-test Ring ❑Open❑1 112❑3 ❑Open❑1 020 3 ❑Open ❑1 ❑2 ❑3 ❑Open ❑1 0 2 Q 3
(select one) OH ❑M ❑L OH ❑M 0 OH ❑M ❑L ❑H OM ❑L
-. DB Fan Pressure -g}_ S Pa Pa Pa Pa
Cu
a~'. 013 CFM ILf 5 CFM CFM CFM CFM
0 ❑5 50 CFM,SW
0. Certification Req. 5 6%of sq ft w/AH ❑ 510%of home's sq ft ❑5 80 CFM,DW
(check all that ❑ 5 4%of sq ft no AH ❑ 10%of home's sq ft ❑ 2 50%Reduction ❑5 120 CFM,TW
aPP1Y)
Q z 50°A Reduction
The duct sealing at this site meets program requirements including:plenum,main ducts,takeoffs and boots sealed;a good faith effort
was made to remove existing duct tape and cover with mastic;metal duct connections are secured with screws. ❑Y ❑N
Last updated:30 November 2012 Page 1 of 2
•
Combustion Appliance Zone(CAZ)Test
Are there any combustion appliances in the home? Combustion Appliance Type: ❑Fireplace or wood stove
❑Y ❑N ❑Gas Furnace ❑Gas water heater ❑Other:
Is there a UL-approved and functioning CO detector A carbon monoxide(CO)detector installed in the home is required in all cases
installed in the home? where a sealed or non-sealed combustion appliance is located in a conditioned
❑Y ❑N space or attached structure i.e.garage. RECOMMENDED CO detector specifications:
UL 2034/CSA 6.19-01,digital display,peak CO memory and recall.
Is a Combustion Air Zone(CAZ)test required by the electric utility? ❑Yes,complete the fields below ❑No,skip to notes
Baseline Pressure with reference to outside(all exhaust devices Weather conditions on day of test: ❑Calm ❑Windy
and air handler fan off): Pa •
With air handler fan ON,record gauge readings: Interior doors open Interior doors closed
Zone Description Reading(Pa) Net(Pa) Reading(Pa) Net(Pa)
Zone 1
Zone 2
Net Depressurization=Net(Pa)=All fans off Reading(Pa)(minus)Air Handler Fan on Reading(Pa)
Example:Baseline reading with all fans off=1 Pa;Reading with air handler fan on=-2Pa. Net Depressurization=1—(-2)=3 Net Depressurization
-Net"equals how much the pressure goes down when the air handler is turned ON(compared to the fan off baseline pressure)
Installation/Technician Notes:
Required Signatures:To be filled out by the electrical utility account holder.This form must be signed by the person whose name appears
on the electric utility account.ENERGY INFORMATION RELEASE:The undersigned utility customer requests and authorizes the specified utility to
release billing and usage information for the account listed below to the PTCS program.With this authorization,the PTCS program can request
billing information for up to two years pre-installation and two years post-installation.The utility customer also hereby releases the utility
company from any and all liability arising from or connected with providing this Information.
Electric Utility: Account#:
Account holder name:
Account holder signature: Date:
By signing below,technician certifies that this form and any accompanying documentation are complete and accurate,and that all
measures associated with this project were completed as of the signature date below. .
Technician Installation 1 Tech Phone It:
name: i i((..p(/ Company: 1Llrk; I44 ( '1 II ) 333 -gs26 ..
Technidan Signature: ' Date: (�1 03 /i
O � /
PRIVACY ACT STATEMENT
Basic authority for collecting this nformation is authorized by 16 U.S.C.§§832 et.seq.,and 838 et.seq.,pursuant to Bonneville Power
Administration's Conservation Program system of records established in 46 FR 31700.
This information is primarily intended to further,but is incidental to the performance of,BPA's overall Energy Efficiency Program,the objective of
which is to acquire energy resources through energy efficiency,to determine what cost-effective conservation and direct application renewable
resources measures should be installed or adopted under different circumstances,and to provide incentives for the installation of such measures.
Other routine Issues of this information include:aggregation into a public database on energy efficiency;furnished to authorized personnel for
installation/repair of equipment;aggregated into a database for program publicity;and in some instances information regarding buildings will be
made available to subsequent purchasers of the buildings. Your disclosure of the requested information is voluntary,however failure to provide
requested information means that it will not be possible for you to participate in this BPA Energy Efficiency program.
Last updated:30 November 2012 Page 2 o