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Home My WebLink About121 Camp St #005 Building PermitsOF F� TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO 6-04-1376_ _ PERMIT ISSUE DATE ; _ _619/2004_ _ ; PROPOSED USE . - - - - - - - APPLICANT-F�ankcapra_ : _ : _ _ _ _ : _ _ _ JOB WEATHER CARD �' PERMIT TO ; New Construction ; AT (LOCATION) 100121CAMPST#5 za*Ne-eis SUBDIVISION MAP LOT BLOCK 044.21.1.C5 BUILDING IS TO BE: LOT SIZE O Bldg. Type: Residential CONST TYPE 5-B USE GROUP R-4 new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans REMARKS 04/26/04 and BOA # 3546. AREA (SO FT) EST COST ($ $148,896.00 PERMIT FEE ($) 1$543.00 OWNER lVillages at Campt St., LLC U LDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville MA 102632 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Certificate Issue Date 000'wA'-e--(. ,� J �)> :CERTIFICATE of OCCUPANCY l Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks BUILDING /lAIt PLUMBING/GAS ELECTRICAL 3 td 6S ENGINEERING -Jrcc� g L Oj' Sys MCP Izt� 1�4�r� 3�)o _ OTHER t ,ems 3 0-5 3 3 0 ro be filled in by each division indicated hereon upon completion of its final Inspection. TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO B-04-1376_ PERMIT ISSUE DATE _6/9/2004_ _ ; PROPOSED USE APPLICANT ,Frank Capra JOB WEATHER CARD -----•----•----------------- - -------- PERMIT TO ; New Construction ' AT (LOCATION) 0012 CCAMP ST # 5 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C5 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE CONTRACTOR new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans REMARKS 04/26/04 and BOA # 3546. AREA (SO FT) EST COST ($ u$148,896.00 PERMIT FEE ($) 1$543.UU OWNER IVillages at Campt St., LLC BUILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville MA 02632 INSPECTION RECORD LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector G - 7, �'ye I ��i /Eff TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT r. APPLICATION RECEIPT Temp Permit No.: T-04-439 Applicant Name: Frank Capra Location: 00121 CAMP ST # 5 Owner's Name: Villages at Campt 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: �7 Z C 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 MATTAr. Xf[Sj/.�� ,1 t �'4hPo.n1-0 V' ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE 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 Office Use Only Permit No. 0 to4�4 Permit Fee �� / ,�t DepositRec'd. $wUVDJ Net Due $7 / U Planning Board Information Plan Type Endorsement Date Recording Date ' an No. Assessors Department Information: Map tot map Lot !. �. Old New 1.4 Property Dimensions: Lot Area (sf) Frontage (it) Lot Coverage Other This Section for Office Use Only Building Per i Number: Date Issued: 100, Signature: -3/- 0 t f Certificate of Occupancy is is not required Building Official Date Section 1 - Site Information Use Group: R-4 Type: 5-13 1.1 Property Address: , S4 1.2 Zoning Information: e O� A2-51 �' 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) Public Private 1.5 Flood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: �L It Ov N me {printk , Mailing Address (2ey, (Vf Q:) 01 l Signature Telephone 2.2 utho rizeq Agent: ✓ ,� r v Name (print) (` 0- P Q � U T i i ddress S- % Signature Telephone U 200¢a MA Section 3 - Construction Services 3.1 Licensed Construction Supervisor: Not A li e License Number O O J I � u A�t 1 Address a _ Zr- Expiration Date Sign a ep one 71 3.2 Registered Home Improvement Contractor: Company Name Not Applicable ❑ License Number Address Signature Telephone Expiration Date os 1— (<'MA 9-15-99 1 of 2 OVER 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 .......... I ` Section 5 - Description of Proposed Work (check all applicable), New Construction Y I No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ IRepair(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: I Brief Description of Proposed Work: 01 l I i Vtti Iln o� I Vl Item I Estimated Cost (Dollars) to be completed by permit applicant Check Below 1. Building b 0 0-0 2. Electrical � ❑ Conservation -Commission Filing (if applicable) 3. Plumbing / Gas Z o 4. Mechanical (HVAC) c ❑ Old Kings Highway& Historical 5. Fire Protection v (a Commission approval 6. Total = (1 + 2 + 3 + 4 + 5) to t 5 7 0 (if applicable) 7. Total Square Ft. (new houses & additions) Section 7a - Owner Authorization`- To be Completed Wh n1l1J J t Owner's Agent or Contractor Applies for Building Permit 1 I, (I v^ln er asAownerof the subject property hereby authorize I to act on m beh , in all matters elative to work authorized by this building permit ppl'cation. { r �- A( 0 Signature of Owner Date Section 77b/ - Owner/Authorized Agent Declaration I, V �/ ; (I it a 1 �CJ'Cl ems _ , aspwner/Authorized Agent 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. Vi t kat, Priname t Signature of Owner/Agent 9-15-99 2 of 2 Date U 4 i Fps ' � r PLEASE PRINT: Job Location: M TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Owner of Property: Construction Supervisor: Address: j; r 1'4A'0 %- -� ", S�',� a- � Can` '✓, (�� Of A as G 3z Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: License No. 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 any other 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 No ❑ If you have checked yas, please indicate the type coverage by checking the appropriate box. A liability insurance policy a.7lo� 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 ❑ Agent Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents ONCO91la7affoadiss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit cif E kk'%'" 4l R, . MA 63-.)-on p .�.)-60-2 7 I am a homeowner performing all work myself. I am a sole proprietor and ha%e no one workine in any capacity I am an employer pro% iding workers' compensation for my employees working on this job. comnanv name: address: city- phone q• insurance co. Amy $1 (/I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below %%ho hase city: phone Ok insurnnce co. Roliev q Failure to secure coverage as required under Section 25A of MGL IS2 can lead to the imposition of criminal penalties of a line up to S1.500.00 and/or one years' imprisonment as well to civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I andentasd'that a copy of this statement may be forwarded to the Office of Iavestigsdons of the DIA for coverage verifieadon. I do hereby terrify the p ns and p ies of perjury that the information provided above is true and eorrec k Signature�LL/�� Oati �1 Print name x L5-09- % 1g 420 of 621 use only do not write in this area to be completed by city or town official city or town: YARMOUTIJ _ permit/liteuse 0 nBuilding Department ❑Licensing Board ❑ check if immediate response is required 261. ❑Selectmen's Me ❑Health Department contact person: phone N: _ (508) 398-2231 ext. MOther. .....1 ....A, a 4 TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS0 6664-4451 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 1 ` p J Work Ad4ress is to be disposed of at the following location: gQl, Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ignatu a of Applicant Date Permit No. � �G— J/:e �ony„�o.+u,eall! o`'Alauacfwaeaa >{ BOARD OF BUILDING REGULATIONS '. License: CONSTRUCTION SUPERVISOR : r Number: CS 012430 Birthdate: 06116/1940 Expires: 06116/2004 Tr. no: 25823 Restricted: 00 FRANK G CAPRA / 40 COPPER LN CENTERVILLE, MA 02632 Administrator 00 - 35.000 cf enclosed space (MGL C.112 S.60L) to - Masonry only 1G -1 S 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: 1888) 344-7233 HI.=�,�rc JL t,tK I RIUATE OF LIABILITY INSURANCE 07/22/2 0 t PRODu R (S08) 994-9688 FAX (508) 991- 5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RLITKbWSKI' & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 414 COUNTY STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR NEW'BEDFORD,.MA 02740 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED.Frank Capra, INSURER A: Providence Mutual PO Box 664 INSURERB: OneBeacon West Hyannisport, MA 02672 INSURER Continental Casualty.Co_....., ._.. .._.. .. -.. _._. INSURERD--_ INSURER E: COVFRAGF.q 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 CLANS, iN-SR— Im A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR POLICY NUMBER PP0053131 00 POLICYE FECTIVE 12/13/2002 POLICY EX IRAT ON 12/13/2003 LIMITS EACHOCCURRENCE $ 1,000.000 FIRE DAMAGE (Any one fire) S S0,000 MED EXP (Any one person) $ 5 000 PERSONAL d ADV INJURY s 1,000,00( GENL AGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ - 2,000.00( PRODUCTS - COMP/OP AGG S 2,000,000 POLICY F1 ECaLOC JT AUTOMOBILE LIABILITY ANY AUTO BXE48125 02/14/2003 02/14/2004 COMBINED SINGLE LIMB (Ea axidenq S ALL OWNED AUTOS X BODILY INJURY (Per person) f 250,000 B SCHEDULED AUTOS HIRED AUTOS BODILY INJURYI (Per accidenq S 500,000 NON -OWNED AUTOS __. GARAGE LIABILITY PROPERTY DAMA 1Peracoldenq9... _ ..... lOQ 000 .- > 1. "-- ' AUTO.ONLY-.EA ACCIDENT . S OTHER THAN EA ACC AUTO ONLY: AGG f . .. - - . -.. ... S EXCESS LIABILITY - OCCUR Q CLAIMS MADE EACH OCCURRENCEAGGREGATE S. S f DEDUCTIBLE S RETENTION S S C WORKERS COMPENSATION AND EMPLOYERS LIABILITY SS59UB86lX751603 03/22/2003 03/22/2004 TORY LIMBS ER EL EACH ACCIDENT f 500,000 EL DISEASE -EA EMPLOYE S 500,000 OTHER tL DISEASE. PoLIGY LIMff S - 500 00 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED, INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gatewood Homes Inc 1600 Falmouth Road Ste 25 Centerville, MA 02632 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 OF NTHE COMPANYMAk_GW!ZLSEE!SkNTATIVES. AUTHORIZED R TATIVE _ ACORD 2s c r�wn �- ©ACORD CORPORATION 1988 Ut' LIAUILI PRODUCE Dowlinj & O'Neil Insurance Agency, Inc. - 222 Wdst Fain St. PO Box 1990 Hyannis, MA 02601 INSURED e Electrical Contractors, Inc. 372 YaBaysirmouth 72 Yarmouth Road Hyannis, MA 02601 I Y INSURANCES DATE(MM/DWYyy) 10/17/03 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. INSURERS AFFORDING COVERAGE INSURERA: Travelers Insurance Com an P y NAIL # INSURERB: Guard Insurance Group P 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 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR A NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR POLICY NUMBER 16801484A82ACOF03 POLICY EFFECTIVE DATE MMIDD Y 10/05/03 POLICY EXPIRATION DATE (MM1DDfYYI 10/05/04 LIMITS EACH OCCURRENCE $1000000 DAMAGE TO RENTED MED EXP (Any one person) E3O0 ODD E$ 000 X OCP PERSONAL &ADV INJURY E1 00O 000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY ET LOC GENERAL AGGREGATE E2 000 000 PRODUCTS-COMP/OP AGG E2 000 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Drive Other Car 18102601W5611ND03 10/05/03 10/05/04 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per parson) E X X BODILY INJURY (Per accident) E X PROPERTY DAMAGE (Per accident) E GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT E OTHER THAN C AUTO ONLY: E EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE 'DEDUCTIBLE RETENTION E qGG EACH OCCURRENCE E E AGGREGATE E E f B WORKERS COMPENSATION AND EMPLOYERS' UAeILLTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 1l yes. describe under SPECIAL PROVISIONS below OTHER BAWG436910 08/18/03 08/18/04 WCSTAru- OTH- E E.L.EACH ACCIDENT E1 OO OOO E.L.DISEASE-EA EMPLOYE E100,000 E.LDISEASE-POLICY LIMB E500,000 DESCRIPTION OF OPERATIONS I 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 ACORD 25 (2001/08) 1 of 2 #M31942 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED 0 ACORD CORPORATION 1988 ur:K'i' = F' 2 CATE OF' 2 NSURANCE Producer:, SOUTHEASTERN INS AGCY 641 MAIN ST HYANNIS MA 02601 Code: ------------------------- Insured: RJ BEVILACOUA P 0 BOX 629 FORESTDALE MA 02644 Issue date: 7122/03 This certificate is issued as a matter of information only and confers no ri hts u on the certificate holder. This certificate does not amend, exten� or a�ter the coverage afforded by the policies below. ----------------------------------------------------------------------- COMPANIES AFFORDING COVERAGE Sub -code: I Cc Ltr A: ARBELLA PROTECTION --------- Co Ltr B_ ARBELLA PROTECTION - ----------------------- Cc Ltr C: Co ltr D: ARBELLA PROTECTION -------------------------------- Cc Ltr E: COVERAGES This is to certify that policies of insurance indicated listed below have been issued to the insured named above for the policyr period term notwithstanding any requirement, or condition of any contract or other document with respect to vhich this certificate may be issued or may pertains the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. ------------------------------------------------------------------------------------------------------------------------------------ Limits shown may have been reduced by paid claims. Cc I I Policy Policy I Ltrl ----------------=---------------------- Type of Insurance I ------------------------ Policy number leffective date lexpiration datel All limits in thousands A (GENERAL LIABILITY I B500019147 ----- ----------------------------------------------- I 7/15/03 I 7/15/04 7---------------- aggregate: 21000 Commercial general liability (General Products-complops aggrey: ( Claims made () Occur �wner's I I Personal/advertising inj: 8 contractor's Prot I (Each occurrence: 11000 l I damage: f00 ------------------------------------------------------------------------------------------------------------------------------------ I (Fire Medical expense: 5 B (AUTOMOBILE LIABILITY 1 86852400001 1 2/21/03 1 2/21/04 (Combined 1 l An rC auto I Single limit: 250/500 lBodily All owned autos inju y Scheduled autos I person`: Hired autos I�Per odily injury Non -owned autos I (Per accident): Garage liability I (Property I ------------------------------------------------------------------------------------------------------------------------------------ I I damage: 500 I i ESS LIABILITY I I Each I n I I Occurrence Aggregate ------------------------------------------------------------------------------------------------------------------------------------ Other than umbrella form I I I I I D I WORKER'S COMPENSATION AND I 9098680403 4/27/03 I I 4/27/04 I StatutorTi I----------------------------- I 100 (Each accident) EMPLOYERS' LIABILITY I I I ( 500 (Disease -policy ---------------------------------- 100- Diseasreach emp-l-oy-ee-. OTHER I I -.Y ------------- --l-im--it--) I I Description of operations/locations/vehicles/restrictions/special items: CERTIFICATE HOLDER GATENOOD HOMES 1600 FALMOUTH RD STE 35 CENTERVILLE MA 02632 - CANCELLATION Should any of the above described policies be cancelled 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 of any kind upon the company, its agents or representatives. Authorized representative: JOAN M MARTIN JA 4199 r+vvr, u Utf< TIFICATE ORLIABILITY INSURANCE =bATE(,M�=DNyy"nPRODUCER SOS-398-6033 FAX SOS-760-1667 ' THIS GERTIFIBATE 151SSUED AS A MATTER OF INFORMATION A17)' ed American Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 Atlantic Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR So Yarmouth MA 02664 ALTER THE COVERAGE AFFORDED BY THE POLICIES RPi nw INSURERS AFFORDING COVERAGE NAIC Li Cape o Custom loots NSURGRA Arhella Protection Ins Company 762 Falmouth Road NsuRERe- Hartford Hyannis MA 02601 INSURER C: INsuaER D: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A90VE FC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RED rGENER"ALLIAMLITY SURANCE POLICY E F TIVE POLICY G POLICY NUMBER 7500000373 12/13/2002 12/13 ENERAL. LIABILITYpE D OCCUR A CEAM AGGREGATE L((IyyMITAPKJES PER: Xl POLICY n JE 3- n LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AVT03 SCHEOULED AUTOS HIREDAUTOS NON•OWNEDAUTOS GARAGE LIABILITY ANY AUTO EXCESSIUMBRELLA LIABILITY OCCUR O CLAIMS MADE DEDUCTIBLE RETENTION 3 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 8 ANY PROPRIETOPIPARTNGR/EXECVTrvE OFFICGRIMEMBER EXCLUDED, I LOCATIONS I VENICLEB I EXCLUSIONS ADDEO BY ENDORSEMENT/ SPECIAL PROVISIONS 1E POLICY PERIOD INDICATED. NOTWITHSTANDIN VHICH THIS CERTIFICATE MAY BE ISSUED OR TERMS. EXCLUSIONS AND CONDITIONS OF SUCH N LIMITH97 RENCE innn 01 RENTED 0( .4rle P�soR1 ADV INJURY 0( GREGATE O( COMP/OPAGG nr COMBINED SINGLE LIMIT S IGa PCdldeN) BODILY INJURY $ (Po onion) BODILY MJURY $ (Per.wdenU PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY; 400 3 EACH OCCURRENCE S E.L. EACH ACCIDENT I S IOOonnn 11 DISEASE - G EMPLOYE S 100 El DISFJISE • POUCV LMIT 3 SnA Evidence of Insurance for work performed within the Insured's scope of normal operations Gatewood.Homes.. 1600 Falmouth Road A25 Centerville, MA 02632 4CORD25(2001lOS) FAX: (508)778-S603 SHOULD ANY OF THE ABOVE DESCRIBED POLICrPs BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAY$ WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRERFRTAA .R ®ACORD CORPORATION 1998 ACQRD CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE (MMIDDlY03 CROWC50 07 25 PROtWCE, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sullivan, Garrity & Donnelly ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 508-754-1767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Institute 4d - PO Box 15010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester MA 01615-0010 Phone:508-754-1767 Fax:508-754-1885 INSURERS AFFORDING COVERAGE NAIC# INSURER A. Hanover Insurance Co INSURER B: Arch Insurance Compa Crowell Construction, Inc. INSURER C: PO BOX 309 INSURER D: So. Dennis MA 02660 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. Mbm LTR INSRE TYPE OF INSURANCE POLICY NUMBER POLICY EF DATE MMrECTIV DfYY EXPIRATION DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY ZHN7007141 05/01/03 05/01/04 PREMISES Eao=rrenee $ 100000 Fx-1 MED EXP (Any one person) S 5000 CLAIMS MADE OCCUR PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE S 2000000 GEN'L AGGREGATE LIMIT APPLIES PER TPRO- PRODUCTS-COMP/OP AGG s2000000 POLICY JECT LOC AUTOMOBILE LIABILITY A ' COMBINED SINGLE LIMIT $ ANY AUTO AEN7001142 05/01/03 05/01/04 (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS (Par ion)INJ (Per Peroon) $1000000 X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Par accident) $1000000 X PROPERTY DAMAGE (Per accident) S SOOOOO GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO - OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE - AGGREGATE i S DEDUCTIBLE $ RETENTION i $ WORKERS COMPENSATION AND B EMPLOYERS'LIABILITY - TORY LIMBS ER E.L. EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTNE IRWCIO0100 03 /22/03 03/22/04 OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOY E $ 500000 -- -11 yes; describe rxMer E.L DISEASE, POLICY LIMIT $500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Fax #508-778-5603 rcn"on♦TC Gatewood Homes 1600 Falmouth Road Suite 25 r Centerville MA 02632 25 GATEWOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOt 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 KINDUPON THE INSURER, ITS AGENTS OR 198 Ac-TM CERTIFICATE OF LIABILITY INSURANCEJ:DATE(MMDDIYYY 1M4/03 PRODOCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling &•O' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Main $t. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED INsuRERA: travelers Insurance Company Gutter Pro Enterprises, Inc. INsuRERe: Guard Insurance Group P.O. Box 1197 Plymouth, MA 02362 INSURER C: INSURER 0: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS RHOVm MAV HGVF eccru ............ i LTR NSR TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMlO LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS.MADE a OCCUR 1680459H3118TCT03 . 11/07/03 11/07/04 - EACH OCCURRENCE s1000000 X TO RENTED PR E300 000 MED EXP (Arty one person) S$ 000 PERSONAL &ADV INJURY E1 000 000 GENERAL AGGREGATE E2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS - COMPIOP AGG $2 000 000 AUTOMOBILE UABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS _ COMBINED SINGLE LIMIT (Ea accident) s BODILY INJURY. (Per Person) E (Peerr aacci Bdent) INJURY cci $ • PROPERTY DAMAGE (Per accident) E GARAGE LIABILITY ANY AUTO . AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S s B EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? H yes, describe under SPECIAL PROVISIONS below OTHER GUWC440685 - 11/07/03 11/07/04 EACH OCCURRENCE $ AGGREGATE S S S WC STATU- OTH. M S E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYE 5100, 000 E.L. DISEASE • POLICY LIMB E500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named insured subject to policy condition's and exclusions. CERTIFICOTF Hni nca Gatewood Homes 1600 Falmouth Road, Suite 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .ID_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) 1 of 2 #32273 ^-� —� LS�_. _moo ACCORD CORPORATION 1sRs I., a., V4 10.11 raa OUV900249 GOLDMAN ASSOC 001 AC-OP.D. CERTIFICATE OF LIABILITY 9?JQE UP mC9: �. Px-OLYA:Fil G'OLClW 6 ASSCCZ=S INSURAMM T-epS NDCONF MI PRODUCER CIA7, sEYV1G83 1NC. HOLDOL ONLY AND C=VERA I ALTER �l ME GQYERRAnG S3�IFAi.Da A 02Rv. 01 2;IGna: SOO-775-6020 F=: 500-790-02:9 MURERZ.`.FFCRi7AiG l RODNEY SAVANO DBA 7SCHANICAL SYSTZM. 110 HOLD6.,LZ- IANS A'RARNSTAME XX 02668 TWEPO ESS OF tMURANCE Lmma faim HAVE BEEN asumTo nmP1CURQ Kqm #Ban FOR THE PO= PERM*1=&TEO. ANOfiG ANY ROIlMA&M. TMWOR CMC(fWOFAWCWTRWT OROT1ER DOCUMiNTYATH RESPELT7VMaC MjaCBi1FICATEIMY SSUFOCFt MAYPFRTAN•negOLeW CtAFFOrC BYTMFV-C♦E =CMBEDOALLTETEFMO,0<710MOMn .NERV"I$V JWrT PCLXES.AOOREOATEUMMSHOINNNAIrMvEf Mpta UC>:DR1•PADCLASM CFSU64 LTN Tier CSroartAxs: POLL=Nulmm "� MATE. OEMET01LIIp817tfi A XaLGETaaaLLY�oat[Y CLA w7 a�P+NeA) HL8172 11J21J03 11/21104 OrAIeE � 1000000 $50000 95000 _ OAw_AA0V&LAJ Y 31000000 Y'2000OOQ' CRUWLAGGRFr TE LMrAPPUEZ FeR; AGGMGAT� S 2000D00 rl PoLmy PPERCo. LOC -COMPIOPAGO 'ANYAGrO SNGLE LBlr s ALLOWNEGAMOS 7 SCMEDUL IIAUrOS' Y�'Ti1Y HYiFDA lTm Po l NOMOWNmAlrOs r- -YKIJRYAMLAGs f E,. i OMAGE Lbl'kIJiY A10TOONLY- EAAOCLEW ANYAUTO. 7 TT4A" EA ACC cKyl. AW 7 . s7A7�LLA LlAOfJ7Y ooast �nAaeerIlDE OCOiYNCE s Te s oa=oucraE s _ s 9 � AJ727p3C9p3 05/03/03 05/03/04 EAa+aoOOEa�r i 100000 �a.o.tea. I�* a OMEMM �E,LOYEE s i00000 uncut DMEASE-P'OIICYL7rtr 3500000 aF OPCMTId3TLOGnvaf :tSAIEan..r.n�A0a®BY pipOlCEaiFMtfiEdMLPiIaNSiO1D CERTO MCAT- HOLDER aAWFOOD EMIKS INC FAX 508-778-5603 1600 FA7i2lOn ROAD- CINTERVILL6 MA 02632 CATEROQ "iNOUWAgYOFTAP DATETfx M TEmsuwoumulmR uaosescomi r4NOR 10 GAYS Y„yMU AM win UPOK THE NOURM RtAaDrM Got ACORI1, CERTIFICATE OF L,�;$ UTY INSURANCE DATZ(�MOpfyYYT) 08/08/200, rRoouceR 508 672 2997 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JOAO-M-OIAS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OIAS INSURANCE HOtDfR-- THIS- CERTIFICATE DOES- NOS AAdEND_ EXTEMQ OR 535 BRAYTON AVE ALTER THE COVERAGE AFFORDED 8Y 7HF POLICIES BELOW. INSURERS AFFORDING COVERAGE �NATC9 PISURERA: GRANITE STATE INSURANCE COMPAONY 1. NYC 484-48-85 FALL RIVER. MA 02721 -- aevREo JOEL FERR£IRq DEALM6IDA t1suReRa; NAUTTEUS-IIVSCPANCE COMPANY- NC275806- �_ DBA EJJA CONSTRUCTION _ NSURERC: i 50 PICKERING ST. APT 17 FALL RIVER, MA, 02720 u14URERO: __ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE FOR THE POLICY PERIOD INDICATE 7. NOTWITHSTANDING AITY..REQLLREMENT. Tents OR CONDITION Or ANY CCNTRACT OR OTWER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRTHED HERIVN19 SUBJECT TO ALL HIE. -TERMS, EXCLUMCN&AND. CQNQITIQNg OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS. N w FOUcrNVMBER EFFCCTVe roUCY EXIRA:W F0I ENERALWBLRT X COMMERCIALOtwrRALLADICITY NC27580E E f,O10000,,'000000- `UCH OCCURRPaN 06/26/2003 06/26/20 CUMSAupG ED OCCUR IPO P «aalL2BdITi1 umC DDsnyoFoMR) IDS I ---5;660- PGRSONALSAVVINIuRY I1 '1000,000 ----- GGWLAGGREGATE LIMITAPPLIES PER: GEMMAEAOOREGATE- -3- _ LOgq:DD� �O• PROOUCTS•COMPAP A•:;G .i 2000000 FOIICY LOC ArUTOMOGLE "I M I 'µv AUTO I. CO atS6ean1)K VT U g MB O C wmE»•G:LyT if I ALL OYINEDAVTOs SCHEBULEDAUTOS R000.TIMJURY I (PltoenaAl HIRGOAUTOS NOMOWN60AUTOS _� _ i lFvaodp.nEOOA.YINNHRY I PROPERTYDAMAGE ,— ts GARAGE LIABILITY AUTODR%YT SAACCYOeHr t ANY AUTO � OTKER AU fl TOONL� LIABILITY eXCE2St1PAeRELL�AEl CLAWS MADE El._�J OCCUR EACHOCCLRRENCE �3 I F- AGGREGATE IS - I DEDUCTIBLE I RIFTENTtON 2 WONNERSCOMRENBATR)RAND ENPLOYER3'LIARILTIY WC- 4g¢47�-8S' V✓C s IA i In . 7TNI I Yif08%i')3-' 14/08/04 RY LIMITS _ ANY PROPmETOWPARTNER,�XF{I,7FVE O�MCOWELIBER EXCLUDED? S.L UCHACC*]ENT S Y,OO@;669- SFEC dR�OVIagIpN6 WW. E-L. OKGASG• EA, EMPL:TYGG f 1•000.00 OTHER CL OIWAW) POLICY% MTF t T OEiO-EiSO- DESCWTIOIYCFOPPRATION9/LOCATIONS!VE4ICLES(EXCLUFiM5ADD aTENOOR3EMgNTfSPECiLLPROVISIONS CERTIFICATSHOLDER GATEWOOD HOMES 1$00 FALM.OUTH RD. CENTER VILLE. MA 02632 SHOULD ANY OFTHE ABOVE 0PdCRt6EO Pa,Aa aeCANCEAEIIBEPORPiNeEXfIRAi7eN- DATE THEREOF, THE [SEUING INSURER WILL ENOLAVOR TO MAIL 10 DAYS WRITTEN NOTtCETO'THE CERTIFlCATE'NOLDER-NAMEDTO THE LER, HOL /JUWgE+n n0 �n �r�, L FAPOse NO OGUGATIOM OR LIABILITY OF ANY XIMD UFoN TIe WBURE,I U3 AOBNTd OR CERTIFICATE OF SLTRAICE tRODUCER PaSS='Leverone & Buckley Insurance Agency Inc P O Box 160 Dennisport, MA 02639 INSURED Patrick K Orcutt Aa. P & S Concrete 37 Ladys Slipper Lane Mashpee, MA 02649 DATE COMPANIES AFFORDING COVERAGE A A.I.M. Mutual Insurance Co rtl !S TO CERTIFY THAT TTEE POLICIES OF INSURANCE LISTED BELOW IIA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING p Ny REQUHIEbIENT .PERM OR CONDITION OF ANY CONTRACTOR OTHER D CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE OCUMENT WITH RESpECrTO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMIT'S SHOWN MAY HHAVFBBgNN REDUCED B PAID DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, TYPE OF INSURANCE POLICY NUMBER POLICY. EFFECTNE POLICY EMMLATIO GENERAL LIABILITYITY DATE(MM/DD/YY) ➢ATE(MM/DD/YY) man - COMMERCIAL GENERAL LIABILITY ENERAL AGGREGATE S IMS MADE[C PRODUCT'S-COMP/OP AGO. S WNER'S & CONTRACTOR'S PROT. PERSONAL & ADV. INJURY S EACH OCCURRENCE S ' FIRE DAMAGE (Am one fire) S UTOMOBUX LIABII.ITY MED. EXPENSE (Any one person) S NY AUTO MBMED SMGLE ALL OWNED AUTOS LIMIT S EDULED AUTOS - BODILY INJURY 'IRED AUTOS person) S NON-0WNED`AUTOS BODILY INJURY ARAGE LIABILITY Per a=jd=) S PROPERTY DAMAGE S CFSS LIABILITY MBRELLA FORM EACHOCCURRENCE S . THAN UMBRELLA FORM GGREGATE S WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY WCSTATU- OTH. 6006181012003 `�' THE PROPRIErow T IM 10212003 10212004 X PARTNERS/D(ECU vE RINCL S OFFICERS ARE: FX EL DISEASE -POLICY LIMIT' I $ 1 -000 0W II EL DISEASE —EA EMPLOYEE $ I non nm Gatewoods Homes 1600 Falmouth Road Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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 LIABILOF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESEITYNTATIVES. AUTHORIZED REPRESENTATIVE "7 _ 564 - 7272 P.01/©1 ;. J'7 HJ J id%n T�' T l/,y;��1i/�y4�ia� DO � ^ .2 •vt +�C�1L q aw'r . DA a ..... rv•...e,...„w.,:w.:..... ...... ... . :s:.•n,�::, H.i 3, PRODUC:A _...K.: ._ 11 i a 5 0 3 THIS CERTIFICATE IS ISSUED AS A AAATTER OF JMWFOiip ATION ONLY AND CONFERS NO RIGHTS UPON THE- CERTIFICATE RIDER. RISK SPECIALISTS A�TER THE 1COVEAdGE AFFO 8ED By TES Favcl TEND O I215URANCE AGENCY, INC. COMP_ P.O.BO% COMPANIES AFFORDINGCOVERAGE 115 � CATAUMET, MA 02534-0115 US LIABILITY INSURA24CE COMPAXy COMPtNsuaED MONUMENT INSULATION, INC. a iAMERICAN HOME INSURANCE COMPANY 223 COUNTY ROAD COMPANY BOURNE, M.A 02532 c CCMPANY D THIS IS TO CERTIFY THAT THE . POUCIEs OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED +NAMED ABOVEE R THE POTJCY PEADOO" �1 .... N INDICATED. NOTWmaSTANDING ANY REGUMEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAW THE INSUFtk4CE AFFORDED BY THE POLICIES DESCRIBED HEAEN IS SUBJECT TO ALL THE TERMS, E(CLUSMS AND CONDITIONS OF SUCH POLICIES. LIARS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. Lin me Of INSURANCE POULYNUMBER POL=yM7ZC7IVE POLIOYCMRA71M . DATE (WAMDiTTI DATE B ROM-M U� A X_, COMMCRCIAL LUsm ' OW401LADREGATE $I 000 0 00 CLAIMS MADE®PFKXlUCM.00MPbPAGG s500 000 me/23/03 OCCUR PERSONSADVNJURY 95000(3"'ERsAc=TCL 8/23/04 EACH DOC PADJCE ,3500, 000 I jlPAMW� UABNm BRELLA FCRM NEN THAN UMBRELLA FORM COMPS MMU AND ENS UADMITt PRIETOR/ Q pv� WC 782 61 72 GATEFTOOD HOMES, INC 1600 FALMOUTH ROAD 025 CENTERVILLE, MA 02632 508 778-5603 cOMBIim SINGLE UWT H ipmPonon"�L jW c eoDILY BUURr I" ;Px c:aewa PR0P9m pAuA= , I s AM0 LY.FAAmmENT s OTHER THAN AUiD DNLY: :"• EACH AUNT i s s 9/5/03 I9/5/04 SHOULD ANY OF THE ABOVE D13cmNED POLICIES BE CANCEUm 991'ONB TIE' E)MRMION GTE TNEAEOF. THE ISSUING COMPANY WILL ENDEAVOR TO DEAL 10 GTs Y/NLTMN NOTICE TO THE CERIDFlGTE HOLDEN NAMWI. IHC0.7i; BUT PUUlNE;TD MAIL DwTSE SHALL DA ND COUGATNDN OA UABIUTY TOTPL P.01 4- CERTIFICA T 21c8haa Insurance Agency, Inc. 749'main Street, Suite#H Osterville, ma. 02655 _ INSUREDSURCDURED Caspersen Overhead Doors Sox 517 East Falmouth, DSA 02536 A LIABILITY INSURANCE ' THIS P.O1 DATE tmwot)IYY) UEKTIFICATE IS ISSUED AS A MATTER OF INFIMF !ATIOI ONLY AND CONFERS No mGUpON TIjE HOLDER. THIS CERTIFICATE DOES NOT AMEND, CEXTEND C ALTER THE COVERAGE Af IFORDED BY THE POLICIES BFLC INSURERS AFFORDING COVERAGE INSURER. A' uay.1 e�2.r�� l TR4 C '— f'ISURER 9: pL• INSURER C INs�aER D ' THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY DE ISSUED I MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SV POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. qj TYPE OF INSURANCEZ` roU-y mu"ER -�OLI� Y EF�ECfryE POLICY EXMA TbN ' kLjA9%M ERCGL OENERAL L"Rt)Y LAIMS MADE �l OCCUR XFP48352ReOAIE LIMIT A!T'LIES PER:Y ��LOC LE LIASMMU/ONCO AUTOSW FO AUTOSAUTOSWNCD AU70r9%M OCCUR I .� CLAIMS MADE aOLOUCTiOLE .�.,.,,.w s-- WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTHER Gateway Xaaec 1600 FAL�utri -Taad-; Suite 25X Centerville, HA 02632 778 5603 ACORD 2-&S (7197) Ei:R�SONAL&ADVINAJRY F.(oM Kral f�tA00�I05/28103 05/28/04 lfRnA AnA 000,000. tE: eeno', )55NGL9 UMIT f ISOOLY INJURY I IPw Palm) i GODLY INJURY (Pw atPCMO f PKOPtRTY DAMAGE (pa, ammm) f AUTO.�,CIOENT f 4DTHER4WAN_. EAACC S AUTO ONLr. �� f EACH OCCURRENCE ; /72/03. 02l22/0; EL.EAOHAccmEnT E.L� EMPLOY f EL. DISEASE •POLICY LIMIT f DATE THEREOF, THE MUMG INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTEN NOHDEFO-TNEOEpTIflCAs6-NpLpER-NAum... . SO SHALL IMPOSE NO OBL IGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR �lCAO!lhN.r..� 0 ACORD COR90RATION 1988 A RD� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDON" ` 07/18/03 UCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION G 4 Dowling & O' Neil Insurance ' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Maiq St. -PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE . INSURED NAIL # Busy Bee, Inc. INSURERA: Hanover Ins. Company P.O. Box 50 . INSURERS: Safety Insurance Company . . East Sandwich, MA 02537 INSURERc: Associated Employers Insurance Compa INSURER D: INSURER E: COVERAGES --�wvv �vc occil 10�U=U I U I III: IN�i(JRED NAMED ABOVE FOR THE POLICY PER OD INDICATED. ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THSTANDING 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 ATEYMMIDD/TIY1I POD CY EXPIRATIONMIWDD/yY LIMITS A GENERAL LIABILITY OHN643998501 06/14/03 06/14/04 EACH OCCURRENCE S1000000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED $300 OOO CLAIMS MADE OCCUR X PD Ded:250 MED EXP (Any one person) - $15 000 PERSONAL d ADV INJURY $1000000 GENERAL AGGREGATE $2 000 000 GENT AGGREGATE LIMB APPLIES PER: . POLICY PRO. PRODUCTS •COMP/OP AGO S2_nnn nnn JE T LOC B AUTOMOBILE UABIUTY 3175394 ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON-OWNEDAUTOS GARAGE LIABILITY 1 ANY AUTO EXCESSIUMBRELLA LIABILITY ] OCCUR CLAIMS MADE DEDUCTIBLE C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER ' 01/14/03 • 01/14/04 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Perperson) $1OO,000 BODILY INJURY. (Per accident) t3OO ,000 PROPERTY DAMAGE (Peraccidera , _ AUTO ONLY • EA ACCIDENT $100,000 " S OTHER THAN - EA ACC AUTO ONLY: ' S S AC,G EACH OCCURRENCE91�dinn AGGREGATE 12012003 06/27/03 06/27/04 WCSTATU- E.L. EACHCCIDENTE.L. DISEASE. FA FMPI DESCRIPTION OF OPERATIONS / LOCATIONS I 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 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 $0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATrV S. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) 1 of 2 #30822 -1 .Qi-- KJS - 9 ACORD CORPORATION 1988 DRNV 80'4T49" E �� ` N 63.34 3, 12lir.2 3 W4 . - LOT 5 SUIMNG M T. 3,605 tS.F. IBy , N • to 6'3,� I Zo PRHOUSE w $ L' PROPOSEDro of L4 (P, DPI�� 0 6 3' (EGRET) GW o 15 \Z 32.0 GW _ 15 0? 18.5' i i., SEA 2 I tfl, �1.07 LOT 1 cZ 71 PROPp: W ASER NpTE N 46" E I PROy R LP%y 3s R- _ p6' ..._ -- - SE`I� 00 \,�9 11 — R 90 %6 AFFORDABLE 1� I LOT�129 NOTE: 3,794 t S-F- ® SEWER LATERAL SHALL BE \ SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN GRAPHIC SCALE 1OFT. OF WATER MAIN. 20 10 0 20 60 NOTICE Unless and until such time as the original (red) stamp of the responsible Professional Engineer. or Professional Land Surveyor appears an this plan: (A) no person or persons, including any municipal or other ( IN FEET) public officials, may rely upon the Information contained heroin: and i inch = 20 )?t (B) this plan remains the property of Holmes & McGrath, Inc. REVISED: 3-8-04 PLOT PLAN holmes and mcgrath, inc. PV\" OF Mqssq OF LOT 5 civil engineers and land surveyors goo TIMOTHYM. cyN PREPARED FOR 362 gifford street o SANTOS MILL POND VILLAGE falmouth, ma. 02540 "a No.CIVIL7B IN - - ��0 9�f''/STEP�O YARMOUTH, MA JOB NO: 201197 DRAWN: LMC FS ot4 ENG� SCALE: 1 "=20' DATE: 1-22-03 DWG. NO.: A2504 CHECKED: -firyS L!r MAScfieck.COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software version 2.01 Release 2 CITY: Barnstable STATE: Massachusetts HOD: 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 Egret 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 1 � 1� COMPLIANCE: PASSES aa Required UA = 216 U Your Home = 123 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ----------------------- ------------------------------------------------------ CEILINGS 832 30.0 30.0 14 WALLS: wood Frame 6" D.C. 1409 15.0 15.0 62 GLAZING: Windo or.Doors 87 0.340 30 GLAZING: Wi ws or Doors 40 0.340 14 DOORS 40 0.086 3 ------------------------------------------------------------------------------- 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 buildin shall be no greater than 125% of the design load as specified i D l" n L� n l Sections 780CMR 1310 and J4.4. Builder/Designer Dateff APR `? 3 7;,C4 Permit # checked by/Date • Massachusetts Energy Code MAscheck software version 2.01 Release 2 The Egret DATE: 4-21-2004 Bldg.l Dept.l use I I I [ ] I C ] C] C] C ] I I I I C ] I I I I I CEILINGS: 1. R-30 + R-30 comments/Locati WALLS: 1. wood Frame, 16" O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. u-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. u-value: 0.086 Comments/Locati AIR LEAKAGE: 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. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: 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 I C7 I C] IUCT INSULATION: DUCVS shall be insulated per Table 34.4.7.1. )UCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 74.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: Low pressure/temp. Low temperature Steam condensate COOLING SYSTEMS: Chilled water or refrigerant PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE NON -CIRCULATING I HEATED WATER TEMP (F): RUNOUTS 0-1" I 170-180 0.5 I 140-160 0.5 I 100-130 0.5 I SIZES (in.) CIRCULATING MAINS & RUNOUTS 0-1.25" 1.5-2.0" 2.0+" 1.0 1.5 2.0 0.5 1.0 1.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department use Only)--------- 00. � `ol TOWN OF YARMOUTH o IC "0 BUILDING DEPARTMENT - O H F ""'�� " ' BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: l a % Proposed Improvement- O.i �J Cd7L Applicant: d/!d"'h 6L62w & ! S V / Map No: 9V Lot No: � /�+.�[�1f C�%d1a.2(,y �- /� aju4 .!: j/ Address: 121 .2S Tel -No.: 778 y46g Date Filed: P d 0 G3a 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, Etc. REVIEWED BY: tl1 WATER DEPARTMENT: DATE: N/A: L, ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: V 4. 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 - Budding Dept - Pmk copy - Water Dept. - Yellow Copy - Health Dept. - Pink Copy - Engineering Dept. - Goldenrod- Fire DeptrConsvvabw MASCAeck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2.01 Release 2 Checked by/Date 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 Egret PROJECT INFORMATION: Mill Pond Village 1600 Falmouth Rd. Unit 25 Centerville, MA. 02632 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA.02675 COMPLIANCE: PASSES Required UA = 219 Your Home = 121 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ---------------------------------------------- CEILINGS 832 -------------------------------- 30.0 30.0 14 WALLS: Wood Frame, 16° O.C. 1432 15.0 15.0 63 GLAZING: Windows or Doors 128 0.320 41 DOORS 40 0.086 --------- 3 ---------------------------------------------------------- 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 7800MR 1310 and J4.4. Builder/Designer Date n Massachusetts Energy Code MAScoeck Software Version 2.01 Release 2 The Egret DATE: 6-20-2002 Bldg.l Dept.l Use I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 168 O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.32 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: 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, 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 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. DUCT INSULATION: I ] I Ducts shall be insulated per Table J4.4.7.1. M DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock.• HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids 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 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0- 2.0+" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- •, E gp'47'4963 �� I — • N 34 3,811 fS.F. - LOT 5 N I w 3,605 ±S.F. s' 24.4 N c 6.3'� I o PRHOOSED USE \i,' PROPODN 6. 3• HOUSE w ;of (SANDPIP (EGRET) Co tiN .co 1S.5'/ �0 26' / 2 '\r 1.07' LOT / ..,d/ 22� MIN• 0 1 ��_. 11 p R SER�pCE SEE SEE OW S NO1E BED E . OPO "P ?'P� N 82 3p6.90' OR Q� R�Ngp��6�Op 1 NOTE: 2 O� EWER LATERAL SHALL BE \ �a EEVED IN ACCORDANCE WI TITLE V IF WITHIN GRAPHIC SCALE APR T. OF WATER MAIN. 20 10 0 20 60 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 ( IN FEET) public offlclals, may rely upon the Information contained herein; and 1 inch = 20 ft (B) this plan remains the property of Holmes & McGrath, Inc PLOT PLAN h I d th `AA&A OF LOT 5 0 meS an mcgra , Inc. civil engineers and land surveyors s- 4 OF jIiSS . ;`. s9ti� PREPARED FOR 362 Ifford street 9 n^ oTHYN1. MILL POND VILLAGE S ATOS falmouth, ma. 02540 :F;,� N . 15078 y IN YARMOUTH, MA JOB N0: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 1-22-03 DWG. NO.: A2504 CHECKED:7MS ,nJ-: % PROPERTY ADDRESS%,,, '/c V CALCULATION FOR PERNT COST TYPE OF Ri ADDITION 719 z5-1. 65 ALTERATIONS ------ � BATH BED ROOM CERTIFICATE OF OPEN WITH ROOF y VATION ONLY GE No. OF BAYS T ROOM IEN WINDOW REPLACEMENT 2-- 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) 21.105 Street 121 CAMP ST #5 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. Owner (Sign) Reference VILLAGES AT CAMP STREET FRANK CAPRA 1600 FALMOUTH RD #25 CENTERVILLE, MA 02632 Yarnfeuth Wafer- Department ►IJ . .... ..-t..,r-<.dLt yC.k._,!.-1iw�.u+k c-y. �-r.h✓srv.. ..., -, _....-..-.... ._. .�_�—+v. � ..r r<v r..... .. e.w r•..� .�.... .. n..r ,....-.--__�. .oF Y9R ,q�q TOWN OF YARMOUTH � �o BUILDING DEPARTMENT O H N wwrrw n s *->-� BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: _Map No: 9V Lot No: ! � C.� Proposed Improvement: h Ofe / W24 a:. Applicant: l� �7� yGGy // �, � hi ,� � Address: Tel.No.: 77X 4( fi Date Filed: � C3a 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, Etc. ------------------------•---•------------------------•-----------•-------------------------------------------•--------------- ------ REEVIEWED BY: VI. WATER DEPARTMENT: DATE: N/A: ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: �/ {/4. HEALTH DEPARTMENT: A, PF11 /�i✓lyd&/ 59F 7*1-0 DATE: N/A: 9 Z3 IND USTRIAL AND/OR�4 COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: --NIA.- PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Whin copy - Building Dope - Pink copy - Water Dept. - Yd1ow Copy - Health Dept, - Pink Copy - Engincering Dept. - Goldenrod - Fire DelXConsmudon i MERIT Pw =rrprFrWV1iew itz SERIES Direct -Vent Gas Fireplaces 71 O�VE EEN NOY IN 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. 9n�141 O'AA}01. The first two model number digits indicate frame width, the last two digits indicate glass width. All arel A.F.U.E: rated high efficiency vented gas fireplace heaters, certified under ANSI Z21.88 and CSA 2.33-M99. MPD4540 MPD4035 MPD3530 MPD33M DIMENSIONS (Rear vent model shown) Standard • Louvered face design 3328 MODELS (This model comes as a top or rear vent only) 131. 1 z^ • Charred split oak gas log set 3"-__ r • Deluxe pan burner for big yellow H ' flames and glowing embers ---- --• t • Charcoal black exterior powder coat A ` o I° F finish 1 + 1 t • Realistic brickaded interior p anels s_,,,,a�, E �' a� � °°� Met • Combo top/rear direct -vent outlets r-+r2' a + 2" 3' 3" (except 3328 models, which have either I E� a top or rear outlet) Front Face Top Right Side • Hi/Lo flame operation 35, 40 & 45 MODELS (These models come with a top and rear vent) • Pre -wired for wall switch 1--+e��T a" • Choice of standing pilot (works in aG G. ower failure) or pilotless electronic A o B U. intermittent) ignition + F • Decorative polished brass or brushed 1 a , stainless accessories (arch door kit, door trim, louvers, hood) tit-afe-1 • Wireless remote controls Front Face Top Right Side • Blower kits (including a temperature FIREPLACE & FRAMING DIMENSIONS control version) • Screen panel kit heat guard) P ( g ) 3328 33t/s 30t/e 17 271/z 33ys 195/a 21yz 103/a '33Ya 331/4 13 • Radiant panel kits 35M 351/8 32Y8 19 291/2 351/8 2111A6 2478 12%6 b5Y4 304 16 (for a clean face look) 4035 401/e 371/8 24 341h 401/8 2611h6 2978 1415/16 '40Y4 401/4 16 All Merit Plus Series direct -vent gas fireplaces utilize either 4540 401/s 371/8 24 39Y2 451/8 2611A6 34N 17%6 45Ya 401/4 16 a Secure Vent (rigid) or Secure Flex (flexible)4.5" 1 inner17.5" outer coaxial venting system, and include a TYPICAL ROOM 20-year limited warranty. ST�, Note: Due to Lennox' ongoing commitment to quality, APPLICATIONS all specifications, ratings and dimensions are subject to 3328T NG 17,500 45 64 62 change without notice. Local conditions, such as elevation, wind vent configu- 3328T LP 17,500 49 66 64 ration and choice of fuel will affect the overall appearance i of the fire. 3328R NG 17,500 53 63 61 El Warnock Hersey Q20006711) Warnock Hersey Vff 3328R LP 17,500 55 66 64 C us 3530 NG 20,000 53 64 62 v® 0 3530 LP 20,000 55 62 60 4035 NG 27,000 59 69 67 4035 LP 27,000 60 69 67 LM 4540 NG 29,000 59 69 67 4540 LP 29,000 59 69 67 1100 lien BSA 785DMM ant RM ©leu,m HoM PvAets2]03 'Intermittent ignition systems Look for the EnerGuide Gas Fireplace Energy Efficiency Rating in this brochure Based on CSA P.a.f-01 Visit us at www.Lennc>d-IearthProducts.com ... . GFFFICIENCY RAMING ama Air Conditioning & Heating 92.6% AFUE MULTI -POSITION CONDENSING GAS FURNACE GMNT SERIES -10- ;&1 *> 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 GNM Series 10/01 www.Qoodmanmf2corn 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 34,000 926 25-55 060-3 60,000 55,000 55,000 51,000 926 35-65 080.4 80,000 73,500 73,000 73,000 926 35-65 100-4 100,000 92,000 92,000 1 85,000 926 40-70 120-5 120,000 110,000 111,000 1 102,000 92.6 40-70 BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA AVAILABLE FROM YOUR RETAILER. SPECIFICATION DATA EIP_rtriral rharartPriefirc 1 •I r,Yl /RA (,ac mn.lro ...,..ne.a�.... v" ror Model Number Motor Blower Vent' Dia. Combustion' Air Filter Size In Perm. / Disp. Electrical Ship Weight HP Spd. Dia. I Width FLA ( Max Fuse 040.3 1/3 3 10 6 7 7 290 / 580 5.2 I. 15 170 060-3 1/3 3 10 6 2" 7 290 / 580 5.2 1 15 180 080-4 12 3 10 8 3' 3' 385 / 770 7.8 1 15 205 100-4 12 3 10 10 3" 3' 385 / 770 7.8 1 15 225 120-5 314 3 11 10 3' 1 3' 1 480 / 960 9.2 1 15 265 •Wl�. rGlp PIIV a 611JYDUVII Oil uIOIIl="=* IIIOy vary uepenumg upon vent lengtn. l:neCKwltn accompany the furnace. 28 A 5" 3• 5,• �58 4JF— t98�6B 4• 8- COMB. AIR INLET i GAS INLET 51 •• 4 i i VENT i lb 27 i LOW VOLTAGE 4" ELEC. 104' which 4 4 � i 1231,i COMB. AIR INLET i 18" Model GMNT A B Combustible Floor Base 040-3 & 060-3 14' 12 %' SBM14 080.4 17'/x 16' SBM17 100-4 21' 19'/¢ SBM21 1205 24 % 23' SBM24 SS-312D 2051" i i i i ' GAS INLET i i i i I VENT • I LOW VOLTA ELEC. CLEARANCES FROM COMBUSTIBLE MATERIALS Sides Rear Front Approved for line contact in the horizontal position •36" clearance for serviceability recommended. 2 f CASED (U) COIL APPLICATION OPTIONS . Furnace Model Number GMNT040-3 & GMNT060-3 GMNT080-4 GMNT100-4 GMNT120-5 Furnace Width 14" 17Y2" .21" 24'i" Coil Model Number Coil Width U-18 14" x U-29 14" x U-30 17W x(1) X(2) U-31 14' X U-32 17 Y:' X (1) X (2) U-35 14' X U36 17'Ya X (1) X (2) U-42 17'/:' X (1) X (2) U-47 17 Ys" X U-49 21' X(1) X(2) U-59 21' X (1) X(2) U-60 24 Y; X(.1) X(2) U-61 24W 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 A .5 .6 .7 .8 HI 1370 1315 1260 1200 1140 1070 1000 925 GMNT 040-3 MED 1210 1170 1130 10a5 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 MED 1725 1700 1670 1615 1550 1475 1375 1275 100-4 LOW 1430 1390 1350 1315 1285 1245 1160 1070 HI 2360 2325 2300 2170 2125 1945 1850 GMNT 120-5 MED 1815 1750 1710 1660 1600 L1545 1480 1415 LOW 1275 1215 1190 1145 1110 985 925 Values indicated by shaded areas represent airflows that are too low for heating temperature rise. SS-312D 3 1 NOTE: SPECIFICATIONS AND PERFORMANCE DATA LISTED HEREIN ARE SUBJECT TO CHANGE WITHOUT NOTICE 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.eoodmamnfe.com for information on: • Goodman products • Warranties • Customer Services • Parts • Contractor Programs and Training • Financing Options SS-312D 4 N 80'47 49" E 63. GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft 3,811 ±S.F. SEWER L SHALL BE SLEEVE IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. TICE Uniess'and-untl-such-time s.the original (red) stamp of the responsible Professional Engineer, or Pr i esslonal Land Surveyor appears on this plan:. (A) no Person or persons. including any municipal or other public officials, may rely upon the Information contained heroin; and (8) this plan remains the propert of Holmes & McGrath, Inc. PLOT PLAN holmes and mcgrath nc. -' OF LOT 5 Fps °F PREPARED FOR civil engineers and land surveyors soy 362 afford street �/ TIMIThvfn. i MILL POND VILLAGE g =1= SPNTOS falmouth, ma. 02540 vj� No 45078 � IN �t civil o r YARMOUTH, MA JOB No: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 1-22-03 DWG. NO.: A2504 CHECKED:-M< • f ''A 52.3E .* \ 6 1, N g! GRAPHIC SCALE 3,811 ±S.F. PROPOSED HOUSE (SANDPIPER, 3WER LATERAL SHALL BE SL EVED IN ACCORDANCE TITLE V IF WITHIN 1OFT. 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 ( IN FEET) public officials, may rely upon the Information contained herein; and I inch = 20 ft. fie) this plan remains the property of Holmes & McGrath, Inc. PLOT PLAN holmes and mcgrath, inc. T�j� of ^14s OF LOT 5 civil engineers and land surveyors PREPARED FOR c> MOTHYM. Gn� MILL POND VILLAGE 362 gifford street TISA,NTOS 6 IN falmouth, ma. 02540 xo.-45073 YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 1-22-03 DWG. NO.: A2504 CHECKED: -Me Full r, 52.38 ccp� �N 8 0.47'49 E - — 63. 34 w "- LOT 5 I 01 9.5' 25.0' a \ 25.9 Z ' LOT 6 6'2 ,� O rnl� 90'� EXISTING rn FOUNDATION Sj 6 6.2 EXISTING �o 0 o FOUNDATION N \lJa N 0 22.9 — � o o. 25.9' 12.1 EXISTING `L� 223� N I 1.07' LOT FOUNDATION w ,�Zd �2�• �, 1 53. \ k _ I. 40 46'W —S82' 4 ,39.9A4' i os \ Ar 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. 1 DATE REGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 fL D Q 0 JUN 1,. 004 D By— 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 C/ DATE REGISTERED PROFESSIONAL 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 (8) this plan remains the property of Holmes & McGrath, Inc AS —BUILT PLAN hoimes and mcgrath, inc. OF LOT 5 civil engineers and land surveyors PREPARED FOR 362 gifford street MILL POND VILLAGE falmouth, ma. 02540 IN YARMOUTH, MA JOB NO: 201197 DRAWN: SCALE: 1"=20' DATE: 6-14-04 DWG. NO.: A25O4 CHECKE OF PM 0MV.&TH vllaFZ.W. of r49 APPLICATION FOR PERMIT TO DO GASF17TING ~2 �' TOWN OF YARMOU (OFFICE USE ONLY) W .,,p By h ®/0 Fee: $ 3�7 0 0 1 2004 PERMIT NO. —'_05— 7&N Building ay Owner'g _ DateO=� O "— /�� AT. Location _ = ��1 �J T Name- - A%~i9w 5/7 Type of Occupancy /E;71tJ / l New [X Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No 1 N co Y U Z X vJ CC M O W Q ¢ D F n Q x a0 WWW o O a O x Z W > a W WW /,V QIAA FW u Z W cc O> U. FVJ 500W WZ I ¢O x 0 0 a00Ww> x IL M V M> 93 o. H 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) � Installing Company Name DiycT - 0 Al hi M ITE1� Address I C' C 14A.% E S f 4 /I/N 1 Sr^ MA Business Telephone J 0 F-7 3 7— 3 6 9 4 Check One: ❑ Corp. ❑ Partnership M Firm/Company Name of Licensed Plumber o, r '7 ck1Ahj `D- L- ^ N ey- INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes a 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. Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 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 Check One: Owner ❑ Agent ❑ Qmah jqe!!�,L.A Signature o Licensed Plumber or Gasfitter 22►5 EIS License Number TVDF 1 Ir FWCF- �r OF y4g''c TOWN OF YARMOUTH _ x YATTACHEESE 4�� O F6 UPir I APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ 9 1 • PERMIT NO. f'(7Z;) Date Building Owner's =12y� r <� AT. Location � � S Name Type of Occupancy r::� )New g/ Reno ❑ Replacement ❑ Plans Submitted Yes o ❑ tA0,4 Z Z J r V) Y N 2 y Q O . Cn Y H CD FQ- O C3 > x 6 o: 1�- (n " N W N Q y= Fes- U M co Z Q (A LL Z p, to Q. X 2 2 Q W C Z O. Q � LL W O O W Q 0 N cc J D O Q FILL >~ O rD y O N F Z O p y Z Z W F O V 2 >i Y J m M D O 1 2 F y 1L L t7 cc O G Q 0 2 m 10 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR J (PRINT OR TYPE) Installing Comr Address Check One: ji ❑ Corp. JUL 2 6 200 ❑ Partns stfio_ Business Telephone — 14 Tb I %7 Name of Licensed Plumbe cF�2�&Y .1 -'E - % 11 INSURANCE COVERAGE: I have a current liability insurance policy its substantial equivalent. Check One: Yes I] No ❑ If you have checked YES, please indicate the type of coverage by c cking 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 voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. A G Signature of Owner or Owner's Agent I 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. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) W1,Y MOUTHBy— � X/�Fee: $ l u J - '� UG 0 4 2004 DI PERMIT NO. ``Os' 7q7 (PLEASE PRINT IN INK ORbl-ig-applicdti-o-n-7ifFe �E W d NNPORMATIQN) Date: To the Inspector of Wires: By —undersigned gives notice of his or her intention to perform t electrical work described below. L / Location (Street & Number) /W //� �v © Owner or Tenant :% W% s of 6ftl 5�. —Telephone No. Owner's Address` Is this permit in conjunction with a building permit? N Yes No (Check Appropriate Box) Purpose of Building IZ42222C Utility Authorization No. Existing Service Amps / Volts Overheadc] Undgrd C3 No. of Meters New Service A'U2 Amps 1:2YO Volts Overhead❑ UndgrdZJ No. of Meters_ Number of Feeders and Ampacity Location and Nature of Proposed electrical Work: do. of Recessed Fixtures - No. of Ceil.-Sus . Paddle Fans o. - of -- -- ---- - _-.._..__ NTotal Transformers KVA ..._..w qW No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool rnd. md. No. of Emergency Lighting Baue Units No. of Receptacle Outlets p2 8" No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches zs No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat p Totals: um er ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal Connection Other No. of Dryers O Heating Appliances KW g PP Secutity Systems: No. of Devices or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent 3 Q d yt yS No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent e / Ct N Arracn aaattionat aetau y desired, or as required by 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 undersi ned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. f CHECK ONE: INSURANCE BOND OTHER (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) ork to Start: . t • d Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this applic 'on is true and complete. *NAME: see: Signature LIC. NO. (If applicable, enter "exempt" ine license n er line.) Bus. Tel. No.: 6/ 9 i Address: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature r_ below, I hereby waive this requirement. I am the (check one) owner CI owner's agent. Q Owner/Agent Signature Telephone [Rev. 04/001 Building Site Location: Proposed Improvement: Address: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Map No: V f Lot No: .� TeI.No.: 77X y665F Date Filed: -5 Y G� G wul3R 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, Etc. --------------------•-------------- --- ----•------------------------•-------------------------------------- REVIEWED BY: ✓1. WATER DEPARTMENT: DATE:�� N/A: VZ ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A 1/4. HEALTH DEPARTMENT: I DATE: N/A: INDU L AND/OR COMMERCLAL PER ITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A 7. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: DATE: WhitecWy-BolldnDept - Pwkcopy -Water Dept. - YdlowCopy -HeahhDept - Pink Copy-Engiaoe *Dept - Goldenrod -Fire Dept/ mmvation - Commonwealth of Massachusetts """"'" "'° ""`r i Permit No. (:;:'-'OS- 17( Department of Fire Services Occupancy and Fee Checked C1.00 b - BOARD OF FIRE PREVENTION REGULATIONS 11/99j ve blan ra ~ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL Wd rj C91 ; 74 All workto be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 Ctr1R 1100� I . (PLEASE PRWT WINK OR TYPE ALL WFigRlllilTl0119 Date: glq� , i AUG 1.3 2004 City or Town of: YAR 110M To the Inspector of Wires• By this application the undersigned gives notice of his or her intention to perform the electrical work de�'cn Location (Street & Number) MILL POND VILLAGE, Cate Street. j3LXj -AkC Owner or Tenant Gatewood Hanes/ Jeff Sollows - Telephone No.508-7789669 Owner's Address 1600 Falmouth Rd., Suite 25, Centerville, M. 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 ❑ Na of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) with back M *battery centrally monitored n.,—..t.a..;...f.A. l.,ll.....:..s MAI,he 4uai "M-hv the TaMertnrnrwiree • No. of Recessed Fixtures addle No. of Ceil.-SusP (Paddle) ) Fans o: of otA Transformers ]KVA Na of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures � g Swimmin Pool ove - ❑ g d. d. o. o Emergency g Battery Units Na of Receptacle Outlets No. of Oil Burners FIRE. ALARr4S No. of Zones -1-' Na of Switches No. of Gas Burners o. of Detection.an 7 Initiating Devices Na of Ranges Total Na of Air Cond. Tons No. of Alerting Devices No. of Waste Disosers P eat mP Totals: umber. Tons o.o - ..tame Detection/Alertin Devices 7 No. of Dishwashers SpacdAreaHeating KW Local ❑ ®Other No. of Dryers .. Heating Appliances KW yConnecption No Securiof Devices orEquivalent No. of Water KWo. Heaters o o. of . Signs Ballasts Data Wiring: No. of Devices or Muivalent No. H dromassa Bathtubs y � No. of Motors Total HP inng: Telecommunications or No. of Devices or E uivalent OTHEIL• • At[acn aaainatat aeratt tJ aestra4 or as regwroa -I -•,::rupaar rn wu= 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. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (SPeCify.- (Expiatrou Estimated Value of Electrical Work $750.00 (When required by municipal policy.) Work to Start 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, 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.: 11 I Uccasee: Jonas R Bielkevieiiis Signature LIC. NO.: 499D (Ifapplicvhle, enter "exempt" in ttte license mw .lute Bus. TeL No: 508-833-0996 Address: PQ BOX -3 09 :Saildwic �. 02563 r Alt TeL Na: 508��-�33 7 OWNER'S INSURANCE WAIVER .I am aware that the Licensee does not have the habrhty 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 PERMIT FEE: $ 40.00 Signature, Telephone No.