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Report //0 5 2_ 5 li✓ Lei cf_.c y Da.i &, Form 640S \I, Completion Certification—Site Inspection ,iN New Homes Program—Single Family EnergyTrust �A 2 of Oregon To be completed by Verifier /r` �� 7 O� Portland Energy Conservation,Inc.(PECI)Is a Program Management Contractor for Energy Trust of Oregon,Inc. Input tab should be completed first to auto-populate applicable fields,indicated by orange highlighted fields. First Inspection Information Second Inspection Information Date: 511120131 Verifier Name: preston k Date: 8/23120131 Verifier Name: preston k • Incentive Payee Company Name: westland Builder or Company: westland industries Contact Name: Performance Testing Company: performance Insulation Technician Name: Verifier Payee Company Name: performance insulation Technician Name: pk Site Information Development Lot 6 west REM/Rate (SrequiOred Proct ID:H project is ENERGY Name&Lot# File#: STARE)) Site Address: 11052 sw legacy oak City: beaverton State: OR Zip: El Unattached ❑ Attached Number of Stories: 3 Total Conditioned Area: 2183 Sq.Ft. I#of Bedrooms: 3 L( None )� Full Basement L Half Basement El Crawispace Water Heater Basement Type: Gas ❑ Garage/basement combo ❑ Slab on grade ❑ Other Fuel: Electric Provider: Portland General Gas Provider: INW Natural Electric Meter Number(must be permanent meter number): Gas Meter Number(must be permanent meter number): 22916986 46361331 Additional Project Information (please mark all that apply) ❑ Code plus Best Practices(meets minimum Best Practice requirements with improvements above code) El Path 1 EPS–Best Practices ❑ Path 2 ENERGY STAR® ❑ Envelope Upgrade ❑ Equipment Upgrade ❑ Ducts&HVAC Equipment Inside ❑ Path 3 ENERGY STAR with ducts inside ❑ Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑ Zonal Electric Efficient ❑ Advanced Electric Resistance ❑ Live Net Zero home ❑ Solar Electric(PV) ❑ Solar Water Heating(SWH) ❑ Small Wind Renewable ❑ Solar Ready Electric(SRPV) ❑ Solar Ready Water Heating(SRWH) Energy ❑ Qualifies for Solar Ready Incentive(must attach checklist) Solar Installer: Name: Company: Low Income El Yes Q No Does this project qualify as Low Income?(must provide documentation from builder) Accessory Dwelling ❑ Yes No Is this home an ADU? Unit ❑ Yes El No Is the ADU separately metered?If so,provide meter numbers above Other Certifications ❑ Earth Advantage-Certification Level ❑ LEED-H-Certification Level: ❑ Other: Return completed form to: Energy Trust New Homes—Single Family 100 SW 5th Ave,#700 Portland,OR 97201-5542 1.877.283.0698 Fax 877.501.9629 Form 640S v08 DRAFT newhomes(8lenergytrust.org Page 1 of 3 Form 640S \li_ Completion Certification—Site Inspection New Homes Program—Single Family EnergyTrust of Oregon Verification Category Type Actual Model Equipment Details&Notes Insulation Flat Ceiling R- 49 Insulation Type: bib Framing Type: Vaulted Ceiling R- Insulation Type: p Standard Scissor Truss R- Insulation Type: El Intermediate Above Grade Walls R- 23 Insulation Type: bib ❑ Advanced Below Grade Walls R- Insulation Type: Framing Size: Floor Over Unheated Space R- 30 Insulation Type: bait Floor Over Garage R- 30 Insulation Type: batt Slab Floor(unheated) R- ❑ Under ❑ Perimeter ❑ Full Slab(Perimeter and Under) Doors Door R- Door Material: Windows U- 30.00 Window Frame Material: Windows SHGC: 30.00 vinyl U- Skylights SHGC: Window Area(Glazing) % Total window area: Lighting #Fixtures: 37 Indoor and Outdoor 81 % #ENERGY STAR fixtures or CFLs: 30 Appliances ENERGY STAR Dishwasher El Yes ❑ No EF: Model#: Cooling Air Conditioning SEER: Btu/Hr: ❑ Fireplace AFUE: 95.5 Brand: fraser johnmston Primary Heat sou rce El Furnace HSPF: Model#: t 9s060 Sou g ❑ Electric ❑ Boiler SEER: Serial#: w1e3708535 El Gas Heat Pumps COP: Btu/Hr. 60,000 ❑ Air Source(ducted) Outdoor Unit(for heat pumps) ❑ Other. ❑ Mini Split(ductless) Location: Model#: ❑ Ground Source cond space Serial#: ❑ Radiant Floor Heat ECM ❑ Yes 0 No Heat pump commissioning report attached or confirmation for ground source heat pumps that ❑ Cadets Electronic Air Cleaner ❑ Yes 0 No manufacturer's start up procedure was performed. ❑ Zonal Backup fuel ❑ Electric Ei Gas ❑ Other ❑ Other ❑ Yes Notes on Primary Heating: Notes on Secondary Heating: Water Heater Type: Gallons: Brand: rinnai p Electric ❑ Storage EF: 82 Model#: rim 0 Gas El Tankless Location: Serial#: cond space Btu/Hr: 180,000 Return completed form to: Energy Trust New Homes-Single Family 100 SW 5th Ave,#700 Portland,OR 97201-5542 1.877.283.0898 Fax 877.501.9629 Form 640S v08 DRAFT newhomes©energytwst.org Page 2 of 3 Form 640S \f! Completion Certification—Site Inspection New Homes Program—Single Family EnergyTrust of Oregon Ventilation ❑ Exhaust Only Meets Energy Trust Mechanical Ventilation Requirements? System Energy Trust of Oregon's El Yes 1:1 No Mechanical Ventilation ❑ Supply Only Requirement Alr Cyder HRV/ERV Model#: ❑ HRV/ERV Ducts ❑ Ducts Inside i%ducts inside: Ducts in Conditioned Space If claiming incentive for ducts inside,check one of the following: El Ducts Tested ❑ Visual Inspection per RTF Specs Duct Insulation R- 8 Duct Location: 50 crawl 50 cond space • Ducts Sealing w/Mastic El Yes ❑ No Performance Testing Duct Leakage Duct Leakage Cubic Feet Per Minute(cfm) Duct Leakage Air Handler in El Yes Air Handler Installed During El Yes 95 @ 50 Pa El Pass ❑ Fail Conditioned Space? ❑ No Test? ❑ No Fan Pressure ❑ DG3 Fan Ring Size/Type ❑ 0 ❑ 2 Leakage Test Total Leakage Gauge DG700 Pressure: 230 (check one) ❑ 1 Ei 3 Method ❑ Leakage to Outside Duct Blaster Location: ra Pressure Tap Location: bath 'Area Tested: 2183 Whole House Leakage Whole House Air Changes per Hour(ACH) Envelope Tightness Cubic Feet Per Minute(cfm) Leakage House Volume: 18750 3.6 @ 50 Pa El Pass ❑ Fail 1140 @ 50 Pa Best Practices Requirements (All requirements must be met to receive an Energy Performance Score) • Thermal Enclosure Checklist complete Ei Pass ❑ Fail 'Thermal Enclosure Checklist attached? ❑ Yes • Insulation Quality Inspection Performed El Yes ❑ No __ (complete insulation verification section below) • Approved Mechanical Ventilation Installed Ei Yes ❑ No —► (complete mechanical verification section below) • Zonal Pressure Relief-All zones comply p Yes ❑ No If no,state reason for failure: • Combustion Appliance Zone Net CAZ Pressure: Pa If not applicable,please explain: Testing (required) Forced air system operation must not depressurize Combustion Appliance Zone(CAZ)by more than 3 Pascals(Pa.) Additional Notes: Signature By my signature,below,I certify that I have performed the tests as described,that the form is complete,and that all information on the form is accurate. Verifier Verifier Signature: preston kuckuck Name: preton kuckuck Date: 8/23/2013 Red Tag Inspection (if needed) Signature (Name IDate: Return completed form to: Energy Trust New Homes-Single Family 100 SW 5th Ave,#700 Portland,OR 97201-5542 1.877.283.0698 Fax 877.501.9629 Form 640S v08 DRAFT newhomes@energytrustorg Page 3 of 3