17651 New Homes Plan Work Completion Form

Energy Right Program

17651

Energy Right Program

OMB: 3316-0019

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energy right® Program

New Homes Plan Work Completion Form


OMB No. 3316-0019

Expires: MM/DD/YYYY


1.

Power Distributor:

     



2.

Work ID Number:

     

(Work ID Number is assigned by energy right Information System)


3.

Inspection (open) Date:

     

(mm/dd/yyyy)


4.

Rating File Name:

     

or

     



(*.blg, other)


(Prescriptive Standard)



5.

Efficiency Rating Version:

     

or

     



Software Version (RR, other)


(Prescriptive Standard)


6.

Builder Name:

     


Builder is Homeowner


7.

Legal 911 Address of New Home:



     


     


Street Address


City, State, Zip Code



8.

Inspector Name:

     



9.

Total Conditioned Floor Area:

     

(square feet)


10.

Structure:

Single Family

Multi-Family



11.

Installed Heat Pump:

ASHP-Package

ASHP-Split

Advanced-Geo

Advanced-Triple Function



Dual Fuel Heat Pump

Multi-Speed Compressor Heat Pump

Other


12.

Number of New Homes Completed at this Address with Efficiency Rating of:


energy right (93 to 86)


     


energy right
Platinum (
85)


     


energy right
Platinum Certified (
85)


     




For Platinum Certified homes only:

HERS Provider

     

HERS Certification Number

     

13.

HERS Rating Index:

     



14.

Total Cooling Capacity:

     

(tons)


15.

Number of Advanced Water Heaters Installed:

     



16.

Total Water Heating Capacity:

     

(gallons)


17.

Average Cooling Efficiency:

     

SEER


18.

Number of New Homes Inspected at this Address:

     



For Distributor Records (Complete the following where required by distributor):

1.

Subdivison or Customer Name:

     



2.

Account Number:

     

Meter Number:



3.

Total Heating Capacity Installed:

     

kbtu


4.

Heat Pump Brand 1:

     

Heat Pump Brand 2:

     


5.

Average Heating Efficiency:

     

HSPF

or

     

COP


6.

QCN:

Yes

No

QCN Contractor:

     


7.

Building Floor Levels:

     



8.

Water Heater Brand:

     



9.

Date Passed Local Standards:

     

(mm/dd/yyyy)


10.

Incentive Paid:

$

     

Retained MVP:

$

     



11.

Rating Certified by:

     



12.

Natural Gas Available?

Yes

No



13.

Contractor Paid?

Yes

No



14.

Comments:

     








Builder’s Signature


Inspector’s Signature


Date Completed


Signatures may be collected on Builder Affidavit


TVA 17651 [08-23-2011]

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleEnergy right® Program
AuthorEMPLOYEE OF TVA
File Modified0000-00-00
File Created2021-01-27

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