HomeMy WebLinkAbout42306-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans ✓
TEL: (631)765-1802 Planning Board approval___
FAX: (631)765-9502 LJ Survey--.....
Southoldtownny.gov PERMIT NO. Check
............
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application—--------------
Flood Permit—..........
Examined 20 Single&Se aratemmm
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 20 Mail to:
Disapproved aJc ................................. Phone:.
Expiration
JECIE DIM B nspector
D[C 2 0 2017 PLICATION FOR BUILDING PERMIT
Date 2 20__L_?
BUILDING DE". INSTRUCTIONS
TOYM OF SOUTHOLD
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
APPLICATION 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 construction of buildings,additions,or alterations or for removal or demolition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code,housing co e,and regulations,and to admit
authorized inspectors on premises and in building for necessary ins
P7
(SigWture of applicant Pi"name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises............04-ao aJo -!�—14 a a L'In'?k —
I (As on the tax roll or latest deed)
alit is a corp �-aflon,s�il,
C - - - t
i,ure of duly authorized officer
,7
(Name and title eorporate,officer)
Builders License No. -2 7 12-3—
Plumbers License No.................................................
Electricians License No.
Other Trade's License No.
1. Location of landL which prods d work will e d 0:
11--1121........................ ..............
House Number Street fiamlet
County Tax Map No. 1000 Section96 Block -L—Lot
Subdivision L-(�"E.. Filed Map No. Lot -
2. State existing use and occupancy of premises and intended use and occupant: of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building___________Addition Alteration
Repair RemovalDemolition _Other Work
(Description)
4. Estimated Cost " Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.
7. Dimensions of existing structures,if any:Front __ I ar Depth
,Height Number of Stories
Dimensions of same structure with alterations or additi s: Front Rear
Depth Height Number ca T
r,w �,
8. Dimensions of entire new construction:Front Rear 1)cpth
Height Number of S'tor' s
9. Size of lot: Front Rear Depth
10.Date of Purchase /eit
ne of Former Owner r- ,
11.Zone or use district inuated
12.Does proposed constring law,ordinance or regulation?YES NO
13.Will lot be re-graded? i11 excess fill be removed from premises?YESNO14.Names of Owner of pAddress Phone No.
Name of ArchitectAddress Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO
*IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?* YES NO
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
cclu "1'Y Ol~ .
SS:
being duly sworn,deposes and says that(s)he is the applicant
(Name of inrlsvi ual sig ing contract)above named,
(S)He is the ''�-' c ( ............_.......
..m.......... ,
(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 knowledge and belief;and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this-
da of 20
"] L.D CFR1
NOTARYPUBLIG.STATE 0ORK
Notary blit QUALIFIED IN SUFFOLK COU �*y.� Signature of Applicant
COMMISSION EXPIRES JUNE 30,;] t
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or
topographic features.
2. l°final Approval l'roan Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building, industrial building, multilile residences and sirnilar buildings and installations,a certificate
of Code Cornpli.ance from architect or engineer responsible:for the building..
6. Submit Planning Board Approval of completed site plan requirements,
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines,streets, building and unusual natural or topographic
features,.
2. A properly completed application and consent to inspect signed by the�ripplican't. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing,to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00, additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building,- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
/Aa-
Date ... �....,. _.. .. _....
r Pre-existing Building:
New Construction: Old (check one)o $
Location of Property.. � :...
mm.. . _.Hamlet... ....
House No. Street
.......
Owner or Owners of Property:�' t � � �.. ;, 4 , .... �.. . ... ...._ .... -�
Suffolk County Tax Map No 1000, Section Block
Lot p'
Subdivision .... Filed Map. Lot:
Permit No... qz3o–(—.. Date of Permit.--.
..Applicant:
Health Dept.Approval:— /20 Underwriters Approval:
Planning Board Approval: (10
Request for: Temporary Certificate Final Certificate: -- (check one)
Fee Submitted: $ .
;. , ..
ocant Signature
g re �"
Scott A. Russell STO]EZI�MIWA\T]EIK
SUPERVISOR DAMIA\ \A�Gi]EM[]E1��C'
SOUTHOLD TOWN HALL-P_O.Box 1179 Q �
53095 Main Road-SOUTHOLD,NEW YORK 11971 T�0 1 own of Sou th o l d
C z- TER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT)
_1. OES u..1111 --ANY ....Off-......THE
e o (CHECK ALL THAT APPLY)
❑ Clearing, grubbing, grading or stripping of land which affects more
tthan 5,000 square feet of ground surface.
B. Excavation or filling involving more than 200 cubic yards of material
` ithin any parcel o, any contiguous area_
El C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
E I ETIE, Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
]' F. Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or moreWP Management Mana em copies of a Stormwater of the above, please submit Two co ntnt Con trol Plan
..�........
and a completed Check List Form to the Building DepartmW-writh-your Building Permit Application.
S.C.T.M. 1000 OaIL:
AP�P°l,:&FANT,, (Property Owner,I�)e� urn Professional,Agent,Contractor,Other) --
AML �.... Se�ct �� ... "
Block Lot
C'4d1.1.B'-- ll D1INiA CN ".� FLIf 7 �:t�t�'�rt "� l...e,,.0.. 0"'I
Contact InCormaharr m_--__--
Reviewed By:
o ... Con
....... Date:
r „ elty1ddress 1.ecatioa ofgtructioZ work ..... _ m-.
approved for processing Building Permit,,
_ .�.m......_1�.. .1. �// L�.......m. Stormwater Management Control Plan Not Required.
/ i7�✓ ,_. — ,— — — — — — r of� s�o`..,,..�a
.. `�,��.." /� . �........ . ...�w.,� ..... ......... Li Stcrnrvater Managcn�e„ .onLol , y„ ,.�
(Forward to Engineering Deparlment for Review.)
FORM ' SMCP - TOS MAY 2014
CNII
Town Hall Annex '" ` `: Telephone(031-1802
54375 Main Road w" Fax(031) 734-9502
CD _
P- O. Box 1179r
Southold, NY 11971-0959 y
BUILDING DEPARTMENT
NOTICE OF UTILIZATIONOFTRUSS TYPE CONSTRUCTION.-PRE-ENGINEERED
NGINEERED
WOOD CONSTRUCTION ANDIOR TIMBER CONSTRUCTION
Date:
Owner i _... _ ...
Location of Property: 1 i � .. C "
_.
:..
Please take notice that the (check applicable line):
New residential structure
Addition to existing residential structure
:r Rehabilitation to an existing residential structure
- to be constructed er{performed at the_subject property„reference above will utilize
(check applicable line):
- Truss type construction (TT)
Pre-engineered wood construction{PW)
Timber construction (TC}
in the following iocation(s){check applicable line):
Floor framing, including girders and beams (F)
6
Roof framing (R)
Floor and roof flaming (FR)
Signatu
(p on sub
Name ers
mrttin this form . _
Capacity(check applicable line):
Owner
.Owner representative
TrussResReg15-dorx Eff4'*:ve 1!1!2015
Generated by REScheck-Web Software
Compliance Certificate
Project Boland New Addition D DD
Energy Code: 2015IECC �JA,N I x)� `
Location: Southold, New York
Construction Type+ Single-family BUMDING
Project Type: Addition TOWN OF SOUTHOLD
g'
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
Boland Residence Pamela Pospisil
1410 Leslie Road Pospisil Brown Architects
Southold, New York 141 Hampton Place
Southampton, New York 11968
631-283-3465
Compliance: 1.5%Better Than Code Maximum UA: 338 Your UA: 333 Maximum SHGC: 0.40 Your SHGC: 0.39
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 Assetnblie5
Ceiling: Flat or Scissor Truss 1,777 0.0 30.0 0.031 55
Wall:Wood Frame, 16in.o.c. 1,824 0.0 21.0 0.039 55
Door: Glass 35 0.250 9
SHGC:0.32
Door copy:Glass Door(over 50%glazing) 35 0.250 9
SHGC: 0.32
Window: Wood Frame 348 0.480 167
SHGC:0.40
Floor:All-Wood joist/Truss Over Uncond.Space 1,327 0.0 30.0 0.029 38
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 be need to meet the 2015 IECC requirements in
REScheck Version : REScheck-Web and to comply with the Ina equirerrle is li to in the E check'Inspection Checklist.
w
Name Title - Signe tore Date
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 1 of 9
REScheck Software Version -. REScheck-W'eb
Inspection Checklist
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.
& R LPm
PI _..mm.. P e mptions
a fied F�eIV luefiednts/Assu-Inspection/Plan Review HN Complies? Comm
103.1, Construction drawings and ❑Complies
103.2 documentation demonstrate ❑Does Not
[PR1]1 energy code compliance for the
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,UP ❑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: ❑Complies
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 Btu/hr Btu/hr ❑Not Observable
approved by the code official. ❑Not Applicable
Additional Comments/Assumptions:
1 HI h Impact Tier 1) 2 I Medium Impact,
(Tier 2) 113 Low Impact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 2 of 9
#lon Foundation Inspection- Complies?
Comments/Assumptionsm�
Sect
303.2.1 ;A protective covering is installed to ❑Complies
[F011]z ',protect exposed exterior insulation ❑Does Not
and extends a minimum of 6 in.below
{grade. '❑Not Observable
;❑Not Applicable
403.9 Snow-and ice-melting system controls ❑Complies
[FO,12,1112 installed. ❑Does:Not
'❑Not Observable
C1NotApplicable
Additional Comments/Assumptions:
J_1 'I High Impact(Tier 1) 2 ,Medium Impact(Ter 2) 3 'Low Impact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 3 of 9
- o 'Plan
Ve fied
# Framing/Rough-in InspectValue
Fiel V luefiedComplies? Comments/Assumptions,
& Req.ID _ E w
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,
[:]Not402.3.6, Not Observable
402.5 ❑Not Applicable
[FR2]1
303.1.3 LI-factors of fenestration products ❑Complies
[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 ❑Complies
[FR23]1 installed per manufacturer's ❑Does Not
instructions.
❑Not Observable
❑Not Applicable
402.4.3 Fenestration that is not site built ❑Complies
[FR2011 is listed and labeled as meeting ❑Does Not
i AAMA/WDMA/CSA 101/LS.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
[FR16]2 sealed at housing/interior finish ❑Does Not
and labeled to indicate<_2.0 cfm
leakage at 75 Pa. ❑Not Observable
❑Not Applicable
403.2.-1-11-11-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. '
403.3.3.5 Building cavities are not used as "❑Complies
'[FR15]3 ducts or plenums. ;❑Does Not
❑Not Observable
❑Not Applicable
403.4 .. .. :._..m ..._ .. _..........
HVAC piping conveying fluids R- R ❑Complies
[FR17]2 above 105°F or chilled fluids ❑Does Not
Gf below 55°F are insulated to >_R-
3 ❑Not Observable
[FR
❑Not Applicable
403 _.�...___m._. _._ ...
4.1 Protection of insulation on HVAC ❑Complies
2411 piping. ❑Does Not
w c-`;,❑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
403.6 Automatic or gravity dampers are i ❑Complies
?,
[FR19]2 installed on all outdoor air :❑Does Not
intakes and exhausts.
❑Not Observable
/,❑Not Applicable
Additional Comments/Assumptions:
wawa....
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 4 of 9
�, 4 mm act(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
1 NIS to It _....
Project Title: Boland New Addition _ Report date: 01/08/18
Data filename: Page 5 of 9
�erl
insulation Inspection p"Iaru
Value Valu pleb er led C ruw pffe 7' omrru ruts/a�ss IT � _...
uuupupp�tM ns
S
303;1 All installed insulation is labeled ❑Complies
[NN1 ]1 or the installed R-values El
Does Not
provided.
'❑Not Observable
❑Not Applicable
n__�...w..._ ��� _�_ _ _�... � �...._.....m..�..
�402.1.1, Floor insulation R-value. R- R- ,❑Complies See the Envelope Assemblies
402.2.6 ❑ Wood ❑ Wood j❑Does Not table for values.
[IN111 ❑ Steel ❑ Steel ;❑Not Observable
lbw ;❑Not Applicable
303.2, Floor insulation installed per .❑Corrplies
402.2.7 manufacturer's instructions and ❑Does Not
[IN2]1 in substantial contact with the
underside of the subfloor,or floor ❑N Observable
framing cavity insulation is in ❑Not Applicable
contact with the top side of
p
sheathing,or continuous
insulation is installed on the
underside of floor framing and
extends from the bottom to the
top of alf perimeter floor framing
members.
1Wall
s wth at least f ofthis
the Wood
402.2.5, maswall a R _. i2- -. __... ❑Complies See the Envelope Assemblies
1 [� ® Wood ❑DogsNot 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 E] Steel ❑Not Applicable
303.2 Wall insulation is installed per ,, '[]Complies
[IN4]1 manufacturer's instructions. ❑Does Not
❑Not Observable
,❑N+atApplicable
Additional Comments/Assumptions:
'N�1igh�lmlraet(Tier 1) 2 pMedium Impact(Tier 2) 3 Low 9mpact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 6 of 9
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies. Comments/Assumptions
& Re .I D e�
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, ❑ Steel ❑ Steel ❑Not Observable
,402.2.6
[FI1]1 ❑Not Applicable
303.1.1.1, Ceiling insulation installed per ❑Complies
303.2 manufacturer's instructions. ❑Does Not
[F12]1 Blown insulation marked every
300 ft2. ❑Not Observable
❑Not Applicable
402.2.3 Vented attics with air permeable ❑Complies
[F122]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
adjacent assembly.
❑Not Observable ,
❑Not Applicable
402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 = ❑Complies
[FI1711 ach in Climate Zones 1-2, and ❑Does Not
<=3 ach in Climate Zones 3-8.
❑Not Observable
❑Not Applicable
403.2.3 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies
[F14]1 cfm/100 ft2 across the system or ftp ft2 ❑Does Not
<=3 cfm/100 ft2 without air
handler @ 25 Pa. For rough-in ❑Not Observable
tests,verification may need to ❑Not Applicable
occur during Framing Inspection.
403.3.2 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies
[F127]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.
403.3.2.1 .Air handler leakage designated ' ' , ❑Complies
[FI24]1 by manufacturer at<=21Y, of �Dl� ❑Does Not
design air flow. /, %;❑Not Observable
❑Not Applicable
403.1.1 Programmable thermostats „ %❑Complies
[F1 9]2 installed for control of primary °❑Does Not
heating and cooling systems and
initially set by manufacturer to M ❑Not Observable
:code specifications. /1� / �, �� r ❑Not Applicable
403.1.2 Heat pump thermostat instal " �' �,, „ �/ ', /'❑Complies —- -
[FI10]2 on heat pumps. '❑Does Not
❑Not Observable ,
_ ,:,iaiii/i ii,c.%, 1/e%/,ir,G° ✓,i,i ! ii i' ❑Not Applicable
403.5.1 Circulating service hot water ''i't '"'/ ''//r 'i°I%' i%/ ;/ /'❑Complies
[FI11]2 !systems have automatic or "ii f J" % i // ❑
'���' %i i �/'iv i' ;. DOeS Not
accessible manual controls. �f%/%/ ;%flal% "ia 'i ❑Not Observable
%///, i/%/o; /f /ii / ' /i i„i; ❑Not
Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3Low Impact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 7 of 9
Final Inspection Provisions Plans Verli'led-11 Fie d Ver! e Complies-, Comments/Assumptions
Value V
403.6.1 All mechanical ventilation system ElComplies
[F125]2 fans not part of tested and listed []Does Not
HVAC equipment meet efficacy
and air flow limits. E]Not Observable
E]Not Applicable
403.2 Hot water boilers supplying heat ElComplies
[F126]2 through one-or two-pipe heating E]Does Not
systems have outdoor setback E]Not Observable
control to lower boiler water
temperature based on outdoor E]Not Applicable
i403.5.1.1 Heated water circulation systems ElComplies
I[FI28]2 have a circulation pump.The E]Does Not
system return pipe is a dedicated F
return pipe or a cold water supply _]Not Observable
pipe. Gravity and thermos- E]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 E]Complies
[F129]2 comply with IEEE 515.1 or UL E]Does Not
515. Controls automatically
adjust the energy input to the E]Not Observable
heat tracing to maintain the E]Not Applicable
desired water temperature in the
03.5.2 Water distribution systems that 'Ekomplies
[F130]2 have recirculation pumps that E]Does Not
pump water from a heated water
supply pipe back to the heated E]Not Observable
water source through a cold E]Not Applicable
water supply pipe have a
demand recirculation water
system. Pumps have controls
that manage operation of the
pump and limit the temperature
of the water entering the cold
water piping to 104LIF.
403.5.4 Drain water heat recovery units ElComplies
[F131]2 tested in accordance with CSA E]Does Not
1355.1. Potable water-side E]Not Observable
pressure loss of drain water heat 'E]Not Applicable
recovery units< 3 psi for
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.
404.1 75%of lamps in permanent ElComplies
fixtures or 75%of permanent E]Does Not
fixtures have high efficacy lamps.
Does not apply to low-voltage 'E]Not Observable
lighting. E]Not Applicable
�404.1.1 Fuel gas lighting systems have fiCo mplies
[F123]3 no continuous pilot light.
�E]Does Not
�E]Not Observable
'E]Not Applicable
Project Title: Boland New Addition Report date: 0I/08/18
Datafi|ename: Page 8of 9
t-Tin ue
�i
� Ctm�nert )AsnfiensinalInspection Provisions Plans VerifiedefComplies?
Val Value
ml
.. __.......
. ... �
4013 Compliance certificate posted. ❑Complies
]'
❑Does Not
❑Not Observable
❑Not Applicable
W _.Manufacturer _ _._..._.._. . .......�.... w.........__......
manuals:30for ❑Complies
[F118) mechanical and water heating ❑Does Not
systems have been provided.
❑Not Observable
-,,[]Not Applicable
Additional Comments/Assumptions:
1 Nigh Impact(Tier 1) 2 Medium Impact(Tier 2) Low impact(Tier 3)
Project Title: Boland New Addition Report date: 01/08/18
Data filename: Page 9 of 9
C2015 1ECC Energy
�(j Efficiency Certificate
e
Above-Grade Wall 21.00
Below-Grade Wall 0.00
Floor 30.00
Ceiling / Roof 30.00
Ductwork(unconditioned spaces):
�® MEMEN=
Window 0.48 0.40
Door 0.25 0.32
MUMMEMMEMOMMOMM
Heating System:
Cooling System:
Water Heater:
Name: , Date: rg'"
Comments