2017 EUC I/O/OO - COMPLETE COMFORT

WELCOME TO THE OFFICIAL iPERMIT

TEST IN/OUT & TEST OUT ONLY FORM
TEST INTEST OUTTEST OUT ONLY

CUSTOMER INFO
CUSTOMER NAME

First NameLast Name
CUSTOMER ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TEST IN DATE

MonthDayYear
TEST OUT DATE

MonthDayYear
SPLIT OR PACKAGE?

SPLITPACKAGE

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 PASSEDNO ONE OR MORE TESTS FAILED
NOTES

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

PASSFAIL
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?

PASSFAIL
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?

PASSFAIL
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?

PASSFAIL
CAZ 4 - NOTES

WATER HEATER
WATER HEATER - LOCATION
WH - NATURAL?

PASSFAIL
WH - UNDILUTED CO (PPM)
WH - UNDILUTED CO (PPM)

PASSFAIL
WH - CO NOTES
SHOW WATER HEATER 2

YES

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

PASSFAIL
WH2 - UNDILUTED CO (PPM)
WH2 - UNDILUTED CO (PPM)

PASSFAIL
WH2 - CO NOTES

HEATING SYSTEM
HEATING SYSTEM - LOCATION
HEAT - NATURAL?

PASSFAIL
HEAT - UNDILUTED CO (PPM)
HEAT - UNDILUTED CO (PPM)

PASSFAIL
HEAT - CO NOTES
SHOW HEATING SYS 2?

YES

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

PASSFAIL
HEAT 2 - UNDILUTED CO (PPM)
HEAT 2 - UNDILUTED CO (PPM)

PASSFAIL
HEAT 2 - CO - NOTES
SHOW HEATING SYS 3?

YES

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

PASSFAIL
HEAT 3 - UNDILUTED CO (PPM)
HEAT 3 - UNDILUTED CO (PPM)

PASSFAIL
HEAT 3 - CO - NOTES

FIREPLACE
FIREPLACE - LOCATION
FIREPLACE

PASSFAIL
FIREPLACE - NOTES
SHOW FIREPLACE 2?

YES

FIREPLACE 2
FIREPLACE 2 - LOCATION
FIREPLACE 2

PASSFAIL
FIREPLACE 2 - NOTES
SHOW FIREPLACE 3?

YES

FIREPLACE 3
FIREPLACE 3 - LOCATION
FIREPLACE 3

PASSFAIL
FIREPLACE 3 - NOTES

OVEN
OVEN - APPLIANCE CO
OVEN - APPLIANCE CO

PASSFAIL
OVEN NOTES
OVEN - AMBIENT CO
OVEN - AMBIENT CO

PASSFAIL
OVEN CO NOTES

RANGE
RANGE - APPLIANCE CO
RANGE - APPLIANCE CO

PASSFAIL
RANGE NOTES
RANGE - AMBIENT CO
RANGE - AMBIENT CO

PASSFAIL
RANGE CO NOTES

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

PASSFAIL
OTHER NOTES
OTHER - AMBIENT CO
OTHER - AMBIENT CO

PASSFAIL
OTHER CO NOTES
SHOW OTHER 2?

YES

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

PASSFAIL
OTHER 2 NOTES
OTHER 2 - AMBIENT CO
OTHER 2 - AMBIENT CO

PASSFAIL
OTHER 2 CO NOTES

CHOOSE TEST
CHOOSE TESTS TO PERFORM

DUCT TESTRCA TESTBLOWER DOOR

CHOOSE TEST OUT
TEST OUT PERFORMED

DUCT TESTRCA TESTBLOWER DOOR

HEATING UNIT INFO
HEATING MAKE:

LENNOXAMANAGOODMANRHEEMTRANEOther
MODEL#
SERIAL#
BTU's (OUTPUT)
kBTU
EFFICIENCY:
%

CONDENSER UNIT INFO
COND. MAKE:

LENNOXAMANAGOODMANTRANERHEEMOther
MODEL#
SERIAL#
TONS:
SEER:

INSULATION
INSULATION ADDED?

YESNO
R VALUE?

DUCTS
DUCTS INSTALLED?

YESNO
R VALUE?

R8R6 BURIEDR6
DUCT NOTES

DUCT TEST
METHOD:

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

PASSFAIL
NOTES

BLOWER DOOR TEST
CFM50
BLOWER PASS?

PASSFAIL
BLOWER NOTES:

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

YESNO

PAYMENTS
DID YOU COLLECT $?

YES
AMOUNT COLLECTED

FINISH
ENSURE YOU HAVE FILLED IN EVERYTHING CORRECTLY BEFORE CLICKING THE SUBMIT BUTTON
Should be Empty: