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121 Camp St #010 Building Permits
�� Commonwealth of Massachusetts Official Use only wi Department of Fire Services Permit No. G �(I� ZS3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1 Z [Rev. 11/991 leave blank APPLICATkON to be FOR PERMIT ormed in ce �TOthe �PERFsachusetts EORM ELlectrical Code( E,C7151000 RK All wor (PLEASEPRIIVTININKORTYPEALL INFORMATION) Date: 09/14/2,0b5 'LN3 AJ City or Town of: YARMOUM MA To the Inspect \� es: Z� By this application the undersigned gives notice of his or her intention to perform the electric work d 'bdd e Location (Street & Number) 121 CAMP ST., UNIT 10 Owner or Tenant GATEWOOD HOMES, INC. T 1 one No. 509 778 9669 Owner's Address 1600 Falmouth Road #25, Centerville, MA 02632 L Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Boa) Purpose of Building RESIDENTIAL Utility Authorization No. 1473062 \Existing Service Amps / Volts Overhead ❑ Undgrd ❑ \� New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X VZ mroFeeders and Ampacity 2/100 %-tt-Location and Nature of Proposed Electrical Work: WIRE HOUSE Completion of the following table may be waived by the Inspector of Wires. • • No. of Meters No. of Meters 1 No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. o Total Transformers KVA No. of Lighting Outlets 8 No. of Hot Tubs Generators KVA No. of Lighting Fixtures 8 Swimming Pool Above El- Elo. md. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets 30 No. of Oil Burners FIREALARMS No, of Zones No. of Switches 10 No. of Gas Burners No. o Detection and Initiatin Devices No. of Ranges 1 No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: umber '_..'...__'.............'...'.___"...._".._"__"_ Tons o. oSelf-Contained Detection/Alertin Devices 6 No. of Dishwashers 1 Space/Area Heating KW Local ❑ Mumcnpal ❑ Other Connection No. of Dryers 1 Heating Appliances KW Security Systems: No. of Devices or Equivalent o. of Water 1 KW 4.5 Heaters 0. o No. o Signs Ballasts Data Wiring: No. of Devices or-1 uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wrnng, No. of Devices or Eau uivalent OTHER: Attach aaaiaonat detail i/ 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 NEC 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: INC. LIC. NO.: A 15542 Licensee: RICHARD PATTON Signature I�LIC. NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508-539-0200 Address: PO BOX_1525, MASIIPEE, MA 02649 Alt. Tel. No.: 774-353-6878 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: $125.00 Signature Telephone No. d LNr� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOVI (PLEASE PRINT IN INK OR (OFFICE USE ONLY) Fee: $ .1=Q-4"ff�y PERMIT NO. I`-C ^6 ^�f�� Date: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to �erform the electrical work described below. I Location (Street & 'k,.=, LM?, " 12f C>)- uss'— I levhone No. Owner's Is this permit in conju toln with a building permit? ❑ Yes 0No (Check Appropriate Box/I) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters New Service tC7c:) Number of Feeders and Location and Nature of Proposed electrical Work: Undgrd � No. of Meters r CA..I.,inn nFth. fnllnvrine mhl..m, 6. urniv.d 6„ A. I ..,...m 'rul"... AWo. of Recessed Fixtures f o. o Total Transformers KVA o. of Lialiting Outlets No. of Hot Tubs enerators KVA No. of Lighting Fixtures Above n- SwimmingPool md. ❑ ❑ d. o. o mergency Lighting Bate Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. or VetecUon an Initiating Devices No. of Ranges Tl No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat mp Totals: um er — ons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P 8 Local ❑ Municipal ❑ Other Connection No. of Dryers 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 wing: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Winng: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to_!be permit issuing office. CHECK ONE.- ' INSURANCE BOND❑ OTHER❑ (Specify:) ( (Expiration Date) Estimated Value of klecIrical Work: (When required by municipal policy.) �y Work to Start: td Db^ Inspections to be requested in cordance with MEC Rule 10, and upon completion. I certify, unde the in an at s of th in f on on this application is true and complete. NAME• J LIC. NO. L ee: Signature LIC. NO. (If applicable, "ex the licqnse number li .) Bus. Tel. No.: Address Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that t e License does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (che k one) o er ❑ owner's agent. Owner/Agent Signature Telephone No. L� • Commonwealth of Massachusetts Department of Fire Services OF FIRE PREVENTION REGULATIONS Official Use Only// Permit No. Occupancy and Fee Checked 0 • (� 111991 ve blank or_e�APP CATION FOR PERMIT TO PERFORM ELECTRICAL WORK wmkto be paf=md in accordance with the Mausarhusetts Electrical Coda (MEG), 527 CM R 12.00 (P.INIIVKORTYPEALLINFORWTIONJ Date: %:ityorTownof-. YARMOUI'fi To the Inspector of Wires:. application the undersigned gjves notice of his or her intention to perform the electrical work described below. Location (Street & Number) MILL POND VILLAGE, 121 Ca . St Bldg # I � Owner or Tenant Gatewood licmes/ Jeff sollows Telephone No. 508-7789669 Owner's Address 1600 Falmoutti Rd., Suite 25, Centerville, Ma. 02632 Is this permit in conjunction with a budding permit? Yes E] 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 ❑ Undgcd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Fire Alarm System (low voltage control panel) with backup battery cenntrallY monitored. n..—..r..:..:...frt.. fnll.....:..e MAY, he ianive?t •Iry di Tiem¢ernr nrwi7ime. No. of R&essed Fixtures sP• (]?addle) No. of Cer1-Su � Fans o: o ot Transformers KVA No. of lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above in Swimming Pool d. . ❑ d. ❑ o. ot Emergency LAghting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones —1—' No. of Switches No. of Gas Burners o. o InitiatetNf Lr 7 . ln ron.an Devices No. of Ranges No. of Air Cond. Tons al No. of Alerting Devices::d No. of Waste Disposers Totalsp [Number. ors o. Detection/Aloer tin Devices 7 No. of Dishwashers Space/AreaBeating KW Local I ®.Other No. of Dryers . . Homing Appliances KW SecurityyyCon icces• 6rEctuivalent o. of Water �y Heaters o. o 140.01 Signs Bauu`•s Data Wiring: No. of Devices or" uivaient Na H idrumassa Bathtubs Y 8e No. of Motors Total HP ommunrcations rang, No. of Devices or Eguivalent OTHER: Amen aamamwr aamr rV aesrrea. or as regwrea ay ru tasp=wr g arras. 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 exlubited proof of same to the permit issuing office. cEEac ONE: INSURANCE M BOND ❑ OTIIER ❑ (specify:) Estimated value of Electrical Wolt $750.00 municipal �-ta>zon (When requited by Pal policy.) Work to Start Inspections to be requested in accordance with NIEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRMNAME: Baltic Securityr Inc LIC.NO.: 1499D ee: LicensJonas R Bielkevicius Signature LIC, Np : 499D flfaHhcable, enter "exempt"in the liemenzwO line Bus. Tel. No.- 508-833-0996 Address: JP0 Box .1<609 S=dw3_C r lam. 02563 Alt. Tel. No.- 508,— 7% 47 OWNER'S INSURANCE WAIVER .I am aware that the Licensee does nothave the liability insurance coverage fly required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent. Own turf. t PERAflT FEE: $ 40.00. Signatnr+e. Telephone No. !C�N Commonwealth of Massachusetts Official Use Only VC Department of Fire Services Permit No. El- t - 020 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 111991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC�e 527 viR 12.00 (PLEASE PRINT IN INK OR TYPE ALL IXF:OR VL4 City or Town of: i/jj�,- By this application the undersigned gives notice of his or wo Location (Street & Number) ce Owner or Tenant t1A! E; Owner's Address k W U H a w rn a E Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service /P Amps /Z!! /�Olts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: TION) Date: Q" 57 an r To the Inspector<1nf Tvir '� //�� L/: �'U ' her intention a form th ectric 1lwork d rt152'd?low �X V, u i AU 2,4 200 ' Iephone,JN9,1 � i Yes No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd Q No. of Meters rmmnlotinn nfthe fnllnwinv table may be waived by the Inspector of lVires. 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 Above In- Swimming Pool rnd. ❑ rnd. ❑ i 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 No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonal No. of Alerting Devices Heat Pump Tons KW No. of elf -Contained No. of Waste Disposers _Number Totals: _ Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW b Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Key Security Svstems: No. orDevices or Equivalent o. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: ,laucn au"munul ucwu y ucjucu ui INSURANCE 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 d undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. a HECK ONE: INSURANCE 04 BOND ❑ OTHER ❑ (Specify:) ���/t?iC' L�I14/1r T (Expiration Date) stimated Value of El ctric Wo - (When required by municipal policy.) ork to Start: Q Inspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under the pal s an penalties of perjury, that the information on this application is true and complete. IRM NAME: LIC. NO.: OZ6 FAC icensee: Signature C. NO.: a ' H(If applicabl , enter "zxem t" in th license numf r lin J Bus. Tel. No.•, 3 Address: ��7v ;l Le o9_ e �' ' J'Alt. Tel. No.:�� Sd9 i'lr`�'�v =OWNER'S INSURANCE WAIVER: I am aware that the Lic nsee doe's 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. P0Owner/Agent P Signature Telephone No. PERetiIIT FEE: $ St)1+9��r1G D�p7, ti LOT 9 aZ/ •a 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 �FLLOOOD HAZARD ARE ATE REGISTERED PRO SIONAL LAND SURVEYOR NOTICE 20 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. 10 FOUND I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN. AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS iOF4H PI PERMI . DATE REGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 M AS —BUILT PLAN holmes and mcgrath, inc. ,�� t aF OF LOT 10 civil surveyors engineers and land ors PREPARED FOR g y 362 gifford street MILL POND VILLAGE falmouth, ma. 02540 NQ j IN Ao� YARMOUTH, MA JOB NO: 201197 DRAWN: LM SCALE: 1 "=20' DATE: 8-9-05 DWG. NO.: A2511 A CHECKED• TOWN OF YAR,P,AOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO B-05-1525 _ PERMIT ISSUE DATE ;_----005_: PROPO D ___.______ APPLICANT .'Frank Capra JOB WEATHER CARD --- --- - PERMIT TO ; New Construction ' AT (LOCATION) 100121CAMP ST Unit 10 ZONING DISTRIC R-25 Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 044.21.1.C10 I BUILDING IS TO BE: LOT SIZE CONST TYPEI 5-B I USE GROUP R-4 new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 05/31/05. REMARKS , CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 AREA (SQ FT) EST COST ($ I$141,600.00 I PERMIT FEE ($) 1$516.00 Centerville MA 02632 OWNER Villages ® Camp St., LLC ILDING DEPT BY 15087789669 ADDRESS 1600 Falmouth Road # 25� _ Centerville I MA 102632 Certificate Issue Date CERTIFICATE of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approved By Remarks BUILDING PLUMBING/GAS 3 [� ELECTRICAL ENGINEERING HEALTH 2 /4v mP1g1-nff1f SSE %) I/'1.3-02 FIRE z-0 WATER To be filled in by each division indicated hereon upon completion of Its final Inspection. 0 L or � TOWN OF YARiVIOt1fiH Building Department BUILDING ' (508) 398-2231 ext.261 PERMIT NO B-Wi525. PERMIT _-:_____ ISSUE DATE ; _ 6/27/2005 _ ; PROPOSE e - - - - - JOB WEATHER CARD APPLICANT Frank Capra ---------------------- -- - a PERMIT TO 'New Construction ' AT (LOCATION) 100121CAMPSTUnitio ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C10 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE O new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 05131/05. REMARKS AREA (SO FT) EST COST ($ $141,600.00 PERMIT FEE ($) OWNER Villages 0 Camp St, LLC BUILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville I MA 102632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY .:Note Progress •� ,//L ► F .01ram, Cipro, Linda From: Raiskio, Peter Sent: Wednesday, March 22, 2006 3:26 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 UNLY - tiU1LWIN(a Pt=KM11 �� = C = AP ICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department ` H 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508)._398-0836 Office. r u*nP��g l Zi F 8oar3ormailon yf='�y`^��3A..rta ��+b��n? ti{ A=i `•.ii�}+'�{•s "�—.�-�t.R,f,.t A'ssessarstJQp `ai7ent`ffr§ifoiri�ation r a r Y" tFe`�' XLy+'Iy-kawa.� +�sxnY.„1� Y'3y 4,,rYscS .Witt 9iy A a `Z 3 3'Fy �'l-�%t 4'. p S EermtUJVfx f I S"'''f ''__ �d t•''}°'?sYS�`^a �P,,�i#'.i'ti ^s. a 1i 3'L�✓'�i i ''ixyyn 1 eR'li ^5G-''h� '�F �' S uJ N'y�� ���±;I. tz �. e[n�i�6'a �i%"t•°Y4 }'!t�k. y ✓✓;;'a r'. xa� w S? j u 3 3 i f �x w L C S�!"�a^ �k. ..{ -+w 4. �rEx '• 1+'1 rl %n, V' yes a t 't �' a- ' Y3µr(f�€}_^ r0� NbF N, 6yVtrl �yPT-*�t'X nx2�T.4''b.�at✓•v �l'.'�M��'Y� �$Ir"i � 'G-I±.'� lj �83 �. %<�°o-*t ���`��+--;u�ii'y�,.T idB.tf1Q. r t:c" �"-`t'`"Ty-�"~ 'il'�,FItI10nS10nS-r1'� r•4. i `k-" , `�. r ,,_r m Yy x -•• `� ,�. `>'Sxi� .M. ..�.{ ♦ r' .� %.•i rµµs { i.z} M." "t�'. .vY ; �ta;s�`�y'�„x'4ps,:r i5 a, ;.S g ,y.- •3"f 'a.t�&'`aa'+' rTTY.XFr� .E��? xdY�"i.x4FAi h"ti rpW�nF P i� 4a e ft t Lti oyes e : �f.. .3t 93?.+.i�+�xj.� }•� `�' '��Nw rR ea d.5' #"%:. M+.'�i ' ^i b. �. .�.2.�y.:s.+�i�S b J .a �vthllt :� (_ �` ' P :�- sl't" . -._.; !x �"i.'"_�-��'"�kFY� ��^��✓i�Z'� geau��M„¢.i."�ae'uly�.{Z�w'�w�e�rs�<'.�r'ii""�., Si'_ i .i NA aAA tY J� S� i"�1"� £�{* ,.Y �y f"•.wjH i ', ©'�Yvf1'�'"L s'M./� L kY�ii.n.:..K4♦-'k F 4 3;,t4•Vim �N'�*sff1F. rin" f 2 iG iN'� 51glx�t P;iF I�di(,(� QtflCi2l �F�AA5 j SrD eo-yer'R cx %" a e O{��Ns 'rP Cllfed" r4 4 _ ..Y x ...� f " V. ��- ectiarl die",r�rztla Use Group: R 4 Tye: 5-B 1.1 Property Address: - 1.2 Zoning Information: Zoning District Proposed Use IZ �6 1.3 Building Setbacks. (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L e. 40. S 54) ManEalPublic Private B� fz�g• �S�crio 5 ropeu0�; � ers p �ut�i�at`z�d�,Age{rt 21 Owni\Q Record: �. f t G / 6 % /Ov ; R v - S [L i > NIme print} Mailing Address (22l^ r Vf 7 M4 J� Signature Telephone 22 Authorizeq Agent: ILnXJ1 OI i G/ 0 G L r Name�rint) (` A MailingO Address — g, a Signature Te ep one (1 Io (i Fax' II IL7 P V � 3.1 Licensed Construction Supervisor. J Li MAY 1 ZOOS -Not Applicable ❑ h 1 L . y t J License Number O o ✓�� Address -778 Expiration Date Si ature Telephone �"�I�e ster�i;' Q>a? roNer.�ent�,Ctiat�fl'�ac�tot,;; _ - Company Name Not Appli JUN 2 4 2005 License Number Address APT) BUILDING . By Expiration Date Signature Telephone 9 - 15 - 99 1 of 2 OVER Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial f the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... 5�ctn�'��Clescr�pt(ar�aFrop�seii3ilf%k.icheck-all�app�tcahtey' New Construction f I No. of Bedrooms No. of Bathrooms Ebsbng Bldg. ❑ Repair(s) ❑ JAlterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: r ` l l^ V►1 t In d A krt V 1 U, Item I 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 0/ Check Below I ❑ Conservation -Commission Fling ('d applicable) ❑ Old Kings Highway& Historical Commission approval ('d applicable) asowner of the subject property hereby authorize 13 d -e c_B. m beh , in all matters elative to work authorized by this building permit Application. o 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. Print name Signature of Owner/Agent Date EPA r 9-15-99 2 of 2 . oo G PLEASE PRINT.• Job Location: _ LN yr 'A.KMOUTH BUILDING DEPARTMENT CONSTRUCTION Owner of Property: V 1 Construction Supervisor: Address: .� Licensed Designee: (If other than Supervisor) Name Name 2.15 Responsibility of each license holder. SUPERVISOR FORM Village L.L G a�':�r08 966 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 onlypursuant 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 Anylicenseewho shallwillfullyviolate subsections 2.15.1, 2.1-5.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. . 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked yg,E, please indicate the type coverage by checking the appropriate box. A liability insurance policy (3000� Other type of indemnity Bond OWNER'S.INSURANCE WAIVER: I am aware that the licensee doesnot ham the insurance coverage required by Ao. Gener w , and that my signature on this permit application waives this requirement. Ch ck one: gent Owner gent Signature: Building Official Approval: aside The Commonwealth of Massachusetts Department of Industrial Accidents OBlee ollevestlystfom 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Ob phone ❑ I am a homeowner performing all work myselL ❑ I_ tm a sole proprietor _r d halve no one working in any capacity ❑ I am .an employer pro% idine workers' compensation for my employees working on this job. any Jdres city: nhnn� N ins insurance 19/1 am a sole proprietor. general contractor. or homeowner (circle one/ and have hired the contractors listed below' who have the following workers' Compensation polices: tiny: nhon # insurnnre co.. nnfin # comonny name address: city: phone tt eacture insecure coverage as required underSeetion 25A of MGL 152 an lad to the iepoaition of eriaasul paalties of a Ane ap.to Sl¢OO tl0 and/or one years' imprisonment as well is civil penaitiei in the form of a STOP WORK ORDER and a tine of S1100.00 it day against me. I andetstand'that a copy of this statement may be forwarded to the Office of investigations of the DIA for. coverage verifiadoa. I do -hereby certify un r the pains and penalti Of Perjury that the information provided above is true and correct k Signature Print name ��0.V., k official use only do not %rite in this area to be completed by city or town oMcial city or town: YARMODT$ permit/license x pe r'iBuilding Department check if immediate response ard D posse is required C3Ucensing Bo 261 i3Seleetmen's OMce COMM person: (]Health Department phonex;_ (508) 398-2231 eat. nOther . .. !,a." oF`•Ygk o � '0 TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH H MASSACHUSETTS 02664 4451 MATTACMCfS Telephone (508) 398-2231, Ext 261 — Fax (508) 398-2365 `6il,+p �[p„antuf� BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at oL i D J Work Ad4ress is to be disposed of at the following location: 1 a li✓r\ 4 f � Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. f�— - Signature of Applicant Date Permit No. �'` �1u �.xal!/s o�.�aaoadeacella BOARD :OE BUILDING -REGULATIONS- Lucense C�ONST.RUCTIOISUPERVISOR. Numb „ej,; 0124307 . Bert ffaafeAM— 40. MS-- 6F€612pQ6. Tr. no 25926 ResTaicte_3'`:i�t FRANK CAPRP(� `.��. 4iCQPPERtrt CEUTERVALLF— MA.0�63� commissioner 00 - 35;000 d•endosecispace (MGL C.1'12rS:80L) y.; `7 tA-Masopr'yoWy_.'.. y. Homes Failure to possess:i-cvrrentedition otthe , I : Ma.sadiusetWState.-Buildingt;dde . is iause fur:revocatibn of thirGcense. DIG. SAFE.CALL.CENTER: j888J344-7233 05105/2005 14:0..9. . 508-760.-1b67 EASTERN-INS-.YARMOUTH PAGE 01 • I TE SURANCE IABUF )ISCERTIFICATE DATE (MM/0Vtn'f ) PRODUCER Eastern Insurance Gr 1 Atlantic Ave So Yarmouth MA 02664 7OF'66 up LLC IS ISSUED ASAMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS -UPON THE CERTIFICATE - ...HOLDER. THIS -CERTIFICATE DOESOTAMEND, EXTEND OR -R ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS -AFFORDING -COVERAGE IN6URSD Cape Cod Custom 762 Falmouth Ro Hyannis MA 0260 .. Floors d INSVRERA. Arbella. Protection Ins Company INSURER-B- Hartford..-' WSURERa INSURER D'-- . BLSURERE- .. COVERAGE "' THE POLICIES OF- INSURANCE ANY REQUIREMENT. TERM 0 MAY PERTAIN, THE INSURAM POLICIES. AGGREGATEUMIT LISTED BELOVTHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHS A DIN CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE LMY-RE ISSIlEn AFFORDED BY THE POLICIESDESCRIRED HEREIN Issvexcr=ALL TrETERlMS; EXCLUSIONS AND'CONDITION3 OF SUES+ .SHOWN MAY HAVE BEEN REDUCED -BY PAID CLAIMS., INSIt DO' TYPE OFJNSUR E .... POLIFK NUMBER-... Pa Y FFECTIVE 12/13/2004 - _ . POLICY EXPIRATION_ 12/13/2005 _ _ - LIMITS A GENERAL LIABILITY. X COMMERCIAL ZENE CLAIMS MADE LIABLITY X_ OCCUR 7S00000373 -EACNOCCURRENCE 1.. 1 000 00 ELATED DAM PREuvzI S SO,Q - . MED EXr (Arty Vlie P*Sgn) _S_ ' S .0O PERSONAL&ADVINIURY S 1.000,000 GENERAL AGGREGATE, S 2. 000 00 _ .., GENT AGGREGATEpLqDT. PPLIES PER PRODUCTS -COMPIOP AGG S Z D00,0O )( POLICY JECpAT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEe emdent) ¢.. ANY AUTO BODILY INJURY (Perpenonl ALL OWNED AUTOS S64DULED AUTOS - .. BOOMM INJURY (fw accldwll) S HMO AUTOS NON -OWNED AUTOS .. ... PROPERTYAAMAGE (Pe.icNda41 - f GARAGEMABILITY - - - - - AUTOONLY--E4ACCIOENT S - OTHER THAN EAACC AUTO ONLYt_ AGG S_. ANYAUTO .. .... S "CESSA RAeLLA LIAR JTY ... EACH OCCURRENCE S- _ 1' ow, 000 X OCCUR Q IMSMADE 460002928S -12/13/2004- 1Z/33/2005-AGGREGATE s A RDEDUCTIBLE X RETENTION- S 10,00 ... W�ORKER5COMMUBATION EMPLOYERS' LIASKA'Y ___. � _ O&WECKL1007� OS/2S/Z004-- _.0S/2S/20OS- OS/ZS-/ZOOS - OS/2S./2.GOfi. � WC STATU• DTIL E1.EACHACCIOFM... S-... 500,00( B ANY PROPRIETORIPARTNE OFFICERMEMBEREXCLUDED? CUTNE - V.L: DISEASE -EAEMPLOVE S S00. 00 E.LDISEASE-PDLICYLMIT S... SOU. Nyea, de;- undo SPECIAL PROVISIONS OHPw - DESCRIPTIONOFOPERATIONS/LO Evidence -of insurance TIONS IVSHICLEB/EXCLUSIONS ADDED RYENDGRSEMENTJSPECIAL PROVISIONS " Y - ^A"^Cl l ATIMU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIONJ)ATE JNEREOF, THE-MSUMG INSURER WILL ENOEAVORTO MAW `10- DAYS WRITTEN NOTICE TO THE CERTWMATE HOLDER NAMED TO THE LEFT. GdteWOOd HOTTIes BUTFMLURE TO MAR SUCTI-NOTICE SHALL IMPOSE I6M NOOBLIGLTORLIABLITK 1600 Falmouth F 1 1125 OF ANY NINOUPON'TNE MURER. ITSAGEHTS(WREPRESEUTATIVM. AUTNoaI PREsENTAT YE Centerville, MA -OZ632 ACORD 2S (2001108). FAX: 1 .(508)778-5603-- - L,,'- � Q7ACORD CORPORATION 1905 9ecs(IRANCFcn A ORM CERTIFICATE OF LIABILITY INSURANCE 1010410 °�""' PRCOUCER Dowling & O'Neil Insurance Agency, Inc. 222 West Main St. PO Box 1990 Hyannis, MA 02601 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 Assurance Construction, Inc. NO Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A. Travelers Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: v 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 (MMIDDfM POLICY EXPIRATION MM DD LIMBS A GENERAL UA31U Y X COMMERCIAL GENERAL LIABILITY 16808387A9841ND04 08/01/04 - 08/01/05 EACH OCCURRENCE $1 000000 DAMAGES ( RENTED s300OOO MED IXP (Any one person) $5 000 CLAIMS MADE O OCCUR - PERSONAL s ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG s2000000 POUCYF-J PE0. LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ee accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ OTHER THAN EA ACC $ 11 ANY AUTO $ AUTO ONLY: AGO IXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ �F� $ DEDUCTIBLE RETENTION $ OTH- STATU$ WC ER WORKERS COMPENSATION AND _LIMIT E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE s E.L. DISEASE. POLICY LIMB s K yas, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I 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 (2001103) 1 of 2 #35866 LID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL in DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL HE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR AUTHORIZED .-.-;: v�-ly-ua peoouceR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING & 0 NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 WEST MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 1990 COMPANIES AFFORDING COVERAGE HYANNIS MA 02601 COMPANY 22LGR A ST. PAUL FIRE AND MARINE INSURANCE COMPANY INSURED �� COMPANY HP BUISNESS SERVIC9S INC Assoc a-ncc eoAs1rvdi B 118 WATERHOUSE RD COMPANY SUITE E /' �� C BOURNE MA 02532 � �CEG.ax COMPANY D 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. IATYPE OF INSURANCE I POLICY NUMBER I DATE (MPOLICY EMWDIYY) I DATE (MMD m FFECTM POLICY NI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE = OCCUR. OWNER'S & CONTRACTOR'S PROT. - GENERAL AGGREGATE Is PRODUCTS-COMP/OP AGG. $ PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per Person) $ BODILY INJURY (Per Accldenq $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: .................................... .................................... .................................... .................................... EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ A WORKER'S COMPENSATION AND EMPLOYER•s LIABILITY THE PROPRIETOR/ X INCL PAK i 1ERS/EXECUTIVE OFFICERS ARE: EXCL 12-24-04 12-24-05 ' STATUTORY UMTS .......................... -` EACH ACCIDENT EACH $ 100,000 DISEASE —POLICY UMM $ -500 000 DISEASE —EACH EMPLOYEE $ 100.000 COVERAGE RESTRICTED TO LEASED EMPLOYEES OF ASSURANCE EXCAVATION INC THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. AUTHORIZED REPRESENTATIVE Date: 5/5/2005 ,TlMes 3:02 FM TO: @ 15057735603 f46n4lr• *A.'kgQ Page: 002.003 CAPFCOORFADV ACQRD- CLI 'CERTIFICATE OF ABILITY INSURANCE D5/ :'Y""Y' PRODUCER ITHIS The Feitelherg Company 222 Milliken Blvd. RET: Box 3220 Fail River, MA 02722 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE -CERTIFICATE - HOLDER: THIS CERTIFICATE DOES NOTAMEND; EXTEND OR - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Cape Cod Ready Mix Inc. PO Box 399 Orleans, MA 02653 INSURER A. Acadia Insurance Com antes INSURER B: Construction industries Compensation 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. NOTWITHSTANBWI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR -OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUEOOR_ MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDMONS OF SUCH POUCIES. AGGREGATE UMRS SHOWN MAY HAVE BEEN REDUCEQBY PAID CLAWS, LTR TYPE OF INSURANCE POUCYNUMBER LIE (MM1ECTIVE PDA X IRATION LIMITS A GENERAL LIABILITY X CCMMERCALGENEPALLIABIUTY CLAIMS MADE al OCCUR CPA013246810- _ Oi(Q?f 5 01"/$t/06.. - EACH OCCURRENCE S1 DOO ODO DAMAGETORENTED $100000 ME EXP (Arty we Px n) S5 000 -PERSONAL & AOV INJURY $1 000 000 GENERALAGCREGATE S2 000000 GEN'LAGORFGATE PCUGY UMIT APPLIES PER: PRO- LOG PRODUCTS -COMPIOP AGG $2000000 A _ AUTOMOBILE -LIABILITY ANY AUTO ALLOWNFOAUTCS SCHEDULED AUTOS HIREDAUTOS NCN-ONNEOAUTOS MAA013246910 01101IM 01/01/D6 . - COMBINED SINGLE LIMIT (Eaaoatlerit S1:�A09 BODILY INJURY e p-P; S X X BODILY INJURY - F�acdtlemJ S X -PROPERTY DAMAGE Per ac$dom) GARAGE LIABILITY .ANYAUTO ' _ _ '- AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGO S S A EXCESSAUMBRELLALIABILJTY _ X OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION $0 CUA013247010 01_/01/06 _ 01/01/06 EACH OCCURRENCE S1000000 AGGREGATE S s S B WORKERS COMPENSATION AND EMPiQYE47r UAaIUTY-- ANYPROPRIETORPARTNER/EXI!CUTNE_ OFFlCB:kWMBEREXCLUDED7 If Yes, c'I be under SPECIAL PROVISIONS ba!o WC0009255 01/01/05 01/01p6 X STATU• DTH- E.L. EACH ACCIDENT $500000- E.L. DISEASE - EA EMPLOYE r50-O, - E.L. DISEASE - POLICY LIMIT _ 55000w OTHER DESCRIPTION OF OPERATIONS / LOCA71ONS [VEHICLES (EXCLUSIONS ADDED-BYENDOASEJRMI WECtat PROVISIONS ' Gatewood Homes Inc. - 1600 Falmouth Road Suite 25 Centerville-, MA 02632 LD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION THERCf ,THEISSUINGINSURER-WILLENDEAVORTO MAIL _%-� DAY&WRRTEN-, E TO THE C:RTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ,E NOOBUGATION OR LIABIUTY OF ANY KIND UPONTHE INSURER; ITSAGENTS OR AGUKLTZS(ZOOI/0311 o12 - #IS68995/M66526 AH1' O-ACORD CORPORATION 1988 05/06/2005 09:38 5084204474 EDWARD A GRAZUL ACOR©,v - CERTIFICATE OF LIABIUTY.Ii�I&URANCE_ THIS CERTIFICATE IS ISSUED AS A MATTER OF PRODUCER ONLY AND .CONFERS NO RIGHTS UPON! THE d A. G5aa11.1rlsla�lce • Tj ^�7.T Z HOLDER. THIS CERTIFICATE 'DOES NOT AMENI ALTER THE .COYERAGE_AFFOHDED :BY THE POI P:0 KC 331' Marstcns MLUsT m WA8 1NSURERSAFFORDING-COVERAGE 8teubm 0u1& ` 145 Camett Pcad . Marstczls Mills, � (�+8 I :OVERAGES THE POLICfE&OF INSURANCE LISTE ANY R£OUIREMENT, •TERM. OR COr MAY PERTAIN, THE' INSURANCE.AFF LIABILITY MEPC IAL GENERAL LIABILITY CLAIMSMADEQCCUR PAGE 02 NAIC F INSURERA:---M _C& alt IN — �INSUEIERQ.. ... •. (N.NREPI Q' - .. - . rp EI pW }LAVE SEEN MSUED TO THE INSURED NAMED ABOVE. FOR THE PCL.ICY PERIOD INDICATED. NOTVOTHSTANDRVG. N OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO"YO CH'THIS CERTIFiCATLL :AAA-K 8E ISSUfiD.�fl-. D SY THE POLgES-t)g%R(BEDHEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH Y HAVE BEEN REDUCED BY PAID CLAIMS. - '— POLR,ryEFTT:OTIYE yOLICVL'XPIRXTON- UNITE OOLIC7 NUMBER EACH OCCURRENCE f TlA/!L}M. — PREMISE9 (E0-y��Ce) -- ,AlY1f� . . GRFAATELNRAPPlIEB PEA' � •`^""'^'�' ANY AUTO ALLOWNED AVTOS SCHEOULEDAUTOS [ HIREDAUTOS IIl NON-OWNED.4LROS — GARAGELIABILRY ANY AUTO 4 I EXSSMRELIABILITYUER' AW oEDUcnBLE RETENTION S Womifts cDMPENBATIONANO . . EMPLOYERS•UASHIT/ ANY PAOMIETOArPARTNERIEXECUlIVE OFFICE W MEMMI% EXCLUDED? 11y,Iee�A weCAM,MtlN S—'Cw. PROVISIONSvelo I OTHER Gate wow H=93" Imc Cf0 BdLTOaer-M311 Rte 28 CJalt€z aleT M4 02632 FAx:. 1-508-778--%03 COMBINEDSINDI.E LIMIT � — BODILY INJURY S (Pxwr i .— BODILY WJUPr ODILYb PROPERYYD'LLDCBE... I (Pet Aeddern) 48 AUTO ONLY-EAACGDEM i EAACC S .ANGL-LL:RYtLIrF... . SHOULD ANY OF THE ABOVE BeeCIROW TOLMMS BE 9ANOELLEO BEFORE THE EXPIRATION DATE THEREOF: THE ISBYWE.R✓tORER PALL EROEAYOR TO MAIL —DAYS VA%rrEN MWICfi TQTHE CERTIRCATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE 40..0eLIC11:1100-09 LIABILITY OF. ANY. KIND UPON THE INSOPER: RYAGENPS-GR- REPRESEMA71YE3. -. . IWTHO%ZEDR%rRESEMAT^E , . CERTIFICATE OF INSURANCE 0510600 MMID D,YY) PRODUCER Harold H Williams IRS Agey Inc 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 81 Bassett Lane POLICIES BELOW. Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE INSURED Stephen M Childs 145 Carllmett Road COMPANY A.I.M. Mutual Insurance Co LETTER A 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 CONTRACT OR 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATIO DATE(MM/DD/YY) LIMITS GENERAL LIABILITY IGENERAL AGGREGATE S PRODUCTS-COMP/OP AGO. S COMMERCIAL GENERAL LIABILITY - LAIMS MADE[�CCUR PERSONAL&ADV. INJURY S EACH OCCURRENCE S OWNER'S& CONTRACTOR'S PROT. FIRE DAMAGE (Any om fire) E MED. EXPENSE (Any om person) $ AU!'OMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT - S S BODILY INJURY (Per pemn) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS - PROPERTY DAMAGE $ GARAGE LIABILITY !EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE S I MBRELLA FORM THER THAN UMBRELLA FORM VOI0' " COMPENSATION AND X A RY H A IPLOYERS' LIABILITY HE PROPRIETOR/ INCL 7015793012004 12/13/2004 12/13/2005 EL EACH ACCIDENT $ 100,000 EL DISEASE —POLICY LIMIT $ 500,000 ARTNERS/EXECUTIVE FFICERS ARE: X EXCL EL DISEASE —EACH EMPLOYEE $ 100,000 OTHER. DESCRI MION OF 01'ERAI'IONS/LOCATTONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gate1V00(I Homes DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE MAIL LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Bell Tower Mall Rte 8 LIABILITY OF ANY HIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. -. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 ACORL). CERTIFICATE OF LIABILITY INSURANCE ° ATE 004 PRODUCER Serial # A1530 - ROBERT P. BIXBY, CPCU 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 P.O. BOX 830 -651 PUTNAM PIKE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GREENVILLE, RI 02828 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NAT'L FIRE INSURANCE CO. OF HARTFORD INSURER B: VALLEY FORGE INSURANCE CO. HOLMES AND MCGRATH, INC. 362 GIFFORD STREET INSURER O: CONTINENTAL CASUALTY CO. FALMOUTH, MA 92540 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAR) CLAMS. Bert ITR Allot TYPE OF INSURANCE POLICY NUMBER - - POLICY EFFECTIVE EXPIRATKN PODLAITCEY - LIMITS A GENERAL LUIBIIJTY X COMMERCIAL GENERAL LIABILITYDAMAG CLAIMS MADE 0 OCCUR - 1074082434 10/06/04 10/06/05 EACH OCCURRENCE $ 1,000,000 Sj% � . $ FIRE 250,000 MEDEXP (Any one $ 10,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000 000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO S 2,000000 PRO- LOC POLICY M AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY per pe) $ HIRED AUTOS NON -OWNED AUTOS .. BODILY INJURY (Per accidellq $ (Peraxidellf) GE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ OTHERTHAN EA ACC AUTO ONLY.. AGG S ANY AUTO $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE S $ DEDUCTIBLE $ RETENTION ,S B WORKER'S COMPENSATION AND EIAPLOYERW LIABILITY ANY O CERIMEMBER�EXCLUDED? 2057445273 09/01104 09/01/05 x TORY WPC STATU IMIT TH- EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE S 1,000,000 a DISEASE - POLICY LIMIT S 1,000,000 MM yyeess� describe under SPECIAL PROVISIONS below OTHER C PROFESSIONAL LIABILITY AEA 00 43133 38 07/13/04 07/13/05 $1,000,000 PER CLAIM/ AGGREGATE DESCRIPTION OF OPERATIONSdDCATIONSNENILY.ESJEXCLUSIONS ADDED BY ENDORSEMENTISPECWL PROVISIONS AGGREGATE LIMITS ARE PER THE TERMS AND CONDITIONS OF THE POLICIES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN GATEWOOD HOMES, INC. 1600 FALMOUTH RD., STE. 25 CENTERVILLE, MA 02632 NOTICE TO THE CERTIFICATE HOLDER NAMED TOTHE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHOR RFPRE ACORD 25 12001108) c -/ VYMVVIW VV,It VMIIVI� .wv C-.TMPROCERTPROS.FP5 ACORD ... CERTIFICATE OF LIABILITY INSURANCES DATEIMMIDOMM 514/05 tNLYAND PRoqucEa United Insurance Agency, Inc.Ina 194.Main Street THIS CEITnRCATE IS ISSLEDASA MATTEROF INFORMATION COWERSNORIGHTS UPONTHECERTFlCA-T-E... MMOM-�E�MATEDOLS-NGF+AMENBLE74T88OR- ALTBRTHECOVEPAGEAFFORDEDBYTHE POLICE BELOW' P.Q. Box 1013, Buzzards Bay, MA 02532 INSURIM AFF0FVNG COVERAGE MOM INSURED - Patton $lactric, Inc. INSURER A. Zurich NA .... INSURERB:Liber Mutual ins. Co. INSURER6'. 128 Scituate Road INSURER0: Mashpee, MA 02644 THE➢OLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T EINSUREO NAMED ABOVEFOR THE POLICY PERIOD INDICATED. Ng7WITHSTANOING ANY REDUfREMENT, TERM OR'CONDITON OF ANY CONTRACT OR:OTHER DOCUMENT WITARESPECT T) WHICtl.THi3 CERTFICATE2MY BE ISSUED OR EREIN IS SUBJECT TO ALL THE TERMS, E MAY'- PERTAIN -THE INSURANCE AFF.OROED BY THE POLICIES DESCRIBED H1af'LUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMSy GENERy-X 7/80/04 7/30/08 A, cpuCNO CLAMS MAOE OX OCCUR GEN1 AGGREGATE UTAIT APPLES PER_ X POLICY JCCT ' �� AUTOMOBLELLAMILRY ANY AUTO : ALLOVWMAUTOE '. SC+IEDULED AUTOIL ... NTIEDAUTOS NON-a%Hw-AuTOS. ANY AUTO PU NI:N)tMODD- REMISEE saotvwos MEDEILPI"V* !w 3 10 000 FERSONALAADVINAIRY S I,.000,,.GDfl__ GENERALAOGREGATE 3 2,000,000 EYCESSNMBRELLA LMBILITY OCCUR CLAIMSNAOE .. IDEDUCTMUR RETENTION 3 WOef BRS COMPENSATION ANO g EMILOYEIe•LMa1LTY WC23133530490-14-.. 12/1OL04 .. i2./.1D/05 ANYPROPR IETORIPMTNERMECUTNE OyFyeeFPPICERINEM BER E=U=M SPEOARDV190V SE9bw X OTHER Electrical COMBINED SINOLE LIMIT s . IE..xw.M GODLY INJURY 3 IPa perwry Ry PROPERTYDAMAOE 3 (Pw w worn AUTO ONLY. Ef NT 3OTHER THANA00 3nUTOONLY-.AGO 3 A nr.C,1RRfTIGE 0 3 3 EA eMKOYEE S PoUCYUMIT Is I FIVLYG,\ ENOULD ANY OF THE ARM DF9CRIBED pOLICESBE CANED CELLBEPOR[TNEEXPBIATON Gateway Homem, Inc. 1.600 .palmouth lid. , unit Z5 PATETNEREOF,TNEmunwzMEN 3URERwLLDEONDRTOMAIL 1� DJ,Y3wRRTEN fax 509-778-5603 NOTCETO THE CERTFN:ATE MOLDER NAMED TO THE LOFT, BUT FAILURETODOB01RAM Centerville, Ada 02633 wroSENOODUM"DNOxfTABiuJYOrUYKIND UPON TNER+4BBERLTSABEHT$OR a�DATE(MMIDIIIYY)NE 9 BILYaNSURA/04 .: ,-A-CORE. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chatfield, Whitman & Young HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 549 Washington Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 850963 COMPANIES AFFORDING COVERAGE Braintree, MA 02185-096 COMPANY q Harleysville Worcester ins Co INSURED t Lawrence Robinson Masonry COMPANY - B 5- Fresh Hole Road Hyannis, MA 02601 COMPANY C ' COMPANY D 7777777777777777 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 L7R TYPE OF INSURANCE POLICY POLICY NUMBER EFFECTIVE YY) DATE (MMIDDI POLICY EXPIRATION DATE (MMIDDIYY) LIMITS - GENERAL AGGREGATE $ 2,000,000 - A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE aOCCUR OWNER'S& CONTRACTOR'S PROT CB 7E 32 32 9/07/04 9/07/05 PRODUCTS-COMP/OPAGG $ 2,000,000 PERSONAL &ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any one (re) $ 100,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS .. BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY ANY AUTO ' _ AUTO ONLY -EAACCIDENT $ OTHER THAN AUTO ONLY: - EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY - EACH OCCURRENCE $ AGGREGATE $ WC STATU-IMOTH- oRRYLITS ER $ .: ' EL EACH ACCIDENT $ EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTP, OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gatewood Homes EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1600 Falmouth Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 25 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABI Centerville, MA 02632 of ANY KIND UPON THE COMPANY E SENTAWES. AUTHORIZED REPRESENTATIVE Robert E. Chatfield ACORD"35S (1/95j ;.. �.......,., oACORD7CORPOFfi4CION,1988' "A)CORD. CERTIFICATE OF LIABILITY INSURANCE Ro 6 09-27-2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 210706 P: (877)287-1312 F: (877)287-1315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 308 FARMINGTON AVE INSURERS AFFORDING COVERAGE FARMINGTON CT 06032 RVSURED - - INSURERA:TWln City Fire Ins Co % INSURER B: LAWRENCE ROBINSON MASONRY INC INSURER C: 5 FRESH HOLE ROAD INSURER D: UVATTATTC MD n,;,A i 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 POLICYEFFECTIVE PoL/CYEXP/RAT/ON Lµ}?S POLLCYNUMBER DATE MM D ATE MM D EACH OCCURRENCE a RrLL4BILfry ABILITYFIRE DAMAGE (AnY one fire) 8 OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY ! a GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG ! POLICY PR0. 71 LOC ALLTOMOBBELLABILLTY COMBINED SINGLE LIMIT (Ea accident) 3 ANY AUTO ALL OWNED AUTOS .. - _ - +.')Per BODILY INJURY person) a ,SCHEDULED AUTOS HIRED AUTOS - - -BODILY - INJURY (Par accident) !.. NON -OWNED AUTOS PROPERTY DAMAGE- (Par. accident) ! AUTO ONLY - EA ACCIDENT 3 LIABILITY E AUTO OTHERTHANEA ACC AUTO ONLY: AGG 3 ! JGACRAE L/ABBITYCUR © CLAIMS MADE EACH OCCURRENCE AGGREGATE - 0 3 DEDUCTIBLE RETENTION - ! X WC STATU-LIMITS OTH- ER a A WORKERS COMPENSATLONAND EMPLOYERS'LLABBm 76 WEG NQ5620 09/06/04 09/06/05 E.LEACH ACCIDENT 1100 000 E.L. DISEASE - EA EMPLOYEE a10 0 , 0 0 0 E.L. DISEASE - POLICY LIMIT a500 000 OTHER DESCAMWON OF OPERA TKINSAOCATLONS VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROWSLONS Those usual to the Insured's Operations. GATEWOOD HOMES 1600 FALMOUTH ROAD, SUITE 25 CENTREVILLE MA 02632 ACORD 25-S (7/97) OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE 00 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR COR A D CORPORATION 1988 12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC UO2 a�7 a 0Ro_ 'CERTIFICATE OF LIAMLITY41 SURANCE CSR AW _ _- -- -_ -_ TAVAN50 12 02 04 PRODUCIA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOLDNAN & ASSOCIATES INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINANCIAL SKIWICES INC. HOLDER: THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 933 FALXOUTS RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HYANNIS NA 02601 Phonol508-715-6010 Fax-.508-790-0249 INSURERS AFFORDING COVERAGE NAICS INSURED INSURERA: MARYLAND CASUALTY COMPANY INSURER B: - RODY TAVANO IHA CHANICAL SYSTElKB DBA POi INSURER C: INSURER M. 110 EOLDER LANE TQ EMNSTABLE NA 02668 INSURER E THE POLICIES OF INSU LANCE LISTED BELOW HAVE BEEN L45UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RrAU1ROArNT. TLRLL OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN: THE INSURANCE AFFORDED UY THE PQLICIES DESCRRED HVRVN IS SV&IECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR NSR TYPEOFINSURANCE POLICY NUMBER DATE (Iflifflign DA E MMA7 — _ UMITg- __ - A GENERALLU9RITY nco, MENCIALGENERALLIABILITY DE CUJMS MA'OCCUR 000372088 11/21/04 11/21/05 EACH OCCURRENCE $1000000 PREMLsEs(6.,.,m) s 300000 MED E%P (Any one Perron) s 1000 0 PERSONAL A AOV INJURY- 31000000 GENERAL AGGREGATE s 2000000 GEM AGGREGATE LIMIT APPLIES PEft POLICY JEPRO- CT LOC PRODUCTS -t:oMPIOP AGG s 2000000 AUTOMOBILL: LIABILITY ANY AUTO ALLOWNEB AUTOS SCHEOULEDAUTOS HIRED AUTOS NON-OWNEOAUT05 - COMBINED SINGLE LIMIT (Ea a=derdl S GODLY INJURY (PSPers.l) S BODILY INJURY IPemmici l) S PROPERTY DAMAGE "w amaenQ s 0APA011LIAWLRY ANYAUI'O - ALTO ONLY -EA ACCIDENT s-- OTHERTHAN EAACC AUTO ONLY: AGO S s F]ICESSIUM11RELLALIABILMY OCCUR CLANS MADE DEWCTIBLE RETENTION. S-.. .. _ -.. __ _ .__. -_ _._. _._. -_.__ EACH OCCURRENCE s AGGREGATE s s _. _.. s s . MF WORKERS COEIISIITION AND .'EMPLOYERS LIA -ITY ANY PROPRIETCRA-ARTNERIEXECUTIVEERUI OFFICERWEMSCLUDEDT SnrPaO=1lsy.ta„ TORY LIMBS ER E.L EACH ACCIDENT s- E.L.DISEASE-EA EMPLOYEE S ELOISFULSE-POLICY LIMB S OTHER DESCTIATIONGpFfRATIL`NS/LC'.ATfCif81 VEf1»iF3ltE �^.L ]E>�'FROYgIQN?--- OD-EOMIS INL�_ FAX 508-778-5603 1600 FALNODTH ROAD SUITE 25 CzNTERVILLB NA 02632 SHOULD ANY OF THE ABOVE DESCRIBED FOLICES BE CANCELLED BEFORE THE E MRAnON MATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYSWBITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LUMITY OF ANY KIND UPON THE NSURER TTs AGENTS OR nzlsIT L.1•ax naz LZVZv 07.774VVA 1v:J5 LIYVP. VVY/VVY Pax r7Cz"VCz" tj'— it i /1\/VRi�I. (/��iF1T--1\ PRODUCER DATELMMWOIYYi -06-05 THIS CERTIFICATE IS ISSUED AS A MATTER- OFINFQRMATIOW� ONLY -'AND- CONFERS- NO - RIGHTS •UPON. THE--CERTIRGATE— GOLDI4AN & ASSOC INS, FIN .HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 933 FALMOUTH RD ALTER—TH€COVERAGE-AEFORDERBXTHEPOLICIESBELOWL..- RTE 28 - HYANNIS MA 026012319 COMPANIES AFFORDING COVERAGE COMPANY - 28HPP A"'AMERICAN- ZURICH' INSDRANCE'COMPANT INSURED COMPANY- TAVANO, RODNEY DBA B•' MECHANICAL SYSTEMS 201 CAPES TRAIL AESI-BARNSTAOLE MA 02668 - COMPANY MP COMPANY D. THIS 1S TO"CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T}IE INSURED NAMED ABOVE -FOR THE.POLPLYPEFWD— INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE ' -CERTIFICATE-MAY SEISSUMOH.MAY PERTAIN,T14EJNSURANC—AFEORDEIIBILTHEPQL)CIESIIESCR)BED HEREINAS SUBJECT TOALLTHETERMS. EXCLUSIONS -AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LT TYPEOf INSURANCE POUCY"NUMSEA .-.. _ POLICY EFFECTIVE QkTET DOYY)"_ POLICY EXPIRATION DATE IMARDBLYYI- _ _ .LIMITS GENERAL UABIUTY GENERAL ACCREW. E $ — COMMERCIAL GENERAL LIABILITY 77 CLAIMS MADE Q OCCUR _ PRODUCTS-COMPIOPAGG. $ PERSONAL B ADV. INJURY $ CHOCCORRETYCE'' S- OWNER'S A CONTRACTORS PROT. FIRE DAMAGE (Any oie fire) S WED. EXPENSE(A-rry me person) S - AUTOMOBILE LIABILITY ANYAAUTO "" ' - - - COMBINED SINGLE IiMIT..... . L BODILY INJURY ALLOWNEDAUTOS ... SCHEDULEDAUTOS- - - (Per Perw). S INUURY (Per Accident) (Per Accident) - $ HIREOAUTOS N9N.OWNED�IU_ - _ PROPERTY DAMAGE S GARAGE,UABIUTY _ -, AUTO ONLY - FAACCIDENT S. OTHER THANAUTOONLY: ANY AUTO. - EACH ACCIDENT S . .. ... AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM _ AGGREGATE S OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLONERS.LIABLLQY (UB-727BA84-9-05) _ 05-03-05 05-03-06 - STAMORY LMRS _ EAC14ACCIDENT S TOD 00.0 THEP,ROPRIETOR/ . PARTNERS(EXECUTIVE INCL DISEASE-POLICYLMIT S 500 000 OFFICERS ARE: X- EXCL DISEASE —EACH -EMPLOYEE -- - - 100, 00.D oQIHER_-. - .. ... D CHIPTION OF OPERATIONS/LOCATION&VEHICLE&RE$TRICTION&SPECIAL.ITEMS - THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. G E}iFIGATE HQLDEfi .,.....mow.. _...,,._ .v.... ..., ....,... ..,._... ..-_, .....:. -. CANCATION . K , . .. W.ELL.. ..,._ .. _ ..... „__ ,....,..;c ...., . ........,...._„ } SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; THE ISSUING' COMPANY WILL: ENDEAVOR TO MALL GATEWOOD HOMES INC 1600 FALMOUTH RD SUITE 25 -10 DAYS " " WRITTEN MOPICETC-RECERM7CATE-HOLDERNAMEDTOTNC LEFT�SUT. FALLURETQ- MAILSUCH..NOTICE.SHALL IMPOSE NO. OBLIGATION 29 CENTERVILLEMA 02632 LIABILITY OF ANY KIND UPON THEECOMPANY, ITS AGENTSOR REPRESEMTA'ITV . ... - AUTHORIZED REPRESENTATIVEjf. of �� TOWN OF YARMOUTH Building Department _ Town Hall e Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-608 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 10 Owner's Name: Villages @ 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.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: ZONING APPROVED Q IEWED BY: WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: XALTH DEPARTMENT: DATE: N/A: BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/23/2005 ••+�c.vu►T�pN FOR PER W Ad — 8s6 297,, Zraw T Kj 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., #10 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. �AlX"t , Owner (Sign) Reference : Villages ® Camp St., LLC : 1600 Falmouth Rd., #25 : Centerville, MA 02632 Ya uth Water Department TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-608 Applicant Name: Frank Capra Applicant Phone: Building Location Owner's Name: Owner's Addres 5087789669 00121 CAMP ST Unit 10 Villages @ Camp St., LLC 1600 Falmouth Road # 25 (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: Map/Lot: 044.21.1.0 new construction: Centerville MA 02632 Ca n�a D Owner's Telephone: (508) 778-9669 MAY `� 4 2005 REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: 6 i3-0 o5— N/A: 5. BUILDING DEPARTMENT DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 5/23/2005 TOWN OF YARMOUTH Building Department Town Hall a.. a Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-608 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 10 Owner's Name: Villages @ 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.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Comments: new construction: Map/Lot: 044.21.1.0 REVIEWED BY: A. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: 4. HEALTH DEPARTMENT: DATE: 5. BUILDING DEPARTMENT: DATE: 6. FIRE DEPARTMENT: DATE: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: N/A: N/A: N/A: N/A: DATE: Date Printed: 5/23/2005 r�'.�`� \ ^^ Cr Ati �� 4n 2 06,41 6, ryN A v OQ�OGPv . ^� .3• 3.21 q10, h^� 63 /per O O ry�rOQY oyQQ• � pQa R n,� O LOT 10 h s 6 41.0 Qom .� � ti S o0 0 ,CP Q L-35 R_25 � C5 4 �v 00 8" fir- Ci SOR0;��,'.,".�t?ot1 Of F ..'. fill t £L S �`\ • NOTE: °�L I ® SEWER LATERAL SHALL BE p� SLEEVED IN ACCORDANCE TITLE V IF GRAPHIC SCAE y 1, .:� OFT. OF WATER MIAINN 20 10 0 20 Ov��G\ �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 p.rscn or persons, including any municipal or cth, IN FEET public officiuls, may rely upon the Information contained here-i; u-ld 1 inch = 20 M (©) this plan remains the property of Holmes ti WGr.tn, inc PLOT PLAN holmes and mcgrath, inc. OF LOT 10 civil engineers and land surveyors r „- PREPARED FOR iF MILL POND VILLAGE 362 gifford street j r; falmouth, ma. 02540 %) yt s, ""l �a <'%. YARMOUTH, MA ,loB No: 201197 DRAWN: LMC b n 0r,a� SCALE: 1"=20' DATE: 1-5-05 IDWG. NO,: A2511 CHECKED: `] . I. MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck Software version CITY: .Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 HEATING SYSTEM TYPE: Other DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Sandpiper PROJECT INFORMATION: Mill Pond village Camp Street -- OYu� to Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 223 Your Home = 138 2.01 Release 2 Family, Detached (Non -Electric Resistance) i I Permit # I I I I I checked by/Date I I I Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 845 30.0 30.0 14 WALLS: wood Frame, 16" O.C. 1415 15.0 15.0 62 GLAZING: windows or Doors 93 0.340 32 GLAZING: windows or Doors 80 0.340 27, ` DOORS 40 0.086 3 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design Conditions found in the Code. The HvAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. Builder/Designer Date a 11 Massachusetts Energy Code MAscheck software version 2.01 Release 2 The sandpiper DATE: 4-21-2004 C] [] CEILINGS: 1. R-30 + R-30 Comments/Location WALLS: 1. wood Frame, 16" o.C., R-15 + R-15 Comments/Locatio WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Locatio 2. u-value: 0.34 For windows without labeled u-values, describe eafeatures: C ] No # Panes Frame Type comments/Locatio DOORS: 1. U-value: 0.086 comments/Locatio AIR LEAKAGE: joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. J —w. a+ oho-3 PRODUCT SPECIFICATIONS GMS9/GCS9 SERIES 93% AFUE Multi -Position, Single-Stage/Multi-Speed Gas Furnace Heating Capacity: 46,000-115,000 BTUH 11FEnNIE�� W IMTED P RiS LIMITED RAT,. Eye WARRANTY. hT' � k (r\ �ama a na ....® < 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 heatingicooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent (I-pipe)applications 9I9I.12219 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 OOA) • 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 (EFROI) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Internal Filter Retention Kit—upflow, horizontal (RF000180) • Internal Filter Retention Kit—downflow (RF000181) ' 1 - • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) SS•377D w .goodmanmfg.com M Mrussztt MPD3530 MPD4035 33' fireplace w/opt. flush face 3S' 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'11 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 3 3 " 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. MPD4540 MPD4035 • Louvered face design • Charred split oak gas log set • Deluxe pan burner for big yellow flames and glowing embers • Charcoal black exterior powder coat finish • Realistic brickaded interior panels • Combo to rear direct -vent outlets (except 3328 models, which have either a top or rear outlet) • Hi/Lo flame operation • Pre -wired for wall switch • Choice of standing ppilot (works in a ower failure) or pilotless electronic intermittent) ignition • Decorative polished brass or brushed stainless accessories (arch door kit, door trim, louvers, hood) • Wireless remote controls • Blower kits (including a temperature control version) • Screen panel kit (heat guard) • Radiant panel kits (for a clean face look) ,s Series direct -vent gas firepplaces utilize either ter or coaxial (rigid) SecureFlex (flexible) 4.5' to venting system, and include a warranty. e to Lennox' ongoing commitment to quality, ms, ratings and dimensions are subject to ut notice. ditions, such as elevation, wind vent condign - nice of fuel will affect the overall appearance Hersey U20006711) Warnock Hersey C ■—�4' US The fast two model number digits indicate frame width, the last two digits indicate glass width. All are A.F.Ul. rated high efficiency vented gas fireplace heaters, certified under 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 only) D 1 673N8" 7-1/Y' 41lY' E --� Front Face Top 35,40 & 45 MODELS (These models come with a top and rear vent) �—G � C C B -,rr' 4,IY• 1 Right Side Front Face Top Right Side FIREPLACE & FRAMING DIMENSIONS /8 211/z 103/4 33N 33N 13 3530 351/s 321A 19 291/t 351/8 211A6 2478 12%6 351/4 35t/4 16 4M5 401/8 37;'s 24 341/z 40t/8 2611h6 29T/8 1415h6 40i/4 40t/4 16 4540 401A 37t/s 24 39% 451/s 26% 34h 17%6 451/4 401/4 16 3328T NG 17,500 45 64 62 3328T LP 17,500 49 66 64 3328R NG 17,500 53 63 61 3328R LP 17,500 55 66 64 3530 NG 20,000 53 64 62. 3530 LP 20,000 55 62 60 4035 . NG 27,000 59 69 67 4035 LP 27,000 60 69 67 4540 NG 29,000 59 69 67 4540 LP 29,000 59 69 67 *Intermittent ignition systems Look for the EnerGuide TYPICAL ROOM APPLICATIONS . Massachusetts Energy code MAscheck software Version 2.01 Release 2 The sandpiper DATE: 4-21-2004 Bldg Dept Use I [] C7 [] I C] [] [] CEILINGS: 1. R-30 + R-30 Comments/Locati WALLS: 1. wood Frame, 16" Comments/Locati O.C., R-15 + R-15 WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. U-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? C ] Yes [ ] No Comments/Locatio DOORS: 1. U-value: 0.086 comments/Locati AIR LEAKAGE: joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type Ic rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. C] I I I I DUCT INSULATION: Ducts shall be insulated per Table 34.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" LOW pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 . 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department use Only)------------------------- APPUCATION FOR PERMIT TO 00 GASFITTING TOWN OF YARMOUTH (OFFICE USE ONLY) i By-------- p Fee: NOV 2 12005 PERMITNO. Date . Building Owner's AT: Location _ �_ Name Type of Occupancy New [X Renovation ❑ Replacement Cl Plans Submitted Yes ❑ No Ik ■���■��■ice■���i��i�■��■����� ��■�■emu■u����■�■■��■���■���■� (PRINT OR TYPE) �� Check One: Installing Company Name -vUc.- V �[H+ 1�_ ❑ Corp. _ r_ Address ❑ Partnership 2-��1. _ �trmrCom n Business TelephoneQ—�- Name of of Licensed Plumber or INSURANCE COVERAGE: Check One 1 have a current liability insurance policy or its substantial equivalent. Yes II No ❑ If you have checked yes, please indicate 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: -.------._..__..._.._.._.__.__-_.--.------_..----.N._- Owner ❑ Agent 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted *Signature Licensed (or entered) in above application are true and accurate to the beat of rPlumber or Gasfitter my knowledge and that all plumbing work and installations performed Z J under Permit Issued for this application will be In compliance with all - ---- pertinent provisions of the Massachusetts State Plumbing Code and License Number _. ._ ... rvoc 6 rreaca.