Date Certificate Posted
Passive (No Fan )
Active (With fan and monometer or
other system monitoring device )
Not applicable, all ducts located in conditioned space
MECHANICAL SYSTEMS
Not required per mech. code
Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
Capacity in
Gallons:
Other, describe:
Heat Loss:
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
City Mailing Address of the Dwelling or Dwelling Unit
Energy Recover Ventilator (ERV) Capacity in cfms:
New Construction Energy
Code Compliance Certificate
This certificate has been completed by the builder
and lists information and values of energy
envelope components required by Minnesota
Residential Energy Code. Post a permanently
visible location inside the building.
Name of Residential Contractor MN License Number
Fiberglass, Batts
House area ____________________Sq. Ft.
Location of duct or system:
Number of bedrooms_________________
Insulation Location
Mineral Fiberboard
Rigid, Extruded Polystyrene
Ceiling, flat
Other Please Describe Here
Total R-Value of all Types of
Insulation
Type: Check All That Apply
Non or Not Applicable
Fiberglass, Blown
Ceiling, vaulted
Bay Windows or cantilevered areas
Bonus room over garage
Describe other insulated areas
Below Entire Slab
Foundation Wall
Perimeter of Slab on Grade
Rim Joist (Foundation)
Wall
Appliances Cooling System
Fuel Type
Solar Heat Gain Coefficient (SHGC):
Windows & Doors
Domestic Water Heater
THERMAL ENVELOPE
Foam, Closed Cell
Foam Open Cell
Type in location: interior exterior or integral
Rigid, Isocynurate
Type in location: interior exterior or integral
RADON SYSTEM
Rim Joist (1
st
Floor+)
Heating or Cooling Ducts Outside Conditioned Spaces
Type in location: interior exterior or integral
R-value
Location of duct or system:
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):
Calculated
cooling load:
Heat Recover Ventilator (HRV) Capacity in cfms:
Manufacturer
Make-up Air Select a Type
Average U-Factor (excludes skylights and one door ) U:
Model
Heating System
Rating or Size
Structure's Calculated
SEER:
Efficiency
AFUE or
HSPF%
Heat Gain:
Output in
Tons:
Combustion Air Select a Type
Total ventilation (intermittent + continuous) rate in cfms:
Continuous exhausting fan(s) rated capacity in cfms:
High:
High:
Mechanical Ventilation System
Capacity continuous ventilation rate in cfms:
