
Building Division | Department for Community Sustainability
City of Lake Worth | 1900 2
nd
Avenue North | Lake Worth, FL 33461
BUILDING DIVISION
DEPARTMENT FOR COMMUNITY SUSTAINABILITY
CITY OF LAKE WORTH
1900 2
ND
AVENUE NORTH
LAKE WORTH, FL 33461
561.586.1647
Florida HVAC Efficiency Card Form
Required for REPLACEMENT of mechanical equipment. This information must be posted on job site.
Two (2) copies are required.
AIR CONDITIONING SYSTEM
SEER: ___________________________ EER: ________________________________
DOE covered products are central, air-source, one-phase systems having capacities under 65,000 BTUH
REPLACEMENT SYSTEM TECHINICAL INFORMATION
Manufacturer __________________________________________________________________________
Air Handler Model No.___________________ Condenser Unit Model No._________________________
Voltage _______________________________ Voltage ________________________________________
Heat Strip _____________________________ Size tons _______________________________________
Min. Circuit Ampacity ___________________ Min. Circuit Ampacity ____________________________
HACR Breaker / Fuse Size HACR Breaker / Fuse Size
Min._________ Max __________ Min._____________ Max ____________________
Wire Size ________________ A.W.G. Wire Size _________________ A.W.G.
Additional information is required if the Air Handler is equipped with one or more evaporator coil.
Evaporator Coil Unit Model Number ________________________________________
EXISTING SYSTEM TECHINICAL INFORMATION
Manufacturer __________________________________________________________________________
Air Handler Model No.___________________ Condenser Unit Model No._________________________
Voltage _______________________________ Voltage ________________________________________
Heat Strip _____________________________ Size tons _______________________________________
Min. Circuit Ampacity ___________________ Min. Circuit Ampacity ____________________________
HACR Breaker / Fuse Size HACR Breaker / Fuse Size
Min._________ Max __________ Min._____________ Max ____________________
Wire Size ________________ AW.G. Wire Size _________________ AW.G.
Additional information is required if the Air Handler is equipped with one or more evaporator coil.
Evaporator Coil Unit Model Number _______________________________________________________
I, hereby certify that information entered on this form is the accurate representation of the systems installed.
Signature of Applicant ___________________________________ Date ___________________________