### Site Information

Customer name (name on electric bill): Customer electric utility account number: Address: City: State: Zip: 

### Design Type of installation: 

##  Replacement 

##  New system - existing home 

##  New system - new home



##  AC only 

##  Heat only 

##  AC & heat Area of zone served by unit: sq ft # of units in home: Is the unit self-contained, or is fan/airflow provided by external device (furnace)? Heat gain method: 

##  Manual J v7 

##  Manual J v8 

##  None 

##  Other: Duct design method: 

##  Manual D 

##  None 

##  Other: Equipm ent specification method: 

##  Manual S 

##  OEM recommendation 

##  Other: Latent heat gain: BTUh Sensible heat gain: BTUh Total heat gain: BTUh Design airflow: CFM Duct design static pressure: IW C Design heat loss: BTUh 

### Equipment Condenser Manufacturer: Model:

Serial num ber: Evaporator Manufacturer: Model:

Serial num ber: System Metering device: 

##  TXV 

##  Fixed orifice 

##  Other:

Refrigerant: 

##  R-22 

##  R-410a 

##  Other: Fan Motor Type: 

##  Fixed speed (e.g. PSC) 

##  Variable (e.g. ECM/ICM) 

##  Other: Cooling Latent Capacity: BTUh ARI EER/SEER:

Sensible Capacity: BTUh ARI Ref #: Total Capacity: BTUh Heating HSPF:

At 17 o F Capacity: BTUh COP: At 47 o F Capacity: BTUh COP: Previous equipment - for replacements only Cooling Total capacity: Btuh ARI EER/SEER: Heating HSPF:

At 17 o F Capacity: BTUh COP: At 47 o F Capacity: BTUh COP: 

## ENERGY STA**R in Cooperation w ith**  **AB C Electric Company**  **Installation Commissioning Report for Central A C and Heat Pump** 

### Equipment - continued

Does capacity

meet requirement of 95-115% (or up to 125% for heat pumps with heat dominated requirements) of calculated load or the next nominal size? 

##  Yes 

##  No 

### Refrigerant Tests **- run system for 15 minutes before testing** Date: Outdoor ambient temp. (at condenser) : o F DB Time of test: Outdoor relative humidity - optional: Barometric pressure - optional: Air temperatures measured in duct near evaporator (not in conditioned building space) :

Cooling Mode Return o F DB o F W B

Supply o F DB o F W B Heating Mode Return o F DB

Supply o F DB Liquid line pressure: psi Liquid line tem p.: o F DB Suction line pressure: psi Suction line tem p.: o F DB Refrigerant Calculations Condenser sat. temp. (from liquid pressure) : o F DB Evaporator sat. temp. (from suction pressure) : o F DB Subcooling (condensing temp. - liquid line temp.) : o F DB Superheat (suction line temp. - evaporating temp.) : o F DB For TXV OEM subcooling goal: o F DB Subcooling deviation (subcooling - subcooling goal) : o F DB For Fixed Orifice Superheat goal (from superheat lookup tables, based on outdoor ambient and return air wet bulb temps.) : o F DB Superheat deviation (superheat goal - superheat) : o F DB Does system meet requirement of subcooling within ±3 o F or superheat within ±5o F of goal? 

##  Yes 

##  No 

### Electrical Measurements - **taken at time of refrigerant tests** Evaporator/air handler fan: am ps volts watts Condenser fan: am ps volts watts Compressor: am ps volts watts 

### Electrical Requirements Does system meets requirements of ACCA QI 4.3? 

##  Yes 

##  No 

### Ai **r Flow Tests**  Date: Outdoor ambient temp. (at condenser) : o F DB Time of test: Outdoor relative humidity - optional: Barometric pressure - optional: Measured air volume at evaporator: CFM



### AC**& Heat Pump Installation Commissioning Report (Page 2 of 3)**

### Ai **r Flow Tests - continued** 

Test peformed in heating or cooling mode? 

##  Heating 

##  Cooling Static pressure Return Static: IW C Measurement location:

Supply Static: IW C Measurement location: Measurement method used: 

##  TrueFlow 

##  Pressure matching (with Duct Blaster) 

##  Anem om eter 

##  Fan Curve 

##  Temperature split (heating only) 

##  Other: Speed Setting If fixed 

##  Low 

##  Med-Low 

##  Med 

##  Med-High 

##  High CFM (at 0.5 IW C) :

If variable Fan set for CFM/ton Does air flow meet requirement of 350-450 cfm or within range recommended by OEM? 

##  Yes 

##  No 

### Duct Leakage Initial Test Date: Time: Final Test Date: Time: Test method used: 

##  Duct Blaster 

##  Blower Door Subtraction 

##  Other: Existing system duct leakage: CFM Post Installation duct leakage: CFM Leakage % reduction ([existing-post]/existing) : Total % leakage (post leakage/design flow) : OR (post leakage/measured flow) : Does duct leakage meet one of the following requirements:



##  No more than 20% of total air flow 

##  A reduction of 50% or more from the initial measurement 

##  Leakage from ducts inside the thermal envelope is no more than 10% of total air flow 

##  No more than 6% of total air flow from ducts outside the thermal envelope 

##  Less than 4 CFM leakage to outdoors per 100 square feet of conditioned floor area 

### Sy**stem Controls** Does system meets requirements of ACCA QI 4.6? 

##  Yes 

##  No 

### Sy**stem Documentation & Ow ner Education**  Copies of this report and OEM manuals left with owner? 

##  Yes 

##  No Demonstrated system for owner? 

##  Yes 

##  No 

### Contractor/Technician Information Technician name: Company: Address 1: Address 2: City: State: Zip: Phone/Em ail: Technician signature: **Please send completed forms to: System Implementer, 123 M**  **ain St, Town, ST, 01234, FAX 555-123-4567** 

### AC**& Heat Pump Installation Commissioning Report (Page 3 of 3)**

existing hom es:

new construction:

### Site Information

Customer name (name on electric bill): Customer electric utility account number: Address: City: State: Zip: 

### Design Type of installation: 

##  Replacement 

##  New system - existing home 

##  New system - new home



##  AC only 

##  Heat only 

##  AC & heat Area of zone served by unit: sq ft # of units in home: Heat gain method: 

##  Manual J v7 

##  Manual J v8 

##  None 

##  Other: Duct design method: 

##  Manual D 

##  None 

##  Other: Equipm ent specification method: 

##  Manual S 

##  OEM recommendation 

##  Other: Latent Heat Gain: BTUh Sensible Heat Gain: BTUh Total Heat Gain: BTUh Design Airflow: CFM Duct Design Static Pressure: IW C Design heat loss: BTUh 

### Equipment - A**C** Condenser Manufacturer: Model:

Serial num ber: Evaporator Manufacturer: Model:

Serial num ber: System Metering device: 

##  TXV 

##  Fixed orifice 

##  Other:

Refrigerant: 

##  R-22 

##  R-410a 

##  Other: Fan Motor Type: 

##  Fixed speed (e.g. PSC) 

##  Variable (e.g. ECM/ICM) 

##  Other: Speed setting If fixed 

##  Low 

##  Med-Low 

##  Med 

##  Med-High 

##  High CFM (at 0.5 IW C) :

If variable Fan set for CFM Latent Capacity: BTUh ARI EER/SEER: Sensible Capacity: BTUh ARI Ref #: Total Capacity: BTUh Previous equipment - for replacements only Total capacity: Btuh ARI EER/SEER: Does capacity

meet requirement of 95-115% of calculated load or the next nominal size? 

##  Yes 

##  No 

## ENERGY STA**R in Cooperation w ith**  **AB C Electric Company**  **Installation Commissioning Report for Central A C and Furnace** 

### Equipment - Furnace

Manufacturer: Model: Serial num ber: AFUE: Gross capacity: Btuh Net capacity: Btuh

Previous equipment - for replacements only Gross capacity: Btuh Net capacity: Btuh Fuel type: 

##  Gas 

##  Oil 

##  Propane 

##  Other: Sealed combustion? 

##  Yes 

##  No Fan Motor Type: 

##  Fixed speed (e.g. PSC) 

##  Variable (e.g. ECM/ICM) 

##  Other: Speed Setting If fixed 

##  Low 

##  Med-Low 

##  Med 

##  Med-High 

##  High CFM (at 0.5 IW C) :

If variable Fan set for CFM Does capacity

meet requirement of 100-140% of calculated load or the next nominal size? 

##  Yes 

##  No 

### Refrigerant Tests **- run system for 15 minutes before testing** Date: Outdoor ambient temp. (at condenser) : o F DB Time of test: Outdoor relative humidity - optional: Barometric pressure - optional: Air temperatures measured in duct near evaporator (not in conditioned building space) :

Cooling Mode Return o F DB o F W B

Supply o F DB o F W B Liquid line pressure: psi Liquid line tem p.: o F DB Suction line pressure: psi Suction line tem p.: o F DB Refrigerant Calculations Condenser sat. temp. (from liquid pressure) : o F DB Evaporator sat. temp. (from suction pressure) : o F DB Subcooling (condensing temp. - liquid line temp.) : o F DB Superheat (suction line temp. - evaporating temp.) : o F DB For TXV OEM subcooling goal: o F DB Subcooling deviation (subcooling - subcooling goal) : o F DB For Fixed Orifice Superheat goal (from superheat lookup tables, based on outdoor ambient and return air wet bulb temps.) : o F DB Superheat deviation (superheat goal - superheat) : o F DB Does system meet requirement of subcooling within ±3 o F or superheat within ±5o F of goal? 

##  Yes 

##  No



### AC**& Furnace Installation Commissioning Report (Page 2 of 4)**

### Electrical Measurements - **taken at time of refrigerant tests**

Evaporator/air handler fan: am ps volts watts Condenser fan: am ps volts watts Compressor: am ps volts watts 

### Electrical Requirements Does system meets requirements of ACCA QI 4.3? 

##  Yes 

##  No 

### Ai **r Flow Tests**  Date: Outdoor ambient temp. (at condenser) : o F DB Time of test: Outdoor relative humidity - optional: Barometric pressure - optional: Measured air volume at evaporator: CFM Test peformed in heating or cooling mode? 

##  Heating 

##  Cooling Static pressure Return Static: IW C Measurement location:

Supply Static: IW C Measurement location: Measurement method used: 

##  TrueFlow 

##  Pressure matching (with Duct Blaster) 

##  Anem om eter 

##  Fan Curve 

##  Temperature split (heating only) 

##  Other: Does air flow meet requirement of 350-450 cfm or within range recommended by OEM? 

##  Yes 

##  No 

### Duct Leakage Initial Test Date: Time: Final Test Date: Time: Test method used: 

##  Duct Blaster 

##  Blower Door Subtraction 

##  Other: Existing system duct leakage: CFM Post Installation duct leakage: CFM Leakage % reduction ([existing-post]/existing) : Total % leakage (post leakage/design flow) : OR (post leakage/measured flow) : Does duct leakage meet one of the following requirements:



##  No more than 20% of total air flow 

##  A reduction of 50% or more from the initial measurement 

##  Leakage from ducts inside the thermal envelope is no more than 10% of total air flow 

##  No more than 6% of total air flow from ducts outside the thermal envelope 

##  Less than 4 CFM leakage to outdoors per 100 square feet of conditioned floor area 

### AC**& Furnace Installation Commissioning Report (Page 3 of 4)**

existing hom es:

new construction:

### Gas Combustion Test

Altitude derating factor (from site elevation) : Return air: o F DB Supply air: o F DB Orifice size: Manifold pressure: psi Gas meter test dial size: Gas meter seconds for one revolution of meter: Low: High: Gas combustion test calculations Gas rate (from meter lookup tables) : Low speed: High speed: Actual firing rate: Low speed: High speed: Percent: Percent: Temperature rise: Low speed: o F High speed: o F 

### Combustion A**naly zer**  **- required for oil systems, optional for other fuels**  O 2 : Stack temperature: o F Efficiency: CO: Draft pressure: psi 

### Sy**stem Controls** Does system meets requirements of ACCA QI 4.6? 

##  Yes 

##  No 

### Sy**stem Documentation & Ow ner Education**  Copies of this report and OEM manuals left with owner? 

##  Yes 

##  No Demonstrated system for owner? 

##  Yes 

##  No 

### Contractor/Technician Information Technician name: Company: Address 1: Address 2: City: State: Zip: Phone/Em ail: Technician signature: **Please send completed forms to: System Implementer, 123 M**  **ain St, Town, ST, 01234, FAX 555-123-4567** 

### AC**& Furnace Installation Commissioning Report (Page 4 of 4)**