5900-197 Data Checklist

OMB No. 2060-0347

ENERGY STAR® Application for Certification

100
ENERGY STAR ®
1
Score

TEST
Registry Name: TEST
Primary Function: Office
Gross Floor Area (ft²): 20,000
Built: 1971
2

For Year Ending: 08/31/2015
Date Application Becomes Ineligible: 12/29/2015

1. The ENERGY STAR Score is based on total source energy. A score of 75 is the minimum to be eligible for the ENERGY STAR.
2. Applications must be submitted to EPA within 120 days of the Year Ending Date. The award is not final until approval is received from EPA.

Please use the Licensed Professional’s Guide to the ENERGY STAR ® for Commercial
Buildings for reference in completing this checklist
(http://www.energystar.gov/lpguide).

Property & Contact Information
Property Address
TEST
53 Perimeter Street East
TEST CITY, Georgia 30346

Property Owner
ICF International
9300 Lee Highway
Fairfax, VA 22031
(____)____-______

Property ID: 4004684
Cambridge Building Energy
Reporting ID: 12125

Primary Contact
Anand Gupta
9300 Lee Highway
Fairfax, VA 22031
703-934-3748
Anand.Gupta@icfi.com

1. Review of Whole Property Characteristics
Basic Property Information
1) Property Name for Registry: TEST

Yes

No

Yes

No

Is this the official name to be displayed in the Registry of ENERGY STAR Certified
Buildings and Plants?
If “No”, please specify: _____________________________________

2) Primary Function: Office
Is this an accurate description of the primary use of this property?

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

3) Location:

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

53 Perimeter Street East
TEST CITY, Georgia 30346
Is this correct and complete?
4) Gross Floor Area: 20,000 ft²
Does this represent the entire property? (i.e., no part of the building/property was
excluded/subtracted from the total) If “no” please specify what space has been excluded.

5) Average Occupancy: 70
Is this occupancy accurate for the entire 12 month period being assessed?

6) Number of Buildings: 1
Does this number accurately represent all structures?

Notes:

Indoor Environmental Standards
1) Ventilation for Acceptable Indoor Air Quality
Does this property meet the ASHRAE Standard 62 for ventilation for acceptable indoor
air quality?

2) Acceptable Thermal Environmental Conditions
Does this property meet the ASHRAE Standard 55 for thermal comfort?

3) Adequate Illumination
Does this property adhere to the IESNA Lighting Handbook for lighting quality?

Notes:

2. Review of Property Use Details

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

Office: Building Use
This Use Detail is used to calculate the 1-100 ENERGY STAR Score.

1) Gross Floor Area: 20,000 ft²
Is this the total size, as measured between the principal exterior surfaces of the
enclosing fixed walls of the building(s)? This includes all areas inside the building(s)
such as: occupied tenant areas, common areas, meeting areas, break rooms,
restrooms, elevator shafts, mechanical equipment areas, and storage rooms. Gross
Floor Area should not include interstitial plenum space between floors, which may house
pipes and ventilation. Gross Floor Area is not the same as rentable, but rather includes
all area inside the building(s). Leasable space would be a sub-set of Gross Floor Area.
In the case where there is an atrium, you should count the Gross Floor Area at the
base level only. Do not increase the size to accommodate open atrium space at higher
levels. The Gross Floor Area should not include any exterior spaces such as balconies
or exterior loading docks and driveways.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

2) Weekly Operating Hours: 66
Is this the total number of hours per week that the property is occupied by the majority
of the employees? It does not include hours when the property is occupied only by
maintenance, security, or other support personnel. The Weekly Operating Hours is not
the same as the hours during which the HVAC equipment is run, but rather should be
based on the hours during which your property is actually occupied by the majority of
the tenants. It is possible that these hours may correspond to hours specified within a
lease, during which the owner is required to provide the leasee with conditioned space.
However, this number should never include additional HVAC startup or shutdown time.
For properties with a schedule that varies during the year, Weekly Operating Hours
refers to the schedule most often followed.

3) Number of Workers on Main Shift: 301
Is this the total number of workers present during the primary shift? This is not a total
count of workers, but rather a count of workers who are present at the same time. For
example, if there are two daily eight hour shifts of 100 workers each, the Number of
Workers on Main Shift value is 100. Number of Workers on Main Shift may include
employees of the property, sub-contractors who are onsite regularly, and volunteers
who perform regular onsite tasks. Number of Workers should not include visitors to the
buildings such as clients, customers, or patients.

4) Number of Computers: 333
Is this the total number of computers, laptops, and data servers at the property? This
number should not include tablet computers, such as iPads, or any other types of office
equipment.

5) Percent That Can Be Heated: 100
Is this the total percentage of the property that can be heated by mechanical equipment?

6) Percent That Can Be Cooled: 100
Is this the total percentage of the property that can be cooled by mechanical equipment?
This includes all types of cooling from central air to individual window units.

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

Notes:

Parking: Parking Use
This Use Detail is used to calculate the 1-100 ENERGY STAR Score.

1) Open Parking Lot Size: 144,840 ft²
Is this the total area that is lit and used for parking vehicles? Open Parking Lot Size
refers specifically to open area, which may include small shading covers but does not
include any full structures with roofs. Parking lot size may include the area of parking
spots, lanes, and driveways.

Yes

No

Yes

No

Yes

No

Yes

No

2) Partially Enclosed Parking Garage Size: 0 ft²
Is this the total area of parking structures that are partially enclosed? This includes
parking garages where each level is covered at the top, but the walls are partially or fully
open.

3) Completely Enclosed Parking Garage Size: 0 ft²
Is this the total area of parking structures that are completely enclosed on all four sides
and have a roof? This includes underground parking or fully enclosed parking on the first
few stories of a building.

4) Supplemental Heating: No
Does the parking garage have a heating system to pre-heat ventilation air and/or
maintain a minimum temperature during winter months?

Notes:

3. Review of Energy Consumption
Data Overview
Site Energy Use Summary
Electric - Grid (kBtu)
Total Energy (kBtu)

EPA Form 5900-197

4,094.4 (100%)
4,094.4

National Median Comparison
National Median Site EUI (kBtu/ft²)
National Median Source EUI (kBtu/ft²)

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130.3
409.3

Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

Energy Intensity
Site (kBtu/ft²)
Source (kBtu/ft²)

% Diff from National Median Source
EUI

0.2
0.6

-99.8%

Emissions (based on site energy use)
Greenhouse Gas Emissions (Metric
Tons CO2e)

0.7

Power Generation Plant or Distribution Utility:
Georgia Power Co [Southern Co]
Note: All values are annualized to a 12-month period. Source Energy includes energy used in generation and transmission to enable an equitable assessment.

Summary of All Associated Meters
The following meters are associated with the property, meaning that they are added together to get the total energy use for the
property. Please see additional tables in this checklist for the exact meter consumption values.

Meter Name

Fuel Type

Start Date

End Date

Associated With

Electric Grid Meter

Electric

12/12/2010

In Use

TEST

Total Energy Use

Yes

No

Yes

No

Yes

No

Do the meters shown above account for the total energy use of this property during the
reporting period of this application?

Additional Fuels
Do the meters above include all fuel types at the property? That is, no additional fuels such as
district steam, generator fuel oil have been excluded.

On-Site Solar and Wind Energy
Are all on-site solar and wind installations reported in this list (if present)? All on-site systems
must be reported.

Notes:

Summary of Additional Meters
None of the following meters are associated with the property meaning that they are not added together to account for the total
energy use of the property.

Meter Name

Fuel Type

Start Date

End Date

Associated With

Electric Solar Meter

Electric on Site Solar

02/04/2015

In Use

None

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

Sub (or Ancillary) Meter Energy Use

Yes

No

Are the meters in this list all sub-meters or other ancillary meters that do not need to be added
to the total energy for the reporting period of this application?

Notes:

Electric Meter: Electric Grid Meter (kWh (thousand Watt-hours))
Associated With: TEST
Start Date

End Date

Usage

Green Power?

09/01/2014

09/30/2014

100

No

10/01/2014

10/31/2014

100

No

11/01/2014

11/30/2014

100

No

12/01/2014

12/31/2014

100

No

01/01/2015

01/31/2015

100

No

02/01/2015

02/28/2015

100

No

03/01/2015

03/31/2015

100

No

04/01/2015

04/30/2015

100

No

05/01/2015

05/31/2015

100

No

06/01/2015

06/30/2015

100

No

07/01/2015

07/31/2015

100

No

08/01/2015

08/31/2015

100

No

Total Consumption (kWh (thousand
Watt-hours)):

1,200

Total Consumption (kBtu (thousand
Btu)):

4,094.4

Total Energy Consumption for this Meter

Yes

No

Do the fuel consumption totals shown above include consumption of all energy tracked
through this meter that affect energy calculations for the reporting period of this application
(i.e., do the entries match the utility bills received by the property)?

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

Notes:

4. Signature & Stamp of Verifying Licensed Professional
___________________ (Name) visited this site on ___________ (Date). Based on the conditions observed at the time
of the visit to this property, I verify that the information contained within this application is accurate and in accordance
with the Licensed Professional Guide.

Signature: _______________________ Date: _________

Licensed Professional
License: XYZ123TEST in GA
ABC XYZ
TEST ADDRESS
TEST CITY, GA 30346
703-934-3748
XYZ@XYZ.com

NOTE: When applying for the ENERGY STAR, the signature of the
Verifying Professional must match the stamp.

Professional Engineer Stamp

5. Signatory Agreement
I hereby nominate the above described property for award of the ENERGY STAR. I have provided a copy of the
Licensed Professionals Guide to the ENERGY STAR for Commercial Buildings to our Licensed Professional (LP) for
reference. As documented by the above checklist, this property meets the conditions necessary to qualify as ENERGY
STAR. I am submitting this application within four months of the Year Ending Date (August 31, 2015) used to generate
the application. I will assist EPA, if requested, in verifying any data included in this application. Furthermore, I agree to
associate the ENERGY STAR logo only with this property and to adhere to the ENERGY STAR Identity Guidelines.
Signature (must be a direct employee of the building owner/manager): _______________________ Date: _________
Signatory Name: Anand Gupta
Property Owner: ICF International

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015

OMB No. 2060-0347

The government estimates the average time needed to fill out this form is 6 hours (includes the time for entering energy data, Licensed Professional
facility inspection, and notarizing the SEP) and welcomes suggestions for reducing this level of effort. Send comments (referencing OMB control
number) to the Director, Collection Strategies Division, U.S., EPA (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460

EPA Form 5900-197

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Tracking Number: APP-20151005-0-4004684
Generated On: 10/05/2015