2017 EUC I/O/OO - COMPLETE COMFORT

WELCOME TO THE OFFICIAL iPERMIT

TEST IN/OUT & TEST OUT ONLY FORM
TEST IN TEST OUT TEST OUT ONLY

CUSTOMER INFO
CUSTOMER NAME

First Name Last Name
CUSTOMER ADDRESS

Street Address

Street Address Line 2

City

Postal / Zip Code
TEST IN DATE

Month Day Year
TEST OUT DATE

Month Day Year
SPLIT OR PACKAGE?

SPLIT PACKAGE

JOB INFO
SQUARE FT
BEDROOMS
BATHROOMS
YEAR BUILT
STORIES
INSIDE TEMP
F°
OUTSIDE TEMP
F°
OCCUPANTS
# OF SMOKE DETECTORS
# OF CO DETECTORS
AVG CEILING HEIGHT

TEST IN DATA
DID ALL TESTS (EXCEPT HEATING SYSTEM) PASS?

YES ALL TESTS HAVE PASSED NO ONE OR MORE TESTS FAILED
NOTES

CHOOSE TEST
TESTS PERFORMED

CAZ WATER HEATER FURNACE FIREPLACE OVEN RANGE OTHER

CHOOSE TEST IN
TEST IN PERFORMED

CAZ WATER HEATER FURNACE FIREPLACE OVEN RANGE OTHER

CAZ 1
CAZ 1 - DESCRIPTION
CAZ 1 - AMBIENT CO (PPM)
CAZ 1 - FINAL NET DEPRESSURIZATION
CAZ 1 - CVA PASS OR FAIL?

PASS FAIL
CAZ 1 - NOTES
SHOW CAZ 2?

YES

CAZ 2
CAZ 2 - DESCRIPTION
CAZ 2 - AMBIENT CO (PPM)
CAZ 2 - FINAL NET DEPRESSURIZATION
CAZ 2 - CVA PASS OR FAIL?

PASS FAIL
CAZ 2 - NOTES
SHOW CAZ 3?

YES

CAZ 3
CAZ 3 - DESCRIPTION
CAZ 3 - AMBIENT CO (PPM)
CAZ 3 - FINAL NET DEPRESSURIZATION
CAZ 3 - CVA PASS OR FAIL?

PASS FAIL
CAZ 3 - NOTES
SHOW CAZ 4?

YES

CAZ 4
CAZ 4 - DESCRIPTION
CAZ 4 - AMBIENT CO (PPM)
CAZ 4 - FINAL NET DEPRESSURIZATION
CAZ 4 - CVA PASS OR FAIL?

PASS FAIL
CAZ 4 - NOTES

WATER HEATER
WATER HEATER - LOCATION
WH - NATURAL?

PASS FAIL
WH - UNDILUTED CO (PPM)
WH - UNDILUTED CO (PPM)

PASS FAIL
WH - CO NOTES
SHOW WATER HEATER 2

YES

WATER HEATER 2
WATER HEATER 2 - LOCATION
WH2 - NATURAL?

PASS FAIL
WH2 - UNDILUTED CO (PPM)
WH2 - UNDILUTED CO (PPM)

PASS FAIL
WH2 - CO NOTES

HEATING SYSTEM
HEATING SYSTEM - LOCATION
HEAT - NATURAL?

PASS FAIL
HEAT - UNDILUTED CO (PPM)
HEAT - UNDILUTED CO (PPM)

PASS FAIL
HEAT - CO NOTES
SHOW HEATING SYS 2?

YES

HEATING SYSTEM 2
HEATING SYSTEM 2 - LOCATION
HEAT 2 - NATURAL?

PASS FAIL
HEAT 2 - UNDILUTED CO (PPM)
HEAT 2 - UNDILUTED CO (PPM)

PASS FAIL
HEAT 2 - CO - NOTES
SHOW HEATING SYS 3?

YES

HEATING SYSTEM 3
HEATING SYSTEM 3 - LOCATION
HEAT 3 - NATURAL?

PASS FAIL
HEAT 3 - UNDILUTED CO (PPM)
HEAT 3 - UNDILUTED CO (PPM)

PASS FAIL
HEAT 3 - CO - NOTES

FIREPLACE
FIREPLACE - LOCATION
FIREPLACE

PASS FAIL
FIREPLACE - NOTES
SHOW FIREPLACE 2?

YES

FIREPLACE 2
FIREPLACE 2 - LOCATION
FIREPLACE 2

PASS FAIL
FIREPLACE 2 - NOTES
SHOW FIREPLACE 3?

YES

FIREPLACE 3
FIREPLACE 3 - LOCATION
FIREPLACE 3

PASS FAIL
FIREPLACE 3 - NOTES

OVEN
OVEN - APPLIANCE CO
OVEN - APPLIANCE CO

PASS FAIL
OVEN NOTES
OVEN - AMBIENT CO
OVEN - AMBIENT CO

PASS FAIL
OVEN CO NOTES

RANGE
RANGE - APPLIANCE CO
RANGE - APPLIANCE CO

PASS FAIL
RANGE NOTES
RANGE - AMBIENT CO
RANGE - AMBIENT CO

PASS FAIL
RANGE CO NOTES

OTHER
OTHER - DESCRIPTION
OTHER - APPLIANCE CO
OTHER - APPLIANCE CO

PASS FAIL
OTHER NOTES
OTHER - AMBIENT CO
OTHER - AMBIENT CO

PASS FAIL
OTHER CO NOTES
SHOW OTHER 2?

YES

OTHER 2
OTHER 2 - DESCRIPTION
OTHER 2 - APPLIANCE CO
OTHER 2 - APPLIANCE CO

PASS FAIL
OTHER 2 NOTES
OTHER 2 - AMBIENT CO
OTHER 2 - AMBIENT CO

PASS FAIL
OTHER 2 CO NOTES

CHOOSE TEST
CHOOSE TESTS TO PERFORM

DUCT TEST RCA TEST BLOWER DOOR

CHOOSE TEST OUT
TEST OUT PERFORMED

DUCT TEST RCA TEST BLOWER DOOR

HEATING UNIT INFO
HEATING MAKE:

LENNOX AMANA GOODMAN RHEEM TRANE
MODEL#
SERIAL#
BTU's (OUTPUT)
kBTU
EFFICIENCY:
%

CONDENSER UNIT INFO
COND. MAKE:

LENNOX AMANA GOODMAN TRANE RHEEM
MODEL#
SERIAL#
TONS:
SEER:

INSULATION
INSULATION ADDED?

YES NO
R VALUE?

DUCTS
DUCTS INSTALLED?

YES NO
R VALUE?

R8 R6 BURIED R6
DUCT NOTES

DUCT TEST
METHOD:

COOLING HEATING
COOLING
UNIT SIZE (TONS)
ACTUAL LEAKAGE
CFM
TOTAL PERCENT LEAKAGE
HEATING
HEAT OUTPUT (kBtu):
kBtu
ACTUAL LEAKAGE
CFM
TOTAL PERCENT LEAKAGE
PASS OR FAIL?

PASS FAIL
NOTES

BLOWER DOOR TEST
CFM50
BLOWER PASS?

PASS FAIL
BLOWER NOTES:

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YES
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YES
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NOTES / RECOMMENDATIONS / REQUIREMENTS
NOTES
RECOMMENDATIONS
REQUIREMENTS
WAS HOMEOWNER NOTIFIED OF CORRECTIONS?

YES NO

PAYMENTS
DID YOU COLLECT $?

YES
AMOUNT COLLECTED

FINISH
ENSURE YOU HAVE FILLED IN EVERYTHING CORRECTLY BEFORE CLICKING THE SUBMIT BUTTON
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