11060134 - TESTREPT j o c9 39
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C Q ii P O 4 A T E •31"
1111
•
TEST AND BALANCE REPORT
PROJECT: A fr t? T,
O( X) 'T .e)fav /4v fr C
" t
• GENERAL CONTRACTOR: f_
ENGINEERED BY: .. t s, a; t- r r,
BALANCE TECHNICIAN: ° 11-
DATE: .DATE:
TECHNCIAN:
111Th •(rl1Lt
rifillit
2161 Oakland Rd.
San Jose,CA 95131
AIR APPARATUS REPORT
PROJECT: Ar.t !C TA L] CETIFIED:
SYSTEMS: Kcidi-it47 1.k 4(litr., k DATE:
EQUIPMENT DATA iii-C .—/ . At...I PUP EY.1.1
LOCATION , i ..- ->
SERVICE 4400.441 ,,,/t' , ''
MANUFACTURER Tr-ant -
MODEL NUMBER S x H L i'-' 7 5 ------>
SERIAL NUMBER Ii I- 01
FAN DATA DESIGN TESTED DESIGN TESTED
OUTLET TOTAL CFM - /1/71 ''','1//
TOTAL AIR CFM — , 2_,Lc-4.-..-:‘7, 6-2, :1):
RETURN AIR CFM ?-1 (-P S!-,
-.•
,---' --- , •
OUTSIDE AIR CFM
FAN RPM { , III f/-P/;._i"
____
--•-- -".,,.6P-''''VV.t.4\ 7., . g',0 - - ,---
.00
DISCHARGE SP"W G , I. R. . /'. ,
SUCTION SP"W.G.
COOLING COIL AP"W.G. --; /
# ,
HEATING COIL AP"W.G. /
---"---/
PRE FILTER AP"W.G. ?. —
,
i
FILTER AP"W.G. 6 . -1
MOT OR DATA NAMEPLATE TESTED NAMEPLATE TESTED. .
MOTOR MFG W G ,//'Y 7 L34 is
HORSEPOWER z..a VI / ; ' ,
FRAME -2-LI 1 7 / / / A 215-T V 4
/ , 4
RPM i ,; ' 1 7
/—
L/ 0/:ç
..
AMPERAGE/SF '`I? .s, , 1,;;"' 5'), 77, /.."'- 'l',":1/1::--7 I ,5-
NO.BELT/SIZE v ->„ • — , A e7F"
FAN SHEAVE x BORE 2_6 ‘7 V I 2 L/ v --: 2_3A 2A i.c. ) 3v , x i, 1 7A(;.
MOTOR SHEAVE x BORE 2_6). --,ver) v,,,;-.:, _ /i- f ..- ,---.0_, .
SHEAVE POSITION OPEN -- - .
REMARKS:
.„........_ — —
(i) if-s 1 ', 1,'' ...1 '--,-r. /".' -• 1 ' . .-•
C- 7,_:-.,,--i,-„ ,-- = ,. _. , 1 , 4,•( . - - - - • . . .. . -
....
, •,(: ‘ .
AAR1 PAGE OF
TECHNICIAN:
ANNE
`flit r H►r�MT�
2161 Oakland Rd.
San Jose,CA 95131
AIR DISTRIBUTION REPORT
PROJECT: A y,lC 7#4 tr CERTIFIED: 7 e
SYSTEM: Gtj r "1' J h J r) I DATE:
AREA CUTLET LINLET. EFFECTIVE
DESIGN PRELIMINARY FINAL.. .. :.:FINAL. ;:..
OE
SERVED. : NO.. TYPE :.SIZE . AREA CFM: :.: .;CFM FPM: :CFM
AC -I
f .
REMARKS:
ADR3 PAGE OF
TECHNCIAN: •
NNW
2161 Oakland Rd.
San Jose,CA 95131
AIR APPARATUS REPORT
�. �'
PROJECT: f.„r c 1/4 1
SYSTEMS: ar�T, r, CETIFIED: ,k,
..
DATE: � �'+ �_.p
EQUIPMENT DATA: Vii. '- ..:.
LOCATION --r
SERVICE -,:-=,-. ..,--4.-* `i F•'I s
`
MANUFACTURER i 1 4 yr-
\.
MODEL NUMBER !_. , ! 1 i
SERIAL NUMBER C 11?: 0367;
FAN:DATA .DESIGN :. TESTED
DESIGN :TESTED
OUTLET TOTAL CFM ,
TOTAL AIR CFM " � S - .
RETURN AIR CFM
OUTSIDE AIR CFM �._
FAN RPM J - 0� �
ESP"W.G.
DISCHARGE SP"W.G. /' .
SUCTION SP"W.G. ' C
COOLING COIL AP"W.G. // L/ 'VA
I
F
HEATING COIL AP"W.G. /f
PRE FILTER AP"W.G. j ty r
FILTER AP"W.G.
MOTOR DATA NAMEPLATE 1. TESTED NAMEPLATE / 'TESTED
� 9 �4//MOTOR MFG �'/ r � f///%x
/ �� �����-
HORSEPOWER LI O
///
Y
i ' r' /��j� �FRAME - """.
,715 ' /� ' /
RPM I`�� , P y'< '-
VOLTAGE/PHASE ' 6
AMPERAGE/SF I k /. i1' � r 1.z//.�/;'��?A (_' :.,, ' .- • "
NO.BELT 1 SIZE 21
FAN SHEAVE x BORE 5' . ;1 u t% - (- .. , _ _----
MOTOR SHEAVE x BORE -� ;.) G. ',1 : r ,''9 /- (1H )- a ,5/13
SHEAVE POSITION OPEN r.' } - t
REMARKS: _ — — - _ -- - -- --
`_.. ' a 1 -,; .. • .—` e ...j
AAR1 PAGE OF
TECHNICIAN:
rrM�-
2161 Oakland Rd.
San Jose,CA 95131
AIR DISTRIBUTION REPORT
PROJECT:
a CERTIFIED: WA
�, .r � �
SYSTEM: iCJ&fop 20,4P I I 1-r DATE:
AREA :OUTLET I INLET . : EFFECTIVE :DESIGN PRELIMINARY FINAL .:FINAL
NOTE
SERVED NO.:: TYPE SIZE AREA CFM :CFM FPM
4
REMARKS:
AOR3 PAGE OF
TECHNITIAN:
MINK.
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: AT,,sr ' CERTIFIED: V4
SYSTEM: R rjf' cr 'I t. DATE
AREA OUTLET I INLET DESIGN PRELIMINARY. PIttAL NOTE
SERVED NO. . TYPE SIZE MIN MAX MIN MAX MIN MAX
VA-v HI .
. .
3
Fr.vvm.ii A: , Trl ''i'2 li,)00 9/0
. - .
vAry I- 2_
, I, C ,.., '1(1 .- 1 3 13-5—
V2 ( Y7 12,15-
t _
.... 1l 1 65— 3 ci 0
1--- ,
, i 150 :
. .
_ .
Pr' ,
_ .
1— LI
,. • c- —..'-2,f) 1- ."-
Z*V-'
. )
, le.------ r3 0
, ,) -,, 10 : ,— '
..,
_ ..
. _
REMARKS:
. _ —
VAV1 PAGE OF
. •
TECHNITIAN:
Mil*
I44P
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
.,..
PROJECT: A of-le CERTIFIED: Alt;
SYSTEM: 1- r.,/ '.7 T, . DATE
AREA OUTLET I INLET _ DESIGN PRELIMINARY FINAL NOTE
SERVED NO. TYPE SIZE MIN , MAX MIN MAX MIN MAX
rr V A-V \-6--
I CD 12 130 14 10
130 i'f 0 1
V/514 1-
iv:.
wi (
2 i/ . ,---
,
.
.
0 7 1/14 V ' 7
.__
‘,, , I ( r ! ( . „.. ,
9 ' ,....
0 V 1.
,
7 r , 0
. : 72
\ , i
PI( 1 1 LI r '140
. - , , _
r, ,t ., . '... '.7
I
REMARKS:
VAV1 PAGE OF
TECHNITIAN:
rillMIF
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: A,,,, c1 CERTIFIED: 11/4-
SYSTEM: R ria icp 1 i - t .. DATE
AREA ' OUTLET/INLET DESIGN PRELIMINARY FINAL NOTE
SERVED NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
'44 V \- 1 0
r
1,4 1-1,0 1 WC.J (s • ' ' .
() \ n ( , . t.7.-- )
- . •
-
. ,
VL, C`.-
,...
_ # (
t 0 1.-.1:1:
._ ,.
I
. _
WV
lot I t.S D PVL.- lc' t ! (
- r
2_ '-' ,
,3 6,r 10 r ) -
(
. .,- 4 `.../ •/ '.., , P
l'-‘).-0
Fr , ,r - e I 6,'e•,
460 LI 0 lu
.1 . -
v A--v 1— 13 - -
Cr) 12 OJL 'NC , - ' • "-)
_ _
7 („
I
- I 1,0 ' /2
3 ,',, -
. Liao
REMARKS: —
VAV1 PAGE OF
...
TECHNITIAN:
mi iiciuicii
rillINIF
2181 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: A-FC T,4 ti CERTIFIED: ////1-
SYSTEM: Ro,-,f 01 I ,' ,r,*P...- DATE
AREA OUTLET I INLET DESIGN PRELIMINARY FINAL NOTE
SERVED NO. I TYPE SIZE MIN MAX MIN MAX MIN MAX
VA-V 1- 19
--- -
r 1 izt'1,, . ‘ L. Sr) ? DV L Io e —
9- 1
----..- ' j (
./2t 0
I _ 0 Li)
. _ , -
S.
C,,, v
_ _
2c0 <lio11,....
'IAV 1 - 1:7
1 66, 1 L SD F DIA 2-2-5- .,
.....,
, .....)
Tur-cd 1110 950 15 0
_
1 6,ir i C D 10 t,vi_ 2 L10 TC, 235-
- (-1
,,,- z ' - ' 3 0
I 6) I -, i )
i
v t
\i, ( \(
q
pr. A e : .1c .
1 2_10 c 1 6,0 -,. `-t:/- 1O
,...,ii
Y A V I. /
1 G- cf , c I 0 Dv, 37s- I '
...
I.
,
,,, ,,,,,, ,.1 . - • ,
A i - .,-* • qc 1300 z','..,;•:; 12 /0
REMAAKS:
VAV1 PAGE OF
•
TECHNITIAN:
MINI*
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: AppIC TA Li CERTIFIED: NA
SYSTEM: r,„:-../: i cir 1,- rd r, i ( .',
DATE
AREA. . .......... ........UTLET/ItILET DESIGN PFIELIPIINARY FINAL NOTE
SERVED NO. TYPE SIZE , MIN MAX MIN MAX MIN MAX
VAV 1 — W
1 i0 I C r I 9 DNL t,-..1"-0 L -
_ \ _
. -
v 3 v
v ,
s
Ai, 1V4,1 soo (65v
1
VA v
CD 10 vv._ '2 50
- , ,-;) ' 4- €r- ., ,-..i,c,c, • ,--, -.
. ,.
Fri.. A r 101A1 _ . i
! r0 1f5()
VAV l- 20
Dtvi__ 17 g-- u- : 75- ./
2 ,
-
13 1,7 5 I
I r, A r ar.,
\ ---6, 5-2s-- .
V A V 1- 21
770 2 11 6.0 -, -s--, 1 --,1 r
,,---- ,
it: 'al 1 710 2_450 , '; 1 '
, ,
_ _
'JAV 1- , '..-
0.„„., • :, ( 7iot (). -,:"(1
iroo
1.-. r , ',.:". :
t , . , _ 71-1 0 :- t 0 7!0 ; .
REMARKS:
VAV1 PAGE OF
TECHNITIAN:
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: Apple- TA'1 CERTIFIED: 1V4
SYSTEM: RU -F ' ,. DATE
AREA : •-OUTLET./INLET . . . . .. DESIGN' .. .PRELIMINARY FINAL
NOTE
i.. .SERVED: . NO,.: TYPE • . •SIZE MIN :. ... MAX- • MIN MAX •MIN MAX: . : .
VAV 1—"2- }
I ( r *Ay*Ay 2.'I S0 ;_ ' 1
2-0 :
12 t7 VA V I -LI
\ 1 CD IX 560 IFr o r '- 1 KoO
e,',„,,.J ,4, .r T,w4(.1.l _ Co I'i'��' . 5-7T i (C'7,-/C.)
VA V 1,
} I CD 1 FFG ,r;.-,e.- t ,', ,.:
')-.' ' I? Ef 5-(ta ) t• ;:? "�' 41~ !}" .)
''` _ -- _, �- to ,-
I, ' -,'C\) O 1( 70 i t'r Iz.�
i
VAV 1- '
r t ( 1, 1 ,, PIVL. IVO . ,- ) Illy
.2 j/;'
�} 1-1( 1 100 .a00 ._t ,- •?.
V/4v I- 2k _
7f 1 r 12 DA/1- Li)
I
Pr.....1,, /, i ICA,I 5-70 I q00 7'7 o _ I ?qo
REMARKS:
VAV1
PAGE OF
TECHNITIAN:
MIA*
omni rtcwrcu
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: 4r . T AV CERTIFIED: i'14
SYSTEM: ' ,r,-r'a ri DATE
AREA OUTLET/INLET DESIGN PRELIMINARY. FINAL
SERVED .NO.�. .TYPE � SIZE � .. MIN. : MAX ,
MIN MAX MIN` MAX: NOTE:
VAV 1-
17'i 1 C 1.. F r'.r' `/5 , k'-
i 2 ,(' i pi
E(13 /
.r 150 `fes 1 i;;4)
r,; .4'r Tc-4e, V5-5' 500 i6C' sI
VA V l— 30 _
1 1c, 1 ( r 1f, .. 27
/
! C0 '245-
t. J'
E _
_ ( --)_s--;.-c r - � z'
1 ./J I 16s3 F;ifi ,00
VA V I- 5'
� r l? !,, _ i_ 3;o I„
�
s . 2
jf ' lr. 2,. 10 70o -c 7i0
/,
, : 100 16-o
1
REMARKS:
VAV1
PAGE OF
TECHNICIAN:
MEW
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: .' r., , CERTIFIED:
SYSTEM: r r 1; =�= r"' • DATE
AREA OUTLET/INLET DESIGN PRELIMINARY FINAL NOTE
SERVED NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
1 Y'I l `
(1 1 D
t .
l .-' -
-
-K-'(..:..- +/I
r ,,,, . ve
VA --
t
,. ,
. a
r
l , , - 7
h ` ,
z
REMARKS:
VAV1 PAGE OF
TECHNICIAN.
MM&
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: �., r I.,-= Li- CERTIFIED: t
SYSTEM: i\rr r t i op 1+ ` r '
DATE
AREA OUTLET 1 INLET DESIGN PRELIMINARY FINAL NOTE
SERVED v NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
Io 3 i /
,% / ,
' IL } . /
• r - - . } / s
•
4 i — —
.ra
Xi -,:5-,,--
-%_t-
VA U \ '42 .
r e 1 r -55-
n y, w
REMARKS:
VAV1
PAGE OF
TECHNICIAN:
mirrrni
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: ,r';, • CERTIFIED: ._`,*
SYSTEM: 1...r.t: ,rr. _,', DATE
AREA OUTLET I INLET DESIGN PRELIMINARY FINAL NOTE
SERVED NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
'. V,4 v I_ I _ ,,') e-
a
z • F+ 1 .
1 � , ~ ") �1
.� e
\/
,
,j=
� / 5
7 —71 CO
i (;) 3 „,.
l r, ,r , , r 7,77.) 0 '2'0
mac' i1'I
REMARKS:
VAV1
PAGE OF
TECHNICIAN:
I•
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: App!P, TA f CERTIFIED:
SYSTEM: ,'- - = :r DATE
AREA OUTLET I INLET DESIGN PRELIMINARY FINAL NOTE
SERVED NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
UAV
l f
2-_
1 "r
1 Li0 JC, r"
_ r �
)
REMARKS:
VAVI
PAGE OF
, .
TECHNICIAN:
1011111111-
URI:W:41:4
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: 4 fjp)r 1- 4 ti CERTIFIED:
,
(I
SYSTEM: DATE
-.4.-0- --,,( ,- / . I-
AREA OUTLET/INLET DESIGN PRELIMINARY FINAL
I NOTE
SERVED I NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
-. ,-- 2_ 10
, - 90 '1 r--(1-3
i i 0
. , - :1,,,-, 721
_
1/ ' ' ' :.'
. ,,
,,,,_
1,2o )
,..,,.
,., / . /
ic ,
I _ a) ‘,,- (
' .
. .
)
' : '-'
. _
REMARKS:
VAV1
PAGE OF
TECHNICIAN:
MUM
2161 Oakland Rd.
San Jose,CA 95131
VAV DISTRIBUTION REPORT
PROJECT: f
CERTIFIED: IL
SYSTEM: ,r r �
• DATE
AREA OUTLET/INLET DESIGN PRELIMINARY FINAL I NOTE
SERVED NO. TYPE SIZE MIN MAX MIN MAX MIN MAX
•
r t
,r.?7
I 11
REMARKS:
VAV1
PAGE OF
TECHNITIAN:
MOM
unik:va.4
2161 Oakland Rd.
San Jose,CA 95131
FLUID PUMP TEST REPORT
PROJECT: f f lc TA?-f CERTIFIED: irkOlL
SYSTEM: 1./177.-= ft7t, DATE: 1 '—
PUMP DATA 4111P P 1
LOCATION rs'
SERVICE
MANUFACTURER
MODEL NUMBER
SERIAL OR I.D.NUMBER
GPM/HEAD ,
MOTOR MFG/FRAME • -1, ,
MOTOR HP/RPM r '/. /
TEST DATA DESIGN TESTED DESIGN TESTED
GPM
•
VOLTAGE/PHASE , /
AMPERAGE/SF
PUMP RPM/HZ
DISCHARGE-PSIG
SUCTION-PSIG
, I r
DIFF.PRESSURE-PSIG - X 2.31 = FT.HD. X 2.31 FT.HD.
SHUT-OFF HEAD TESTED TESTED
DISCHARGE-PSIG )5.
SUCTION-PSIG
r
DIFF.PRESSURE-PSIG - X 2.31 = FT.HD. X 2.31 FT.HD.
I
IMPELLAR DIAMETER
REMARKS:
PUMP PAGE OF
TECHNITIAN:
1-
2161 Oakland Rd.
San Jose,CA 95131
FLUID FLOW MEASURING STATION REPORT
PROJECT: ,-' f . 1 CERTIFIED: i`. E
SYSTEM: 5 ' , • DATE: ',
tINAL AUJ.
FINAL VALVE
SERVICE OR DESIGNATION SIZE MFG:I MODEL DESIGN GPM %OR° �P FINAL GPM NOTE
CLORFl�
r
fv
.5
r
1
.1 t
C"
REMARKS:
FLUIDI PAGE OF
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 1 of 3)
Project Name/Address:
) /))/Z. '/r9 4' /0a00 /�.��/a� i' � � �C? t.4
' j
System Nam or Identification/Tag: Systemstem Locktion or rea Served:
fiL
/ /' c)
Enforcement Agency: Permit Number:
Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date
that must demonstrate compliance.
FIELD TECHNICIAN'S DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance(Field Technician).
• I certify that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and
specifications approved by the enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in
Reference Nonresidential Appendix NA7.
• I have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed and is
posted or made available with the building permit(s)issued for the building.
Company Name:
(fin/,/�si) AdG/4Ge 4)/&1 L- /4)L-
Field Technician's Name: Field Tec 's S' nature:
jes /A.) 6 tin, Z
Date Sig d: P•ion N'ith Col ipany(Title):
RESPONSIBLE PERSON'S DECLARATION STATEMENT
• I certify under penalty of perjury.under the laws of the State of California.that I am the Field Technician.or the Field Technician is acting
on my behalf as my employee or my agent and I have reviewed the information provided on this form.
• I am a licensed contractor,architect.or engineer,who is eligible under Division 3 of the Business and Professions Code,in the applicable
classification,to take responsibility for the scope of work specified on this document and attest to the declarations in this statement
(responsible person).
• I certify that the information provided on this form substantiates that the construction/installation identified on this form complies with the
acceptance requirements indicated in the plans and specifications approved by the enforcement agency.and conforms to the applicable
acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7.
• I have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed and is
posted or made available with the building permit(s)issued for the building.
• I will ensure that a completed,signed copy of this Certificate of Acceptance 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 signed copy of this
Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy.
Company Name: / Phone: /
Lit' 'Zi /(14C-4/kV 4c, /e
Responsible Person's Name: Respo ' efiep's Si}t'ature:
License: Date Si ed:// I' itio With Company(Title):
�Z G'/// `%�I j rG`45'1V 4.)
2008 Nonresidential Acceptance Forms August 2009
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 2 of 3)
Project Name/Address:
A#16:-
System Name or Identification/Tag: System Locatimpr Area Served:
/OCT—
Intent: Verify measured outside airflow reading is within±10%of the total required outside airflow value found in the
Standards Mechanical Plan(MECH-3C,Column H or Column I),per NA7.5.1.
Construction Inspection
1 Instrumentation to perform test includes,but not limited to:
a. Watch
b. Calibrated means to measure airflow
2 Check one of the following:
Variable Air Volume(VAV)-Check as appropriate:
a. Sensor used to control outdoor air flow must have calibration certificate or be field calibrated
❑ Calibration certificate(attach calibration certification)
A' Field calibration(attach results)
0 Constant Air Volume(CAV)-Check as appropriate:
0 System is designed to provide a fixed minimum OSA when the unit is on
NA7.5.1.1 Outdoor Air Acceptance
A. Functional Testing (Check appropriate column) CAV VAV
a. Verify unit is not in economizer mode during test-check appropriate column
Step 1:CAV and VAV testing at full supply airflow _
a. Adjust supply to achieve design airflow �(
b. Measured outdoor airflow reading(cfm) 230
c. Required outdoor airflow(cfm)(from MECH-3C, Column I) 23 Vr•
d. Time for outside air damper to stabilize after VAV boxes open(minutes) ✓/
e. Return to initial conditions(check) ✓
Step 2:VAV testing at reduced supply airflow
a. Adjust supply airflow to either the sum of the minimum zone airflows or 30%of the total design airflow
b. Measured outdoor airflow reading(cfm) Xn-Sr
c. Required outdoor airflow(cfm)(from MECH-3C,Column 1) 23 c
d. Time for outside air damper to stabilize after VAV boxes open and minimum air flow
achieved(minutes)
e. Return to initial conditions(check)
B. Testing Calculations&Results CAV VAV
Percent OSA at full supply airflow(%OAFA for Step 1)
a. %OAFA=Measured outside air reading/Required outside air(Step l b/Step 1 c) % /e; g
b. 90%<%OAFA<_110% Y / N Y N
c. Outside air damper position stabilizes within 15 minutes(Step 1 d<15 minutes) Y / N Y / N
Percent OSA at reduced supply airflow(%OARA for Step 2)
a. %OARA=Measured outside air reading/Required outside air(Step2b/Step2c) % ("4 %
b. 90%<%OAR,<110% Y (1)
c. Outside air damper position stabilizes within 15 minutes(Step 2d<15 minutes) � / N
Note:Shaded boxes do not apply for CAV systems
2008 Nonresidential Acceptance Forms August 2009
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 3 of 3)
Project a/Address:
System Name or Identification/Tag: System Locatioj.or Area Served:
/
C. PASS/FAIL Evaluation(check one):
0 PASS:All Construction Inspection responses are complete and Testing Calculations&Results responses are positive
(Y-yes)
FAIL:Any Construction Inspection responses are incomplete OR there is one or more negative(N-no)responses in
/T Testing Calculations&Results section.Provide explanation below. Use and attach additional pages if necessary.
2008 Nonresidential Acceptance Forms August 2009
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 1 of 3)
Project ane/Address 442
System Name or Identification/Tag: SystemL ation or Area Served:
/9C- Z- . F
Enforcement Agency: Permit Number:
Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use. Checked by/Date
that must demonstrate compliance.
FIELD TECHNICIAN'S DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California.the information provided on this form is true and correct.
• I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance(Field Technician).
• I certify that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and
specifications approved by the enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in
Reference Nonresidential Appendix NA7.
• I have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed and is
posted or made available with the building permit(s)issued for the building.
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Field
Field Tehnician's Name: Field Tee i 'e- jrlK L
Date Signe9: Positron ith Conany(Title):
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RESPONSIBLE PERSON'S DECLARATION STATEMENT
• 1 certify under penalty of perjury.under the laws of the State of California.that I am the Field Technician.or the Field Technician is acting
on my behalf as my employee or my agent and I have reviewed the information provided on this form.
• I am a licensed contractor,architect,or engineer,who is eligible under Division 3 of the Business and Professions Code,in the applicable
classification,to take responsibility for the scope of work specified on this document and attest to the declarations in this statement
(responsible person).
• I certify that the information provided on this form substantiates that the construction/installation identified on this form complies with the
acceptance requirements indicated in the plans and specifications approved by the enforcement agency,and conforms to the applicable
acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7.
• I have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed and is
posted or made available with the building permit(s)issued for the building.
• I will ensure that a completed.signed copy of this Certificate of Acceptance 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 signed copy of this
Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy.
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2008 Nonresidential Acceptance Forms August 2009
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 2 of 3)
Project Name/Address:
,9,e,' 2 /dc/
System Name or Iden'motion/Tag: System Location or Area Served:
r)e — let,e) .
Verify measured outside airflow reading is within±10%of the total required outside airflow value found in the
Intent:
Standards Mechanical Plan(MECH-3C, Column H or Column I),per NA7.5.1.
Construction Inspection
1 Instrumentation to perform test includes,but not limited to:
a. Watch
b. Calibrated means to measure airflow
2 Check one of the following:
Variable Air Volume(VAV)-Check as appropriate:
a. Sensor used to control outdoor air flow must have calibration certificate or be field calibrated
Calibration certificate(attach calibration certification)
Field calibration(attach results)
0 Constant Air Volume(CAV)-Check as appropriate:
❑ System is designed to provide a fixed minimum OSA when the unit is on
NA7.5.1.1 Outdoor Air Acceptance
A. Functional Testing (Check appropriate column) CAV VAN'
a. Verify unit is not in economizer mode during test-check appropriate column
Step 1:CAV and VAV testing at full supply airflow
a. Adjust supply to achieve design airflow
b. Measured outdoor airflow reading(cfm) _24'ta
c. Required outdoor airflow(cfm)(from MECH-3C,Column I) 0 V,r
d. Time for outside air damper to stabilize after VAV boxes open(minutes)
e. Return to initial conditions(check)
Step 2:VAV testing at reduced supply airflow
a. Adjust supply airflow to either the sum of the minimum zone airflows or 30%of the total design airflow
b. Measured outdoor airflow reading(cfm) /2–/D
c. Required outdoor airflow(cfm)(from MECH-3C, Column I) y(
d. Time for outside air damper to stabilize after VAV boxes open and minimum air flow
achieved(minutes)
e. Return to initial conditions(check)
B. Testing Calculations&Results CAV VAV
Percent OSA at full supply airflow(%OAFA for Step 1)
a. %OAFA=Measured outside air reading/Required outside air(Step 1 b/Step 1 c) % /2'' %
b. 90%<%OAFA<_110% Y / N 'Y N
c. Outside air damper position stabilizes within 15 minutes(Step Id<15 minutes) _ Y / N N
Percent OSA at reduced supply airflow(%OARA for Step 2)
a. %OARA=Measured outside air reading/Required outside air(Step2b/Step2c) % ,Zr, ,%
b. 90%<%OARA<110% Y ^1-'
c. Outside air damper position stabilizes within 15 minutes(Step 2d<15 minutes) ASP N
Note:Shaded boxes do not apply for CAV systems
2008 Nonresidential Acceptance Forms August 2009
CERTIFICATE OF ACCEPTANCE MECH-2A
NA7.5.1 Outdoor Air Acceptance (Page 3 of 3)
Project N e/Address:
� % �
%Z
System Name or Identification/Tag: System Lc tiion g4Area Served:
C. PASS/FAIL Evaluation(check one):
Li PASS:All Construction Inspection responses are complete and Testing Calculations&Results responses are positive
(Y-yes)
FAIL:Any Construction Inspection responses are incomplete OR there is one or more negative(N-no)responses in
Testing Calculations&Results section.Provide explanation below. Use and attach additional pages if necessary.
2008 Nonresidential Acceptance Forms August 2009