Existing Building Retrofit Energy Certification Form

1. Building Information

Building Name Address Owner / Responsible Party Contact Email Contact Phone Building Type Residential Commercial Mixed-Use Other Year Constructed Gross Floor Area (m²)

2. Retrofit Project Information

Description of Retrofit Measures Retrofit Completion Date Main Objectives

3. Energy Performance Data

	Before Retrofit	After Retrofit
Annual Energy Use (kWh)
Annual Energy Cost
GHG Emissions (tons CO₂e)

4. Certification Details

Certification Type LEED BREEAM ENERGY STAR National Cert. Other Certification Level (if applicable) Certification Body Date of Certification

5. Additional Comments

6. Declaration

Name of Declarant Date