IOWA STATE ENERGY
CODE STATEMENT OF
REVIEW FORM
OFFICIAL USE ONLY
June 2014
IOWA STATE FIRE MARSHAL OFFICE
STATE BUILDING CODE BUREAU
215 EAST 7TH STREET
DES MOINES, IA 50319
Business Hours: 8am - 4:30pm M-F
Phone: 515-725-6145
Building Code Bureau: www.iowabuildingcode.org
Fax: 515-725-6172
Email: [email protected]
State Fire Marshal: www.dps.state.ia.us/fm/index.shtml
Please submit this completed form with applicable energy calculations or software printouts along with fees to the SFM’s
address listed above. This form is required for new buildings or new additions to buildings per Iowa Code 103A and
Administrative Rule 661-303.1(3).
Project Name:
Project Street Address:
City:
Iowa, Zip:
County Name:
Architect/Engineer Firm Name:
Phone:
A/E Responsible Designer’s Name:
IA License #:
A/E Firm’s Street Address:
City:
State:
Zip:
A/E Contact Email:
Indicate type of building project:
Residential Building (R2,R3 & R4 occupancies 3 stories or less above grade)
Commercial Building (All other occupancies not considered residential buildings per IECC)
Indicate the climate zone for this project: (IECC Climate Map):
5
6
Indicate below the method used to determine compliance with State Energy Code-2014 International Energy
Conservation Code (IECC). http://www.legis.state.ia.us/aspx/ACODOCS/DOCS/661.303.pdf
IECC 2012 or ASHRAE 90.1 2010 Prescriptive Provisions (For Residential or Commercial Buildings).
COMcheck ™ (US DOE) - http://www.energycodes.gov/comcheck/ IECC C402.1.2 or ASHRAE 90.1-5.2.1
REScheck ™ (US DOE) - http://www.energycodes.gov/rescheck/ IECC R402.1.4
IECC 2012 – Performance Provisions for Residential Buildings (US DOE) IECC Section R405
ASHRAE 90.1 2010 – Performance Provisions for Commercial Buildings (US DOE) Chapter 11 (Only)
I certify to the best of my knowledge that all the information submitted on this form and supporting
documentation is accurate and true and that this engineering document was prepared by me or under my
direct supervision, and that I am duly licensed professional engineer or architect under the laws of the State of
Iowa.
$ 25 Filing Fee required with this form payable to State of Iowa Treasurer
Responsible Designer’s Signature:
License/Registration Expires:
Date:
Engineer or Architect Seal