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Home My WebLink About121 Camp St #002 Building PermitsAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN QF-aR OUTH �AUG 2 2004 -- (PLEASE PRINT IN INK OR TYPLJ INFORMATION) To the Inspector of Wires: By this plicatiowthemndersig work described below. Location (Street & Owner or Tenant // %7 �+ (OFFICE USE ONLY) By .d c Fee: $ 51•021 PERMIT NO. k-OS— (;, � Date: g/i, �z gives notice of his or her intention to perform the electrical IL- 1firc74 �/i, 6 _'14 No. Sds( 7%fS - 9G6/ Owner's Address 1660 �,�/cm t;^e , j/e /3�l/ facuc2 ✓�l�(C L .cs,4 a a 63Z Is this permit in conjunction with a building permit9 E� Yes Q No '(Check Appropriate Box) Purpose of Buildings G�iL��c,•�Q Utility Authorization No. 3 Existing Service Amps / Volts OverheadO Undgrd C3 No. of Meters New Service /G O Amps YG /l w Volts Overhead Undgrd 9— No. of Meters i Number of Feeders and Ampacity ez?z le, Location and Nature of Proposed electrical may No. of Recessed Fixtures 0 No. of Ceil: Sus . Paddle Fans No. of Total Transformers KVA No. of Li%zhting Outlets No. of Hot Tubs 0 Generators KVA No. of Lighting Fixtures Cj ove In- SwimmingPool md. � rnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets 9/e No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches ? No. of Gas Burners o. of Detection an Co Initiatin Device a ! r7 0 Ranges No. of Ran g � No. of Air Cond. Total [� Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Num er — — Tons — — KW-- — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers / Space/Area Heating KW Municipal Local Connection Other No. of Dryers rY Heating Appliances KW g PP Security Systems: No. of Devices or Equipvalent No. of Water Heaters f KW No. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or mvalent Attach additional detail if desired, or as required by the Inspector of Wlres. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same t9ke permit issuing office. CHECK ONE: INSURANCE BOND OTHERC] (Specify:) G (Expiration ate) Estimated Value of Electrical Work: K .. XGl/ (When required by municipal policy. Work to Start: ISM? /de.Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ai sn and penalties of perjury, that the information on this application is true and complete. FIRM NAME: C LIC. NO. 3ec-5 Licensee: Signature LIC. NO. (If applicable, enter "exempt" in the license nu er line.) Bus. Tel. No.: Address: ^1' Cat A",-77-r- 75—�1,r,% �%%7cP%re1 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner Q owner's agent. Owner/Agent Signature Telephone No. [Rev. 04/00] • • • : Commonwealth of Massachusetts Official use Permit No. Department of Fire Services L Occupancy and Fez � • ; ck� BOARD OF FIRE PREVENTION REGULATIONS ptev.1v99] ve APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ff OY All workto be performed in aecordaace with the Massarhusctts Blectrical Code (bMC), 527 q&M 12. (PLEASE PRZNTINWKORTYPEALL WFORMA770NJ Date: City or Town of: YARMOUPH To the Inspector of Wires: \/ By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) MELT POND VILLAGE, Camp Street de— D G A— Z OwnerorTenant Gatewood Homes/ Jeff Sollows Telephone No.508-7789669 Owner's Address 1600 Falmouth Rd., Suite 25, Centerville, Ma. 0263.2 Is this permit in conjunction with a building permit? Yes X❑ No ❑ (Check Appropriate Box) Purpose of Building single family residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worlc Fire Alarm System (low voltage control panel) with bacuM battery, centrally Mnitored. ComDletlon ofthe following table may be ivaive2l'bv the Inmeemr ofLYires No. of Recessed Fixtures No. of Cell-Susp. (Paddle) Fans No.'of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool d e d BatteryUn1757. iency g No. of Receptacle Outlets No. of Oil Burners FIRE.ALARMS No. of Zones —1— No. of Switches No. of Gas Burners o. 01 Detection.an 7 InitiatinLr Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat p Totals: umber. Tons o. o ontaine Detection/Alerting Devices 7 No. ofDishwashers Space/AreaHeating KW Local Conn�ii' ® Other No. of Dryers .. Heating Appliances KW SecuritySystems: No. of Devices orEquivalent No. of Water KW Heaters o, o o. o Signs Ballasts Data Wiring; No. of Devices or Fquivalent No. Hydromassage Bathtubs No. of Motors Total HP Tel ecommunncations ,ring No. of Devices or E uivalent OTHER: Attach aaamcnal aetail Tdetire4or as required by the Irapecror cffi= INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHEM ONE: INSURANCE M BOND 0 OTHER 0 (Specify:) Estimated Value of Electrical Work $750.00 (Expuahon Date (When required by municipal policy.) Work to Start Z-i 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I ca fy, under the pains and penalties of perjury, that th a information on this application is true and complete FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C Licensee: Jonas R Bielkevicius Signature �" LIC.NO: 499D (IfaH&able,enter"erempt"in the: ltcewenumpe linej_ 02563 Bus. Tel. No: 508-833-0996 Address: PO 'Box -3 09 SaAdwxc Alt. Tel No.: 508508� 776-333 7 OWNER'S INSURANCE WAIVER .I am aware that the Licensee does not have the liabilityinsurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) 0 owner ❑ owner's agent Owner/Agent PERMIT FEE: Signature TelephaneNo. $ 40.00. TOWN OF YARMOUTH JUN 3 0 2004 DEPT(, APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) Byded Fee: $ p PERMIT NO. 1 — 05 Date l Building Owner's afE a%on f � Vr76 API 3d 6 AT: —Location l \ -t Name / Type of Occupancy / New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ zCD ? - X rA rA M O U Z Z W W �\ w y Y �' N Q 2 Q to Z M O C7 fA a OG OJ Z N y FQ W WW D: W y 2 LL Z Z a Z 3 X W (n W x >. a N co Y Z_ O d Q Z Q 0 a Q a 0 w O M w Q y 0 Q (p 2 fA J G G LL w x a= 3 0 z x 3 Y o. p F- Q Y. Q w LL Y w a > '' ° ai v°i a o a ° ° a 9 ¢ Lu a °o a Y J m N C Q J x F fA LL (7 � Q Q 9 oC m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) f Check One: Installing Company Name art �Lm 6i ❑ Corp.. Address 1 ❑ Firm/Compa nership ' 1 Qr �f%- 0 Z 7 9 n Business Telephone 77 Y 610 1 Marne of Licensed Plumber -- 'Eon )g o Q rrlbp o )105 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage the Mass. General Laws, and that my signature on this permit application waives this reglnfr )ment. Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Bond ❑ by Qhapter 142 of of Licensed Z51 9-7 License Number Type: Master❑ Journeyman n/ le 4 TOWN 0 ,�YARM TH—,-T 1 NOV 0 1 2004 U EUILEiNG E-'T. APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By t&Pi Fee: $ �q6-0 PERMIT NO. CZ-05 — ?j109 Date Building Owner'g // _ AT: Location t Z C �Q i Yl S % NamekA—Czes AT e%W-4 5T Type of Occupancy_le l/ New EX Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No t' ` to Yz ccIn ¢ O ~ �- m C Z x x z W w o o o ZLU LU °C z a CAm z O z O rn x a x w>¢ w 0}C J V ¢ > x O a H O x O 0x u0. G C7 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) �� Installing Company Name -�UGTS' U A//,( � tTe-D o Address I C 14r4s 6 S Check One: ❑ Corp. ❑ Partnership — f lie A Al /V I S M A Q 2. !Lr1Q d � Firm/Company Business Telephone 190 Fs —7 3 % r 3_6 9 q Name of Licensed Plumber order ']S: c�o 7 INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes E�'No ❑ If you have checked yes, please indicate t e type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Signature o Licensed Plumber or Gasfitter Zt 7 E� License Number TV= 1 IrFMCG• DOWI E BfiM PE 189 Harbor Point Road Cummquid, MA 02637-0361 Phone (508) 362-6016 August 16, 2004 James Brandolini, Building Commissioner Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 AUG 1 7 A04 Project: 22604 Mill Pond Village Camp Street Yarmouth, MA Today, I made a site visit to the above property t ct an inspection ff-- `' _ floor joists with holes for plumbing. This was in E p g t, Lot #1 a d in Clo r, Lot #2. The floor joists are 2x10's @ 16" o.c. and have been ith 3/4" CD plywood each side. The holes in the joists, Lot #1, over the kitchen area, are near the ends and would be a shear concern, not moment. The holes in the joists, Lot #2,over the bathroom area, are also near the end and are further supported by the closet walls. I believe that these details are structurally sound. Daniel E. Braman, PE R ti _LL✓ r% ;71 .� _.SIT COPY N 10-47' Ai -I — � rn ' �pUNDP�pN o b�\ N EXISTING FOUNDATION LOT 3 L=51 I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREA. Qwto 9 DATE REGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft. REVISED: AS —BUILT PLAN OF LOT 2 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA SCALE: 1 "=20' DATE: LOT 2 %, FpXUN P-�ON LOT 6 I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF THE 40B SPECIAL PERMIT. 01 9AL".'A?— REGISTERED P OFES ZONAL LAND SURVEYOR NOTICE Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein; and (0) this plan remains the property of Holmes do McGrath, Inc. holmes and mcgrath, Inc. civil engineers and land surveyors 362 gifford street falmouth, ma. 02540 JOB NO: 201197 DRAWN: DWG. NO.: A2501 A CHECKE MJ) (� Ca(�w' 0. s "PATH 7 OF r TOWN OF YARMOUTH Building Department BUILDING r Z (508) 398 2231 ext.261 f PERMIT NO 6-04-1373_ - PERMIT ISSUE DATE ; _ _6/9/2004_ _ ; APPLICANT Frank PROPOSED USE ---- Capra - --------------------- JOB WEATHER CARD , ----------------------------- PERMIT TO New Construction ' AT (LOCATION) 100121CAMPST#2 ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 144.21A.C2 LOT SIZE BUILDINGISTOBE: CONSTTYPE15-B I USEGROUPI R-4 new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plan dated REMARKS 03/31/04 and BOA # 3546. AREA (SO FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 OWNER lVillages at Camp St., LLC UILDING DEPT BY ADDRESS 1600 Falmouth Road #25 Centerville I MA 102632 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 Certificate Issue Date )71 D o s / CERTIFICATE of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Ap roved By Re arks BUILDING ^� d PLUMBINGIGAS ELECTRICAL ENGINEERING OTHER 4r,- 12e"h' _e -ht,C 3 h To be filled in by each division indicated hereon upon completion of its final inspection. A TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ _ _ _-,3�(508) 398-2231 ext.261 = PERMIT NO B.oa3 _ . _ - .. - - PERMIT - - -137 e ISSUE DATE 619/2004_ _ ; PROPOSED USE """"""""""""""""""""" APPLICANT JOB WEATHER CARD Frank Capra PERMIT TO ' New Construction ' AT (LOCATION) 100121CAMPST#2 ZONING DISTRIC R-40 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 144.21A.C2 BUILDING IS TO BE: CONST TYPE 5-B LOT SIZE new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plan dated "REMARKS 03/31/04 and BOA # 3546. AREA (SO FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 OWNER lVillages at Camp St., LLC BUILDING DEPT BY ADDRESS 1600 Falmouth Road #25 Centerville MA 02632 INSPECTION RECORD USE GROUP CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector cr ram( o� Q/ �n A 11 � r,qj)--, 1 TOWN OF YARMOUTH Building Department ` Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 r U(!g JD BUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-434 Applicant Name: Frank Capra Location: 00121 CAMP ST #2 Owner's Name: Villages at Camp St., LLC Owner's Addres 1600 Falmouth Road #25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 614 Net Owed: ($50.00) Application Date: 3/8/2004 Issue Date: Expiration Date Comments: new construction: This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 3/15/2004 ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH AONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, MA 02664-4492 Tel (508) 398-2231 x261 • Fax: (508) 398-0836 Use Only; Planning El6ard Information Assessors Department Infomiabon Permit No 11Office Plan hype Map Lot Ma Lot x ( t Endorsement Date f I•� f S P t Permit Fee $ /. t , Old New 1 4 Property Dimensions s Deposit Rec'd'f�� Date Net Due � Areas FrotLtCna"� m. Btiildin F" "r`" It Nu E f Certificate of Occupancy i is " ' is not , - required'. �t = ? 'Building Official,,,_'pate .._. , ; SectionJi;-.Sitelnforri ttion`: UseGroup:R-4 Type:5-B 1.1 Property Address: 54 1.2 Zoning Information: a 1 CA I° pl� 94-511 A-V I Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) 1 5 Flood Zone Information Comments Public Private ;Zone aBFE . Section 2 =,Property,OwnershiptAuthorized'Agent` 2.1 Owner�f Record: l(L / oc? � uv \\1 6 , N me Sprintk �7 Mailing AddressA)I k (G-Cunze Signature Telephone 2.2 tAuthorizejAgent: Name (print) t^a�N ailing Address I 6 Op Signature Telepho� Sectiori!3 ` C66`truction.Services - 3.1 Licensed Construction Supervisor. M Not Applicable ❑ r� License Number O ✓I �a ll res dd j r 7 Expiration Date G2 r� Signature Telephone 3.2 RegisteredHome Irt provemept, Contractor--_ Company Name Not Applicable ❑ Address I _ V License Number Expiration Date Signature Telephone M I— Qe ml 9- f5-99 1 of 2 OVER Secti6n4-Workers' Corr pen'satiori Insurance Affidavit (M.G Cc,152 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial f the issuance of the building permit. ` Signed Affidavit Attached Yes .......... No .......... Sectloit ,= Description. ot,roposed, Work'{checkl)applicable); New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ 1 Repair(s) ❑ I Alterations ❑ Addition ❑ AccessoryBldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: < < i✓� W. (V,, Costs Estimated Cost (Dollars) to be Check Below 'Se6066 .Estimated Construction Item completed by permit applicant i ! % ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway & Historical Commission approval o (if applicable) Tob6CompletedWN e�� 1. Building . 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new houses & addi iom) Sectionl7a OwnerAUthanzation Owne'sA ent;or,ContractorAp fes.forBuilding;Perm ner of the subject property /altwA hereby authorize �r�I ��"`� 1'� e S `-04 ii- to act on m beh , in all matters elative to work authorized by this building permit a Ijcation. 102, Signature of Owner Date S&6tionrr7b,=,Owner/Authorized Agfent Dec aratiori' iOlv�., I , asQwner/Authorized Agent VV ► 1 d sPw er/Au hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Pri name _Signature of Owner/Agent Date N 9-15-99 2 of 2 ►. k TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT - job job Location: Owner of Property: Construction Supervisor: Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. aa63a- 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes (E( No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy � 7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner I] Agent ❑ Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial.-fccidents oJJles0/1"Ost/ SONS 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit cit, i �l.,V Q /v l 7 7b J�— phone a 0 I am a homeowner performing all work myself. Lam a sole proprietor and ha%e no one nvorking in any capacity p I am an employer pro%iding workers' compensation for my employees working on this job address, city: phone # iinsurance co. noliev 0 C9/l am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed helnw nhn ha%e insurance co. policy H rauure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of erimiaal penalties of a flat up to slM 0o and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flue of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Me of Investigations of the DIA for coverage verifieatioa. 1 do hereby cerrifyunder the pains anenalties of perjury that the information provided above is true and correct k Signatures Print name • official use oniy do not %rite in this area to be completed by city or town ofBeial miry or town: YARMODT$ _ permit/license M (OBuilding Department 13Llcensing Board check if Immediate response is required 261. E3seleetmen's Omee Health Department contact person: phone N: _ (5O8) 398 -?231 eat. r,Other. ... .I .a I.II 11. 0 TOWN OF YARMOUTH (� `3 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 G MATTACN[CS Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at p Work AaAiress is to be disposed of at the following location: i 2,f6` � tl Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Permit No. Date �`� ✓iie Toanyrnosuoea� 'i `�Cr!aaaaclu�ae!!a r ('{ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 012430 ::ii Birth date: 06/16/ 1940 Expires: 06/16/2004 Tr. no: 25823 Restricted: 00 FRANK G CAPRA 40 COPPER LNG' CENTERVILLE, MA 02632 Administrator 00 - 35.000 d enclosed space (MGL C.112 S.60L) 1A - Masonry only 1 G -1 6 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code Is cause for revocation of this license. DIG SAFE CALL CENTER: (888) 344-7233 H�vnLJTM I:CK i It-iLATE OF LIABILITY INSURANCE DATE(MM/DD/M ` 07/22/2003 1 PRODUfrER (508)994-9688 FAX (508)991-5461 THIS CERTIFICATF IR IS RIIFn Ac A ss Arrr-.. .... ...___. RUTKOWSKI & KESTENBAUM 414 COUNTY STREET NEW BEDFORD, MA 02740 PO Box 664 West Hyannisport, MA 02672 ONLY AND CONFERS NO RIGHTS Iury UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE caeacon ntinental Casualty.Co_:... COVERAGES INSURER e 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, NSR TYPE OF INSURANCE POLICY NUMBER POLICY FF EC NE PO ICY EX (RATION GENERAL LIABILITY PP0053131 00 LIMITS 12/13/2002 12/13/2003 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FIRE DAMAGE (Any one fire) S 50 QQQ X OCCUR A MED EXP (Any one person) s - 5 000 GGEEM,L,,A,,GGREGAATT1E LIMIT APfPUPS PER: PO LICY fI JJECar 1 1 LOC AUTOMOBILE LIABILITY BXE48125 ANY AUTO ALL OWNED AUTOS B X SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY 3ttL�LL EXCESS LIABILITY . 7 OCCUR O CLAIMS MADE DEDUCTIBLE L_JRETENTION S WORKERS COMPENSATION AND CEMPLOYERS' LIABILITY HOLDER Catewood Homes Inc 1600 Falmouth Road Ste 25 Centerville, MA 02632 BY LETTER INSURER B: INSURER C ----- -- INSURERD:—_ PERSONAL 3 ADV INJURY S 1 000,000 GENERAL AGGREGATE S 21000,000 PRODUCTS-COMP/OP AGO $ 2. 000.OnD '--" COMBINED SINGLE LIMB S (Ea accddenq BODILY INJURY (Per person) S 2 SO , 00( BODILY INJURY S (Paraccidenq 500,.00( PROPERTY DAMAGE' S (Peraccidenq 100_ .00c •PIS CIDENT. S EA ACC S AGG S E t S S EL EACH ACCIDENT $ SOO EL DISEASE-EA EMPLOYE S 500 EL DISEA"t-POLICYUh11Y $- S00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 'T""""' %.Mrc IriLA t OF LIABILITY INSURANCE" DATE (MM/DD/yyyy) PRODUCER 1Q/17/03 Dowling & O'Neil Insurance THIS CERTIFICATE IS ISSUED. S A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Maid St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURED INSURERS AFFORDING COVERAGE NAIC # Bayside Electrical Contractors, Inc. INSURERA: Travelers Insurance Company 372 Yarmouth Road INSURERB: Guard Insurance Group Hyannis, MA 02601 INSURER C: INSURER D: 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 CONTRACT OR OTHER DOCUMENT MAY PERTAIN, -RESPECT A WITH TO WHICH THIS CERTIFICATE MAYBE ISSUED THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A NSR TYPE OF INSURANCE POLICY NUMBER OFOR SUCH POLICY EFFECTIVE POLICY EXPIRATION DA E MMIDD DATE GENERAL LIABILITY 16801484A82ACOF03 10/05/03 MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY21 10/05/04 EACH O OCCURRENCE OOO OOO CLAIMS MADE X OCCUR DAMAGE TO RENTED $300 000 MED EXP (Any one person) S5 000 X OCP PERSONAL &ADV INJURY $1 000000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2 QQQ QQQ POLICY 71 PRO- LOC PRODUCTS -COMPIOPAGG $2 000 000 A AUTOMOBILE LIABILITY 18102601W5611ND03 10/05/03 ANY AUTO 10/05/04 COMBINED SINGLE LIMIT ALL OWNED AUTOS (Ea accident) $1,000,000 X SCHEDULED AUTOS - BODILY INJURY X HIRED AUTOS (Per person) $ X NON -OWNED AUTOS BODILY INJURY X Drive Other Car (Peraccident) $ GARAGE LIABILITY PROPERTY DAMAGE $ (Per amIdent) ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ EXCESSNW MBRELLIABILITY AUTO ONLY: AGG S OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S "DEDUCTIBLE _ S RETENTION S $ B WORKERS COMPENSATION AND BAWC436910 08/18/03 EMPLOYERS' UASILITY 9 08/18/04 WC STATU- OTH- ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED) E.L. EACH ACCIDENT e'I nn nnn OTHER DESCRIPTION OF OPERATIONS) LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT) SPECIAL PROVISIONS Operations performed by the named Insured subject to policy conditions and exclusions. - Gatewood Homes 1600 Falmouth Road Suite 25 Centerville, MA 02632 anUUW ANT OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR IAUTHORIZED ACORD 25 (2Do1/o8) 1 of 2 #M31942 0 ACORD CORPORATION 1988 OF 2 N� L7RANCE Producer: ' SOUTHEASTERN INS AGCY 641 MAIN ST HYANNIS MA 02601 Code: -- ---------------------- Insured: RJ BEVILACOUA P 0 BOX 628 FORESTDALE MA 02644 Issue date: 7/22/03 -- This Thisncertaficatendoesnnotoamend, extent or after the coverage afforded by the policies below. ---------------------------------------------- - - COMPANIES AFFORDING COVERAGE Sub -code; I Co Ltr A:___ ARBELLA PROTECTION Co Ltr B; ARBELLA PROTECTION Co Ltr C: •---------- ---------------------- Co Ltr D: ARBELLA PROTECTION -------------------------------- Co Ltr E: COVERAGES This is to certify that policies of insurance listed below have been issued indicated notwithstanding any requirement, term or condition of any contract to the insured named above for the policy period or other document certifica4e may be issued or may ertainr the insurance afforded by the exclusions, and conditions of such policies. Limits with respect to which this policies described herein is subject to all the terms, - ------------------------------------------------------------------------------------------ shown may have been reduced by paid claims. Co I Ltrl Type of Insurance I -----I I Policy Policy number leffective date --------------------------------------------------------------------------------------- I Policy I - (expiration date) All limits in thousands A I I ENERCo LIABILITY I Commercial general liability 850001BI47 I 7/15/03 I 7/15/04 (General aggregate: 2,000 [ Claims made () Occur Products-comp/o s aggre y. wner's 8 contractor's prat I I I (Personal/advertising inf: I I I I Each occurrence: 1,000 (Fire damage: too ------------------------------------------- B IAUiOMOBILE LIABILITY I An auto ---------------------------------------------------------------------------------------- 86852400001 I 2/21/03 I 2/21/04 Medical expense: 5 (Combined All owned autos I I I Sin le limit: 250/500 8Scheduled autos Bodilyinjuy PerpersonNon-ovned liodily Hired autos I I autos injury Garage liability I I I (Per accident): I --- ---- ----------------------- -----------[- I Pro Property damage: 500 a y 9---------- I�X�ESS LIABILITY ----------------------- -- — ---------------- Each I ----------------------------------------------------- Other than umbrella form I I I I Occurrence Aggregate D I WORKER'S COMPENSATION I ----------------------------------------------------------------------------- 90886B0403 I 4/27/03 I 4/27/04 IStatutort I----------------------------- EMPLOYERS' LIABILITY 100 Each accident) 500 Disease -policy limit) --(OTHER-------------------------------T------------------ 100. Disease. -each. emp.loyee.J... Description of operations/locations/vehicles/restrictions/special items: CERTIFICATE HOLDER GATEWOOD HOMES 1600 FALMOUTH RD STE 35 CENTERVILLE MA 02632 4/89 CANCELLATION Should any of the above described policies be cancelled before the expimailrat10n date thereof, noticestontheocertificateeholderrnamed to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. ----------------------------------- ----------------------------------- Authorized representative: JOAN M MARTIN JA A L{JIJ S64 • TN18 CEPTIF1C.iTE is ISSUED AS A tdaTTw nc �v-..�.----- RIDER. RItK SPECIALISTS INSURANCE AGENCY, INC. F.O.BOX 115 ATAUMET, MA 02534-0115 COMPANY IRED - US LIABILITY INSURANCE COMPANY COMPANY MONUMENT INSULATION, INC. 9 223 COUNTY ROAD AMERICAN HOME I2dSUAANCE COMPA.*1Y COMP BOURNE, MA 02532 c ANY COMPANY ID THIINDICATED, A E CERTIFY THAT THE P ANY RE UMENT.INSURANCE LISTED 6dOW HAVE BEEN 1S . .. TO THE INSURED NAMED ABOVE FOR THE POLICY PERTOD" WDICA'f�..D, NOTWLTFISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTTH RESPECT TO WHICH THIS f)(CLUSIONS MAY 8E ISSUED OR MAY PERT: {THE It AFFORDED BY THE POL'CIES DE3CR19ED HEREIN IS SU3JECT TO ALL THE TERMS. r^C. CLUSIONS AND CONDITIONS OF SUCH POLICIES. LJMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIPJED H S. TYPE Of INSURANCE POUCYNUNBEN POLICY 2J'fEC71VE. rOYLY$.PIRArl DATE (NNAIDM'I GATE OIYNIDGYTT UC7: OENERM.l7A8111fY X coNMERGAI LTEN67ALtU19lVfY OENERALAOORECATE I $I 000 , 0O1 n�MSMnoE® PROOUCTT3•COMPAPAGG s500 000 _M OwNEASACCNTRACTOA9PR0T CLII35745 PETL�ONALBADUDIIURY t500 000 8/23/03 8/23/04 EACHC=pRe'l $500.000 ALITO"DIU! LIABILITY ANY AUTO ALL OWN® AUTOs SCHI AU bS NFMALrCS NONOWNEDAU793 LA �!c8lLAS1LLTY . . -I ANYALTTO- UMBRpLt FORM OTHER THAN UMeRELIA FC WORKERS COMPEAWTION AND VapLDTl16' Uawl NYC. J TIC 782 61 72 GATEWOOD HOMES,INC 1600 FALMOUTH ROAD 125 CENTERVILLE, MA 02632 508 778-5603 ComeBN® SINGLE IJLBT 12 B PwwJL t FJOCILYIJJURY t iPoL acd� PROPERTY DANAGC t AUTO ONLY. EA ACCMW 3 OTHER THAN AUTO MI SACHACC ENT i ASGREGATS a -- EACH it �7 9/5/03 19/5/04 L SHOULD ANY OF THE ABOVE DUMBED POLICIES BE CANCELLED BBFONEAVTRr CIRLJI LUTE THL9IEOF, THE ISSUING COMPANY WRL ENDEAY011 YO NAM 10_ DI WLRTI NOTICE TO THE CEFIINGTE HOLDER NANED"TZ-nw Fr BUT fAlUl11E JD HALL . rOTTCE SHALL Bt YO anuaaT10N OIL UABLLRY OF 71_r7;+.IP4D i�:UPCK CO ne OB REMPtNrratrosc- TOTAL P.01 P.O1 ACORM CERTIFICATE OF LIABILITYINSURANCE DATEIMIA/00lYn PRODUCER THIS CERTIFIL.•TE IS 138U0-0 ED AS A MATTER OF INFORMATION mcamm Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE. 749 Main Street, suite#A MOLDER TM18 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERA Ostarvilla, Ma. 02655 AE AFFORDED BY THl1 POLICIES BELOW. 50.$-A2Q= 1.3 INSURERS AFFORDING COVERAGE INSURED CaspOrDOn Overhead Doors INSURER A: 1 INSURER Ik Box 517 wSURER Cl. East Falmouth, XA 02S36 INSURER COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 INDICATED. NOTWITHSTANBING- ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY INSR PAID CLAIMS. OF SUCH 7 TYPE OF INSURANCE POLICY NUMB£RTE uEFFECTIVE POa CY GENERAL LIABILITY �XPIAATK)N LIMITS COMMEACUL GENERAL UABIUIY EACHOCCUARENCE [ d.A.,Q$O- � CLAIMS MADE XJ OCCUR L FIRE DAMAGE ( aIa Mel [ $ QQ . 000 . A MP?48352 MED EXP(AWy person) S , 05/28/03 05/29/04 PtAsoNALaAovINJURY [ 0 OEN'L AGGREDAIE LIMM Ar rUES PER GENERAL AGGREGATE [l POLICY J� LOC PRODUCTS • COMPA3P AGO [ _ 000. 000 AUTOMOBILE LIASgM ANY AUIO - SINGLE LT SA ALLOWNEDAUT09 (COMBIIIN �) Ef SCHEOUI FO AUTOS SOOILY INJURY - HIRCD AUTOS IP.r p..wn) S NQH-OWNCDAU?OS- GODILY INJURY _ (P...eaOaK) PROPERTY OAMAGE (Pa. aO l"al) [ GARAGE LIABKJTY Au7O CNLV - EA ACCIDENT S EA ACC [ !XClS9'pA7sRii�'- AUTOONIY: AGO f OCCUR �CLAIMS MADE F.ACHOCCURRENCF - [ AGGREGATE [ 0lOVCTKriL M91ENMON_ >~_ WORKERS COMPENSATION AND [ EMPLOYERS LIABILITY WCP4 Q+T.Y c� A ��-i-_ 70gY LIMITS ER - 02 /ZZ103. 02J22/04 E•L. £ACH AcnOlNT OTHCR E.L. DISEASE • POLICY IpAIT t IC A A n n n BY Gateway Homea 1600 Fa"�Qut.Ti Road-, 8ui-te 25X Centerville, MA 02632 778 5603 ACORD 25.8 (7197) DATE THEREOF, THE LTSUINO INSURER WILL ENDEAVOR 70 MAIL_ DAYS WRrT7LT1 SHALL NOHC""'IECERfIFIDA7f.yIOLDE IMPOSE NO OBLIGATION OR UABfJTY OF ANY KIND UPON THE IN" 0 .bftmbe...... — _ ER, R'f AGEWS20 NTf OOR O ACORD CORPORATION Teas ' u 211""u uw<TIFICATE OF,LIABILITY INSURANCE = DATE (MMmO/1'YriN PRODUCER 508_398_6D33' 07/21/2003 FAX SOS-760-1667:jj CERTIFICATE tS ISSUED AS A MATTER OF INFORMATION Allied American Insurance Agency LLC Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 Atlantic qve DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SD YarlBOUth Mq 02664 ER THE COVERAGEAFFORDED By THE POLICIES ELOW, IN9URFD ERS AFFORDING COVERAGE NAIC li ape o Custam Floors 762 Falmouth Road Arbella Protection Ins CompanyHyannis MA 02601 e� Hartford 2WIER D: INSURER E OV A S THE 11 POLICIES OF NT, TERM Of LISTED BELOW HAVE BEEN ISSUED TO THC INSURED NAMED ABOV ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESP MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, N DD TYPE OF INSURANCE POLICY NUMBER POLICY E FE TIVE DOU GENERAL LIABILITY 7500000371 12/13/2002 12 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR A CEN'L AGGREGATE LIMITAPPLIES PER: X POLICY JM n.LOC AOTOMOBILE LIABILITY AWAUTO ALL OWNED AOT09 SCREDULEDAUTOS i NIRED AUTOS NON'OWNEDAUTOS GARAGE LIABILITY I ANY AUTO EKCESSMMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 8 ANY PROPRIETORNARTNER/EXECUTVE OFFICERJMEMBER EXCLUDED? OF 5 FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN :T TO WHICH THIS CERTIFICATE MAYBE ISSUED OR .L THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH EACH OCCURRENCE _ DAMAGE 0 RENTED = MED EXP (Any One p.%M) S PERSONAL A ADV INJURY 1 GENERAL AGGREGATE _ PRODUCTS. COMP/OF AGO S CONLY: ED SINGLE LIMIT e.�q S INJURYen) � i INJURYld.nU S.riiIIDAMAGE fNLY . EA ACCIDENT SHAN IA ACC iNLY: AGO S f f s s ACCIDENT Is BE.EAEMPLOYE a Evidence of Insurance for work performed within the Insured's scope of normal operations Gatewood Homes.. 1600 Falmouth Road Y2s Centerville, MA 02632 4CORD25(2001108) FAX: (508)778-S603 I N SHOULD ANY OF THE ABOVE DESCRIBED POUCIEB BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE BHA" IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TNfi INSUAEfl, n3 gpENTS OR REPREBENTATwE$. AUTHORIZEp B®{jEbENTATIV€ Z 7ii t' ®ACORD CORPORATION 1998 CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE(MMIDONYYY) CROWC50 1 07 25 03 IACORD PRODUCER Sullivan, Garrity & Donnelly 5,08-754-1767 10 InstitVte Rdt - PO Box 15010 Worcester MA 01615-0010 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 POLICIES BELOW. Phone: 508-754-1767 Fax: 508-754-1885 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURERA Hanover Insurance Co 22292 INSURER B: Arch Insurance Company Crowell Construction, Inc. PO Box 309 So. Dennis MA 02660 INSURER C: INSURER D: INSURER 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSK ALIVE LTR INSFU TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MTaTCTETRUTY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR ZHN7007141 05/01/03 05/01/04 EACH OCCURRENCE $1000000 X PREMISS ffa occurance $100000 MED EXP (Any one Person) $ 5000 PERSONAL R ADV INJURY $ 1000000 GENERAL AGGREGATE s 2000000 GENT AGGREGATE LIMIT APPLIES PER POLICY • '.PRO- 'JECT LOC PRODUCTS-COMP/OP AGG $2000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAIJTOS NON -OWNED AUTOS ABN7001142 ` 05/Ol/03 05/Ol/04 COMBINED SINGLE LIMIT (Ea accident) $ BODILY Person) (Per Person) $1000000 X X BODILY eracci accident) (Par accident) $1000000 X PROPERTY DAMAGE (Per accident) SSOOOOO GARAGE LIABILITY ANY ALTO AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S $ EXCESSAIMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE $ AGGREGATE $ S S S B -- WORKERS COMPENSATION AND EMPLOYERS'LIABIUTY ANY PROPRIETORIPARTNER/EXECUTN OFFICER/MEMBER EXCLUDED? :IF yes; describe under SPECIAPROVISIONS below OTHER IRWCI00100 03E /22/03 03/22/04 STORY LIMITS I ER E.LEACHACCIDENT $ 500000 E.L DISEASE - EA EMPLOYE $500000 E.L DISEASE. POLICY LIMIT $ 5 0 0 0 0 0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Fax #508-778-5603 CFRTIFICATF WnI neFa Gatewood Homes 1600 Falmouth Road Suite 25 Centerville MA 02632 25 GATEWOO I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND -UPON THE INSURER, ITS AGENTS OR 9 CERTIFICATE OF LIABILITY INSURANCE =DATE(MWDD/ItPROpUCER Dowling B O'Neil Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURED INSURERS AFFORDING COVERAGE NAIC # Gutter Pro Enterprises, Inc. INSURERA: Travelers Insurance Company P.O. Box .1197 INSURER B: Guard Insurance Group Plymouth, MA 02362 INSURER C: INSURER D: Prnrco A � INSURER E: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .TR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY DATE MM/DD D TE MMND LIMITS 1680459H3118TCT03 11/07/03 11/07/04 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 0 CLAIMS.MADE OROCCUR R MI ff $300,000 MED EXP (Any one person) $5 000 PERSONAL S ADV INJURY s-i nnn nnn GEN'L AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY _ ANY AUTO - COMBINED SINGLE LIMIT ALL OWNED AUTOS ( Ea accident) S SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) S NON -OWNED AUTOS BODILY INJURY (Per accident) S PROPERTYDAMAGE GARAGE LIABILITY (Per accident) ( $ ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ EXCESSNMBRELLA LIABILITY AUTO ONLY: AGG S OCCUR CLAIMS MADE EACH OCCURRENCE y AGGREGATE S DEDUCTIBLE S RETENTION f $ B WORKERS COMPENSATION AND GUWC440685 S EMPLOYERS'LIABILm' 11/07/03 WCSTATU- 11/O7/O4 OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT 51( n yes, tlescdbe under SPECIAL PROVISIONS below E.L. DISEASE . EA EMPLOYE S1( OTHER DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ACORD 25 (2001/08) 1 of 2 #32273 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL M POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED O ACORD CORPORATION 1988 11/11/VJ 10•11 riu OU87900249 GOLDMAN ASSOC t A-cOPIDL CERTIFICATE OF LIABIL)T- Y INS lPAN PFOOUC�PI GOId"rM i ASSOCIATES Z1iSmLv4c= -C in C�riCATe i3., rZt"Imcin SERVICES INC. ONLY AND CONFsOo I 933 TAxalvrp RD. HOLDEFL THi8 cERTIF KLMNIS MR 02601 ALTERTHECOVERAG P:eonat SOS-775-6010 Fa:: 5OS-7Q0-0249 . igL'Rg, aRs"f, kiG Am• R00t$Y tAVANO R@ ZiliiZC3.IPF(�maiFA DE A NECHaLVICAL SSSTZM. sas s 110 HOIAEei' IAM H'EA;W$TARLE M& 02668 MUERDt O e-AGF—e b.StatFAE THE �TE3 s OF PEURAMME LMTET 0w PAW MEN 6SLF.OTO T}G.omxw Kww Avow FOR THE P ou PERI00 p+araisc. AWREnLGW-%W n.Y-FOAMcacrrn+OFirmconnxwFcmanffxoommAWmrmwAKTWms ErrrowHc"- �xn�icnrew�r na OM wurvl<srAGQM0TEUMrTSV4* i0mK%Wq by TM U=sO MMWI9M�.IEcr'TOALLTWTMa8.E AND oPSLCH Pauca s AoaaEwTs tmri rkuwN wtrNwE t�EN pEMXMnr PADCL#AM A X ru cFaExaLuFaLM a'L8172 11/21/03 11/21/04 Mlta xa oc" NLA r�TELWTAPPLWSPt9L poicy PRO. Au}COP`�` .E LILESlrr 1NrA7TT0 ALLOWNWAuTca 6A1JIp6' . liPFDN�TO@ N0*0w%WALFros GLRAOE U&PA RY ANYAUTO. iA LWALay G?LZ.Pt �CLASSPACE DEOLMEM �Trrsa i �FAb 0004MAEATf.^•lAND VM%M"3W LMMLFTr R ARR#R rttrr,E,_ 37=7�-�-Ra903 05/0 //03 05/03/04 GAVEWWD H aes 114E FAX 508-778-S603 1600 FALMMn RpAD-. CENTSRVILLE MA 02632 GATzwocr WfoLWoAfcw;wm OATEnWtL , T:E m NO =TMTdECMM ueoseNoaeuaLraN s 9 001 XtWWIL 10 DAYS warrrLm Lz rartPAtUtEToQOE07NKL t �AC.t? . CERTIFICATE OF LIA,Bi1 TY INSURANCE PRODUCeR 508 672 2997 THIS CERTIFICATE is ISSUED 40A4M-DNAS ONLY AND CONFERS NO RK OCAS INSURANCE HOLDER: THIS- CE-kT1FICAT6 G 535 BRAYTON AVE ALTER THE COVERAGE AFFOR FALL RIVER. MA 02721 tNslmsoe AssnenlAr. NSVREO JOEL FERREIRA OEALMEIOA DBA EJJA CONSTRUCTION 50 PICKERING ST. APT 17 FALL RIVER, MA 02720 COVERAG A DATE (NM(DOfiyYYl 08/08r003 MA1CIr LLIVZ KALIC3 - THE POLICIES OF INSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ALLY. REDTAIN. THE I SURAT"M OR CONDITION OF ANY CC N7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE MSURANCE AFFORDED BY THE POLICIES DESCRIBE0'HEREW'laSUBdEET YO ALL THSTERMS. EXCLUSIONS.AND rnNDITLQN4 OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RSR oO' 14 P.OW�'NVMEER PQL EFF[CTW! POUCY EXPIRATION LIMITS GENEML W6XITY `EACHOCCUR MNCE E T,000.'000- X COMMERCIALOtfwr"LLWeIL" NC27580E 06/26=03 06126/2004 P S ocuMcl el—.}tjFs— 100,000 GLAIMSMADE OCCUR I MEO EXP(Any OAl patsM) I S rj-Tmr PER: I I AUTOMOBLE UAEILTTY ANY AUTO I r �ALLOWNEOAUTO$ I SCHfBULEDAVTOS "QED ALROS l NONAWNEaAUT05 I H AGE L4U ury ANY AUTO .f OCCUR CLAIMS MADE -,I OEDUCTBLE _ I I RETENTION S WOARSR COMRENa&TIONANO EMPLOVIRS'LUVLILITY AM'000" ErOPIPARTNEREXE{LTNE OFFICEfLMEMSER EXCLUDED? GATEWOOD HOMES 1600 FALMOUTH RD. CENTER VILLE. MA 02632 WC' 49�,r'4$'-W- COMB C= &"GL6 U T S (Ea accl"o 600II.YINJURy (Par Penal/ E00'LYIWURY I Ir•asacieanel I S PROPERTY DAMAGE — 11Ff— mv AUTOONLW EiTACCIDEI+? r OTNERTHAN EAJ= I =. AUTO ONLY: �— tt/0$/03 1 N06f04 I EL I S ENOVLO ANY OF THE AOOvr.OPSCAIpEa PpLGI[j al CANCE.CE SeFoRITNEEXMRq;gµ- DATE THEREOF. THE KIUING INSURER WILL ENDEAVOR TO MAIL t0 DAYS WRITTEN HOTTCETO'TRE'CVMFtCAl?-"*WF*"MND TO THE LEFT, IRM FAEANIE.TO nn •n ,,.. WIPOSE NO OBLIOATIOR OR LABILITY OP ANY KM UPON TN[ WDURER, ITS AOlNTS OR UTHORIIED R` ESENTAT L1 ACORO CORPORATION-i48e t I, CERTIFICATE O� IN�LCE PRODUCER Passaro Leverone & Buckley Insurance Agency Inc P 0 Box 160 Dennisport, MA 02639 µSSUE DATE COMPANIES AFFORDING COVERAGE INSURED Patrick K Orcutt 6a P & S Concrete cLOE Pv A A.I.M. Mutual Insurance Co 37 Ladys Slipper Lane Mashpee, MA 02649 COVERAGES THIS LS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ICERTIFICATE NDICATED, MAYBE ISSUED O ANY PERT IN, TI I NS TR OR CONDITION OF ANY COMMA' OR OTHER DOCUMENT FOR THE POLICY PERIOD EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITSAOWN MAY HAVE Y THE PPLICIES HREDUCED DESCRIBEDHER��S•EIN IS SUHBJRESPECTTO WHICHECT TO ALL THE TERMS, TYPE :o TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPnRATIO DATE(MMIDDNY) DATE(MM/DD/YY) LMTTS GENERAL LIABILITY ^r-OMMERCIAL GENERAL LIABILITY ENERAL AGGREGATE S OWNER'S & CONTRACTOR'S PROT. UTOMOBILE LIABILITY NY AUTO ALL OW NED AUTOS EDULED AUTOS ]RED AUTOS - NON-0WNEErAUT05 ARAGE LIABILITY XCESS LTABn,I rY MBRELLA FORM HER THAN UMHRPT I A FORM WORKER'S COMPENSATION AND EMPLOYERS• LIABfLRY `9' THE PROPRIETOR/ 6006181012003 110/21/2003 PARTNERS/EXECUTIVE INCL OFFICERS ARE EX OTBER ESCFUPITON OF OPIIIATIONS/LO(`ATTnNcrvrnrrr rercn.:.............. Gatewoods Homes 1600 Falmouth Road Centerville, MA 02632 JUCIS-COMP/OPAGG. t ONAL &ADV. INJURY I f OCCURRENCE S DAMAGE (Any one fin:) S EXPENSE (Any om person) S NNED SINGLE • S LY INJURY nson) S .Y INJURY oident) S iRTY DAMAGE S OCCURRENCE S :GATE S 10/21/2004 E ELSE -POET LIMTI' SEL SE -EA EMPLOYEE S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRrMN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATTVR /J i��RD, CERTIFICATE OF LIABILITY INSURANCE oD7AT °^ ' 1pUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION „ Dowling & 0' Neil Insurance - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i" Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Main St..PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE . INSURED NAIL # INSURER A: Hanover Ins. Company BUS. Bee, Inc. - INSURER B: Safety Insurance Company . P.O. Box 50 . East Sandwich, MA 02537 INSURERc: Associated Employers Insurance Compa INSURER D: INSURER 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR X PD Ded:ZSO POLICY NUMBER OHN643998501 POLICYDATE EFFECTIVE 06/14/03 PDATE EXPIRATIONMMIDDIYY 06/14/04 .LIMITS EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED MED EXP (Any one persm) S300OOO $15 000 PERSONAL &ADV INJURY $1 000 000 GENT AGGREGATE LIMIT APPLIES PER- PRO, POLICY Jr�T LOC GENERAL AGGREGATE $2 000 000 PRODUCTS-COMP/OP AGG s22000,000 B AUTOMOBILEUA131UTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS 3175394 01/14/03 • ... 01/14/04 COMBINED SINGLE LIMIT (Ea aeddmq $ BODILY INJURY (Per persm) $100,000 X X BODILY INJURY. Per ecddenq S30O ,000 X PROPERTY DAMAGE (Per accident) f1OO,000 GARAGE LIABILITY ANY AUTO - " AUTO ONLY • FA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S S C EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? N yes. describe under SPECIAL PROVISIONS below OTHER WCC5002932012003 06/27/03 JAGGREGATE 06/27/0WCSTATU- H OCCURRENCE S f S S OTH- E.L. EACH ACCIDENT f1OO,000 E.L. DISEASE- EA EMPLOYEEf $100.000 G.L.DISEASE -POLICY LIMIT $500.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured Subject to policy conditions and exclusions. i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Gatewood Homes DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN 1600 Falmouth Road Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #30822 1 1 1 G LAN - �T KJS @ ACORD CORPORATION 1988 0 PROPERTY: ADDRESS; :ALCULATION FOR PER COST TYPE OF ROOD god, 284.7d ADDITION out. ` 1 r" ALTERATIONS BED ROOM n M CERTIFICATE OF OCI WITH DEN DINING ROOM I' FAMILY ROOM z FIREPLACE FOUNDATION ONLY GARAGE NO. OF BA GREAT ROOM KITCHEN LAUNDRY ROOM LIVING ROOM MUQ ROOM OFFICE PORCH CLOSED PORCH OPEN REROOFING SHED STORAGE AREA SUN ROOM HEATED SUN ROOM UNHEATED SWOWAMP POOL A 4 SWIMMING POOL MR WINDOW REPLACEN EIr (01�-/�) NO z TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Mar 18, 2004 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 21.1.C2 Street 121 CAMP ST #2 as shown on Assessors sheet/map # 44 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand the provisions/restrictions of this Letter of Water Availability. Reference : VILLAGES AT CAMP STREET : FRANK CAPRA : 1600 FALMOUTH RD #25 : CENTERVILLE, MA 02632 Owner (Sign) Yarmouth Water Depa ment Building Site Location: Proposed Improvement: Address: & UU TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET 12u�f T Cvt� Map No: 'IV LotNo:P/• . L4'o� a The Building Department will be responsible for assisting the applicable departments. ` -77P 946 y Filed: 3 G l bydispatching your plans and or application to the following :% RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. ----------------------------------------------------I -------------------------------------------------------------------- _- - - - - - - - - REVIEWED BY: ✓I. WATER DEPARTMENTil RTMENTc DATE: !%&PNIA- "'2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A VIC HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A 7. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White copy - Building DepL - Piok copy -WawDepL - Yellow Copy -H"DepL '- Pink Copy -Eog gDept - Goldenrod-FiroDMVCwwva6on .1-11,.. — u."P.`ev4 r.... . • 4 ._.- �. �- - e.. �' 11._ ".-y� r�. a-.^.. Y.�a� •-....._ Building Site Location: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF r1 TRANSMITTAL SHEET JAJ1� Map No: Ll y Lot No: Proposed Improvement: JLP u/ l it7Ur�LotL r/h Pti `U�GC�.d� ST Applicant: � 7 7 Address: 16 00 �Tel.No.: % % y lF016 9 Date Filed: 3 D 0 a63a The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. ' ' RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal '------------•----------• -----------------------• Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta •-------------------------------------------------------------•------------------------------ REVIEWED BY: 41. WATER DEPARTMENT: DATE: N/A: _ 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A Vff HEALTH DEPARTMENT- ?a �DsT/� � �JF �.i —D DATE: �-04 N/A:. INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR DATE: N/A 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: White cops' - Buddmg Dept - Pink copy - Wata Dept - Yellow Copy - I-IaM Dept - Pick Copy - Engm=ing Dept - Goldenrod -Fire DgACzn9ervation i u � I MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck software Version 2.01 Release 2 I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: other (Non -Electric Resistance) DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Plover PROJECT INFORMATION: Mill Pond village 1600 Falmouth Road Unit 25 Centerville, MA. 02632 COMPANY INFORMATION: Northside Design Assoc. 141 Main street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 237 Your Home = 133 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 823 30.0 30.0 14 WALLS: wood Frame, 16" O.C. 1588 15.0 15.0 70 GLAZING: Windows or Doors 97 0.340 33 GLAZING: windows or Doors 40 0.340 14 DOORS 20 0.086 2 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed buirding 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 requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions in the Code. The HvAC equipment selected to heat or cool the iligj2 shall be no greater than 125% of the design load as specified sections 780CMR 1310 and 34.4. APR 9. >,,2nP4 Builder/Designer r • T Massachusetts Energy Code MAscheck'software version 2.01 Release 2 The Plover DATE: 4-21-2004 Bldg.l Dept.l use I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Location I WALLS: [ ] I 1. wood Frame, 16" O.C., R715 + R-15 Comments/Location WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location [ ] I 2. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No comments/Location DOORS: [ ] I 1. U-value: 0.086 Comments/Location AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: i 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can i be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 Release 2 I I i I Checked by/Date I I CITY: Barnstable STATE: Massachusetts HOD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 6-20-2002 TITLE: The Plover PROJECT INFORMATION: Mill Pond Villages 1600 Falmouth Rd. Unit 25 Centerville, MA. 02632 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 235 Your Home'= 127 Area or Cavity Cont. Glazing/Door• Perimeter R-Value R-Value U-Value UA ---------------------- CEILINGS ------------------------------------------------- 802 30.0 30.0 14 WALLS: Wood Frame, 160 O.C. 1588 15.0 15.0 70 GLAZING: Windows or Doors 129 0.320 41 DOORS 20 0.086 2 ------------------------------------------------------------------------------- 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 requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Dat `Massachusetts'Energy Code MAScheck"S(*tware Version 2.01 Release 2 The Plover DATE: 6-20-2002 Bldg.l Dept.l Use I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Location i WALLS: [ ] I 1. Wood Frame, 16" O.C., R-15 + R-15 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.32 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location I DOORS: [ J I 1. U-value: 0.086 Comments/Location I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I DUCT INSULATION: I ] I Ducts shall be insulated per Table J4.4.7.1. i DUCT -CONSTRUCTION: [ J I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating i and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. . I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5- CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in.): I PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" I 170-180 0.5 I 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 i 100-130 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department Use Only)------------------------- MERIT PU J _ iew A; o SERIES Direct -Vent Gas Fireplaces MPD3328 MPD3530 MPD4035 33' fireplace w/opt. flush face 35' fireplace w/brushed stainless 40' fireplace w/polished brass louver and door trim trim arch door kit Beauty, efficiency, convenience and reliability. Just some of what you'll find in our Lennox Merit® Plus Series direct -vent gas fireplaces. Our combo DV configuration, with both top and rear outlets, allows for top or rear venting (except our 33" units which have either a top or rear outlet). Standard features include a deluxe pan burner that produces big yellow flames and glowing embers, brickaded interiors and Hi/Lo flame opera- tion. And, these models are even easier to warm to when you select one of our optional remote controls, or polished brass or brushed stainless trim options. / O MPD4540 MPD4035 • Louvered face design • Charred split oak gas log set • Deluxe pan burner for big yellow flames and glowing embers • Charcoal black exterior powder coat finish • Realistic brickaded interior panels • Combo top/real• direct -vent outlets (except 3328 models, which have either a top or rear outlet) • Hi/Lo flame operation • Pre -wired for wall switch Options • Choice of standing pilot (works in a power failure) or pilotless electronic intermittent) ignition • Decorative polished brass or brushed stainless accessories (arch door kit, door trim, louvers, hood) • Wireless remote controls • Blower kits (including a temperature control version) • Screen panel kit (heat guard) • Radiant panel kits (for a clean face look) All Merit Plus Series direct -vent gas fireplaces utilize either a Secure Vent (rigid) or Secure Flex (flexible) 4.5" inner/7.S" outer coaxial venting system, and include a 20-year limited warranty. Note: Due to Lennox ongoing commitment to quality, all specifications, ratings and dimensions are subject to change without notice. Local conditions, such as elevation, wind vent configu- ration and choice of fuel will affect the overall appearance of the fire. Warnock Hersey (J20006711) Wamoek Hersey C ■—�& US liMo USA 785MM n z C%M ©IanmH®whRadc M = The first two model number digits 5 - indicate frame width, the last two digits indicate glass width. All are A.EU.E: rated high efficiency vented gas fireplace heaters, certified under ANSI Z21.88 and CSA 2.33-M99. MPD3% MPD3328 DIMENSIONS (Rear vent model shown) 3328 MODELS (This model comes as a top or rear vent only) C B B 8-13/16" Front Face Top 35, 40 & 45 MODELS (These models come with a top and rear vent) Right Side Front Face Top Right Side FIREPLACE & FRAMING DIMENSIONS 1 331/8 308 17 27' 3530 351/s 32t/s 19 29y2 35t/s 21tth6 2478 12%% 35t/4 35t/4 16 4035 40t/8 371/s 24 34t/2 40% 2611h6 29%8 14u/l6 401/4 401/4 16 4540 401/8 37t/8 24 391/2 451/8 2611A6 34%8 17%6 451/4 401/4 16 rr UM 3328T NG 17,500 45 64 62 3328T LP 17,500 49 66 64 3328R NG 17,500 53 63 61 3328R LP 17,500 55 66 64 3530 NG 20,000 53 64 62 3530 LP 20,000 55 62 60 4035 NG 27,000 59 69 67 4035 LP 27,000 60 69 67 4540 NG 29,000 59 69 67 4540 LP 29,000 59 69 67 'Intermittent ignition systems Look for the EnerGuide Gas Fireplace Energy Efficiency Rating In this brochure Based on csa v4.r-oz U9t us at wwwLenno>HearthProducts.com TYPICAL ROOM APPLICATIONS I imp... . . . . . . . . . . . . 4 MIX w O OFFCIENCY �• ~ FtING TFlED �� TI . ama �IV Air Conditioning & Heating USTE� ® ueTEo 92.6% AFUE MULTI -POSITION CONDENSING GAS FURNACE GMNT SERIES Satc7iF�mii S.m6YawMxx Description / Application • All models design certified by ITS to be in compliance with ANSI Z21.47 and CAN/CGA 2.3 (Canada) safety standards • Completely assembled, factory run -tested furnace, for heating or combination heating/ cooling application • For utility room, closet, alcove, basement or attic application • Vertical or horizontal venting with 2" PVC for 40k, 60k, and 3" PVC for 80k, 100k and 120k • Capable of multi -position installation — upflow, downflow or horizontal • For direct vent (2 pipe) or non -direct vent (1 pipe) installations Construction • Heavy gauge, reinforced, wrap -around insulated steel cabinet with durable baked enamel finish • Tubular heat exchanger (Primary) • Bottom or side air inlet • Aluminized steel inshot burners • Convenient left or right hand connection for gas, electric service, combustion air and vent • Removable solid bottom block -off Standard Equipment • Energy saving PSC, multi -speed, direct drive blower motors • Quiet operating, sound isolated blower assembly • 40VA transformer for heating and air conditioning control service • Combination redundant gas valve and regulator • Integrated furnace control with diagnostics • Blower door safety switch • Energy saving Hot Surface Ignition system • Multiple flame roll -out switches • Outlet air limit switch • Pressure switch for proof of air • Complies with California NOX Standards • Completely insulated cabinet • Corrosion resistant 294C secondary heat exchanger that extracts energy from the gas and converts it to usable heat • Quiet, corrosion resistant plastic induced blower assembly • Drain kit contains vent screens, drain trap, hoses & clamps Optional Equipment • L. P. Conversion Kit (LPT-01) • Concentric Vent Kit (CVK-00) As an Energy Star Partner, Goodman Mfg. Co., L.P., has determined that this product meets the Energy Star guidelines for energy efficiency Information contained herein is subject to change without notice. Made in the USA by: Goodman Manufacturing Company, L.P. SS-312D 2550 North Loop West, Suite 400 - Houston, Texas 77092 GMNT Series 10/01 www.goodmamnfg.com I � PERFORMANCE RATINGS Model Number GMNT Natural Gas Input BTUH Natural Gas Output BTUH Propane Gas Input BTUH Propane Gas Output BTUH DOE AFUE Temp. Rise 040-3 40,000 37,000 37,000 34,000 92.6 25-55 060-3 60,000 55,000 55,000 51,000 92.6 35-65 080-4 80,001) 1 73,500 1 73,000 73,000 92.6 35-65 1004 1 100,000 92,000 1 92,000 1 85,000 92.6 40-70 120-5 1 120,000 110,000 1 111,000 1 102,000 1 92.6 40-70 BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA AVAILABLE FROM YOUR RETAILER. SPECIFICATION DATA �L..........t...L..a:.... 14 rM Ian l:�c ccnniirn r nnnrfinn 1/0 PPT Model Number Motor Blower Vent' Dia. Combustion` Air Filter Size In Perm. / Disp. Electrical Ship Weight HP Spd. Dia. Width FLA Max Fuse 040-3 1/3 -3 10 6 2' 2' 290 / 580 52 15 170 0603 1/3 3 10 6 T T 290 / 580 5.2 15 180 080-4 1/2 3 10 8 T 3' 385 / 770 7.8 15 205 1004 1/2 3 10 10 T 3' 385 / 770 7.8 15 225 120-5 314 3 11 10 T 3' 480 / 960 92 15 265 -Note: vent ano COMDUS➢On alf Olaf nelelb IIK1y valy uaNcnuwuy uNun _cui cnya,. accompany the furnace. 28" A 58" 41.1 98„ I;47 F B 11 4$ 3 • 4 4 -r 8„ COMB. AIR INLET GAS INLET 511, 4 VENT n O 27" LOW VOLTAGE 4" i ELEC. 7 ()4 Model GMNT A B Combustible Floor Base 040-3 & 060-3 14' 12'/:' SBM14 OBO4 17'% 16' SBM17 100-4 2T 19'/:' SBM21 1205 24 f, 23- S13M24 SS-312D rn r=eraerucFc FRnM CAMRIISTIRLE MATERIALS Sides Rear Fronr Vent Top V 0' 3" 0- 1' ApprOVeo Tor nine Comact In ine nonzonial pusawn. •36" clearance for serviceability recommended. 2 CASED (U) COIL APPLICATION OPTIONS Furnace Model Number GMNT040-3 & GMNT060-3 GMNT080-4 GMNT100-4 GMNT120-5 Furnace Width 14' 17'Y2' 21' 24'/=' Coil Model Number Coil Width U-18 14• x U-29 14' x U-30 17'/:' X (1) X (2) U-31 14' X U-32 17'/:" X (1) X (2) U-35 14' X U-36 17Y2' X (1) X (2) U-42 17Y2' X(1) X(2) U-47 17'/z X U-49 21' X(1) x(2) U-59 21' X (1) X(2) U-60 24W X(1) X(2) U-61 24'W X(1) X(2) U-62 21' X (1) X (2) (1) Using the factory installed bottom cabinet filler plates (2) Discard bottom cabinet filler plates Due to the rating mix/match of various coils with outdoor units it is important to match the furnace air flow for the total system capacity. Refer to furnace, heat pump and/or condensing unit specification sheets. AIRFLOW DATA CFM - NO FILTERS MODEL STATIC .1 .2 .3 .4 .5 .6 .7 .8 HI 1370 1315 1260 1200 1140 1070 1000 925 GMNT 040-3 MED 1210 1170 1130 1085 1040 980 920 860 LOW 895 880 870 840 825 780 725 680 HI 1360 1300 1250 1190 1135 1065 1000 930 GMNT 060-3 MED 1200 1170 1130 1080 1035 975 925 880 LOW 910 895 885 855 835 790 750 700 HI 1865 1800 1735 1660 1590 1510 1415 1320 GMNT 080-4 MED 1690 1645 1600 1545 1485 1410 1345 1245 LOW 1450 1400 1390 1360 1325 1270 1200 1125 HI 2010 1945 1875 1800 1715 1620 1510 1400 GMNT 100-4 MED 1725 1700 1670 1615 1550 1475 1375 1275 LOW 1430 1390 1350 1315 1285 1245 1160 1070 HI 2360 2325 2300 2170 2125 M45 1945 1850 GMNT 120-5 MED 1815 1750 1710 1660 1600 1545 1480 1415 LOW 1275 1215 1190 1145 1110 1055 985 925 Values indicated by shaded areas represent airflows that are too low for heating temperature rise. SS-312D 3 s. RL NOTE: SPECIFICATIONS AND PERFORMANCE DATA LISTED HEREIN ARE SUBJECT TO CHANGE WrW.OUW L" QTICE Quality Makes the Difference! All of our systems are designed and manufactured with the same high quality standards regardless of size or efficiency. Our designs virtually eliminate the most frequent causes of product failure. They are simple to service and forgiving to operate. We use the highest quality materials and components available because if a part fails then the unit fails. Finally, every unit is run tested before it leaves the factory. That's why we know... There's No Better Quality. Visit our web site at www.goodmamnfg.com for information on: • Goodman products • Warranties • Customer Services • Parts • Contractor Programs and Training • Financing Options SS-312D 4 559.97' •e b, %7 50.75 A 3,574 6.3 ?Pop E rn 32 r Z 9Lo R i N . 3,387 ±S.f N LOT 1 Ln i cr � ' N 36 •gi �. PRpPOSSo NCE� \o_ � 38�p'1 �1 WP�ER LOT 2 \� ._ 5 to �,55.35 30Ar 4't PROpOS�`.�RP� NG' SEAR � E _ N 113 e; R�,36•g .u:r� .1 00 �=53' R G7 o Q - �2 UN. � N 1 �y NOTE: ® SEWER LATERAL SHALL BE 32 SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN GRAPHIC SCALE 10FT. OF WATER MAIN. NOTICE 20 10 0 20 60 Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other IN FEET Public officials. may rely upon the Information contained herein; and (B) this plan remains the property of Holmes & McGrath. Inc. 1 inch = 20 fL PLOT PLAN holmes and mcgrath, inc. 3 �a�\j" OF,�,ss..� PREPARED LOT FOR civil engineers and land surveyors s �o�. MICHAEL qv{ MILL POND VILLAGE 362 gifford street 13. MCGRATH IN falmouth, ma. 02540 9 No.289M YARMOUTH, MA o�F 9F DATE: 1-22-03 JOB NO: 201197 DRAWN: LMC ' ss T SCALE: 1"=20' REV' 9-24-031 DWG. NO.: A2501 CHECKED: �� N 80.47— GRAPHIC SCALE NOTE: ® SEWER LATERAL SHALL BE ss SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. - NOTICE Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other public officiate. may rdy upon the Information contained herein; and ( IN FEET) (B) this plan remains the property of Holmes do McGrath. Inc. i inch = 20 ft REVISED: 3-8-04 PLOT PLAN holmes and mcgrath, inc. P�(H OF n,,qs` OF LOT 2 civil engineers and land surveyors oa`yG PREPARED FOR 7INlOTHY M. MILL POND VILLAGE 362 gifford street sz rTM N No. falmouth, ma. 02540 ctvu.. YARMOUTH, MA 90 �FGfsT°�� DATE: 1-22-03 JOB NO: 201197 DRAWN: LMC �Fsro SCALE: 1 "=20' REV. 9-24-03 DWG. NO.: A2501 CHECKED: 75 TOWN OF YARMOUTH BUILDING DEPARTMENT PLAN REVIEW c MMmING PERNII'T A;PPI ATION REVIEW NOTES. ADDS REss: MaR Lot Date oftiaW ::3 �29-a S/O�: A,ralziatm lr:�� NOTES: Zooing Denial (if k?_ secfioti 1043.Z, pa Cbmim Exbusim or Alteration (pm -exit notx�oyormi� T P• opted rMPA-es a Special P=mt from the Zorateg Board ofAppeals. Other ^ DAIding Denialffappficable) s- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN (PLEASE PRINT IN INK OR To the Inspector of Wires: By work described below. Location (Street & N (OFFICE USE ONLY) Fee: $ /02.5. 6d PERMIT NO. f,-OS- 13DO Date: notice of his or her 7./,/ -J� U. to perform the electrical Owner or Tenant G/' %1¢ Gl O4 Ce:g i F74 C Telephone No. Sa9'- Owner's Address 11660 A46�7 o 0�/Lr-t✓ Cce �e R vi 11P /Sc// f6Gu Pt lull Z(_ •�� d� 6 Is this permit in conjunction with a building permit? C]No (Check Appropriate Box) g Cry Purpose of Building Utility Authorization No. �/ 3 / ,9 -< Existing Service mps / Volts Overhead❑ Undgrd r] No. of Meters New Service /00 Amps 2 Yeti / I �o Volts OverheadO Undgrd Q— No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical may No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs a Generators KVA No. of Lighting Fixtures % ove In- SwimmingPool md. md. � No. of Emergency Lighting Battery Units No. of Receptacle Outlets '/2 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches S'' No. of Gas Bumers ITE.—of Detection and C6a? Initiatin Devices CCe, G No. of Ranges / Total No. of Air Cond. Tons No. of Alerting Devices No, of Waste Disposers Heat Pump Totals: um er — — Tons — — K — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection ❑ Other No. of Dryers rY / Heating Appliances KW g PP Security Systems: No. of Devices or Equipvalent No. of Water Heaters �f KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach add[tional detail if aesirea, or as required oy the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to permit issuing office. �/�� CHECK ONE: INSURANCE BOND OTHERC] (Specify:) (Expiration Date) Estimated Value of Electrical Work:(When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pajns and penalties of pedury, that the information on this application is true and complete. S FIRM NAME: Hgp hGAC/7 LIC. NO. r oC Licensee: a Signature LIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 5 V;� Address: /yr' Ce2 b*gl -,07`/z2 ql !02 O2Z� Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. Owner/Agent Signature Telephone [Rev. 04/00]