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Home My WebLink About121 Camp St #006 Building Permits`OF X TOWN OF YARMOUTH Bullding Department BUILDING � + (508) 398-2231 ext.261 PERMIT NO B-0713_ .......... PERMIT ISSUE DATE ;_ _9/5/2006_ _ ; PROPOSE _ _ _ _ _' APPLICANT Louis & Patricia Vigliordo . JOB WEATHER CARD PERMIT TO Alterations AT (LOCATION) 100121CAMPSTUnR6 ZONING DISTRICT R-2 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1044.21.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE add door at second floor landing for access to storage space over master bedroom & bath, remove scuttle REMARKS access from master bedroom ceiling. Add one window & install light in storage space as per plans dated 08/22106. Note: Limited to alter access change only AREA (SQ FT) EST COST ($ 1$2,200.00 PERMIT FEE ($) 1$75.00 OWNER Louis & Patricia Vigliordo BUILDING DEPT BY ADDRESS 100121 CAMP ST Unit 6 West Yarmouth I MA IF2673 ,CONTRACTOR LICENSE O PHONE 15M79M921 INSPECTION RECORD FIELD COPY 0 s oF''rgRONE & TWO FAMILY.ONLY - BUILDING PERMIT p �+ [ APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE R a AIR AV �[LL�JD •' (0 — y Town of Yarmouth Building Department MATTACMEES 1146 Route 28 • Yarmouth, MA 02664-4492 AUG 1 1 2006 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 •ao Office Use Only Planning Board Information Assessors Department Informati gy: Permit No. 1- 3 Date Plan Type Map Lot Endorsement Date ai Permit Fee $ New Deposit Rec'd. $a Date�Recording Date 6 Plan 1.4 Property Dimensions: Net Due $L5?,/ ther Lot Area (sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Per 't m Date Issued: Signature: .- 22- �66 Certificate is of Occupancy is not required Building Official Date Section 1 - Site Information I Use Group: R-4 Type: 5- 1.1 Property Address: /Z i CAH10 sT . 0A) 17 `6 1.2 Zoning Information: Zoning —District Proposed Use AI. YdoekoU7'H 802623 -3zSS 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 Inftion: Zone: � BFE: Comments: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: '/ W Y/9IZ'` f�V yi f1A zoos .P, q Y PA%R�� lA B. /k-/O/?01-0 izl rMR S o 2673 -325] Name (print) Mailing Address /V"-;1e-kTelephoneSignature � 2.2 Authorized Agent: r• Name (print) Mailing Address SEP Signature Telephone Fax. Section 3 - Construction Services I 3.1 Licensed Construction Supervisor: (Pa-t 4 t CC/,I 5Ei�-0 Not Applicable ❑ License Number Address H— S`o8 '7'7f732 3 CELL - SD,Q_73-1f Zq3 Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Company Name Not Applicable ❑ Address Signature Telephone License Number Expiration Date 1 of 2 fuvt;m -vvvaw,-v-vvVnco vvl�lcOatV1 uJWanl.Ci ry111VG1Y1l.�rvl.li. L. G. IC7L:O GD4',a0j; Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ...Il . No .......... Section 5 • Description of Proposed Work (check all applicable) New Construction ❑ Existing Bldg. 0' No. of Bedrooms No. of Bathrooms Repair(s) ❑ Alterations Ca-1 Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: oq D 19 DO0P_ 7 tf 6 5'15LWD Ftdaye L ND A3%i r C E O VE 7 -itF - U S O- C C —S P M k - ,C r tit c —190b nAJF_D S e Section 6 - Estimated Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building z 000 2. Electrical Z &0 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection —� 6.Total=(1+2+3+4+5) ZZ 7. Total Square Ft. (new houses & additions) Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) I, Lot,/5 R - V141-10ROL 0 , as owner of the subject property hereby authorize - DAL 1 D0 W N06cJF2 to act on my behalf, in all matte relativ to work authorized by this building permit application. Signature o(Owner Date I, L o U / S k. V/GL io RoLO , as Owner/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. L.nV/S Print name Of 9-15-99 2 of 2 it)(, 'D6 Date }}�`.YAR'�+C TOWN OF YARMOUTH 0 . H,.;,u,�,,,; S BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: /Z I CA WE S>_ , UNIT G V • Y'61?1-4)1] 7N Number Street Village Owner of Property: 1-t7oi5 ?A7R lL'I A J . ✓/ I-IM 0L0 ' ft -Soy 771 -'?3Z3 Construction Supervisor: DALE D00140W E L cctc -S'D,P 737-k2-93 Name License No. Phone No. Address: / 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 kes, please indicate the type 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 152 ovi e M ss. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of wner r wner's Agent Owner Agent ❑ Signature: Building Official Approval: For Office Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the `reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied building containing at least one but not more than four dwelling units or structures which are adjacent to such residence or building' be done by registered contractors, with certain exceptions, along with other requirements. Type of Work: 41_T 2ATia V Est. Cost 2 z t7fi Address of Work /Z/ r AM P ST o n7 I7 6 bt) . YA 2MOc> rH, PA - Owner Name: LDuis q- p✓97-2101,4 A. V l6-L10 /20LO Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): v Work excluded by law Job under $1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name W Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name The Commonwealth ofMassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 1/ rbNEpcvl%1 LcJt S l . V a-zaeQ LD Name (Business/Organization/Individual): O ✓Address:0,�WR 5 T. [J R)/ ? F 'City/State/Zip: tt . Y)g MD t1::1 .�4 Phone #: SD R 9,9 Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance — fequired.] 3. M I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. D�emodeling 8. ❑ Demolition 9. ❑ Building addition ME] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs ME] Other 'Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information.: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . / I do hereby certify under the pains apd penalties of perjury that the information provided above is true and correct v Cianathrrer 0 10, VV L,,l /nA� Date- // AU15- '%%Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple pemuttlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would bike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-OS www,mass.gov/dia TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: / 2-f C 7�P _5* , u Dy / W , Y7X M) U lf/ NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER"-Lou/5 E.&LIO&LO Sog79039Z1 -7,y 93S 2473 NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 17 1 ^J)41►° 5 T- . J7 6 tV. V,,f RHO u7f/ M A -. 0267? CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner — occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such homeowner shall act as supervisor. (State Building Code Section 108.3.5.1) Definition of Homeowner: Person(s) who owns a parcel of land on which he / she resides or intends to reside, on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and / or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner; such "homeowner" shall submit to the building official, on a form acceptable to the building official, that he / she shall be responsible for all such work performed under the building permit. (Section 108.3.5.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned `homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. Yes ❑ No ❑ If you have checked yes, please indicate the type 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: Signature of Own r or Owner's Agent Owner V Agent ❑ hhomeownrlicexemp BUILDING TOWN OF Y A R M O U T H ELECTRICAL 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664.4451 GAS Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT 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 /Z I S`7,ya 1 ! ti (P&L 40 U/1,41¢60 Work Address is to be disposed of at the following location: P a L Pvofl Vy(q E cOasTW#-%/p1-) pl/NP5xr2 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. e V004, - Si ure of Applicant Permit No. ii BUG o,C Date e THE PLOVER SECOND FLOOR PLAN 1/6' . I'-0' 374! f.;. I TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT' COMPLIANCE. DATE: —ZZ 06 BUILDING OITICIAL FILE COPY BEDROOM �T#2 -I-'T �rYT BED-lRoOOM,nTeruB e U r — 1.yXkI'DSwi-0 Today Real Estate 487 Station Avenue South Yarmouth, MA 02664 „'V LLf:.Gr P/ 508-398-0600 f/508-398-0684 www.todayrealestate.com RECEIVED EAUG112006 BUILDING DEPT. By: — THE PLOVER FIRST FLOOR PLAN 1/6' • P-O' 7" t *Jr. I it L=5.41' 8047'49" E N LOT 6 4,705 ±S.F. --,--'63.34 LOT 5 3.605 ±S.F. SEE Sin SOW SEWER LATERAL SHALL BE 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 Professlonal Englneer, 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 (lib) this plan remains the property of Holmes & McGrath, Inc. 1 inch � 20 M PLOT PLAN holmes and mcgrath, inc. ,%:.' OF LOT 6 civil engineers and land surveyors PREPARED FOR ( 362 gifford street 1'-t MILL POND VILLAGE Falmouth, ma. 02540 ,� "� "c 5 �t !' IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1 =20 DATE: 1-22-03 DWG. NO.: A2505 CHECKED: j1V,3 of TOWN OF YARMOUTH Building Department _ Town Hall a Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-07-061 Applicant Name: Louis & Patricia Vigliorolo Applicant Phone: Building Location: 00121 CAMP ST Unit 6 Owner's Name: Louis & Patricia Vigliorolo Owner's Addres 00121 CAMP ST Unit 6 West Yarmouth MA 02673 ' Owner's Telephone: (508) 790-3921 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Check ChkNo.: 120 Net Owed: ($25.00) Application Date: 8/11/2006 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF Comments: Map/Lot: 044.21.1 add door at second floor landing for access to storage space over master bedroom & bath, remove scuttle access from master bedroom ceiling. Add one window & install light in storage space ZONING APPROVED_ DATE: DATE: DATE: DATE: DATE: DATE: N/A: N/A: N/A: N/A: N/A: N/A: TE: G Date Printed: 8/16/2006 PILE COPY . a Bk 18627 Pg 344 #40616 r� the said departments rules and regulations. �� --C) 26. The petitioner shall be allowed to make minor variations in the architectural layout to return to the Board f or approval, provided they are substantially ythe designs presented to and approved of hereunder. Subsequent to he homes herein authorized, in conformance with the plans herein lsions or exterior alterations of the homes shall be allowed, nor shall able interior space be added, without approval of this Board, in the Comprehensive Permit. rehensive Permi including the above stated P � g waivers, upon all of 517. j conditions and restrictions, was made by Mr. St. George, and I he Board Members voted as follows: In Favor: Mr. Reid, Mr. Richards, Mr. Sarnosky, Mrs, Moudouris, and Mr. St. George. Opposed: None. The revised Comprehensive Permit is therefore granted. Dated : //�/�K , 2001. ZONING ARD OF APPEALS A'A I • : - Commonwealth of Massachusetts Official use only . :�.. Permit No. — Department of Fire Services Ocarpancy and Fee Cbecloed 40100 BOARD OF FIRE PREVENTION REGULATIONS .111991 ve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO All workto be pedonned in a=dance with the Muhusetts Electrical Code (hffiC), 327 CMR 1 : l jA� �� L us (PLSE PRINT IYEAW OR TYPEALL DeT0RMAT70A9 Date: B 9 6 EAl- 171 1"b City or Town of. YAI MDUPH To the Inspector of Wir p l' " ' By this application the undersigned gives notice of his or her intention to perform the electrical work ed below. Location (Street & Number) MILL 'POND VILLAGE, Camp Street Owner or Tenant Gatewood Homes/ Jeff Sollows Telephone No. 7Uc—ttcynoy Owner's Address 1600 Falmouth Rd., Suite 25, Centerville, Ma. 0263.2 Is this permit in conjunction with a building permit? Yes XQ No ❑ (Check Appropriate Box) Purpose of Building single family residence Utility Authorization No. Erisdng Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters Number of Feeders and Amp acity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) wi h ba ktm battery I centrally monitored _ n_�_r_.r,... ,.ht. f )1....,:.... ml,ls..,.... Jes wnivn?7•hv flea lam¢eMr nFlYire_e No. of Recessed Futures No. of Cell.-Susp. (Paddle) Fans of Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators HVA No. of Lighting Fixtures Swimmia Pool ove ❑ g d.. d. o. o mergency g BatteryUnits Na of Receptacle Outlets No. of Oil Burners FIRE. A? •ARMS No. of Zones —1— Na D an 7 Initiating Devices Na of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste D' osers uP eat Pump Totals: um er. ' Tons o. a ontaine Detection/Alerting Devices 7 No. ofDishwashers Space/AreaHeating KW Local ❑ fylumciyConnecpal tion ® Other No. of Dryers .. Heating Appliances KW Security a f Devices orE ivalent o. o ater KW Heaters o. o Ballasts Signs Data Wiring: No. of Devices or E uivalent No. H dromassa Bathtubs y ge No. of Motors Total HP ecommunrcations inng No. of Devices or E uivalent OTSEI2: • graven amioonat oermi rj aearreq ar as regwrx+ ay "ec yr(/e<wr {y n emu. 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 ® BOND El OTHM 0 (Specify) (Expiration ate Estimated Value of Electrical Woric $750.00 (When required by municipal policy.) Work to Starr 0 Inspections to be requested in accordance with NMC Rule 10, and upon completion I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C Licensee: Jonas R Bielkevicius Signature �" LIC.NO.: 499D (ljappRcable, enter "exempt" in the license n:rmbe .Ivre. Bus Tel No: 508-833-0996 Address: PO Box 1609 :Sandw'c't lam. 02563 Alt. TeL Na 508 7 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 PERMIT FEE: $ 40 , 00. Signaturetali. Telephone Na. W C a W c A m a H ,C\ Commonwealth of Massachusetts Department of Fire Services - BOARD OF FIRE PREVENTION REGULATIONS Official Use Only . Permit No. E— 05' 1 `bq Occupancy and Fee Checked — :ev. 11/991 (leave hlnnkl APPLICATION FOR PERMIT TO PERFORM ELECTRI All work to be performed in accordance with the Massachusetts Electrical Code (MEC 527 C (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: xe City or Town of:To the Inspector of By this application the undersigned gives notice of his or her intention t per fo a glectrical Location (Street & Number) Owner or Tenant 10,ez /_ or,_/ rere. tin Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service ZOO Amps Z 2 Zcr Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: below. Z0p4 Yes (__ No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd a No. of Meters Cmmnlalinn nrthu !n/lnw:nn rnA/n ... . 1.., . -a A.. It— !.. _rrro__ No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures �� SwimmingPool Above ❑ n- ❑ rnd. rnd. o. o Units Emergency tg rug Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of AlertingDevices No. of Waste Disposers Heat Pump Totals Num er I Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent o. of ea KW Hea ters _ o. of o. o _Sin Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage o ubs � S L Nail o Motors Total HP n Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail ijdesired, or as required by the Inspector of IVires. INSURANCE COVE y GE•Jr�lesbwaiv y th owner, no permit for the performance of electrical work may issue unless W he licensee provides pt�W f oflbrlity insurance incl ding "completed operation" coverage or its substantial equivalent. The aundersigned certifies th t-sue e�srn orce, and has exhibited proof of same to the permit issuing office. HECK ONE: INSURANCE EZOND ❑ OTHER ❑ (Specify:) i��I,LS (Expuauon Date) Estimated Value of El e trt al Work: (When required by municipal policy.) Work to Start: f!O Inspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under the poi sand penalties of perjury, that the information on this application is true and complete. IRM NAME: LIC. NO.: roZ6,9,/= icensee: Signature LIC. NO.:1:?_00 1pl o: (Ijapplicable, curer "exempt"' i the license umb r line.) Bus. Tel. No.•y 2Z-A dJ14F Address: —ei? Alt. Tel. No.:�:5 E--r CL x OWNERS INSURANCE WAIVER: l am aware that the icens a does not have the Ility insurance coverage normally a required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent � Signature Telephone No. PERMIT FEE. $ M4- Nevv1X Plans Submitted )F_YA OUTH NOV 0 1 04 6U:LG.PdG DEPT. Renovation ❑ Yes ❑ No t' APPLICATION FOR PERMIT TO DO GASFITTING (OFFICEUSE, ONLY) Fee: $ �3 PERMIT NO. CT— OS— 373 Named /Actom Arril , 5 Type of Occupancy_/Ei%M / l/ Replacement ❑ y Yz W fA CrN cc Cn Q 0 O ~ �[ Z J kx ~ W a W r Z Z O~ w Q (� W W ►w- N O 0 W > Uj Z a a x z O 13 W WW x O> Z LL O HV J O Hy Wz x .. M w M 2 3 Q a O O W o ow> 0 M x 0 0 x LL M e 0-j 0 ac > o. I- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) "-�� UGTS ^1 Installing Company Name �1 r^t tTE1� Address IN G 14AI E S T Check One: ❑ Corp. El Partnership — Cf Firm/Company Business Telephone SO F— 7 3 _ 3 Name of Licensed Plumber orP tier L-A W G' INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes ENo ❑ If you have checked yes, please indicate t e type of coverage by checking the appropriate box. A liability insurance policy IOther 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 I hereby certify that all of the details and information I have submitted V) Signature o Licensed (or entered) in above application are true and accurate to the best of Plumber or Gasfitter my knowledge and that all plumbing work and installations performed 2,1 S 1 0S under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Lrvoc I F:NQr- of rq APPLICATION FOR PERMIT TO DO PLUMBING TOWN OF YARMOUTH (OFFICE USE ONLY) MMT HEESE By Fee: $ d d ek- ( ip`i PERMIT N07 Ob— QaP P ejo Date % 20 614 � � a;5 Building � Owner's�TT1s ®[" q�q d - Name 6 fit; 6- tS� Ttq Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ Dy Z fA (A rn O Y Z H Z > W M W 0? Cn W O Z Z Z J y W N N 2 N S H U Q 2 W N U1 Y Q rA a Q d Q X M Z¢ W O D w Cl) U) 13 � Q w Z r/) o Q 0: m J Z Y o a o OJ � W= Q Q S �+ N O y Z= a 3 Y ZQ a 0 p 0 H Q Q W LL Y W a Q= Q 0 N Q¢ it OWC Q O Q~ Y J m rn Q G J = H LL a O t] Q tr m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR (PRINT OR TYPE) Installing Company Name s Address Check One: ❑ Corp. ❑ ParVy, JUL 2 6 2nna Business Telephone` 2� `7r U -J ! �e of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy o is substantial equivalent. Check One: 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 ❑ Yes ❑ No ❑ 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 recuirement. 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. Type: 7,�g77 License Number Journeyman Master ❑ f J N 80•47/ 1 N 1 2 .0s 371 JUN " 2004 LOT 5 t� LOT 6 a8' s.2 Exis-nr FOUNDA I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C FLOODAS SHOWN ON COMMUNITY PANELNO. IN250015CMAP 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREA. REGISTER PR ESSIONAL DATE LAND SURVEYOR GRAPHIC SCALE Z 0. w I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS CONFORMS TO T MINIMUM SETBACKNREQUIREMENTS OFiE THE 40B SPECIAL PERMIT »� DATE REGISTERED SURVEYORIONAL NOT IC Unless and until such time as the original (rod) stamp of the responsible Professional Engineer. or Professional Land Surveyor appears on this plan: 9 any municipal or other (A) no person or persons. Y public officials, may rely upon the Information of contames ined herein; and McGrath. Inc. (B) this plan remains the property 1 inch = 20 M AS —BUILT PLAN holmes and mcgrath, Inc.,tt� °f OF LOT 6 civil engineers and land surveyorso� LN� PREPARED FOR 362 gifford street MILL POND VILLAGE falmouth, ma. 02540, IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC uN SCALE: 1 =20 DATE: 6-09-04 DWG. NO.: A2505 of r TOWN OFYARMOUTH Building Department BUILDING ' (508) 398-2231 ext.261 PERMIT NO _ B -13n_ ; PERMIT ISSUE DATE ;_ _619/2004_ - ; PROPOSED USE - APPLICANT Franknk Capra ---------------------- JOB WEATHER CARD apr PERMIT TO :New Construction ------------ AT (LOCATION) 1001121CAMPST#6 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDINGISTOBE: CONSTTYPE1 5-B I USEGROUPI R-4 new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans REMARKS dated 03/30/04 and BOA # 3546. AREA (SO FT) EST COST ($ I$117,024.00 OWNER lVillages at Camp St., LLC U, ADDRESS 11600 Falmouth Road # 25 Centerville I MA 102632 PERMIT FEE ($) 1$427.00 .DING DEPT BY CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 MA 02632 l Certificate Issue Date %7ri�'Tr�i 7 VY CERTIFICATE'of OCCUPANCY; Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks BUILDING PLUMBINGIGAS ELECTRICAL S ENGINEERING 1) tae,_7w\- 3 6 65- 57,J-c DCP I� t` f 17Q1�rc( '3 i oSl OTHER To be filled In by each division indicated hereon upon completion of Its nnai inspection. TOWN OF YARMOUTH Building Department . BUILDING _ _ _ _ _ _ _ - (508) 398 2231 ext.261 (79�' PERMIT NO 6-04-13n_ PERMIT ISSUE DATE _6/912004- - ; PROPOSED USE , APPLICANT .'Frank_ Capra_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ JOB WEATHER CARD ------------ PERMIT TO ' New Construction ' AT (LOCATION) 100121CAMPST#6 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C6 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans REMARKS dated 03/30/04 and BOA # 3546. 1REA (SQ FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 OWNER lVillages at Camp St., LLC ADDRESS 11600 Falmouth Road # 25 Centerville I MA 102632 BUILDING DEPT BY INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector ell - 3 I OV'-k TOWN OF YARMOUTH Building Department Town Hall a Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-04-435 Applicant Name: Frank Capra Location: 00121 CAMP ST # 6 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 $ oF'YgR ONE & TWO FAMILY ONLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department 'e " T'T. EES 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Office Use Only': Permlt N ate f//J��%%/��/ i/�/j r Deposit Rec'd ,$�(}�Date�� Net Due$3� GV, Planning'Board Information. ,Plan Type Endorsement Date Recording Uate Other,` " Assessors Department Information , Map �� tot r'Map",L t Oyd New 1 4 Property imensions D LotArea{sf) Frontage{t[) ,. ,� Lot coverage#` Section for`Office Use'Qni .; .,-.:. ..• �;w _ _ �<,.;� Buildiii {R " 3 f' a cf f Signature Geitrfl ate of Occupancy �7 ' is not="' regwretl t< „ Building Official- Section 1 aSite Information` Use Group: R-4 Type: 5-B 1.1 Property Address: a � 54 - 1.2 Zoning Information: Zoning District Proposed Use L�u 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided —so P► go A• 508• 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1 5 Flood Zone 11forfnanoni Comments Zone. xBFE:: 'a Section 2- Prope'rry.'QWnership/Aii#Fiorized'Agent 2.1 Ownekoof Record: �G / \l /b Oto IN me(;printk R(AoA go > Mailing Address CZLr rV£ l C Signature Telephone 2.2 utho0rrzOeq Agent:AJ �L OI i L/ 0 O Name (print) r a-° a Mailing Address \A Y Signature Telephone Fax VIM Section 3: Construction Services. 3.1 Licensed Construction Supervisor: r� of le ❑ O I & o ✓r, �_ r „✓� ( 3 ` �{ `jam 1 License Number O Adre s � Expiration Date '. —0 Signature Telephone I 3.2,Re91stered Hmne.lmpro"verfient- C wCaiciR.`K 0 Company Name JUN 0 8 2004 Not Applicable. ❑ License Number Address 6Y7 Bv- r� Signature Telephone Expiration Date I— 9- 15-99 1 of 2 OVER w v : N 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 .......... Section;:YD.escr�pil©ii,of,Prpposed'Warklpheckatlappiicablet New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. ❑Type Demolition Other Specify: Brief Description of Proposed Work: t I t Vk (V., Item Estimated Cost (Dollars) to be completed by permit applicant 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 & additions) Q WE I Check Below I ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) asowner of the subject property hereby authorize 120 -e L-0r to act on m beh , in all matters elative to work authorized by this building permit ppl'cation. l 0- 03 Signature of Owner Date Section 7b,,-,Owner/Authorized, Agent, Declaration �/v ; L � i a-t,.., I,'C1 as Qwner/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. JAI I t l k'64.,. P A Q_F_ Print Signature of Owner/Agent —� Date u 9-15-99 2 of 2 It TOWN.OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Job Location: _ Owner of Property: Construction Supervisor: Address: I (ro 00 M Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: Q� �A oaG3Z 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 Qa� No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy all� 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 Q Agent Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents ONCO0/1"affoadsss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit 1 am a homeowner performing all work myself. O Lam a sole proprietor anJ halve no one working in any capacity C3 I am an employer pro%iding workers' compensation for my employees working on this job. company name - address: city: phone N• insurance co. policy 0 CB/I am a sole proprietor. ?general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e city: nhone N• insurance co policy 0 Failure to secure coverage as required under Secnou 25A of MGL 152 can lead to the imposition of criminal penalties of a Brae up to SI,MMG and/or. one years' imprisonment as well as civil penaldeti is the form of a STOP WORK ORDER and a floe of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. l do hereby certi • under the pains and penalties of perjury that the information provided above is true and eorree k Signature ��szt�.� Date X Print name 1 ' fit^,\ cLk= V PhoneKCQ ��—%7 —74 4 P ofl'acial use only do not write in this area to be completed by city or town official city or town: YARMOUTIJ _ permittlicense N mBuilding Department pLieensiag Board C3 check if immediate response is required 261 OSeleetmen's Otlfee (508) 3982231 eat. �1lealth Department contact person: phone N7 — _ mother Y TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 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 I conducted at 11\ 0 J - Work Ad4ress is to be disposed of at the following location: �(i✓r� 10�d �` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. v Signat fApplicant Date Permit No. .• �^� ✓%e TOaiivurorewea� o�✓`la:uat�i�saeQa FBOARD OF BUILDING REGULATIONS '11-icense: CONSTRUCTION SUPERVISOR zber: CS 012430 c ate:06116/1940 Expires: 06116t2004 Tr. no: 25823 Restricted: 00 FRANK G CAPRA 40 COPPER LN CENTERVILLE, MA 02632 Administrator 00 - 35,000 d enclosed space (MGL CA 12 S.601-) 1A - Masonry only 1 G -13 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 M,_w VtK i iric:ATE OF LIABILITY INSURANCE DATE (MM/DD"r 07/22 22003 PRODUCER (508) 994-9688 FAX (508) 991- 5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RbTkQWSKI & 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 -� JNSURER A: Providence Mutual. PO Box 664 INSURERB: OneSeacon West`Hyannisport, MA 02672 INSURER C Continental Casualty.Co._:_. _ . ._.. ....... .. _ INSURERD:_.._ :. . rrnrco once .. WSURERE 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. -SR TIN A TYPE OF INSURANCE GENERAL LIABILITYCOMMERCIAL X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR POLICY NUMBER PP0053131 00 POLICY EFFEC IVE 12/13/2002 POLIC EXPIRATION 12/13/2003 LIMITS EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one fire) S 50,000 MED EXP (Any one person) S 5,000 PERSONAL R ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000, .OOO PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY JE O LOC AUTOMOBILE LIABILITY ANY AUTO CBXE48125- 02/14/2003 02/14/2004 COMBINED SINGLE LIMB (Ea accident) S ALL OWNED AUTOS BODILY INJURY (Per person) S 250,00 B X SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) S 500,000 NON -OWNED AUTOS PROPERTY DAMAGE (Per axlee .9 -AUTO ONLY -EA ACCIDENT. S _ ..... 100.000 S GARAGE LIABILITY 'ANY AUTO ... ..'.'c .•. .. ' .. OTHER THAN EA ACC AUTO ONLY: AGO S _ . ... ... S EXCESS LIABILITY - OCCUR O CLAIMS MADE ' . ,. EACH OCCURRENCE S. AGGREGATE S $ DEDUCTIBLE S RETENTION $ LIMITS ER S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY 6SS9UB86IX751603 03/22/2003 03/22/2004 EL EACH ACCIDENT 50000 SE500 _ .._.... _ EL DISEASE - EA EMPLO $500 , 000 OTHER E.L.DI$EASE-POLICYLIMI'f S- VIC DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ...... ...__.. __._.. 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, Gatewood Homes Inc BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Falmouth Road Ste 25 OF NTHE COMPANY�AGggS.111R EPR N FIVES. Centerville, MA 02632 AUTHORDEDR R ATnre -�� ►��M %.#CM i INL A I t of LIABILITY INSURANCE °A�'MM°°,YYYY) PRODUCER r 10/17/03 Doavllh�g & O' Neil Insurance THIS CERTIFICATE IONLY AND S ISSUED AS A MATTER OF INFORMATION HOLDER. THIS CERTIFICATE M TE DOES NOT END, EXTEND R RIGHTS UPON THE CERTIFICATE Agency, Inc. 222 West Main 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 INSURERS: Guard Insurance Group Hyannis, MA 02601 INSURER C: INSURER D: 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 CONDRIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _TR NSR TYPE OF INSURANCE POLICY NUMBER PDATCYM FFEC V POOLAICY ME)�PIDD TION LIMITS A GENERAL LIABILITY 16801484A82ACOF03 10/05/03 10/05/04 EACH OCCURRENCE y X COMMERCIAL GENERAL LIABILITY 1 QQO QQQ DAMAGE TO RENTED $300 000 CLAIMS MADE D OCCUR MED EXP lAnv ona oarsnnt I tr. nnn X I OCP GEN'L AGGREGATE LIMIT APPLIES PER -- A I LAffOMOBIUE LIABILITY AUTO OWNED AUTOS 18102601W561IND03 10/05/03 10/05/04 CO aBINEDDlSINGLE LIMB (Ea $1,000,UOD EDULED AUTOS - D AUTOS BODILY INJURY (Per parson) : BODILY INJURY (Peraccident) S WNED AUTOS e Other Car PROP ERTYDAMAGE (Per accident) E ABILITY LEXCESSIUMBRELLA AUTO ONLY - EA ACCIDENT $ UTO OTHER THAN EA ACC AUTO ONLY: $ MBRELLA LIABILITYEACH AGG S OCCURRENCE S R CLAIMS MADEAGGREGATE S CTIBLENTION S $ 9 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY BAWC436910 Q8/16/U3 08/18/04 WC STATU• OTH- ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? E.L EACH ACCIDENT $1 OO,DOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 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 IQ_ 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 ACORD 25 (2001108) 1 of 2 #M31942 - LS1 O ACORD CORPORATION 1988 L-:r.:K'1' = F' = CATE OS' 2 NSL7RANCE Producer: SOUTHEASTERN INS AGCY 641 MAIN ST HYANNIS MA 02601 Code: ------------------------- Insured: RJ BEVILACOUA P 0 BOX 629 FORESTDALE MA 02644 Issue date; 7/22/03 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. COMPANIES AFFORDING COVERAGE ----------- ------------------------------------------------------------ Sub -code: I Co Ltr A: ARBELLA PROTECTION ---------------------------------------------------------------------------------------------- _ Co-Ltr-B; ARBELLA PROTECTION ------ -------------------------------------------------------------- ---------Co---Ltr----C: ---=---------------------------------------------------- Co Ltr D_ ARBELLA PROTECTION ------------------------------------------------------ I Co Ltr E: COVERAGES This is to certify that policies of indicated notwithstanding insurance listed below have been issued term to the insured named above for the policy period any requirement, or condition of any contract or other document with respect to which this certificate may be issued or may ertain, exclusions, and conditions of such policies. the insurance afforded by the Limits shown have been policies described herein is subject to all the terms, by ----------------------------------------------------------------------------------------------------------------------------------- may reduced paid claims. Co I Ltrl Type of Insurance ----_I ------------------------------------ I I Policy Policy number leffective date ---------------------------------------------------------------------------------------- Policy I lezpiration datel All limits in thousands A I I ENERAL LIABILITY Commercial general liability 850001B147 7/15/03 I 7/15/04 (General aggregate: 21000 ( Claims made (] Occur kner's I contractor's i I Products-comp/ops aggrey: Personal/advert) ' sing ink: (Each prot occurrence;1,000 I I l (Fire damage: 100 - ----------------- ------ -------------------- ---------------------------------------------- Medical 5 B (AUTOMOBILE LIABILITY 1 86852400001 2/21/03 2/21/04 -expense_ --------------------- (Combined An z auto All owned autos i i Single in le limit. 250/500 l Bodily Scheduled autos I I 1Per �6odily Hired autos Non -owned autos l I injury (Per accident): Garage liability (Property j ---------------------------------------------------------------------------------------------------------------------------------- I damage; 500 LIABILITY I I Each In -I ------------ ] J Other than umbrella form -------------------------------------------------------------------------------------------------------------------- I Occurrence Aggregate D I WORKER'S COMPENSATION A l 9088680403 l 4/27/03 l 4/27/04 IStatutor( I----------------------------- EMPLOYERS' LIABILITY I l l 100 500 Each accident) Disease—policy (Disease -policy limit) - - - -- 100_ emp_Loyee.y.. (OTHER I I I--------------�---------------------------------------- Description of operations/locations/vehicles/restrictions/special items: CERTIFICATE HOLDER CANCELLATION l Should any if the above described policies be cancelled before the GATElJOOD HOMES expiration date thereof, the issuing company will endeavor to 1600 FALMOUME RD STE 35 I mail 10 days written notice to the certificate holder named to the 1600 FALMOURVILLE MA 02631 left, but failure to mail such notice shall Impose no obligation or CENTliability of any kind upon the company, its agents or representatives. ------------------------------------------------------------------------- Authorized representative: I JOAN M MARTIN JA /89 -------------------- r7l�K UW(TIFICATE QF,LIABILITY INSURANCE PRODUCER 508-398-6033 FAX S08-760-1667 Allied ATHIS CERTIFICATE IS'ISSUED AS A MAT ' merican Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON 1`Atl antic Ave HOLDER. THIS CERTIFICATE DOES NOT SO Yarmouth MA 02664 ALTER THE COVERAGE AFFORDED AV' INSURERS AFFORDING COVERAGE ape o Custom Floors INSURERI 762 Falmouth Road Arbella Protection I Hyannis MA 02601 INSURERS' Hartford INSURER C: INSURER 0: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLM et MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D TYPE OF INSURANCE POLICY NUMBER POLICY E GENERAL LIAmLITY 7500000373 12/13 X COMMERCIAL GENERA. LIABILITY CLAIMS MADE D OCCUR 7A OENL AGGREGATE POLICY n jECT ( f LRRBAOOLT.APIPL�IEIS PEF 'L LOO AUTOMOBILE LIABILITY ANYAUTO ALL OWNEO AUTOS ' SCHEDULED AUTOS HIREDAUTOS NON'OWNEDAUTOS GARAGE LIABILITY L LLA DABILITY OCLAIMS MADEE 3 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B ANY PROPRIETORUPARTNER/EXBCUTvE OFFICER/MEMBER EXCLUDED? E FOR THE POLICY PERIOD INDICATED. 6 ECT TO WHICH THIS CERTIFICATE MAYS ALL THE TERMS, EXCLUSIONS AND CON( CY EXPIRAWPFRSONALAA0VINJURY LIMIT$ 1 3/20E 3ED $p.MM) 3NJURY3 GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG 3 COMBINED SINGLE LIMIT 3 (Ea aeeldenq BODILY INJURY " (Pm POMM) 3 BODILY INJURY 3 (Pat ecodeny PROPERTY DAMAGE 3 (Pa eecidsm) AUTO ONLY - EA ACCIDENT 3 OTHER THAN EA ACC 3 ' AUTO ONLY: ADO i EACH OCCURRENCE S I EXCLUSIONS ADDED aY ENDORSEMENT I SPECIAL DATE (MIWODNYYYI 07/21/?nnz NAIC IT ISSUED OR (IONS OF SUCH 1 2 E.L EACH ACCIDENT S 100,000 E.L. DISEASE - EA EMPLOYE 3 106, 000 EL DISEASE - POLICY LIMIT 3 snn _ nnn Evidence of Insurance for work performed within the Insured's scope of normal operations Gatewood Homes.. 1600 Falmouth Road 825 Centerville, NA 02632 4CORD25(2001108) FAX: (S08)778-5603 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 MAIL SVCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRASENTATVES. AUTHORIZED RESENTATIV Qi ®ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE (MMfDDIYYYY) CROWC50 07 25 03 vaooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sullivan, Garrity 6 Donnelly ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 508--154-1767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Institute Rd - 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 # INSURED INSURER A: Hanover Insurance Cc 22292 INSURER B: Arch Insurance Company Crowell Construction, Inc. INSURER C: PO Box 309 INSURER D: So. Dennis MA 02660 INSURER E: COVFRAf:FC 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. LTRINSRt PE OF INSURANCE POLICY NUMBER DATE MMIDDM' DATE I MUM /DDIYI' I W LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE f X] OCCUR ZHN7007141 05/01/03 05/01/04 EACH OCCURRENCE $1000000 X PREMISES Es occuranca $100000 MED EXP (Any one person) $5000 PERSONAL d ADV INJURY $1000000 GENERAL AGGREGATE s 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: . POLICY "'JECOT LOC PRODUCTS -COMPfOP AGG $2000000 A AUTOMOBILE LIABILITY ANY AUio ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS ARN7001142 - ` 05/01/03 05/01/04 COMBINED SINGLE LIMIT (Ea accident) s BODILY INJURY (Per person) $SOOOOOO X X BODILY INJURY (Per accident) $1000000 X PROPERTY DAMAGE (Per accident) SSOOOOO GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S S EXCESSNMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE S AGGREGATE S S S S B -- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? -Ifyyes;describsunder SPECIAL PROVISIONS below OTHER IRWCI00100 - 03/22/03 03/22/04 - AIUl TORY LIMBSI ER E.LEACHACCIDENT. $500000 E.LDISEASE- EAEMPLOYE $500000 E.L.DISEASE. POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY END Fax #508-778-5603 ORSEMENT /SPECIAL PROVISIONS CERTIFICATE;4ni nFR Gatewood Homes 1600 Falmouth Road Suite 25 Centerville MA 02632 25 GATEWOO I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .1 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER, ITS AGENTS OR ACORD.CORPORATION 1 °ATE,MMD°^ 6cU�,~ CERTIFICATE OF LIABILITY INSURANCE powl;ng & O' Neil Insurance Agency, Inc. 222 West Main St. PO Box 1990 Hyannis, MA 02601 Gutter Pro Enterprises, Inc. P.O. Box 1197 Plymouth, MA 02362 COVERAGES 11l14l03 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 NAIC # INSURER A: travelers Insurance Company INSURERB: Guard Insurance Group INSURER C: INSURER D: 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. LTR A NSR TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS.MADE O OCCUR POLICY NUMBER 1680459H3118TCT03 POLICY EFFECTIVE DATE MMIDDIYY 11/07/03 POLICY EXPIRATION DATE MM/D 11/07/04 LIMITS EACH OCCURRENCE E1 000 000 DAMAGE TO RENTED $300 OOO MED EXP (Any one person) E5 O00 PERSONAL &ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2 000 000 PRODUCTS - COMP/OP AGG EZ 000 000 POLICY PRO-CT LOC AUTOMOBILE LIABILITY S ANY AUTO COMBINED SINGLE LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) E SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) S NON -OWNED AUTOS . PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: S EXCESSNMBRELLA LIABILITY AGG $ $ OCCUR CLAIMS MADE EACH OCCURRENCE AGGREGATE E S DEDUCTIBLE $ RETENTION E B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY GUWC44068$ 11/07/03 11/07l04 WC STATLL OTH- E ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L EACH ACCIDENT $100 000 E.L. DISEASE - FA EMPLOYE $100,000 If es, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT t500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER „A,,,,�, I ,_ -, Gatewood Homes 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ACURD 25 (2001108) 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 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 AUTHORIZED ACORD CORPORATION 1988 10.11 niA OU67900249 GOLDMAN ASSOC I aO1 s ' A3.I.'.i CERTIFICATE OF LIABILITY INSURANCE in ... �iA:cm 1 17/03 ATE LDtW S ASSCCSATSS IiibiJ WCR rIPD,:7CIA7, SERV2CY3 INC. .. Tlr=CEEMF1CAfE IS Lf 0411P ONLY AND CONFERS NO R]gqHT3 HOLDER THIS CERMFICATEIDOES A5 A fdAt .OF WFOR&tA7j TN - UPON THE CE MpcAT€ NOT AMEND, EXTEND OR 933 FA ACUTa RD. ALTER THECOYERAGEAFFORDED-6Y.THE POUCIE&SO ow .- RYANNis 1SA 02601 Plant SOO-775-6010 Fax! 505-790-0248 pNffiSfRE AFFORMUC &W CE NA,;, ayoullem 1 WaAMR A: COb2SRC8 INSfjkhNCE CO 1D7-AA ° g-ZORZC3.IN Eavrr�c CC?5FRb7Y__ RODNEY TAVANO DBA N=UL7ICAL SSS72M. 110 HOLDER LANE V-SAWSTARLE XX 02669 ?�eR o MA RFR L %.%;v TM PCUCFS OF NMJPA MLWM 9R VV HAY£W94C =70 nM0=FFD WAM A90VE FOR VK LC= PERIm VVOCATEn. ANY RICUNEwm. TE MCR CONOffMOFAMfCMPA.•TOROTNEROCURSWWOTV RESPEcT7OVrtfQ4nMCFRWCATEMAY MIRPfRTAKTW-CCfXiM=AR;OFt=6YTMFV-iC=CCSCMBWHU NSSt,B=TTOAlLTMTBMB8 ESR1S AAMO POLICIES. AGO MOATE LaffM SOWN yYM►YF MEN FtEDUCMffr PA®CLAW ANO?c SSUEDOR OFSJCN LTA TWU Cf CvCaAS9 VeZL"T ACI®SpA bl �1E Lpm A oENF3t•LWLBfliT X cowwEFmxmL a CLAW4wm%a=m IM8172 11/21/03 11/21/04 -Wo OCaIRRENCE s 1000000 _ "T 350000 EXPYt N i5000 oWL•Awrass y- s 5000000 x7oieEa,LTE Y 2aaaaav- GPRtAGGRErATE LnsTAPFUW FM J'p-1OY � LGC -00MAO9AG0 12000000 £LYE'TrY •AN1-AUTO ALLowNfn"Hm rw�nAvroo NYw ao.mArras C&MAAnCr!^ NMW4MEUWr - $ a YPiLJtY r r do . �o s s �aT1A11AnE ""I"CUAMM ANYNJTO. A4ffoa&Y-EAAOCmwr S fiY1rf E'AAGC ONLY: AW f i wcc�Laa�aw uA6rdiY O xw 0aAMS wOE DE CMF S T2 S I S 8 TVRS M C'O;VM%%Ar--%rya VskaTOWLWMUTY ;� ARr?dCPjCT.CUlVF- °FFrXxrXEb0FRExtuCCDt cAL�bmim. 17279AS4903 05/03/03 05/03/04 TORY nears s'R ELEACHAP=Exr $100000 t tsisaASE_eAEx�enYr� s 100000 cW.PZE-POUOYLwr 5500000 aJoeER O6?l:PJnONOf OP':R•TpePiJLOCdL71qRf'VE)�"^JEYGil7li71i •pp®6�/@IC'alap@(rA MPFCW pokligidR F_LLC nw (� .. SN0=AW0FTWA8OIIR PoLrAmOC ��w•��mFrsesr 0ATETFOMM. THE MUS0 RMURER OOFA ORTOUM 20 aATsWW M C3►1'?P30rD E0M3 LEEC wLTcemTe� mTef u�reurfauroaoaysw�tt PAX 508-778-560361DOH1°'L�� ANri°cLsvwTe��e+�JtrtsAGENtsat 1600 FAL)v O ROAD- A71VEZ CENTFIMLLS MA 02632 • - ' ACORQ;, CERTIFICATE OL.IABLUTY INSURANCE ` rRooucER THIS CERTIFICATE IS ISSU " • JOAO-M OIAS- `�� 672 2997 ONLY AND CONFERS NO OCAS INSURANCE HOLDER: THtS CER-FiF443W 535 13RAYTON AVE ALTER THE COVERAGE AF FALL RIVER. MA 02721 _ __ INSURERS AFFORDING COVE asuREa a1SURERA: GRANITE STATE fN: JOEL JJAFERCONSEIRA MUDEACTION r1suRER e: NAUTIEUS tUSVRAR i PBA EJJA CONS 1 rtLiCTION 50 PICKERING ST. APT 17 Flsl/RERC; FALL RIVER, MA 02720 �INSUREROI 1I INSURER E• COVERAGES DATE imMmon'Yn 0=8=03 CAT7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD INDICATE 7, NOTWITHSTANDtNG Aro:.REOWREMENT, TERM OR CONDITION OR ANY CCNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES OESCRIBEO7iEREW-OSUBJEBT TO ALL. THSTERMS, FXCLUSjCNS.ANO.CONDITt2NS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCCO BY PAID CLAIMS, TR oo• RNCE P.OLNS'NVMBER PO EFFECTNC POUCYEAPIRATION 1pMIrs GENERAL UABRITT ORCUPI!M ' X MMERCwLOtWfA LVAeRm NC27580E 0626/2003 06/2612004cDCIAIA$AUD6 AACH 5CC w10000,0O0O0 F-IOCCUR I Sto—oO- P0MONALSAUv IN2uRY 13 1,000,000 GENI7T/LrmOGREGAT& S- Z,000.000_ Ii ---- f.61YLACGREGATEUMITAPPLIESPER: PRODUCTS.00Nw,pP C ,f 2000000 POLICY PRO' LOC AUTOM00lE LIABiLtiY µY AUTO � � COMawm GNCL6 t:uT fEP aeeiaanq f I ' J ALLOMEDAUT05 SCHEBIILEDAVrOS UODArIauUNr (PbIHMTpIt I= •—' I � HMO AUTOS wNE NON,OOAINTOS --_II- 1' (Paraoc.Nm)RY . I = PROPERTY OAMAGE ^— --- tPw aa;�— II I GARAGE LIABRITY AUTOONLY169ACCNDEHT 1• ANY AUTO ( t OTNERTHM cc AUTOONLY: -- NO(C£SSNUM6RCLLA LIA;NIJTY EACHOCCUTRENCE J OCCUR ED CLAIMS MADE r AGGREGATE I S _ -�I- OEDUCT78LE _ -- S I RETENTION S .. --�' f VVOAND AL�M EMPLO EAVI.LPENB.LTION lwwTr WC 49 '48 8S' tt/0$/03 1i108J04 p EL EACNACC7091T S %D0.000 ANY9lQO"I 6�CCLCLUOE ^RLTIVE IOFnCLPMELN 4L. fNGCAS6 •N;,l [NPL:ir6E f f�00D,�D�� ryyrp�T,, EeafYfDA Vndrr SPECIA{,PAOVISN)NAMIoi CL OIWAW! POCIC7L Wt t 1•tIYIFYWV- OTHER DESCRIPTION OPOPCRRTXM N LOCATIONS! VEHIGLUN EXCL UEMNIAOD@QY POORSCMEIYT ISPECZAL PROV190NS T:FBTIAICATC UnI ncn GATEWOOD HOMES 1500 FALMOUTH RD. CENTER VILLE. MA 02632 SHOULD ANY OF THE ABOVE ORSCAUM PGNg,A EC CAYCEjX7NFGIWTHE VU` kAON- DATE TNEREOF, THE ISSUING MSU.RER WILL ENOCAVOR TO MAR 10 OATS WRITTEN MOTICKT?THE"CERrwcATE'HOI:DGrI•NAMED TO THE LEFT, IIITI•AGOat, To nn_ —10 3wy_ TAP03E NO OBLIGATION OR LumLITV Of ANY NINO UPON THE MUREN, " AGENTS OR 1 t>Vd 564 7272 P.01i01 CONFERS nna ..cn� r,...�.c Was Nwa AMCNU. MEND OR RIDER. RISK SPECIALISTS JA tH€ covAGs araNnEn i3v THE Foucics eslow. INSURANCE AGENCY, INC. COMPANIES AFFORDING COVERAGE P.O-BOX 115 CATAUMET, MA 02534-0115 US LIABILITY INSURANCS COMPANY MONUMENT INSULATION, INC.AMERICAN HOME INSURANCE COMPANY223 COUNTY ROAD BOURNE, MA 02532 ANY �1� „:. to ,. +...+•-+r�.M a.,-.w.�r�._(y.r Lyµ �w .'.: t. ...'.rJ�`''"v._rww.e� ,'n ^.-, is ,,. N,2. r.:_V ;-..:-' ., csw...! - +5«x. >.. - 'i. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERTOQ' 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lin TYPEof UNBURANCE POLICY NDMBER POL/CY2T14CTNE POU4/.�WIRAT" Ua nATE (MUUMUU/ I DATE QIOUDDIYIT A ERAL a 1eanc-®OCCUR .M CMNSsACONTRACTORSPROT CLI135745 I 8/23/03 8/23/04 PFCM=M.COMP10PAGG s500 000 PERSCNALAAIMNAM s500 000 EACH OOCURRENCE S500 000 FIRE OAMADE(Am o my $50 000 MIME)IP aAabonon)' $5 1000 AMNOBILE UAMLnY ANY AUTO ALLCWN»AUMS SCHEDULED AU bS MIREO AUTC$ NON-OWNTDAVICS COMBINED SINGLE UAY S IPPWpffmsJ mJa+ s BOOILY"-xa — s PROPERTY OAMAGI: 3 OAP-�D� IlABILUTY Y.. AUTO ONLr• EA AC=ENT 3 UMBPEUA FC(�A y On eR THAN UMBRELLA FC wow -cm mumm9Anow AND 02PLOYEW Liamuny g me PROPRIETOW n PARTNER%EMZ M%M FH====11 *=IWC 782 61 72 GATEWOOD HOMES,INC 1600 FALMOUTH ROAD 125 CENTERVILLE, MA 02632 508 778-5603 9/5/03 19/5/04 END= ANY OF THE AIM DP.ECfaBED PCUCUES BE CMC.EUJM BBYORE THE C04PMION DATE THFAEOP, THE M=NG COYPABY WILL DIDEAwN To ma- 10 DAPS WRITTEN NOTICE To THE CENMnCATE HOLDER NAMVM WCIfTTT', BUT PAIUIRE rD MA0. . NOTICE SHAM - yIMU�. BO OBUOATM OB UABUUTY OFy�NA::g1{C,r::UPO1fr THE CO Qlr.r�Ot71~14 OR REPHPSi mmA TOTAL P.01 ...�-vo v4: 14H r . U l ACDM- CERTIFICAT E OF LIABILITY INSURANCE DATE ILMMUffY) PRODUCER THIS Cc7TIFICAT'F IS ISSUED AS A MATTER OF INFORMATION Z&ghee. Znsuraace Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE.. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749. Main Street, Suite#A ALTER THE COVERAGE AFFORDED BY THE POLICIES IBELOW. Deterville, ma. 02655 506-A20-9013 INSURERS AFFORDING COVERAGE INSURED Casperson. OVarhead Doors INSURER _. BAA7Y �euAYcliii w d CO • . INSURER !i Box 517 IN SVREIi a East Falmouth, MA 02536 INSURER D,. INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO INDICATED. NOTWITHSFANBING. ANY REOVIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY W ISSUED iN MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. ISR T TYPE OF INSURANCE POLICY NUMBER PAT= uEFFECTNE PO CY E1. PIRA ION LSMTB -- GCNEAAL LIABILITY EACH occuggEFJCE f COMMERCLV. GENERAL IOCCUR ^^^^^FIRC DAMAGf.. (AmI DM af*1 ES�e000CLAMS MADE MEN E AL(AI AGGREGATE TE S JL "PP48352 05/28/03 05/28/04 PLRSONAL&AOVPLIURY s 000 OEN'L AGGREDAIE UMU NTLFES PER GENERAL AGGREGATE E T A O .O.D3L.. A )NOBLE LIABILITY ANY AU+O ALL OWNED AUTOS WACO AUTOS GARAGE LIABILITY OCCUR CLAPAS MADE Ot000TgLc R€TFxLIOeL F__ WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTHER Gateway YomeJs 1600 FaSawutri AbaM% suite 25X Centerville, MA 02632 778 5603 ACORD 25-S (7197) AGO I $I 0Q0,00^ WMBINED SINGLE LIMIT (EA lQWV) SODLY INAIRY {PN DNsaI) F BODILY INJURY S (PN.e6ESM) (PN iDCIGIrt)�-� S AUTO ONLY. EA ACCIDCNT S DIP A49Aµ_ . EA ACC s AUTOONLY; AOO E F.ACH OCCURRENCE S 02/22/03. L02/32/04 ELE61AIQ CMENT� E-L DISEASE• EA EMPLOYE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 14 _ DAYS WRITTEN NOi1EET$-Tf1F0EpTFp{µTyJ10LDERJuuan ... IMPOSE NO OBLIGATION �—�LTO'p0 SO SkpLL . TION OR LIABKJTY OF ANY KIND UPON THE INSUREIL ITS AGENTS OR Taea ACRD, CERTIFICATE OF LIABILITY INSURANCE I DATE(M 3D�) 07/181 IWODUCER • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ,L 4lowyng & O'Neil Insurance' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED Busy Bee, Inc.INSURER A: Hanover Ins. Company . INSURER S: Safety Insurance Company . P.O. Ban . INSURERc: Associated Employers Insurance Compa East Sandwich, ich, MA 02537 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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDIYYI POLICY EXPIRATION DATE 4MMtDDIYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X PD Ded:250 OHN643998501 - 06/14/03 06/14/04 EACH OCCURRENCE $1000000 DAMAGE TO RENTED PREMISES (Ea acnim ei $300 OOO MED EXP (Any we person) - $1$ O00 PERSONAL& ADV INJURY 51 OOO OOO GENERAL AGGREGATE s21000.000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $Z 000 000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS 3175394 01/14/03 "' 01/14/04 - COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Pa Persw) $10Q 000 r X X POeracdden)DILY � S300,000 X PROPERTY DAMAGE '(Per accident) $100,000 ' GARAGE LIABILITY ANY AUTO ' " ` ' AUTO ONLY • EA ACCIDENT s ' OTHER THAN - EA ACC AUTOONLY: AGG s S EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE -DEDUCTIBLE ' RETENTION s EACH OCCURRENCE - $ AGGREGATE s ' S s s. C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WCC5002932012003 06/27/03 06/27/04 OTH- WC ORY I LIMITS] E.L. EACH ACCIDENT $100,000 E.L DISEASE - EA EMPLOYE1 $100 000 E.L. DISEASE -POLICY LIMIT s5OO,000 OTHER 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. i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Gatewood Homes DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In 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 - KjS © ACORD CORPORATION 1988 ` CERTIFICATE OF. ISE K r t PJODUCER Passaro Leverone & Buckley Insurance Agency Inc P 0 Box 160 Dennisport, MA 02639 INSURED Patrick K Orcutt 6a P & S Concrete 37 Ladys Slipper Lane Mashpee, MA 02649 NO RIGHTS UPON Paa.nic: 11VLUJ;R. THIS THE COVERAGE AFFOF COMPANIES AFFORDING COVERAGE A A.I.M. Mutual Insurance Co THE ilifSNDI IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMBD ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY O ISSUED O MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXMATIO DATE(MM/DD/YY) DAT'E(MM/DD/YY) LIMITS LIABILITY AMERCUL GENERAL LIABILITY ENERAL AGGREGATE S DCLAIMS MADEEC PRODUCTS-COMP/OP AGG. S VER'S &CONTRACTOR'S PROT. PERSONAL&ADV. INJURY S ' EACH OCCURRENCE $ RE DAMAGE (Any one Pm) S LE LIABILITY MED. EXPENSE (Any cm Pon) ers S I AUTO COMBINED SINGLE LIMIT S OWNED AUTOS :DULED AUTOS BODRY INJURY Pe son) S D AUTOS OWNEIiAUTOS BODILY INJURY accident) S 10E LIABILITY PROPERTY DAMAGE S CESS LIABILITY MBRELLA FORM CH OCCURRENCE $ CGRECATE S THAN UMBRELLA FORM WORKER'S COMPENSATION AND WCSTATU- EMPLOYERS' LIABILITY X OTH- `� THE PROPRIETOR/ 6006181017A03 I 1021/200; 1021200A _ S PARTNERS/EXECLMVE INCL �O,F.�FICnERS ARE: FXCL EL DSSEASE—POLE LIMIT S IV' I EL DISEASE —EA EMPI OYM S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPBtATION 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 GatewoodS Homes LIABILITY OF ANY KIND UPON THE COMPANY. 1TS AGENTS OR 1600 Falmouth Road REPRESENTATIVES. Centerville, MA 02632 AUTAORIZED REPRESENTATIVE �� 0 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) 21.106 Street 121 CAMP ST #6 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 Building Site Location: Proposed Improvement: Applicant: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET No: 'IV Lot No. o'/-/ e Address: 1600 Vu >>ctfl �1 fti( 75 >>�G� Tel -No.: %%k y?6 `1 Date Filed: 8 U 4�Z'2a The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. 4 RESIDENTIAL AND/OR COMMERCIAL BUILDING 1 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: 3/ ' % 0 N/A V'2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: V . HEALTH DEPARTMENT. DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMM 5. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: , 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: White copy - Building Dept - Pink oopy - Water Dept - Yellow Copy - Health Dept. - Pink Copy - Engrg Dept - Goldenrod - Fie DepUCorecvz iw 63.34 N ao•4T49" E ,•� '— LOT 5 67.57 3,605 ±S.F. \ /26 /. N � cf! LOT 6 OSE 4,705 ±S.F. \ 8 w. r P HpUSE 2 (EGRET Z ' 1-0 0-. �� SEO a6 \O 26.. 6• f , ' \ , PRpQo o�Eii 2 L=5.41' ry� \.'1rL1 aJ <1 G SOP Q4P- GRAPHIC SCALE NOTE: ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 1OFT. OF WATER MAIN. \ NOTICE I -r L' D Unless and until such time as the ongin re I stamp of the responsible Professional Edlneer, or Professional Land Surveyor g appears on this plan: I I f .; ', .� l (A) no person or] peramas � inducting` anynmunicipal � other ( IN FEET) public officials, may rely upon the Information contained+herein; and (B) this plan remalne-the property_of-iolmeM& McGrath, Inc. 1 inch = 20 ft j h DePt. I PLOT_ PLAN holmes and mcgrath inc. OF LOT 6 PREPARED FOR civil engineers and land surveyors Tr,orwr, 1 362 gifford street MILL POND VILLAGE fa i� IN falmouth, ma. 02540 ti YARMOUTH, MA JOB No: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 1-22-03 DWG. NO.: A2505 CHECKED: -.rAZs "4 091 I TOWN OF YARMOUTH o{ y BUILDING DEPARTMENT "-«K°•5 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: Proposed Improvement: Address: The Builc applicable departments. C 4()1V ManNo: yy Lot No: a1' 1 C,,, 778' 9G4 9 %7? 9610 Date Filed: 8 U your plans and or application to the following 4 RESIDENTIAL AND/OR COMMERCIAL BUT DING 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: V'2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: y�� 4. HEALTHDEPARTMENT: /wa ii�p� ,�j,d� J4Z-17 DATE: 1-L`O 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: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Weft copy - Buddmg Dept - Pick copy - WaWDM, - YetlowCopy - HeaM DTL - P& Copy -En gDVL - GoMenrod-Fire Damon �ti MERIT PLUS ew 2 l �"Y 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. III!!'! 0!lM �R01, MPD4540 MPD4035 Standard Features • Louvered face design • Charred split oak gas log set Is Deluxe pan burner for big yellow flames and glowing embers • Charcoal black exterior powder coat finish • Realistic brickaded interior panels Is Combo top/rear direct -vent outlets (except 3328 models, which have either a top or rear outlet) • Hi/Lo flame operation Is Pre -wired for wall switch Options Is 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) Is Wireless remote controls • Blower kits (including a temperature control version) Is 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/7.5" 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) Warnock Hersey C ■—�T US uu," usw 785078M Nv2 09/03 0t Hersh RoducMM The first two model number digits indicate frame width, the last two digits indicate glass width. IAll are A.F.U.E: rated high efficiency vented gas fireplace heaters, certified tmder ANSI Z21.88 and CSA 2.33-M99. MPD3530 MPD3328 DIMENSIONS (Rear vent model shown) 3328 MODELS (This model comes as a top or rear vent o Inly) Front Face Top 35,40 & 45 MODELS (These models come with a top D14 1 avr ! E Front Face To FIREPLACE & FRAMING DIMENSIONS rear vent) Right Side �m 3328 331/8 301/8 17 27A 33Y8 193/8 21Y2 103/4 33Y4 33Y4 13 3530 351/8 321/8 19 291/2 351/8 211A6 2478 1 %% 351/4 35Y4 16 4035 401/8 37Y8 24 341/2 401/8 2611/16 297s 1 uh6 401/4 401/4 16 4540 401/8 37Y8 24 39Y2 451/8 261A6 34N 1�16 45Y4 40Y4 16 332ET 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 Canatral Look for the EnerGuide Gas Fireplace Energy Efficiency Hating In this brochure Booed RR csa vataz Visit us at wwvvL.ennod-I earthProducts.com TYPICAL ROOM APPLICATIONS VERTICAL = A A IiiqM111F ililihIIIlp-r MAScheck 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 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 I I I I Permit # I I I I I Checked by/Date.) I I Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA -------------------------------------------------------------- CEILINGS 823 30.0 30.0 14 70 WALLS: wood Frame, 16" O.C. 1588 15.0 15.0 0.340 33 GLAZING: windows or Doors 97 40 0.340 14 GLAZING: Windows or Doors 20 0.086 2 DOORS ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is calculations consistent with the building plans, specifications, and other the application. The proposed building has been submitted with permit designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, found has been determined using the applicable standard Design Conditions equipment selected to heat or cool the building in the Code. The HVAC shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. Builder/Designer Da 0 V u APR/213 2004 DEPT. Massachusetts Energy code MAscheck Software version 2.01 Release 2 The Plover DATE: 4-21-2004 Bldg.l Dept.l use I I CEILINGS: [ ] I 1. R-30 + R-30 Comments/LOcati I WALLS: [ ] I 1. wood Frame, 16" Comments/Locati I o.c., R-15 + R-15 WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.34 For windows without labeled u-values, describal eafeatures: C ] No # Panes Frame Type Comments/Location [ ] I 2. u-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? C ] Yes C ] No comments/Locatio DOORS: [ ] I 1. U-value: 0.086 comments/Location AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building i envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I. 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 I marked on the building plans or specifications. I I • EFFICIENCY • • • • RATING CERTIFIED i LiTI __ Gama k CIV 1; Air Conditioning & Nesting tsTe< <,STEo � 92.6% AFUE MULTI -POSITION CONDENSING GAS FURNACE GMNT SERIES Wedsal �ti�m ��: A �G�va�"9 tiEi1M� �R�7: 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., LP., 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.goodmanmfg.com I 5 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 80,000 73,500 73,000 73,000 926 35-65 100-4 100,000 92,000 92,000 85,000 92.6 40-70 120-5 120,000 1 110,000 1 111,000 1 102,000 92.6 40-70 BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA AVAILABLE FROM YOUR RETAILER. SPECIFICATION DATA tIeC�el cn Number --Mato W W " w Blower Vent' Dia. vCombustion* Air Filter Size In Perm. / Disp. Electrical I Ship Weight HP Spd. Dia. Width FLA e 040 3 1/3 3 10 6 2' 7 290 / 580 5.2 15 180 O60 3 1/3 3 10 6 7 7 290 / 580 52 15 10 O80 4 1/23 10 8 3' 3' 385 / 770 7.8 15 205 100-4 1205 12 314 3 3 10 11 10 10 3' 3' 1 3' 1 3' 385 / 770 1 480 / 960 .. " lN.....b 7.8 92 ...a4. 15 15 ;ne+n, r4inne 225 265 which `Note: Vent ana Comm5wii all ulaluma.a...oy --y accompany the furnace. 28" A 55"8 3-t98.. 6" �B� � 4 . 47 8 fE — 4".1 4 i �COMB.ARNLET28 dH - GAS INLET 51 ., 4 VENT O O � 27.. LOW VOLTAGE 4' ELEC. to-" 18" Model GMNT A B Combustible Floor Base 040-3 & 06" 14' 22'/z SBM14 080.4 17'/: 16' SBM17 100r4 21' 19 V.-SBM21 120-5 24 Y, 23" SBM24 SS-312D M COMB. AIR INLET GASINLET VENT LOW VOLTAGE ELEC. w. r A M A nee• tnflllil f•nu121100TIRI r Ulk-17FRIe1 S Sides I Rear Front* Vent Top 1' 1 a, 3. 0. 1. Approve(] Tor line cumau Ill LIM llUl1LVIaai Nva.a.vl.. •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 Y:" 21" 24 W Coil Model Number Coil Width U-18 14" x U-29 14" x U-30 17 Yi x (1) x (2) U-31 14" x U-32 17Yi X(1) X(2) U-35 14' X U-36 17'W X(1) X(2) U-42 171/2" X(1) X(2) U-47 171/2" X U-49 21" X (1) X(2) U-59 21" X (1) X(2) U-60 24 '/{ X(7) X(2) U-61 24 Y:' 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 1 1130 1080 1 1035 975 925 880 LOW 910 895 885 855 835 790 750 700 GMNT HI 1865 1800 1735 1660 1590 1510 1415 1320 080-4 MED 1690 1645 1600 1545 1485 1410 1345 1245 LOW 1450 1400 1390 1360 1325 1270 1200 1125 HI 2010 1945 1 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 2045 1945 1850 GMNT 120-5 MED 1815 1750 1710 1660 1600 1545 1480 1415 LOW 1275 1 1215 1 1190 1145 1110 1055 985 925 Values indicated by shaded areas represent airflows that are too low for heating temperature rise. SS-312D 3 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. Thats why we know... There's No Better Quality. Visit our web site at www.eoodmanmfe.com for information on: • Goodman products • Warranties • Customer Services • Parts • Contractor Programs and Training • Financing Options SS-312D 4 L=5.4 N g0'47'49" E LOT 6 4,705 ±S.F. �iS. o� QRooCIsE 1 N lP�o��Zo G .r 7 i OC G Sip ,,---63.34 LOT 5 3,605 ±S.F. G? / y A T ii ( Z3 POPROHODS EG a , O GW µ1N- I LNG No EE BEV AFFOP' NOTE. SEWER LATERAL SHALL BE a SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN GRAPHIC SCALE LOFT. 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 ar persons, including any municipal or other ( IN FEET) public afficiale may rely upon the Inform contained hereto; and i inch = zo it REVISED: 3-8-04 (8) this plan remains the property of Holmes & McGrath. Inc. 0O LOTA6 holmes and mcgrath, inc. a��P�1N OF M4SSgOs PREPARED FOR civil engineers and land surveyors Z TIMOTHYM. G� 362 gifford street sANTos MILL POND VILLAGE No. 450713 IN falmouth, ma. 02540 9 c1VIL�a o,�• YARMOUTH MA FGrSTEe FSs, JOB NO: 201197 DRAWN: LMC otu E SCALE: 1 "=20' DATE: 1-22-03 DWG. NO.: A2505 CHECKED: -firms B N 80•47' 49 LOT 6 4,705 ±S.F. GRAPHIC SCALE ( IN FEET ) I inch = 20 M ------`63.34 LOT 5 3.605 ±S.F. SEE 5�-Q SOW NOTE: �U ® SEWER LATERAL SLEEVED IN ACCO AN 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 officials, may rely upon the Information contained herein; and (B) this plan remains the property of Holmes & McGrath, Inc. PLOT PLAN holmes and mcgrath, inc. OF LOT 6 civil engineers and land surveyors Zz s� PREPARED FOR TISA T O M. 362 gifford street a o saNrs F MILL POND VILLAGE 0 No 45078 v IN falmouth, ma. 02540 q 9 CIVIL o 7 a YARMOUTH, MA �.�°SSG ST JOB N0: 201197 DRAWN: LMC SCALE: 1 "=20' DATE: 1-22-03 DWG. NO.: A2505 CHECKED: ;rA.13 , IiE- PROPERTY ADDRESS, Awl .-ALCULATION FOR PERMIT COST TYPE, OF RO(A goo - 290-16 ADDITION wiE9P ALTERATIONs KATH BED ROOM �Fo CERTIFICATE OC FA MILY FIREPLACE FOUNDATION ONLY GARAGE NO.OF BA GREAT ROOM KITCHEN OFFICE PORCH CLOS PORCH OPEN REROOFING SHED SUN SUN ROOM t4EAT SUN ROOM UME SWWAVAG POOL SWIMMING POOL gril 4a ` ` � } < K : �� \\\�� }7 <� i � �� - : � <» �ry<\ � � � \ � \ � i . � � � \ . � \�� \/� � � G :� . :� , % z � \\� : .� � � \ � »»©:.� : .,��. � «\ \§�: �� /21tA � ��,>< ,/\�\ �` . . \ : | � � . \ < \� ! ° \� � \ �.. .\ � \ � | \� .� � � : `�� }\ � � � . ��.. a. /\\/ ��\� »� .Z \ oil mi 7 TIME CALL TAKEN BY PHONE CALL DATE APhR M T Y NAME PHONE ` ADDRESS REMARKS CALL GIVEN TO � SERVIC ANTEO ROUTE