HVAC Contractor Service Request

Please provide as much information as possible. In order for us to provide the final HERS report, we will need all of this data.

Project Type
Project Name

Smith Residence or Starbuck's
Date of installation: Date of installation: / MM / DD YYYY
HVAC Company:
HVAC Company Phone: HVAC Company Phone: - ### - ### ####
Home/Building Owner Name: Home/Building Owner Name: First Last
Home/Building Owner Phone: Home/Building Owner Phone: - ### - ### ####
Project Address: Project Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Time (allow +1 hour of window time): Time (allow +1 hour of window time): : HH MM AM/PM
Date of Appointment:
(Please call if within 72 hours) Date of Appointment:
(Please call if within 72 hours) / MM / DD YYYY
What e-mail should we use to contact you (certificate delivery).

Provide an email address for which we can send the invoice and copies of certificates.
Contractor's License Number:
Who is enforcing inspections?

i.e Building Department of Los Angeles County, City of San Diego, County of San Diego, etc.
Permit Number:

If you already have a permit, please provide the number.
On what dat was the permit applied? On what dat was the permit applied? / MM / DD YYYY
Approximate Conditioned Floor Area Served by the System(s):
How many HVAC systems are new or altered?
Is the system zoned?

Is the system zoned? Yes No
SC (Space Conditioning) System Information:
(check all that apply)

SC (Space Conditioning) System Information:
(check all that apply) SC system is ducted Installing a refrigerant containing component Installing a new SC system component Installing more than 40' of new ducts Installing entirely new duct system Installing entirely new SC system
Type of HEATING system:
Type of COOLING system
Altered/Replaced Heating Component Information
(check all that apply):
Altered/Replaced Cooling Component Information
(check all that apply)
New or Replaced duct length:
(total in lineal feet)
Are all ducts accessible?

Are all ducts accessible? Yes No
Return Air Location

Return Air Location Upflow - Return on pedestal Ceiling - Ducted return on ceiling Wall Return - Using walls cavities for return
I understand, for all supply and return registers, that the spaces between the register boot and the interior finishing wall must be properly sealed BEFORE ANY HERS testing is conducted.

IF SPACES AREN'T SEALED, JOB AUTOMATICALLY FAILS & WILL REQUIRE A RE-INSPECTION / RE-SCHEDULE.

I understand, for all supply and return registers, that the spaces between the register boot and the interior finishing wall must be properly sealed BEFORE ANY HERS testing is conducted.

IF SPACES AREN'T SEALED, JOB AUTOMATICALLY FAILS & WILL REQUIRE A RE-INSPECTION / RE-SCHEDULE. Yes, I agree and gaps will be sealed prior to inspection.
Additional site visit and/or re-inspection for previously identified HERS measure(s) not passing.

Additional site visit and/or re-inspection for previously identified HERS measure(s) not passing. I understand that if any HERS measure fails thus requiring an additional site visit, I will be charged for the additional site visit at the billing rate of $120 for the first hour and $80/hour for each additional hour thereafter rounded to the nearest half hour. This is a request for an additional site visit billed at $120 for first hour. $80/hour each additional thereafter rounded to the nearest half hour.
Notes: