One Texas Center | 505 Barton Springs Road, Austin, Texas 78704 | Phone: 512.978.4000

Commissioning Summary Template The following template shall be completed and submitted for permit review. Provide additional attachments as appropriate.

To complete this form electronically: Open with Internet Explorer, then Click Here to Save and continue.

Section 1: Project Description

Project Name: _________________________________________________________

Project Address: _______________________________________________________

Building/Mechanical Permit Number: _______________________________________

Owner: _______________________________________________________________

Commissioning Authority: ________________________________________________

Architect: _____________________________________________________________

Engineer: _____________________________________________________________

General Contractor: _____________________________________________________

Mechanical Contractor: __________________________________________________

Section 2: Summary of Owner’s HVAC Project Requirements

Summer Outdoor Design Conditions* 96 °F DB 74 °F WB Winter Outdoor Design Conditions* 25 °F DB Summer Indoor Design Conditions (occupied) °F DB %RH

Summer Indoor Design Conditions (unoccupied) °F DB %RH

Winter Indoor Design Conditions (occupied) °F DB Winter Indoor Design Conditions (unoccupied) °F DB Hours of Operation per Week Hours Conditioned Floor Space Area Sq. Ft.

* - From ASHRAE 90.1-2013, Table D-1

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Section 3 – Description of Commissioning Process

This section sequentially details the commissioning process by commissioning task or activity.

3.1 General Description of Roles

Project Manager (PM):

Provide general project overview assisting the coordination of the Cx process.

Commissioning Authority (CA):

Coordinates the Cx process, develops testing plans, oversees and documents performance tests.

General Contractor (GC):

Facilitates the Cx process, ensures that Subs perform their responsibilities and integrates Cx into the construction process and master schedule. Facilitates the work of the CA.

Sub-Contractors: Assist CA in functional performance testing as necessary.

Architect/ Engineer (A/E):

Perform construction observation, approve O&M manuals and assist in resolving problems. Provides final approval of Cx work.

3.2 Commissioning Scoping Meeting A commissioning scoping meeting is planned and conducted by the CA. In attendance are the respective representatives of the GC, CA, A/E, and the mechanical and electrical subcontractors. At the meeting commissioning parties are introduced and the commissioning process reviewed, management and reporting lines determined, and the flow of documents is discussed. The Cx Plan is reviewed, process questions are addressed, lines of reporting and communications determined and the proposed commissioning schedule is provided. Prior to this meeting the CA is given, by the PM, all drawings and specifications and the construction schedule by trade.

3.3 Site Observation The CA makes periodic visits to the site, as necessary, to witness equipment and system installations.

3.4 Miscellaneous Meetings The CA attends selected planning and job-site meetings in order to remain informed on construction progress and to update parties involved in commissioning. The GC provides the CA with information regarding substitutions, change orders and any Architect’s Supplemental Instructions (ASI) that may affect commissioning equipment, systems or the commissioning schedule.

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3.5 Miscellaneous Management Protocols The following protocols will be used on this project.

Issue Protocol For requests for information (RFI) or formal documentation requests: The CA goes first through the GC to the subs.

For minor or verbal information and clarifications: The CA goes direct to the informed party.

For notifying contractors of deficiencies: The CA documents deficiencies through the GC, but may discuss deficiency issues with the Subs. For scheduling commissioning meetings: The CA selects the date and schedules through the GC. For making a request for significant changes: The CA has no authority to issue change orders.

For making small changes in specified sequences of operations:

The CA may not make changes to specified sequences without approval from the Engineer of Record.

Subcontractors disagreeing with requests or interpretations by the CA shall:

Try and resolve with the CA first. Then work through GC who will work with CA directly.

3.6 Start-Up Documentation For equipment indicated in Section 4, Table 1 below, the installing sub-contractor shall submit equipment manufacturer provided start-up forms and documentation to the Commissioning Authority for review. In lieu of manufacturer generated start-up forms, contractor generated start-up forms are acceptable if they are submitted to the Commissioning Authority for review prior to start-up. This start-up documentation shall be completed prior to the mechanical rough-in inspection.

3.7 Execution of Functional Testing Procedures 3.7.1 Overview and Process

The CA schedules functional tests through the GC and affected Subs. The CA performs the functional testing of all equipment and systems according to the Specifications and the Cx Plan. The control system is tested before it is used to verify performance of other components or systems. Testing proceeds from components to subsystems to systems and finally to interlocks and connections between systems.

3.7.2 Deficiencies Correction The CA documents the results of the testing. Corrections of minor deficiencies identified are made during the tests at the discretion of the CA. The CA records the results of the test on the procedure or test form. Deficiencies or non-conformance issues are noted and reported. A field progress report summarizing all deficiencies will be issued. Subs correct deficiencies, notify the CA, and return form certifying correction. Decisions regarding deficiencies and corrections are made at as low a level as possible, preferably between CA or GC and the Sub. For areas in dispute, final authority, besides the Owner’s, resides with the Engineer of Record. The CA recommends acceptance of each test to the GC and/or Owner. City of Austin | Commissioning Summary Template 7/6/2016 | Page 3 of 5

Section 4 – Description of Equipment To Be Commissioned

Use Table 1 to list the quantity of each type of HVAC equipment installed on the project, and the quantity of each type to be functionally tested. Include in this list the type and quantity of sensor/instruments to be calibrated during testing. Attach additional pages as necessary.

Table 1 - List of Equipment and Testing Plan

Type of Equipment Qty

Installed on Project

% of Item to be

Tested1

Qty to be

Tested

Start-Up Forms Req’d2

Example: DX Rooftop Units 17 50 9 Y

Notes: 1. The minimum percentage of any equipment type to be tested is 20% rounded up to the next

whole integer.2. Refer to section 3.6 above for start-up documentation requirements.

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Section 5 – Sequence of Operations

Use this section to describe in detail the sequence of operations to be tested for each piece of equipment listed above OR provide specific reference to the Construction Documents (drawing number, specification section, and paragraph number) in which the Sequence of Operations is contained. Attach additional pages as necessary.

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IntroductionSection 1: Project DescriptionSection 2: Summary of Owner’s HVAC Project RequirementsSection 3 – Description of Commissioning ProcessSection 4 – Description of Equipment To Be CommissionedSection 5 – Sequence of Operations

Project Name: Project Address: Commissioning Authority: Architect: Engineer: General Contractor: Mechanical Contractor: Type of EquipmentRow1: Quantity Installed on ProjectRow1: Percent of Item to be TestedRow1: Quantity to be TestedRow1: StartUp Forms RequiredRow1: Type of EquipmentRow2: Quantity Installed on ProjectRow2: Percent of Item to be TestedRow2: Quantity to be TestedRow2: StartUp Forms RequiredRow2: Type of EquipmentRow3: Quantity Installed on ProjectRow3: Percent of Item to be TestedRow3: Quantity to be TestedRow3: StartUp Forms RequiredRow3: Type of EquipmentRow4: Quantity Installed on ProjectRow4: Percent of Item to be TestedRow4: Quantity to be TestedRow4: StartUp Forms RequiredRow4: Type of EquipmentRow5: Quantity Installed on ProjectRow5: Percent of Item to be TestedRow5: Quantity to be TestedRow5: StartUp Forms RequiredRow5: Type of EquipmentRow6: Quantity Installed on ProjectRow6: Percent of Item to be TestedRow6: Quantity to be TestedRow6: StartUp Forms RequiredRow6: Type of EquipmentRow7: Quantity Installed on ProjectRow7: Percent of Item to be TestedRow7: Quantity to be TestedRow7: StartUp Forms RequiredRow7: Type of EquipmentRow8: Quantity Installed on ProjectRow8: Percent of Item to be TestedRow8: Quantity to be TestedRow8: StartUp Forms RequiredRow8: Type of EquipmentRow9: Quantity Installed on ProjectRow9: Percent of Item to be TestedRow9: Quantity to be TestedRow9: StartUp Forms RequiredRow9: Type of EquipmentRow10: Quantity Installed on ProjectRow10: Percent of Item to be TestedRow10: Quantity to be TestedRow10: StartUp Forms RequiredRow10: Type of EquipmentRow11: Quantity Installed on ProjectRow11: Percent of Item to be TestedRow11: Quantity to be TestedRow11: StartUp Forms RequiredRow11: Type of EquipmentRow12: Quantity Installed on ProjectRow12: Percent of Item to be TestedRow12: Quantity to be TestedRow12: StartUp Forms RequiredRow12: Type of EquipmentRow13: Quantity Installed on ProjectRow13: Percent of Item to be TestedRow13: Quantity to be TestedRow13: StartUp Forms RequiredRow13: Type of EquipmentRow14: Quantity Installed on ProjectRow14: Percent of Item to be TestedRow14: Quantity to be TestedRow14: StartUp Forms RequiredRow14: Type of EquipmentRow15: Quantity Installed on ProjectRow15: Percent of Item to be TestedRow15: Quantity to be TestedRow15: StartUp Forms RequiredRow15: Type of EquipmentRow16: Quantity Installed on ProjectRow16: Percent of Item to be TestedRow16: Quantity to be TestedRow16: StartUp Forms RequiredRow16: Type of EquipmentRow17: Quantity Installed on ProjectRow17: Percent of Item to be TestedRow17: Quantity to be TestedRow17: StartUp Forms RequiredRow17: Type of EquipmentRow18: Quantity Installed on ProjectRow18: Percent of Item to be TestedRow18: Quantity to be TestedRow18: StartUp Forms RequiredRow18: Type of EquipmentRow19: Quantity Installed on ProjectRow19: Percent of Item to be TestedRow19: Quantity to be TestedRow19: StartUp Forms RequiredRow19: Type of EquipmentRow20: Quantity Installed on ProjectRow20: Percent of Item to be TestedRow20: Quantity to be TestedRow20: StartUp Forms RequiredRow20: Type of EquipmentRow21: Quantity Installed on ProjectRow21: Percent of Item to be TestedRow21: Quantity to be TestedRow21: StartUp Forms RequiredRow21: Type of EquipmentRow22: Quantity Installed on ProjectRow22: Percent of Item to be TestedRow22: Quantity to be TestedRow22: StartUp Forms RequiredRow22: Type of EquipmentRow23: Quantity Installed on ProjectRow23: Percent of Item to be TestedRow23: Quantity to be TestedRow23: StartUp Forms RequiredRow23: BuildingMechanical Permit Number: Owner: Sequence of Operations: SAVE Form: Summer Indoor Design Conditions (occupied): Degrees F DB: Summer Indoor Design Conditions (occupied): Percent RH: Summer Indoor Design Conditions (unoccupied): Percent RH: Summer Indoor Design Conditions (unoccupied): Degrees F DB: Winter Indoor Design Conditions (unoccupied): Degrees F DB: Winter Indoor Design Conditions (occupied): Degrees F DB: Hours of Operation per Week: Conditioned Floor Space Area: SAVE form: