Commissioning Documentation For Permit

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Commissioning Documentation for Permit

Chapter 1

Project Name:_________________________________________________________________________________
Project Address:_____________________________________________ Permit Number:______________________
Commissioning Provider:_________________________________________________________________________
Company/Entity Address: ________________________________________________________________________
CxP Phone Number: ______________________________ CxP Email Address:_____________________________
CxP Certification (if required)______________________________________________________________________
Chapter 2

Commissioning Documentation Approval


Project Requirements for Commissioning
Project requirements and design completed, documented, and included in the project
documentation, including the list of systems to be commissioned and their performance criteria
Contractor and Construction Instructions
Chapter 3

Plans and commissioning specifications, with equipment performance requirements shown,


completed and included in contract documents
Design Review
Commissioning design documents review completed with response from Design Team
Commissioning Plan
Initial Cx Plan (for permit) completed with required contents and provided by the CxP for Owner and
AHJ review

Commissioning Provider Acknowledgment


I have reviewed the documents and verified that they meet the OPR:
Name: ______________________________________________________________________________________
Chapter 5

Company Name: ______________________________________________________________________________


Signature: ______________________________________________________________ Date: ________________

Owner/Owner’s Representative Acknowledgment


The project documents include the items listed in this form and have been approved by the Owner or Owner’s
representative:
Appendix A

Name: ______________________________________________________________________________________
 Owner  Owner’s Representative
Company Name: ______________________________________________________________________________
Signature: ______________________________________________________________ Date: ________________
Appendix B
Appendix B
Appendix B

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