334 S OCEANWALK DR RESA21-0023 REVISION 9-19-22 ENERGY SHEETS 0!--01'r Revision Request/Correction to Comments **ALL INFORMATION
ri HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
sl
Li 800 Seminole Rd, Atlantic Beach, FL 32233 c C ,C,-7
'P Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: t 5A-Ig ^ crDi9
Revision to Issued Permit OR ❑Corrections to Comments Date:`} •2• CZ--
Project
-Project Address: 4- t2(,A4J (Z.. 5
Contractor/Contact Name: Ota 4c L
Contact Phone: (kg _ S•67`-1 Email: r l IGfeA4L0/144/ -f4ZO (0/1/
Description of Proposed Revision/Corrections:
affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
•W.W. proposed revision/corrections add additional square footage to original submittal?
E.INo ®Yes (additional s.f.to be added:
• l roposed revision/corrections add additional increase in building value to original submittal?
No g]*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities _
Public Safety Date
Fire Services Updated 10/17/18
FORM R405-2020
RESIDENTIAL ENERGY CONSERVATION CODE DOCUMENTATION CHECKLIST
Florida Department of Business and Professional Regulation
Simulated Performance Alternative (Performance) Method
Applications for compliance with the 2020 Florida Building Code, Energy Conservation via the
Residential Simulated Performance Alternative shall include:
❑ This checklist
❑ Form R405-2020 report
❑ Input summary checklist that can be used for field verification (usually four pages/may be greater)
❑ Energy Performance Level(EPL) Display Card(one page)
❑ fIVAC system sizing and selection based on ACCA Manual S or per exceptions provided in Section R403.7
❑ Mandatory Requirements (five pages)
Required prior to CO:
❑ Air Barrier and Insulation Inspection Component Criteria checklist(Table R402.4.1.1 -one page)
❑ A completed 2020 Envelope Leakage Test Report(usually one page); exception in R402.4
allows dwelling units of R-2 Occupancies and multiple attached single family dwellings to
comply with Section C402.5
❑ If Form R405 duct leakage type indicates anything other than "default leakage", then a completed
2020 Duct Leakage Test Report-Performance Method(usually one page)
3/23/2022 11:39:49 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020)Compliant Software Page 1 of 1
FORM R405-2020
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
Florida Department of Business and Professional Regulation - Residential Performance Method
Project Name: TLR Heating and Air 334 Ocean Walk Drive S Builder Name: Built Rite
Street: 334 Ocean Walk Drive S Permit Office:
City,State,Zip: Atlantic Beach , FL,32233 Permit Number:
Owner: Jurisdiction:
Design Location: FL,Jacksonville County: Duval(Florida Climate Zone 2 )
1. New construction or existing New(From Plans) 10. Wall Typ$2852.0 sqft.) Insulation Area
2. Single family or multiple family Detached a. Frame-Wood, Exterior R=13.0 2650.00 ft2
b. Frame-Wood,Adjacent R=13.0 202.00 ft2
3. Number of units,if multiple family 1 c.N/A R= ft2
4. Number of Bedrooms 4 d.N/A R= ft'
11.Ceiling Types (2868.0 sqft.) Insulation Area
5. Is this a worst case? No a.Roof Deck(Unvented) R=38.0 2868.00 ft'
6. Conditioned floor area above grade(ft2) 3475 b.N/A R= ft2
Conditioned floor area below grade(ft2) 0 c.N/A R= ft2
7. Windows(394.3 sqft.) Description Area 12. Ducts R ft2
a.Sup:Attic, Ret:Attic,AH:Attic 6 347.5
a. U-Factor: Dbl, U=0.29 394.28 ft2 b.Sup: Attic,Ret:Attic,AH:Attic 6 347.5
SHGC: SHGC=0.19
b. U-Factor: N/A ft' 13.Cooling systems kBtu/hr Efficiency
SHGC: a.Central Unit 46.0 SEER:14.00
c. U-Factor: N/A ft2 b.Central Unit 22.2 SEER:14.50
SHGC: 14.Heating systems kBtu/hr Efficiency
Area Weighted Average Overhang Depth: 2.597 ft.
Area Weighted Average SHGC: 0.190 a.Electric Heat Pump 45.5 HSPF:8.20
b.Electric Heat Pump 22.2 HSPF:8.20
8. Skylights Area
c. U-Factor:(AVG) N/A ft' 15. Hot water systems
SHGC(AVG): N/A a.Propane Tankless Cap: 1 gallons
9. Floor Types (3475.0 sqft.) Insulation Area EF:0.900
a. Slab-On-Grade Edge Insulation R=0.0 2368.00 ft' b. Conservation features
b. Floor Over Other Space R=0.0 607.00 ft' None
c.other(see details) R= 500.00 ft' 16.Credits Pstat
Total Proposed Modified Loads: 88.33 PASS
P w C
Glass/Floor Area: 0.113
Total Baseline Loads: 104.44
fir....;..........,....
I hereby certify that the plans and specifications covered by Review of the plans and rvoIHE ST4gT....�
this calculation are in compliance with the Florida Energy specifications covered by this ' 4,�! "` .,,qt.
Code. calculation indicates compliance y
with the Florida Energy Code. O
PREPARED BY: Ed Wolfe Before construction is completed ( z `,;;.�' _ C
DATE: this building will be inspected for i'+ a=
2022.03.23 11:43:45 -04'00 compliance with Section 553.908 1„ , .,
Florida Statutes. �,
I hereby certify that this building,as designed, is in compliance ,..14,.,--' 9
with the Florida Energy Code . OD w>);'C�.
OWNER/ ENT: BUILDING OFFICIAL:
DATE: ../.2.-2.Z DATE:
- Compliance requires certification by the air handler unit manufacturer that the air handler enclosure qualifies as
certified factory-sealed in accordance with R403.3.2.1.
-Compliance requires an Air Barrier and Insulation Inspection Checklist in accordance with R402.4.1.1 and this project requires an
envelope leakage test report with envelope leakage no greater than 7.00 ACH50(R402.4.1.2).
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 1 of 5
FORM R405-2020 INPUT SUMMARY CHECKLIST REPORT
PROJECT
Title: TLR Heating and Air 334 Oce Bedrooms: 4 Address Type: Street Address
Building Type: User Conditioned Area: 3475 Lot#
Owner Name: Total Stories: 2 Block/Subdivision:
#of Units: 1 Worst Case: No PlatBook:
Builder Name: Built Rite Rotate Angle: 0 Street: 334 Ocean Walk Drive
Permit Office: Cross Ventilation: County: Duval
Jurisdiction: Whole House Fan: City,State,Zip: Atlantic Beach ,
Family Type: Detached FL, 32233
New/Existing: New(From Plans)
Comment:
CLIMATE
/ Design Temp Int Design Temp Heating Design Daily Temp
V Design Location TMY Site 97.5% 2.5% Winter Summer Degree Days Moisture Range
FL,Jacksonville FL_JACKSONVILLE_INT 32 93 70 75 1281 49 Medium
BLOCKS
Number Name Area Volume
1 Blockl 2343 42642.6
2 Block2 1132 16980
SPACES
Number Name Area Volume Kitchen Occupants Bedrooms InfiIID Finished Cooled Heated
1 Main 2343 42642.6 Yes 3 2 1 Yes Yes Yes
2 Master 1132 16980 No 2 2 1 Yes Yes Yes
FLOORS
# Floor Type Space Perimeter Perimeter R-Value Area Joist R-Value Tile Wood Carpet
1 Slab-On-Grade Edge Insulatio Main 93 ft 0 1236 ft2 -- 0 0 1
2 Floor Over Other Space Main __ ___ 607 ft' 0 0 0 1
3 Floor over Garage Main _ ___ 500 ft2 19 0 0 1
4 Slab-On-Grade Edge Insulatio Master 117 ft 0 1132 ft2 _— 0 0 1
ROOF
/ Roof Gable Roof Rad Solar SA Emitt Emitt Deck Pitch
V # Type Materials Area Area Color Barr Absor. Tested Tested Insul. (deg)
1 Hip Composition shingles 3320 ft2 0 ft2 Medium N 0.75 No 0.9 No 38 30.26
ATTIC
V # Type Ventilation Vent Ratio(1 in) Area RBS IRCC
1 Full attic Unvented 0 2868 ft2 N N
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 2 of 5
FORM R405-2020 INPUT SUMMARY CHECKLIST REPORT
CEILING
✓ # Ceiling Type Space R-Value Ins Type Area Framing Frac Truss Type
1 Under Attic(Unvented) Main 0 Blown 1736 ft' 0.11 Wood
2 Under Attic(Unvented) Master 0 Blown 1132 ft' 0.11 Wood
WALLS
/ Adjacent Cavity Width Height Sheathing Framing Solar Below
V # Clmt To Wall Type Space R-Value Ft Jn Ft In Area R-Valu Fraction Ahcor f;rarie°/n
1 NE Exterior Frame-Wood Main 13 7 8 56.0 ft' 0.23 0.3 0
2 E Exterior Frame-Wood Main 13 3 8 24.0 ft2 0.23 0.3 0
_ 3 NE Exterior Frame-Wood Main 13 5 8 40.0 ft' 0.23 0.3 0
4 NW Exterior Frame-Wood Master 13 15 8 120.0 ft2 0.23 0.3 0
5 NE Exterior Frame-Wood Master 13 26 8 208.0 ft' 0.23 0.3 0
6 SE Exterior Frame-Wood Master 13 42 8 336.0 ft' 0.23 0.3 0
7 SW Exterior Frame-Wood Master 13 34 8 272.0 ft' 0.23 0.3 0
8 SW Exterior Frame-Wood Main 13 24 8 192.0 ft' 0.23 0.3 0
9 NW Exterior Frame-Wood Main 13 20 8 160.0 ft' 0.23 0.3 0
10 SW Exterior Frame-Wood Main 13 7 8 56.0 ft2 0.23 0.3 0
11 NW Exterior Frame-Wood Main 13 18 8 144.0 ft' 0.23 0.3 0
12 NE Garage Frame-Wood Main 13 25 3 8 202.0 ft' 0.23 0.01 0
13 NE Exterior Frame-Wood Main 13 37 8 296.0 ft2 0.23 0.3 0
14 SE Exterior Frame-Wood Main 13 45 8 360.0 ft2 0.23 0.3 0
15 SW Exterior Frame-Wood Main 13 7 8 56.0 ft' 0.23 0.3 0
16 NW Exterior Frame-Wood Main 13 41 3 8 330.0 ft' 0.23 0.3 0
DOORS
V # Omt Door Type Space Storms U-Value Width Height Area
Ft In Ft In
1 NE Wood Main None .46 3 6 8 20 ft2
2 NE Insulated Main None .4 2 8 6 8 17.8 ft'
WINDOWS
Orientation shown is the entered,Proposed orientation.
/ Wall Overhang
V # Ornt ID Frame Panes NFRC U-Factor SHGC Imp Area Depth Separation Int Shade Screening
1 NE 1 Vinyl Low-E Double Yes 0.29 0.19 N 25.0 ft' 15 ft 0 in 1 ft 4 in None None
2 E 2 Vinyl Low-E Double Yes 0.29 0.19 N 10.0 ft' 17 ft 0 in 8 ft 0 in None None
3 NE 5 Vinyl Low-E Double Yes 0.29 0.19 N 50.0 ft' 1 ft 4 in 1 ft 4 in None None
4 SE 6 Vinyl Low-E Double Yes 0.29 0.19 N 12.5 ft' 1 ft 4 in 1 ft 4 in None None
5 SE 6 Vinyl Low-E Double Yes 0.29 0.19 N 4.0 ft' 1 ft 4 in 1 ft 4 in None None
6 SW 7 Vinyl Low-E Double Yes 0.29 0.19 N 8.0 ft2 1 ft 4 in 1 ft 4 in None None
7 SW 7 Vinyl Low-E Double Yes 0.29 0.19 N 12.0 ft' 1 ft 4 in 1 ft 4 in None None
8 SW 7 Vinyl Low-E Double Yes 0.29 0.19 N 17.8 ft' 1 ft 4 in 1 ft 4 in None None
9 SW 8 Vinyl Low-E Double Yes 0.29 0.19 N 24.0 ft' 1 ft 4 in 1 ft 4 in None None
10 SW 8 Vinyl Low-E Double Yes 0.29 0.19 N 24.0 ft' 1 ft 4 in 1 ft 4 in None None
11 SW 8 Vinyl Low-E Double Yes 0.29 0.19 N 40.0 ft' 1 ft 4 in 1 ft 4 in None None
12 NW 9 Vinyl Low-E Double Yes 0.29 0.19 N 36.0 ft' 1 ft 4 in 10 ft 4 in None None
3/2312022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 3 of 5
FORM R405-2020 INPUT SUMMARY CHECKLIST REPORT
WINDOWS
Orientation shown is the entered,Proposed orientation.
/ Wall Overhang
V # Ornt ID Frame Panes NFRC U-Factor SHGC Imp Area Depth Separation Int Shade Screening
13 SW 10 Vinyl Low-E Double Yes 0.29 0.19 N 16.0 ft2 1 ft 4 in 10 ft 4 in None None
14 NW 11 Vinyl Low-E Double Yes 0.29 0.19 N 16.0 ft2 1 ft 4 in 10 ft 4 in None None
15 NW 11 Vinyl Low-E Double Yes 0.29 0.19 N 12.0 ft2 1 ft 4 in 10 ft 4 in None None
16 NE 13 Vinyl Low-E Double Yes 0.29 0.19 N 60.0 ft2 1 ft 4 in 1 ft 4 in None None
17 SE 14 Vinyl Low-E Double Yes 0.29 0.19 N 6.0 ft2 1 ft 4 in 1 ft 4 in None None
18 NW 16 Vinyl Low-E Double Yes 0.29 0.19 N 15.0 ft2 1 ft 4 in 1 ft 4 in None None
19 NW 16 Vinyl Low-E Double Yes 0.29 0.19 N 6.0 ft2 1 ft 4 in 1 ft 4 in None None
GARAGE
✓ # Floor Area Ceiling Area Exposed Wall Perimeter Avg.Wall Height Exposed Wall Insulation
1 600 ft2 600 ft2 73 ft 8 ft 0
INFILTRATION
# Scope Method SLA CFM 50 ELA EgLA ACH ACH 50
1 Wholehouse Proposed ACH(50) .000763 6956 381.63 716.46 .2456 7
HEATING SYSTEM
V # System Type Subtype Speed Efficiency Capacity Block Ducts
1 Electric Heat Pump/ Split Singl HSPF:8.2 45.5 kBtu/hr 1 sys#1
2 Electric Heat Pump/ Split Singl HSPF:8.2 22.2 kBtu/hr 2 sys#2
COOLING SYSTEM
V # System Type Subtype Subtype Efficiency Capacity Air Flow SHR Block Ducts
1 Central Unit/ Split Singl SEER: 14 46 kBtu/hr 1380 cfm 0.84 1 sys#1
2 Central Unit/ Split Singl SEER: 14.5 22.2 kBtu/hr 800 cfm 0.79 2 sys#2
HOT WATER SYSTEM
V # System Type SubType Location EF Cap Use SetPnt Conservation
1 Propane Tankless Exterior 0.9 1 gal 70 gal 120 deg None
SOLAR HOT WATER SYSTEM
VFSEC Collector Storage
Cert # Company Name System Model# Collector Model# Area Volume FEF
None None ft2
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 4 of 5
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FORM R405-2020 INPUT SUMMARY CHECKLIST REPORT
DUCTS
/ —Supply--- --Return— Air CFM 25 CFM25 HVAC#
V # Location R-Value Area Location Area Leakage Type Handler TOT OUT QN RLF Heat Cool
1 Attic 6 347.5 ft Attic 86.875 Default Leakage Attic (Default) (Default) 1 1
2 Attic 6 347.5 ft Attic 86.875 Default Leakage Attic (Default) (Default) 2 2
TEMPERATURES
Programable Thermostat:Y Ceiling Fans:
CoolingJan Feb Mar [ A r ]Ma r]Jun [X]Jul Au (X]Se Oct Nov Dec
HeatinlX; Jan tXi Feb X Mar [ Apr t ]May ]Jun [ ]Jul t Au [ ]Sep Oct X Nov X]Dec
Ventin [ Jan [ Feb X Mar X A r [ ]Ma ]Jun [ ]Jul [ Aug [ ]Sep X Oct X Nov Dec
Thermostat Schedule: HERS 2006 Reference Hours
Schedule Type 1 2 3 4 5 6 7 8 9 10 11 12
Cooling(WD) AM 78 78 78 78 78 78 78 78 80 80 80 80
PM 80 80 78 78 78 78 78 78 78 78 78 78
Cooling(WEH) AM 78 78 78 78 78 78 78 78 78 78 78 78
PM 78 78 78 78 78 78 78 78 78 78 78 78
Heating(WD) AM 66 66 66 66 66 68 68 68 68 68 68 68
PM 68 68 68 68 68 68 68 68 68 68 66 66
Heating(WEH) AM 66 66 66 66 66 68 68 68 68 68 68 68
PM 68 68 68 68 68 68 68 68 68 68 66 66
MECHANICAL VENTILATION
Type Supply CFM Exhaust CFM Fan Watts HRV Heating System Run Time Cooling System
None 0 0 0 1 -Electric Heat Pump 0% 1 -Central Unit
None 0 0 0 2-Electric Heat Pump 0% 2-Central Unit
MASS
Mass Type Area Thickness Fumiture Fraction Space
Default(8 lbs/sq.ft. 0 ft2 0 ft 0.3 Main
Default(8 lbs/sq.ft. 0 ft2 0 ft 0.3 Master
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 5 of 5
FORM R405-2020
ENERGY PERFORMANCE LEVEL (EPL) DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE INDEX* = 85
The lower the EnergyPerformance Index, the more efficient the home.
334 Ocean Walk Drive S, Atlantic Beach , FL, 32233
1. New construction or existing New(From Plans) 10. Wall Type and Insulation Insulation Area
2. Single family or multiple family Detached a. Frame-Wood, Exterior R=13.0 2650.00 ftz
b. Frame-Wood,Adjacent R=13.0 202.00 ft
3. Number of units,if multiple family 1 c.N/A R= ft2
4. Number of Bedrooms 4 d.N/A R= ft'
11.Ceiling Type and insulation level Insulation Area
5. Is this a worst case? No a.Roof Deck(Unvented) R=38.0 2868.00 ft2
6. Conditioned floor area(ft') 3475 b. N/A R= ft2
7. Windows** Description Area c. N/A R= ft2
2
a. U-Factor: Dbl, U=0.29 394.28 ft' 12. Ducts,location&insulation level R fi
a.Sup:Attic, Ret:Attic,AH:Attic 6 347.5
SHGC: SHGC=0.19 b.Sup: Attic,Ret:Attic,AH:Attic 6 347.5
b. U-Factor: N/A ft2
SHGC: 13.Cooling systems kBtu/hr Efficiency
c. U-Factor: N/A ft2 a.Central Unit 46.0 SEER:14.00
SHGC: b.Central Unit 22.2 SEER:14.50
d. U-Factor: N/A ft2 14. Heating systems kBtu/hr Efficiency
SHGC: a. Electric Heat Pump 45.5 HSPF:8.20
Area Weighted Average Overhang Depth: 2.597 ft. b. Electric Heat Pump 22.2 HSPF:8.20
Area Weighted Average SHGC: 0.190
8. Skylights Description Area 15. Hot water systems Cap: 1 gallons
a. U-Factor(AVG): N/A ft2 a.Propane
EF:0.9
SHGC(AVG): N/A
b. Conservation features
9. Floor Types Insulation Area None
a.Slab-On-Grade Edge Insulation R=0.0 2368.00 ft' Credits(Performance method) Pstat
b. Floor Over Other Space R=0.0 607.00 ft'
c.other(see details) R= 500.00 ft'
.-
I certify that this home has complied with the Florida Energy Efficiency Code for Buildin .00.06.....
;v* � tNE S7 . y
Construction through the above energy saving features which will be installed (or exceeded) :•�'�,O` FQ�q
in this home before final inspection. Otherwise, a new EPL Display Card will be completed :'o, /, ,e
based on installed Code compliant features. '~�- '`- „,..ts"1 `o
Builder Signature: "� Date: Z
Address of New Home: 33,f pc ,rGh,v 44-..11 D lj City/FL Zip: 'L 3Ts,' ���4v5�,s.:°
.. DWE ,..,
*Note: This is not a Building Energy Rating. If your Index is below 70, your home may qualify for energy efficient
mortgage (EEM) incentives if you obtain a Florida Energy Rating. For information about the Florida Building Code,
Energy Conservation, contact the Florida Building Commission's support staff.
**Label required by Section R303.1.3 of the Florida Building Code, Energy Conservation, if not DEFAULT.
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 1 of 1
Florida Building Code, Energy Conservation, 7th Edition (2020)
Mandatory Requirements for Residential Performance, Prescriptive and ERI Methods
ADDRESS: 334 Ocean Walk Drive S Permit Number:
Atlantic Beach , FL ,32233
MANDATORY REQUIREMENTS - See individual code sections for full details.
SECTION R401 GENERAL
R401.3 Energy Performance Level(EPL)display card(Mandatory). The building official shall require that an energy performance level(EPL)
display card be completed and certified by the builder to be accurate and correct before final approval of the building for occupancy. Florida law
❑ (Section 553.9085, Florida Statutes)requires the EPL display card to be included as an addendum to each sales contract for both presold and
nonpresold residential buildings.The EPL display card contains information indicating the energy performance level and efficiencies of components
installed in a dwelling unit.The building official shall verify that the EPL display card completed and signed by the builder accurately reflects the plans
and specifications submitted to demonstrate code compliance for the building.A copy of the EPL display card can be found in Appendix RD.
SECTION R402 BUILDING THERMAL ENVELOPE
❑ R402.4 Air leakage(Mandatory). The building thermal envelope shall be constructed to limit air leakage in accordance with the requirements of
Sections R402.4.1 through R402.4.5.
Exception: Dwelling units of R-2 Occupancies and multiple attached single family dwellings shall be permitted to
comply with Section C402.5.
R402.4.1 Building thermal envelope.The building thermal envelope shall comply with Sections R402.4.1.1 and
R402.4.1.2.The sealing methods between dissimilar materials shall allow for differential expansion and contraction.
❑ R402.4.1.1 Installation. The components of the building thermal envelope as listed in Table R402.4.1.1 shall be installed in accordance
with the manufacturer's instructions and the criteria listed in Table R402.4.1.1,as applicable to the method of construction.Where required
by the code official, an approved third party shall inspect all components and verify compliance.
❑ R402.4.1.2 Testing. The building or dwelling unit shall be tested and verified as having an air leakage rate not exceeding seven air
changes per hour in Climate Zones 1 and 2,and three air changes per hour in Climate Zones 3 through 8.Testing shall be conducted in
accordance with ANSI/RESNET/ICC 380 and reported at a pressure of 0.2 inch w.g.(50 pascals).Testing shall be conducted by either
individuals as defined in Section 553.993(5)or(7), Florida Statutes,or individuals licensed as set forth in Section 489.105(3)(f),(g)or(i)or
an approved third party.A written report of the results of the test shall be signed by the party conducting the test and provided to the code
official.Testing shall be performed at any time after creation of all penetrations of the building thermal envelope.
Exception: Testing is not required for additions,alterations,renovations,or repairs,of the building thermal envelope of existing
buildings in which the new construction is less than 85 percent of the building thermal envelope.
During testing:
1. Exterior windows and doors,fireplace and stove doors shall be closed,but not sealed, beyond the intended weatherstripping or
other infiltration control measures.
2. Dampers including exhaust,intake,makeup air,backdraft and flue dampers shall be closed,but not sealed beyond intended
infiltration control measures.
3. Interior doors,if installed at the time of the test,shall be open.
4. Exterior doors for continuous ventilation systems and heat recovery ventilators shall be closed and sealed.
5. Heating and cooling systems, if installed at the time of the test,shall be tumed off.
6. Supply and return registers,if installed at the time of the test,shall be fully open.
n
R402.4.2 Fireplaces. New wood-burning fireplaces shall have tight-fitting flue dampers or doors,and outdoor combustion air.Where
using tight-fitting doors on factory-built fireplaces listed and labeled in accordance with UL 127,the doors shall be tested and listed for the
fireplace.Where using tight-fitting doors on masonry fireplaces,the doors shall be listed and labeled in accordance with UL 907.
❑ R402.4.3 Fenestration air leakage. Windows,skylights and sliding glass doors shall have an air infiltration rate of no more than 0.3 cfm
per square foot(1.5 L/s/m2),and swinging doors no more than 0.5 cfm per square foot(2.6 L/s/m2),when tested according to NFRC 400 or
AAMA/WDMA/CSA 101/I.S.2/A440 by an accredited, independent laboratory and listed and labeled by the manufacturer.
Exception: Site-built windows,skylights and doors.
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MANDATORY REQUIREMENTS - (Continued)
aR402.4.4 Rooms containing fuel-burning appliances. In Climate Zones 3 through 8,where open combustion air ducts provide combustion air to
open combustion fuel burning appliances,the appliances and combustion air opening shall be located outside the building thermal envelope or
enclosed in a room,isolated from inside the thermal envelope.Such rooms shall be sealed and insulated in accordance with the envelope requirements
of Table R402.1.2,where the walls,floors and ceilings shall meet not less than the basement wall R-value requirement.The door into the room shall be
fully gasketed and any water lines and ducts in the room insulated in accordance with Section R403.The combustion air duct shall be insulated where it
passes through conditioned space to a minimum of R-8.
Exceptions:
1. Direct vent appliances with both intake and exhaust pipes installed continuous to the outside.
2. Fireplaces and stoves complying with Section R402.4.2 and Section R1006 of the Florida Building Code, Residential.
R402.4.5 Recessed lighting. Recessed luminaires installed in the building thermal envelope shall be sealed to limit air leakage
between conditioned and unconditioned spaces.All recessed luminaires shall be IC-rated and labeled as having an air leakage rate not
more than 2.0 cfm(0.944 L/s)when tested in accordance with ASTM E283 at a 1.57 psf(75 Pa)pressure differential.All recessed
luminaires shall be sealed with a gasket or caulk between the housing and the interior wall or ceiling covering.
SECTION R403 SYSTEMS
R403.1 Controls.
R403.1.1 Thermostat provision(Mandatory). At least one thermostat shall be provided for each separate heating and cooling system.
R403.1.3 Heat pump supplementary heat(Mandatory). Heat pumps having supplementary electric-resistance heat shall have controls
that,except during defrost,prevent supplemental heat operation when the heat pump compressor can meet the heating load.
❑ R403.3.2 Sealing(Mandatory) All ducts,air handlers,filter boxes and building cavities that form the primary air containment passageways
for air distribution systems shall be considered ducts or plenum chambers, shall be constructed and sealed in accordance with Section
C403.2.9.2 of the Commercial Provisions of this code and shall be shown to meet duct tightness criteria below.
Duct tightness shall be verified by testing in accordance with ANSI/RESNET/ICC 380 by either individuals as defined in Section 553.993(5)or
(7),Florida Statutes,or individuals licensed as set forth in Section 489.105(3)(f),(g)or(i), Florida Statutes,to be"substantially leak free"in
accordance with Section R403.3.3.
❑ R403.3.2.1 Sealed air handler. Air handlers shall have a manufacturer's designation for an air leakage of no more than 2 percent
of the design airflow rate when tested in accordance with ASHRAE 193.
nR403.3.3 Duct testing(Mandatory). Ducts shall be pressure tested to determine air leakage by one of the following methods:
1. Rough-in test:Total leakage shall be measured with a pressure differential of 0.1 inch w.g.(25 Pa)across the system,
including the manufacturer's air handler enclosure if installed at the time of the test.All registers shall be taped or otherwise
sealed during the test.
2. Postconstruction test:Total leakage shall be measured with a pressure differential of 0.1 inch w.g.(25 Pa)across the entire
system, including the manufacturer's air handler enclosure.Registers shall be taped or otherwise sealed during the test.
Exceptions:
1. A duct air leakage test shall not be required where the ducts and air handlers are located entirely within the building
thermal envelope.
2. Duct testing is not mandatory for buildings complying by Section 405 of this code. Duct leakage testing is required for Section
R405 compliance where credit is taken for leakage, and a duct air leakage Qn to the outside of less than 0.080(where On=
duct leakage to the outside in cfm per 100 square feet of conditioned floor area tested at 25 Pascals)is indicated in the
compliance report for the proposed design.
A written report of the results of the test shall be signed by the party conducting the test and provided to the code official.
EIR403.3.5 Building cavities(Mandatory). Building framing cavities shall not be used as ducts or plenums.
El
R403.4 Mechanical system piping insulation(Mandatory). Mechanical system piping capable of carrying fluids above 105°F(41°C)
or below 55°F(13°C)shall be insulated to a minimum of R-3.
❑ R403.4.1 Protection of piping insulation. Piping insulation exposed to weather shall be protected from damage,including that
caused by sunlight,moisture,equipment maintenance and wind,and shall provide shielding from solar radiation that can cause
degradation of the material.Adhesive tape shall not be permitted.
❑ R403.5.1 Heated water circulation and temperature maintenance systems(Mandatory). If heated water circulation systems are
installed,they shall be in accordance with Section R403.5.1.1. Heat trace temperature maintenance systems shall be in accordance with
Section R403.5.1.2.Automatic controls,temperature sensors and pumps shall be accessible.Manual controls shall be readily accessible.
❑ R403.5.1.1 Circulation systems. Heated water circulation systems shall be provided with a circulation pump.The system return pipe shall
be a dedicated return pipe or a cold water supply pipe.Gravity and thermosiphon circulation systems shall be prohibited.Controls for
circulating hot water system pumps shall start the pump based on the identification of a demand for hot water within the occupancy.The
controls shall automatically turn off the pump when the water in the circulation loop is at the desired temperature and when there is no
demand for hot water.
❑ R403.5.1.2 Heat trace systems. Electric heat trace systems shall comply with IEEE 515.1 or UL 515. Controls for such systems shall
automatically adjust the energy input to the heat tracing to maintain the desired water temperature in the piping in accordance with the
times when heated water is used in the occupancy.
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MANDATORY REQUIREMENTS - (Continued)
n R403.5.5 Heat traps(Mandatory). Storage water heaters not equipped with integral heat traps and having vertical pipe risers shall have
heat traps installed on both the inlets and outlets.External heat traps shall consist of either a commercially available heat trap or a
downward and upward bend of at least 3'/2 inches(89 mm)in the hot water distribution line and cold water line located as close as possible
to the storage tank.
R403.5.6 Water heater efficiencies(Mandatory).
R403.5.6.1.1 Automatic controls. Service water-heating systems shall be equipped with automatic temperature controls capable
of adjustment from the lowest to the highest acceptable temperature settings for the intended use.The minimum temperature
setting range shall be from 100`F to 140°F(38°C to 60°C).
❑ R403.5.6.1.2 Shut down. A separate switch or a clearly marked circuit breaker shall be provided to permit the power supplied to
electric service systems to be turned off.A separate valve shall be provided to permit the energy supplied to the main burner(s)of
combustion types of service water-heating systems to be turned off.
R403.5.6.2 Water-heating equipment. Water-heating equipment installed in residential units shall meet the minimum efficiencies of
Table C404.2 in Chapter 4 of the Florida Building Code,Energy Conservation,Commercial Provisions,for the type of equipment installed.
Equipment used to provide heating functions as part of a combination system shall satisfy all stated requirements for the appropriate
water-heating category.Solar water heaters shall meet the criteria of Section R403.5.6.2.1.
R403.5.6.2.1 Solar water-heating systems. Solar systems for domestic hot water production are rated by the annual solar energy
factor of the system.The solar energy factor of a system shall be determined from the Florida Solar Energy Center Directory of
Certified Solar Systems. Solar collectors shall be tested in accordance with ISO Standard 9806,Test Methods for Solar Collectors,
and SRCC Standard TM-1, Solar Domestic Hot Water System and Component Test Protocol.Collectors in installed solar
water-heating systems should meet the following criteria:
1. Be installed with a tilt angle between 10 degrees and 40 degrees of the horizontal:and
2. Be installed at an orientation within 45 degrees of true south.
• R403.6 Mechanical ventilation(Mandatory). The building shall be provided with ventilation that meets the requirements of the
Florida Building Code, Residential,or Florida Building Code, Mechanical,as applicable,or with other approved means of ventilation
including: Natural, Infiltration or Mechanical means.Outdoor air intakes and exhausts shall have automatic or gravity dampers that
close when the ventilation system is not operating.
❑ R403.6.1 Whole-house mechanical ventilation system fan efficacy. When installed to function as a whole-house mechanical
ventilation system,fans shall meet the efficacy requirements of Table R403.6.1.
Exception: Where an air handler that is integral to tested and listed HVAC equipment is used to provide whole-house mechanical
ventilation,the air handler shall be powered by an electronically commutated motor.
O R403.6.2 Ventilation air. Residential buildings designed to be operated at a positive indoor pressure or for mechanical ventilation
shall meet the following criteria:
1. The design air change per hour minimums for residential buildings in ASHRAE 62.2,Ventilation for Acceptable
Indoor Air Quality,shall be the maximum rates allowed for residential applications.
2. No ventilation or air-conditioning system make-up air shall be provided to conditioned space from attics,
crawlspaces,attached enclosed garages or outdoor spaces adjacent to swimming pools or spas.
3. If ventilation air is drawn from enclosed space(s),then the walls of the space(s)from which air is drawn shall be
insulated to a minimum of R-11 and the ceiling shall be insulated to a minimum of R-19,space permitting,or R-10
otherwise.
R403.7 Heating and cooling equipment.
R403.7.1 Equipment sizing(Mandatory). Heating and cooling equipment shall be sized in accordance with ACCA Manual S based
II on the equipment loads calculated in accordance with ACCA Manual J or other approved heating and cooling calculation
methodologies, based on building loads for the directional orientation of the building.The manufacturer and model number of the
outdoor and indoor units(if split system)shall be submitted along with the sensible and total cooling capacities at the design
conditions described in Section R302.1.This Code does not allow designer safety factors,provisions for future expansion or other
factors that affect equipment sizing.System sizing calculations shall not include loads created by local intermittent mechanical
ventilation such as standard kitchen and bathroom exhaust systems. New or replacement heating and cooling equipment shall have
an efficiency rating equal to or greater than the minimum required by federal law for the geographic location where the equipment is
installed.
TABLE R403.6.1
WHOLE-HOUSE MECHANICAL VENTILATION SYSTEM FAN EFFICACY
FAN LOCATION AIRFLOW RATE MINIMUM MINIMUM EFFICACY a AIRFLOW RATE MAXIMUM
(CFM) (CFM/WATT) (CFM)
HRV or ERV Any 1.2 cfm/watt Any
Range hoods Any 2.8 cfm/watt Any
In-line fan Any 2.8 cfm/watt Any
Bathroom,utility room 10 1.4 cfm/watt <90
Bathroom,utility room 90 2.8 cfm/watt Any
For SI: 1 cfm=28.3 L/min. a. When tested in accordance with HVI Standard 916
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MANDATORY REQUIREMENTS - (Continued)
• R403.7.1.1 Cooling equipment capacity. Cooling only equipment shall be selected so that its total capacity is not less
than the calculated total load but not more than 1.15 times greater than the total load calculated according to the procedure selected in
Section R403.7,or the closest available size provided by the manufacturer's product lines.The corresponding latent capacity of the
equipment shall not be less than the calculated latent load.
The published value for AHRI total capacity is a nominal, rating-test value and shall not be used for equipment sizing.Manufacturer's
expanded performance data shall be used to select cooling-only equipment.This selection shall be based on the outdoor design dry-bulb
temperature for the load calculation(or entering water temperature for water-source equipment),the blower CFM provided by the expanded
performance data,the design value for entering wet-bulb temperature and the design value for entering dry-bulb temperature.
Design values for entering wet-bulb and dry-bulb temperatures shall be for the indoor dry bulb and relative humidity used for the load
calculation and shall be adjusted for return side gains if the return duct(s)is installed in an unconditioned space.
Exceptions:
1. Attached single-and multiple-family residential equipment sizing may be selected so that its cooling capacity is less than the
calculated total sensible load but not less than 80 percent of that load.
2.
When signed and sealed by a Florida-registered engineer,in attached single-and multiple-family units,the capacity of
equipment may be sized in accordance with good design practice.
R403.7.1.2 Heating equipment capacity.
R403.7.1.2.1 Heat pumps. Heat pump sizing shall be based on the cooling requirements as calculated according to Section
R403.7.1.1,and the heat pump total cooling capacity shall not be more than 1.15 times greater than the design cooling load even if
the design heating load is 1.15 times greater than the design cooling load.
R403.7.1.2.2 Electric resistance furnaces. Electric resistance furnaces shall be sized within 4 kW of the design
requirements calculated according to the procedure selected in Section R403.7.1.
❑ R403.7.1.2.3 Fossil fuel heating equipment. The capacity of fossil fuel heating equipment with natural draft atmospheric burners
shall not be less than the design load calculated in accordance with Section R403.7.1.
a R403.7.1.3 Extra capacity required for special occasions. Residences requiring excess cooling or heating equipment capacity on an
intermittent basis,such as anticipated additional loads caused by major entertainment events,shall have equipment sized or controlled to
prevent continuous space cooling or heating within that space by one or more of the following options:
1. A separate cooling or heating system is utilized to provide cooling or heating to the major entertainment areas.
2. A variable capacity system sized for optimum performance during base load periods is utilized.
R403.8 Systems serving multiple dwelling units(Mandatory). Systems serving multiple dwelling units shall comply with Sections
C403 and C404 of the Florida Building Code,Energy Conservation—Commercial Provisions in lieu of Section R403.
• R403.9 Snow melt and ice system controls(Mandatory) Snow-and ice-melting systems,supplied through energy service to the building,
shall include automatic controls capable of shutting off the system when the pavement temperature is above 50°F(10°C),and no
precipitation is falling and an automatic or manual control that will allow shutoff when the outdoor temperature is above 40°F(4.8°C).
❑ R403.10 Pools and permanent spa energy consumption(Mandatory). The energy consumption of pools and permanent spas
shall be in accordance with Sections R403.10.1 through R403.10.5.
R403.10.1 Heaters. The electric power to heaters shall be controlled by a readily accessible on-off switch that is an
integral part of the heater mounted on the exterior of the heater,or external to and within 3 feet(914 mm)of the heater.Operation
of such switch shall not change the setting of the heater thermostat.Such switches shall be in addition to a circuit breaker for the
power to the heater.Gas-fired heaters shall not be equipped with continuously burning ignition pilots.
❑ R403.10.2 Time switches. Time switches or other control methods that can automatically turn off and on according to a preset schedule
shall be installed for heaters and pump motors.Heaters and pump motors that have built-in time switches shall be in compliance with this
section.
Exceptions:
1. Where public health standards require 24-hour pump operation.
2. Pumps that operate solar-and waste-heat-recovery pool heating systems.
3. Where pumps are powered exclusively from on-site renewable generation.
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R403.10.3 Covers. Outdoor heated swimming pools and outdoor permanent spas shall be equipped with a vapor-retardant cover on or at
the water surface or a liquid cover or other means proven to reduce heat loss.
Exception: Where more than 70 percent of the energy for heating,computed over an operation season,is from site-recovered
energy,such as from a heat pump or solar energy source,covers or other vapor-retardant means shall not be required.
❑ R403.10.4 Gas-and oil-fired pool and spa heaters. All gas-and oil-fired pool and spa heaters shall have a minimum thermal
efficiency of 82 percent for heaters manufactured on or after April 16,2013,when tested in accordance with ANSI Z 21.56.Pool
heaters fired by natural or LP gas shall not have continuously burning pilot lights.
1-1 R403.10.5 Heat pump pool heaters. Heat pump pool heaters shall have a minimum COP of 4.0 when tested in accordance
with AHRI 1160,Table 2,Standard Rating Conditions-Low Air Temperature.A test report from an independent laboratory is
required to verify procedure compliance.Geothermal swimming pool heat pumps are not required to meet this standard.
❑ R403.11 Portable spas(Mandatory). The energy consumption of electric-powered portable spas shall be controlled by the
requirements of APSP-14,
ElR403.13 Dehumidifiers(Mandatory If installed,a dehumidifier shall conform to the following requirements:
1. The minimum rated efficiency of the dehumidifier shall be greater than 1.7 liters/kWh if the total dehumidifier capacity for the house
is less than 75 pints/day and greater than 2.38 liters/kWh if the total dehumidifier capacity for the house is greater than or equal to 75 pints/day.
2. The dehumidifier shall be controlled by a sensor that is installed in a location where it is exposed to mixed house air.
3. Any dehumidifier unit located in unconditioned space that treats air from conditioned space shall be insulated to a minimum of R-2.
4. Condensate disposal shall be in accordance with Section M1411.3.1 of the Florida Building Code, Residential.
DR403.13.1 Ducted dehumidifiers. Ducted dehumidifiers shall,in addition to conforming to the requirements of Section R403.13,
conform to the following requirements:
1. If a ducted dehumidifier is configured with return and supply ducts both connected into the supply side of the cooling system,a backdraft
damper shall be installed in the supply air duct between the dehumidifier inlet and outlet duct.
2. If a ducted dehumidifier is configured with only its supply duct connected into the supply side of the central heating and cooling system,
a backdraft damper shall be installed in the dehumidifier supply duct between the dehumidifier and central supply duct.
3. A ducted dehumidifier shall not be ducted to or from a central ducted cooling system on the return duct side upstream from the
central cooling evaporator coil.
4. Ductwork associated with a dehumidifier located in unconditioned space shall be insulated to a minimum of R-6.
SECTION R404
ELECTRICAL POWER AND LIGHTING SYSTEMS
R404.1 Lighting equipment(Mandatory). Not less than 90 percent of the lamps in permanently installed luminaires shall have an
efficacy of at least 45 lumens-per-watt or shall utilize lamps with an efficacy of not less than 65 lumens-per-watt.
R404.1.1 Lighting equipment(Mandatory). Fuel gas lighting systems shall not have continuously burning pilot lights.
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2020 -AIR BARRIER AND INSULATION INSPECTION COMPONENT CRITERIA
TABLE 402.4.1.1
a
AIR BARRIER AND INSULATION INSPECTION COMPONENT CRITERIA
Project Name: TLR Heating and Air 334 Ocean Walk Drive S Builder Name: Built Rite
Street: 334 Ocean Walk Drive S Permit Office:
City,State,Zip: Atlantic Beach ,FL,32233 Permit Number:
L
Owner: Jurisdiction:
Design Location: FL,Jacksonville v
COMPONENT AIR BARRIER CRITERIA INSULATION INSTALLATION CRITERIA
General A continuous air barrier shall be installed in the building envelope. Air-permeable insulation shall
The exterior thermal envelope contains a continuous air barrier. not be used as a sealing material.
requirements Breaks or joints in the air barrier shall be sealed.
The air barrier in any dropped ceiling/soffit shall be aligned with The insulation in any dropped ceiling/soffit
Ceiling/attic the insulation and anygaps in the air barrier shall be sealed.
9 P shall be aligned with the air barrier.
Access openings,drop down stairs or knee wall doors to
unconditioned attic spaces shall be sealed.
Walls The junction of the foundation and sill plate shall be sealed. Cavities within corners and headers of frame walls
The junction of the top plate and the top of exterior walls shall be shall be insulated by completely filling the cavity
sealed. with a material having a thermal resistance of R-3
Knee walls shall be sealed. per inch minimum.
Exterior thermal envelope insulation for framed
walls shall be installed in substantial contact and
continuous alignment with the air barrier.
Windows,skylights The space between window/door jambs and framing,and
and doors skylights and framing shall be sealed.
Rim joists Rim joists shall include the air barrier. Rim joists shall be insulated.
Floors The air barrier shall be installed at any exposed edge of Floor framing cavity insulation shall be installed to
(including insulation. maintain permanent contact with the underside of
above-garage subfloor decking,or floor framing cavity insulation
and cantilevered shall be permitted to be in contact with the top side
floors) of sheathing,or continuous insulation installed on
the underside of floor framing and extends from the
bottom to the top of all perimeter floor framing
members.
Crawl space walls Exposed earth in unvented crawl spaces shall be covered with Where provided instead of floor insulation,insulation
a Class I vapor retarder with overlapping joints taped. shall be permanently attached to the crawlspace walls.
Shafts,penetrations Duct shafts,utility penetrations,and flue shafts opening to
exterior or unconditioned space shall be sealed.
Batts in narrow cavities shall be cut to fit,or narrow
Narrow cavities cavities shall be filled by insulation that on
installation readily conforms to the available cavity
spaces.
Garage separation Air sealing shall be provided between the garage and conditioned spacss.
Recessed lighting Recessed light fixtures installed in the building thermal envelope Recessed light fixtures installed in the building
shall be sealed to the finished surface. thermal envelope shall be air tight and IC rated.
Plumbing and wiring Batt insulation shall be cut neatly to fit around wiring
and plumbing in exterior walls,or insulation that on
installation readily conforms to available space shall
extend behind piping and wiring.
Shower/tub The air barrier installed at exterior walls adjacent to showers and Exterior walls adjacent to showers and tubs shall
on exterior wall tubs shall separate them from the showers and tubs. be insulated.
Electrical/phone box or The air barrier shall be installed behind electrical or communication
exterior walls boxes or air-sealed boxes shall be installed.
HVAC register boots HVAC supply and return register boots that penetrate building
thermal envelope shall be sealed to the sub-floor,wall covering or
Concealed When required to be sealed,concealed fire sprinklers shall only be
sprinklers sealed in a manner that is recommended by the manufacturer.
Caulking or other adhesive sealants shall not be used to fill voids
between fire sprinkler cover plates and walls or ceilings.
a.In addition,inspection of log walls shall be in accordance with the provisions of ICC-400.
3/23/2022 11:39 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020) Compliant Software Page 1 of 1
Envelope Leakage Test Report (Blower Door Test)
Residential Prescriptive, Performance or ERI Method Compliance
2020 Florida Building Code, Energy Conservation, 7th Edition
Jurisdiction: Permit#:
Job Information
Builder: Built Rite Community: Lot: NA
Address: 334 Ocean Walk Drive S
City: Atlantic Beach State: FL Zip: 32233
Air Leakage Test Results Passing results must meet either the Performance, Prescriptive, or ERI Method
O PRESCRIPTIVE METHOD-The building or dwelling unit shall be tested and verified as having an air leakage rate of not exceeding 7 air
changes per hour at a pressure of 0.2 inch w.g.(50 Pascals)in Climate Zones 1 and 2.
O PERFORMANCE or ERI METHOD-The building or dwelling unit shall be tested and verified as having an air leakage rate of not exceeding
the selected ACH(50)value,as shown on Form R405-2020(Performance)or R406-2020(ERI),section labeled as infiltration,sub-section ACH50.
ACH(50)specified on Form R405-2020-Energy Ca/c(Performance)or R406-2020(ERI): 7.000
x 60 - 59623 = Method for calculating building volume:
CFM(50) Building Volume ACH(50)
O Retrieved from architectural plans
PASS •Code software calculated
•
When ACH(50)is less than 3, Mechanical Ventilation installation O Field measured and calculated
must be verified by building department.
R402.4.1.2 Testing.Testing shall be conducted in accordance with ANSI/RESNET/ICC 380 and reported at a pressure of 0.2 inch w.g.(50 Pascals).
Testing shall be conducted by either individuals as defined in Section 553.993(5)or(7), Florida Statues.or individuals licensed as set forth in Section
489.105(3)(f),(g),or(i)or an approved third party.A written report of the results of the test shall be signed by the party conducting the test and
provided to thecode official. Testing shall be performed at any time after creation of all penetrations of the building thermal envelope.
During testing:
1. Exterior windows and doors,fireplace and stove doors shall be closed,but not sealed, beyond the intended weatherstripping or other infiltration
control measures.
2. Dampers including exhaust,intake,makeup air,back draft and flue dampers shall be closed, but not sealed beyond intended infiltration control
measures.
3. Interior doors,if installed at the time of the test,shall be open.
4. Exterior doors for continuous ventilation systems and heat recovery ventilators shall be closed and sealed.
5. Heating and cooling systems,if installed at the time of the test,shall be turned off.
6. Supply and return registers,if installed at the time of the test,shall be fully open.
Testing Company
Company Name: Phone:
I hereby verify that the above Air Leakage results are in accordance with the 2020 7th Edition Florida Building Code
Energy Conservation requirements according to the compliance method selected above.
Signature of Tester: Date of Test:
Printed Name of Tester:
License/Certification#: Issuing Authority:
3/23/2022 11:40:02 AM EnergyGauge®USA 7.0.00-FlaRes2020 FBC 7th Edition(2020)Compliant Software Page 1 of 1
BuildingAnalysis Job: TLR Heating and Air 334...
4 wrightsoft y Date: March 23,2022
MAIN By: Energycalcsplus
TLR Heating and Air
Phone-.9123769838 Fax.8885441223 Email.energywlesplus(Lilad.corn
Pro-act Information
For: Byrnes
334 Ocean Walk Drive S.Mantic Beach,FL 32233
Desi e n Conditions
Location: Indoor: Heating Cooling
Jacksonville Intl,FL,US Indoor temperature(°F) 70 75
Elevation: 26 ft Design TD(°F) 37 18
Latitude: 31°N Relative humidity(%) 50 50
Outdoor: Heating Cooling Moisture difference(grub) 32.9 49.8
Dry bulb(°F) 33 93 Infiltration:
Daily range(°F) - 18 ( M ) Method Simplified
Wet bulb(°F) - 77 Construction quality Average
Wind speed(mph) 15.0 7.5 Fireplaces 0
Heatin t
Component Btu MP Btuh %of load
Walls 32 14132 31.1 Vertilaicn
Giaang 17.6 5096 112
Doors 14.5 551 12 VAIs Ducts
Ceilings 1.6 2823 6.2
Floors 3.1 5509 12.1
Infiltration 2.0 8841 19.5
Ducts 4419 9.7
Piping 0 0 IrfillydiQt
Humidification 0 0
Ventilation 4006 8.8 Gaarg
Adjustments 0 Q Floars
Total 45377 100.0 C, rr�
Coolin
Component Btu Mt' Btuh %of load
Walls 2.1 9109 27.5tiatim
Glazing 30.4 8805 26.5
Doors 11.8 448 1.4 V1tlls
Ceilings 1.1 1983 6.0 rtiald Cis
Floors 0.0 57 0.2
Infiltration 02 855 2.6
Ducts 2647 8.0
Ventilation 1906 5.7
Internal gains 7360 22.2 °11111Duds
Blower 0 0 Irfiltraticn
Adjustments 0 D�RJ q�Ceilirxg;
Total 33171 100.0
Latent Cooling Load=7072 Btuh
Overall U-value=0.171 Btuh/ft'-°F
Data entries checked.
_ * wrryr�tsott 2022-Mer-2311:35:23
Rig htSuitcGi+U rrscrsal 202121.0.11 RSU27534 Page
A ...1TLR Heatng and Air 334 Ocean Wain Drive S.rup Calc-MJ8 Front Door laces:NE
Building Analysis Job: TLR Heating and Air 334...
4 wrightsoft Date: EnM2
arch
ecalcs plus
TLR Heating and Air
Phone:9123769638 Fax:8885441223 Email:energycak:splus@ad.com
Pro'ect Information
For: Byrnes
334 Ocean Walk Drive S,P lantic Beach,FL 32233
Desi•n Conditions
Location: Indoor: Heating Cooling
Jacksonville Intl,FL,US Indoor temperature(°F) 70 75
Elevation: 26 ft Design TD(°F) 37 18
Latitude: 31°N Relative humidity(%) 50 50
Outdoor: Heating Cooling Moisture difference(gr/lb) 32.9 49.8
Dry bulb(°F) 33 93 Infiltration:
Daily range(°F) - 18 (M ) Method Simplified
Wet bulb(°F) - 77 Construction quality Peerage
Wind speed(mph) 15.0 75 Fireplaces 0
Heatin•
Component Btuh/1t2 Btuh %of load
Walls 3.4 5334 24.1tiatiat
Glazing 17.6 1838 8.3
•
Doors 0 0 0 ;gip •ucts
Ceilings 1.6 1785 8.1 zs:W ,,
Floors 4.3 4916 222
Infiltration 2.0 3312 15.0
Ducts 2180 9.8
Piping 0 0 Gairg Infiliaicn
Humidification 0 0
Ventilation 2780 12.6 Criirts
Adjustments 0 Rom
22144 100.0
Coolin•
Component Btu h/IF Btuh %of load
Walls 1.4 2258 14.5 \krtilaticrt
Glazing 28.3 2956 19.0
Doors 0 0 0
Ceilings 1.1 1255 8.1
Floors 0 0 0
Infiltration 02 320 2.1g---
Ducts 1453 9.4 herd(;Eire
Ventilation 1323 8.5
Internal gains 5960 38.4
Blower 0 0
Adjustments 0 Irl 1i
Total 15527 100.0 Ducts
Latent Cooling Load=4229 Btuh
Overall U-value=0200 Btuh/lt2--°F
Data entries checked.
"4 wrightsott- 2022-Mar-23 11:35:23
Rig Id-Suited/UNversal 2021 21.0.11 RSU27534 Page2
_ak
...1TLR Heating and Air 334 Ocean Walk Drive S.rup Calc=MJ8 Front Door laces:NE
Pro ect Summa Job: TLR Heating and Air 334...
t ry
4 wrightsoftDate: March 23,2022
MAIN By: Enargycalcsplus
TLR Heating and Air
Phone:9123769638 Fax.8885441223 Email:energycalcsplus@ad.corn
Pro'ect Information
For: Bymes
334 Ocean Walk Drive S,Atlantic Beach,FL 32233
Notes:
Desi•n Information
Weather: Jacksonville Inti,FL,US
Winter Design Conditions Summer Design Conditions
Outside db 33 °F Outside db 93 °F
Inside db 70 'F Inside db 75 °F
Design TD 37 °F Design TD 18 °F
Dailyrange M
Relative humidity 50
Moisture difference 50 gr/Ib
Heating Summary Sensible Cooling Equipment Load Sizing
Structure 36952 Btuh Structure 28618 Btuh
Ducts 4419 Btuh Ducts 2647 Btuh
Central rent(98 cfm) 4006 Btuh Central vent(98 cfm) 1906 Btuh
Outside air Outside air
Humidification 0 Btuh Blower 0 Btuh
Piping 0 Btuh
Equipment load 45377 Btuh Use manufacturer's data y
Rate/swing multiplier 1.00
Infiltration Equipment sensible load 33171 Btuh
Method Simplified Latent Cooling Equipment Load Sizing
Construction quality Average
Fireplaces 0 Structure 1889 Btuh
Ducts 1866 Btuh
Central vent(98 cfm) 3317 Btuh
Heating Cooling Outside air
Area(ft') 2343 2343 Equipment latent load 7072 Btuh
Volume(ft') 42527 42527
Air changes/hour 0.31 0.06 Equipment Total load(Sen+Lat) 40243 Btuh
Equiv.AW(cfm) 216 44 Req.total capacity at 0.84 SHR 3.3 ton
Heating Equipment Summary Cooling Equipment Summary
Make GRANDARE Mike GRANDAIRE
Trade Trade
Model WCH4484GKP Gond WCH4484GKP
AHRI ref 204861961 Coil WAHL484B
A-IRI ref 204861961
Efficiency 8.2 HSPF Efficiency 11.5 EER,14 SEER
Heating input Sensible cooling 38640 Btuh
Heating output 45500 Btuh @ 47°F Latent cooling 7360 Btuh
Temperature rise 30 °F Total cooling 46000 Btuh
Actual airflow 1400 cfm Actual airflow 1400 cfm
Ar flow factor 0.034 cfrnBtuh Ar flow factor 0.045 cfm/Btuh
Static pressure 0.50 in H2O Static pressure 0.50 in H2O
Space thermostat Load sensible heat ratio 0.82
Capacity balance point=0°F
Calculations approved byACCAto meet all requirements of Manual J 8th Ed.
± wright[soff 2022-Mar-2311.35:23
RightSuite®U reversal 2021 21.0.11 RSU27534 Page'
-( ' ...\TLR Heating and Air 334 Ocean Walk Drive S.rep Calc=MJ8 Front Door faces:NE
Pro ect Summa Job: TLR Heating and Air 334...
+ wrightsoft Da ; March 23,2022
MASTER By:te
Ene gycalcsplus
TLR Heating and Air
Phone:9123769638 Fax:8885441223 Email:energycalcsplus§ao.com
Pro'ect Information
For: Bymes
334 Ocean Walk Drive S,Atlantic Beach,FL 32233
Notes:
Desi•n Information
Weather: Jacksonville Int,FL,US
Winter Design Conditions Summer Design Conditions
Outside db 33 'F Outside db 93 °F
Inside db 70 °F Inside db 75 °F
Design TD 37 °F Design TD 18 °F
Dailyrange M
Relative humidity 50 %
Moisture difference 50 gr/Ib
Heating Summary Sensible Cooling Equipment Load Sizing
Structure 17185 Bbih Structure 12750 Btuh
Ducts 2180 Btuh Ducts 1453 Btuh
Central Ment(68cfm) 2780 Btuh Central vent(68cfm) 1323 Btuh
Outside air Outside air
Humidification 0 Btuh Blower 0 Btuh
Piping 0 Btuh
Equipment load 22144 Btuh Use manufacturer's data y
Rate/swing multiplier 1.00
Infiltration Equipment sensible load 15527 Btuh
Method Simplified Latent Cooling Equipment Load Sizing
Construction quality Average
Fireplaces 0 Structure 958 Btuh
Ducts 970 Btuh
Central vent(68 cfm) 2302 Btuh
Heating Cooling Outside air
Area(its) 1140 1140 Equipment latent load 4229 Btuh
Volume(ft°) 17100 17100
Air changes/hour 028 0.06 Equipment Total Load(Sen+Lat) 19756 Btuh
Equiv.AW(cfrn) 81 16 Req.total capacityat 0.77 SHR 1.7 ton
Heating Equipment Summary Cooling Equipment Summary
Make GRANDAIRE Make GRANDAIRE
Trade Trade
Model WCH4244GKP Cond WCH4244GKP
AH RI ref 204861992 Coil WAHL244C
AHRI ref 204861992
Efficiency 82 HSPF Efficiency 11.5 EER,14.5 SEER
Heating input Sensible cooling 17094 Btuh
Heating output 22200 Btu h@47°F Latent coding 5106 Btuh
Temperature rise 25 °F Total cooling 22200 Btuh
Actual airflow 800 cfm Actual airflow 800 cfm
Ar flow factor 0.041 cfm/Btuh Ar flow factor 0.056 cfmBtuh
Static pressure 0.50 in H2O Static pressure 0.50 in H2O
Space thermostat Load sensible heat ratio 0.79
Capacity balance point=0°F
Calculations approved byACCAto meet all requirements of Manual J 8th Ed.
_ -14e- wrlgt-stsoft Rig hi-Suttee Universal 2021 21.0.11 R5U27534 2022-Mar-231 9
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ManualS Compliance Report Job: TLR Heating and Air 334...
+++ wrightsoft Date: March 23,2022
MAIN By: Energycalcsplus
TLR Heating and Air
Phone:9123769638 Fax:8885441223 Email.:energycalcsplus@aol.com
Project Information
For: Bymes
334 Ocean Walk Drive S,Atlantic Beach,FL 32233
Cooling Equipment
Design Conditions
Outdoor design DB: 92.7°F Sensible gain: 33171 Btuh Entering coil DB: 76.4°F
Outdoor design WB: 76.9°F Latent gain: 7072 Btuh Entering coil WB: 64.0°F
Indoor design DB: 75.0°F Total gain: 40243 Btuh
Indoor RH: 50% Estimated airflow: 1400 cfm
Manufacturers Performance Data at Actual Design Conditions
Equipment type: SplitASHP
Manufacturer: GRANDAIRE ktdel: WCH4484GKP+WAHL484B
Actual airflow: 1400 cfm
Sensible capacity 38500 Btuh 116%of load
Latent capacity 7500 Btuh 106%of load
Total capacity 46000 Btuh 114%of load SHR: 84%
Heating Equipment
Design Conditions
Outdoor design DB: 32.8`F Heat loss: 45377 Btuh Entering coil DB: 677E
Indoor design DB: 70.0°F
Manufacturer's Performance Data at Actual Design Conditions
Equipment type: SplitASHP
Manufacturer: GRANDAIRE Nbdel: WCH4484GKP+WPHL484B
Actual airflow: 1400 cfm
Output capacity 45500 Btuh 100%of load Capacity balance: 0 `F
Supplemental heat required: 0 Btuh Economic balance: 0 °F
Meets all requirements ofACCAManu al S.
wrightsoft 2022-Mar-2311:35:23
RghtSuite®Universal 2021 21.0.11 RSU27534 page 1
ACG.,..1TLR Hearing and Air 334 Ocean Walk Drive S.rup Cale=MJ8 Front Door faces:NE
Manual S Compliance Report Job: TLR Heating and Air 334...
+}+ wrightsoft Date: March 23,2022
MASTER By: Energycalcsplus
TLR Heating and Air
Phone:9123769638 Fax:8885441223 Email:energycaksplus@ad.com
Project Information
For: Bymes
334 Ocean Walk Drive S,Atlantic Beach,FL 32233
Cooling Equipment
Design Conditions
Outdoor design DB: 92.7°F Sensible gain: 15527 Btuh Entering coil DB: 76.6°F
Outdoor design WB: 76.9°F Latent gain: 4229 Btuh Entering coil WB: 64.3°F
Indoor design DB: 75.0°F Total gain: 19756 Btuh
Indoor RH: 50% Estimated airflow: 800 cfm
Manufacturer's Performance Data at Actual Design Conditions
Equipment type: Split ASHP
Manufacturer. GRANDAJRE Model: WCH4244GKP+WAHL244C
Actual airflow: 800 cfm
Sensible capacity 17000 Btuh 109%of load
Latent capacity 5200 Btuh 123%of load
Total capacity 22200 Btuh 112%of load SHR: 77%
Heating Equipment
Design Conditions
Outdoor design DB: 32.8°F Heat loss: 22144 Btuh Entering coil DB: 66.7°F
Indoor design DB: 70.0°F
Manufacturer's Performance Data at Actual Design Conditions
Equipment type: SplitASHP
Manufacturer: GRANDAJRE Nbdel: WCH4244GKP+WAHL244C
Actual airflow: 800 cfm
Output capacity 22200 Btuh 100%of load Capacity balance: 0 °F
Supplemental heat required: 0 Btuh Economic balance: 0 °F
Meets all requirements ofACCAManual S.
444- wrightsoft 2022-Mar-2311:35:23
^�'' Rig ht-Su ite®U niv ersal 2021 21.0.11 RSU27534 Page
M...ITLR Heating and Air 334 Ocean Walk Drive S.rup Calc=MJ8 Front Door faces:NE
❑ Scottsdale Insurance Company ❑ Scottsdale Surplus Lines Insurance Company
Home Office: One Nationwide Plaza Adm. Office: 8877 North Gainey Center Drive
Columbus, Ohio 43215 Scottsdale, Arizona 85258
Adm. Office: 8877 North Gainey Center Drive
Scottsdale, Arizona 85258
❑ Scottsdale Indemnity Company
Home Office: One Nationwide Plaza
Columbus, Ohio 43215
Adm. Office: 8877 North Gainey Center Drive
Scottsdale, Arizona 85258
BUILDERS RISK PROGRAM APPLICATION
Applicant's Name: Michael Munn Agency Name: _
Mailing Address: Agent No.:
10 10th St, Atlantic Beach, Florida, 32233 Address:
Location Address: E-mail:
Phone No.:
PROPOSED EFFECTIVE DATE: From To 12:01 A.M.,Standard Time at the address of the Applicant
ANSWER ALL QUESTIONS—IF THEY DO NOT APPLY, INDICATE "NOT APPLICABLE" (N/A)
Applicant is: (check all that apply)
❑ Developer ❑ General Contractor ❑ Owner ❑ Tenant/Occupant
❑ Individual ❑ Corporation ❑ Partnership ❑ Joint Venture ® Limited Liability Company
❑ Other(Specify):
Website Address:
E-mail Address: michaelmunnciec@gmail.com Phone No.: 904-305-6741
Coverages and Coinsurance:
Indicate limits for new construction or renovation/remodel. If existing structures are being insured on this policy with reno-
vation/remodel, limits must add up to one hundred percent (100%) of the completed value.
Coverages Total Limits/
Coinsurance
New Construction Covered Property(Building, Equipment and Supplies): $
Renovation/Remodel Property(Building, Equipment and Supplies): $
Existing Structure ACV Replacement $
Property At Offsite Temporary Storage or Staging Locations: ❑ $5,000 included
❑ Other$
Signs (not attached or part of a building): $
Maximum value per sign $
Debris Removal—Additional Amount: $
(twenty-five percent[25%] per coverage form included.)
Nationwide
IM-APP-11 (2-17) Page 1 of 6
Total Limits/
Coverages
Coinsurance
Lawns, Trees, Shrubs or Plants Outside the Building: ❑$1,000 included
❑ Other$
Pollutant Cleanup and Removal Twelve (12) Month Policy Aggregate: $10,000 included
Fire Department, Police Department or Emergency First Responder Service Charge: El$1,000 included
❑ Other$
Fungi, Wet Rot Or Dry Rot Twelve (12)Month Policy Aggregate: $10,000 included
Business Income and/or Extra Expense: $
Rental Value: $
Soft Costs: $
Property In Transit(excluding while waterborne): ❑$5,000 provided
❑ Other$
Property in Transit(while waterborne—Inland waterways only): $
Advise waterways utilized:
❑ Coverage A
Ordinance or Law: ❑ Coverage B
❑ Coverage C
Equipment Breakdown (Sublimits of$100,000 apply to Expediting Expense, ❑Yes ❑ No
Hazardous Substances and Data Restoration):
All Covered Property In Any One Occurrence $
Coinsurance
MICHAEL MUNN CONSULTING AND CONSTRUCTION LLC
1. Applicant's Business: Number of Years in Business:
2. Inspection Contact Name:
E-mail Address: Telephone Number:
3. Has applicant declared bankruptcy or been in receivership within the past five years? ❑Yes ❑ No
If yes, provide date(s):
4. Is applicant a general contractor? ❑Yes ❑ No
If no:
a. Advise name of general contractor for construction project:
b. Advise experience of general contractor:
c. Advise three year loss history of general contractor:
d. Advise website of general contractor:
Property Coverage Details:
5. Mortgagee Name:
Address:
6. Deductible: ❑ $1,000 ❑ Other:
7. Protection Class:
Nationwide'
IM-APP-11 (2-17) Page 2 of 6
8. Number of Stories:
9. Total square footage of building:
10. Construction: ❑ Frame ❑ Joisted Masonry ❑ Fire Resistive ❑ Masonry Non-combustible
❑ Modified Fire Resistive ❑ Non-combustible ❑ Other:
11. Building's intended usage at completion?
12. What are planned dates of construction? Begin: End:
13. Has any construction/renovation/remodel operations already started? ❑ Yes ❑ No
If yes:
a. Percentage:
b. How long has the project been dormant and/or abandoned?
c. Why was the project delayed?
d. Has there been a change in the General Contractor? ❑ Yes ❑ No
14. Will any portion of the structure be occupied prior to completion of the project? ❑ Yes ❑ No
If yes, advise details:
PROTECTION OF PROPERTY
15. Is guard service employed? ❑ Yes ❑ No
If yes, what hours of the day?
16. Is there security lighting at the job site? ❑ Yes ❑ No
17. Is the job site fenced? ❑ Yes ❑ No
If yes, height of fencing:
18. If the applicant has hazardous or flammable materials stored at the jobsite,what are they and what storage
controls are in place to prevent fire potential?
19. Are licensed riggers used if hoisting or rigging is necessary? ❑ Yes ❑ No
20. Are there portable fire extinguishers located at the construction site? ❑ Yes ❑ No
21. Any building supplies or materials transported by air? ❑ Yes ❑ No
22. At the job site:
a. What is the distance in feet to the nearest fire hydrant?
b. What is the distance in miles to the nearest responding fire department?
23. Has a released bill of lading from the carriers been obtained in the event transportation is by
common or contract carrier at the applicant's risk? ❑ Yes ❑ No
PRIOR COVERAGE AND LOSS HISTORY
24. During the past three years, has any company ever cancelled, declined or refused to issue simi-
lar insurance to the applicant? (Not applicable in Missouri) ❑ Yes ❑ No
If yes, explain:
rI Nationwide
IM-APP-11 (2-17) Page 3 of 6
•
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25. Prior Carrier Information:
Year: Year: Year:
Carrier
Policy No.
26. Loss History:
Indicate all claims or losses (regardless of fault and whether or not insured) or occurrences that may give
rise to claims for the prior three years. ❑ Check if no losses in the last three years.
Date of Amount Amount Claim Status
Loss Description of Loss Paid Reserved (Open or Closed)
27. Renovation/Remodel Operations:
a. Structural or Non-Structural?
b. Any hot work (i.e., cutting, torch work, welding, bracing, soldering, grinding, thermal spraying and
sweating of pipes)? ❑ Yes ❑ No
c. Any electrical work? ❑ Yes ❑ No
d. Is the interior of the project one hundred percent(100%)deadbolt-locked? ❑ Yes ❑ No
e. Is there an operating central station burglar alarm? ❑ Yes ❑ No
f. Is there an operating central station fire alarm? ❑ Yes ❑ No
g. Are recognized approved fire extinguishers on premises? ❑ Yes ❑ No
h. Are the standpipes operational and filled with water? ❑ Yes ❑ No
i. Is the structure sprinklered? El Yes ❑ No
If yes, is system turned on? ❑ Yes ❑ No
This application does not bind the applicant nor the Company to complete the insurance, but it is agreed that the infor-
mation contained herein shall be the basis of the contract should a policy be issued.
FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an
application for insurance or statement of claim containing any materially false information or conceals for the purpose of
misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and
subjects such person to criminal and civil penalties. (Not applicable in AL, CO, DC, FL, KS, LA, ME, MD, MN, NE, NY,
OH, OK, OR, RI, TN, VA, VT or WA.)
NOTICE TO ALABAMA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a
loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be
subject to restitution fines or confinement in prison, or any combination thereof.
NOTICE TO COLORADO APPLICANTS: It is unlawful to knowingly provide false, incomplete, or misleading facts or in-
formation to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may
include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance
company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for
the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award pay-
able from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory
Agencies.
rNationwide
IM-APP-11 (2-17) Page 4 of 6
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WARNING TO DISTRICT OF COLUMBIA APPLICANTS: It is a crime to provide false or misleading information to an
insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addi-
tion, an insurer may deny insurance benefits if false information materially related to a claim was provided by the appli-
cant.
NOTICE TO FLORIDA APPLICANTS: Any person who knowingly and with intent to injure, defraud, or deceive any insur-
er files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a fel-
ony of the third degree.
NOTICE TO KANSAS APPLICANTS: Any person who, knowingly and with intent to defraud, presents, causes to be pre-
sented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any
agent thereof, any written, electronic, electronic impulse, facsimile, magnetic, oral, or telephonic communication or state-
ment as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or
commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal
insurance which such person knows to contain materially false information concerning any fact material thereto; or con-
ceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act,
which is a crime and subjects such person to criminal and civil penalties.
NOTICE TO LOUISIANA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a
loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be sub-
ject to fines and confinement in prison.
NOTICE TO MAINE APPLICANTS: It is a crime to knowingly provide false, incomplete or misleading information to an
insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of
insurance benefits.
NOTICE TO MARYLAND APPLICANTS: Any person who knowingly or willfully presents a false or fraudulent claim for
payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty
of a crime and may be subject to fines and confinement in prison.
NOTICE TO MINNESOTA APPLICANTS: A person who files a claim with intent to defraud or helps commit a fraud
against an insurer is guilty of a crime.
NOTICE TO OHIO APPLICANTS: Any person who, with intent to defraud or knowing that he is facilitating a fraud against
an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
NOTICE TO OKLAHOMA APPLICANTS: Any person who knowingly, and with intent to injure, defraud or deceive any
insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading infor-
mation is guilty of a felony.
NOTICE TO RHODE ISLAND APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment
of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be
subject to fines and confinement in prison.
FRAUD WARNING (APPLICABLE IN VERMONT, NEBRASKA AND OREGON): Any person who intentionally presents
a materially false statement in an application for insurance may be guilty of a criminal offense and subject to penalties un-
der state law.
FRAUD WARNING (APPLICABLE IN TENNESSEE, VIRGINIA AND WASHINGTON): It is a crime to knowingly provide
false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penal-
ties include imprisonment, fines, and denial of insurance benefits.
NEW YORK OTHER THAN AUTOMOBILE FRAUD WARNING: Any person who knowingly and with intent to defraud
any insurance company or other person files an application for insurance or statement of claim containing any materially
false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a
fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars
and the stated value of the claim for each such violation.
Nationwide
IM-APP-11 (2-17) Page 5 of 6
APPLICANT'S STATEMENT:
I have read the above application and I declare that to the best of my knowledge and belief all of the foregoing statements
are true, and that these statements are offered as an inducement to us to issue the policy for which I am applying. (Kan-
sas: This does not constitute a warranty.)
APPLICANT'S SIGNATURE: DATE:
CO-APPLICANT'S SIGNATURE: DATE:
PRODUCER'S SIGNATURE: DATE:
AGENT NAME: AGENT LICENSE NUMBER:
(Applicable to Florida Agents Only)
IOWA LICENSED AGENT:
(Applicable in Iowa Only)
IMPORTANT NOTICE
As part of our underwriting procedure, a routine inquiry may be made to obtain applicable information concerning
character, general reputation, personal characteristics and mode of living. Upon written request, additional information
as to the nature and scope of the report, if one is made, will be provided.
r I Nationwide
IM-APP-11 (2-17) Page 6 of 6
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