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Report , '1 I2 - cro217 Program Use Only �f Form 640S FastTrack ID Completion Certification—Site Inspection EnergyTrust New Homes Program—Single Family Data check by of Oregon (initials) To be completed by verifier Portland Energy Conservation,Inc.(PECI)is a Program Management Contractor for Energy Trust of Oregon. Date: 12-3-12 Verifier Name: ereston kuckuck Date: 1-7-13 Incentive Payee Company Name: Builder or Company: Westland industries Contact Name: Performance Testing Company: Fireside Home Solutions Technician Name: Preston As � � s ^. i ��:4' Si;�� .n - „ r tj _ tic �- a • - lte"IIfO .11.,`t101 1 .IGr� �iaia yudl K uS•s;:.,..x Sy°r + .d .01,. -�._ e_ r .� ?4 Development Lot Number: REM/Rate SCO Project ID: Name: white oak File#: (required from verifier if 17 project is ENERGY STAR°) Site Address: 7577 sw torchwood City: tigard State OR Zip: a Unattached ❑Attached Number of Stories: 3 Total Building Square Footage: 2183 Number of Bedrooms 3 Basement ❑ None ❑ Full Basement ❑ Half Basement xxJ Crawlspace Type ❑Garage/basement combo ❑Slab on grade ❑Other Electric Provider In PGE❑ PAC❑Other: Gas Provider ]NWN❑CNG❑Other: Electric Meter Number: 26926835 Gas Meter Number: (must apply to permanent meter) (must apply to permanent meter) 41951057 �dd_tor T o1e_- . or 1.t.e . 7t" s tr°..it__._.__ -. , . . r .:,. . _. .._.. ❑ Code plus Best Practices(meets minimum Best Practice requirements with improvements above code) ❑ Path 1 EPS Best Practices )] Path 2 ENERGY STAR ❑ Envelope Upgrade ❑ Ducts&HVAC Equipment Inside ©Equipment Upgrade ❑ Path 3 ENERGY STAR with ducts inside ❑Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑Zonal Electric Efficient ❑Advanced Electric Resistance ❑ 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® No Does this project qualify as Low Income?(must provide documentation from builder) Accessory ❑Yes© No Is this home an ADU? Dwelling Unit ❑Yes[ No Is the ADU separately metered?If so,provide meter numbers above Other ❑ Earth Advantage—Certification Level: ❑Other(please specify): Certifications ❑LEED-H-Certification Level: Form 640S v10 120101 Page 1 of 3 Return completed form to: Energy Trust New Homes Program—Single Family 100 SW Main Street,#1600•Portland,Oregon 97204 1.877.283.0698•Fax 1.855.575.4315 newhomes©energytrust.org Form 640S ..17 Completion Certification—Site Inspection EnergyTrust New Homes Program—Single Family of Oregon To be completed by verifier . Portland Energy Conservation,Inc.(PECI)is a Program Management Contractor for Energy Trust of Oregon. V• .Ifl "cll.' Ca e9�rY. T-ED '.Equ pment f7etai s i3 ' ,• Insulation Flat Ceiling R- 49 Insulation Type: •ib Framing Type: Vaulted Ceiling R- 38 Insulation Type: Batt • ❑Standard Scissor Truss R- Insulation Type: ❑Advanced Intermediate Above Grade Walls R. 23 Insulation Type: bib Framing Below Grade Walls R- Insulation Type: • Size: Floor Over Unheated Space R- 30 Insulation Type: bait Floor Over Garage R- Insulation Type: • Slab Floor(unheated) R- • ❑Full Slab ❑Perimeter Doors Door R- Windows Windows U 30 Window Frame Material: vinyl SHGC: .30 Skylights U- SHGC: Window Area(Glazing) % Total window area: Lighting Indoor and Outdoor 80 % #fixtures: 34 27 #of ENERGY STAR fixtures or CFLs: • Appliances ENERGY STAR Dishwasher Di2 Yes❑No EF Cooling Air Conditioning SEER: 13 Btu/Hr: tcjd30s41 sia s/n w 1 h20950S6 Primary Heat ci Fireplace AFUE: 95.5 Brand: fraser johnston Outdoor Unit(for heat Source Gas Furnace pumps) ❑Electric HSPF: Model#: TG9S060A 1 OMP 11 A ❑Boiler Model#: aGas Heat Pumps: SEER: Serial#: W 1 E 1 987221 ❑Other: ❑Air Source(ducted) COP: Btu/Hr: 60,000 Serial#: ❑Mini Split(ductless) . • ❑Ground Source Location: ECM: ❑Yestl No Heat pump commissioning ' ❑Radiant Floor Heat �C P P 9 ❑Cadets Electronic Air Cleaner: ❑Yes d No report attached or cond confirmation for ground • ❑Zonal Backup fuel:❑Electric❑Gas❑Other source heat pumps that • ❑Other: space X manufacturer's start up procedure was performed Additional notes on primary heating: Notes on secondary heating: Water Heater ❑Storage Gallons: Brand: Rinnai ❑Electric KaTankless X]Gas EF: 82 Model#: R175 Location: Serial#: Dv ca-065900 cond space Btu/Hr: 180,000 • Form 640S v10 120101 Page 2 of 3 Return completed form to: Energy Trust New Homes Program—Single Family 100 SW Main Street,#1600•Portland,Oregon 97204 1.877.283.0698•Fax 1.855.575.4315 newhomes@energytrust.org Form 640S �l7 Completion Certification—Site Inspection EnergyTrust New Homes Program—Single Family of Oregon To be completed by verifier Portland Energy Conservation,Inc.(PECI)is a Program Management Contractor for Energy Trust of Oregon. ,41 lfLC Lt o �- .' r' r'lokc , tl a a d � � � � � wi , �� �' SKr '- E�`rip De Its 8 otes�,� �� � �� 1Cate.o. /1, ..v,y, ry R{1:2zt 3a$ ,L FriZi.ems, .._ s ,,sup.,.dl.. 1-s�:,,'. .«.. J7'.ol<.v�. , - •— ,,..,,`>i Ventilation Energy Trust Mechanical ❑Exhaust rots Energy Trust Mechanical Ventilation Requirements System Ventilation Requirement supply ❑Yes ❑No ❑Exhaust&Supply ❑Heat Recovery ERV/HRV Model#: Ducts ❑Ducts Inside %ducts inside: Ducts in Conditioned Space Timing incentives for ducts inside,check one of the following: ucts Tested❑Visual Inspection per RTF specs Duct Insulation R- Duct Location 75 attic 25 cord space Duct Sealing w/Mastic Paste OxYesID No Pe ormance_Ttes.in. & D :c. S stela In orma ion ..,;, _ , it., Ducts Duct leakage must not exceed 0.06 CFM @50 x floor area,or 75 CFM @50,whichever is greater.When tested without the air handler, leakage must not exceed 0.04 CFM @50 x floor area,or 50 CFM @50,whichever is greate&Multiple tests may be required. Duct Cubic Feet Per Minute Duct Leakage Air Handler In in Yes Air Handler Present )El Yes Leakage: (CFM) @ 50Pa: 97 NPass❑Fail Conditioned Space ❑No During Test ❑No Fan Pressure ❑DG3 Fan -235 Ring Type ❑0 ❑2 Leakage Test Total Leakage Gauge ❑(DG700 Pressure: (check one) Ell iq 3 Method ❑Leakage to Outside Duct Blaster Pressure Tap Location: Bath Area Tested: 2183 Location: Main return Whole House Air Changes per Hour lEnvelope Tightness Cubic Feet Per Minute Leakage: (ACH)@ 50Pa: 3.4 Pass❑Fail (CFM) @ 50Pa: 1 098 House Volume: 18880 Best Practices Requirements (All requirements must be met to receive an Energy Performance Score) • Thermal Enclosure Checklist Complete IN Pass ❑ Fail Thermal Enclosure Checklist attached? ❑Yes • Insulation Quality Inspection Performed IN Yes ❑ No 4 (complete insulation verification section below) • Approved Mechanical Ventilation Installed El Yes ❑ No - (complete mechanical ventilation section below) • Zonal Pressure Relief—All zones comply ®Yes ❑ No If no,state reason for failure: • Combustion Appliance Zone Testing Net CAZ Pressure: Pa If not applicable, please explain: (required) Forced air system operation must not depressurize Combustion Appliance Zone(CAZ)by more than 3 Pascals(Pa.) *AII shaded sections are required for Best PraccttiEces.Applications will not be processed without these sections completed. tom• tart .,t✓• o 11�a.L,.,.i.:,i,-.,L.u.,.1..J r.iu .i.. .. i.r: i.;l'.a,.-4Yn 4t-,A,.vriti�r .iotrl:e.-,r_uuiG .L_.e.t.,rii If any values on this form do not meet Builder Option Package(BOP)requirements,please indicate which Technical Compliance Option(s)allow the variance and explain which component was traded. TCO#: Explanation: Sli r a t r e . ..].]_. _.+..a..„ .•,..L,.s, :Lr.... _ ...._d Z,is.c...+k!:.—' _ -aL...,1.-...LS12.g.. _,_.;;Lc:,.zz. .mss. 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 Preston Kuckuck Verifier Date: Signature: Name: Preston Kuckuck 1-7-13 lOtilTag`Inspection'(If needed): Signature: Name: Date: Form 640S v10 120101 Page 3 of 3 Return completed form to: Energy Trust New Homes Program—Single Family 100 SW Main Street,#1600•Portland,Oregon 97204 1.877.283.0698•Fax 1.855.575.4315 newhomes @energytrust.org