12010124 (2) INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R
Site Address Permit Number
J o+(o5 Dem
An installation certificate is required to be posted at the building site or ma available for all app riate inspections.(The
information provided on this form is required)After completion of final i pecti n, o ust, vided to the building
department(upon request)and the building owner at occupancy,per Sec io 0 a). V�
HVAC SYSTEMS: Z-' J,2,
Heating Equipment
Efficiency
CEC Certified Mfr. #of Duct Duct or Heating Heating
Equip Type Name and Model Identical (AFUE,etc.) Location Piping Load Capacity
(pkg.heat um Number Systems (>_CF-1R value) attic,etc. R-value (Btu/hr) (Btu/hr
C4drjrh 'i' 8 O l Crowd IQ.$ 70 k34.. go k
Cooling Equipment
CEC Certified Mfr. #of Efficiency t Duct Cooling Cooling
Equip Type Name and Model Identical (SEER or EER) Location Duct Load Capacity
(pkg.heat pump) Number S stems >_CF-1R value) (attic,etc.) R-value (Btu/hr) (Btu/hr
1. >symbol reads greater than or equal to what is indicated on the CF-IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓�I I,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2)equivalent to or
more efficient than that specified in the certificate of compliance (Form CF-1R) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable.
Installing Subcontractor(Co.Name)OR General
Contractor(Co.Name)OR Owner
Signature: N&Add Date: 2, 2 ZD (7—
Copies
Z„Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005