HomeMy WebLinkAboutBLD-19-4071 • ems- '/7/11
ONE & TWO FAMILY ONLY- BUILDING PERMIT
•
Town of Yarmouth Building Department
1146 Route 28,South Yarmouth,MA 02664-4492
508-398-2231 ext. 1261 Fax 508-398-0836 i` !'1:�
Massachusetts State Building Code,780 CMR J
Building Permit Application To Construct,Repair,Renovate Or Demolish
a One-or Two-Family Dwelling
This Section For Official Use.a:,a
Building Permit Number- /g CJZL 0707/ Date Apph :
1r". =
Building Official(PrintName) SignMae Date
SECiTON 1:SITE INFORMATION ., :.
1.1 Property Address: j 1.2 Assessors Map&Parcel Numbers
30 011enne,/fn;Id IJrt4C 11/ /)-
1.1a Is this an accepted street?yes _t./.--no Map Number Parcel Number
1.3
607n ZoningEaformation: e'01' l / 1.4,P7roc ODimensions: CI Dimensions: r
Zoning District Proposed Use y 4 Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required /Provided Required Provided
5-- -- fl 6 7
1.6 Water pply:(M.O.1,c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private Zone. Outside Flood Zone? Municipal O On site disposal system iiK '
Check if yes0
.
•.. : ; SECTION 2::PROPERTY OWNERSHIP". ; r I. ::
2.1err of Record:
fine o c r.l1nc/ po%n.4 2L6- sli etran1 M19- Dao G7
Name(Print) City,State,ZIP
-1 L)i /J,et_il,s RoatI
No.and Street Telephone Email Address
SEC1'1ON 3'I)ESCRYPTION pF PRO14O510W14(2(check AIt that apply) '
New Construction O Existing Building 0 Owner-Occupied Repairs(s) 0 ` Alteration(s) 0 Addition l3'
Demolition O Accessory Bldg.0 er of Units_ Other 0 Specify:
Brief Description of ProposedWorlc: Aid;¢`�O er '- A- &-y Ai/ /ap)-' ell a
3 l x l n W ec J . tm!e a 15 .1- • -
d• . r t. re _
L* ±e .t t Ofd hr n o4- s ro e O-•L 54 rn j ::.- C E J v C ®
^• „ ',sECTIQN 4t EST11VIATED CONSTI(11703'IQ cio , :414
Item`( Estimated Costs r ;,--.......0,.2.;;,--:,.,.; rbresSii t ' ~ f F+ r• Q-, .
(Labor and Materials) ;,k ., i . : 2` ,1
1.Building $ 3 So-o >-).:BurldnrgPetmit.Eeesffi i 5O- iindi At ii t W rs.'..
—
2.Electrical $ �Stanflacd;Ctty/fown Apphesfiotl er
j Se 0 U.Tota1PtojectCost�?• t�em xmuktpliec i i >.
3.Plumbing $ 5-G O 2` Ctheil ees $+ r 3 ,;! t
4.Mechanical (HVAC) $ 1.5-e,-4 List " e r p S i
5.Mechanical (Fire r: v v. }. L + 'W f y ss ,,i*I ,`f Y t ',
Suppression)
$ .Total All Fees $ < ;i'
'heck Nd ' Check Amount' Casi '' ' ''±'
6.Total Project Cost $ 1 f- r
1/J GO �c3 Paiq m'Fnn , . ,,;'�Otustandmg pnatant:e I3ue ?is
• . .: - .. SECTION S:.CONSTRUCTION SERVICES .. ..
• 5.1 Constructionquperviso License(CSL) 03-1/39 G ^ _q
U
• 'V C) i4 to ht 4LSe LicenseNumber iratio Datatee o
Name of CSL Holder
44 �Rdf- �mo10t-( At✓y List CSL Type(see below) u
No.andStRet1YPe .. Desc
iption •
EA,
eU hen
thlhAi
O3.5-2c,
rip Unrestricted(Buildings up to Restricted l&2 Family Dwelling000 ca ft)
City/Town,State,ZIP M Masonry
RC Roofing Covering
� WS Window and Siding
OAR -:)1:3hlwe lltG3 n SI Burning A
PP
Insulation -
elephone Email address y4
C0.e len D Demolition I
5.2 R erect Hone Improvement Contractor(HIC) I S7 y 3 r , '7/h-/�/p
4 LJ•)� hi
ts-c HIC Registration Number Expiration Datea
HI Company Name HI eN e
c0 Eqf7-
telt hksy, LAI e. n�;c3 yBiihnc e eh
No' d � / Email address
LFd fKL Ole/4 "1l 11 3.1 �8—qb),
City/Town,State,ZIP Telephone//,f3
SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M. •G. .c.152.§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuanceceof the building permit.
Signed Affidavit Attached? Yes G� No 0 •
. SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf;in all matters relative to work authorized by this building permit application.
X ,t rso .57.� U t3- 117
Print Owner's Name(Electronic Signature) Date
• • SECTION 7b OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in :, y ation is and accurate to the best of my knowledge and understanding.
ier
Print a .er's or Agent's Name(Electronic Signature) ate
<.NOTES
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(RIC)Program),will t�or have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oc4Information on the Construction Supervisor License can be found at www,mass.gov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) 3 7 v (including garage,finished basement/attics,decks or porch)
GLOSS living area(sq.ft) '3 y/ Habitable room count .1
Number of fireplaces Number of bedrooms Q
Number of bathrooms nut l4 Number of half/baths 2
Type of heating system�V4 L Sp t ry d'dcr'i Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
• • • The Commonwealth of Massachusetts
• :p.
'l Department ofIndustrial Accidents
• eElO1= 1 Congress Street,Suite 100
V:1= Boston,MA 02114-2017
:,,;,.sl www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH TI3E PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): r '1 q /12ti/ k (, `e
Address: a co gq )j- �r �-i o k✓ lc✓y
City/State/Zip: �9 i i_ I ire t t%dS3 b
1`T � �( h hone#: .nr^ LL7/es
Are you an employer?Cheek the appropriate box:
Type of project(required):
L❑I em a employer with employees(MI and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodelin
any capacity.[No workers'comp.insurance required.] ❑ g
3. I em a homeowner loin all work 9. ❑D olition
❑ Bmyself.[No workers'comp.insurance required.]t
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 wilding addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
pro with no employees.
12.❑Plumbing repairs or additions
5. am a general contractor and t have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14.❑Other
152,I1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowner who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
.1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
.1 do hereby certi nder th airs and penalties of perjury that the information provided e is e and correct
Signature: Date: l
Phone#: SUk -1J k3
Official use only. Do not write in this area,to be completed by city or town official
•
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
0t''°'�R,� TOWN OF YARMOUTH
,; e o BUILDING DEPARTMENT
• 3 ::a,Gc e
o Y•i '� y 1146 Route 28,South Yarmouth,MA 02664
N� 1 508-398-2231 ext. 1261 Fax 508-398-0836
• BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR,Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 3 a G 4 -, 1 N{j/ PO /Dr.,frc
Work Address
Is to be disposed of at the following location: 430 u rkl C l-a LI/1/,-
Said
/,.Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signatu e of Application Date
Permit No.
•
, Massachusetts Department of Public Safety
iv Board of Building Regulations and Standards
License:CS-002439 _ .- _
Construction Supervisor
"130
MATTHEW MASE
200 EAST FALMOUTH HWY: .
EAST FALMOUTH MA-02538'
•
1%4:Zr C./.� Expiration:
• Commissioner 06262018
12,I vm
Prite W0 0/PdeadrAtid
• Office of Consumer Affairs and Business Regulation
` = 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 181438
Type: Individual
MATTHEW MASE _ F�ipira0orr 4t doh Trs 264342
MATTHEW MASE
200 EAST FALMOUTH HWY
EAST FALMOUTH, MA 02536
- Update Address and return card.Mark reason for change.
scAs 6 2asi-0snr o Address [J Renewal 0 Employment 0 Lost Card
diZacennneonweakA ofC �tzuaituuelld
c11- Mee of Consumer Affairs&Business Reguladon License or registration valid for individul use only
0. ""E`OME IMPROVEMENT CONTRACTOR
u before the expiration date. If found return to:
"ua Istration 181430 Type: Office of Consumer Affairs and Business Regulation
� Ex�ratlon Individual 10 Park Plaza-Suite 5170
.r7.9)11/4.R%9 Roston,MA 02116
MATTHEW MASE ..1%.•:".„-„: =-
MATTHEW MASE
200 EAST FALMOUTHFON1r •s - /�/`�/ — i — e/`
EAST FALMOUTH,MA 02518 � fir^
Uedeneerehq _ Not valid without signature
•
c' Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-002439 Expires:06/26/2020
•
MATTHEW MASE :-' - .
200 EAST FALMOUTH HWY 4 11,1we
EAST FALMOLITH MA 02536
Commissioner CAL
• ACORD Client#: DATE
TM
CERTIFICATE OF LIABILITY INSURANCE 01/03/2019
• THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is en ADDITIONAL INSURED,the pollcypes)must be endorsed.If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endoreement(s).
PRODUCER CONTACT Guilherme Camossato
,JAuo
PHONE 197817269830
DISCOVERY INSURANCE AGENCY LLC EMAIL GWWlaoveryODmvlcom
• 668 MAIN ST-UNIT A ADDRESS:
HYANNIS,MA 02601 Phone:
(508)7714600 Raphaeldiscoverytegmail.com
INSURER(S)AFFORDING COVERAGE NAIL
INSURED INSURER A:ATLANTIC CASUALTY
INSURER B:
FINISHING PLUS CARPENTRY INC INSURER C:
101 QUAKER ROAD INSURER D:TRAVELERS COMMERCIAL
HYANNIS,MA 02601 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
TO TALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRL ADDU SUER POLICY EFF POLICY LEP
TR TYPE OF INSURANCE NSR WD POLICY NUMBER IMMIDAANY) (1IMrDDM'YY) UMTS
A GENERAL M JTY EACH OCCURRENCE $ 1,000,000.00
•
W
X fmSEwarn,IL
RCVL GENERAL warn, pREE (RErviED
MISESOER RENTED
$ 100,000.00
CLAIMS-MADE Ix I OCCUR E)e IM
p E� MED V UP,w,I N $ 5,000.00
X AAHS1000016243 10/13/2018 10/13/2019 PERSONAL E AV INJURY $ 1,000,000.00
GENERAL AGGREGATE $ 2,000.000.00
71 peony
LMMtt APPLIES PERPROpKTS-COMPFV AGO S 2.000,000.00
X I Potty I I PROJECT I 'LCC -
B AUTOMOBILEWBIIIrY COMBINED SINGLE LIMIT
(Enteldwal
MY ANO BODILY EWRY(Pep...4
ALL OWNED AUTOS SCHEDULED
_firms
BOGEY INJURY ryELaMrXI
NONq•MEO PROPERTY DMMOE
HIRED AUTOS AUTOS
IPMweewe
NIIEREIUIMB CCCUII EACH OCCURRENCE
EXCESS LMB C1M4M
IS • MITIGATE
DED RETENIONS
D WORN ERS COMPENSATION WC STATUTORY 0TH
AND EP/GLOVERS'IMSNJTT LIMITS
µY PROPRIETORFIATNER,ENECLITNE 1r'. ... ER
OfFICERAEEBEREXCLUCEDL C EL.EACH ACCIDENT $ 1,000,00o.00
N/A N/A 6HUB1K23000318 3/8/2018 3/8/2019
,Mandatory In NH) ELDISEASE-EA EWILOY'EE $ 1.000.000.00
nws.sob.HES
DESCRRTKKH OF OPERATIONS tawE.L DISEASE $ 1.000.000.00
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Mach ACORD 101.Additions Rema,ka Sc edula.it mote space is required)
• Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement IAC 200306 B,no authorization is given to pay
claims for benefits to employees In stain other than Massachusetts N the insured hires,or has hired those employees outside of Massachusetts.
' This certificate of Insurance shows the policy In pee on the date that this certificate was issued(unless the expiration date on the above poky precedes the
issue date of this certificate of insurance).The status of this coverage can be monitored daily by accessing the Proof of Coverage•Coverage Verification
Search tool at wwwmess govaad'wo kers-compensatbrvbvestpations!
General Liability for regular end usual Jobs.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE IT IS THE CUSTOMER'S RESPONSABILITY TO INFORME ANY
MATTHEW MASE CHANGES OR CANCELATIONS.
30 CHANNEL POINT DRIVEW
WEST YARMOUTH,MA 02673 GUILHERME CAMOSSATO
1/1 01988.2010 ACORD CORPORATION.A8 rights reserved.
ot: eas TOWN OF YARMOUTH
•
°�
•oHEALTH DEPARTMENT
! a
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: >O C VI 4 /MQ/ f 0 t n4 /) nIe
Proposed Improvement: 5 - t a rh e 4-
rGat'-t 1-1/:111/i1th n (# q ,. l tlr+ G'/fri S N i'0
Applicant: VVI I q' ec / k"/ Gt IC J Tel. No.: Ye k 9 6 I k3
Address:a/0 Ca �� �l y or�� RCt . Eli !1 %/!M<N- h Date Filed: I /3 /1
0c)5tc
••lfyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: C a-hf n( ( I c /k4 L C
Owner Address: 3G C 1'l all tie / I' of J 00 rV vc Owner Tel.No.:
Y.4 rMru ig- '" .--__...__ ____._._-....__._ __....._-.._... .._._.._..__..._._....--_---._.......
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: AIL DATE: //CA
PLEASE NOTE
COMMENTS/CONDITIQNS: y
6.7 wt / unit 6' ctcac`t o /3 y-o rye el—
Ntcj goav-s ,-0 ( 4/t-! - at. 1, 049
•
YARMOUTH WATER DIVISION
99 BUCK ISLAND ROAD
•
WEST YARMOUTH, MA 02673
PH.: 508.771.7921
FAX: 508-771-7998
BUILDING PERMIT APPLICATION
DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET
Bldg. Site Location 3c C I?4h4 / rc, Dr* .
Proposed Improvement:
I ' S-4-ciy 4.c1 JI, 4tc h
Applicant: " l c tIiL' L"i,� Vc f
Address a-cc `r !} tr/Gicer-�q /Tel. #: 5otq 17/t3 Date Filed: k/3
far+ Fa/' 7ct-i1, "FP
�as3�
RESIDENTIAL AND / OR COMMERCIAL BUILDING
Water Department: Determines Compliance of Water Availability and or Existing Location
Engineering Department: Determines Compliance for Parking and Drainage
Conservation Commission: Determines Compliance to Wetlands Acts; I.e. If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc...
Health Department: Determines Compliance to State and Town Regulations, I.e., Requirements
for Septage Disposal and other Public Health Activities
Fire Department: Determines Compliance to State and Town Requirements for Personal,
Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc...
'/3 /�c
•
SigOture of applic. t Date
PLEASE NOTE:
COMMENTS:
•
Reviewe by:Water Division l Date
• {7 a- 3 git.
• ' Ralph Selomons .
7862-33-4-1977 r
NAME, �! J ..
-
' .STREET" . 30 CI?.Y,S'ELT. PO]:NT P12.11n; . LOT 4 ..
VILLAGE • .tSe lir-Milt . . •
• SERVICE NO. 7862 - 3 3
24,650c ia.-<!•ys goo ay
METER NO. e427/ .i/ FG714///' ,,0 1
d-• F
Ri
•
5-5-011,, Pt
kyr•«
cam,
•
•
fre r'
1711°"
.• 1
t
t% PPM" I/ /l't iht
rue, re OS t v t keN�
mar VRatr I"tmbfr �
< < Lter we TfmbAr b
all
i /�
yo•ct..37 ° .r Cii/l9NNe/ �aini D/tut.:
•
,
6'',P11-ar .
an y .,-
Hydra rli NO.. et?
di;1741i
j� ' \o Town of Yarmouth
of y Conservation Commission
."�•ori" Building Permit Sign-off Application
TO BE FILLED OUT BY APPLICANT:
Building Site Location: .4 OA4ifrini/ ash 4- Urike
Map # t y / Lot(s) # I I3—
Property Owner: CV) /cthh{ / eG; hT LL c
Applicant: h7rG�t•#11-L�,/ 1hl 2 f 11 /r
Applicant Address: d-G G rot i fri /Y4-7 c pr h 44 y Cc 14 frit /m 0,,-14
GkS3 6
Telephone: ,'frig- ' i 0)- '7/Pi Date Filed 1 IIC/l el
Proposed Project Descn ti
1 s4-n-y Add, t c h k, c//
of c i1,tqL 'f-c- J° etrec f Q
7 . h� c yyA / aro- S :o —
Plans: An /0 a top,�yc/ 4 /I/ofe o//n, 'ni Gi 30
Ch a mu/ form( DVf"re Esc aroup /2/3///s
TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR:
Do You Have A Valid Permit From The Conservation Commission For The Proposed
Project? yes
Comments from Conservatio• 'ommission.
Approved Conditionally Approved Rejected
All work related debris sha . . _• : 5 • . .isposed in a legal upland location
At the end of each day,the area shall be clean and no debris shall be in the Resource Area
Refer to: SE83- 2/-7 9 or DOA permit
at-4 /retonSAuo/zoo is/ /.e tith'-
Conservation Commission Sign-off Signature:
Date: l 110 /l G•
— ,SCOS✓ n tit
1�v o�� �`t o�.s
g.eLOnit 0rote O --;ol"Pc�.
Qvostem CO
•
REScheck Software Version 4.6.4
Ene Compliance Certificate
Project Cooper Residence
Energy Code: 2015 IECC
Location: West Yarmouth, Massachusetts
Construction Type: Single-family
Project Type: Addition
Climate Zone: 5 (6137 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
30 Channel Point Mathew Mase
West Yarmouth,MA
om. lancer 'asses usm•'UAtrade-o 1
Compliance: 7.2%Better Than Code Maximum UA: 138 Your UA: 128
The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Envelope Assemblies -
Gross Area Cavity Cont.
Assembly or R-Value R-Value U-Factor UA
Perimeter
Ceiling 1: Flat Ceiling or Scissor Truss 341 38.0 0.0 0.030 10
Wall 1:Wood Frame, 16"o.c. 604 21.0 0.0 0.057 28
Door 1: Glass 21 0.300 6
Window 1:Vinyl/Fiberglass Frame:Double Pane with Low-E 93 0.300 28
Floor 1:Slab-On-Grade:Unheated 82 10.0 0.684 56
Insulation depth: 4.0'
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements In
REScheck Version 4.6.4 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title Signature Date
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxi Page 1 of 9
ciREScheck Software Version 4.6Checklist.4
vs,
Energy Code: 2015 IECC •
Requirements: 0.0% were addressed directly in the REScheck software
Text In the "Comments/Assumptions" column is provided by the user in the REscheck Requirements screen. For each
requirement, the user certifies that a code requirement will be met and how that Is documented, or that an exception
is being claimed.Where compliance is itemized in a separate table, a reference to that table is provided.
Section Plans Verified Field Verified
# Pre-Inspection/Plan Review value Value Complies? Comments/Assumptions
& Req.ID
103.1, ;Construction drawings and 'r: ;❑Complies
103.2 'documentation demonstrate 4❑Does Not
[PRI], i energy code compliance for the 6
0 'building envelope.Thermal ' +❑Not Observable
envelope represented on j❑Not Applicable
I construction documents. - a
103.1, Construction drawings and ❑Complies
103.2, ;documentation demonstrate ❑Does Not
403.7 (energy code compliance for ,. I
[PR3]1 Ilighting and mechanical systems. ' ;❑Not Observable
+fd' ;Systems serving multiple ❑Not Applicable
Idwelling units must demonstrate I
'compliance with the IECC
Commercial Provisions. I.
302.1, " !Heating and cooling equipment Is Heating: Heating: OComplies
403.7 ;sized per ACCA Manual S based Btu/hr_ Btu/hr ❑Does Not
[PR2]2 I on loads calculated per ACCA Cooling: Cooling:
1 Manual J or other methods ONot Observable
Btu/hr Btu/hr
I approved by the code official. ❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 13 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 2 of 9
Section Plans Verified Field Verified
# Foundation InspectionValue ValueCompiles? Comments/Assumptions
& Req.ID
402.1.2 I Slab edge insulation R-value. R- R- ❑Complles See the Envelope Assemblies
(F0l]1 I 0 Unheated ❑ Unheated ❑Does Not table for values.
9
V 0 Heated 0 Heated ❑Not Observable
❑Not Applicable
402.1.2 iSlab edge Insulation ft _ft ['Complies See the Envelope Assemblies
[F03]1 Idepth/length. ❑Does Not table for values.
9 I ❑Not Observable
❑Not Applicable
303.2.1 'A protective covering Is Installed ❑Complies
[F011]2 Ito protect exposed exterior ( '❑Does Not
Insulation and extends a
{ ❑Not Observable
minimum of 6 M. below grade.
{ i❑Not Applicable
403.9 !Snow-and Ice-melting system [ ❑Complies
[F012]2 Icontrols Installed. I ' 1❑Does Not
if) I , - ❑Not Observable
! ❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 3 of 9
Section Plans Verified Field Verified •
# Framing/Rough-In Inspection value Value Complies? Comments/Assumptions
402.1.1, IGlazing U-factor(area-weighted U-_ U-_ ❑Complies See the Envelope Assemblies
402.3.1, Iaverage). ODoes Not table for values.
402.3.3, I
402.3.6, I ONot Observable
402.5 { ❑Not Applicable
[FR211
iii i
303.1.3 I U-factors of fenestration products ; ❑Complies
[FR4]1 fare determined In accordance 'ODoes Not
a !with the NFRC test procedure or t I 1❑Not Observable
taken from the default table.
I ❑Not Applicable 1
402.4.1.1 lAir barrier and thermal barrier I ;❑Complies
[FR23]1 'Installed per manufacturer's i❑Does Not
,$ !Instructions.
LJ Observable
` ONot Applicable
402.4.3 I Fenestration that is not site built ' ❑Complies
[FR2011 is listed and labeled as meeting ❑Does Not
HAMA/WDMA/CSA 101/I.S.2/A440 I
a or has infiltration rates per NFRC , ❑Not Observable
'400 that do not exceed code ❑Not Applicable
limits.
402.415 jIC-rated recessed lighting fixtures[ ❑Complies
[FR16]2 Isealed at housing/interior finish [ ;❑Does Not
land labeled to Indicate s2.0 cfm } ❑Not Observable
;leakage at 75 Pa. [$ „❑Not Applicable
403.2.1 i{Supply and return ducts in attics 1 .❑Complies
[FR12]1 !insulated >= 11-8 where duct Is ODoes Not
>=3 Inches in diameter and >_ !❑Not Observable
IR-6 where< 3 Inches.Supply and
{return ducts in other portions of a❑Not Applicable
(the building insulated >= R-6 for
I diameter>=3 inches and R-4.2
;for< 3 Inches In diameter. 1
403.3.3.5 Building cavities are not used as i ❑Complies
[FR1511 (ducts or plenums.
ODoes Not
a I ONot Observable
I ONot Applicable
I 1
403.4 HVAC piping conveying fluids R- R- ❑Complies
[FR1712 above 105 aF or chilled fluids ODoes Not
below 55 vF are Insulated to ZR-
❑Not Observable
O Not Applicable 1
403.4.1 :Protection of Insulation on HVAC ,❑Complies
t
[11124]1 piping. 1 ❑Does Not
11 I ONot Observable
I i ONot Applicable
403.5.3 Hot water pipes are Insulated to R- R- ❑Complies
[FR1812 aR-3. ODoes Not
30 ONot Observable
O Not Applicable
403.6 ;Automatic or gravity dampers are I ,OComplies
[FR1912 'Installed on all outdoor air ODoes Not
'I
Intakes and exhausts. `❑Not Observable
I ❑Not Applicable
Additional Comments/Assumptions:
1 High Impact (Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 4 of 9
.tel
1 High Impact(Tier 1) 2 IMedlum Impact(Tier 2) I 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 5 of 9
Section Plans Verified Field Verified
e#cop Insulation Inspection value` Value Complies? Comments/Assumptions
303.1 I All Installed Insulation is labeled " ❑Complies
flN13]2 'or the installed R-vaiues =❑Does Not
•V !provided.
❑
{ Not Observable
p' ❑Not Applicable
402.1.1, {Wall Insulation R-value.If this Is a R- R- ❑Complies See the Envelope Assemblies
402.2.5, I mass wall with at least'h of the ❑Wood 0 Wood ❑Does Not table for values.
402.2.6wall insulation on the wall
(INV ;exterior,the exterior insulation ❑ Mass ❑ Mass [Not Observable
4 requirement applies(FR10). ❑ Steel ❑ Steel ❑Not Applicable
303.2 (Wall insulation is installed per ❑Complies
[IN4]' ;manufacturer's instructions. J❑Does Not
{ !
I .;❑Not Observable
❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 6 of 9
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
&Req.ID
402.1.1, ;Ceiling insulation R-value. R- R- ❑Complies See the Envelope Assemblies
402.2.1, ; ID Wood ❑ Wood ODoes Not table for values.
402.2.2, ❑ Steel 0 Steel ONot Observable
[FII]1)2 ONot Applicable
[F
ii
303.1.1.1,;Ceiling Insulation Installed per 4 ';❑Complies
303.2 ;manufacturer's Instructions. ODoes Not
[FI2]1 !Blown Insulation marked every 1 ❑Not Observable
300 IV f. ,
❑Not Applicable
402.2.3 Vented attics with air permeable
[F12212 insulation include baffle adjacent I ODoes Not
to soffit and eave vents that
extends over insulation. ONot Observable
f '❑Not Applicable 1
402.2.4 'Attic access hatch and doorR-_ R- ❑Complies
[FI3]2 1 insulation zR-value of the ODoes Not
!adjacent assembly.
ONot Observable
ONot Applicable 1
402.4.1.2 ;Blower door test @ 50 Pa. <=5 ACH 50= ACH 50 =_ ❑Complies
(FI17]1 'ach In Climate Zones 1-2, and ❑Does Not
<=3 ach in Climate Zones 3-8. ONot Observable
E I I ONot Applicable
403.2.3 'Duct tightness test result of<=4 dm/100 dm/100 ❑Complies
[FI4]1 ;cfm/100 ft2 across the system or ftr— fr ODoes Not
I<=3 dm/100 ft2 without air ONot Observable
handler @ 25 Pa. For rough-In ❑Not Applicable
tests,verification may need to pP
(occur during Framing Inspection. ,
403.3.2 'Ducts are pressure tested to cfm/100 dm/100 ❑Complies
(F12712 Idetermine air leakage with T ft2 ODoes Not
either: Rough-in test:Total ❑Not Observable
!leakage measured with a
;pressure differential of 0.1 inch ONot Applicable
Iw.g. across the system including
Ithe manufacturer's air handler
enclosure if installed at time of
test. Postconstructlon test:Total
leakage measured with a
pressure differential of 0.1 Inch
I w.g.across the entire system
;Including the manufacturer's air
handler enclosure.
403.3.2.1 ;Air handler leakage designated j ;❑Complies
[F124]' Iby manufacturer at<=2%of P ODoes Not
'design air flow. k ;❑Not Observable
❑Not Applicable 1
403.1.1 1 Programmable thermostats 1 ;❑Complies
[FI9]2 installed for control of primary I "❑Does Not
heating and cooling systems and g
'initially set by manufacturer to ❑Not Observable
'code specifications. ONot Applicable
403.1.2 (Heat pump thermostat Installed ❑Complies
(FI10)2 Son heat pumps. '4❑Does Not
❑Not Observable
t ONot Applicable 1
403.5.1 'Circulating service hot water {. ❑Complies
(F1ll]2 !s
yes have automatic or ODoes Not
accessible stmmanual controls. '❑Not Observable
ONot Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 7 of 9
•
Section Plans Verified Field Verified •
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
&Req.ID
4016,1 ;All mechanical ventilation system ❑Complies
[F125]2 ;fans not part of tested and listed '❑Does Not
I HVAC equipment meet efficacy t
;and air flow limits. ;❑Not Observable
❑Not Applicable
403.2 I Hot water boilers supplying heat i ;❑Complies
[F126]2 ;through one-or two-pipe heating ❑Does Not
=!systems have outdoor setback ❑Not Observable
control to lower boiler water
;temperature based on outdoor I ,❑NotApplicable
I temperature.
p
403.5.1.1.IHeated water circulation systems '. " ;❑Complies
[FI28]2 I have a circulation pump.The 1 1 t❑Does Not
)system return pipe is a dedicated
)return pipe or a cold water supplyf ;❑Not Observable
{pipe.Gravity and thermos- " +!❑Not Applicable
'syphon circulation systems are S
•
;not present.Controls for
'circulating hot water system I`p
(pumps start the pump with signal
for hot water demand within the 1Ioccupancy.Controls l' C
, I automatically turn off the pump
,when water is in circulation loop ;
1 is at set-point temperature and E
I no demand for hot water exists. y
403.5.1.2 I Electric heat trace systems ;❑Complies
[F129]2 ;comply with IEEE 515.1 or UL ❑Does Not
515.Controls automatically ❑Not Observable
adjust the energy input to the
heat tracing to maintain the ❑Not Applicable
I desired water temperature in the i
!piping. j
403.5.2 ;Water distribution systems that " •❑Complies
[F130]2 -II have recirculation pumps that •❑Does Not
pump water from a heated water Observable
supply pipe back to the heated ❑Not A
II water source through a coldApplicable
1 water supply pipe have a
demand recirculation water
!system. Pumps have controls i
`that manage operation of the x
;pump and limit the temperature
of the water entering the cold
Iwater piping to 104°F.
403.5.4 I Drain water heat recovery units ',g❑Complies
[F131]2 •;tested In accordance with CSA 1 I❑Does Not
1655.1.Potable water-side
I pressure loss of drain water heat ,❑Not Observable
recovery units<3 psi for •
LJ
Applicable
Individual units connected to one ;
1
or two showers.Potable water-
]side pressure loss of drain water dE
heat recovery units< 2 psi for
individual units connected to
;three or more showers.
404.1 175%of lamps in permanent I ❑Complies
(FI611 fixtures or 75%of permanent ODoes Not
fixtures have high efficacy lamps. ❑Not Observable
Does not apply to low-voltage
lighting. ❑Not Applicable
404.1.1. -;Fuel gas lighting systems have s,:'I❑Compiies
[F123)3 Ino continuous pilot light. »❑Does Not
tio. I y❑Not Observable
1 1 'i❑NotApplicable
1 High Impact(Tier 1) I 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 8 of 9
, Section Plans Verified Field Verified
# Final Inspection ProvisionsValue Value': Complies?., Comments/Assumptions
&Req.ID
401.3 (Compliance certificate posted. I "I❑Complles
[FI7]' I ❑Does Not
ONot Observable
f ;❑Not Applicable
303.3 Manufacturer manuals for ((( ❑Complies
(F118]3 I mechanical and water heating I "❑Does Not
systems have been provided, I[Not Observable
j❑Not Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Cooper Residence Report date: 01/11/19
Data filename: Untitled.rxl Page 9 of 9
,E4 2015 IECC Energy
Efficiency Certificate
Insulatio 'ating
Above-Grade Wall 21.00
Below-Grade Wall 0.00
Floor 10.00
Ceiling / Roof 38.00
Ductwork (unconditioned spaces):
Glass&Door Rating ll- actor'
Window 0.30
Door 0.30
Heating&Cooling Equipment
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments