32A-057 ` BP- 2011 -0383
GiS #: COMMONWEALTH OF MASSACHUSETTS
�� CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Build DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: B UILDING PERMIT
Permit # BP- 2011 -0383
Project # JS- 2011- 000642
Est. Cost: $559000.00
Fee: $3354.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID FORTIER 008026
Lot Size(sq. ft.): Owner: VAN EPPS TIMOTHY & WENDY
Zoning: Applicant DAVID FORTIER
AT. 38 UNION ST
Applicant Address: Phone: Insurance:
32 Laurel St (413) 586 -8965 WC
NORTHAMPTONMA01060 ISSUED ON :1112312010 0:00:00
TO PERFORM THE FOLLOWING WORK .- DEMO FRONT PORTION & REBUILD
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature
FeeType: Date Paid: Amount:
Building 11/23/2010 0:00:00 $3354.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
File # BP- 2011 -0383
APPLICANT /CONTACT PERSON DAVID FORTIER
ADDRESS/PHONE 32 Laurel St NORTHAMPTON (413) 586 -8965
PROPERTY LOCATION 38 UNION ST
MAP 32A PARCEL 057 000 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid J Ic
Typeof Construction: DEMO FRONT PORTION & REBUILD (! /
New Construction OK
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 008026
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF� ATION PRESENTED:
'i�►// Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay F ' J L L.L O N l 1,9/(o
(;; ws J 0 l l n C�
Signature of Building fficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
t ,
M ,
City of Northampton
Building Department
212 Main Street
> 'Room 100
flopampton, MA 01060
phone 41 - 587 -1240 Fax 413 - 587 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address This section to be completed by office
Map ;' Lot Unit
Zone Overlay District
Elm St District CB District
SECTION ,2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
►v°rt Lq t A 1 Un► ( S Un ix wt S hi ' "^f' �` � o i�6
Name (Prin Current Mailing Address:
Telephone
Signat
2.2 Authorized Agent:
/
Name (P t) . �.-- Current Mailing Address:
1 )!]�, vt I — '�' S 9
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION iCO STS
'
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building Ll L Q ` v U (a) Building Permit Fee
2. Electrical .— (b) Estimated Total Cost of
J 1L C • " Construction from 6
3. Plumbing Building Permit Fee
3 006'
4. Mechanical (HVAC)
5. Fire Protection r 7, 00C), o G
6. Total = 1 + 2 + 3 + 4 + 5) c, v . i u Check Number
This Section For Official Use Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
r
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size _
-�—
Frontage i__
Setbacks Front = p , t I
J
Side L. R: l L: R -�'
Rear
Building Height l " 357 I y
Bldg. Square Footage . z . % -- -- - I
Open Space Footage %
(Lot area minus bldg & paved
par
# of Parking Spaces
Fill:
volume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW � YES Q
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:;
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q
IF YES, describe size, type and location: 'o
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition [] Replacement Windows Alterations) Roofing 12
Or Doors ❑
Accessory Bldg. ❑ Demolition New Signs [O] Decks [❑ Siding [W Other [a
Brief Description of Proposed T F- G (P 5 A - V � o)
Work: i ST[/y� AQA�IZ - -;�r,5 1"i vJ.'� 69 -0�y+ r f REAutC6 ro Pt^ ✓-5 ;
Alteration of existing bedroom -- —Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa. - lf �ie�nrfi�i�sandor, ai�rlEfi�lc�rr °'���:xi�st�rta�u��n�p �r�oriili�eEe #h� fa►ti�yi�llnp:
a. Use of building : One Family �_ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. (D fit` Dimensions
e. Number of stories?
f. Method of heating? 1r 4 v O �Ireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? y IC
h. Type of construction 5
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes _ No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? _X Yes No.
I. Septic Tank City Sewer _ Private well City water Supply _
SECTION 7a -OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize IJ A .) 1,3 t A i ( li i
to act on m alf, in all matters relative to work authorized by this building permit application.
4 C 10
Signatbre of ner Date
r�A .-1 � -T icz as Owner/ uthoiz
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of krfowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
� , f,�- ( � -,* ell-
t'� a� av)(Q
Signature of Own /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder 'I /'9 (� t Td ��, l (�'i� C� S i G 6 )'
License Number
Address r"' Expiration DWe
�4
Signature G,' Telephone
S 'Deaf[ster cl ltt rnb:i iiprove iter Corifr;�elbr .� _ x ; � x . x .' Not Applicable ❑
`
tv3��y
Company Name Registration Number
;�✓�L) i v -,o% (11- v;t. _19�� 7 fjo ��1
Address Expiration JDate
(
A Ol {�,�it. S . 0. Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG.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....... No...... ❑
n
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures 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
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents .
Office of In vestigations
' 600 Washington Street
Boston, MA 02111
w w w. mass gov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/organization/Individual):. n C % ( vlC �c�s
Address:
City /state/zip: Pee, iy QV 1& D 1 b b d Phone. #: 1 �
Are you an employer?. Check the appropriate box: Type of project (required) :.
LP 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
2.0 I am a sole proprietor or partner- listed on the attached sheet 7. (] Remodeling
shin and have no employees These sub - contractors have. .8. E] Demolition
worldng for me in any capacity. emp 1loyee4 andhave workers' _ . .
9. Butt addition
[No workers?. insurance _. camp. ,,,�,�c 0 � - -...
required] 5. We are a corporation and its 10-El - Electrical repairs or additions
officers have xerdsed their
3.0 I am a homeowner doing all work ;. 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12. Roof airs
c. 152 and we have no - rep
insuran required:] t ' § 1 4 ()'
employees: [No workers' 13.0 Other
comp. insurance regtiired j.
'Any applicant Shat checks box #1 mustalso fill out the section below showing theirworkas'- compensation policy information.
t Homeowners who submit this affidavit.mdicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that check this box must attached an additional sheet showing the name of the sub - contractors and state whethcr ornot those entities have
employees. If the sub - contactors have employees, they must provide their workers' comp policy number .
tam an employer that is provfding workers' compensation insurance for my employees Below is the policy and job site
info rma do, .�
Insurance Company Name: �� � scull H t
Policy # or Self -ins. Lic ' #: j/V r— 15 0 3 / 9 Expiration Dater
J ob S ite Addres 3S U d W 0'V .S�• �/ [ A�y`�/
(�.__� �M !�"1: dl&t) City /State/Zip
Attach a copy of the workers'' compensation policy declaration page (showing the pglicy number and ezpiration date).
Failure . to secure coverage: as required t der.Sectton'25t1 ofMGL d. 152 can lead to f e nitposition of penalties of a
fine up to $1,500.00 and/or one. -year imprisonment, as well as civil penalties is the form of a STOP WORK ORDER and- a fine
of up to $250.00 a day against the violator Be advised that a copy of this statement maybe forwarded to the Office of
_- _. —-
Inveshirations ° ofthe - DIA for insurance' coverage verification.-
I i16 hereby ce upder the t arns and penalties ofperjray that the information provuiedlrbove tssrue aaLrvrrect - --
(T
Si tore: t�,�, Date J a
Phone #: "I � � `O (Q
Of use only. Do not write ui this area, to be completed by cagy or town offciaL
City or Town: Permit/Llcense #
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 #:
1. .
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures 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."
The building, department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervsor;'to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the.building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
�ermits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
.(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued tome.
Date
Address of work
location
b/ 1 J!
A CERTIFICATE OF LIABILITY INSURANCE OATEIMMIDDM^M
10/26/2010
PRODUCER 413. 586. 0111 FAX 413. 586.6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
Webber & Grinnell Ins. Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
8 North King Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Northampton, MA 01060
IN SURERS AFFORDING COVERAGE NAIC #
iNsui Leonard . Buck & David Fortier INSURER. Peerless Insu rance !
DBA: Buck Brothers Concrete Service r!NSURERE Excelsior/Peerless 11045 _
Dave Fortier Builders C J-
PO Box 416 INSURER o --
Halley, MA 01035 NSURER E.
COVERAGES
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 MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGG L I M ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY EFF
L171 Ns TYPE OF INSURANCE P0-ICY NUMBER DATES W DEM Oq� E rMMIDO UMrrS
OENERALLIABILITY CBP8501791 09/05/2010 ( 09/05/2011 EaC� $ 1,000
— —�
j X CCAA/EP�:AL GErERA L,ASILIT/ �PREMIS a ,ccurre j T 10 0,000
� CLCJrvI, MADE X i � cuP � � r.1EC f✓XP (And ono Carson � $ 15, OU)�
A �� PERSOraLL s acv IrJ x $ 1,000,00
r,E!` aAL a,Gr5RE - -,HTE $ 2,0 00,0
I > N'_ AGGREGATE LIMIT,APPLIES o_R 2 1; ODUC' - CIlr1+1P!0� AGG $ 20 000
' Fo-IC 77 0 - cc i
JET
AUTOMOBILE L IAWTY BA8528085 10/08 10/08/2011 COMEINED SIN LE Li\m�T
i ;Ee a cident; $ 1, 000 000
r�vr a;ro �
�1 I
� ALL 'J' 4r.ECPiJf I t I BCCIL`r IVJUP.'
;Per person) $
B 1�. — HEDULEC ,+UTOS - - - - - --
F A l HIRE'' AUTOS J
ECCILY Iv.URY $
'I (Paraccirl6n:; I
x j ?V7�'V- OV�+faED AUTGS � !
PRCIR °_PTY GPMAGE $
PeraGrl INCLUDE
GARAGE LIASLITJ j 4Ur0 CNLV - 54 A C DENr $ _
AU") j OTHtR THAN L A,:i. IS
4U7D CM Ar >G ! $
j I L KCESS) UMBRELLA LIABILITY EACH OCCURR $
_I OCCU? 0_AIUS MADE AGGRE3ATE
DEDJCTISLE I I $
1 RE7EW)ON $
WORKERS COM ?[LI PENSATION WC8503991 09/05/2010 'I 09105/2011 X ! 1 " `' -R
ANC EMPLOYERS' LIABILITY YIN
N TOP.1' LIMITS
I !!ETOP /PA.RTVER /= ;<ECJTIVE E L EACHACCIDEM' $ 100, 000!
A -PF PROPP /NIZMEIER EXCLLCED7 T —
—
(MancatorYInNH) I cL DISEASE - EAEhAFLOfEE $ 100,00
I. yy.,, )esorite eider
SPE(:!A' PR0'FISI0NS b?IO'N j E.L. GISEPSE-POLICY LIMIT $ 500,00
THEIR
I I
I
I I i I
I
OEs ERIPTI )N OF OPERATIONS (LOCATIONS I VEHICLES I EXCLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISIONS
I
�Orker, Compensation Policy Excludes owners: Leonard Buck & David Fortier
I
CERT , iOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISBUING INSURER WILL ENDEAVOR TC MAIL 10 DAYS WRITTEN
City �f Northampton NOTICE TO THE CERTIFICATE HOLDER. NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Ci ty i al l IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Main 5 reet REPRESENTATIVES.
No rt harpy on , MA 01060 AUTHORJZED REPRESENTATNE
Vicki Vincent CISR ICKI LAC - G+.7
ACORD 25 (200810') 01988 -2008 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
REScheck Software Version 4.3.1
Compliance Certificate
Energy Code: 2009 IECC
Location: Northampton, Massachusetts
Construction Type: Single Family
Project Type: Addition /Alteration
Heating Degree Days: 6404
Climate Zone: 5
Construction Site: Owner /Agent: Designer /Contractor:
38 Union St Timothy & Wendy VanEpps David Fortier
Northampton, MA
e s
Compliance: 23.8% Better Than Code Maximum UA: 853 Your UA: 650
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.
• o e
e k e 91 a e
a
Wall 1: Wood Frame, 16" o.c. 2280 27.0 0.0 98
Window 1: Wood Frame:Triple Pane with Low -E 360 0.240 86
Wall 2: Wood Frame, 16" o.c. 2280 27.0 0.0 86
Window 2: Wood Frame:Triple Pane with Low -E 556 0.240 133
Door 1: Glass 21 0.240 5
Door 2: Glass 21 0.240 5
Wall 3: Wood Frame, 16" o.c. 728 27.0 0.0 32
Window 3: Wood Frame:Triple Pane with Low -E 80 0.240 19
Door 3: Solid 21 0.280 6
Wall 4: Wood Frame, 16" o.c. 794 27.0 0.0 33
Window 4: Wood Frame:Double Pane with Low -E 152 0.240 36
Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1848 40.0 0.0 46
Ceiling 1: Flat Ceiling or Scissor Truss — — -- --
Exemption: Framing cavity not exposed.
Ceiling 2: Flat Ceiling or Scissor Truss -- — — --
Exemption: Framing cavity not exposed.
Ceiling 3: Cathedral Ceiling (no attic) 2150 52.0 0.0 43
Ceiling 4: Flat Ceiling or Scissor Truss 860 52.0 0.0 22
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 2009 IECC requirements in
REScheck Version 4.3.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name - Title Signature Date
........ ......... ......... ....... ........, .......... . ........................................ ......... ......... _........ ...... .........
Project Title: Report date: 10/25/10
Data filename: Untitled.rck Page 1 of 5
C�(J REScheck Software Version 4,3.1
Inspection Checklist
Ceilings:
❑ Ceiling 1: Flat Ceiling or Scissor Truss
Exemption: Framing cavity not exposed.
Comments:
❑ Ceiling 2: Flat Ceiling or Scissor Truss
Exemption: Framing cavity not exposed.
Comments:
❑ Ceiling 3: Cathedral Ceiling (no attic), R -52.0 cavity insulation
Comments:
❑ Ceiling 4: Flat Ceiling or Scissor Truss, R -52.0 cavity insulation
Comments:
Above -Grade Walls:
❑ Wall 1: Wood Frame, 16" o.c., R -27.0 cavity insulation
Comments:
❑ Wall 2: Wood Frame, 16" o.c., R -27.0 cavity insulation
Comments:
❑ Wall 3: Wood Frame, 16" o.c., R -27.0 cavity insulation
Comments:
❑ Wall 4: Wood Frame, 16" o.c., R -27.0 cavity insulation
Comments:
Windows:
❑ Window 1: Wood Frame:Triple Pane with Low -E, U- factor: 0.240
For windows without labeled U- factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window 2: Wood Frame:Triple Pane with Low -E, U- factor: 0.240
For windows without labeled U- factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window 3: Wood Frame:Triple Pane with Low -E, U- factor: 0.240
For windows without labeled U- factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window 4: Wood Frame:Double Pane with Low -E, U- factor: 0.240
For windows without labeled U- factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
Doors:
❑ Door 1: Glass, U- factor: 0.240
Comments:
❑ Door 2: Glass, U- factor: 0.240
.. ......... ........ ......... ......... ......... ......... ......... ......... .................................... .............
Project Title: Report date: 10/25/10
Data filename: Untitled.rck Page 2 of 5
r
Comments:
❑ Door 3: Solid, U- factor: 0.280
Comments:
Floors:
❑ Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R -40.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
Air Leakage:
❑ Joints (including rim joist junctions), attic access openings, penetrations, and all other such openings in the building envelope that are
sources of air leakage are sealed with caulk, gasketed, weatherstripped or otherwise sealed with an air barrier material, suitable film or
solid material.
❑ Air barrier and sealing exists on common walls between dwelling units, on exterior walls behind tubs /showers, and in openings between
window /door jambs and framing.
❑ Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk
between the housing and the interior wall or ceiling covering.
❑ Access doors separating conditioned from unconditioned space are weather - stripped and insulated (without insulation compression or
damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed
to maintain insulation application.
❑ Wood - burning fireplaces have gasketed doors and outdoor combustion air.
Air Sealing and Insulation:
Building envelope air tightness and insulation installation complies by either 1) a post rough -in blower door test result of less than 7
ACH at 33.5 psf OR 2) the following items have been satisfied:
(a) Air barriers and thermal barrier: Installed on outside of air - permeable insulation and breaks or joints in the air barrier are filled or
repaired.
(b) Ceiling /attic: Air barrier in any dropped ceiling /soffit is substantially aligned with insulation and any gaps are sealed.
(c) Above -grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier.
(d) Floors: Air barrier is installed at any exposed edge of insulation.
(e) Plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to fit around wiring and plumbing, or
sprayed /blown insulation extends behind piping and wiring.
(f) Corners, headers, narrow framing cavities, and rim joists are insulated.
(9) Shower /tub on exterior wall: Insulation exists between showers /tubs and exterior wall.
Sunrooms:
❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U- factor of 0.50 and the maximum
skylight U- factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope
requirements.
Vapor Retarder:
❑ Vapor retarder is installed on the warm -in- winter side of all non - vented framed ceilings, walls, and floors; or it has been determined that
moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided.
Comments:
Materials Identification and Installation:
❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions.
❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R- value.
❑ Materials and equipment are identified so that compliance can be determined.
❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
❑ Insulation R- values, glazing U- factors, and heating equipment efficiency are clearly marked on the building plans or specifications.
Duct Insulation:
❑ Supply ducts in attics are insulated to a minimum of R-8. All other ducts in unconditioned spaces or outside the building envelope are
insulated to at least R -6.
Duct Construction and Testing:
❑ Building framing cavities are not used as supply ducts.
❑ All joints and seams of air ducts, air handlers, filter boxes, and building cavities used as return ducts are substantially airtight by means
of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Tapes, mastics, and fasteners are rated UL 181A or
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UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and /or fittings are mechanically
fastened. Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three
equally spaced sheet -metal screws.
Exceptions:
Joint and seams covered with spray polyurethane foam.
Where a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the
joint so as to prevent a hinge effect.
Continuously welded and locking -type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa).
❑ Duct tightness test has been performed and meets one of the following test criteria:
(1) Postconstruction leakage to outdoors test: Less than or equal to 8 cfm per 100 ft2 of conditioned floor area.
(2) Postconstruction total leakage test (including air handler enclosure): Less than or equal to 12 cfm per 100 ft2 pressure differential of
0.1 inches w.g.
(3) Rough -in total leakage test with air handler installed: Less than or equal to 6 cfm per 100 ft2 of conditioned floor area when tested at
a pressure differential of 0.1 inches w.g.
(4) Rough -in total leakage test without air handler installed: Less than or equal to 4 cfm per 100 ft2 of conditioned floor area.
Temperature Controls:
❑ At least one programmable thermostat is installed to control the primary heating system and has set - points initialized at 70 degree F for
the heating cycle and 78 degree F for the cooling cycle.
Heating and Cooling Equipment Sizing:
0 Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
Lj For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial
Building Mechanical and /or Service Water Heating (Sections 503 and 504).
Circulating Service Hot Water Systems:
❑ Circulating service hot water pipes are insulated to R -2.
F1 Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the
system is not in use.
Heating and Cooling Piping Insulation:
❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R -3.
Swimming Pools:
❑ Heated swimming pools have an on /off heater switch.
F1 Pool heaters operating on natural gas or LPG have an electronic pilot light.
❑ Timer switches on pool heaters and pumps are present.
Exceptions:
Where public health standards require continuous pump operation.
Where pumps operate within solar- and /or waste - heat - recovery systems.
F1 Heated swimming pools have a cover on or at the water surface. For pools heated over 90 degrees F (32 degrees C) the cover has a
minimum insulation value of R -12.
Exceptions:
Covers are not required when 60% of the heating energy is from site - recovered energy or solar energy source.
Lighting Requirements:
F1 A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following:
(a) Compact fluorescent
(b) T-8 or smaller diameter linear fluorescent
(c) 40 lumens per watt for lamp wattage — 15
(d) 50 lumens per watt for lamp wattage > 15 and — 40
(e) 60 lumens per watt for lamp wattage > 40
Other Requirements:
❑ Snow- and ice - melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting
off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is
above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement's').
Certificate:
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❑ A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R- values; window
U- factors; type and efficiency of space- conditioning and water heating equipment. The certificate does not cover or obstruct the visibility
of the circuit directory label, service disconnect label or other required labels.
NOTES TO FIELD: (Building Department Use Only)
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�J( 2009 Energy
Efficiency Certificate
f a
Ceiling / Roof 52.00
Wall 27.00
Floor / Foundation 40.00
Ductwork (unconditioned spaces):
b.D a P
Window 0.24
Door 0.24 NA
e D P s a t
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments: