# ENERGY **ST AR**  **Multifamily High**  **Rise Submittal** 

**Validation Form,**  **Version 1.0** 
**INSTR U**  **CT I**  **ONS** The ENERGY STAR Multifamily High Rise Submittal Validati o n Form is used by the licensed profe ssional to validate submittals. This form must be sign e d and stamped by a professional en gineer or registered architect and submitted to EPA or its designated agent for approval. For more information on program submi ttals see the Licensed Professional ’

s Guide to the ENERGY STAR Lab el for MFHR Buildings. **BUILDI N**  **G I**  **NFO R**  **MA**

**T I**  **ON Building**  **Ad dress**  **ENERGY STA** **R Developer**  **Partn e**  **r Licensed**  **Professional Project**  **N a**  **me: Street:**  **Cit y** **, State**  **: ZIP:**  **Compa n**  **y Name**  **: Contact**  **N a**  **me: Phone:**  **Email: Compa**  **n y**  **Name :**  **Contact N**  **a me:**  **Phone: Email:**  **SUBMITA L**  **VA LIDA** 

**T I**  **O N**  This buil d i n g is earning the ENERGY STAR using the foll owing (Please check the appropriate box): **Perfor m**  **ance Path**  **Prescriptive Path**  This validat i on form pertains to the following (pl e ase check the appropri ate box) **Proposed Building**  **Submittal (The**  **foll o** **w i**  **ng documents**  **must be**  **included as**  **part of**  **the submittal)**  1. Proposed Building Rep o rting Summary (Performance Path Only) 2. Testing and Verification Wo rksheets **As -**  **Built Building**  **Submittal (The**  **foll o** **w i**  **n g**  **documents must**  **be part**  **of the**  **submittal)** 1. As - Built Bui l ding Reporting Summary (Perform a n ce Path Only) 2

. Testin g an d Verificatio n Wo rksheets 3. Photo Tem p late By signing and stamping this form the licensed p rofes s ional i s not guara n teeing perfo rmance of the operating building nor does it require that t he licens e d professional certif y that t he building will perform to any spec ified level. By validating t h e submissi o n , the lice n sed professi o nal is certifying that the i nformation contained wi t hin the su b mitted documents i s accurate a nd in accord ance with t h e program’s guidelines, based on th e conditio n s observed. OMB Control No. 2060 -0586

# ENERGY **ST AR**  **Multifamily High**  **Rise Submittal** 

**Validation Form,**  **Version 1.0** 

**HOW T** **O S**  **UBMIT DOCUMENTS**  To ensure t hat EPA or its designated agent has a complete file for each project participating in t he program the Proposed and As- Built Building S u bmittals sh o uld be submitted as in d icate below. 1. The followi n g documents must be submitted in Portable Document Format (PDF)

- Proposed Building Rep o rting Summary

- As - Built Bui l ding Reporting Summary

- ENERGY STAR M F HR Submittal Validation Fo rm

- Photo Tem p late 2. The Testing and Verificat ion Wo rksh e ets Excel fi l e must be submitted in i ts entirety
All documents should be emailed as an attachment to mfhr@energystar.gov with the following the subject l ine, **[Proposed] or**  **[A**

**s -**  **Built] Building**  **Submittal (Project**  **Name, Ad**  **dress, Cit** **y ,**  **State )** 

. **Contact information**  **for questions:** 
• **Email:** mfhr@energystar.gov

• **Website:** www.energystar.gov/mfhr If the licensed professional chooses to submit hard copy documents to EPA they s h ould be sent to the following address Ma iling Address ENERGY STAR Label for Multifamily High Rise Buildings U. S. Enviro nmental Protection Ag e n cy (6202J) 1200 Pennsylvania Avenue, NW Washington, DC 20460 Express Ma i l and Courier ENERGY STAR Label for Multifamily High Rise Buildings Room 927P 1310 L Street, NW Washington, DC 20005

EPA Form 5900 -270 The government estimates the average time needed to fill out this form is 0. 10 hours and welcomes suggestions for reducing this effort. Send comments (referencing OMB Control Number) to the Director, Collection Strategies Division, U.S. EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460

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