Form 482-0651-0720114F "Air Balancing Matrix 4f" - Illinois

What Is Form 482-0651-0720114F?

This is a legal form that was released by the Illinois Department of Public Health - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Illinois Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 482-0651-0720114F by clicking the link below or browse more documents and templates provided by the Illinois Department of Public Health.

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Download Form 482-0651-0720114F "Air Balancing Matrix 4f" - Illinois

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Air balancing matrix 4F
IDPH number
To be completed by design engineer
To be completed by test and air balance technician
Actual CFM
Design CFM
Percent of design
VAV min/max
VAV Min/Max
Pressure
Actual # air
Room
Space
Room use
Supply
Return
Exhaust
relationship
Supply
Return Exhaust
Supply
Return
Exhaust
changesper
number
volume
hour
+0-
Add Page
Page
of
Form # 482-0651-0720114F
Air balancing matrix 4F
IDPH number
To be completed by design engineer
To be completed by test and air balance technician
Actual CFM
Design CFM
Percent of design
VAV min/max
VAV Min/Max
Pressure
Actual # air
Room
Space
Room use
Supply
Return
Exhaust
relationship
Supply
Return Exhaust
Supply
Return
Exhaust
changesper
number
volume
hour
+0-
Add Page
Page
of
Form # 482-0651-0720114F
Air balancing matrix 4F
IDPH number
To be completed by design engineer
To be completed by test and air balance technician
Design CFM
Actual CFM
Percent of design
VAV min/max
VAV min/max
Pressure
Actual # air
Space
Room no.
Room use
Supply
Return
Exhaust
relationship
Supply
Return
Exhaust
Supply
Return
Exhaust
changes per
volume
+0-
hour
Pressurization
0 =
Within +/- 10% of design CFM supply and return/exhaust.
Equal:
+ =
Exceeds 10% or 50 CFM
supply CFM over return/exhaust CFM.
Positive:
(which ever is greater)
- =
Exceeds 10% or 50 CFM
return/exhaust CFM over supply CFM.
Negative:
(which ever is greater)
Actual values listed that are more than 10% departure from design values without clarification will not be accepted.
I certify that the air conditioning and ventilation systems have been tested and balanced in accordance with the plans and specification, NFPA 90A/90B
and/or NFPA 99 ( for OR's, Labs, etc. ) and the Illinois Hospital Licensing Act
Air balance technician name & company
Signature
Date
Comments
Page
of
Form # 482-0651-0720114F
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