HomeMy WebLinkAbout121 Camp St #009 Building PermitsTOWN OF YA.RMC;JTH Building Department
(508) 398-2231 ext.261
PERMIT NO 6-OS-1524.
ISSUE DATE 6/27/2005 . ; PROPOSED USE
APPLICANT _Frank Capra
BUILDING
PERMIT
JOB WEATHER CARD
OCGAAIT TA ' Now CnnStrtIDtion
AT (LOCATION) 00121CAMP ST Unit 9 ZONING DISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C9 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R•4
LOT SIZE
new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 05/31/05.
REMARKS
AREA (SQ FT) EST COST ($ I$141,600.00 PERMIT FEE ($) 1$51s.UU
OWNER I Villages 0 Campt St., LLC BUILDING DEFT BY
ADDRESS 11600 Falmouth Road # 25 /(
Centerville I MA 102632 1Lam%
CONTRACTOR
LICENSE 012430
Capra, Frank
1600 Falmouth Road #25
MA 02632
Certificate Issue Date %%LQ sz3 a v u CERTIFICATE of OCCUPANCY
Departmental Approval for Certificate of Occupancy and Compliance
Insnector Date Permit Number Approved By Remarks
ELECTRIqw®�1
ram= .
W OWN
Pe �1112
r -
To be filled in by each division indicated hereon upon completion of its final Inspection.
L
I
INSPECTION RECORD
FIELD COPY
Date
Note Progress - Corrections and Remarks
Inspector
?
m 7
Cipro, Linda
From: Raiskio, Peter
Sent: Wednesday, March 22, 20063:26'PM
To: Cipro, Linda
Subject: Units 9+10 Mill Pond Village Camp St
Linda
The Lt. checked the smokes for these units and they are all set.
Thanks
Peter
Peter A Raiskio
Deputy Chief
Yarmouth Fire Department
UNh & 1 WU FAMILY ONLY - 131.1ILUIN(a PLKM1I
;� APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
y ct Town of Yarmouth Building Department
N MATTActlCCi 1146 Route 28 • Yarmouth, MA 02664-4492
Tel: (508) 398-2231 x261 • Fax: (508),398-0836
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. MIRRMM, Use Group: R-4 Type: 5-B
1.1 Property Address:
1.2 Zoning Information:
L.o
Zoning District Proposed Use
1.3 Building Setbacks (ft)
Front Yard
Side Yards Rear Yard
Required
Provided
Required
Provided Required
Provided.
1.4 Water Supply (M.G.L c. 40. S 54)
i '� yr�Wy*�5��7v',
*
Public Private
bZoYY�aotte x�'' a r�x_
.m
NMI- 'wrgpert Owners _ tltonzed�Agi#
21 OvmVt fQ Record:
S - La, // R ; 1
,
N mePintk Mailing Address U4, v pZ
t n M%rna -
Signature Telephone
2.2 uthovrize d Agent: /A I IVnCI1
01 i L/ 0 O C .i
Name,(print) � P a Mailing Address
r= tU4 q-,95-ZZ9
Signature Telephone F r
Se.�ro�t �- Q'-, -tict •,tServxces i , U
3.1 Licensed Construction Sup erviso� ' " •
AY � � �� t u''� �
Not Applicable ❑
ry
i
License Number
1pA(,
BUiLCi" �D-P1. t
3a'
O�
dd)s
77
Expiration Date
V b i6 —0
Signature Telephone
Rs„ C 0,f € prpe_l r veir eni t p t#ra�ta)
Company Name
2 4 2005
Not Applicable
N
License Number
Address
BUILDING D
Expiration Date
Signature Teleph
EN
:�(te--M
9 - 15 - 99 1 of 2 OVER
,Joie
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 ..........
New Construction L+f I No. of Bedrooms I Nn- of Rathrnnms
Existing Bldg. ❑
Repair(s) ❑
Afterations ❑
Addition ❑
Accessory Bldg. El Type
Demolition
Other Specify:
Brief Description of Proposed Work:
04
[ (V.,Rot/ P69 V1 U1.
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 & adcUons)
Q
Check Below
❑ Conservation -Commission Fling
(if applicable)
Q Old flings Highway& Historical
Commission approval
(if applicable)
14�I
as
,,owner of the subject property
hereby authorize 0 a -e L.0'P if
m beh , in all matters elative to work authorized by this building permit Application.
r
Signature of Owner Date
to act on
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.
t l \�i�(r� ��C%eQ r
Print name
Signature of Owner/Agent Date
u
9-15-99 2 of 2
k
1 %-/ w 1N . yr XAKMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
Job Location:_
Owner of Property: V
Construction Supervisor.
Name
Address: � ® O
Licensed Designee:
(If other than Supervisor) Name
2.15 Responsibility of each license holder:
Street Village
PJ� Daly 96�`
r / License No. / 'P%hone No.
ftl,
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 anyother section of these
rules and regulations and any procedures, as amended, shallbe 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 12( No
If you have checked }des, please indicate the type coverage by checking the appropriate box.
A liability insurance policy E Other type of indemnity ❑ Bond
OWNEChapte S.INSUR CE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter of�lass. Genec36Law�and that my signature on this permit application waives this requirement.
Signature:
L,necK one:
Owner_ Agent Q
Building Official Approval:
G
:.�
■
ail6"\
a+e-L,..»,-).A
0
The Commonwealth of Massachusetts
Department of Industrial Accidents
Of/Iceolleves�►pstlsis
600 Washington Street
Boston. Mass. o2111
Workers' Compensation Insurance Affidavit
M
I am a homeowner performing all work myself.
I am a sole proprietor _-,a, ha%e no one working
in any capacity
p 1 am_an employer pro,6idine workers' compensation for my employees working on this job.
n • na
addres
city:
phone a
0
insurance co.
policy is
am a sole proprietor. general contractor. or homeowner (circle onwt Anti hnv^ t,a..a th.,
,..
insuronce co.. n21ie� #
N.
auess.78 - ant bet= -
Failure to secure coverage as required under Section 25A of MGL I52 as lad to the imposition of erimlMal penalties of; One up to S1.SD0 00 and/or
one years' imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a Age of SI00.00 a day against me. I anderstand'that a copy of this statement may be forwarded to the Office of investigations of the DIA for.eoverage verification.
I do.hereby certify under thr pains andnaldcs ofperyury that the information provided above is true and eo .tx
k Signature X �`S
Date
Print name rO—t-I. i\
�aaaaa�l�l��nl _. _ • '!one w �Vr� / �T
oMcial use only do not w rite in this srea to be completed by city or town official
city or town: YARMOM _ permit/licensc p MBuilding Department
check if immediate 'response ❑Ueensing Board
❑ ponse is required 13Seleetmen's Office
contact person: 2ex ❑Health Department
phonel:_ C508) 398�2231 eat. Mother.
TOWN OF YARMOUTH CIN�
1146 ROUTE 28 SOUTH YkRMOU'TH MASSACHUSEM 02664 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`
Work Ad ess
is to be disposed of at the following location: I—. L✓►^� OTC /� , ,e(�j �(%�
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
/dam
Date
Permit No.
cry. �oo riswnweal!/� o � aawrivaalCtr
BOARD OF., BUILDING -REGULATIONS
'3 License;. CONSERU.CTIOtI3UPERMSOR.
Numbe�;6S. 012A30 .
Binffda eg,� -Xff— %94Q
Exlxret2bO6Tr: no 25926
� s .
Restnct�� „-
FRANK.G:.CAPRA�
,
40:COPPERLN'
CENTEMALLE, MA .C'163:i;'
Commissioner
00 - 35;000 d enclosed•space c
(MGL C-M.SmL)
1A- Masonry..-onlg
t•G'= 4 kzFainit Homes
Failure to�possess:a-curiBMedNon o[ihe
Massachusetts' SMte:Building.t',cde, -
} iscause forrevocaEortofthisrGcense.
DIG SAFE:CALL.CENTER: 1888) 344-7133
05105/2005 IC 09 508-760-1_667 EASTERN-INS-YARMOUTH PAGE 01
w A CE
TIFICATE OF LIABILITY INSURANCE
°&Vos/zoo '
PRODUCER. 508-398_6033
Eastern Insurance Group
1. Atlantic Ave
So Yarmouth NA 02664
FAX 508-760-1667
LLC
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS -UPON THE CERTIFICATE -
KOL.DER.THIS-CERTIFICATE DOES NOTAMEND.EXTEND-OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS -AFFORDING -COVERAGE
NAIC li.
INSURED Cape. Coal Custom
762 Falmouth Rod
Hyannis MA 0260
..
Floors
.
INSVRERA: Ac ella. Protection Ins Company
INSuKwB-Hartford-
INSURER C: -
TJBVRER V._ -
ILSUREFLE-
THE POLICIES OPINSURANC
ANY REQUIREMENT. TERM OF
MAY PERTAIN, THE INSURANC
POLICIES, AGGREGATE LIMIT
, LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INDICATED: NOTWITHSTANDIN
CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIACATE MAY-Rr- MIR rcn na
EE AFFORDED BY THE POLICIESUESCREED HEREIN ISSUBJECT707ALL TPeTERMS EXCLUSIONS ikND-CONDITIONS OFSUBI+
SHOWN MAY HAVE BEEN REDUCED -BY PAIR CLAIMS:. ...
INSR
DO'
.TYPE OF INSURWTY
E - ...
POLICY NUMBER- - ..
V EFFECTIVE
-DATE ....
POLICY EXPIRATION
-
.... LIMITS
_
A
GENERAL LIAB..
)( COMMERCIALGENEF
CLAIMS MADE
LIABILITY
X_ OCCUR
7S00000371
i2113/201114
_ _.
12/13/2005
..
. _ .
_EACHOCCURRENCE
S. 1,000,000
DAMAGE TO RENTED
S - SO,QD
MED E%P (Arry arw-pelTpn)
_S_ - S , OO
PERSONAL,& AGV INJURY
S 1 r 000, 0
GENERALAGGREGATE- _
i 2,000,00(
GENLAGGREGATELIMIT
X POLICY M
PPLIESPER.
_ LOC
PRODUCTS -COMPIOPAGG
S 2 .oO0,00
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCNSDULNO AUTOS
HIRED AUTOS
NON -OWNED AUTOS
-
....
..
'
-
COMBINED SINGLE LIMIT
(Es PepOeeO
_
BODILY INJURY
IPupenp°)
BODILY INJURY
A
PROPERTYDAMAGE
(Perem0a4)
S .
GARAGE LIABILITY
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AUTO ONLY -EAACCIDENT
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OTHER THAN EA ACC
AUTO ONLY!.. AGG.
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10, 00
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12/13/ZO05-
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S. 1 1" 000 i
AGGREGATE
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WORKERSCOMPERSATION A
EMPLOYERS' LIABRJTY
ANY PROPRIETORPARTNEWEX
OFRCERIMEL/BEREXCLUDEO'1
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SQ LPROVISIONSEeIow
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OTHER ...
BEICRIPTIONOFOPrRATMMSILOC
denceof Insurance
TIONS I VEMICLESIEXCWSION ADDED BY ENODRSEMENTJ SPECIAL PROVSIONS
GateWOOd H¢mES �.
1600 Falmouth #25
Centerville, -02632-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATIONDATE JNERffOF, THEISS,UING INSURER WIILLEN°EAllONTO MAIL
-10- DAYs WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUJ FAILURE TO MAIL SUCnNOTICF SHALL IMPOSE NO OBLIGATIOMORLIABILLTY
ACORD 2S (2001f0Hy FAX: ,(509>778-5603-- OACORD CORPORATION less
-;J-A Client#• 18434
2ASSURANCECO
A ORDr. CERTIFICATE OF LIABILITY
INSURANCE 1o04104 YY"
PRCOUCER _
Dowling 8: O'Neil Insurance
Agency, Inc.
9 yr
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.
222 West Main St. PO Box 1990
Hyannis, MA 02601
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A.- Travelers Insurance Company
Assurance Construction, Inc.
A/O Assurance Excavation, Inc.
550 Willow .Street
West Yarmouth, MA 02673
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lNb
LTR
WU
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE DATE
rfn
POLICY
DATE EXPIRATION
SOS
A
GENERAL LIABILITY
16808387A9841ND04
08/01/04
08/01/05
EACH OCCURRENCE
$1000000
X. COMMERCIAL GENERAL LIABILITY
-
DAMAGE TO RENTED
S300OOO
CLAIMS MADE Q OCCUR
MED EXP (Any one person)
S$ OOO
PERSONAL B ADV INJURY
$1 00O OOO
GENERAL AGGREGATE
52 OOO 000
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS -COMPIOP AGG
52000000
POLICY PRO-
JECT LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per parson)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
-
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
S
AUTO ONLY: AGO
ENCESSIUMBRELLA
LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
$
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION ANDLIMITS
WC STATU- Ohl -
EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNERIEXECUTIVE
-
E.L. EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOYEE
$
OFFICERIMEMBER EXCLUDED?
n yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
S
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.
Gatewood Homes, Inc.
Attn: Paula
1600 Falmouth Road, Suite 25
Centerville, MA 02632
ACORD 25 (2001/08)1 of 2 #35866
LID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1D._ DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
LS1 O ACORD CORPORATION 1988
.'�i1�ii. CERTIFIC�4TE
OF 11�ISURANCE
DaTE (�e�DD�YIp
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...: .. ...
::
.. .;: .:;: .? _ -05
PRODUCER '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
DOWLING & 0 NEIL INS AGC
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
222 WEST MAIN STREET
ALOTER THE COVERAGEAF ORDED BY THE POLICIES BEELOW OR
PO BOX 1990
HYANNIS MA 02GOI
COMPANIES AFFORDING COVERAGE
22LGR
NY
ST. PAUL FIRE AND MARINE INSURANCE COMPANY
INSURED
NYHP
BUISNESS SERVICES INC ASS U, a-hC¢
LDI'ISl118
fA
WATERHOUSE RD
SUITE E ',n�
BOURNE MA 02532 UIl� JUtFae
(1
NY
COMPANY
D
COVERAflES
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN
MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
CO
LTA
TYPE OF INSURANCE
POLICY NUMBER
POUCY EFFECTIVE
POLICY EXPIRATION
DATE (MM1DMYY)
DATE (MM OMYY)
LIMITS
GENERAL LIABILITY
REGATE
$
COMMERCIAL GENERAL LIABILITY
MADE71OCCUR.
OMP/OP AGG.
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& CONTRACTOR'S PROT.
RENCE
min
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$E
AUTOMOBILE
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S
ANY AUTO
COMBINED SINGLE
$
LIMIT-
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per Person)
$
HIRED AUTOS
NON -OWNED AUTOS
-
BODILY INJURY
$
(Per Accident)
PROPERTY DAMAGE
$
GARAGE
LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE Is
UMBRELLA FORM -
AGGREGATE Is
OTHER THAN UMBRELLA FORM
A
WORKER'S COMPENSATION AND
EMPLOYER'S LIABILITY (UB-4042B37-2-04)
12-24-04
12-24-05
STATUTORY LIMITS
THE PROPRIETOR,
X
INCL
EACH ACCIDENT
$ 100 000
PARTNER
OFFICERS ARE
EXCL
DISEASE -POLICY LIMIT$
500,000
OTHER
DISEASE -EACH EMPLOYEE $ 100, 000
DESCRIPTION
OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL
ITEMS
COVERAGE RESTRICTED TO LEASED EMPLOYEES
OF ASSURANCE EXCAVATION INC
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED
TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER
CAFlCELLATiN
GATEWOOD. HOMES.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
ATTN: PAULA
EXPIRATION DATE THEREOF, THE I SSUING COMPANY WILL ENDEAVOR TO MAIL
1600 FALMOUTH RD
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
UNIT 25
LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
CENTERVILLE MA 02632
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
L' �k�j/,/�//J
ACORD 25�5 (3[93j,
, _:
RD COFi ; Ind .1 9
Date: 5/5/2005 Time: 3t02 PM Tot (6 15957765603
f`1t:...aN. awern'
Paget 002-003
,ACCORD- CERTIFICATE OF LABILITY INSURANCE
DATENYYY)
PROD
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The FeifelbeM Company
ONLY AND CONFERS NO RIGHTS UPON THE -CERTIFICATE -
222 Milliken Blvd.
HOLDER: THIS CERTIFICATE DOES NOTAMEND, EXTEND OR-
P.O. Box 3220
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fall River, MA 02722
INSURERS
INSURERS AFFORDING COVERAGE
NAIC A
INSURED
Cape Cod Ready Mix Inc.
A: Acadia Insurance Com anles
INSURER B: Construction Industries Compensation
PO Box 399
INSURER C:
Orleans; MA 02653
INSURER D:
INSURER E:
nnveewn_re
ncr La IcaUr"WKANULLISTEDBELOWHAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVEFOR THE POLICY PERIODINDICATED. NOTWTTHSTAQNG--
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR -OTHER DOCUMENiWITH'RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEDOR-
MAY PERTAIN, THE WSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCWSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE OMITS SHOWN MAY HAVE BEEN REDUCM3Y'PAIO CtA%4s,
LM
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICYEXPiPAnoN
LIMTTS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE alOCCUR
CPA0132468t0-
-
'..
'
- _
-
EACH OCCURRENCE
51000000
DAMAGE TO RENTED
5100000
MED EXP (Any we Person)
S$ 000
ERSONALSADVINJURY
S1,000,000
GENERALAGGREGATE
S2 OOB 0OO
GEN'LAGGREGATE LIMIT APPLIES PER:
PODGY PRO-- LOC
PRODUCTS - COMPUOP AGG
12000000
A
_
AIROMoBfLE
LIABILm
ANYAUTO
ALLOWNFDAUTOS
SCHEDULED AUTOS
HIREDAUTOS
NO -C%VNEDAUTCS
MAA01324SQ10
41/01/OS
01/01/106 .
COMBINED SINGLE UMIT
(Ea az icbrq -
s1,000,00D '
O - PI ) RY
S
X
X
BODILYINJURY
�aacadax}
S
X
aertJ ERTYDAMAGE.
�a a�
-
A
B
GARAGE LIABILITY
.ANY AUTO
EXCESSAJMBRELLA UABILRY
X OCCUR CLAIMS MADE
DECUCTIBLE
X RETENTION so
WORKERS COMPENSATION AND
EMPLOYEWIUARILrrF- '- "
ANY PRCPRIETCRUPARTNER{EXECUTNE
OFFICERIMEMBER EXCLUDED?
If you, tXscxibe wow
SPECIAL PROVISIONS belnrr
CUA0132470JO
C000925$
0.1/01�05
01/01/OL5 -
_
01/01/06
01/01/06
AUTO ONLY -EA ACCIDENT
S
-
OTHER THAN EA ACC
AUTO ONLY: AGO
EACH OCCURRENCE
-
S
S
51000000
AGGREGATE
$
S
X STATU- GTH•
- -
S
_
E.L. EACH ACCIDENT
$500000'
E.L. DISEASE -EA EMPLOYE E
S500000
E.L. DISEASE - POLICY UMIT
$5000D0-
OTHER
DESCRIPTIONOF OPERATIONS I LOCATIONS [VEHICLES fEKcLUSf0Ng ADDED-BrENOORSEIIIENrj SPET]At PROVISIONS .. -
CERTIRCATEHOLDER- CANCELLATION- -
Gatewood Homes Inc."
1600 Falmouth Road Suite 25
CenterviBa, MA 02632
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATE THERE9F THEISSUINGINSURER-VALLENDEAVORTO MAIL A& DAYSjNiPTEN-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
MPOSENDOBUGAT1gNORUABRITYOFANYKMIDUPONTHEINSU ;EFL iSACENFSOR .
REPRESENTATIVES.
TNT/
�A-EKf.C/VC�t
2i (L' Pm) 1 of #S689"66526 - AHtPACORD CORPORATION 1988'
05/06/2005 09:3B 5084204474
EDWARD A GRAZUL PAGE 02
ACORB,� CERTIFICATE OF UASIUTY. INSURANCE..
DAt!(MWOD/YY
osE�6Eo�
;i
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT
►RODuCEA
ONLY AND -CONFERS NO RIGHTS UPON THE CER7IFIG
r
End A. ( i1,TTt� Ya Ye Iac.
E ,E
HOLDER. THIS CERT►FlC/[TE DOES MOT AMEND;-MEM-
ALTER THE LOVERAGEAFFOROED:BY THE MUMS, BELI
.
ABC
M3t[I75 WU.ST MN M48
INSURERS_AFFORDING�C�O�VFAAGTC
NAIC C
r_lC7tJylt.i1.7..,
$teYil QYl)C�S
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=
145 CanTett Roed
' INSUAERC. - -
•
MaC"'um 1"1udls2 VAV[i7+V
I1I—tNS47nER 4• .. -
_
SHOULD ANY OFT EADDvEar= 5E2roL= sOCCANCELLEDDEeonETHE""=A ..
Gate 67001 Fbms,,�I m, LAT4 TMEREOF: THE ISSVW4A1SUREA PALL tNDEAYOR TO MAIL _DAYS WWJTM
CA) B.�dpL TaAI2C tbil %CTICD TO_THE CERTIFICATE HOLDER NAMEO TO THE LEFr. OUT FAILURE TO DO SO SHALL
.. Rte,,-2`3—_ '-.. ��•I - NAPOSEaO-ODLICATION-Op uAou .. OF. ANY. KMD VPON THE IHSDAEItrt!"A6EMT8-OR
Gmte � ille, M �J2632 � � REPAESENTATIYES. _
FAX.. 1 SOB-%IS-S6Q3 AUTnoI�zEonerREEENTarnc
C,
ERTIFICATE OF
INSURANCE ISSUE DATE (MM/DD/YY)
F
PRODUCER
Harold H Williams Ins Agcy Inc
81 Bassett Lane
611005
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
Hyannis, MA 02601
INSURED
Stephen M Childs
145 Cammett Road
COMPANY
LETTER A A.I.M. Mutual Insurance Co
Marstons Mills, MA 02648
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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.
LTR
T
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DD/YY)
POLICY EXPRATIO
DATE(MM/DD/YY)
' LIMEYS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
!AIMS MADE�CCUR
OWNER'S& CONTRACTOR'S PROT.
GENERAL AGGREGATE
S '
PRODUCES-COMP/OP AGG.
E
PERSONAL & ADV. INJURY
S
EACH OCCURRENCE
S
FIRE DAMAGE (Any one fire)
$
MED. EXPENSE (Any one person)
S
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE
LIMIT
S
ALL OWNED AUTOS
CHEDULEDAUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON -OWNED AUTOS
BODILYent)
(Per a�xidcnq
S
GARAGE LIABILITY
-
PROPERTY DAMAGE
S
:EXCESS LIABILITY
EACH OCCURRENCE
$
MBRELLA FORM
AGGREGATE
S
THER THAN UMBRELLA FORM
A
VORRER'S COMPENSATION AND
MPLOYERS' LIABILITY
HE PROPRIETOR/ INCL
ARTNERS/EXECUTIVE
-
7015793012004
12/13/2004
12/13/2005
X 1.1C.STAT11R
ITS
EL EACH ACCIDENT
S 100,000
EL DISEASE —POLICY LIMIT Ts
500.000
FFICERS ARE: X EXCL
OTHER
EL DISEASE—CACH EMPLOYEE S 100.000
DESCRIP'J'JO,N OF 0I9;ItA7'IONS/LOCATIONS/VEffiCLES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Gatewood IIomeS
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
-
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Bell Tower Mall Rte 8
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
Centerville, MA 02632
AUTHORIZED REPRESENTATIVE
e4rORD, CERTIFICATE OF LIABILITY INSURANCE
°1028` rzoo '
PR Serial # A1530
ROBERT P. BIXBY, CPCU
P.O. BOX 830 -651 PUTNAM PIKE
GREENVILLE, RI 02828
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#
INSURED -
HOLMES AND MCGRATH, INC.
362 GIFFORD STREET
FALMOUTH, MA 02540
INSURER A: NAIL FIRE INSURANCE CO. OF HARTFORD
INSURER B: VALLEY FORGE INSURANCE CO.
INSURER C: CONTINENTAL CASUALTY CO.
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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LNtTS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS.
ruaTR
A
a0O1
TYPE Or INSURANCE -
GENERAL LIABILITY
x COMMERCIAL GENERAL LIABILITY
CLAIMS MADE QX OCCUR
POLICY NUMBER POLICY
1074082434
DAT EFFECTNE
10/06/04
r EXPIRATKN
10/06105
LIMITS
EACH OCCURRENCE - $ 1,000,000
A AG O ENTED $
FIRE 250,000
MmEXP aae $
10,000
PERSONAL& ADV INJURY $
1,000,000
GENERAL AGGREGATE $
2,000,000
PRODUCTS- COMP/OP AGO S
2,000,000
GENL AGGREGATE LIMIT APPLIES PER
POLICY PRO-JECT M LOC
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS)
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accK"
$
BODILY INJURY
$
SC � Y
$
W.PERTYrMAGE
S
GARAGE LIABILITY
ANY ALTO
AUTO ONLY -EA ACCIDENT
S
OTHERTHAN EA ACC
AUTO ONLY.. AGG
$
S
EXCESSNMBRELLA LIABILITY
OCCUR DCWMS MADE
DEDUCTIBLE
RETENTION S
EACH OCCURRENCE
$
AGGREGATE
$
S
$
S
B
WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY
ANY EXECUTIVE
O CERIMEIMBERER EXCLUDED?
describe under AL PROVISIONS below
MI
2057445273
09/01/04
09/01/05
TORY X WCSTMTU-
EL EACH ACCIDENT
s 1,000,000
EL DISEASE -EA EMPLOYEES
1000000
EL DISEASE - POLICY LIMITS
1,000,000
C
JOTHER
PROFESSIONAL LIABILITY
AEA 00 43133 38
07/13/04
07/13/05
$1,000,000 PER CLAIM/
AGGREGATE
DESCRIPTION OF OPERATK)JSLOCATIONSM941CLES=CLUSMS ADDED BY ENDORSEMENTISPECULL PROVISIONS
AGGREGATE LIMITS ARE PER THE TERMS AND CONDITIONS OF THE POLICIES.
CERTIFICATE HOLDER CANCELLATION
GATEWOOD HOMES, INC.
1600 FALMOUTH RD., STE. 25
CENTERVILLE, MA 02632
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CER711F1CATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE ND OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES.
ALIT
wt,�u •eee
ACORD 25 (2001/08) c - /
C:\FMPRO\CERTPROS.FP5
ACORD .. CERTIFICATEDLIABILITY INSURANCE 1 °"�`iai05 '
Vnited Insurance Agency, Ina.
299 Main Street
P.O. Box 1013
Buzzarde Bay, MA 02532
INSURED
Patton Electric, Inc.
128 Scituate Road
Mashpee, MA 02649
COVERAGES
THIS CERTIFICATE IS IM
ONLY ANC COMERS NO
INSURER A:
INSURER e:
INSURER C:
INSURER O:
C'IL.:7
TNEPOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POUCY PEILIUL, UYUIUA ICU. my I.n I .....
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT pR:OTHER DOCUMENT WPM RESPECT TO WHIC". THIS CERTIFICA-W M&Y BE ISSUED OR
MAY -PERTAIN -THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, E:77CLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID'CLAIMS.-'-
roucrwusBETt
rovDYEFFFCTH3;
wuer oTl
A
4ENERALjIMUTY -
6omERmALOEMERALLu muTy
CLAMS MIOE ®OCCUR
SCP42415399
-
Tf30f44
"' 7/30f0$
EACH OCCURRENCE
�oog
3 i,00oMAM
FREMtSEs Paxv
= 30b,000
f 10,000
MED EIm {AryanA
PERSONALSADVINJURY
3 Sy-000-rQIID--
GENERALAOGREGATE
3 2,000.000
PRODUCT$•CDMP2IP AGG
i �Q
GENT AGGRECATE OMIT APPLIES PER:
X POLICY jECT - ... LAC-
-
AUTOMORILELUIBILITY
-
COMINNED �SINOLE LIMIT -
3.
ANYAUTO
-
ALLOMMAUTO6
...
DODLYINJURY
Up- I ve"
9
3CHGDULEQAUTOa ...
NIREDAUTOS
..
(W-"6y.INJURY
{P,rAWpN11(
3..
HaI.OWNEOA4ITOS.-
.. ._
PROPERTYDAMAOE
(Praderq
S
GARAGEUABLITY
ANYAUTO
....
AUTOONLY-EA ACCIDENT
3
OTHER THW EAACC
ALITOONLY: AGO
3
S
EACH OCCURRENCE -
3
EXCFSSNMBRELLA LIABLIT'/
OCCUR CLAIMSMADE
AGGREGATE
S ,
DEDUCTIBLE
RETENTION
2
} .
g
WOetetSCOMPENSWION AMP
EM0.0YERS-UMLR'Y
ANYpROPRIETOR/PAtTNERE(ECUTNE
O�FFAICERAF-MBER EACLU OWI
WC23-i335304-941d-.... "
...12,/10LD4
...12%�1D5
'
&L EACNACCIDENT- ...
I .. lgII,-000
EL.O16EASE-EAEMKOYEE
S 500,000
RLDISEAM-POUCYLIMIT
Is 100 000 '
SPEGAL PROVI9OVSOebw X
OTHER
OIsCRIPTION of 0MRATIONS IOOCATOONS/YEN C13'S tUCLU910NS ADDED BY ENDORSE IEBT ISP%-L L►ROVI60NS
Electrical
Gateway Homea, Inc.
1600 Ralmouth Rd., unit 25
fax 508-779-5603
Centerville, Ma 02632
SHOULD ANY OF THE ADOVE DESCRIBED POUCIESBECANCELLED BEPORE THE LOVIATNTN
PATETHEREDF. THEIEEUINGTNSURER WILL ENOEAVORTQMAL 10 D'VZWRITTEN
NOTCETO me CERTIFICATE MOLDER NAMED TO THE L5FT, BUT FAILURETODQBQBRAtt
INPOSENO ODUDATNW OR,LIABLITYOT,UY KINQ UPDN TNEIN6URER.tTSAG M0 OR
A..t�RD = CERTIFICATE+.OF•LIABILITYr
WS,UR
NCE
s °A 9i15 04 h'
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Chatfield, Whitman & Young
549 Washington Street
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 850963
COMPANIES AFFORDING COVERAGE
Braintree, MA 02185-096
COMPANY
A Harleysville Worcester Ins Co
INSURED r
-
COMPANY _
Lawrence Robinson Masonry
B
COMPANY
5 ' Fresh Hole Road
Hyannis, MA 02601
C
COMPANY
D
COVERAGES,_
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
_ -
POLICY NUMBER
POLICY EFFECTIVE
DATE(MM/DD/YY)
POLICY EXPIRATION
DATE(MMIDDIYY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OP AGG
$ 2,000,000
A
COMMERCIAL GENERAL LIABILITY
CB 7E 32 32
9/07/04
9/07/05
CLAIMS MADE 7XOCCUR
PERSONAL B ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
S 100,000
MED EXP (Any one person)
$ 5 , 000
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULEDAUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
PROPERTYDAMAGE
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO •
EACH ACCIDENT
$
AGGREGATE
$ -
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
-
WORKERS COMPENSATON AND
EMPLOYERS LIABILITY
'
WC STATU- OTH-
TORY LIMITS ER
EL EACH ACCIDENT
$ '
THE PROPRIETOR/ INCL
PARTNERS/EXECUTME
EL DISEASE - POLICY LIMIT
$
EL DISEASE -EA EMPLOYEE
$
OFFICERS ARE: JR1 EXCL
OTHER
DESCRIPTION OF OPERATIONSILOCATONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER _ '
.„. ;�.�..
CANCELLATIONa' .b
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Gatewood Homes
1600 Falmouth Road
Suite 25
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Centerville, MA 02632
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LJABILV
OF ANY KIND UPON THE COMPANY E SENTA S.
AUTHORIZED REPRESENTATIVE
Robert E. Chatfield
f.. r*, 77` ��.
ACbRD'25S (tl9j , ,,' _ - -�
,ram----�.,....: T ,_. _..�.._ .�...�..
, z <.�, �„-„ ,_; � ,'; � �o'�CORD"GOR�+ORATIOM'7988;
0
iCORD CERTIFICATE OF LIABILITY INSURANCE 076
TN R076
DATE
09-27-2004
PRODUCER
PAYCHEX AGENCY INC.
210706 P: (877)287-1312 F: (877)287-1315
308 FARMINGTON AVE
FARMINGTON CT 06032
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
INSURED
LAWRENCE ROBINSON MASONRY INC
5 FRESH HOLE ROAD
HYANNIS MA 02601
INSURERA:TWln City Fire Ins Co
INSURER B:
INSU2 C:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OFINSURANCE
POL/CYNUMSER
POLICYEFFECTfVE
DATE MM D
POL/CVEXPIRAT/ON
DATE MM D
L/6UT5
GENERAL LIABAJTY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE O OCCUR
•
EACH OCCURRENCE
a
FIRE DAMAGE (Any one fire)
a
MED EXP (Any one person)
a
PERSONAL & ADV INJURY
a
GENERAL AGGREGATE
a
GENT AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO- LOC
PRODUCTS - COMP/OP AGG
a
AU70MO8BE
LLABB?Y
ANY AUTO
ALL OWNED AUTOS
,SCHEDULED AUTOS
HIRED AUTOS
. -
NON -OWNED AUTOS
. _
-
-
-
COMBINED SINGLE LIMB
(Ea accident)
S
BODILY INJURY
(Par Perwn)
a '
-
BODILY INJURY
.(Per accident)
a _
PROPERTY DAMAGE
(Par accident)
-
-
GARAGEL/ABILITY
ANY AUTO
-
AUTO ONLY - EA ACCIDENT
a
OTHER THAN EA ACC
AUTO ONLY: AGG
a
a
EXCESS LIABRITY
OCCUR O CLAIMS MADE
DEDUCTIBLE D
RRETENTION a
EACH OCCURRENCE
a
AGGREGATE
D
a
a
a
A
EMPLOVWORKERS COMPEN-ITY NANDLIMITS
EMPLOYERS'[/ABB/TY
76 WEG NQ5620
09/06/04
09/06/05
X WC STATU- OTH-
I ER
E.LEACH ACCIDENT
$100 000
E.L. DISEASE - EA EMPLOYEE
$100, 000
E.L. DISEASE - POLICY LIMIT
a500 000
OTHER
DESCRP77ON OF OPERA TIONSA OCA77ONSIVEMCLESMXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Those usual to the Insured's Operations.
�.ur, u-wr���nvwcn ruwr,v,vnurvavrtcu; avaurtcrt asr ¢rt; �.HIVLCLLli 11V 1V
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE 00 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
GATEWOOD HOMES HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1600 FALMOUTH ROAD, SUITE 25 REPRESENTATIVES.
CENTREVILLE MA 02632
ACORD 25-S (7/97) 0 ACORD CORPORATION 1988
12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC
.L,,, .jaQ0—Ro CERTIFICATE OF LlaBtttTy-tNaLq;MN M-
Ra ER -_.. _.__.. TAI
GOLIY6AN & ASSOCIATES INSURANCETHIS CERTIFICATE 13 ISSUED AS A MAT
FINANCIAL SRIMICES INC'. ONLY AND CONFERS NO RIGHTS UPON
HOLDER: CERTIFICATE DOES NOT
ti FALFSORD. ALTER THEE COVERAGE AFFORDED BY_1
HY7CANNI9 WAA 021601
Allcus, 508-715-6010 Fax:508-790-0249 INSURERS AFFORDING COVERAGE
Iktllawn
RODWX TAVANO
DBA blXCBANICAL SYSTXKS
WBASNBTASLBEKA 02669
B:
12/02/04
IRMATION
ICATE
t'END OR
S BELOW.
NAIC 0
THE POLICIES OF INSUIPANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY PERTAIN. THE S',R OR CONDITION OF ANY CONTRACT OR OTHER OOCUMGNT WITH RESPECT TO WHICH THIS CERTffICATE MAY BE ISSUED OR
MAY PERTAIN, THE MS JRANQE AFFORDED BY THE PQMiES C-$CAIM HM"IS SVD,IECT TO ALL THE TE.R*& EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LBUfS SHOWN MAY HAVE BEEN RES PCED BY PAID CLAIMS..
LTR
NSR
TYPE OF INSURANCE
GENERAL IUJMJTV
PdJC'! NUMBER
DATE MMID
L1MR$
-
A
Y COMMERCIALGENERALLtABIL17Y
CUJMSMADE Fj OCCUR
000372088
11/21/04(FaRmN
7NO000
URRENCE
s 1000000
)
s300000
nyonepelW)
s10000
& AOV INnMY
S 1000000
AGGREGATE
S 2000000
GEMAGGFB:GATE Ill"fTAPPLIES PER:
POLICY ? LOC
S-COMPAP AGO
$2000O00
AUTOMOBILE:
LIABRITY
-
....
ANY AUTO
COMBINED SINGLE
OBSINGLE LIMIT
s -
ALLOWHEBAUFos
-
BODILY INJURY
(PwpR )
y
SGiEDULmAUT03
HIRED AUTOS
BODILY INJURY
(PeTeWCmt)
f
NON-ON'NEOAUTOS
DAMAGE
s
OARAGE
LJAMUTY
ANY SUIT] ..... .._ _
-EA ACCIDENT
S-
FJIACC
S
4:
4AUTO
AGG
S
EXCESS RELLALIABILITYRLLrNDEOCCUR
CLAW MADE
y
S
DEDUCTIBLE
RETENTION• S
__.
S
MORIWO COMPEIUAMON AND
-
-
EMPLOYERS-LULBIJTY
70RY LIMBS ER
ANY PROPRIETORPARTNEWEXECUTIVE
OFFICERIMEMSER I>LCLUDED?
-
E.L EACH ACCIDENT
y
E.L. DISEASE -EA EMPLOYEE
S
a Gip Om
SF6GAL pROV�IQ�
OTHER
EL DISEASE -POLICY LIMIT
t
09CI1:PTION OF OPSRATICMISlLG.A77C0.7lVF"mil FQ/E„^,L .. �ECLRtFR^pYJRYf?—.. _.
CERTIFICATE HOLDER w...w�...�.�..
rAcrr OD'riomms INL---
FAY 508-778-5603
1600 FALlsOOTB ROAD SUITE 25
C1I=11RVILLE HA 02632
SHOULD ANY OFTHE ABOVE DESCRIBED Pmmm*R BE CANCELLED BEFORE THE EXPIRATX M
GATE THEREOF, THE Q9UM INSURER Val ENDEAVOR TO MAIL 30 BAYS WRITTEN
NOTICE TO THE CERTIFICATE "OLDER NAMED TO THE LEFT. BUT FAILURE TO DO 80 SHALL
M'MX NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGEMS OR
nXk5nl_rG,2% naZI-XVIVI U101"uu Lv;uu eAur. vv-tfvv-t rAx ouz-vt;z*
D .1mmom"T..
IT 54"', C
05-06-05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.
-
ONLY - AND- CONIFFR%- NO � R4GHTS •UF4DN - THE-
GOLD14AN ASSOC IN cERTtFIcATE-
S FIN HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
933 MMOUTH AD ALTER-THECOVERACZ-AFFORDEDLBXrUEp6lZffiaELOML
RTE 28"
HYANNIS MA 026012319
COMPANIES AFFORDING COVERAGE
28HPP
COMPANY
k AMERICAN zuRicry rNsuRmcz -compAyr
INSURED
COMPANY
TAVANO, RODNEY DEA
MECHANICAL SYSTEMS
201 CAPES TRAIL
COMPANY
WLST"BARNSTABLE MA 02666
C_ - -
COMPANY
D.
D
'Pq m...... It,
THIS a TO, CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T_IIE INSURED NAMED ABOVE -FOR THE.PQLr_rPERj3UU
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE -MAY RE-ISSUMOR-MAY PERTAIN, THEJNSURANCF- AFEORDEIL WL THE- POUCIES. DESCRIBED HEREIN.IS SUBJECT
EXCLUSIONS�AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TO-ALLT]dE TERMS -
co
LTF
TY-PF-OF INSURANCE
POUCLY-NUMOER
POLICY EFFECTIVE
DATE-(Fj06T=YY)-
POLICY EXPIRATION
DATE j(9[&TWYlf)-
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
=CLAIMS MADE OCCUR
1-1
OWNERS & CONTRACTORS PROT.
GENERAL AGGREGATE
$
PRODUCTS-COMP[OP AGG.
'$
PERSONAL & ADV_ INJURY
$
CH OCCURRENCE-
_s
FIRE DAMAGE (Any oie fire)
$
MED. EXPENSE(xrtr�eperson)
AUTOMOBILE LIABILITY
—7' ANY -AUTO
COMBINED SINGLE
LIMIT.._ -
ALLOWNEDAUTCS
SCHEOULEDAUTOS-
...
BODILY INJURY
(Per per%Qn).
S.
KIRECAUTOS
BODILY INJURY
(Per Acdclard)
$ .
NON-OWNEaAUIOS_.
PROPERTY DAMAGE
GARAG"ABIUTY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN AUTO ONLY.
EACH ADCIDENIT
AGGREGATE
$
EXCESS
LIABILITY
UMBRELLA FORM
EACH OCCURRENCE
$
AGGREGATE
OTHER THAN UMBRELLA FORM
A
WORKERS COMPENSATION AND
EMPLaYEFrS_UARUffy
(UB-7278A84-9-05)
05-03-05
05-03-06
1 STATUTORY LNIFTS
EACRACCCENT
loorl 000
THE PROPRIETOR(
PARTNERS/EXECUTIVE
ER- Rx. 'NCL
OFFICERS APC- EXCL -
DISEASE- POU& Lmrr
$ 500 000
DISEASE -EACH -EMPLOYEE -
f)O(l
Ot iCRIPTION OF OPERATION&LOrATIONS/IVEHCLES(RFSTRICTIONS;SPECIAL ITEMS I
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS C01'T COVERAGE.
.77 _�c AN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
GATEWOOD HOMES INC
1600 FALMOUTH RD SUITE 25
EXPIRATION DATE THEREOF, THE ISSUING' COMPANY WILL ENDEAVOR TO MAIL
'10 DAYS ... WRITTEN NOTtCeTO-RiEtERnfp=Tr;-"OtVeFrNAMeiy-roTMe
LEFrIIUT. FAILURF-TQ_ MAIL, SUCH -NOTICE, SHALL IMPOSE No OBLIGAUDN OR
CENTERVILLE MA 02632
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES;
AUTHORIZED REPR[ESEAITATIVE f -------
o TOWN OF YARMOUTH
of • r
Building Department
,.
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-05-607
Applicant Name:
Frank Capra
Applicant Phone:
5087789669
Building Location:
00121 CAMP ST Unit 9
Owner's Name:
Villages @ Campt St., LLC
Owner's Addres
1600 Falmouth Road # 25
Centerville MA 02632
Owner's Telephone: (508) 778-9669
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 943
Net Owed:
($50.00)
Application Date: 5/12/2005
Issue Date:
Expiration Date
Comments:
new construction:
Map/Lot: 044.21.1
ZONING APPROVED
REVIEWED BY:
WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
,{ CONSERVATION:
4. ALTH DEPARTMENT:
. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
PLEASE NOTE
N/A:
N/A:
N/A:
N/A:
N/A:
N/A:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 5/23/2005
Temp Permit No.:
Applicant Name:
Applicant Phone:
Building Location:
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
T-05-607
Frank Capra
5087789669
00121 CAMP ST Unit 9
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 943
Net Owed:
($50.00)
Application Date: 5/12/2005
Issue Date:
Expiration Date
Comments:
new construction:
Owner's Name: Villages @ Campt St., LLC
Owner's Addres 1600 Falmouth Road # 25
Centerville MA 02632
Owner's Telephone: (508) 778-9669 �n
REVIEWED BY: t n ^=' ' ' ""
1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT: �( DATE: —/3 N/A:
5. BUILDING DEPARTMENT: DATE: N/A:
6. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
044.21.1. L
DATE:
Date Printed: 5/23/2005
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date of Issue : May 31, 2005
Letter of Water Availability
1. Single Family Dwelling X 2. Duplex Family Dwelling
3. Condominium Dwelling 4. Commercial / Industrial
5. Other (Specify)
Reference; Massachusetts General Laws Chapter 40, Section 54
To : Town of Yarmouth Building Inspector
Please be advised that the Town of Yarmouth Public water supply
is available to service lot/parcel(s) 21.1 Street 121 Camp St., #9
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. P � ` fl /� n
Owner (Sign)
Reference
: Villages @ Camp St., LLC
: 1600 Falmouth Rd., #25
: Centerville, MA 02632
Department
TOWN OF YARMOUTH
8` Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-05-607
Applicant Name: Frank Capra
Applicant Phone: 5087789669
Building Location: 00121 CAMP ST Unit 9
Owner's Name: Villages @ Campt St., LLC
Owner's Addres
1600 Falmouth Road # 25
Centerville MA 02632
i
Owner's Telephone: (508) 778-9669
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 943
Net Owed:
($50.00)
Application Date:
5/12/2005
Issue Date:
Expiration Date
Comments:
new construction:
Map/Lot: 044.21.1. e, 9
DATE: N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
Date Printed: 5/23/2005
• -yam
LOT 9
^Nv
3 /
�0, h 1��\rry
6 3. \V ?)
O
o`'�� h
N� � �O 47¢ NO
Q
Q ii p
LOT 10
ti.
3.21 r
1 �
�• QO J`11
F�
O
ae
OQ
Q�
LOT 8
iP
NOTE: ��r►�• ,s yfGISTEF``v, ter`.
2a L LAMP
\� ® SEWER LATERAL t "BE
J SLEEVED IN ACCORDANCE
WITH TITLE V IF WITHIN
GRAPHIC SCALE MPS ��. 10FT. OF WATER MAIN.
20 10 0 20 NOzIC?
Unless and until such tirne as the original (red) stem; of :h;
r"-,onsl, e Frofa,akncl Englneer, or Prof"sinncl Lend Surveyor
nepa.i-s en this plan: . .
(A) no person or persons, inOudinn any rnun'c;n::! cr o...-
( IN FEET) _ra ore: �iy. may r>ly upon the +r..' rr, cant r c i 'n
1 inch = z� f (Bl 'hts pan remains the pr ,pert y �f I{.DIm" �'- . ..
►►�I't.'RA.
PLOT PLAN
holmes and mcgrath, inc.
OF LOT 9 civil engineers and land surveyors o VAOTHYM
PREPARED FOR
362 gifford street
MILL POND VILLAGE
4 G�l!L L Y
falmouth, ma. 02540
IN
YARMOUTH, MA- ssy0"a`Ey`
JOB N0: 201197 DRAWN: LMC rT '
SCALE: 1"=20' DATE: 1-5-05 DWG. NO.: A2510 CHECKED: �p
r3/
a
/
j B
o oh \
LOT 9 \ ��
.SrL
\
8
o/ ss• LOT 8
6',� Il ti• ►
o I
f QO
o �
^ -n�
O
QO�OJQQ tyrO'h
O
LOT 10
1
GRAPHIC
( IN FEET )
1 inch = 20 M
3Q�Q�`r�GP
\ .21
VZ'
�e0
4� �v
• 4f A
i ho' o NOTE:
® SEWER LATERAL SHALL BE
113
SLEEVED IN ACCORDANCE
.� WITH TITLE V IF WITHIN
lIL MPS 10FT. OF WATER MAIN.
6 NOTICE
Unless and until such time as the original (red) stamp of the
responsible Professional Engineer. or Professional Land Surveyor
oppeers on this plan:
(A) no person or persons, Including any municipal or other
public officials, may rely upon the Informotion contained h=.rein; cnd
(9) this plan remains the property of Holmes k McGrath, Inc.
PLOT PLAN
holmes and mcgrath, inc. `w
OF LOT 9 civil engineers and land surveyors,
PREPARED FOR 362 gifford street
MILL POND VILLAGE falmouth, ma. 02540 "u
IN j
;v
YARMOUTH, MA-
JOB N0: 201197 DRAWN: LMC
SCALE: 1"=20' DATE: 1-5-05 DWG. NO.: A2510 CHECKED:p --"
Late. a+ OG--3
Jl
DUCT SPECIFICATIONS
GMS9/GCS9 SERIES
93% AFUE
Multi -Position,
Single-Stage/Multi-Speed
Gas Furnace
Heating Capacity:
46,000-115,000 BTUH
W PARTS
LIMITED
xf x WARRANTY
NTY
'Q_ ' Mama ETA ETA m
3
Standard Features
• Corrosion -resistant, aluminized -steel tubular heat
exchanger and stainless -steel recuperative coil for
maximum efficiency
• Designed for multi -position installation—GMS9:
upflow, horizontal right or left; GCS9: downflow,
horizontal right or left
• Energy -saving, reliable Hot Surface Ignition system,
featuring a Norton® Mini -Igniter with patented
adaptive learning algorithm to maximize igniter life
• Aluminized -steel inshot burners
• Energy -saving PSC, multi -speed, direct drive
blower motor
• Quiet, corrosion -resistant induced draft
blower assembly
• Integrated furnace control with improved
diagnostics
• Low voltage terminal blocks
• Multiple flame roll -out switches, blower door safety
switch, outlet air -limit switch and pressure switch for
proof of combustion air
• 40VA transformer for heating and air conditioning
control service
• Combination redundant gas valve and regulator
• Top venting is standard; alternate flue/vent located
on right side
• Completely assembled, factory run -tested furnace for
heating or combination heating/cooling application
• All models comply with California NOx Standards
• Suitable for direct vent (2-pipe) or non -direct vent
(1-pipe) applications
0I0I.10010
Air Conditioning & Heating
The GMS9/GCS9 single -stage,
multi -speed gas furnaces offer
installation versatility.
Cabinet Construction
• Heavy -gauge, reinforced, fully insulated -steel cabinet
with durable baked -enamel finish
• Attractive architectural gray paint finish
• Foil -face insulation -lined heat exchanger
compartment
• Coil and furnace fit flush for easy installation
• Convenient left or right connection for gas and
electric service
• Bottom or side air inlet (GMS9)
• Removable, solid -bottom block -off (GMS9)
Accessories
• L.P. Conversion Kit (LPT 00A)
• L.P. Gas Low Pressure Kit (LPLP01)
• High Altitude Natural Gas/L.P. Kits (HANG11,
HANG12, HALP10)
• High Altitude Pressure Switch Kit (HAPS27)
• External Filter Rack (EFR01)
• Horizontal Concentric Vent Kit (HCVK)
• Vertical Concentric Vent Kit (VCVK) .
• Internal Filter Retention Kit—upflow, horizontal
(RF000180)
• Intemal Filter Retention
Kit—downflow
(RF000181) MID
• Thermostats Blower Motors
(CHT18-60, CH70TG,
CHSATG, H2OTWR)
SS•377D w .goodmanmfgxom 6/04
•
•
•
Commonwealth of Massachusetts official Use Only
Ulu
Department of Fire Services Permit No. I ' 1�—Z "M
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked SUL
[Rev. 11199] eave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINTININKORTYPEALLINFORMATION) Date: 09/14/2005
City or Town of: YARMOUTH,, M4 u
To the Inspec o0 described
By this application the undersigned gives notice of his or her intention to perform the electri or described 06y.
Location (Street & Number) 121 CAMP ST., UNIT 9 P 2 IZS
Owner or Tenant GATEWOOD HOMES, INC. eliphonne.l`io� 8 96
Owner's Address 1600 Falmouth Road #25 C�,tpmafP MA m,c-2e 4��i
Is this permit in conjunction with a building permit? Yes X No ❑ (Chee z ppropriate Boa)
Purpose of Building RESIDENTIAL Utility Authorization No. 1473065
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1
Number of Feeders and Ampacity 2/100
Location and. Nature of Proposed Electrical Work: WIRE HOUSE
Cmmnletlnn nftha fill ,: ♦..0.L. —_
-------------------
Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
No. o Total
Lighting Outlets
8
No. of Hot Tubs
Transformers KVA
PNonf
Generators KVA
Lighting Fixtures
8
Swimming Pool Above ❑ -
❑
o. o Emergency �g mg
rnd. rnd.
Batte Units
Receptacle Outlets
30
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
10
No. of Gas Burners
No. o etection and
Initiatin Devices
No. of Ranges
1
No. of Air Cond. T nsl
No. of Alerting Devices
No, of Waste Disposers
Heat Pump Number Tons
o. o el - ontame
_
Totals. Detection/Alertin Devices 6
No. of Dishwashers
1
Space/Area Heatin KW
g
Munn:r al
Local ❑ Connection ❑ Other
No. of Dryers
I
Heating Appliances KW
Security Systems:
o. of water
Heaters I KW 4.5
No. of No. o
Signs Ballasts
Na of Devices or Equivalent
Data Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
Telecommunications Wining:
OTHER:
No. of Devices or E uivalent
�•• " +••.�..". urju« q aesirea, or as required by the Inspector of Wires.
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 X BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work:
(When required by municipal policy )
10/31/2005
(Expiration Date)
Work to Start: Inspections to be requested in accordance with AMC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is due and complete
FIIiM NAME: PATTON ELECTRIC, INC.
eensee: RICHARD PATTON
fapplicable, enter "exempt" in the licence numhor
LIC. NO.. A 15542
_ Signature LIC. NO.:
1 Bus. Tel. No.:_508-539-0200
m vri.r n' a uv tc 5uAAUE 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/Agent El owner's agent.
Signature Telephone No. rPERMIT FEE. $125.00
I
•
Commonwealth of Massachusetts
Department of Fire Services
)Y FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. - Z0'
Occupancy and Fee Checked
11/991 ve blank
APPGCATION FOR PERMIT TO PERFORM ELECTRICAL WORK
//All wakto be pedamed in accordance with the Masxc nct. Electrical Code (MEQ, 527 CMfR 12=
(PLEdSEPRMT1YINKORTYPEALLflYMRW770N9 Date: R�zi loS
00 or Town of. YARN UTH To the Inspector of Wires: .
By lication the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) MILL POM VILLAGEj, 121 Camp St Bldg # .
Owner or Tenant Gatewood Hanes/ Jeff Sollows Telephone No. 5 0 8-77 8 96 6 9
OwnWsAddress 1600 Falmouth Rd., Suite 25, Centerville, Ma. 02632
Lt this permit in conjunction with a building permit? Yes KI No ❑ (Check Appropriate Box)
Purpose of Building single family residence Utility Authorization NO.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ IIndgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Fire Alarm System (low voltage control panel)
with back m battery, centrally, monitored
r_n1, w* ofthe foilmang table may be iaaive?lbv the Iaaoeator o/•Wirr
No of Recessed Fixtures
Na. of Cell.-Susp. (Paddle) Fans
Troansfonners KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Il tin Fixtures
gh g
Swimmin Pool Above
g d. d.
o. o eits g
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones —1—
No. of Switches
No. of Gas Barriers
o. of Detection.and 7
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
THeaotals Pumam
er.
ons
Detntained
ection/Alertin Devices 7
No. of Dishwashers
Space!Area Heating KW
Local 0 Municipal
an ® Other
No. of Dryers
Heating Appliances XWNo.
Security yyC
of st or Equivalent
o. of Water KW
Heaters
o. o o. o
. Signs BaL_sts
Data Wiring: .
No. of Deuces or uivaleat
No. H dromassa a Bathtubs
y g
No. of Motors Total HP
Telecommunications iriag:
No. of Devices or Equivalent
OTTHER:
Aura&, adXtfa wl aaraiujdesired or as.egWrad by uurnrpeaw ofW;,rx
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.
(EEC1t ONE: INSURANCE M. BOND E) OTFIER 0 (specify:)
Estimated value of Electrical Woric $750.00 (When required by municipal policy)
Work to Start Inspections to be requested in accordance with NEC Rule 10, and upon completion.
Icerdfy, under thepa!= andpenalties ofperjury, that the infohnadon on this application is true and complete
FIRM NAME: Baltic Security, Inc LIC. NO., 1178C
Licensee: Jonas R Bielkevicius Signature —'" LIC.NO.. 499D
• flfivikable,vaer"exempt"in the
,lieaueBus. TeLNo.• 508-833-099
w/n02563Addrtss: PO Box .1609 Sanj 6
Alt. Tel No.: 508-7 / —3 7
OWNER'S INSURANCE WAIVER .I am aware that the Licensee does not have the liabilityinsurance coverage normally
required by law. By my signature. below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a em.
Owner/Agent PEM17T FEE: $ 40.00
Signature _ Telephone No.
CJ
r
L
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
OCT 072
(PLEASE PRINT IN INK RCS )M
To the Inspector of Wires: By this
work described below.
Location (Street & Nu
�OFFICE USE ONLY) -.
ey�/�
Fee: $��s
PERMIT
-ex- 32
IAT ON) Date: ` "/ / /v�)
undersigned gives notice of his or her intention to perform the electrical
�.1/,>0 ��14�,� a 09;l <?
Owner or Tenant_,/` u/o 6I /r(' Telephone No.��� 9��9
Owner's
Is this permit in conjunction with a building permit? TYes C3 No (Check Appropriate Box)t�
Purpose of Building 44te". � i�t�r� Utility Authorization No. 1 � `t� r ,:X I
Existing Service Amps / Volts Overheadrl Undgrd [I o. of Meters
New Service AO,�� Ampso� iel //,�o Volts Overhead UWgrd No. of Meters_
Number of Feeders and Ampacitv. —yl 0 l r ) ' — - fza
Location and Nature of Proposed electrical Work:
Cmmnletinn ofthe fnllnwine table may be waived by the ln.snertornfWires
No. of Recessed Fixtures 19
No. of Ceil.-Sus . Paddle Fans
No. of Total
Transformers KVA
No. of Lighting Outlets 56
No. of Hot Tbbs
Generators KVA
No. of Lighting Fixtures l
Above In-
SwimmingPool d. md. ❑
No. of Emergency Lighting
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
7No. of Zones
No. of Switches 3 6,
No. of Gas Burners
o. of Detection an
Initiating Devices
No. of Ranges I
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers CD
Heat mp
Tot s:
um er
— —
Tons
— —
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers /
Space/Area Heating KW
Municipal
Local Connection ❑ Other
No. of D
Dryers v
rY
Heating Appliances KW
g PP
Security Systems:
No. of Devices or Equipvalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H dromassa a Bathtubs
Y g
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices orEquivalent
l Attach additional detail if desired, or as required by the Inspector of Wires.
9 INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
force, and has exhibited proof of same to the permit issuing office. , t
CHECK ONE: INSURANCE BOND ❑ OTHER[] (Specify:)
(ExplAtion Date)
Estimated Value of Electrical Work::j2Go (When required by municipal policy.)
cA Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the p 'sand penalties of perjury, that the information on this application is true and complete
NAME: e i LIC. NO. 3
rcensee:o_►t-Q Signature f LIC. NO.
�(If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:
Address* Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent.
Owner/Agent
Signature Telephone No.
[Rev. 04/00]
Page 1 of 1
Cipro, Linda
From: Raiskio, Peter
Sent: Monday, March 13, 2006 5:14 PM
To: Cipro, Linda
Subject: RE: final for occupancy inspections 0 121 Camp St - Units 9,10 & 133
L-nda
The crew Wert over to do th s inspeC,hon Units 9 & lid not pas. no power to the detectors. Unit 133 passed.
Peter
-----Original Message ----
From: Cipro, Linda
Sent: Monday, March 13, 200610:08 AM
To: Kelleher, Robert; Raiskio, Peter, Sherman, C Randall
Subject: final for occupancy inspections @ 121 Camp St - Units 9, 10 & 133
The Building Department is scheduled to conduct a final for occupancy inspection 0 121 Camp Street
Units 9, 10 & 133 today 3/13/06 in the afternoon and would like for you to attend. Thanks - Linda
I,NI(lQ Ciprn
Building /)rynrr7urr,rN
Admini.slrnlivc ;1 sci.s/rrotl
4 /t A MAA4
TOWN OF YARMOUTH
`
Building
AT: Location
New [X
�66
Plans Submitted
p N 9 � U T N
NOV 2 12005
D
Renovation ❑
Yes ❑ No IR
APPLICATION FOR PERMIT TO 00 "SFITTING
--(OFFICE USE ONLY) ------- _ -- j�
Fee:
PERMIT NO.E
ineuwner Na
Type of Occupancyl�L_
Replacement CJ
I
1
EMMNMMNMNMMMMMNMEMMMENOMMMMENEENI
(PRINT OR TYPE) �� Check One:
Installing Company Name �UG.T,S -j,r� {T_ ❑Corp. —
Address .__ t �__�_i�8�s r J Partnership —
�/
Flrm/Company _-----.. _._ .__—__.—.
Business TelephoneQ—� Z� �LZ----
Name of Licensed Plumber of r _._�oL.�- L._—_
INSURANCE COVERAGE: Check One
I have a current hablity insurance policy or its substantial equivalent. Yes t�'No ❑
If you have checked yes, please indicare a type of coverage by checking the appropriate box.
A liability insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Signature of Owner or Owner's Agent
Owner ❑ Agent ❑
I hereby certify that elf of the details and Information I have submiltw
Signaturerof Licensed —
(or entered) In above application are true and accurate to the best of
Plumber or Gastiitter
My knowledge and that all plumbing work and installations performed
2 5
under Permit issued for this application will be In compliance with all
----- ------
pertinent provisions of the Massachusetts State Plumbing Code and
License Number
- ..
runts t W.6"ca.
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(OFFICE USE ONLY)
TOWN OF YA MOUTH By
- Fee: $ `
p(� PERMIT NO. (,. —L
(PLEASE PRINT IN INK OR PE ALL 1NFOR ATION) Date: t p
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to berform the electrical
work described below.
Location (Street & ;4tpftber)V�"t
Owner's Address lEo 41-4.33WW-
Is this permit in conju ton with a building permit? 0 Yes Q No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts OverheadO Undgrd C3 No. of Meter
New Service loc:)
Number of Feeders and
Location and Nature of Proposed electrical
Undgrd Lam No. of Meters
FixturesAfto. of Recessed
. of Ce'1-Susp,(PaddIe) Fans
o. of ota
Transformers KVA
o. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
ve n-
SwimmingPool rnd. d. ❑
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No, of Zones
No. of Switches
No. of Gas Burners
o. o tecuon an
Initiating Devices
No. of Ranges
No. of Air Cond. Total
No. of Alerting Devices
No. of Waste Disposers
eat mp
Totals:
um r
Tons
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
5 ace/Area Heating KW
P g
Local Q Municipal Q Other
Connection
No. of Dryers
�Y
Heating Appliances KW
g PP
Secutity Systems:
No. of Devices or ui valent
No. of Water
Heaters KW
No. of No. o
Signs Ballasts
Data Winng:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Wiring;
Telecommunications of Devices or
No. of Devices or uivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
BNSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides
1 proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in
pw force, and has exhibited proof of same to a permit issuing office.
CHECK ONE: INSURANCE BONDO OTHER (Specify:)
r (Expiration Date)
\ Estimated Value of ec 'cal Work: (When required by municipal policy)
Work to Start: 1p ob Inspections to be uested in qfcordance with MEC Rule 10, and upon completion.
I certify, unde the n an alti s of pep th t
NAME: f
L ee: Si
(If applicable, p "ez t ". q th� lic se number li
Address• 1 ►�4
OWNER'S INSURANCE WAIVER: I am aware that t e Licei
below, I hereby waive this requirement. I am the (cheZk one)
Owner/Agent
`G Signature
informaAort on this application is true and complete.
LIC. NO.
:tr��Alt.Tel.No.-'*
LIC. NO.
Bus. Tel. No.
does not have the liability insurance coverage normally required by law. By my signature
ter ❑ owner's agent. Q
Telephone No.
Commonwealth of Massachusetts 0 icial use only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 0�5
[Rev. 11/99] leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 527 , 12.00
rn (PLEASE PRhVT IN INK OR TYPE ALL Irti•FOR l'L4TION) Date: d c r
NCity or Town of: ��,q�LjLtol, To the Inspector of N ire: ' ��
3 By this application the undersigned gives notice of his or her intention to erform the ele ical w k des tl> i( � 4 2004
wo Location (Street & Number) f �7i/ (�1h i ���� l]]
w
d
A
w
U
H
a
w
rn
x Owner or Tenant ',�f, Telephone`No.
E' Owner's Address Zd` l'L��+�/�� �M.9' �Z(0/ �6Y
w
� Is this permit in conjunction with a building permit? Yes E3 No ❑ (Check Appropriate Box)
,�-4 Purpose of Building Utility Authorization No.
w
d
A
Existing Service Amps / Volts
New Service Amps 1 Z / QD?' Volts
Number of Feeders and Ampacity
Location and Nature of Proposed
Electrical Work:
Overhead ❑ Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ®`--�No. of Meters
Cmmnletinn nfthe followinn table may be waived by the InsDector of U ires
No. of Recessed Fixtures
No. of Ceil: Susp. (Paddle) Fans
TransTotal
Trsformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
g s
Swimming Pool Above ❑ [n- ❑
rnd. rnd.
i o. o mergency Lighting
Battery Units
No. of Receptacle Outlets O
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. Tonal
No. of Alerting Devices
Heat Pum
Number
TOffi
No. of elf -Contained
No. of Waste Disposers
Totals
_KW_
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of D ers
ry
Heating Appliances KEY
Security Systems:
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring: `�
Heaters
Sions Ballasts
No. of Devices or E uivalBtfT
Telecommunications Wiring:
No. H dromassa a Bathtubs
y g
No. of Motors Total HP
No. of Devices or E uivalent
OTHER:
/ufacn aaaamonai aerau ff aeslrea, or as requtrea ay iae vi •• .. _�•
NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
,Le licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
F' undersigned certifies that such coverage in force, and has exhibited proof of same to the permit issue /gg office.
a HECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) %2 J"2'G ; /i �;
f v J (Expiration Dale)
stimated Value of E ecWW;rk:i Djf�(When required by municipal policy.)
ork to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
certify, under t/re pa' s and penalties ofperjuty, that the inforLnadon on this application is true and complete.
IRM NAME: / If- LIC. NO.: Joe-,4�g,E
icensee �>`>l Signature IC. NO.:
a (lfapplicable, ent r "ex mpt" in the li eme n-_umbbeerr dint g) Bus. Tel. No. ---✓ ���?
3 Address: 7;717 �✓r✓! / /'poi% 1/ �Z�� Alt. TeL No.
xOWNER'S INS II
a required by law.
Owner/Agent
ZSignature _
JRANCE WAIVER: I am aware th t the Licensee oes not have the liability insurance coverage norm" y
By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Telephone No. PERMIT FEE: S
LOT 9AU01 \
5
I CERTIFY THAT THE FOUNDATION IS
LOCATED IN FLOOD PLAIN ZONE C
AS SHOWN ON FLOOD INSURANCE RATE MAP
COMMUNITY PANEL NO. 250015 0005D
AND THAT FLOOD PLAIN ZONE C IS NOT A
SPECIAL FLOOD HAZARD AREA.
G2 ��
ATE REGISTERED P OFES60NAL
LAND SURVEYOR
NOTICE
Unless and until such time as the original (red) stamp of the
responsible Professional Engineer, or Professional Land Surveyor
appears on this pion:
(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 do McGrath. Inc.
EASTIN'
FOUNDATION
"ti
I CERTIFY THAT THE FOUNDATION IS
LOCATED ON THE LOT AS SHOWN. AND
THAT ITS LOCATION CONFORMS TO THE
MINIMUM SETBACK REQUIREMENTS 9
THE 40B SP CIA.�//�PER MI
L,
ATE REGISTEREDtOROFE5SIONAL
LAND SURVEYOR
GRAPHIC SCALE
( IN FEET )
1 inch = 20 ft
AS —BUILT PLAN holmes and mcgrath, inc.
N>+ ar
OF LOT 9 civil engineers and land surveyors ���`gc
PREPARED FOR 362 gifford street MiC1a 111 1
MILL POND VILLAGE
IN falmouth, ma. 02540 o McGRATF) ! y
C N�
YARMOUTH, MA JOB NO: 201197 DRAWN: LMC ,qf
SCALE: 1"=20' DATE: 8-9-05 DWG. NO.: A2510A CHECKED: i t
7