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A. System information
HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry.
Ol
System Identification or Name
1301/2 47th st.
02
System Location or Area Served
WHOLE HOUSE
03
CF3R-MCH-25-H
CERTIFICATE OF VERIFICATION
04
Condenser (or package unit) model number
MX2-4C36NA2
OS
Nominal Coaling Capacity (tons) of Condenser
3
(Page 1 of 4)
Refrigerant Charge Verification
GlU10977B
07
Refrigerant Type
R -410A
1301/2 47th st. Enforcement Agency: City of Permit Number:
0
Project Name:
Newport
Beach
Yes
09
1301/2 47th st. City:
Newport Beach Zip Code:
92663
Dwelling Address:
A. System information
HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry.
Ol
System Identification or Name
1301/2 47th st.
02
System Location or Area Served
WHOLE HOUSE
03
Condenser (or package unit) make or brand
Mitsubishi
04
Condenser (or package unit) model number
MX2-4C36NA2
OS
Nominal Coaling Capacity (tons) of Condenser
3
06
Condenser (or package unit) serial number
GlU10977B
07
Refrigerant Type
R -410A
OS
Other Refrigerant Type (if applicable)
N/A
Liquid Line Filter Drier Installed According to Manufacturers
Yes
09
Specifications (if applicable)
10 1 System installation Type
11 Fault Indicator Display (FID) Status (Note: Even systems with
,TF
FID must have refrigerant charge verified by installer)
Is the system of a type that the minimum airflow can be
12 verified using an approved measurement procedure (RA3.3
or RA3.3.3)?
Is the system of a type that approved refrigerant charge
13 verification procedures can be used to verify compliance
13]
with the refrigerant charge verification requirements when
temperatures are >= 55-F (RA3.2.2, or RA1)?
14 1 Date of Refrigerant Charge Verification for this system
Refrigerant charge verification method used.
=rson who performed the Refrigerant Charge Verification
irted on this Certificate of installation
rification Compliance Requirement Status
New
This system does not have a FID device installed
No, the airflow rate measurement procedures in RA3.3 or
RA3.3.3 are not applicable to this system, therefore
compliance shall use HERS Rater observation of the
installer's weigh-in charging procedure
No, none of the refrigerant charge verification procedures in
RA3.2.2, or RAI are applicable to the system therefore
compliance shall use HERS Rater observation of the
installer's weigh-in charging procedure
2017-10-24
Weigh-in with HERS Rater Obsesrvation
HVAC system installer
System does not qualify for group sampling
harge verification method used by HERS Rater. I Weigh -In Observation
Registration Date/Time: 2017-10-24 13.21.06
HERS Provider: CaICERTS
M25001A-M25A Report Generated: 2017-10-24 13:18:36
,,ency Standards Report Version: 2016.1.006
npliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF31R-MCH-2S-H
Refrigerant Charge Verification (Page 2 of 4)
MCH -25c - Refrigerant Charge Verification - Weigh In Observation Procedure
B. Measurement Access Hole (MAH) Verification
01
HERS Raters are required to visually field verify MAH.
Procedures for installing MAH are specified in Reference
Residential Appendix RA3.2.2.3
Specify the Method of Weigh-in
The airflow rate measurement procedures in RA3.3 or
02
System Airflow Rate Verification Status
The airflow rate measurement procedures in RA3.3 or
04
Method Used to Demonstrate Compliance with the
compliance shall use HERS rater observation (RA3.2.3.2) of
RA3.2.2.7 are not applicable to this system, therefore
01
Measurement Access Hole (MAH) Requirement
06
compliance shall use HERS Rater observation (RA3.2.3.2) of
3
07
Installed Liquid Line Length (ft)
the installer's weigh-in charging procedure (RA3.2.3.1); and
08
Installed Liquid Line Diameter (in)
0.38
compliance with MAH installation shall not be required
C. Minimum System Airflow Rate Verification
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.3.3.
01
Minimum Required System Airflow Rate (cfm)
1050
02
Specify the Method of Weigh-in
The airflow rate measurement procedures in RA3.3 or
02
System Airflow Rate Verification Status
RA3.3.3 are not applicable to this system, therefore
04
Manufacturer Standard Liquid Line Length (ft)
compliance shall use HERS rater observation (RA3.2.3.2) of
05
Manufacturer's Standard Liquid Line Diameter (in)
the installer's weigh-in charging procedure (RA3.2.3.1);
D. Weigh In Charge Procedure
HERS Rater must observe and confirm all data collected. Procedures for Refrigerant Charge using the Weigh-in Charging Procedure
are given in Reference Residential Appendix RA3.2.2.2 and RA3.2.3
01
Measured Condenser Air Entering Dry-bufb Temperature
(Tcondenser, db) ((" F)
87
02
Specify the Method of Weigh-in
TotalCharge
03
Manufacturer Standard Charge for Condenser (lbs, oz.)
6,13
04
Manufacturer Standard Liquid Line Length (ft)
86
05
Manufacturer's Standard Liquid Line Diameter (in)
0.38
06
Manufacturer's Standard Indoor Coil Size (tons)
3
07
Installed Liquid Line Length (ft)
86
08
Installed Liquid Line Diameter (in)
0.38
09
Installed Indoor Coil Size (tons)
3
10
Charge Adjustment to Standard Charge from Manufacturer's
Specifications (ounces, positive = add, negative = remove)
0
Registration Number:
217-A020344598A-000-001-M25001A-M25A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-10-2413:21:05 HERS Provider: CaICERTS
Report Version: 2016.1.006 Report Generated: 2017-10-24 13:18:36
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4)
The indoor coil correction to refrigerant weight is used if it is supplied by the manufacturer.
D. Weigh In Charge Procedure
HERS Rater must observe and confirm all data collected. Procedures for Refrigerant Charge using the Weigh-in Charging Procedure
are given in Reference Residential Appendix RA3.2.2.2 and RA3.2.3
microns after 5 minutes.
Refrigerant Required to be Weighed in by the Installer (lbs,
6,13
11
oz)
(Note: If Verification Status for this table indicates "Fail", the
12
Refrigerant Weighed in by Installer (lbs, oz)
6,13
Verification Status:
System complies with the Weigh-in charge requirement
13
(Note: if Verification Status for this table indicates "Fail", the
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Correction Notes in this table.
reason shall be described in the correction notes for this
table.)
Correction Notes:
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Correction Notes in this table.
E. Weigh In Charge Procedure - Additional Requirements
01
The indoor coil correction to refrigerant weight is used if it is supplied by the manufacturer.
02
Prior to Introducing refrigerant, system is evacuated to S00 microns or less and, when isolated, has risen no more than 300
microns after 5 minutes.
Verification Status:
Pass - all applicable requirements are met
03
(Note: If Verification Status for this table indicates "Fail", the
reason shall be described in the correction notes for this
table.)
Correction Notes:
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Correction Notes in this table.
F. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
101 I Complies: All specified verification protocol requirements on this document are met.
Registration Number:
217-A020344598A-000-001-M25001A-M25A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-10-24 13:21:05 HERS Provider: CaICERTS
Report Version: 2016.1.006 Report Generated: 2017-10-24 13:18:36
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 4 of 4)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: —_
Serj Jankozian
Company:
Date Signed:
Rapid Duct Testing & Air Balancing
2017-10-24 13:21:05
Address:
CEA/ HERS Certification Identification (if applicable):
401 N Verdugo Rd Suite C
City/State/Zip:
Phone:
Glendale CA 91206
818-468-5744
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The Information reported on applicable sections of the Certificate(s) of Installation (MR) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
S. I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
1 MARTIN INDOOR AIR QUALITY LLC
Responsible Builder or Installer Name:
CAB License:
Jared Martin
998956
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Rapid Duct Testing & Air Balancing
Responsible Rater Name:
Responsible Rater Signature:
Serj Jankozian
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2006125
2017-10-24 13:21:05
Digitallysignedby CalCERTS. This digital signature isprovided in order to secure the content of this registered document, and in noway implies
Registration Provider responsibility for the accuracy of the information.
Registration Number:
217-AO20344598A-000-001-M 25001A-M25A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-10-24 13:21:05 HERS Provider: CaICERTS
Report Version: 2016.1.006 Report Generated: 2017-10-24 13:18:36
Schema Version: rev 10/16
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