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Report Si ® 13 - cru-o3 ' Form 640S \lam_ Completion Certification—Site Inspection New Homes Program—Single Family EnergyTrust of Oregon To be completed by Verifier 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: 5/1/20131 Verifier Name: preston k Date: 6/14120131Verifiier Name: preston k Incentive Payee Company Name: Builder or Company: westland industries Contact Name: Performance Testing Company: performance insulation Technician Name: 'Verifier Payee Company Name: Technician Name: pk Site Information Development lot 24 REM/Rate ISCO Project ID: (required horn verifier if project is ENERGY Name&Lot# File#: STARS) Site Address: 11072 sw legacy oak City: beaverton State: OR Zip: 12 Unattached ❑Attached Number of Stories: 3 Total Conditioned Area: 2183 Sq.Ft. of of Bedrooms: 3 Basement Type: UNone Full Basement UHalf Basement UCrawlspace Water Heater 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): 31841756 _46204850 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 ❑Yes El No Does this project qualify as Low Income?(must provide documentation from builder) Accessory Dwelling ❑Yes p No Is this home an ADU? Unit ❑Yes p 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©energytrust.org Page 1 of 3 Form 640S \Ii Completion Certification—Site Inspection 3;1` New Homes Program Single Family EnergyTrust of Oregon Verification Category Type Actual Model Equipment Details 8 Notes Insulation Flat Ceiling R- 49 Insulation Type: bib Framing Type: Vaulted Ceiling R- Insulation Type: ['Standard Scissor Truss R- Insulation Type: •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: batt 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 Source El Gas Furnace HSPF: Model#: tg9s060 ❑Electric ❑Boiler SEER: Serial#: w1n2352271 10 Gas Heat Pumps COP: Btu/Hr. 60,000 ❑Air Source(ducted) Outdoor Unit(for heat pumps) Daher: ❑Mini Split(ductless) Location: Model#: ❑Ground Source cond space Serial#: ❑Radiant Floor Heat ECM ❑Yes •No Heat pump commissioning report attached or ❑�dets Electronic Air Cleaner ❑Yes Q No confirmation for ground source heat pumps that manufacturer's start up procedure was performed. ['Zonal Backup fuel ❑Electric •Gas ❑Other ❑Other ❑Yes Notes on Primary Heating: Notes on Secondary Heating: Water Heater Type: Gallons: Brand: rinnai ❑Electric ❑Storage EF: B2 Model#: 1175 •Gas El Tankless Location: Serial#: dh.ca-074056 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 1.877.283.0698 Fax 877.501.9629 Form 640S v08 DRAFT newhomes(genergytrust.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 regon's ❑s„ppyOr,y El Yes ❑No Mechanical Ventilation Requirement El Air Cyder HRV/ERV Model 4: ❑HRV/ERV Ducts ❑Ducts Inside %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(dm) Duct Leakage Air Handler in El Yes Air Handler Installed During El Yes 95 @ 50 Pa El Pass ❑Fall Conditioned Space? ONO Test? ❑No Fan Pressure ❑DG3 Fan Ring Size/Type 00 ❑2 Leakage Test El Total Leakage Gauge El DG700 Pressure: 230 (check one) 01 El 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 3.2 @ 50 Pa El Pass ❑Fail 1022 CO 50 Pa Best Practices Requirements (All requirements must be met to receive an Energy Performance Score) • Thermal Enclosure Checklist complete El Pass ❑Fail 'Thermal Enclosure Checklist attached? ❑Yes • Insulation Quality Inspection Performed El Yes ❑No —> (complete insulation verification section below) • Approved Mechanical Ventilation Installed El Yes ❑No -+ (complete mechanical verification section below) • Zonal Pressure Relief-All zones comply El 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 Verger Signature: Preston kuckuck Name: preton kuckuck Date: 611712013 Red Tag Inspection (if needed) Signature Name Date: 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