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HomeMy WebLinkAbout51043-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY l pP BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51043 Date: 8/7/2024 Permission is hereby granted to: Os ina, Aidderman R 7 Carriage Ln Southampton, NY 11968 To: construct additions and alterations and to legalize "as built" finished second floor to existing single-family dwelling as applied for. Additional certification may be required. At premises located at: 435 N Ba view Road Ext, Southold SCTM # 473889 Sec/Block/Lot# 78.-8-16.2 Pursuant to application dated 5/8/2024 and approved by the Building Inspector. To expire on 2/6/2026. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $1,277.50 AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $555.00 CO-ADDITION TO DWELLING $100.00 Total: $1,932.50 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 Ott s://www.souttioldtown�ny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only t<,e PERMIT NO. Building Inspecton Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant Is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 5 W24 OWNER(S)OF PROPERTY:�Nj Name: 1dd8 1` �s (Nl� SCTM #1000- 079 . Project Address: 435 444 L view (hied Mail t `f�'' Phone#: ;1 _ -2 Email: Mailing Address: 05y �� ><V�aY���1�;��t' �('ol`t �'l«Zc� CONTACT PERSON: Name: r �. C l �j C' #2D 7 �C Mailing Address: SO Ill etef. sw AY 11461L Phone#: $Ib 651 2S69 I `;I ZoAt S'7ls I Email•ANd rcS 4 lCit DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: SO gillXrftt I D Phone#: 671 204 571S CONTRACTOR INFORMATION: Name: Ago # A lomf ko. Mailing Address: lsftl ( � kr- AWA044 111 1101 Phone#: 631 165 160 Email: -eacos awo 44ftill.COM DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure HAddition MAlteration ❑Repair ®Demolition Estimated Cost of Project: ❑Other bk 00 , Will the lot be re-graded? ❑Yes I&No Will excess fill be removed from premises? ❑Yes 5<No 1 PROPERTY INFORMATION Existing use of property: * du a, Intended use of property: RCSduffo( (SAAC) Zone or use district in which premises is situated„ Are there any covenants and restrictions with respect to this property? Dyes I§No IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design Professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the co.tsb uction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized Inspectors on premises and In building(s)for necessary inspections.False statements made herein are punishable as a class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name): RgAuthorized Agent ❑Owner 110-1 Signature of Applicant: , C Date: �!z�2y STATE OF NEW YORK) SS: COUNTY OF 5 JK ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the Apow (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of i , 20iA i Notary Public KEVIN RODRIGUEZ OSORIO NOTARY PUBLIC,STATE OF NEW VO R Y.O.01RO6416209 FN' ���II �IY��"�R r 11-11I JTII "IORI ����� ig QUALIFIED IN SUFFOLK COUNTY dwdwd----�.� �,..�.� �� ��� � �������� TERM EXPIRES APRIL 12,2025 (Where the applicant is not the owner) residing at do hereby authorize ML-01 e to apply on my behalf to the Town 7 � of Southold Building Department for approval as described herein. 4 (gym 11441-1- Owner's ignat re Date Date A& t Print Owner's Name 2 Building Department ARplication AUTHORIZATION (Where the Applicant is not the Owner) residing at 15 q 7 NCYt VV\JJ L fi 2 k!2. (Print property owner's name) (Mailing Address) `1b I _ do hereby authorize . ........� l (Agent) to apply on my behalf to the Southold Building Department. 71171 (Own ' Sign (Date) °int et.... ...._. ... ( >s ame) 5'u.orn -�v �e(or¢ the, Agar, , %2VVIN R()[)d{TV+tjtt j„T7 No.0 QUA CAI "CIE o IN��J�� �&s'���t J)dltiO V^ TERM T 9I!TE"aAP-11T 12, g�)Z; ' ORK Workers' CERTIFICATES STATE Compensation NYS WORKERS' COMPENSATION URANCE C V&4 1a.Legal Name&Address of Insured use street address'onl 1b.Business Telephone Number of In 631-965-9615 ARD Management Corp. I 1547 Northville Turnpike 1c.NYS Unemployment InsuranceImber of Riverhead,NY 11901 I Insured j Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in Now York estate,i.e.,a Wrap-tip 13614) Number i 882265667 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Property and Casualty Insurance Company of Hartford i Suffolk County Department of Labor, 3b.Policy Number of Entity Listed in Box"Ila" Licensing&Consumer Affairs 12 WEC AS7RDE PO BOX 6100 Hauppauge,NY 11788 3c.Policy effective period to r i 2. 3d.The Proprietor,Partners or Executive Officers are included.(Only check box If all partners/officers Included) ❑X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NiY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation Insurance policy), The Insurance Currier or Its licensed agent will send this Certificate of Insurance to the entity,listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy Is canceled due to nonpayment of premiums or within 30 days iIF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured front the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed In box"3c",whichever is'earlier. This certificate is Issued as a matter of information'only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contalned in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued.. y a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Co erage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an,authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured has the coverage as depicted on this form. I Approved by: Nicholas Zulk'ofs e (Print name f authorized representative or licensed agent of insurance carrier) Approved by: '" Z (61gn (D ataJ Title: Authorized Agent Telephone Number of authorized representative or licensed agent of Insurance carrier: 631-941-4113 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are N.QI authorized to issue It. C-105.2(9-17) www.wcb.ny.gov I y6 , workers'STATE Co nsation CERTIFICATE OF INSURANCE COVERAGE nT)ae Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie ........... _ .......... 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ARD MANAGEMENT CORP 631-965-9615 1547 NORTHVILLE TPKE RIVERHEAD, NY 11901 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,I.e.,Wrap-Up Policy) 882265667 ............... 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ANNEX 3b.Policy Number of Entity Listed in Box"1 a" 54375 MAIN RD P.O. BOX 1179 DBL667282 SOUTHOLD, NY 11971 3c.Policy effective period 06/01/2023 to 05/31/2025 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: R] A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. 4/18/2024 Date Signed By "Uflw rj tdr ww. (Signature of Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. W_ .__M ........._. .. ...... PART 2.To be completed by the NYS Workers'Compensation Board (only If Box 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees, Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) - Telephone Number Name and Title .......... Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 111111111 !�°°°1°o°°°°��!��°!'!"!�°IIIIIII CERTIFICATE OF LIABILITY INSURANCE UATE(MIVIID°"""' Alm O 10411812024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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 an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CONTACT Josh Talley FA?t Brookhaven Agency,Inc. PHONE z.j1,(631)941.4113 (6Li 941-4 05 100 Oakland Avenue,Ste 1 AnnR oshtalle Insures hotmalil,com Pori Jefferson NY 11777 INSURERS AFFORDING.COVERAGE NAI 0 N . Merchants Mutual Insurance Com an INSURED jNWIM&qLProperty&Casualt Insurance Co.of Hartford ARD MANAGEMENT CORP Lwt RER 1547 NORTHVILLE TURNPIKE s D RIVERHEAD NY 11901 Rt INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSrt DDL, IJIBR POLICY EFF POLICY EXIP LIMITS ITR TYPE OF INSURANCE OUCY UMBE X COMMERCIAL GENERAL LIABILITY CH OCCURRENCE 1 OOO,ODO A CLAIMS-MADE �OCCUR DAMAOETO NTOEO $5001000 CONTRACTUAL LIABILITY Y Y CTRIO12671 09/29/2023 09/29/2024 li MED FafP An one erson $5,000 PRIMARYAND NON-CONTRI PERSONAL&ADV INJURY $1 000 000 NIL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PECT LOC PRODUCTS-COMP/OP AGG 2 00O OOO AUTOMOBILE LIABILITY COMBINEAmidJ�. INGt.E LIMIT $1 000 000 A IANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED Y Y CAP1084013 03/31/2024 03131/2025 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE. $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE .A 2,000,000 A EXCESS LIAB CY.AIMS S ... Y Y CUP1005291 09/29/2023 09/29/2024 AGGREGATE $.2,000,000 X R T N N 10 000 WORKERS COMPENSATION X PER ER B OFFMERIML":MBEREXCLUDED? Y N/A Y 12WECAS7RDE 06/01/2023 06/01/2024 � cHr+CCIDENT $1000000 AND EMPLOYERS'LIABILITY ANY PR OPRIETORIPARTNER)E'XEICUTNVE E. (Mlandatory in N71) I..DISEASE EA EMPLOYEE 1 000 000 II ycs,desCrM1t a undor '...LB&T ..EL DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN HALL ANNEX 54375 MAIN RD ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 1179 SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE <BS> ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 5� �olk Coun De�'artment o f Labor Licensing ,�. Consumer Affairs Elm, T TOWN VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 4/17/2024 No. HI-70154 SUFFOLK COUNTY =; Home Improvement Contractor License This is to certify that Fabian D Acosta Villamarin doing business as ARD Management Corp having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws; rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. NOT VALID WITHOUT Restrictions Additional Businesses DEPARTMENTALSEAL H22-Glass; AND A CURRENT H50-Renovations ` d CONSUMER AFFAIRS ID CARD Wayne T. Rogers Commissioner f This license is the property of Suffolk County Department of Labor, Licensing & consumer Affairs, * ier Possession of this license does not guaranteeits validity. r Additional Business Name License category 1-122 - Glass; H50 - Renovations t Generated by RScheck- eb Software Compliance Certificate Project 435 N Bayview Road Extension Energy Code: 2018 IECC ID Location: Southold New York Construction Type: Single-family 1 9 2 024 Project Type: Addition Climate Zone: 4 (5572 HDD) BtMDING DEPT- Permit Date: Permit Number: TON" F S All Electric false Is Renewable false Has Charger false Has Battery: false Has Heat Pump: false Construction Site: Owner/Agent: Designer/Contractor: 435 N Bayview Road Extension Stephen D. Lemanski Southold, NY 11971 Southampton Engineering Services 50 Hill Street Southampton, NY 11968 Compliance: 17.5%Better Than Code Maximum UA: 480 Your UA: 396 Maximum SHGC: 0.40 Your SHGC: 0.32 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. SIIm::b-oin grade uradeanffs are no longer coirn:uuid::Ted in the U anu fur=:rforrrrornruce una:nunnir�llia nce qua i"n on Rli:�w�u:i°ua ck, IF Each aalalb Taro-gr��ad �ussennnbu y in the specifiedn:.l'ma�te zone rruu.ft r'neet tlinnn miiniirrnu.urn e nEYgy code insuuiatlloi n IF..vahie and d(1)l:h ira:qu.:ilirerrne nts Envelopg As5emblie5 Prop.Gross Area Cavity Cont. Prop. Perimeter Ceiling: Flat Ceiling or Scissor Truss 1,600 30.0 30.0 0.017 0.026 27 42 Wall: Wood Frame, 16" D.C. 2,264 21.0 0.0 0.057 0.060 83 88 Window: Wood Frame 800 0.270 0.320 216 256 SHGC: 0.32 Basement Wall: Solid Concrete or Masonry Wall height: 8.0' 1,600 30.0 0.0 0.044 0.059 70 94 Depth below grade: 7.5' Insulation depth: 7.5' Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 1 of10 Compliance Statement: The proposed building design described here is conslste /din wilding plans, specifications, and other calculations submitted with the permit application.The proposed building has deto meet the 2018 IECC requirements in REScheck Vers"on . REScheck-Web and to comply with the mandatory requi ara is I! he REScheck Inspection Checklist. ?-I/- Zy Name-Title Slgnat a Date r,,o66. art (P "~ 3N :AO y Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 2 of10 o REScheck Software Version : REScheck-Web C=Nl �j Inspection Checklist cl list Energy Code: 2018 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 Verifled # Pre-Inspection/Plan Review Complies? Comments/Assumptions & Reg.ID Value Value 103.1, !Construction drawings and ❑Complies 103.2 documentation demonstrate ❑Does Not [PR1]1 energy code compliance for the V, building envelope.Thermal ❑Not Observable envelope represented on ❑Not Applicable construction documents. 103.1, Construction drawings and ❑Complies 103.2, 'documentation demonstrate ❑Does Not 403.7 ;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 Commercial Provisions. 302.1, Heating and cooling equipment is Heating:_ Heating:g. ❑C�mplies 403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: ❑Not Observable Manual J or other methods Btu/hr Btu/hr approved by the code official. ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2Medium Impact(Tier 2) 3 Law Impact(Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 3 of10 section Plans Verified Field Verified & Re ID ­­_­__­____.__1__.p ..�....Mu Value ....Value .._. .....................�_...._..Comments/Assumptions# Foun at on Ins ect on om ies7 402.1.1 Conditioned basement wall R- R- ❑Complies See the Envelope Assemblies [F04]1 '[insulation R-value.Where interior R- R- ❑Does Not table for values. kn insulation is used,verification may need to occur during ❑Not Observable Insulation Inspection.Not ❑Not Applicable j required in warm-humid locations j in Climate Zone 3. 303.2 Conditioned basement wall ❑Complies [F05]1 insulation installed per ❑Does Not manufacturer's instructions. ❑Not Observable Conditioned basement wall ft ft..........�...... v . ❑Not Applicable 402.2.9 ❑Complies !See the Envelope Assemblies [F06]1 insulation depth of burial or `❑Does Not table for values. distance from top of wall. ❑Not Observable ❑Not Applicable 303.2.1 A protective covering is installed ❑Complies [FO11]2 to protect exposed exterior ❑Does Not insulation and extends a minimum of 6 in. below grade. ❑Not Observable ❑Not Applicable 9 Snow-and ice-melting system ❑Complies [FO12]2 controls installed. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact (Tier 1) 2.. Medium Impact(Tier 2 3 Low Impact(Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 4 of10 . �. ry _ Section Plans Verified Field Verlfled # Framing / Rough-In Inspection Value Value C o mpiles? Comments/Assumptions &....Re .ID , p...,,. 402.1.1, Glazing U-factor(area-weighted U- U- ❑Complies See the Envelope assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, 402.5 ❑Not Observable [FR211 ❑Not Applicable 303.1.3 U-factors of fenestration products ❑Complies [FR411 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 ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable v,S^ ❑Not Applicable 402.4.3 (Fenestration that is not site builte ❑Complies [FR2011 is listed and labeled as meeting ❑Does 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 j limits. 402.4.5 IC-rated recessed lighting fixtures � ❑Complies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate :52.0 cfm leakage at 75 Pa. ❑Not Observable _ ❑Not Applicable 3 1 Supply and return ducts in attics ❑Complies [FR12]1 insulated >= R-8 where duct is ❑Does Not >= 3 inches in diameter and >_ R-6 where < 3 inches. Supply and ❑Not Observable return ducts in other portions of ❑Not Applicable the building insulated >= R-6 for diameter>= 3 inches and R-4.2 for< 3 inches in diameter. '403.3.2 Ducts, air handlers and filter ❑Complies [FR1311 boxes are sealed with ❑Does Not ;joints/seams compliant with International Mechanical Code or ❑Not Observable International Residential Code, as ❑Not Applicable applicable. 403.3.5 Building cavities are not used as ❑Complies [FR15]3 ducts or plenums. ❑Does Not ❑Not Observable ❑Not Applicable 403.4 HVAC piping conveying fluids R-- � R�-� -JJJ� .. , P�p� 9 Y� 9 - ,❑Complies [FR17]2 above 105 °F or chilled fluids ❑Does Not below 55 °F are insulated to >_R- 3 '❑Not Observable ❑Not Applicable 403.4 1 Protection of insulation on HVAC - - ❑Complies [FR24]1 piping. ❑Does Not - ❑Not Observable ❑Not Applicable 403.5.3 Hot water pipes are insulated to R- R- _.. ❑Complies [FR18]2 >_R-3. ;❑Does Not :❑Not Observable ❑Not Applicable 6 Automatic or gravity dampers are ❑Complies [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable 1 ,High Impact (Tier 1) 2 Medium Impact (Tier 2) 3m Low Impact (Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 (Medium impact(Tier 2) 3 Low Impact (Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 6 of10 .,,�._.# ......� .Insulation inspection,.��.�.�... Section Plans Verlfled Field VeNfled 7 Comments Assum tlons complies? / P P Value Val a ue e 303.1 All installed insulation is labeled ❑0ompliies JIN1312 or the installed R-values ❑Does Not 11 provided. ❑Not Observable ❑Not Applicable 402 'Wall insulation R-value. If this is a, - �.1 1 R- R- ❑Complies see the Envelope Assemblies 402.2.5. mass wall with at least"A of the ❑ Wood ❑ Wood ,❑Does Not ;table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass ❑Not Observable [IN3]1 exterior, the exterior insulation requirement applies (FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 :Wall insulation is installed per ❑Complies [IN4]1 manufacturer's instructions. []Does Not ❑Not Observable 1 ❑Not Applicable Additional Comments/Assumptions: � _ _ ._:_ 1 .....,High Impact (Tier 1) 2 Medium Impact(Tier 2) 3 'Low Impact(Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 7 of10 Section T lans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Req.ID ...... ........W.............. ,, �_ .. .... 402.1.1, 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 j❑Not Observable ; [FI1]1 1EINot Applicable ............ -----_. 303.1.1.1, Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [FI2]1 Blown insulation marked every 300 ft2. ❑Not Observable ❑Not Applicable 402.2.3 Vented attics with air permeable ❑Complies 22]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable 402.2 4 :Attic access hatch and door R- R- ❑Complies [FI311 'insulation �!R-value of the ❑Does Not j adjacent assembly. ❑Not Observable i❑Not Applicable 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. j❑Not Observable j❑Not Applicable } 403.3.3 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies [FI27]1 determine air leakage with ft2 ft2 ❑Does Not either: Rough-in test:Total leakage measured with a ❑Not Observable pressure differential of 0.1 inch ❑Not Applicable :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. 403.3.4 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies [FI4]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air ❑Not Observable handler @ 25 Pa. For rough-in tests,verification may need to j❑Not Applicable occur during Framing Inspection. 403.3.2.1 'Air handler leakage designated ❑Complies [FI24]1 by manufacturer at<=2% of ❑Does Not design air flow. ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats ❑Complies [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 403.1.2 Heat pump thermostat installed ❑Complies [FI10]2 on heat pumps. ❑Does Not ❑Not Observable ❑Not Applicable 403.5.1 Circulating service hot water ❑Complies [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 Low Impact(Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 8 of10 # m._ Final Inspection Provisions _ �� �_._. Section Ti.Plans Verified Fleld Verified & Re ID Value Value WX Comments/Assumptions o..-.. sons �..,.M M - o Complies? Comm................. 403.6.1 All mechanical ventilation system ❑Complies [F125]2 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy and air flow limits per Table ❑Not Observable R403.6.1. ❑Not Applicable 403.2 Hot water boilers supplying heat ❑Complies [F126]2 through one-or two-pipe heating ❑Does Not systems have outdoor setback control to lower boiler water ❑Not Observable temperature based on outdoor ❑Not Applicable temperature. 403.5.1.1 Heated water circulation systems - ... . w v .a... ❑Complies [FI28]2 have a circulation pump.The ❑Does 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 [FI29]2 comply with IEEE 515.1 or UL ❑Does 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. 403.5.2 Demand recirculation water ❑Complies [F130]2 systems have controls that ❑Does Not manage operation of the pump and limit the temperature of the ❑Not Observable water entering the cold water ❑Not Applicable piping to <= 104°F, ,_ .... ..w 403.5.4 Drain water heat recovery units ❑Complies [FI31]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. e_W_W.. ......._.w_....... 404.1 90%or more of permanent ❑Complies [FI6]1 fixtures have high efficacy lamps. ❑Does Not ❑Not Observable _ ❑Not Applicable 1 Fuel gas lighting systems have ❑Complies [F123]3 no continuous pilot light. ❑Does Not 'vJ. ❑Not Observable i ❑Not Applicable 3 Compliance certificate posted. ❑Complies [FI7]2 ❑.,Does Not ❑Not Observable ❑Not Applicable (High Impact (Tier 1) 2 Medium Impact (Tier 2) 3 Low Impact(Tier 3) Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 9 of10 Section 7s �'ans Verlfled Field Verlfled Final In ctlon Provi 1 m 1 ? m um ins spe s oValue ValueCo pies Co meMs/Ass pt oRet#ID303.3 ._ _m�. .............. �.o... .._.. a.. .... .R _ ee Manufacturer manuals for ❑Complies [FI1813 mechanical and water heating ❑Does Not systems have been provided. ❑Not Observable '. ❑Not Applicable Additional Comments/Assumptions: 1 High Impact (Tier 1) ct(Ter2) er 3)Project Title: 435 N Bayview Road Extension Report date: 07/11/24 Data filename: Page 10 of10 tll 2018 CC Energy Mi Effidency Certificate Above-Grade Wall 21.00 Below-Grade Wall 30.00 Floor 0.00 Ceiling / Roof 60.00 Ductwork (unconditioned spaces): Window 0.27 0.32 Door Heating System: Cooling System: Water Heater: Name: Date: Comments Y ' Q LL ~ U Z u.l N 6O Y ¢w o w H m w LLJ Of co 0 LLI O Z� b Of 0 Z eo a wis OW p 0I NM Q ? _ zIt nsi m O O o� QW s E' napz = z m m " AVM3AR10 12110 Q O N N V O J T _ _ ® — wzcDm LL. 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