Passive (No Fan )
Active (With fan and monitoring
device )
Location (or future location) of Fan:
Other Please Describe Here
Not applicable, all ducts located in conditioned space
Not required per mech. code
Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
Capacity in
Gallons:
Other, describe:
AFUE or
HSPF%
Cfm's
" round duct OR
" metal duct
Not required per mech. code
Passive
Low:
Other, describe:
Low:
Location of fan(s), describe:
Cfm's
" round duct OR
" metal duct
Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution
panel.
New Construction Energy Code Compliance Certificate
Name of Residential Contractor
MN License Number
City
Mailing Address of the Dwelling or Dwelling Unit
Heat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
Combustion Air Select a Type
Location of duct or system:
Rim Joist (2nd Floor+)
Building envelope air tightness:
Below Entire Slab
Fuel Type
Solar Heat Gain Coefficient (SHGC):
Windows & Doors
Ceiling, vaulted
Bay Windows or cantilevered areas
Floors over unconditioned area
THERMAL ENVELOPE
Wall
Perimeter of Slab on Grade
RADON CONTROL SYSTEM
Total R-Value of all Types of
Insulation
Type: Check All That Apply
Insulation Location
Describe other insulated areas
Ceiling, flat
Fiberglass, Batts
Foundation Wall
Output
in Tons:
Appliances
Cooling System
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
Make-up Air Select a Type
Domestic Water
Heater
Model
Heating System
Rim Joist (1st Floor)
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Rating or Size
Efficiency
Heating Gain
Cooling Load
Select Type
Describe any additional or combined heating or cooling systems if installed: (e.g. two furnaces or air
source heat pump with gas back-up furnace):
Residential Load
Calculation
SEER
/EER
Capacity continuous ventilation rate in cfms:
Heating Loss
Manufacturer
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Date Cert. Posted
R-value
MECHANICAL SYSTEMS
Builders Associaton of Minnesota version 101014
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