Get documents about "Flat Lease Agreement Template - Excel
Description
Flat Lease Agreement Template document sample
Document Sample
LEED Version 2.1 Letter Templates
Introduction - LEED Version 2.1 Letter Templates replace LEED Version 2.0’s LEED Application
Template and LEED Calculator. Letter Templates simplify the submittal and certification process by
prompting for correct and complete documentation and incorporating straightforward and integrated
calculators.
Navigation - Users navigate through the templates by clicking the tabs at the bottom of each page.
Prompts, identified as any red text, guide users through the completion of each template. Each
template begins by prompting the user to fill in his or her name in the declaration statement.
Subsequent prompts appear on the page until the user has entered enough information about the
project to document that the prerequisite or credit requirement has been met.
Submittal - Each credit and prerequisite template should be printed and submitted to USGBC on the
letterhead of the individual signing the template. Additionally, the complete Letter Templates file must
be submitted electronically to USGBC on a CD.
Usability - The Letter Templates file utilizes Microsoft Excel macros. For the application to function
properly, users must chose "Enable Macros" if prompted to do so when opening the file. If users
experience difficulty opening the Letter Template file, they may have the security level on their
computers set too high thus preventing files containing macros from running. These users should
lower the security level on their computers and try opening the file again.
Text within the template may run into the margins when viewed on some computers. Adjusting the
monitor's screen resolution or the "Zoom" settings under "View" in Excel usually resolves this issue.
The file is already set to print on one page within the margins. Accordingly, users will notice that even
though the template may not appear to fit on one page when viewed on a computer monitor, it will still
print to one page.
Warning- Attempting to alter the document by changing cell references; cutting and pasting
sheets, rows and columns; or inserting new rows into tables and calculators can result in
damage to the Letter Templates file requiring the user to download a new copy of the file and
re-enter data.
File last modified: August 1, 2003
Contents
The Team - Allows contact information to be entered for all of the team members responsible for
compiling LEED documentation for the project. It can also serve as the contact list for the project.
Responsibility - Used to allocate responsibility to different team members for each of the different
prerequisites and credits. Once responsibility is assigned, the related letter template automatically updates
to display the responsible team member's name, title and organization.
Credit Summary - Maintains an automatically updated tally of the credits being documented and their
status -- pending or complete. Worksheet also contains the USGBC response identifying the credits
approved or subject to audit, the result of the audit, and the final USGBC approved rating.
Project Info - Serves as a reference for frequently cited project characteristics. Data entered in this
worksheet automatically updates the calculators embedded in subsequent Letter Templates.
Letter Templates - Provides instrument to declare fulfillment of credit requirements, prompts for correct
and complete supporting documentation and integrates embedded calculators.
File last modified: August 1, 2003
The Team
Professional
Team Member Signatory Name Reg No. Telephone Number Fax Number Mobile Number Email Address Company Name Company Street Address City State Zip Code
1 Client/Owner/Developer
2 Cost Consultant
3 Broker
4 Tenant
5 Project Manager
6 Architect
7 Structural Engineer
8 HVAC Engineer
9 Civil Engineer
10 Landscape Architect
11 Interior Designer
12 Contractor
13 Commissioning Agent
14 Environmental Adviser
15 Ecologist
16 Artist
Other: (please list)
17
18
19
20
21
22
23
24
25
26
27
28
29
30
File last modified: August 1, 2003
Innovation
in Design
Cr 2 Needed-->
Cr 1.1 Needed-->
File last modified: August 1, 2003
Cr 8.1-8.2 Needed-->
Cr 7.1-7.2 Needed-->
Cr 6.1-6.2 Needed-->
Cr 5 Needed-->
Cr 4.1-4.4 Needed-->
Cr 3.2 Needed-->
Indoor Environmental Quality
Cr 3.1 Needed-->
Cr 2 Needed-->
Cr 1 Needed-->
Pr 2 Needed-->
Pr 1 Needed-->
Cr 7 Needed-->
Cr 6 Needed-->
Cr 5.1-5.2 Needed-->
Cr 4.1-4.2 Needed-->
Materials & Resources
Cr 3.1-3.2 Needed-->
Cr 2.1-2.2 Needed-->
Cr 1.1-1.3 Needed-->
Pr 1 Needed-->
Cr 6 Needed-->
Cr 5 Needed-->
Cr 4 Needed-->
Cr 3 Needed-->
Cr 2.1-2.3 Needed-->
The Team
Energy & Atmosphere
Cr 1.1-1.10 Needed-->
Pr 3 Needed-->
Pr 2 Needed-->
Pr 1 Needed-->
Cr 3.1-3.2 Needed-->
Water Efficency
Cr 2 Needed-->
Cr 1.2 Needed-->
Cr 1.1 Needed-->
To assign responsibility for each credit, type a "y" in the matrix where the credit column intersects the row for the appropriate team member.
Cr 8 Needed-->
Cr 7.2 Needed-->
Cr 7.1 Needed-->
Cr 6.2 Needed-->
This Worksheet is used to allocate responsibility to different team members for each of the different credits.
Cr 6.1 Needed-->
Cr 5.2 Needed-->
Cr 5.1 Needed-->
Cr 4.4 Needed-->
Cr 4.3 Needed-->
Cr 4.2 Needed-->
Cr 4.1 Needed-->
Cr 3 Needed-->
Sustainable Sites
Cr 2 Needed-->
Cr 1 Needed-->
Pr 1 Needed-->
Signatory Name
Client/Owner/Developer
14 Environmental Adviser
Commissioning Agent
Landscape Architect
Structural Engineer
Other: (please list)
Interior Designer
Project Manager
Cost Consultant
HVAC Engineer
Team Member
Civil Engineer
Contractor
15 Ecologist
Architect
Tenant
Broker
16 Artist
1
2
3
4
5
6
7
8
9
10
11
12
13
17
18
19
20
21
22
23
24
25
26
27
28
29
30
This worksheet sumarizes the prerequisities and credits documented and achieved and provides a notes area for the team to track credit issues
Compiled automatically from the individual letter templates for each prerequisite and credit - only the Team Notes can be manually entered by the team on this sheet
Credits and Prerequisites Team Notes
Sustainable Sites Possible Pending Documented Responsible
Prerequisite 1 Erosion & Sedimentation Control 0 No No #N/A
Credit 1 Site Selection 1 0 0 #N/A
Credit 2 Urban Redevelopment 1 0 0 #N/A
Credit 3 Brownfield Redevelopment 1 0 0 #N/A
Credit 4.1 Alternative Transportation, Public Transportation Access 1 0 0 #N/A
Credit 4.2 Alternative Transportation, Bicycle Storage & Changing Rooms 1 0 0 #N/A
Credit 4.3 Alternative Transportation, Alternative Fuel Refueling Stations 1 0 0 #N/A
Credit 4.4 Alternative Transportation, Parking Capacity 1 0 0 #N/A
Credit 5.1 Reduced Site Disturbance, Protect or Restore Open Space 1 0 0 #N/A
Credit 5.2 Reduced Site Disturbance, Development Footprint 1 0 0 #N/A
Credit 6.1 Stormwater Management, Rate and Quantity 1 0 0 #N/A
Credit 6.2 Stormwater Management, Treatment 1 0 0 #N/A
Credit 7.1 Landscape & Ext Design to Reduce Heat Islands, Non-Roof 1 0 0 #N/A
Credit 7.2 Landscape & Ext Design to Reduce Heat Islands, Roof 1 0 0 #N/A
Credit 8 Light Pollution Reduction 1 0 0 #N/A
Sustainable Sites Totals 14 0 0
Water Efficiency Possible Pending Documented Responsible Team Notes
Credit 1.1 Water Efficient Landscaping, Reduce by 50% 1 0 0 #N/A
Credit 1.2 Water Efficient Landscaping, No Potable Use or No Irrigation 1 0 0 #N/A
Credit 2 Innovative Wastewater Technologies 1 0 0 #N/A
Credit 3.1 Water Use Reduction, 20% Reduction 1 0 0 #N/A
Credit 3.2 Water Use Reduction, 30% Reduction 1 0 0 #N/A
Water Efficiency Totals 5 0 0
Energy & Atmosphere Possible Pending Documented Responsible Team Notes
Prerequsite 1 Fundamental Building Systems Commissioning 0 No No #N/A
Prerequisite 2 Minimum Energy Performance 0 No No #N/A
Prerequisite 3 CFC Reduction in HVAC&R Equipment 0 No No #N/A
Credit 1.1-1.10 Optimize Energy Performance 10 0 0 #N/A
Credit 2.1 Renewable Energy, 5% 1 0 0 #N/A
Credit 2.2 Renewable Energy, 10% 1 0 0 #N/A
Credit 2.3 Renewable Energy, 20% 1 0 0 #N/A
Credit 3 Additional Commissioning 1 0 0 #N/A
Credit 4 Ozone Depletion 1 0 0 #N/A
Credit 5 Measurement & Verification 1 0 0 #N/A
Credit 6 Green Power 1 0 0 #N/A
Energy & Atmosphere Totals 17 0 0
Materials & Resources Possible Pending Documented Responsible Team Notes
Prerequisite 1 Storage & Collection of Recyclables 0 No No #N/A
Credit 1.1 Building Reuse, Maintain 75% of Existing Shell 1 0 0 #N/A
Credit 1.2 Building Reuse, Maintain 100% of Existing Shell 1 0 0 #N/A
Credit 1.3 Building Reuse, Maintain 100% Shell & 50% Non-Shell 1 0 0 #N/A
Credit 2.1 Construction Waste Management, Divert 50% 1 0 0 #N/A
Credit 2.2 Construction Waste Management, Divert 75% 1 0 0 #N/A
Credit 3.1 Resource Reuse, Specify 5% 1 0 0 #N/A
Credit 3.2 Resource Reuse, Specify 10% 1 0 0 #N/A
Credit 4.1 Recycled Content, Specify 5% PC or 10% PC+PI 1 0 0 #N/A
Credit 4.2 Recycled Content, Specify 10% PC or 20% PC+PI 1 0 0 #N/A
Credit 5.1 Local/Regional Materials, 20% Manufactured Locally 1 0 0 #N/A
Credit 5.2 Local/Regional Materials, of 20% Above, 50% Harvested Locally 1 0 0 #N/A
Credit 6 Rapidly Renewable Materials 1 0 0 #N/A
Credit 7 Certified Wood 1 0 0 #N/A
M aterials & Resources Totals 13 0 0
Indoor Environmental Quality Possible Pending Documented Responsible Team Notes
Prerequisite 1 Minimum IAQ Performance 0 No No #N/A
Prerequisite 2 Environmental Tobacco Smoke (ETS) Control 0 No No #N/A
Credit 1 Carbon Dioxide (CO2) Monitoring 1 0 0 #N/A
Credit 2 Increase Ventilation Effectiveness 1 0 0 #N/A
Credit 3.1 Construction IAQ Management Plan, During Construction 1 0 0 #N/A
Credit 3.2 Construction IAQ Management Plan, Before Occupancy 1 0 0 #N/A
Credit 4.1 Low-Emitting Materials, Adhesives & Sealants 1 0 0 #N/A
Credit 4.2 Low-Emitting Materials, Paints 1 0 0 #N/A
Credit 4.3 Low-Emitting Materials, Carpet 1 0 0 #N/A
Credit 4.4 Low-Emitting Materials, Composite Wood 1 0 0 #N/A
Credit 5 Indoor Chemical & Pollutant Source Control 1 0 0 #N/A
Credit 6.1 Controllability of Systems, Perimeter 1 0 0 #N/A
Credit 6.2 Controllability of Systems, Non-Perimeter 1 0 0 #N/A
Credit 7.1 Thermal Comfort, Comply with ASHRAE 55-1992 1 0 0 #N/A
Credit 7.2 Thermal Comfort, Permanent Monitoring System 1 0 0 #N/A
Credit 8.1 Daylight & Views, Daylight 75% of Spaces 1 0 0 #N/A
Credit 8.2 Daylight & Views, Views for 90% of Spaces 1 0 0 #N/A
Indoor Environmental Quality Totals 15 0 0
Innovation & Design Process Possible Pending Documented Responsible Team Notes
Credit 1.1 Innovation in Design 1 0 0 #N/A
Credit 1.2 Innovation in Design 1 0 0 #N/A
Credit 1.3 Innovation in Design 1 0 0 #N/A
Credit 1.4 Innovation in Design 1 0 0 #N/A
Credit 2 LEED™ Accredited Professional 1 0 0 #N/A
Innovation & Design Process Totals 5 0 0
TOTAL 69 0 0
All prerequisites not documented.
Potential LEED Rating Uncertified
Certified: (26 to 32 points) Silver: (33 to 38 points) Gold: (39 to 51 points) Platinum: (> 52 points)
744f3697-7b36-40d8-9dca-e61b62a81564.xls
This worksheet provides a space for general project information that can be referenced for calculations in the proceeding templates.
Project Information
Project Name
Location
LEEDTM Project Number
Site Characteristics
Site Area [acres] Unbuilt Site Area [acres]
Building Square Footage [SF] Building Footprint [SF]
Building Occupancy Parking Characteristics
Estimated Male Occupants Parking Area [acres]
Estimated Female Occupants Parking Footprint [SF]
Annual Work Days
Project Status
Status at Application Budget per Square Foot [$]
Completion Date (actual or est.) Height or Number of Floors
Project Type Owner Occupied?
Project Contact Information
Project Manager
Contact
Address
Phone
Email
USGBC Member? [yes or no]
File last modified: August 1, 2003
U S Green Building Council Project Info LEEDTM Calculator 2.0
SS Prerequisite 1: Erosion & Sedimentation Control
EITHER
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that I have designed, specific to the site, a sediment and erosion
control plan that conforms to the United States Environmental Protection Agency (EPA) Document No. EPA 832/R-92-005
(September 2000) Storm Water Management for Construction Activities, Chapter 3 as follows:
Brief description of measures implemented EPA 832/R-92-005 Reference
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OR
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that I have designed, specific to the site, a sediment and erosion
control plan that conforms to local erosion and sedimentation control standards. Furthermore, I affirm that
these standards are equally or more stringent than those described by EPA Document No. EPA 832/R-92-005
(September 2000) Storm Water Management for Construction Activities , Chapter 3 as follows:
List of Measures Implemented Describe how local code meets or exceeds EPA 832/R-92-005
SS Pr 1 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 1: Site Selection
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that no buildings, roads or parking areas have been or will
be developed on portions of sites that meet any one of the following criteria:
Prime farmland as defined by the United States Department of Agriculture in the United States’ Code of Federal Regulations,
Title 7, Volume 6, Parts 400 to 699, Section 657.5 (citation 7CFR657.5),
Land whose elevation is lower than 5 feet above the elevation of the 100-year flood as defined
by the Federal Emergency Management Agency (FEMA),
Land which is specifically identified as habitat for any species on Federal or State threatened or endangered lists,
Within 100 feet of any water including wetlands as defined by United States’ Code of Federal Regulations 40 CFR,
Parts 230-233 and Part 22, and isolated wetlands or areas of special concern identified by state or local rule, OR greater
than distances given in state or local regulations as defined by local or state rule or law, whichever is more stringent,
Land which prior to acquisition for the project was public parkland, unless land of equal or greater value as parkland is
accepted in trade by the public landowner (Park Authority projects are exempt).
Special Circumstances
I have provided a narrative describing how this project meets the intent of this credit despite one or more conflicts
with the credit requirements.
Points Documented
SS Cr 1 (1 point): Site selection avoiding inappropriate locations 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 2: Development Density
Declaration not made
Architect, Civil Engineer or Responsible Party)
I, , declare that the project increases localized density to
conform to existing or desired density goals by utilizing a site that is located within an existing minimum development density of 60,000
square feet per acre.
Project Density Density Radius
Building Gross Property
Square Footage Area Density Property Area Radius
(ft2) (acres) (ft2/acre) (acres) (ft)
- 0.00 - 0.00 0
Density Boundary
Gross Square
Building(s) Within Boundary Footage Property Area
(as indicated on site plan) (ft2) (acres)
Building Gross Square Footage (ft2) 0.00
Total Property Area (acres) 0.00
Average Density (ft2/acre) 0.00
I have also provided the following supplementary information to support the declaration:
Site Plan
Site location highlighted on Site Plan. Include density radius line.
Graphic scale provided on Site Plan
Points Documented
SS Cr 2 (1 point): Project and surrounding area densities >= 60,000sq ft per acre 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 3: Brownfield Redevelopment
Declaration not made
(Civil Engineeror Responsible Party)
I, , declare that this project is developed on a site
documented as contaminated (by means of an ASTM E1903-97 Phase II Environmental Site Assessment)
or on a site classified as a brownfield by a local, state, or federal government agency or a narrative describing real
or perceived contamination has been provided.
The following documents have been provided to document the contamination:
EITHER
A copy of pertinent sections of the Phase II Environmental Site Assessment documenting the site contamination
OR
A letter from a local, state or federal regulatory agency confirming that the site is classified as a brownfield by that agency.
OR
A narrative and supporting documentation describing real or perceived site contamination that has been remediated
prior to development.
In addition, I confirm that the following remedial measures have been or will be taken prior to construction to protect
the environment:
Contamination Risk Areas of the Site Affected Remedial Measures Taken
Points Documented
SS Cr 3 (1 point): Brownfield Redevelopment 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 4.1: Alternative Transportation, Public Transportation Access
Declaration not made
(Broker, Architect, Civil Engineer or Responsible Party)
I, , declare that the project building(s) is located within
1/2 mile of a commuter rail, light rail or subway station or 1/4 mile of two or more public or campus bus lines
usable by building occupants as outlined below.
I confirm that I have provided the following:
An area drawing or transit map
The building location is highlighted
Fixed rail stations are highlighted and distances between stations and building are indicated
Bus lines are highlighted and distance between bus stops and building are indicated
The map includes a scale bar for distance
The distances between the building and the public transit points are as shown in the following table. (Distances are
measured as the walking distance from a regular building exit to the bus stop location or rail station entrance).
Choose unit
Public Transit Stops - Locations feet Distance from
yards the Building(s)
miles feet
Commuter Rail, Light Rail or Subway Station
Public or Campus Bus Lines
Points Documented
SS Cr 4.1 (1 point): Alternative Transportation, Public Transportation Access 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 4.2: Alternative Transportation, Bicycle Storage & Changing Rooms
EITHER
For Commercial or Institutional Buildings:
Declaration not made
(Architect or Responsible Party)
I, , declare that secure bicycle storage, with convenient changing/shower
facilities (within 200 yards of the building) will be provided for at least 5% of regular building occupants as follows:
Number of regular building occupants assumed: 0 Enter data into Project Info worksheet.
Number of secure bicycle storage slots provided within 200 yards of building:
Number of showers and changing facilities within 200 yards of building
Adequate bicycle storage provided? NO
Adequate showers and changing facilities provided? YES
OR
For Residential Buildings:
Declaration not made
(Architect or Responsible Party)
I, , declare that covered storage facilities for securing
bicycles will be provided for 15% of building occupants as follows:
Number of regular building occupants assumed: 0 Enter data into Project Info worksheet.
Number of covered bicycle storage slots provided within 200 yards of building:
Adequate bicycle storage provided? NO
Points Documented
SS Credit 4.2 (1 Point): Alternative Transportation, Bicycle Storage & Changing Rooms 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 4.3: Alternative Transportation, Alternative Fuel Vehicles
EITHER
Declaration not made
(Building Owner, Tenant, Architect, Civil Engineer or Responsible Party)
I, , declare that alternative fuel vehicles will be provided
for 3% of building occupants and preferred parking will be provided for these vehicles.
I have provided the following to support the declaration:
Proof of ownership of, or 2 year lease agreement for, alternative fuel vehicles
Site drawing or parking plan highlighting preferred parking for alternative fuel vehicles
Number of regular building occupants assumed: 0
Number of alternative fuel vehicles provided:
Percentage of regular building occupants provided with an alternative
fuel vehicle 0.00%
OR
Declaration not made
(Building Owner)
I, , declare that alternative-fuel refueling station(s) will be provided
for 3% of the total vehicle parking capacity of the site.
I have provided the following to support the declaration:
Site drawings and specifications highlighting alternative-fuel refueling stations
Total vehicle parking capacity (in spaces):
Number of vehicles alternative fuel refueling stations can service:
Percentage of total vehicle parking capacity serviced by alternative-fuel
refueling stations: 0.00%
Points Documented
SS Cr 4.3 (1 point): Alternative Transportation, Alternative Fuel Vehicles 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 4.4 : Alternative Transportation, Parking Capacity
EITHER
For New Projects:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the parking capacity meets, but does not exceed
the minimum zoning requirements and parking facilities provide preferred parking for carpools or van pools
capable of serving 5% of the building occupants.
The following has been provided to support the declaration:
Documentation of minimum zoning requirements or narrative if no zoning requirements exist.
Parking plan with preferred carpooling spaces indicated.
Documentation of carpooling program
Total number of regular building occupants: 0 <--Fill in number on Project Info worksheet
Number of carpool or vanpool spaces:
Percentage of building occupants provided with carpool
or vanpool preferred parking: 0.00%
OR
For Rehabilitation projects:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that no new parking capacity has been added to the site and
preferred parking has been provided for carpools or vanpools capable of serving 5% of the building occupants.
The following has been provided to prove preferred spaces for carpools and vanpools.
Parking plan with preferred carpooling spaced indicated.
Documentation of carpooling program
Total number of regular building occupants: 0 <--Fill in number on Project Info worksheet
Number of carpool or vanpool spaces:
Percentage of building occupants provided with carpool
or vanpool preferred parking: 0.00%
Points Documented
SS Cr 4.4 (1 point): Alternative Transportation, Parking Capacity 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 5.1 :Reduced Site Disturbance, Protect or Restore Open Space
EITHER
For Greenfield Sites:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that site disturbance including earthwork and clearing of
vegetation has been limited to:
40 feet beyond the building perimeter,
5 feet beyond primary roadway curbs, walkways, and main utility branch trenches, and
25 feet beyond constructed areas with permeable surfaces.
I have provided the following to support the declaration:
site drawings and specifications highlighting limits of construction distubance.
OR
On Previously Developed Sites:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that I have restored 50% of the site area that does not fall within
the building footprint by replacing impervious surfaces with native planting or adaptive vegetation.
I have provided the following to support the declaration:
site drawings with area calculations demonstrating that 50% of the site area that does not fall within the building footprint
has been restored.
Points Documented
SS Cr 5.1 (1 point): Reduced Site Disturbance, Protect or Restore Open Spaces 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 5.2: Reduced Site Disturbance, Development Footprint
EITHER
For areas with zoning requirements:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the open space exceeds the local zoning open space
requirement for the site by 25%.
I have provided the following to support declaration:
a copy of the local zoning requirements highlighting the criteria for open space and
calculations illustrating development footprint.
OR
For areas with no zoning requirements:
Declaration not made
(Property Owner or Responsible Party)
I, , declare that I have designated open space area adjacent to the building
that is equal to the building footprint.
I have provided the following to support declaration:
letter from the building owner declaring that this open space will be conserved for the life of the building and
area calculations illustrating development footprint.
Points Documented
SS Cr 5.2 (1 point): Reduced Site Disturbance, Development Footprint 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 6.1: Stormwater Management, Rate/Quantity
EITHER
If existing site imperviousness is less than or equal to 50%:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the post-development 1.5 year,
24 hour peak discharge rate does not exceed the pre-development 1.5 year 24 hour peak discharge rate.
EITHER
I have provided the calculations found in the table below and certify that existing site imperviousness is less than or equal to 50%
OR
I have provided a design narrative for the stormwater management technology/plan implemented and pre/post development
stormwater rate and quantity calculations to support this claim.
OR
If existing site imperviousness exceeds 50%:
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that implementation of the project stormwater
management plan results in at least a 25% decrease in the rate and quantity of stormwater runoff.
EITHER
I have provided the calculations found in the table below and certify that existing site imperviousness exceeds 50%.
OR
I have provided a design narrative for the stormwater management technology/plan implemented and pre/post development
stormwater rate and quantity calculations to support this claim.
Surface Type Table
Runoff
Suface Type Coefficient
Pavement, Asphalt 0.95
Pavement, Concrete 0.95
Pavement, Brick 0.85
Pavement, Gravel 0.75
Roof, Conventional 0.95
Roof, Garden Roof (< 4 in) 0.50
Roof, Garden Roof (4 - 8 in) 0.30
Roof, Garden Roof (9 - 20 in) 0.20
Roof, Garden Roof (> 20 in) 0.10
Turf, Flat (0 - 1% slope) 0.25
Turf, Average (1 - 3% slope) 0.35
Turf, Hilly (3 - 10% slope) 0.40
Turf, Steep (> 10% slope) 0.45
Vegetation, Flat (0 - 1% slope) 0.10
Vegetation, Average (1 - 3% slope) 0.20
Vegetation, Hilly (3 - 10% slope) 0.25
Vegetation, Steep (> 10% slope) 0.30
Other (user defined)
Other (user defined)
Other (user defined)
-
Design Case Table
Surface Runoff Impervious
Type Coefficient Area Area
[SF] [SF]
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
-
21 0.00 0
Total Area 0
Total Impervious Area 0
Imperviousness 0.00%
Baseline Case Table
Surface Runoff Impervious
Area
Type Coefficient Area
[SF] [SF]
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
-
21 0
0.00
Total Area 0
Total Impervious Area 0
Imperviousness 0.00%
Baseline imperviousness is less than or equal to 50% so the target increase is 0%
Imperviousness decrease is: 0.00%
Points Documented
SS Cr 6.1 (1 point): Stormwater Management, Rate/Quantity 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 6.2: Stormwater Management, Treatment
EITHER
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the design will comply with or exceed Best Management
Practices (BMPs) outlined in Chapter 4, Part 2 (Urban Runoff), of the United States Environmental Protection Agency’s (EPA’s)
Guidance Specifying Management Measures for Sources of Nonpoint Pollution in Coastal Waters , January 1993
(Document No. EPA-840-B-92-002) for removal of 80% of the average annual post-development total suspended solids (TSS)
and 40% of the average annual post-development total phosphorous (TP).
I further certify that the EPA standard is more stringent than the applicable local standard.
I have provided a brief narrative of the design including assumptions and any calculations necessary to support
TP and TSS removal efficiencies.
OR
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the design will comply with or exceed the local Best
Management Practices implemented for removal of TSS (total suspended solids) and TP (total phosphorous).
I further certify that the local standard is more stringent than the EPA standard.
I have provided a brief narrative of the design including assumptions and any calculations necessary to support
TP and TSS removal efficiencies.
Points Documented
SS Cr 6.2 (1 point): Stormwater Management, Treatment 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 7.1: Heat Island Effect, Non-Roof
EITHER
Declaration not made.
(Civil Engineer or Responsible Party)
I, , declare that a minimum of 30% of non-roof impervious surfaces
areas will be shaded within five years, and/or constructed with light-colored/high albedo materials (reflectance of at
least 0.3) and/or open-grid paving systems.
I have provided a site plan demonstrating areas of paving, landscaping (with species) and building footprint to support
the declaration.
OR
Declaration not made.
(Civil Engineer or Responsible Party)
I, , declare that a minimum of 50% of parking spaces have been placed
underground or are covered by structured parking.
I have provided a site plan demonstrating areas of paving, landscaping (with species) and building footprint to support
the declaration.
OR
Declaration not made.
(Civil Engineer or Responsible Party)
I, , declare that an open-grid pavement system (that is less than 50% impervious)
has been used for a minimum of 50% of the parking lot area.
I have provided a site plan demonstrating areas of paving, landscaping (with species) and building footprint to support
the declaration.
OR
Declaration not made.
(Civil Engineer or Responsible Party)
I, , declare that more than one strategy or design has been implemented to
achieve this credit.
I have provided the required documentation for each as outlined above.
Points Documented
SS Cr 7.1 (1 point): Heat Island Effect, Non-Roof 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 7.2:, Heat Islands Effect, Roof
EITHER
Declaration not made
(Architect, Civil Engineer or Responsible Party)
I, , declare that the building plan is designed to the following specifications:
roofing materials comply with the Energy Star® label requirements and have:
emissivity of at least 0.9 when tested in accordance with ASTM 408
AND
the ―green‖ (vegetated) and/or high albedo roof areas constitute at least 75% of the total roof area.
Roof Area, Total (ft2):
High Albedo
Roof Area (ft2):
Green Roof Area (ft2):
Percentage covered by green
or high albedo materials: 0.00%
OR
Declaration not made
(Architect, Civil Engineer or Responsible Party)
I, , declare that the ―green‖ (vegetated) roof areas constitute at least 50%
of the total roof area.
Roof Area, Total (ft2):
2
Green Roof Area (ft ):
Percentage of roof vegetated: 0.00%
Points Documented
SS Cr 7.2 (1 point): Heat Island Effect, Roof 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
SS Credit 8: Light Pollution Reduction
Declaration not made
(Engineer, Architect or Responsible Party)
I, , declare that this project's exterior lighting has been designed
according to the Illuminating Engineering Society of North America (IESNA) Recommended Practice Manual: Lighting
for Exterior Environments (RP-33-99) such that:
all exterior luminaires with more than 1000 initial lamp lumens are shielded and all luminaires with more than 3500 initial
lamp lumens are Full Cutoff (IESNA Classification).
the maximum candela value of all interior lighting shall fall within the building (not out through windows) and the
maximum candela value of all exterior lighting shall fall within the property.
any luminaire within a distance of 2.5 times its mounting height from the property boundary shall have shielding such
that no light from that luminaire crosses the property boundary.
as demonstrated by the photometric site plan provided, the overall site illuminance meets the average illuminance
levels and uniformity ratios recommended by the Illuminating Engineering Society of North America (IESNA)
Recommended Practice Manual: Lighting for Exterior Environments (RP-33).
Points Documented
SS Cr 8.1 (1 point): Light Pollution Reduction 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
WE Credit 1.1: Water Efficient Landscaping, Reduce by 50%
Declaration not made
(Architect, HVAC Engineer, Civil Engineer, Environmental Advisor, Ecologist or Responsible Party)
I, , declare that potable water consumption for site irrigation has been reduced by 50%
through:
high efficiency irrigation technology
OR
no permanent irrigation system
OR
captured rain or recycled site water.
I have provided the following to support the declaration:
a brief narrative of the equipment used and/or the use of drought-tolerant or native plants.
Points Documented
WE Cr 1.1 (1 point): Water Efficient Landscaping, Reduce by 50% 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
WE Credit 1.2: Water Efficient Landscaping, No Potable Use or No Irrigation
WE CREDIT 1.1 MUST BE DOCUMENTED BEFORE ATTEMPTING TO DOCUMENT WE CREDIT 1.2
Declaration not made
(Civil Engineer, Landscape Architect or Responsible Party)
I, , declare that the project site will not use any potable
water for irrigation.
I have provided the following to support the declaration:
EITHER
narrative describing the captured rain system or recycled site water system and system capacity.
narrative describing all species of plants to be used and their irrigation needs.
calculations demonstrating that irrigation requirements can be met from captured rain or recycled
site water.
OR
narrative describing how the landscape design does not require a permanent irrigation system.
Points Documented
WE Cr 1.2 (1 point): Water Efficient Landscaping, No Potable Use or No Irrigation 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
WE Credit 2: Innovative Wastewater Technologies
Declaration not made
EITHER
(Civil Engineer or Responsible Party)
I, , declare that municipally provided potable water for building sewage
conveyance will be reduced by at least 50%
I have provided the following to support the declaration:
a narrative demonstrating the measures used to reduce wastewater by at least 50% from baseline conditions.
Fixture Chart
Fixture Type GPF
Conventional Water Closet 1.6
Low-Flow Water Closet 1.1
Ultra Low-Flow Water Closet 0.8
Composting Toilet 0.0
Conventional Urinal 1.0
Waterless Urinal 0.0
Other (user defined)
Other (user defined)
Other (user defined)
---
Design Case
Occupant Sewage
Fixture Type Daily uses Flow Rate users Generation
[GPF] [gal]
--- 10
Male 0.0 0
Female 0.0 0
--- 10
Male 0.0 0
Female 0.0 0
--- 10
Male 0.0 0
Female 0.0 0
--- 10
Male 0.0 0
Female 0.0 0
--- 10
Male 0.0 0
Female 0.0 0
Total uses by all occupants 0
Total Daily Volume [gal] 0
Annual Work Days 0 <-- Enter number in Project Info sheet
Annual Volume [gal] 0
Graywater or Stormwater Reuse Volume [gal]
Total Annual Volume [gal] 0
Baseline Case
Occupant Sewage
Fixture Type Daily Uses Flow Rate users Generation
[GPF] [gal]
--- 10
Male 0.0 0
Female 0.0 0
--- 10
Male 0.0 0
Female 0.0 0
Total uses by all occupants 0
Total Daily Volume [gal] 0
Annual Work Days 0 <-- Enter number in Project Info sheet
Total Annual Volume [gal] 0
Wastewater Generation Reduction 0.00%
Declaration not made
OR
(Civil Engineer or Responsible Party)
I, , declare that 100% of wastewater will be treated to tertiary standards on site.
I have provided the following to support the declaration.
A narrative describing the on-site wastewater treatment system.
Points Documented
WE Cr 2 (1 point): Innovative Wastewater Technologies 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
WE Credit 3: Water Use Reduction
Declaration not made
(Tenant, Project Manager, HVAC Engineer, Civil Engineer or Responsible Party)
I, , declare that the project uses at least 20% less water than baseline fixture
performance requirements of the Energy Policy Act of 1992.
Flow Fixture Chart Flush Fixture Chart
Flow Fixture Type Water Use Flush Fixture Type Water Use
Duration
[GPM] [sec] [GPF]
Conventional Lavatory 2.5 15 Conventional Water Closet 1.6
Low-Flow Lavatory 1.8 15 Low-Flow Water Closet 1.1
Kitchen Sink 2.5 15 Ultra Low-Flow Water Closet 0.8
Low-Flow Kitchen Sink 1.8 15 Composting Toilet 0.0
Shower 2.5 300 Conventional Urinal 1.0
Low-Flow Shower 1.8 300 Waterless Urinal 0.0
Janitor Sink 2.5 15 Other (user defined)
Hand Wash Fountain 0.5 15 Other (user defined)
Other (user defined) Other (user defined)
Other (user defined) ---
Other (user defined)
---
Design Case
Daily Sewage
Flush Fixture Uses Flow Rate Duration Occupant users Generation
[GPF] [flush] [gal]
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
Daily Sewage
Flow Fixture Uses Flow Rate Duration Occupant users Generation
[GPM] [sec] [gal]
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
Total uses by all occupants 0
Total Daily Volume [gal] 0
Annual Work Days 0 <-- Enter number in Project Info sheet.
Annual Volume [gal] 0
Graywater or Stormwater Reuse Volume [gal]
Total Annual Volume [gal] 0
Baseline Case
Daily Sewage
Flush Fixture Uses Flow Rate Duration Occupant users Generation
[GPF] [flush] [gal]
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
--- 10
Male 0.0 1.0 0
Female 0.0 1.0 0
Daily Sewage
Flow Fixture Uses Flow Rate Duration Occupant users Generation
[GPM] [sec] [gal]
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
--- 12 0.0 0 0
Total uses by all occupants 0
Total Daily Volume [gal] 0
Annual Work Days 0 <-- Enter number in Project Info sheet.
Total Annual Volume [gal] 0
Water Use Reduction 0.00%
Points Documented
WE Cr 3.1 (1 point): Water Use Reduction, 20% Reduction 0
WE Cr 3.2 (1 additional point): Water Use Reduction, 30% Reduction 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Prerequisite 1: Fundamental Building Systems Commissioning
Declaration not made
(Owner, Project Manager, HVAC Engineer or Responsible Party)
I, , declare that the following best practice commissioning procedures
outlined below have been implemented or a contract is in place to implement them.
Under
Completed Contract
Engage a commissioning team that does not include individuals directly responsible for project
design or construction management.
Review the design intent and the basis of design documentation.
Incorporate commissioning requirements into the construction documents.
Develop and utilize a commissioning plan.
Verify installation, functional performance, training and operation and maintenance documentation.
Complete a commissioning report.
EA Pr 1 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Prerequisite 2: Minimum Energy Performance
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare that the building complies with the following energy code:
ASHRAE/IESNA 90.1-1999
OR
local energy codes.
I have provided documentation to demonstrate that the local code is equivalent to or more
stringent than ASHRAE/IESNA 90.1-1999.
EA Pr 2 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Prerequisite 3: CFC Reduction in HVAC&R Equipment
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare that there are no CFC-based refrigerants in the HVAC&R systems
for the building.
EA Pr 3 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 1.1-1.10: Optimize Energy Performance
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare the following reduction in design energy cost compared to the energy
cost budget for energy systems regulated by ASHRAE/IESNA Standard 90.1-1999 (without amendments):
New Buildings Existing Buildings
15% 5%
20% 10%
25% 15%
30% 20%
35% 25%
40% 30%
45% 35%
50% 40%
55% 45%
60% 50%
I have provided the following to documentation to support the declaration:
quantitative summary table (as per LEED reference Guide) showing the energy saving measures incorporated in
the building design. The summary table includes detailed data on both design and budget assumptions.
summary printout from an energy simulation package demonstrating that the design energy cost is lower than the
energy cost budget as defined in ASHRAE/IESNA 90.1-1999, Section 11. The summary printout contains all the information
requested by the ASHRAE/IESNA 90.1-1999, Section 11 ECB.
Points Documented
EA Cr 1 (10 possible points): Optimize Energy Performance 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 2: Renewable Energy
Declaration not made
(Owner, Architect, HVAC Engineer or Responsible Party)
I, , declare that at least 5% of the building’s energy is provided by on-site renewable
energy supply.
I have provided the following to support the declaration:
a narrative describing on-site renewable energy systems installed in the building
AND
the calculations below demonstrating that the declared percentage of total energy costs are supplied by the renewable
energy systems.
Regulated Systems Energy Use
Energy Type Annual Use Annual Cost Energy Supplied
[103 Btu] [$] [%]
0.00%
0.00%
0.00%
0.00%
0.00%
Total Non-Renewable 0 0 0.00%
Renewable Energy
Energy Type Annual Use Annual Cost Energy Supplied
[103 Btu] [$] [%]
0.00%
0.00%
0.00%
0.00%
0.00%
Total Renewable 0 0 0.00%
Total Energy Use 0 0 0.00%
Points Documented
EA Cr 2.1 (1 possible point): Renewable Energy >= 5% 0
EA Cr 2.2 (1 additional point): Renewable Energy >= 10% 0
EA Cr 2.3 (1 additional point): Renewable Energy >= 20% 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 3: Additional Commissioning
Declaration not made.
(Owner, Project Manager, Architect, or Responsible Party)
I, , declare that the following best practice commissioning procedures
outlined below have been implemented or a contract is in place to implement them.
Under
Completed Contract
A commissioning authority independent of the design team shall conduct a review of the design
prior to the construction documents phase.
The independent commissioning authority shall conduct a review of the construction documents
near completion of the construction document development and prior to issuing the contract
documents for construction.
The independent commissioning authority shall review the contractor submittals relative to systems
being commissioned.
Provide the owner with a single manual that contains the information required for re-commissioning
building systems.
Have contract in place to review with operational staff current building operation, including plan for
resolution of outstanding commissioning-related issues within one year after completion of construction.
Points Documented
EA Cr 3 (1 possible point): Additional Commissioning 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 4: Ozone Protection
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare that the HVAC&R systems as-built are free of HCFC's and Halons.
Points Documented
EA Cr 4 (1 possible point): Ozone Protection 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 5: Measurement and Verification
Declaration not made
(Project Manager, Architect, HVAC Engineer, Contractor, Commissioning Agent or Responsible Party)
I, , declare that metering equipment for the following end-uses
has been installed:
YES N/A
Lighting systems and controls
Constant and variable motor loads
Variable frequency drive (VFD) operation
Chiller efficiency at variable loads (kW/ton)
Cooling load
Air and water economizer and heat recovery cycles
Air distribution static pressures and ventilation air volumes
Boiler efficiencies
Building-specific process energy efficiency systems and equipment
Indoor water risers and outdoor irrigation systems
I have provided the following documentation to support the declaration:
the M&V plan as indicated above, following IPMVP, 2001 version, consistent with*:
Option B Option C Option D
(*note that option B is used for measuring and verifying the performance of individual energy efficiency measures, while
Option C and D are primarily used for measuring and verifying the performance of the whole building.)
a copy of the Measurement & Verification plan following the IPMVP, 2001 version including an executive summary.
Points Documented
EA Cr 5 (1 possible point): Measure and Verification 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EA Credit 6: Green Power
Declaration not made
(Owner, Tenant or Responsible Party)
I, , declare that the supplied renewable power is equal to 50% of the project’s
energy consumption and the sources meet the Green-e definition of renewable energy. The power was procured from:
a Green-e certified power marketer
a Green-e accredited utility program
a Green-e certified Tradable Renewable Certificate.
other power supply that meets the Green-e renewable power definition.
AND
I have provided the following to support the declaration:
a copy of the two-year electric utility purchase contract for power generated from renewable sources.
Points Documented
EA Cr 6 (1 possible point): Green Power 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Prerequisite 1: Storage & Collection of Recyclables
Declaration not made
(Architect, Interior Designer or Responsible Party)
I, , declare that an easily accessible area of appropriate
size has been dedicated to serve the recycling needs of the entire building.
The separation and storage area for recycling will accomodate the following materials (at a minimum):
paper
corrugated cardboard
glass
plastics
metals
I have provided the following documentation to support the declaration:
a plan showing the area(s) dedicated to recycled material collection and storage
MR Pr 1 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 1.1 - 1.3: Building Reuse
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that the following building reuse data are correct.
Structural Element Existing Reused Reused
[CF] [CF] [%]
Foundation/Slab on Grade 0.00%
Columns 0.00%
Beams 0.00%
Basement Wall 0.00%
Floor Decks 0.00%
Diaphragms 0.00%
Roof Deck 0.00%
Sub-total 0 0 0.00%
Shell Element Existing Reused Reused
[SF] [SF] [%]
Roofing 0.00%
Exterior Walls 0.00%
Sub-total 0 0 0.00%
Total Structural and Shell Reuse 0.00%
Interior Element Existing Reused Reused
[SF] [SF] [%]
Ceilings 0.00%
Wood Flooring 0.00%
Other Flooring 0.00%
Floor Coverings 0.00%
Walls 0.00%
Wall Panels 0.00%
Other 0.00%
Total 0 0 0.00%
Points Documented
MR Cr. 1.1 (1 point): Retained structural and shell >= 75% 0
MR Cr. 1.2 (1 additionall point) Retained structural and shell = 100% 0
MR Cr. 1.3 (1 additional point) Retained internal elements >= 50% 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 2.1-2.2: Construction Waste Management
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , certify that this project has implemented a waste management plan
and diverted the following quantities of construction, demolition and land-clearing waste to uses other than landfill.
The quantity diverted materials and means of diversion are explained in the table below.
How and where waste is diverted Diverted
Material, in:
tons
cubic yards
Total quantity of diverted waste 0
Total quantity of waste <-- Needed
Percentage of waste diverted
Points Documented
MR Cr. 2.1 (1 point): Diverted from landfill >= 50% 0
MR Cr. 2.2 (1 additional point): Diverted from landfill >=75% 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 3.1-3.2: Resource Reuse
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that this project used the salvaged, refurbished or reused
materials, products and furnishings listed below, and that the typical replacement value of these materials as shown in the table
below is equivalent to at least 5% of the value of the total materials for the project.
Total construction cost Needed if using default
for default total materials cost; OR -
Provide total materials cost (exclude labor,
equipment) Needed if not using default
Product Name Vendor Product value $
Sub-total salvaged or reused $ -
Cost of salvaged and reused materials as a
percentage of total materials cost 0.00%
Points Documented
MR Cr. 3.1 (1 point): Salvaged/Reused >= 5% 0
MR Cr. 3.2 (1 additional point): salvaged/Reused >=10% 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credits 4.1 - 4.2: Recycled Content
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that this project uses materials with recycled content so that the sum
of the post-consumer recycled content plus one-half of the post-industrial recycled content constitutes at least 5% of the total value of
materials in the project.
Total construction cost
for default total materials cost; OR $ -
Provide total materials cost (exclude labor, equipment)
$ 1,000
Product name Vendor Product Cost $ % Post- % Post- Recycled content
Consumer Industrial information source
Product Cost Subtotal $ -
Total value of post-consumer content $ -
Total value of post-consumer content as a percentage of total cost of all materials 0.00%
Total value of post-industrial content $ -
Total value of post-industrial content as a percentage of total cost of all materials 0.00%
Combined value of post-consumer and half of post-industrial content $ -
Combined value of post-consumer content plus half of post-industrial content as a percentage of total cost of
all materials 0.00%
Points Documented
MR Cr. 4.1 (1 point): Combined Post Consumer plus one-half Post Industrial >=5% 0
MR Cr. 4.2 (1 point): Combined Post Consumer plus one-half Post Industrial >=10% 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 5.1 - 5.2: Regional Materials
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that a minimum of 20% of the total value of the materials and products used are
manufactured regionally within a 500-mile radius. Of the 20% regionally manufactured materials requirement, at least 50% of the
content is extracted regionally (equal to 10% of total materials by cost).
Total construction cost <-- Needed if using default materials calculation
for default total materials cost; OR $ -
Provide total materials cost (exclude labor, equipment) <-- Needed if user providing own materials calculation
Product name Vendor Product Cost $ Distance Distance Regional content
between project between project information source
and and extraction
manufacturer (in site (in miles)
miles)
Product Cost Subtotal $ -
Total cost of regionally manufactured materials $ -
Cost of regionally manufactured products as a percentage of the cost of all materials
0.00%
Total cost of regionally extracted materials $ -
Cost of regionally extracted materials as a percentage of total materials cost. (These
materials were used in regionally manufactured products). 0.00%
Points Documented
MR Cr. 5.1 (1 point): Regional Materials: Manufactured Regionally 0
MR Cr. 5.2 (1 point): Regional Materials: Extracted Regionally 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 6: Rapidly Renewable Materials
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that rapidly renewable building materials and products (made from plants
that are typically harvested within a ten-year or shorter cycle) were specified/used for 5% of the total value of all building materials
and products used in the project.
Total construction cost <-- Needed if using default materials calculation
for default total materials cost; OR $ -
Provide total materials cost (exclude labor, equipment)
<-- Needed if user providing own materials calculation
Product name Vendor Product Cost $ % Renewable Rapidly renewable
content information
source
Product Cost Subtotal $ -
Total value of rapidly renewable products $ -
value+ of rapidly renewable building materials and products as a percentage of the cost of all
project building materials 0.00%
Points Documented
MR Cr. 6 (1 point): Rapidly Renewable Materials >= 5% 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
MR Credit 7: Certified Wood
Declaration not made
(Owner, Architect, Contractor or Responsible Party)
I, , declare that a minimum of 50% of wood-based materials and products, certified
in accordance with the Forest Stewardship Council's Principles and Criteria, were used for wood building components.
Total project cost <-- Needed if using default materials calculation
for default total materials cost; OR $ -
Provide total materials cost (exclude labor, equipment)
<-- Needed if user providing own materials calculation
Total cost of all wood-based products <-- Needed
Cost of wood-based products as percentage of total materials
cost 0.00%
Product name Vendor Product Cost $ Certfied Forest Stewardship
Wood % Council chain-of-
custody certificate
number
Product Cost Subtotal $ -
Total value of certified wood products $ -
value of certified wood products as a percentage of the cost of all wood based building
materials 0.00%
Points Documented
MR Cr. 7 (1 point): Certified Wood >= 50% of total wood-based materials and products 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Prerequisite 1: Minimum IAQ Performance
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the project is fully compliant with ASHRAE 62-1999 and all
approved Addenda published at the time of LEED project registration.
I have provided supporting documentation describing the procedure employed in the IAQ analysis (Ventilation
Rate Procedure).
EQ Pr 1 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Prerequisite 2: Environmental Tobacco Smoke (ETS) Control
Declaration not made
(Owner, Tenant or Responsible Party)
I, , declare that the project provides for zero exposure of non-smokers to ETS.
Zero exposure of non-smokers to ETS is accomplished through:
EITHER
Prohibition of smoking in the building,
AND
Locating any exterior designated smoking areas away from entries and operable windows.
OR
Designated smoking rooms that are directly exhausted to the outdoors and do not allow ETS to enter the non-smoking
areas of the building
AND
Enclosing smoking areas with impermeable deck-to-deck partitions, operated at a negative pressure compared with the
surrounding areas of at least 7 PA (0.03 inches of water gauge)
AND
Verification, by using tracer gas testing methods described in the ASHRAE 129-1997, that the smoking areas' independent
ventilation system operates at a negative pressure compared with the surrounding spaces of at least 7 PA.
Furthermore, I have provided drawings and a narrative to support the claims above.
EQ Pr 2 Prerequisite NOT Documented
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 1: Carbon Dioxide (CO2) Monitoring
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the installation of a carbon dioxide monitoring system is
complete and the operational design and controls/zones for the system conform to the specifications below:
CO2 differentials for all types of occupancy are in accordance with ASHRAE 62-2001, Appendix C.
I have provided the following to support the declaration:
summary of target CO2 differentials per end use
summary of the installation that documents how target CO2 differential is measured and maintained
summary of the installation that documents how CO2 differentials are measured and maintained.
Points Documented
EQ Cr 1 (1 point): Carbon Dioxide (CO2) Monitoring 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 2: Ventilation Effectiveness
EITHER
For mechanically ventilated spaces:
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the design achieves an air change effectiveness (εac) of 0.9 or
greater in each ventilated zone, as determined by ASHRAE 129-1997.
I have completed the table below summarizing the εac achieved for each zone and provided a design narrative
and airflow calculations.
Ventilation Effectiveness Table
Air Change
Zone Effectiveness
OR
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the design complies with the recommended design approaches
in ASHRAE 2001 Fundamentals Chapter 32, Space Air Diffusion.
I have completed ADPI calculations for each major space and verified compliance with the guidelines in ASHRAE 2001
Fundamentals Chapter 32, Space Air Diffusion.
OR
For naturally ventilated spaces:
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that design provides effective ventilation in at least 90% of each room
or zone area in the direction of airflow for at least 95% of hours of occupancy.
I have included a table summarizing the airflow simulation results for each zone.
I have provided a sketch indicating air flow patterns for each zone.
Points Documented
EQ Cr 2 (1 point): Increase Ventilation Effectiveness/Efficiency 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 3.1: Construction IAQ Management Plan, During Construction
Declaration not made
HVAC Engineer, Contractor or Responsible Party)
I, , declare that an Indoor Air Quality (IAQ) Management Plan has been
developed and implemented for the construction and pre-occupancy phases of the building. The following filtration media was
used during construction (if air handlers were operated) and installed after construction:
Filtration Media Used Manufacturer Model Number MERV Value
Installed during construction:
Installed at the end of construction:
I have provided the following additional documentation to support the declaration:
EITHER
18 photographs—six photographs taken on three different occasions during construction
AND
Identification of the SMACNA approach featured by each photograph, in order to show consistent adherence to the
credit requirements.
OR
I certify that the five Design Approaches of SMACNA IAQ Guidelines for Occupied Buildings under Construction, 1995,
Chapter 3, were used during building construction.
AND
I have included a brief description of some of the important design approaches employed.
Points Documented
EQ Cr 3.1 (1 point):Construction IAQ Management Plan, During Construction 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 3.2: Construction IAQ Management Plan, Before Occupancy
OPTION 1:
Declaration not made
HVAC Engineer, Contractor or Responsible Party)
I, , declare that a minimum two-week building flush-out was conducted
with new Minimum Efficiency Reporting Value (MERV) 13 filtration media at 100% outside air. The filtration media after
flush-out has been replaced with new MERV 13 filtration media, except the filters solely processing outside air.
To support the declaration, I have provided a description of the building flush out procedures.
Flush-out start date
Flush-out end date
OPTION 2:
Declaration not made
HVAC Engineer or Responsible Party)
I, , declare that the referenced standard's IAQ testing protocol has been followed
and I have attached a copy of the testing results.
Points Documented
EQ Cr 3.2 (1 point): Construction IAQ Management Plan, Before Occupancy 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 4.1 - 4.4: Low-Emitting Materials
EQc4.1: Adhesives & Sealants
Declaration not made
(Architect, Interior Designer, Contractor or Responsible Party)
I, , declare that the VOC levels in all adhesives and sealants used in the project do
not exceed the current VOC content limits of South Coast Air Quality Management District (SCAQMD) Rule #1168, AND all
sealants used as fillers meet or exceed the requirements of the Bay Area Air Quality Management District Regulation 8, Rule 51.
I have provided a list of all adhesives and sealants used in the project and have indicated the VOC content for each product.
Credits Awarded: 0
EQc4.2: Paints & Coatings
Declaration not made
(Architect, Interior Designer, Contractor or Responsible Party)
I, , declare that the VOC levels in all interior paints and coatings addressed by
Green Seal Standard GS-11 do not exceed the VOC and chemical component limits of the standard.
I have provided a list of all interior paints and coatings used in the project that are addressed by the referenced standard
and have stated the VOC content for each product.
Credits Awarded: 0
EQc4.3: Carpet
Declaration not made
(Architect, Interior Designer, Contractor or Responsible Party)
I, , declare that all carpet systems meet or exceed the current
Carpet and Rug Institute's Green Label Indoor Air Quality Test Program requirements.
I have provided a list of all carpet systems used in the project.
Credits Awarded: 0
EQc4.4: Composite Wood and Agrifiber Products
Declaration not made
(Architect, Interior Designer, Contractor or Responsible Party)
I, , declare that all composite wood and agrifiber products used in the building
contain no added urea-formaldehyde resins.
I have provided a list of all composite wood and agrifiber products used in the project.
Credits Awarded: 0
Points Documented
EQ Cr 4.1 - 4.4 (4 points possible): Low-Emitting Materials 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 5: Indoor Chemical & Pollutant Source Control
Declaration not made
(Architect, Interior Designer or Responsible Party)
I, , declare that the following indoor chemical and pollutant source control
measures have been taken:
Permanent entryway systems (grills, grates, etc.) to capture dirt, particulates, etc. are employed at all high volume entryways
Chemical use areas and copy rooms have been physically separated with deck-to-deck partitions; Independent
exhaust ventilation has been installed at 0.5 cfm/square foot or greater and a negative pressure differential of 7 Pa
has been achieved
In spaces where water and chemical concentrate mixing occurs, drains are plumbed for environmentally appropriate
disposal of liquid waste
Points Documented
EQ Cr 5 (1 point): Indoor Chemical & Pollutant Source Control 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 6.1 - 6.2: Controllability of Systems
For Perimeter Spaces (EQ Credit 6.1):
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare, as demonstrated by calculations and drawings provided, that for
regularly occupied perimeter areas (defined as those areas within 15 feet of the perimeter wall), a minimum of one operable window and
one lighting control zone are provided per 200 square feet on average.
Please complete table to support declaration. Place 'NA' in table if not applicable to project.
Perimeter Spaces
(where 75% or more of a room is within the 15-foot offset
line)
Perimeter
Windows
Operable
Controls
Lighting
Area
[SF] [Qty] Pass? [Qty] Pass?
No No
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare, as demonstrated by calculations and drawings provided, that for group
multi-occupant perimeter areas (75% or more of floor area within 15 feet of the perimeter wall AND sharing a physical connection with the
building exterior), a minimum of one operable window is provided per 200 square feet on average and lighting controls have been installed
as required.
Please complete table to support declaration. Place 'NA' in table if not applicable to project.
Group Multi-Occupant Perimeter Spaces
(where 75% or more of a room is within the 15-foot offset line)
Total Multi-
Number of
Occupant
Perimeter
Windows
Operable
Controls
Lighting
Rooms
Area
[Qty] [SF] [Qty] Pass? [Qty] Pass?
No No
For Perimeter and/or Non-Perimeter Group Multi-Occupant Spaces (EQ Credits 6.1 & 6.2):
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare, as demonstrated by calculations and drawings provided, that for group
multi-occupant perimeter areas (less than 75% of floor area within 15 feet of the perimeter wall AND sharing a physical connection with the
building exterior) AND group multi-occupant non-perimeter spaces, airflow controls, temperature controls, and lighting controls have been
installed as required. For perimeter spaces in this category, a minimum of one operable window per 200 SF of the perimeter area on average
has also been provided.
Please complete table to support declaration. Place 'NA' in table if not applicable to project.
Group Multi-Occupant Perimeter and Non-Perimeter Spaces
(where less than 75% of a room is within the 15-foot offset line)
Non- Perimeter
Perimeter Area
Temperature
Room Size
Number of
Windows
Operable
Controls
Controls
Controls
Lighting
Airflow
Rooms
Range
Area
[SF] [Qty] [SF] [SF] [Qty] Pass? [Qty] Pass? [Qty] Pass? [Qty] Pass?
<=2,500 No Yes Yes Yes
>2,500 and
<=5,000 No Yes Yes Yes
>5,000 and
<=7,500 No Yes Yes Yes
>7,500 and
<=10,000 No Yes Yes Yes
>10,000 No No No No
For Non-Perimeter Spaces (EQ Credit 6.2):
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare, as demonstrated by calculations and drawings provided, that for regularly
occupied non-perimeter areas (defined as those areas not within 15 feet of the perimeter wall), controls for individual airflow, temperature and
lighting are provided for at least 50% of the occupants.
Please complete table to support declaration. Place 'NA' in table if not applicable to project.
Non-Perimeter Room Spaces
(where less than 75% of a room is within the 15-foot offset line)
Non-Perimeter
Temperature
Occupants
Controls
Controls
Controls
Lighting
Airflow
Area
[SF] [Qty] [Qty] Pass? [Qty] Pass? [Qty] Pass?
No No No
EQ Credit 7.1 - 7.2: Thermal Comfort
COMPLIANCE WITH ASHRAE 55-1992
EITHER
For Mechanically Ventilated Spaces:
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the project has been designed to maintain interior
comfort within the ranges established by ASHRAE Standard 55-1992,Addenda 1995.
Thermally Controlled Zone Temperature Control Range Humidity Control Range Method of Control Used
OR
For Naturally Ventilated Spaces:
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that the project complies with the 90% acceptability limits of the
adaptive comfort temperature boundaries in the California High Performance Schools (CHPS) Best Practices Manual
Appendix C – A Field Based Thermal Comfort Standard for Naturally Ventilated Buildings, Figure 2.
PERMANENT MONITORING SYSTEM
Declaration not made
(HVAC Engineer or Responsible Party)
I, , declare that a permanent temperature and humidity monitoring system
will operate throughout all seasons to permit control of the building zones within the thermal comfort ranges defined in
ASHRAE 55-1992, Addenda 1995.
Furthermore, I certify that the temperature and humidity controls were, or will be, tested as part of the scope of work for the Energy
and Atmosphere Prerequisite 1, Fundamental Building Systems Commissioning.
Commissioning work is identified in:
Document Name:
Section Number:
Points Documented
EQ Cr 7.1 (1 point): Thermal Comfort, Compliance with ASHRAE 55-1992 0
EQ Cr 7.2 (1 point): Thermal Comfort, Permanent Monitoring System 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
EQ Credit 8.1 - 8.2: Daylight and Views
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare that there exists a minimum Daylight Factor of 2% (excluding all direct
sunlight penetration) in 75% of all space occupied for critical visual tasks.
I have provided calculations tabulated in a spreadsheet and drawings that define the daylight zone and prediction calculations
or daylight simulation results to demonstrate a minimum Daylight Factor of 2% in 75% of all space occupied for critical
visual tasks.
Credit Awarded: 0
Declaration not made
(Architect, HVAC Engineer or Responsible Party)
I, , declare that the building occupants in 90% of regularly occupied spaces
will have direct lines of site to perimeter glazing.
I have provided calculations tabulated in a spreadsheet and drawings highlighting direct line of sight zones to support
declaration.
Credit Awarded: 0
Points Documented
EQ Cr 8.1 (1 point): Daylight and Views, Daylight 75% of Spaces 0
EQ Cr 8.2 (1 point): Daylight and Views, Views for 90% of Spaces 0
Total Points Documented 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
ID Credit 1: Innovation in Design
Declaration not made
(Responsible Party)
I, , submit the following innovation credit proposals for exceptional performance
above the existing LEED requirements and/or innovative green building performance of a type that is not currently addressed
within LEED. The following documentation has been provided:
I am seeking credit(s) for:
ID Credit 1.1 (1 point) Title:
ID Credit 1.2 (1 point) Title:
ID Credit 1.3 (1 point) Title:
ID Credit 1.4 (1 point) Title:
For each innovation credit proposal, I have attached a sheet that succinctly identifies the intent of the proposed innovation credit,
the proposed requirement(s) for compliance, the proposed submittal(s) to demonstrate compliance, and the design approach
(technologies and strategies) that might be used to meet the requirements. I have also attached the relevant submittals as
evidence of compliance.
Points Documented
ID Cr 1 (4 points possible): Innovation in Design 0
Name: #N/A
Organization: #N/A
Role in project: #N/A
Signature:
Date: 4/13/2011
File last modified: August 1, 2003
ID Credit 2: LEED Accredited Professional
Declaration not made
(Civil Engineer or Responsible Party)
I, , declare that the following principal participant of the project team has successfully
completed the LEED Accredited Professional exam:
I have provided a copy the participant's LEED Accredited Professional award certificate.
Name: Please provide name.
Title: Please provide title.
Company: Please provide company.
Street Address: Please provide street address.
City: Please provide city.
State: Please provide state.
Zip code: Please provide zip code.
Phone: Please provide phone number.
E-mail: Please provide e-mail address.
Point Documented
ID Credit 2 (1 point): LEED Accredited Professional 0
Name #N/A
Organization #N/A
Role in project #N/A
Signature
Date 4/13/2011
File last modified: August 1, 2003
