Compliance Form Chicago – Fill Out and Use This PDF

COMMERCIAL COMPLIANCE FORM - Chicago Energy Conservation Code

Permit Application Number: ________________________________________________________________________

Project Address: __________________________________________________________________________________

Instructions: Select compliance method A, B, C, D or E by marking the appropriate check box, and then select all required sub-boxes as applicable. Sign and complete contact information and attached back-up as required.

A. ComCHECK

	Report, Check List,	504: Service Water Heating
ComCHECK	Certificate, Project	*ARTICLE 5
	Details, Permit Date	(504 is in addition to Comcheck)

Print and attach ComCHECK compliance certificate. (required)

-----------------------------------------------OR-------------------------------------------------

B. Prescriptive Path (check one)

Article 5	502, 504, and 505	503: Mechanical Systems
		503.3: Simple HVAC Systems
OR
Article 5	502, 504, and 505	503: Mechanical Systems
		503.4: Complex HVAC Systems

-----------------------------------------------	OR-------------------------------------------------
C. Total Building Performance
Article 5	506: Total Building Performance

-----------------------------------------------OR-------------------------------------------------

See other side for Ashrae 90.1-2004 compliance

REV. 4/2/09

D.ASHRAE/IESNA 90.1-2004 (check one option for section 5, 6 and 9)

Ashrae/IESNA

90.1-2004

		5: Envelope					6: HVAC				9: Lighting				7: Service Water Heating
	(5.1, 5.4, 5.7, 5.8)				(6.1, 6.7, 6.8)							(9.1, 9.4)			(7.1, 7.4, 7.5, 7.7, 7.8)
															8: Power
															(8.1, 8.4, 8.7)
	5.5		5.6		6.3		6.4			9.5		9.6
															10: Other Equipment
															(10.1, 10.4, 10.8)

-----------------------------------------------OR-------------------------------------------------

E. ASHRAE/IESNA 90.1-2004 (Energy Cost Budget)

Ashrae/IESNA	11: Energy Cost Budget
90.1-2004

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I certify that I am a Registered Energy Professional (REP). I also certify that to the best of my knowledge and belief the plans for the project listed above fully comply with the requirements of Chapter 18-13, Energy Conservation, of the Municipal Code of Chicago, including all relevant provisions of Article 1. The method of compliance used for this property is clearly marked on the flowchart above.

Signed:		Print Name:				Date:
Address:				Telephone:
Email:				License #:

REV. 4/2/09