HomeMy WebLinkAboutBLDR-25-275 application RECEIVED
O NE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth BuildingDepartment �' Yq
JUN 3 2025 P �O -t4\
1146 Route 28, South Yarmouth,MA 02664-4492 h
BUILDING DEPARTMENT ho,‘
508-398-2231 ext. 1261 Fax 508-398-0836 is __
By. Massachusetts State Building Code,780 CMR �, 4'
Building Permit Application To Construct, Repair, Renovate Or Demolish ��e 4^
a One-or Two-Family Dwelling �RPORATEo
This Section For Official Use Only
►ry -�
Building Permit Number: , 2S Date Applied:
Building Official(Print Name) ' Signature Date
SECTION 1: SITE INFORMATION
Property Mdd[es 1.2 Assessors Map&Parcel NumberstoVAfW `fA fad is% 48
1
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R •1445 14 14% 244 .14
Zoning District Proposed Use Lot Afea(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
30 35°.4 et, 45.2 20 3/. i
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public% Private 0 Zone: X Outside Flood Zone? Municipal 0 On site disposal system ..
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record
-o t L�'R'�t�: 1 t'Vr
Name(Print) City,State,ZIP
(a eWettt LA qA IOACCAA 114•4t1 .Wt.. aaweAtEM �1«.�604ECeP
No.and Street b2015 Telephone Email Address •e>s
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition x'
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work':ATM •6 QQey- elrime •10Ecy...
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 30 OcDO 1. Building Permit Fee:$ Indicate how fee is determined:
( 0 Standard City/Town Application Fee
2.Electrical $ �)poC 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ rj, 2. Other Fees: $
4.Mechanical (HVAC) $ 1 p,ci�,'a List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
,/� Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ -j�ji:;GC) 0 Paid in Full 0 Outstanding Balance Due:
d. n nl'S S-ecAshor� ho rvu5
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 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�tt�vy lOk+Iiefaa•wp Lefo1/4.01.1 U
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
;(.Boy enter' Rmy n.' e be•:,'�-by attest under the rate to thepains and be t of p knowled s f perjury that all e and understanding.
theinformation
Gr 1 f my g g•
Print Owner's or Au . . •gent's Name(Electronic Signature) Date
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(HIC)Program),will not 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Thee Commonwealth of Massachusetts
�\ Department of Industrial Accidents
Y
72 1s Office of Investigations
== s.J Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeEibly
Name (Business/Organization/Individual): . t ) J Jj Rblp—�
Address: i'D .eMj 46+ ,4 L. -)
City/State/Zip: iv PcXr Phone #: 17 Li •4 8? •$'D'co
1+tt2wY�yT
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have n Demolition
working for me in any capacity. employees and have workers'
insurance.* n Building addition
[No workers' comp. insurance comp. I I�.n Electrical repairs or additions
required.] 5. ❑ We are a corporation and its
3. I am a homeowner doing all work officers have exercised their 1 1.n Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners 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.
I 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. Lic. #: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 an' • 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 d., agai st the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of th; DIA fo insurance I erage verification.
I do hereby c ify i h a 4 'ail'es of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: 114 ' 44 •iq vL
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
11=1Board of Health 20 Building Department 3E1City/Town Clerk 4.1:Electrical Inspector 50Plumbing
Inspector 6.0Other
Contact Person: Phone#:
TOWN OF YARMOUTH
YA \\ Office of the Building Commissioner
Y z, --5`, 1146 Route 28, South Yarmouth, MA 02664
� 508-398-2231 ext. 1260 Fax 508-398-0836
as HOMEOWNER LICENSE EXEMPTION
DATE:/i/!. /z
JOB LOCATION: Ib. ..zlkAS)16% .S L.A.J's, i MAAAPt. 24:11"T-
NAME STREET ADDRESS SECTION OF TOWN
HOMEOWNER '11'+ ' 07' gD
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 11) V ¢ Y L ~ •
`46•4200.514 cQQ cr 1U . D2(o'11j
CITY OR TOWN STATE ZIP CODE
Definition of Homeowner:
Person(s)who owns aparcel ofland on which he or she resides or intends to reside,on which there is or is intended
to be, a one or two family attached or detached structure accessory to such use and/or farm structures. A person
who constructs more than one home in a two-year period shall not be considered a homeowner.
Any homeowner performing work for which a building permit is required shall be exempt from the licensing
provisions of780 CMR 110.R5,provided that if a homeowner engages a person(s)for hire to do such work, then
such homeowner shall act as supervisor. This exception shall not apply to the field erection of manufactured
buildings constructed pursuant to 780 CMR 110.R3
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes, by-laws,rules and regu . ' ,and certifies that he or she understands the Town of Yarmouth
Building Department minimum inspecti, procedures and r-- -ments and that he or she will comply with said
procedures and requirements.
Jam'
HOMEOWNER"S SIGNATURE
TOWN OF YARMOUTH
ryO Y9�'TA
Office of the Building Commissioner
1146 Route 28, South Yarmouth, MA 02664
�`b,4Hn0 PAT EO�yc'�
508-398-2231 ext. 1260 Fax 508-398-0836
DEMOLITION DEBRIS DISPOSAL APPLICATION
Pursuant to M.G.L. c.40 §54 and 780 CMR Section 105.3.1 #4.
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at. 4.) 41 ITV fail- ��11
Work Address , �
Is to be disposed of at the following location: "Elcv
Said 4ispos. site shall b- a licensed solid waste facility as defined by M.G.L.
Cha,,ter 111, §150A.
t�
Sri ure of Tip Date
Permit No.
L0r,,, TOWN OF YARMOUTH 1AV°..h S [lj)
. .3 1146 ROUTE 28,SOUTH YARMOUTH,MA 02664-4451
Telephone(508)398-2231 Ext.1292—Fax(508)398-0836 MAY 0 q 2025
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
?ARMOUR!TOWN CLERK RE APPLICATION FOR Old stori s Highway
HAY 29 25 AH9:26 CERTIFICATE OF APPROPRIATENESS Historic District
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,Acts of 1973 as
amended,for proposed work as described below&on plans,drawings,photographs,&other supplemental info accompanying this
application, PLEASE SUBMIT 4 Copies OF SPEC SHEET(S),ELEVATIONS,PHOTOS,&SUPPLEMENTAL INFORMATION.
Check All Categories That Apply: Indicate type of Building. Commercial ✓Residential
1)Exterior Building Construction: New Building Addition _Alterations Reroof Garage
Shed _Solar Panels _Other: Ss.k1.1 0e611)A 4 efeibb3 rCK4,611114. clt-
2)Exterior Painting: ✓Siding Shutters Doors ✓Trim ''Other:
3)Signs/Billboards: New Sign Change to Existing Sign
4)Miscellaneous Structures: _Fence Wall Flagpole Pool Other:
Please type or print legibly:
�n ,.��w / �-` l{ }f1LT �f b
Address'offpro_posedd work:
VD V AKSINWI) UJW�C.'1,(4 rq� Map/Lot# 14 II`.48 t�
210
Owner(s):1JI OLA4.4 ° 'n►,v1Ps5C4 l D '73 Phone#:T?4 4ST.-to%
All applications must be submitted by owner or accompanied by letter from owner approving submittal)of application.
Mailing address: toe P� c.,4 1 � �.r7 D Year built 2616
Email:0•e%�t'ba$130s CA ^Preferred notification method: Phone ✓ Email
Agent/contractor: Dv-Nut's Phone#:
Mailing Address- 511r.„
Email: Preferred notification method Phone ✓ Email
Description of Proposed Work:
ADD 6a�JtabCJMS AzD c1C To Fy.�sct.wc. �.
E,c'ftQ. 4. ev 5tAc....0.0,
i :- _ colo,Q tb wAtt -c,nlwtat4'Magni►Ns.. E
M�TM.d2,00c Co ;...•ut,..4.1.2.2..«ye»a 12.6dF
ik ! J/ t
Signed(Owner or agent): �� Date' a/` e.5
Ownercontractoragent is aware that a permit is requir•• rom the Building Department(Check other departments also
If application is approved approval is subject to a 10-day appeal period required by the Act
This certificate is good for one year from approval date or upon date of exp ration of Building Permit whichever date shall be later
All new construction will be subject to.specnon by OKH.OKH-approved plans MUST be available on s'•te for tram ng&final inspections
For Committee use only: Approved Approved with_Modifications�l14?> U 6js �����`
...,
, 1'UtJL
Rcvd Date '�f� Reason for Demal_.
Amount LA
CashiCKa (05�7 NAY J 2A24
Signed:
Rcvd by' Li 5 J --
t in ,Highway
45 Days:
S.f�, -e e) -1
Date Signed ? !��9„3,�. . /1=z1-s 4'.._
1' 2 5 - A 0 6 5
APPLICATION#:
•
Generated by REScheck- Web Software
'4#°°°14111;- s
a. Aie
Compliance Certificate
..
. ,.,
:„..
Project 10 Embassy Lane
Energy Code: 2021 IECC
Location: Yarmouth Port, Massachusetts
Construction Type: Single-family
Project Type: Addition
Project SubType: None
Orientation: Bldg. faces 90 deg. from North
Climate Zone: 5 (6137 HDD)
Permit Date:
Permit Number:
All Electric false
Is Renewable false
Has Charger false
Has Battery: false
Has Heat Pump: false
Construction Site: Owner/Agent: Designer/Contractor:
Compliance: Passes using UA trade-off
Compliance: 0.0% Better Than Code Maximum UA: 68 Your UA: 68
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.
Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade
assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements.
Envelope Assemblies
Gross Area Cavity Cont. Prop. Req. Prop. Req.
Assembly or R-Value R-Value U-Factor U-Factor UA UA
Perimeter
Ceiling: Steel joist/Rafter, 16in. o.c. 430 60.0 0.0 0.026 0.024 11 10
Wall: Wood Frame, 16" o.c. 128 30.0 0.0 0.049 0.045 4 3
Orientation: Front
Window A: Vinyl Frame 53 0.280 0.300 15 16
Orientation: Front
Wall 2: Wood Frame, 16" o.c. 192 30.0 0.0 0.049 0.045 7 6
Orientation: Right side
Window A: Vinyl Frame 53 0.280 0.300 15 16
Orientation: Right side
Wall 3: Wood Frame, 16" o.c. 128 30.0 0.0 0.049 0.045 4 4
Orientation: Back
Door: Glass Door (over 50% glazing) 22 0.280 0.300 6 7
Orientation: Back
Window B: Vinyl Frame 10 0.280 0.300 3 3
Orientation: Back
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 1 of10
Gross Area Cavity Cont. Prop. Req. Prop. Req.
Assembly or R-Value R-Value U-Factor U-Factor UA UA
Perimeter
Window B:Vinyl Frame 10 0.280 0.300 3 3
Orientation: Back
Energy Credits
Not a..licable
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 2021 IECC requirements in
REScheck Version : REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title Signature Date
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 2 of10
r * REScheck Software Version : REScheck-Web
Inspection Checklist
Energy Code: 2021 IECC
Requirements: 100.0% 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.
i Section i
# Pre-Inspection/Plan Review Plans Verified i Field Verified Complies? Comments/Assumptions
& Req.ID Value Value
f 103.1, Construction drawings and ❑Complies Requirement will be met.
103.2 documentation demonstrate ❑Does Not
[PR1]1 energy code compliance for the
building envelope. Thermal ❑Not Observable
envelope and energy compliance ❑Not Applicable
path represented on construction
documents.
103.1, Construction drawings and ❑Complies Requirement will be met.
103.2, documentation demonstrate ❑Does Not
403.8 energy code compliance for
[PR3]1 lighting and mechanical systems. [Not Observable
Systems serving multiple ❑Not Applicable
dwelling units must demonstrate
compliance with the IECC
I Commercial Provisions.
302.1, Heating and cooling equipment is Heating: Heating: ❑Complies Requirement will be met.
403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not
[PR2]2 on loads calculated per ACCA Cooling: Cooling:
Manual J or other methods ['Not Observable
approved by the code official. Btu/hr Btu/hr ❑Not Applicable
I
Additional Comments/Assumptions:
1 ;High Impact(Tier 1) ; 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) i,
Project Title: 10 Embassy Lane Report date: 05/27/25
Page 3 of10
Data filename:
•
Section
Foundation Inspection Complies? Comments/Assumptions
&Req.iD
303.2.1 A protective covering is installed to ❑Complies Requirement will be met.
[FO11]2 protect exposed exterior insulation ❑Does Not
and extends a minimum of 6 in. below
grade. ❑Not Observable
ONot Applicable
403.9 Snow and ice-melting system controls ❑Complies Requirement will be met.
[F012]2 installed to shut off system when ❑Does Not
pavement temperature> 50F and no
precipitation. Not Observable
❑Not Applicable
Additional Comments/Assumptions:
11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 4 of10
Section Plans Verified Field Verified
# Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions
&Req.lD
402.1, Glazing U-factor(area-weighted U- U- DComplies See the Envelope Assemblies
402.3.1, average). ❑Does Not table for values.
402.3.3,
402.5 ❑Not Observable
(FR2]1 [Not Applicable
303.1.3 U-factors of fenestration products ❑Complies Requirement will be met.
[FR4]1 are determined in accordance ❑Does Not
with the NFRC test procedure or
taken from the default table. :Not Observable
❑Not Applicable
402.4.1.1 Air barrier and thermal barrier DComplies Requirement will be met.
[FR23]1 installed per manufacturer's ❑Does Not
instructions.
['Not Observable
❑Not Applicable
402.4.3 Fenestration that is not site built DComplies Requirement will be met.
[FR2011 is listed and labeled as meeting DDoes Not
AAMA/WDMA/CSA 101/I.S.2/A440
or has infiltration rates per NFRC ❑Not Observable
400 that do not exceed code ❑Not Applicable
limits.
402.4.5 IC-rated recessed lighting fixtures ['Complies Requirement will be met.
[FR16]2 sealed at housing/interior finish ❑Does Not
and labeled to indicate s2.0 cfm ONot Observable
leakage at 75 Pa. ❑Not Applicable
403.3.1 Supply and return ducts in attics DComplies Requirement will be met.
[FR12]1 insulated >= R-8 where duct is ❑Does Not
>=3 inches in diameter and >_
R-6 where < 3 inches. ❑Not Observable
❑Not Applicable
403.3.4 Ducts, air handlers and filter ❑Complies Requirement will be met.
(FR13]1 boxes are sealed with ❑Does Not
joints/seams compliant with
International Mechanical Code or ❑Not Observable
International Residential Code, as ❑Not Applicable
applicable.
403.3.7 Building cavities are not used as DComplies Requirement will be met.
[FR15)3 ducts or plenums. ❑Does Not
['Not Observable
❑Not Applicable
403.4 HVAC piping conveying fluids R-
_____ R- DComplies Requirement will be met.
[FR17]2 above 105 9F or chilled fluids ❑Does Not
below 55 9F are insulated to zR-
3 :Not Observable
❑Not Applicable
403.4.1 Protection of insulation on HVAC DComplies Requirement will be met.
[FR24]1 piping. ❑Does Not
❑Not Observable
❑Not Applicable
402.4.6 Electrical and communication DComplies Requirement will be met.
[FR29)3 boxes installed in the thermal ❑Does Not
boundary of the envelope sealed
to limit air leakage between ❑Not Observable
conditioned and unconditioned ❑Not Applicable
spaces.
403.5.2 Hot water pipes are insulated to R- R- DComplies Requirement will be met.
[FR18]2 >_R-3. ❑Does Not
:Not Observable
❑Not Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 5 of10
Section Plans Verified Field Verified
# Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions
&Req.ID
403.6 Automatic or gravity dampers are ❑Complies Requirement will be met.
[FR19]2 installed on all outdoor air ❑Does Not
intakes and exhausts for
mechanical ventilation systems. DNot Observable
:Not Applicable
403.6.1 Ventilation systems in climate ❑Complies Requirement will be met.
[FR30]2 zones 7 &8 shall utilize heat or ❑Does Not
energy recovery
❑Not Observable
ONot Applicable
Additional Comments/Assumptions:
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 6 of10
I
Section Insulation Inspection Plans Verified I Field VerifiedComplies? I Comments/Assumptions
Valuealue
& Req.ID
303.1 All installed insulation is labeled ❑Complies Requirement will be met.
[IN13]2 or the installed R-values ❑Does Not
provided.
['Not Observable
❑Not Applicable
402.1, Wall insulation R-value. If this is a R- R- ❑Complies See the Envelope Assemblies
402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood ❑Does Not table for values.
402.2.6 wall insulation on the wall
[IN3]1 exterior, the exterior insulation ❑ Mass ❑ Mass ❑Not Observable
requirement applies (FR10). ❑ Steel ❑ Steel ❑Not Applicable
303.2 Wall insulation is installed per ❑Complies Requirement will be met.
[IN4]' manufacturer's instructions. ❑Does Not
❑Not Observable
❑Not Applicable —I
Additional Comments/Assumptions:
1 ;High Impact(Tier 1) j 2 ;Medium Impact(Tier 2) 13 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 7 of10
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
& Req.ID
403.2 Hot water boilers supplying heat ❑Complies Requirement will be met.
[F126]2 through one-or two-pipe heating ODoes Not
systems have automatic outdoor
setback control to lower boiler Not Observable
water temperature based on ❑Not Applicable
outdoor temperature, indoor
temperature or water
temperature sensing.
403.5.1.1 Heated water circulation systems ❑Complies Requirement will be met.
[FI28]2 have a circulation pump.The ODoes Not
system return pipe is a dedicated
return pipe or a cold water supply Not Observable
pipe.Gravity and thermos- ❑Not Applicable
syphon circulation systems are
not present. Controls for
circulating hot water system
pumps start the pump with signal
for hot water demand within the
occupancy. Controls
automatically turn off the pump
when water is in circulation loop
is at set-point temperature and
no demand for hot water exists.
403.5.1.2 Electric heat trace systems ❑Complies Requirement will be met.
(FI29)2 comply with IEEE 515.1 or UL ODoes Not
515.Controls automatically
adjust the energy input to the Not Observable
heat tracing to maintain the ❑Not Applicable
desired water temperature in the
piping.
403.5.3 Drain water heat recovery units ❑Complies Requirement will be met.
[F131)2 tested in accordance with CSA ❑Does Not
B55.1. Potable water-side
pressure loss of drain water heat ❑Not Observable
recovery units<3 psi for ❑Not Applicable
individual units connected to one
or two showers.Potable water-
side pressure loss of drain water
heat recovery units<2 psi for
individual units connected to
three or more showers.
403.6.2 All mechanical ventilation system ❑Complies Requirement will be met.
(F12512 fans not part of tested and listed ODoes Not
HVAC equipment meet efficacy
and air flow limits per Table Not Observable
R403.6.2. ❑Not Applicable
403.6.3 Mechanical ventilation systems ❑Complies Requirement will be met.
[F133]2 tested and verified to meet the ODoes Not
minimum flow rates required by
Section R403.6. ['Not Observable
❑Not Applicable
403.5.1.1. Demand recirculation water ❑Complies Requirement will be met.
1 systems have automatic controls ODoes Not
[F132]2 to start pump when hot water is
requested. ❑Not Observable
❑Not Applicable
404.1 100%of permanent fixtures have ❑Complies Requirement will be met.
(F16)1 high efficacy lamps. ❑Does Not
:Not Observable
ONot Applicable
404.1.2 Fuel gas lighting systems have ❑Complies Requirement will be met.
[F123)3 no continuous pilot light. ODoes Not
❑Not Observable
❑Not Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 9 of10
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
& Req.ID J
404.1.1 Exterior lighting for multifamily ❑Complies Requirement will be met.
[FI35]3 buildings shall comply with ❑Does Not
Section C405.4.
ONot Observable
ONot Applicable
404.2 Permanent interior lighting shall ❑Complies Requirement will be met.
[FI36]3 be controlled with either a ❑Does Not
dimmer,occupancy sensor or
other control built into the ❑Not Observable
fixture. ONot Applicable
404.3 Exterior lighting >= 30 watts ❑Complies Requirement will be met.
[F137]3 shall have the following controls: ❑Does Not
manual on/off switch with
automatic shut-off, automatic ❑Not Observable
shut-off in daylight hours, and ONot Applicable
controls that override automatic
shutoff that returns to automatic
control within 24 hours.
401.3 Compliance certificate posted ❑Complies Requirement will be met.
[F17)2 with building specifications and ❑Does Not
compliance path and results.
:Not Observable
ONot Applicable
303.3 Manufacturer manuals for ❑Complies Requirement will be met.
[F118]3 mechanical and water heating ❑Does Not
systems have been provided.
ONot Observable
ONot Applicable
Additional Comments/Assumptions:
l 1 High Impact(Tier 1) 2 'Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 10 of10
r2021 IECC Energy
At4; Efficiency Certificate
Above-Grade Wall 30.00
Below-Grade Wall o.00
Floor o.00
Ceiling/Roof 60.00
Ductwork(unconditioned spaces):
Glass&Door Rating U-Factor SHGC
Window 0.28
Door 0.28
Heating&Cooling Equipment Efficiency,x };-
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
Section Plans Verified iField Verified
# Final Inspection Provisions Value i Value Complies? Comments/Assumptions
& Req.ID
402.1, Ceiling insulation R-value. R- R- ❑Complies See the Envelope Assemblies
402.2.1,
❑ Wood [] Wood ❑Does Not table for values.
402.2.2,
402.2.E ❑ Steel ❑ Steel ❑Not Observable
[F11)1 ❑Not Applicable
303.1.1.1, Ceiling insulation installed per ❑Complies Requirement will be met.
303.2 manufacturer's instructions. ❑Does Not
[F12]1 Blown insulation marked every
300 ft2. ❑Not Observable
❑Not Applicable
1402.2.3 Vented attics with air permeable ❑Complies Requirement will be met.
I[F122j2 insulation include baffle adjacent ❑Does Not
to soffit and eave vents that
extends over insulation. :Not Observable
❑Not Applicable
1402.2.4 Attic access hatch and door R- R- ❑Complies Requirement will be met.
i[F13]1 insulation ?R-value of the ❑Does Not
{ adjacent assembly.
❑Not Observable
❑Not Applicable
1402.4.1.3 Blower door test @ 50 Pa. <_5.0 ACH 50 = ACH 50 = ❑Complies Requirement will be met.
i[F117]1 ach in Climate Zones 1-2, and ❑Does Not
<=3.0 ach in Climate Zones 3-8.
:Not Observable
❑Not Applicable
403.3.5 Ducts are pressure tested in cfm/100 cfm/100 OComplies Requirement will be met.
[F127]1 accordance with ft2 ft2 ❑Does Not
ANEi/RESNET/iCC 380 or
ASTME1554 to determine air [Not Observable
leakage with either: Rough-in ❑Not Applicable
test: Total leakage measured
with a pressure differential of 0.1
inch w.g. across the system
including the manufacturer's air
handler enclosure if installed at
time of test. Postconstruction
test: Total leakage measured
with a pressure differential of 0.1
inch w.g. across the entire
system including the
manufacturer's air handler
enclosure.
403.3.6 Duct tightness test result of <=4 cfm/100 cfm/100 ❑Complies Requirement will be met. —�
[FI4]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not
<=3 cfm/100 ft2 without air
handler @ 25 Pa. Duct tightness ['Not Observable
<= 8 cfm/100 ft2 for ducts within ❑Not Applicable
thermal envelope. For rough-in
tests, verification may need to
occur during Framing Inspection.
1403.3.4.1 Air handler leakage designated ElComplies Requirement will be met.
[FI24]1 by manufacturer at <=2% of ❑Does Not
design air flow. ❑Not Observable
[Not Applicable
403.1.1 Programmable thermostats OComplies Requirement will be met.
[FI9]2 installed for control of primary Does Not
heating and cooling systems and
initially set by manufacturer to ❑Not Observable
code specifications. ❑Not Applicable
403.5.1 Circulating service hot water OComplies Requirement will be met.
[FI11]2 systems have automatic or ❑Does Not
accessible manual controls.
['Not Observable
[Not Applicable
1 High Impact (Tier 1) 2 !Medium impact (Tier 2) 3 jj..ow Impact (Tier 3)
Project Title: 10 Embassy Lane Report date: 05/27/25
Data filename: Page 8 of10