5900-270 MFHR Submittal Validation Form

Energy Star Program in the Residential Sector (Renewal)

MFHR Submittal Validation Form_V1.0

Energy Star Program in the Residential Sector: Private Sector

OMB: 2060-0586

Document [docx]
Download: docx | pdf

Shape6

ENERGY STAR Multifamily High Rise Submittal

Validation Form, Version 1.0

Shape7



INSTRUCTIONS

The ENERGY STAR Multifamily High Rise Submittal Validation Form is used by the licensed professional to validate submittals. This form must be signed and stamped by a professional engineer or registered architect and submitted to EPA or its designated agent for approval. For more information on program submittals see the Licensed Professionals Guide to the ENERGY STAR Label for MFHR Buildings.


BUILDING INFORMATION

Building Address ENERGY STAR Developer Partner Licensed Professional

Project Name: Street: City, State:

ZIP:

Company Name: Contact Name: Phone:

Email:

Company Name: Contact Name: Phone:

Email:


SUBMITAL VALIDATION

This building is earning the ENERGY STAR using the following (Please check the appropriate box):



Shape1 Shape2 P

OMB Control No. 2060-0586

erformance Path



Shape3 Prescriptive Path



This validation form pertains to the following (please check the appropriate box)


Shape4 Proposed Building Submittal (The following documents must be included as part of the submittal)


1. Proposed Building Reporting Summary (Performance

Path Only)

2. Testing and Verification Worksheets



Shape5 As-Built Building Submittal (The following documents must be part of the submittal)


1. As-Built Building Reporting Summary (Performance

Path Only)

2. Testing and Verification Worksheets

3. Photo Template



By signing and stamping this form the licensed professional is not guaranteeing performance of the operating building nor does it require that the licensed professional certify that the building will perform to any specified level. By validating the submission, the licensed professional is certifying that the information contained within the submitted documents is accurate and in accordance with the program’s guidelines, based on the conditions observed.




HOW TO SUBMIT DOCUMENTS


To ensure that EPA or its designated agent has a complete file for each project participating in the program the

Proposed and As-Built Building Submittals should be submitted as indicate below.


1. The following documents must be submitted in Portable Document Format (PDF)


- Proposed Building Reporting Summary

- As-Built Building Reporting Summary

- ENERGY STAR MFHR Submittal Validation Form

- Photo Template



2. The Testing and Verification Worksheets Excel file must be submitted in its entirety




All documents should be emailed as an attachment to [email protected] with the following the subject line,

[Proposed] or [As-Built] Building Submittal (Project Name, Address, City, State).



Contact information for questions:

Email: [email protected]

Website: www.energystar.gov/mfhr



If the licensed professional chooses to submit hard copy documents to EPA they should be sent to the following address


Mailing Address

ENERGY STAR Label for Multifamily High Rise Buildings

U. S. Environmental Protection Agency (6202J)

1200 Pennsylvania Avenue, NW Washington, DC 20460


Express Mail 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.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleMicrosoft Word - ENERGY STAR MFHR Submittal Validation Form_V1.0
Authorgvijayakumar
File Modified0000-00-00
File Created2021-01-29

© 2024 OMB.report | Privacy Policy