5900-270 ENERGY STAR Multifamily High Rise Submittal Validation F

ENERGY STAR Multifamily High Rise Submittal
Validation Form V1.4
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
Professional’s Guide to the ENERGY STAR Multifamily High Rise Program.
BUILDING INFORMATION
Date (mm/dd/yyyy): ______/_______/_______
Building Address

Permit Date (mm/dd/yyyy): ______/_______/_______

ENERGY STAR Developer Partner

Licensed Professional

Project Name: ________________

Company Name: ______________

Company Name: ______________

Street: _______________________

Contact Name: ________________

Contact Name: ________________

City, State: ___________________

Phone: ______________________

Phone: ______________________

ZIP: _________________________

Email: _______________________

Email: _______________________

SUBMITTAL VALIDATION
1. The units in this building are earning the ENERGY STAR using the following (Please check the appropriate box):
Performance Path
2009 IECC
State code at time of permit:1 Choose
 an item.
an item.
Performance target:2 Choose 
15% above
ASHRAE 90.1-2007
Prescriptive Path
2. This validation form pertains to the following (please
check the appropriate box)
Proposed Design Submittal (The following

documents must be included as part of the

submittal)

1. Proposed Design Performance Path Calculator3
(Performance and Prescriptive Path)
2. Testing and Verification Worksheets
3. Statement of Energy Design Intent

1.
2.
3.
4.

As-Built Submittal (The following documents must

I declare that I have examined this certification,
be part of the submittal)

including accompanying documents, and to the
As-Built Performance Path Calculator
best of my knowledge and belief, the facts
presented in support of this certification are
(Performance and Prescriptive Path)
true, correct and complete.
Testing and Verification Worksheets
Photo Template
Accepted Proposed Design Submittal Review Form (with response to EPA comments if appropriate)

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 or units will perform to any specified
level. By validating the submission, the Licensed Professional is confirming that the information contained within the
submitted documents is accurate and in accordance with the program’s guidelines.
Updated August 2017 

ENERGY STAR Multifamily High Rise Submittal
Validation Form V1.4
The ENERGY STAR MFHR Developer Partner or the Licensed Professional working on their behalf may engage a
third party, who is not a Licensed Professional, to conduct some or all of the inspections and diagnostic testing
required per the ENERGY STAR MFHR Testing and Verification Protocols. However, the ENERGY STAR MFHR
Submittal Validation Form must bear the seal and signature of the Licensed Professional, who remains responsible
for all work performed by others under his or her direction and control.
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 Design and As-Built Submittals should be submitted as indicated below.
 The following documents must be submitted in Portable Document Format (PDF)
-
-

ENERGY STAR MFHR Submittal Validation Form
Statement of Energy Design Intent

 The following documents must be submitted in their entirety
- Performance Path Calculator Excel file3 (Performance and Prescriptive Path)
- Testing and Verification Worksheets Excel file
 There are multiple options for submitting the Photo Template. Please visit the Guidance Document page for more
information.
All documents should be emailed as an attachment to [email protected] with the following the subject line,
[Proposed Design] or [As-Built] Submittal (Project Name, City, State).
Contact information for questions:
•
Email: [email protected]
•
Website: www.energystar.gov/mfhr

1

 All Project Applications submitted on or after January 1, 2015 must pursue a Performance Target of 15% better than the state energy code
that is in effect when the building is permitted. For example, MFHR projects pursuing ENERGY STAR certification in states that have adopted
ASHRAE 90.1-2010/2012 IECC are required to meet a Performance Target of 15% over ASHRAE 90.1-2010, rather than the national
requirement of 15% over ASHRAE 90.1-2007. Please visit the Program Requirements page for more information.  
2
 To reduce the burden of applying two different codes to a given project, a Policy Record has been established that requires higher
performance targets based on earlier code years. More information is available in the Policy Record located on the Program Requirements
page.  
3
 For the Performance Path, submission of the Excel file, with Basic Info, Reporting Summary, and the three lighting worksheets completed, is
mandatory. For projects using eQUEST, all worksheets are expected to be completed, except the SIR by Measure worksheet. For projects
using the Prescriptive Path, only the Basic Info, In-Unit Lighting, Interior Lighting, and Exterior Lighting tabs are required to be completed and
submitted, in order to verify compliance with lighting requirements of the Prescriptive Path.

Updated August 2017