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HomeMy WebLinkAbout121 Camp St #100 Building PermitsG TOWN APPLICATION FOR PERMIT TO DO GASFITTING E C p (OFFICE USE ONLY) JUL 0 5 2006 lFee:BUILDING DEPT. !PERMIT NO. _ .C{ O7 b__._Date�Bu Idinq/CAT: L«cationi�52Q�L1[NameType of Occupancy -New Of Renovation C_j Replac:ement C? Flans Subm;tteo Yes No to zJ co bWZin 0 J z a i�ff a wz Q =n0=�M 010 Q. oSUB-BSMT. BASEMENT 1ST FLOOR2NO FLOOR LOO�_ - iPCJ:>F! Check One -Installing Company Name �tJG �=:yirh IT 7D U CorAddress .._.l_&'...._G_#JA❑ Partnership�rm/CompanyBusiness TelephoneName of Ucensed Plumber o, r...___.....' �- �._ �_,. _^%. ... __-------...... INSURANCE COVERAGE: Check One I have a current i-ability insurance policy or vs sunstant;al equivalent. Yes No '.J It you ha a checked yes please int;-care t to type of coverage by checidng the appropriate box. A liability ,nsurance po!acy Other type or indemnity ❑ Bond _ OWN£R S INSURANCE WAIVER ! am aware twit me;;can oe does not have the insurance coverage required by Chapter 142 o' the Mass General Laws. and that my ,•gnalure an tnis pc+rma app!rcation waives this requirement. Check One'Owner �.7 AgentS;gnatuiti of Owner ur Owner's Agent9 f hereby certify that all of the details and Informat+on t have spbmitted Signature o Licensod(or entered) in above application are true and accurate to the best of Plumber or Gaslrtter my knowledge and that all plumbing work and installations performed 2,( S!gunder Permit Issued for this application will be in compliance with allpertinent provisions of the Massachusetts State Plumbing Code and License Number Tvoc r veticc- TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee:$ -a6@0 PERMIT NO. P bb - 7 D 5 Date L- 20 Building�� G Owner's AT: Location c7 Name Type of Oc ancy New novation ❑ Replacement Plans Submitted Yes No ❑ Z� wag/ Z z l� Cn z y z W w O Z Z � W W J Cn �Q�+ U Q z z z a 7 N 2 fA F W y F- U a' N Qa W U- Z_ a Z_Q 3 x N W y N S Q' Q W N ? Q y C� �y G' R' �J LL. V W O W Q W p Q J W W F Q Y O W u. U. L W r H v j F=- O y N Q O z 0 0 Q 0: 0: D: Q O Q Y J m V1 G G J S E= co LL V' 7 O Q �' m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Check One: ❑ Corp. Address N 7 yL� ❑ Part ip Fir ompal Business Telephone lame of Licensed Plumber u55 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. Bond El liability insurance policy El Other type of indemnity ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 1142 of the General Laws. Check on Owner ❑ Agent v Signature of Lice ed Plumber Z3 &7 License Number Type: Master❑ Journeyman L=11.1 LOT 99 45.00 S84'23 45 W DRIVEWAY 95 L=71.51 i 11 LOT 100 Z vc.v O �a v N o O vi N EXISTING 1 w FOUNDATION �3.3' I 1 I CERTIFY THAT THE FOUNDATION IS FE 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 AR 1�Z71a7S�,,� DATE REGISTERED PROFESSIONAL LAND SURVEYOR NOTICE 20 10 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; Inc. (8) this plan remains the property of Holmes k McGrath, 1 /1�/ —�. �I? ,0 0 fo� �o ACVIV �y EXISTING FOUNDATION LOT 101 I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF THE 40B SPECIAL PERMIT. t 27 DATE REGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE 20 60 ( IN FEET ) 1 inch = 20 ft. AS —BUILT PLAN holmes and mcgrath, inc.'r> ry trl OF LOT 100 civil engineers and land surveyors IMACHA.EL Q,> PREPARED FOR 362 gifford street trtitI�art1 `' MILL POND VILLAGEIN falmouth, ma. 02540 � AEGISTIL YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1 "=20' DATE: 12-27-01 DWG. NO.: A2548A CHECKED-AYAv O F TOWN OFYARMOUTH Building Department BUILDING (508) 398-2231 ext.261PERMIT NO _=B=os_444 pERM ISSUE DATE ; _ 9/29/20Q5 _ : b USE - - - - - _ _ _ ---- JOB WEATHER CARD APPLICANT. Frank Capra ' ------------ - ons -- - PERMIT TO 'New Construction ' AT (LOCATION) 00121CAMP ST Unit 100 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK U4.21.1.C100 I BUILDING IS TO BE: LOT SIZE CONSTTYPE1 5-A I USEGROUPL R-4 new construction - Affordable: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per REMARKS plans dated 08129/05. AREA (SO FT) EST COST ($ I$148,896.00 PERMIT FEE ($) Iyu.uu OWNER Villages @ Camp Street, LLC BUILDING DEPT BY ADDRESS 1160OFalmouth Road # 25 �. Centerville I MA 102632 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 MA 02632 Certificate Issue Date .CERTIFICATE.of_OCC.UPANCY)s Departmental Approval for Certificate of Occupancy and Compliance Inspector•��' .:, WN ►`_ ELECTRICAL ENGINEERING To be filled in by each division indicated hereon upon completion of its final inspection. of r TOWN OF YARMOUTH Building Department (508) 398-2231 ext.261 BUILDING.- ---- PERMIT w = PERMIT NO _ B-06-444 wrmai .e ISSUE DATE , _ 9/29/2005 _ ; PROPOSED USE ----------- APPLICANT '.Frankbapra JOB WEATHER CARD ----------------------------- ------------ PERMIT TO ; New Construction AT (LOCATION) 100121CAMP ST Unit 100 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C100 BUILDING IS TO BE:. CONST TYPE 7 USE GROUP R-4 LOT SIZE new construction - Affordable: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per REMARKS plans dated 08/29/05. AREA (SO FT) EST COST ($ 1$148,896.00 PERMI I I•tt (Z�) 14)U.Uu i OWNER I Villages @ Camp Street, 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 WE. �On / r � � Cop% Commonwealth of Massachusetts official Use Onll/y Department of Fire Services Permit No. —d o' �4D 6 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked t&rj' •[Rev- 11/991 Ocave 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 5/10/2006 City or Town of: YARMOUTH, MA To the Inspector of Wires: By is application the undersigned gives notice of his or her intention to perform the electrical work described below. �n� Lod tion (Street & Number) 121 CAMP ST., UNIT 100 ,_l. O er or Tenant GATEWOOD HOMES Telephone No. v v o 0 ees Address 1600 FALMOUTH RD UNIT 25 CENTERVILLE MA 02632 'Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Boa) so a5 Purpose of Building SINGLE FAMILY DWELLING Utility Authorization No. 1520366 • Exis ing Service Amps / Volts Overhead ❑ Undgrd No. of Meters m Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: WIRE HOUSE, INSTALL SERVICE i.__._,_..__ ..t.L.. � n....d.,.....6/. ,.,..., hn.u/,ivod hu the rnsnectnr nt Wires. No. of Recessed Fixtures W No. of Ceil: Susp. (Paddle) Fans No. o Total No. KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Bate Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. o Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Tons Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: [ Number Tons_ KW_ _ _ No. oSelf-Contained Detection/AlertingDevices No. of Dishwashers Space/Area Heating KW g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances liances KW Security Systems: No. of Devices or Equivalent No. of Water Heaters KW No. o No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent OTHER: »_.,___. J771 afA..-/....d .. mdrod by rho rnenortnr of Wlre.0 !1{{L{l/f "Nt.1/.v/aNi uu..... J ..v+.. v..r "• _] _� 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.) 10/31/2006 (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certifv. under the pains and penalties of pedury, that the information on this application is true and complete - FIRM NAME: PATTON ELECTRIC Licensee: RICHF ja lieable enter �v(I PP Address: PAT] OWNER'S INS required by law. 11 wner/Agent Signature _ LIC. NO. A15542 PATTON SignatureS._.�04�1.�/�. -ham LIC. NO.: mpt" in the license number line.) %r- Bus. Tel. No508 539 0200 LECTRIC INC. PO BOX 1525 MASHPEE, MA 02649 Alt. Tel. No.: JRANCE WAIVER I am aware that the Licensee does not have the habilrty insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. PERMIT FEE: 125.00 WPS - Permit Pam loffI 1 0 • 0 Wor — rmk Order Infoation NSTAR WPS - Permit Dalp: D5f1II1nm P.ampam 1F UNDABISFIOP ftgmn W YAR 121 CAMP ST UNnV VILLAGES AT CAW ST Type: RES Statttirs: PLAN Se niter NEW I'"""' a diNoft `�O"ANDHOLE___TRANSFW25r= IN VMS E�PST_ SUCK RD .1200 SQ IL FT.._ELECT RANGEIDRYER...NO AIC NO HOT TUB OR =UZ71....GAS HT& W SN*_1ce bftmwri r T mTe is no Service 1Ttformation. Permit Information Permit #: E06-1006 Meters: 1 Reseal (YIN): Y Date: 07/10r2006 Inspector_ W0060 Descriptiona s Search 1 Detail Contacts - NSTAR Home WPS Lonon WPS Help Comments WO Request WPS News ✓a Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. All rights reserved. Reproduction in whole or in part of any graphics, images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result in criminal prosecution. http://Www.nstaronline.comlappslwpslwpspermit.cfm?Page=Permit&Unique= f is '2006-0... 7/10/2006 .I OF y4 9 • MAWEESE ems" o APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 JUN 0 6 2006 (PLEASE PRINT IN INK-OrT'YPE ALL INP URI To the Inspector of Wires: By this application the work described below. Location (Street & Nu Owner or (OFFICE USE ONLY) OUTH Itj Fee: $ PERMIT Date: gives notice of his or her intention to Owner's Address - t Is this permit in conj ion writh a building permit? 0 Yes C3No Purpose of Buildint✓f o'NQ q__ _Utility Existing Service Amps / Volts OverheadEl New Service V= Amps k 240 ll?f4l Volts OverheadO Number of Feeders and IR Location and Nature of Proposed electrical Work: K (Check Appropriate Box) Authorization No. the electrical Undgrd No. of Meters Undgrd No. of Meters_ h No. of Tota No. of Recessed Fixtures No. of Ceil: Sus . Paddle Fans Transformers KVA No. of Li Lighting Outlets No. of Hot Tubs A eve n- Generators KVA No. o Emergency Lt ling No. of Li Lighting Fixtures Swimming Pool md. md. BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. o etectton an No. of Switches No. of Gas Burners Devices No. of Ranges TotalInitiating No. of Air Cond. Tons No. of Alerting Devices eat Pump Nu m er Tons _ _ — — No. of Self -Contained No. of Waste Disposers Totals: — Detection/Alerting Devices Municipal Other Local No. of Dishwashers Space/Area Heating KW Connection Secutity Syystems: No. of Dryers Heating Appliances KW No. of Devtces or Equipvalcnt No. of Water No. of No. of Data Wiring: No. of Devices or Equivalent Heaters KW Signs Ballasts Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent dd 1 d t it if desired or as required by the Inspector of Wires. Attac a #tona e a 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 I` force, and has exhibited proof of same to permit issuing office. V CHECK ONE: INSURANCE _jBOND OTHER (Specify:) (Expiration Date) Estimated Value of lectrical Work: Work to Start: r spe tions to be n I certify, and the [ 'ass and pet 1 ies dury,�at NIRM NAM '� �' (If applicab+j(jtWr "e tii t" i the OWNER'S INSURANCE WAIVER: I am aware that the below, I hereby waive this requirement. I am the (check Owner/Agent Signature [Rev.04/001 (When required by municipal policy.) lue ed ' a cordance 'th MEC Rule 10, and upon completion. r fo ti on this pplication is taste and complete. LIC. NO. ;nature LIC. NO. Bus. Tel. No.: '- 4_.,...�� Alt. Tel. No.: see oe not have the liability insurance coverage normally required by law. By my signature owner owner's agent. 13 Telephone OONE & TWO FAWLY ONLY - BUILDING PERMIT APPLICATION TO CONSTRICT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department N „ATTgp„«S % 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 ffice Use Onlyw Tanning Board lnformaUon Assessors DepartmentJnformation, Permit No ate ' i Map Lot �p Permlt�Fee $ dorsementDate ©1d New Rkc rdmg Date 1 4 Property Dimensions DeposliRec d, r$ Date, Plan _ "Net'Du`e� Other. 7'1otXirea{sf) Frontage (ft) tot Coverage _` s . This Section for Office usd,ohl Buildin .PerN�i ber. Date�ssded `t �Certlflcate of Occupancy - Signature �....` n , as is not -required -_ BuildmgOfficial, Date., Section 7: = Site Jnfor naboh,.I Use Group: R-4 Type: 5-13 /Address: c 1.1 Property 1.2 Zoning Information: 2� / 5� elf -�- ^� / Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard' Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) 1 5 Flood Zone Informaton a Comments +.. Public Private Zone: BFE'" section 2 �' Property; Ownership/AuthoriAgent ��zed or/eq 46 Mint) Mailing Addres ,�-�v���ld� ez-4 L Name (pr43 Signature Telephone e-- 2.2 AuthorizpdeAgent: n /*/r NI ) f?-6 Na print) Mailing Address��'f!yy:,-/� aum p3 77� � Signature Telephone Fax S00tlOn 3-,�'iORStrl7CtlOr1 Services' 3.1 Licensed Construction Supervisor: Not Applicable ❑ ��V'/ (rye & 6l�lC License f•L' W 0Expiration AAddr Date ge Telephone V 3.2 Registered.Home linproveinent:Contractor: Company Name R�� 1 ^ / Not Applicable V gUJIL „ License Number Address By Expiration Date Signature Telephone �ern /J 9 - 15 - 99 1 of 2 "" `^ Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. • , Signed Affidavit Attached Yes ......... No .......... New Construction,No. of Bedrooms \2 I No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations CI FAdditinn n Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: e- Item Estimated Cost (Dollars) to be completed by permit applicant 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total=(1 +2+3+4+5) 7. Total Square Ft. (new houses & adddions) 0 1, i//VAeZA hereby authorize . my behalf, in all m 0 Check Below ❑ conservation -Commission Filing (if applicable) - ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property to act on rela ' e to w rk authorized by this building permit application. Date , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. . PrinMame Sig at of O ner/ gent Date 9- 15-99 2 of 2 x T. The Commonwealth of Massachusetts Department of Industrial Accidents Of/Ice offavestfpufiss 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit cit. ( :P—L� o ( W1 �9 , C1163i non, a {0 —'7 7 ti-`S C (9`1 I am a homeowner performing all work myself. L am a sole proprietor =J ha, a no one working in any capacity [am .an employer pro% iding workers' compensation for my employees working on this job. comnany name• address: city: phone Of, insurnnee ce, noliev to I]?/[ am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below uho ha%e city: phone #• insurance co.. pelicy # comnanv name: address- city' phone #• Failure to secure coverage as required under Section 2SA of MGL 152 an lead to the imposition of criminal penalties of a fine ap.to SI.5NM andtor one years' imprisonment as well as civil pensidei in'the form of a STOP WORK ORDER and a fine of SIt10A0 a day against me. I understand that it copy of this statement may be forwarded to the Office of Investigations of the DU for.eoverage veriliatio■. 1 do hereby certiJ er thr alas a e Uiet ojpery'ury that the irtjormatiort provided above is tare and eorrea/ k S i g n a ture Print name official use on1% do not u rite in this area to be completed by city or town official city or town: YAItHODT$ _ permit/license # nBuildiag Department OLicensing Board 0 check if immediate response is required 263. C3selectmen's Office pHealth Department contact person: phone#:— C508) 398�2231 eat. MOther. TOWN OF YARMOUTH 1146ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 026644451 Telephone (508) 398-2231, Ext.261 — Fax (508) 398.2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at t � ��p 3 tj Work Ad ess is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. k 1vwlyUr YARMOUTH U11YSNOe BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PRINT. - Location: Ca Lq, p job Number; v Street Village Owner of Property: LL G Construction Supervisor: C 669 Address: O cName License No. Phone No. Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 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 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 �3( - No If you have checked es please indicate the type coverage by checking the appropriate box. A liability insurance policy 3--� Other type of indemnity ❑ Bond OWNER'S INSU NCE WA VER: I aware that the licensee does not have the insurance coverage required by Chapte 1 o ass. al a s, and that my signature on this permit application waives this requirement. Check one: SignattIre of er or Owner's Agen Owner ❑ Agent Signature: Building Official Approval: tr 1 •P SPECIFICATI GMS9/GCS9 .SERIES 93% AFUE Multi-Tosrtioni. Single-Stage/Multi-Speed- Gas Fu;rr_acp ... Heating Capacity:_ 46,000-115,000 BT(JH YFT� n1c, `° aka Standard Features • Corrosion -resistant, aluminized steel tubular heat exchanger and stainless steel recuperative coil fos maximum efficiency • Designed for multi -position installation—GM59:' up.1 horizontal right (it left; GCS9: downflow, horizontal right or left Energy -saving, reliable Hot Surface ignition system, featuring a Norton Mini•igtkiter with patented adaptive learning algorithm to maximize ignieer life- • Aluminized• steelinshor burners • Energy -saving PSC,mul6lipeed-, direct drive blower motor • Quiet, corrosion resistant induced draft blower assembly • Integrated furnace control. with improved_.... diagnostics • Low voltage terminal blocks • Multiple flame toll -out switches, blower door safety switch, outlet 2u,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 fltteJver rlocated on right side • Completcly.assertbled.factorxrun•testedfurnace.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 Air-Cunditinnirrg-& 1-teatirrg'-- The GMS9/GCS9 single -stage, multi -speed -gas furrram ohfe installation versatillty CabirTLrCarrsttvctiort • Heavygauge, 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 infer (GMS9) • Removable, solid bortom block=off (GM59), Accemori6 • L.P. Conversion Kit (LPT-OOA) —LP-Gas Low Prc"utCKit-(i:PLPOI) • High Altitude Natural Gas/L.P Kits (HANG11, HAN012, HALPIO) • High Altitude Pressure Switch Kit (HAP527) • External Filter Rack .(EFROI). • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent -Kit (VCVK). • Internal Filter Retention Kit—upflow, horizontal (Ilteoal?ic3 - - • Internal Filter Retentions Kit—downflow /, f . • Thermostats Blower Motors (CHTIM0. CH70TG. CHSATG, H20TWR) $$-377D .w .goodm nmfg.corn —_ 6/04 t PEQDUQT SPECIFICATIONS - Nomenclature FG]EM] S 8 070 3 iIFAX Revision Goodman® Brand 4: Initial Releasa- - NOX I't Revision - Air Flow Direction M: NaturalGas on C. 2"d Revision W.- UpflowlHorizontal X. Low NOx D: Dedicated Downflow C: Downflow/Horizonlail Cabinet Width H: HFAir Flow A: 14" 8: 17A" Description C-, 2V'. single Stage/MUM-Speed rvs: D; 24'A" Two Stage/Variable-speed .I- KBTUH 045-. 45,000 070: 70,000 090: 90,000 .115: 2- Maximum CFM 0 0.51, ESP 4: 1,600 5: 2,000 1 PRODUCT SPECIFICATIONS GCS9 Dimensions LEFTSMS . . vlEw FRONT VIE. "Mr 310E wEw e v. �xvs IR INTANE PiPF NNN AW) AKE rFnnrwe lwE x-PVCrovc (' -� it cRAWTRAP TARP,"2W'PVC r1ewVGLrAG(pRAW t LOW VOLTAGE t Ye i MCNAROf.ELfCTRIC+uROIF ELECTRKAL ROLE LeeTSIDGI_L2/cots. / :s asn L DRAW TRAP r Q AARDAROGAa-� II } nlv2 fiV-KYNDLe AYa I,. �Eorw�1nay ` POLO{tl FLANOEe fNSGRaRO{AIR T.. - ... see RATAaE;t)6/.T4 i a7 oRAw ng -Qq1 u.{ `` AIGNT FADF - I♦ '_ UtAW LINE 11 le NOLEa ALTERNATE rns V 1A' - - 9L�a2�"' �3 e•.£.. :b�-..iC)s rk P'r�� - NMI -. .'�+Y `��"C� f1F /b.` ak- 4%Jr ' - GCS904539XA 17h" 16^ 14h" Tb^ GCS907038XA Mi" 1b'f. _ t2sh" 1411"..... 14" GCS90904CXA 21^ 19p1" GCS91155OXA 24+k" 23C._.1720'/e".. Z1,h" 23" 1 ing4tr must supply one or two PVC pipes: one for combu don a(r-(uptiona)) and *nc4Qr-the-flue oudec (requited): Vint pipe must he either 2"or 3" in diameter. depending upon furnace input; numberuf elbows, length of run and' installation (1 or 2 pipes). The optional Combustion Air Pipe is dependent on inaallallonkode requttemen,3 and must be 2" or Y diameter PVC. 2. Line voltage witing can enter through the -eight or lefrode-chhe fumaeo Low voltage wiring camenter through fie rghr or left side of Furnace. 3 Conversion kits for hn h altitude natural gas operadon are available. Contact your Goodman ductibuto, or dealer for derails. 4. Imcallet must supply fulktwing gas line fittings, according to which entranceiaused: Left-7 a+ 9fia elbawi. one close nipple, straight pipe Right—Sttaighe pipe to teach gas valve Minimum Clearances to Combustible Materials C . Combustible: l(placed nn tutnbustible floor, the flour MUST be wood ONLY. NC = Non -Combustible: A combustible floor subbase must be used for installation on combustible flooring No7T5: • For servicing or cleaning, a 36" front clearance is recommended. • Vnit amnecnone (electrical. flue and drain) may necessitate greater elearancuthaD.themMitnumdFarancea listed below: - • In EA cases, accessibility clearance must take precedence over de smDets from the endoevre where accessibility cleanocez an greater. PRODUCTSPECC SPECIFICATIONS Blower Performance Specifications j "; t6"�' t Vie si __-� t. u;, . a /yp WID4.'J.l 't Mai' t. UVWXAJAW, (ZIA EASIL: -�CBb 63SE: - CR HIGH 3.0 t,3S2 t,3.16 t,260 ...... 1,202 a idnc 5l' G_S90453EXA MED MED-LO 2.5 2.0 1,214 997 - •-•- 1 112 994.......960 -- 1,123 -- 35 1,C64 923 1 36 (LOW) 1 47^ 44 G_5907039XA MED MED'•C0 25 2.0 1,192 481 53 1,172 96Z 54 17,141 943 45 55 1 0 917 47 56 �• � (MED-Hq LOW 1.5 750 -- - 730 ---- 714 ...... 692 G 590904CRA HlGli.^---• MED ...4.0.. 3.5 1,713 - 39 t,-S74- 1,650 _.35- ' 40 1;157 1,572 ..35- 42 1,,667- 1.510 40- . 44 ' , ' , (MED-LO) MED-LO 3.0 It970 1,439 46 1,412 47 - 1,370 48 'S9- 1,327 �-,,t �' 50 ._ As$ItF. LOW-- rs 11a3 s6 1.,ss sr- 40 , 1n 42 1,103. 1,941 60- 443�nT-Ei HIGH 5.0 2,134 40 2,103 2,029 G_5911550 CA MED 4.0 1,679 51 1.a643 _ 52. 1,643 - 52.. 1.:.577 54 rtFs933F i-1 f.: i; .. (MED•Hq MED-LO 3.5 1,453 58 1,440 59 1,426 59 1,367 62r LOW ..3.0.. 1 254 ..67. 1,Z34 ..68.. ] Z20 1..70. [1,191 NOTES: 1. CFM in chat le without til[er(s). Fihcra do nM +hip-seieh this two'rettsp,s. , this chart assumes hoth filter are installed. - 2. A8 furnaces ship as high speed ennling. lntallcr meat adjust blower ermll„x speed as needed. 3- For mtut jobs. aboi.t 400 GFM per tun when ctniling is dvsirlble. 4. INSTALLATION IS TO BE ADJUSTED TO OBTAIN TbMPFRATURF• RISE WITI IIN'Mk: RANOE SPECIFIED ON THE RATING. PLATE. 5. The char, is for IrAsrmation only. For satisGctory Oper:aion, external static pressure meat nut exceed value shown mi ,he r;,ting plate The shadcJ area indicares tamer In <xctn of maximum state pressure ;dtuwed when heating. 6. The dashed ( .... ) areas indicare ,r WIT"atore rise scut re"Eaa» rsded k,r9,lsn% klel- 7. The above chat is fun U.S. furnaces installed at 0' • 2.000•. At higher altitudes, a properly de -rated unit will hava'approxinsately du sane tcmperatnrr wt at .1 pardculi,r CFM,. while ESP at the CFM wdl be.ktwet..... J PRODUCT SPECIFICATIONS Accessories IL.P. Conversion Kit ✓ ✓ ✓ ✓ LPT-OOA LPLPOt L.P. Gas Low Pressure Kit ✓ ✓ HANGI t High Altitude Natural Gas Kit t t 1 t - HANG12 High Altitude Natural Gas Klt 2 2 2 2 HALPtO High Altitude L.P. Gas Kit 3 . .. 3..... 1 .... 3 _. " HAPS27 High Altitude Pressure Switch Kit 3 3 1 3 3 ..Ffnt... External Fllter.Rack....... .. _. _. ✓....... ..... ✓ ...... ✓.- �..... DCVK-2D Horizontal/vertical Concentric Vent Kit (2") ✓ ✓ DCVK-30 Horizontal/Vertical ConcentricverttKit(Y')— .... ✓' ✓ ✓ Available for this model (1) 7,001`to 9,000' (2) 91001al I I,I1000' (3) 7,001' m I1,000' Note: All Installetians above 7,000' require a Pressure switch chamgr.. For arstaRation in Canatht, furnaces are certified only to 4,500'. Dov nflow Floor Base: When the GCS9 model 6 installcd directly on a wmd floor, a downflow R wr base mustbe used.:ThtUe model numbers_., arc: CEB17, CF627 and CF624. Thermostats CHTt8-60 t .� , .. }� a'E. - <; ram , Cooling/Heating, Mechanical CH70TG Cooling/Heating, Digital, Non -programmable CHSATG - - Cool"Meating Mechanical -" HZOTWR Heating Only, Mechanical 7 61 x ` �% oPoo ii wnweafrfi 'a rae/uee . Y r BO'.4Ra OF., BUILMUG REGULATIONS { License;. CONSTRUCRONSUPERVISOR . . Nurnbe8�. Qt2430 . Expf _O6 i5T2006. Tr: no: 25926 ` Restrid�d�a��` - y s FRANKZ, CAFR 40 COPPER CEDI:CEIZIALLE !NA 0263 commissfoner 1 i 00-35;000ctepdosedsp2ce — — (MGL: C,Tlzssop th-Masoprj�ofitg ! IGrI-KZFa- imfYHomes Failure to possessa curientedrtan of the MassadwsertSS tMmft ldiiq.-Code . is-cause.6r revocatfoiivtthis license. i 7' 1. DIG SAFE:CALL CENTER: (888)<344-7133 DATE(MMIDDNYYY) A O . CERTIFICATE OF LIABILITY INSURANCE 0719/2005 - PRODUCER • (SOB) 790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sandpiper Ins. Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 12 Enterprise Road MA 02601- First INSURED Filho, Antonio DBA BR ROOFING Po Box 1231 136 Stevens st W.--,; � MA 02601- nn\/FRAr,FS MnTMTHSTANDING ANY THE REQUIREMENT, THE AGGREGATE POLICIES INSURANCE OF INSURANCE LISTED BELOW TERM OR CONDITION OF ANY AFFORDED BY THE POLICIES LIMITS SHOWN MAY HAVE BEEN TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR HAVE BEEN 155Utu IU I nIZ uNauncv CONTRACT OR OTHER DOCUMENT DESCRIBED HEREIN IS SUBJECT REDUCED BY PAID CLAIMS. POLICY NUMBER 491FOO2639 �.,,,.�•, r,..-.- WITH RESPECT TO ALL THE POLICY EFFECTIVE DATE(MMIDDIYY) 06/21/2005 • -• • • • - -- - - TO WHICH THIS CERTIFICATE TERMS, EXCLUSIONS POLICY EXPIRATION DATE (MMIDDIYY) 06/21/2006 MAY BE ISSUED AND CONDITIONS LIMITS EACH OCCURRENCE OR MAY PERTAIN. OF SUCH POLICIES. S 1,000,000 INSR LTR INSRD ADO'L A DAMAGE TO RENTED PREMISES Ea occurrence) S 100,000 MED EXP (Any one person) S 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS. COMPICP AGG S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRO- POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED (E(Ea axiSINGLELIMIT a dertt) S / / / / ANY AUTO ALL OWNED AUTOS B (Per Person) (Per person) S SCHEDULED AUTOS HIRED AUTOS H BODILY INJURY (Per axidenQ S NON -OWNED AUTOS PROPERTY DAMAGE (Per amdent) S AUTO ONLY - EA ACCIDENT S GARAGE LIABILITY ' OTHER THAN EA ACC S S ANY AUTO AUTO ONLY: AGO IXCESSIUMBRELLA LIABILITY OCCUR •❑ CLAIMS MADE EACH OCCURRENCE S AGGREGATE" S S DEDUCTIBLE S RETENTION S- WORKERS COMPENSATION AND EMPLOYERS LIABILITY / / / / WC STATU- OTH- TORY LIMITS ER El- EACH ACCIDENT S __ EL DISEASE - EA EMPLOYEE S ANY PROPRIETOWPARTNERIEXECUTIVE OFFICERMIEMBER EXCLUDED? / / / / E.L. DISEASE- POLICY LIMIT S If yes• describe under SPECIAL PROVISIONS below OTHER / / / / DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS SIDING AND ROOFING. (508) 778-5603 GATEWOOD HOMES 1600 FALMOUTH RD SUITE 25 A{�CORD 25 (2001J08) PL,N INS025 (010e).D5 02632- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPO$E�JO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPS SE TO—" AUTHORIZED ELECTRONIC LASER FORMS. INC. - © ACORD CORPORA I ION lUtH Page 1 of 'i ifs � t� MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE . lVV e this forin to request a Certificate of Insurance from an Assigned Risk Pool Carrier. M1f Please provide all of the requested information, including the facsimile nur>;r-+s) of the person or persons to whom 'the Certificate of Insurance: should be issued. If this form is fully and accure-11 c rnplated, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, two (2) business days of the carrsers receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Comnrwrn<!'Iysection of the Bureau's webr..,e Nmrv. wcribma.oro). 1: Name, address, telephone number of facsimil number of the INSURED: Name:e— n Mailing Address: Physic! Address:_ —_ _._ — Pho Fax: — 2. lame, adaresss�ephone nuum/bber%annd/ Name: "�` Mailing Address: Physical Address Phone: number of the CERTIFICATE HOLDER: Fax: sc e-0-3A V /` 3. Name, address, contact person, telephone number and facsimile number of the PRODUCER: Name: Sander Tnsurance Acreric,1*° Inc. MailinaAddress: 12 Enterprise Road Hyannis, MA 02601 Contact Person: Chri g or Andrea Phone: 508-790-1919 Fax: 508-790-3560 4. Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term, provide the`Policy Number, Effective Date and Expiration Date for each policy term. If the policy has not yet bean issued, you must attach a copy of the Notice of Assignment. Policy Number: Effective Date: Expiration Date: 5. List any special requests for optional coverages I endorsements (see Page 2 for listing of coverages available in the pool and the conditions of availability) or additional information (including changes in exposure not yet reported to the carrier) that will assist the carrier in the issuance of the Certificate of Insurance. NOTE: An additional insured(s) shall not be listed on any Certificate of Insurance unless such additional insured(s) is a named insured on the policy. ------------------------ Tat— Tima: 3:02 PM TO: ® 15087785603 Page: 002.003 /�-1Lrl RD. 'r✓5E..RTIF1C$5TE 010 LIAR ��1 � 3�j3SURAN�C.. 06% .1rYY'O PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE Thor Feitelberg Company HOLDER: THIS CERTIFICATS DOES -NOT AMENDT E)9ENO OR- 222 Milliken Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.Q. Box 3220 Fail River, MA 02722 INSURERS AFFORDING COVERAGE NAIC # INSURED NSURERA: Acadia Insurance Companies Cape Cod Ready. Adi% Inc. INSURER B: Construction Industries Compensation PO Box 398 NSURER C Ordains, VA 02653 INSURER D: OVERAGES y THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHST*mwa-- ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR-OTHEA DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BEiSSUEU OR - MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES -AGGREGATE LIMITS SHOWN MAY HAVE BEEN FED Irrn By PAID CLAIMS.- ILNTYPE TR NSR OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILI TY CLAIMS MADE.51OCOJR CPA0132468tD- 0t/tit/0$". "' 01'/Dt/06- .. EACH OCCURRENCE 51 000 000 DAMAGE T O RENTED FF 5100 DDD MED EXP(AnY me Person) S$000 PERSONAL A ADV INJURY S1.000.000 GENERAL AGGREGATE S2 006000 GENL AGGREGATE POLICY UMIT APPLIES PER LOC PRODUCTS'- C„^MP/OP AGG s2,000,000 A _ AUTOMOBILE LIABILITY ANYAUTO ALL CWNFD AUTOS SCHEDULED AUTOS HIREOALITOS NONIDANEDAUTCS MAA013246$10 01/01/w 01101/06 COMBINED SINGLE UMIT �aaca�rA} 511000,0 BODILY INJURY - Pg G3r�1 S X X BODILY INJURY ,Par acdaemj S X PROPERTY DAMAGE Pe aa'caK) S - GARAGE UA13UN .ANY AUTO - - AUTO ONLY• EA ACC'DENT S OTHER THAN EA ACC AUTO ONLY: AGO S S - A EXCESSAIMBRELLAUABILITY X CCCL'R CLAI MS MADE a DEDUCTIBLE X RETENTION so CUA013247010 01/01/w 01/01/06 EACH OCCURRENCE 51000000 AGGREGATE $ S. S " _ S B WORKERS COMPENSATION AND EMPLOYERS' I:1P.H4:Jl°Y- ANYPRCPRIE TXECUTNE CFFiCERIMEMBER EXCLUDED! I CPECALPP,,VS1(arNCo WC0009255 01/01ins 01/01/06 X gSTA iT• OTH• El.EIiG'iACOCENT 550000 F_L. DISEASE EA EMPLOYE $$00000 E.L. DISEASE-PWCYLIMIT S500r,0M OTHER DESCRIPTION OF OPERATIONS I LOCATIONS (VEMCLES JEXQU90NS ADDED-B tENDORSEMEMI SPECVS PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION GateWood-Homes Inc. DATETHEREOF, THE ISSUING MSURER WILL ENDEAVOR TO MAIL AA DAYS WRITTEN 1600 Falmouth Road Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Centerville, MA 02632 iMPOSE No OBUOATION OR LIABILITY OF ANY KIND UPON THE INSURER, IrS AGENTS OR REPRESENTATIVES RED NTA� ACORD 25(2001/08) 1 Ot 2 4S68995/M66526 AH1' 0 AGORD CORPORATION 1933 05/06/2005 09:38 5084204474 EDWARD A GRAZUL PAGE 02 . In RTIFICATE OF LtABtUr'f.1USURAN THIS C£R tFlCATE t5 M1SSUED AS A MATTER OF INFORMATION ONLY AND .CONFERS no RIGHTS l2PON THP CERTtND-4M: "e �YT Z�' CERT1FfCATE'DOEs iVpT AMENDI C- SBEL Oi.kLTER THE-COYEAAQE AFF08D9_D :BY TldE POU�CIES EELOII+J._t 02648 INSURERS.AFFORDINGCO RAGE NAIC _ 1N6URED �_, INSURER 9� �L,,� . .Jt Ly LL �NSURERC _._—.. i45 canmtt PcedI�-wR�aac Mmstfm Al s, Ito UL�+B Nsw was COVERAGES CERTIFICATE -MI" TFIE PCtfCIES OF:INSUFIANCS USTEO.BELOW.NAVE SEEN ISSUEDTO THE INSURED NAMED ABOVE FOR TIE POLICY PFRIC0INDlCA7ED. NOTWBE ITHSTANDING MAY PERTAIN, THE !NSURANG£AF OR ED 0.Y THE POtIGES OCSCRlsea+HE E;ONTRACT OR OTHER CNIMENT WITH S SUBJECT TO HE! TE;L EXCLU510NSOCO D K)NSS �>� V� POLICIES: AGGREGATEUMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C o• UEY ErYTtcnvE va.ICYEXmaaTION- LIMITS lii'vi %� T AOLIC7 NUMREfl EACH OCCURRENCE S 1.'00t.}y — GEME/IALLIABBAY ���--•• (If I PREMISES (Eft TFRm..,�. Jr�S MMMERCIALGENERALL LABILITY »L CrLRmmma MADE PepgONnLdwOVMttIRy�rxY�_�TQl�.ruM•T�L_ 5�,.��,y��`-�,uy_i�-• — LAOGAEOAT- EClMRAPPLIES PER' 28GEEATE �C�- .. z; �,��p-L�614 PRO- RAbACCRG 0�i6 POLICY LamCEeINESIAR1fUMDNO R AUTOMOBILE LASILDY ANYAUTO c4hts._ ' I BODILY INJURY I I ALL OWNED AUTOS I f (Pxw+euq IL9CNEOULEO wuTCS F. LLL MREO AUTOS aOD+LY MJUP�' 1 (Pm Yementl _ NON-OYYNEO'AUTW - I - PRCPERTYOAWIOE' � S _.� `I (Px semerhl -- I �AUTfl ONLY•EA ACCIDENT A. .. — GARAOEUABKJTY EAACC S OTKERTHAN AN'N 44TO I � '- - AUTO ONLY: AOAIS-- I EACOCCURRENC- 1 — II ESCeSSNaBREt S A LUBILLTT H AGGREGATE �S ccCLR' - �_� CLANS MADE � S _I I - oECt1CTBCE I .. I - RETENTION S WGSYATL, TH• QBY LD•A .ERL WORKERd COMPENSATIONANI]�. E5@LOYERT I IAMUTY ACCIDENT I -7. ANY PACMSETObAA0.TNEa4xEOLTIVE EL DISEASE• EA EM[F".OYc-E S- . OFFICED ERMEMSER SXCLUOT r ` I I 6.L. DISEASE. POLICY LIMIT VY,S CEECRIt•170N CF Q2te-Wbad ikrt3 53 Im- CLO bdL J.OEr- tkbn - Rte 2B - CE�ryj c^'v31j1eej MA C2532 FPX.. 1-51 -7788 -%W .A'NGtZLAYtVIr... F,HCULC ARV OF THE ABC VE nE=B BEQ POLICIPS SE SANCELLED BEF.ORETHM FKPIRATION DATE THEREOF: THE ISBWNGYOLL DMIAVOR TO MAIL —PAYS WRITM MaTICC• TgTHE CERTIFICATE HOLDER NAMED TO THE LEFT, DUT FAILURE TO OO SQ SMALL IMPOSE-NO-0000ASION-OR 1LL21LLT: OF, ANY. KIND.UPOM THE IR`J* RE7CRYA6ERFT5-9R REPAESENTATVES• - - 1UTA0MED P.EFRESENTA71^E CERTIFICATE OF INSURANCE THIS CERTIFICATE lG IT5 ISSUED AS A RT MATTER j ACA PRODUCER ' DOES NOT AMEND, EXTEND OR ALTER THE Harold H Williams Ins Aacy Inc AI Rnssett Lane Hyannis, MA 02601 INSURED Stephen M Childs 145 Cammett Road Marstbns Mills, MA 02648 j i COVERAGES ZANY NOTWITHSTANDING REQUIREMENT, TERM OR INDICATED, 1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE S EXCLUSIONS AND CONDITIONS O SUCH POLICIES. LIMITS SS14C CO a TYPE OF INSURANCE POLICY NUMBER 1 F LTRI .GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY .CLAIMS MADE=DCCUR OW--NER'S & CONTRACTOR'S PROT. IA VI'OMOBILE LIABILITY j—�ANY AUTO �ALL OWNED AUTOS r]HIREDAUTOS SCHEDULED AUTOS NON -OWNED AUTOS I I GARAGE LIABILITY 'EXCESS LIABILITY iMBRFLLA FORM OTHER THAN UMBRELLA FORM wOItFD• It'S COMPENSATION AND I.MPLOYERS' LIABILITY 7015793012004 A IfHE PROPRIETOR/ INCL PARTNIE EXECUTIVE )OFFICERS A-- IX EXCL (HER i IJI(SCRII.1'I0N OF OI'FltA7'IONSILOCATIONS/VEIIICLXS/SPECIAL ITEMS CERTIFICATE HOLDER Gatewood IIomes Bell Tower Mall Rte 8 Centerville, MA 02632 ISSUE DATE (MM/DD/YY) THIS CERTI AFFORDED COMPANIES AFFORDING COVERAGE :OMPANY A.I.K. Mutual Insurance Co .ETTERA BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FULIL I rn1UUu CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECT TO ALL THE TERMS, WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DLICY EFFECTIVE POLICY EKKRATIO LIMITS )ATE(MM/DD/YY) DATD•(MM/OD/YY) I - IGENERAL AGGREGATE I S 1PRODucTs-COMP/OP AGG. f PERSONAL& ADV. INJURY f EACH OCCURRENCE S FIRE DAMAGE (Any one tire) f MED. EXPENSE(Any one Person) I S COMBINED SINGLE I f LIMIT I BODILYINIURY $ (Per person) (BODILY INJURY ! S (Per xodenq IPROPERTY DAMAGE ! f i jEACHOCCURRENCE S oc�erc � S 1T/13/2004 112/13t2005 EL EACH ACCIDENT j S _ EL DISEASE --POLICY LIMIT S IEL DISEASE —EACH EMPLOYEE I S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. - AUTHOR 2ED REPRESENTATIVE ' ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID K CROWC5A DATE (MM DD YYYY) 06/06/05 PRODUCER Sullivan, Garrity & Donnelly 508-754-1767 10 Institute Rd - PO Box 15010 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. Worcester MA 01615-0010 Phone:508-754-1767 Fax:508-754-1885 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER ALEA NORTH AMERICA .INS CO INSURER B: Hanover Insurance Co 22292.. INSURER C: Crowell Construction, Inc. PO BOX 309 So. Dennis MA 02660 INSURER D: - - INSURER E: Ar-FS 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. INb uu'� LTR lNSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY) EXPIRATION POLICYDATEMM/DD/YY LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADEK OCCUR - ZHN700714102 - 05/01/05 - 05/01/06 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurence) S100,000 MED FXP-(Any one person) s5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1-1 POLICY F71 JECT PRO- LOC PRODUCTS - COMP/OP AGG $2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS - AFN7001142-02 05/01/05 - 05/01/06 - COMBINED SINGLE LIMIT (Ea accident) $ 1X BODILY INJURY (Per person) $ 1 , 000 , 000 X BODILY INJURY (Per accident) $ 1,000,000 X PROPERTY DAMAGE (Per accident) $500,000 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION E EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILTY ANY PROPRIETOR/PARTNER/EXECl1TNE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC1049858 03/22/05 03/22/06 I TORY LIMBS X ER E.L EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500, 000 E.L. DISEASE -POLICY LIMB 1 $500,000 B OTHER Property Section DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Subject to policy forms, conditions and exclusions. CERTIFICATE HOLDFR CANCELLATION GATEWOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Gatewood Homes NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1600 Falmouth Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Suite 25 Centerville MA 02632 REPRESENTATIVES. A EPRESEN ACORD 25 (2001/08) © ACORD CORPORA [ION 1VtJU JUN 16 '05 04:03PM SANDPIPER INS ---ten �TI�1,3� 4F LIABILITY INSURANCE PRODUCER (306) 790-1919 THIS CERTIFICATE IS ISSUEI ONLY AND CONFERS NO Sandpiper Ina. Agency, Inc. HOLDER. THIS CERTIFICATE 12 Enterprise Road ALTER THE COVERAGE AFFO INSURED Gualberto, Paula D.. 21 Quippish Rd ![m s rnvaoefas:c - _ P. 12 DATE (MMIODIYYYY) RATTER OF UPON THE Eil THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PEP.IDD INDICATED, NOTWI I/•.'STANDING ANT REouIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES OBSCRIBED }$REIN. IS. SUBJECT TO ALL THE TERMS. . EXCLUSIONS AND CONDITIONS. OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAIMS. INSR P U.NAP A00'L TYPE DA MISURANCE POLICY NUM9ER POLICY EFFECTIVE DATE MMIODIYY POLICY EXPIRATION GATE MMIDWY LIMITS A GENERAL LU.BAJTY %� COMMERUAL Oc7'IERAL LIABILITY CLAIMS MACE OCCUR SCP0427723YS 11/20/2008 11t20`/20D5 OCCURRENCE S 1,000,000 OMVADE TO RENTED PREMISESP� Cteu,tefi 3 3OO OOO MED ExP I ny one Venom 3 10,000 PERSONA a ADV INJURY 4 1,000,000 004MALAOGPMokTE' B 2,000,000 I GENL AGOREOATEPPURMrQT APPLIES PER: PRCOUCTS•COMPtOPA00 S 2,000,000 POLICY TL% LOC' AUTOMOBILE LIABILITY I I I / COMBINED SINGLE LIMIT (EA xo"flk 3 . ANY AUTO BODILY INJURY (PSI SON=) - 3 ALL OWNED AUTOS I SOMEOULEDAUT05 MIRED AUTOS I / I % BODILY INJURY (?x ac�en0 �S NOWOW ZO AUTOS PROPERTY DAMAGE (PH Sceleee0 GARAGELIA9'LITY I ANY AUTO AUTO ONLY. EA ACCIDENT 3 OTHER THAN EA ACC II 3 AUTO ONLY: AGO LIARLLITY I / / / / EACH OCCURRNOE IS AGGREGATE S' �EICEzzfumBRELLA OCCLqCLAIMS MADE DEDUCTIBLE '_ RETENTION 3 WO;tXVM COMPENSATION ARID - E.L EACN ACCIOEM EMPLOYERS' LIABILITY ANY PROPRIETCR/PARTNEA/GXEC MVC OFFICERIMEMBER VCLUDEAT / / / / E.I. DISEASE - , 0Mnoycm 3 E.L. DISEASE • POIJCY LNdR i 3 N Y-1. IALL PR Aa IF+ee, SPECOV1bONE he OTHER DESCRIPTION Of OPERATCNWLOCATICNSIVEMMX"XCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I:VT*M:CR A= XX:=XOR DALNTING - CERTIFICATE HOL DEf4 ..nr�..ssa....+.+. ( ) — (SOS) 779—S603 SHOULD ANY Of THE ABOVE DESCRIBED POUCIES BE CANDELL50 BEFORE iHH EXPIRATION DATE THEREOF. THE ISEUINO INSURER WILL • ENOEAVOR TO NAIL 10 DAYS WRITTEN NOTICE TO THE CST I Ti HOLDER NAMED TO THE LEFT. BUT (jAyy^yr�,QyT Av}jya FAILURE TO 00 50 SMALL IMPOSE NO 0 OATI N OR UABILITY Of ANY KIND UPON THE 1600 7A WOU"Y SUIT 25 NgURER, ITS AGENTS OR REPRESENT AUTHORIZED REPRESENTATIVE TaR�uvzTz NA 025326411 — ORD 23 (2001102) i� - INS02S (0t03I.0S ELECTRONIC LASER FORMS,.INt - (60D)02T-CS45 ON 1991 Page 4 oi- , a/ ,DATE CERTIFICATE OF (MMV)D\YY) INSURANCE _. �� 06-20—OS PRODUCER SANDPIPER INS AGCY INC 12 ENTERPRISE ROAD 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 COMPANY 27ECN A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED. COMPANY GUALBERTO, PAULO L. B 20FERN BROOK LANE CENTERVILLE MA 02632 COMPANY C COMPANY D COVERAQES .. ': .. .... ...............................:.:..................:.................:;:.:..............::;:................;:;_........ 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 L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM\DD\YY) POLICY EXPIRATION DATE (MM1DD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL LIABILITY CLAIMS MADE = OCCUR. PERSONAL & ADV. INJURY S EACH OCCURRENCE $ MOWNER'S& CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE OMIT S . BODILY INJURY (Per Person) - $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Accident) S HIRED AUTOS NON -OWNED AUTOS - PROPERTY DAMAGE S GARAGE LIABILITY ALTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACHACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (LIB-0243648-0-04) it-22-04 11-22-05 STANDBY UMRS `.. .. ,. ................::.........:...:� EACH ACCIDENT S 100,000 THE PROPRIETOR/ �� INCL PARTNERStEXECUTNE DISEASE —POLICY LIMIT S 500,000 DISEASE —EACH EMPLOYEE S 100,000 OFFICERS ARE X EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECWL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL GATEWOOD HOMES 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1600 FALMOUTH RD SUITE 25 CENT E RV I NE MA 02632 - LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORII25'-S {3�93j ; `. AC ORATION i983; P_09 AUg—UZ-U7 UtSLor ACOR& - CERTIRCAT LLABUTY bim"'uRANCE_- DATE 0*&OD/YY) oero2(2Q05 PRCDucER Serial g A1530 BUSY MSURANC£ AGENCY, lP6 :. THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY' -A#D' EOIT NFERS- N- RW4ffS UPON THE- CERTIFICATE . . HOLDER THIS CERTIFICATEDOES NOT AMEND, EXTEND OR . • • P.O. BOX 830 - Sal PUTNAM PI1(i ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . GREENVILLE. RI 021123 ... .. INSURERS AFFORDING COVERAGE NA" PLSURm NsIRERA_ NATO FIRE INSORANCECO.OFHARTFORD" INSURER s: VALLEY FORGE INSURANCE CO. HOLMES AND MCGRATH, IN, %. 362 GIFFORD STREET 06URERr47' CON'T NTAt INSURANCE CO. FALMOUTH, MA 02540 1 INSURER O: COVERAGES THE.POUCIESCF INSURANCE LISTED BELOW I AVEBEEN MSLEDTQ THE.t1!ISUREQ W.IALED.ABOVEFOR TL�POLICY PERIOD INCIGATt:D. NQTWITHSTANDPIG ANY REOLMEW-UT, TERM OR CONDITION OF WY CONTRACS MCITHEft MMMENT 'A= RES?EGT TO- gVHiCH-THIS CERTIFICATE MAY BE W IFD OB MAY PERTAN. THE MXWJCE AFFORDED BY THE PCUCES DESCRIBED HEREIN MSUBECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE U FTS SHdAW MAY W VE BEEN REDUCED 13Y PAID CLAIMS. A� A . TYPE OF MSURAPCE GENERAL UABLITY X CEYI AERpAL GENERAL LMBLITY CLAIMS MACE Q acGUR POLBCYfR1'JIBER 10. 4082434 � 1010=4 P&ME>� 1001105 tlMlTs EACH OCCURRENCE S 1 000,00" AMAG O RENTEv7 ,j FlRE 250-,006 Mm EXP m s 10,000 PERSONAL&ADVRA3JRY s 1,000,000 GENERAL AGGREGATE S 2,000.000 PRODUCTS - COLLPoOP AGO S 2 000,000-1 GENL AGGREGATE UMR LI APPES PER 7' POUCT PRO LOC AUTOMOBRE LIASKJTY comumcED SINGLE LRAM (Ea r AW AUTO ALLOWNEDAUTOS BODILY 1K<!RY Ulm P—) S SCHEDLAEDAUTOS - H DAUTOS NON -OWNED AUTOS 9cmv mutt' (Per mcc eN) S. AMACE s GARAGE LIABILITY AUTO OILY -EA ACCIDENT S OTHER THAN EA ACC AUTOONLY' AGG S' ARYAUTC S E cEsB1UAt lAAMLav, p0INSMAM EAC"OCCURRENEE s AGGREGATE S. L DEDL C71BLE - s. RETENTION $ - E lVOltl�R's COMP£NSwiION AND EMPLOYERS LLLVArY AN OPREMBOER IXUDED?Ep�E 20" 7445273- 09161104 .. ... 09101105- x WC STATLL TH- EL EACH ACLi0E777 s T 000' 000- EL DISEASE. EA EMPLOYEE s 1,000,000 ELMSEA5E.POLCYLVAF ... 1000000" R yyeessMscoft unaet SPEEYIL PROV651ON3 eelc�r .... C OTHER PROFESSIONAL LIABILITY AE4 00 43133 38_ . 71t3R5. 071t3M t,000= PE _CLAMU AGGRETGATE- DESCRIPTION OF OPERAYMSILOCATIOUSNFNICLESM 1USION,i ADO® BY FMAAISONXyISPEQAL PRM"*Ls AGGREGATE LIMITS ARE PER THE TER VAS AND CONDITIONS -OF THE POLICES. CERTIFICATE HOLDER CANCELL&TIaL SHIXAO ANY OF THE ABOVE DESCRf8E0 POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP. THE MSUNG MSURER WILL ENDEAVOR TO MA L DAYS WRITTEN GATEWOOD HOMES 1600 FALMOUTH RD.. STE.; 5 CENTERVILLE. MA 02632 NQTICCTaTHE CERTFILTTEHOME/tNAMWTO THE LEFT, ROTFNLLJRE TODO'saS+A¢ S" No O�� ' "T OR L "B trr OF ANY K`"° UP°"T"E Nst'RER' Rs AGENTS OR REPRE581LA7AfE5 ALIT wiA/E ACORD 25 (2001109) C:1FhPROICERTPROS FP5 • I - / I 'w ^4Vmu .aw A A ACDRD,� CERTIFICATE OF UABILIT f INSURANCE DATEei�NYYYI iD PRODUCER United Insurance Agencyi-.Inc. 199 Main Street THIS CERTIFICATE ISISSLEDASAMATTEROFINFORMATION . O14EYANbCO11FERSNORr4HMUPONTHECEFCrIF"TE... . HOLDEFtT44CERTIRCATEDOESNOT "M9 ,,EATEDOR ALTER THECOVERAGEAFFORDM BY THE POLICIES BELOW. P.O. Box 1013 Buzzards Hay, MA 02532 INSURERS AFFORDING COVERAGE NAIC 0 I N&UR� INSOREWA Zur cIT NA _ .. .. wsURER9 Cemnarea Insurance Co. - Patton Electric, Inc. NGvRERG:-Li Matual -Ins. Co: 128 Scituate Road. Mashpee, MA 02649 Nsuafae. wsuaETre- ..THE-POLJCLES OF INSURANCE LISTED . BELOW .HAVE. BEEN ISSUED. TOSHF—MSURED. NAMED AEOVE-FORL 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 114SR OF LNq1Ip_ANCr POL(CYNUMBER POULYEF PECTtW_ IMMOD(M POUCY oNIT, UMLTS' GENDATE ERAL LIABRITY EACHOCCURRENCE f 1,000,000 PREMISES traumrl = 300,000 f 10,000 A Ir I COMMERCIALGEENERALUAGUTY CLAMS MADE ® OCCUR $CP424-15"9- 7/30/05 7/30/06 NED EXPIAn "9 "IPn PERSONAL& ADV INJURY S I,Oaa,-aoa GENERAL AGGREGATE S 2,000,000 GCML AGGRCCATG LIMIT APPLES PER! PRODUCTS-COMPIWAGG S 2- ao0 X POLICY JFCCT LOC AUTOMOBILE LIABILITY ANYAUTO - COMBINED SWOLE UNIT (Ef Kesdem & BODILY INJURY (PEPWIOM or 10a,000- E! ALL OWNED AUTOS SCHEDULEDAVTOS YW9338 10/3/04 10/3/05 900PLY�RY IE 300,00& HIREDAUTOS NON-OxMED AUTO$ _ IpRwEc�daMAGE = 10G, aa4 ! GARAGE LIABILITY AUTO ONLY -CA ACCIDENT- 1 - OTHER THAN EAACC AUTO ONLY: AGG S ANYAUTO A. EYCESSAIMBRELLALIABILITY EACH OCCURRENCE S AGOPEGATE S p OCCUR CLAIMS.MAOE. S DEDUCTRUi _ f RETENTION 3 C W OIDL BIS COMPEN'TRION AND EYROYERS'LDIBILITY ANY PROFR GTORJPAR TNERJOCECUTNE OFFttICERNIEMBER EXCLUDED? WC23IS353049014 12110/'04 121IOI05 WC 3LATU- rg E.L. EACH ACCIDENT S i0a OIIO E.L.DISEASE- PAEMPLOYEE f 500.000 vEt1pROOW5ICAFSbMw X E.L DISEASE-POLIGYLIMIT S l00 000 OTHER DMCRIPTIONOFOFERATIONSILOCATIONSlVENCEMEXCtHSIONSADOEDETENOdtEBAENTfOPECtlIL PROY1ffiON&" ' Electrical Gatavood Homes Fax No. (508) 778-5603 1600 Falmouth Road Suite 25 CointevilZa, ME 02632 ACORO 2S (2001108) CAbrALLATIOM- SNOULO ANY OF THEASOVE DESCRIBEO POLICIF118E CANCELLED BEFORE THE EXPIRATION DA=ETHEREIIf,TUEL"UR4&]MWOERYYBi EBDEAVCRTOMAIL . _j_Q—,OAYBWRITTEN NOTIC ETD THE CERTWICATENOLOER NAMEO TO TM CLEFT. BUTFN[UBETD•OC=VH`ALL ] IMPOSENO OBLIGATION OR LIAB0.RY Of ANY KIRO UPON THE INSLIREAL ITS AGENTS OR AUTHORIZED REPRESENT 4 ;, I PRODUSER Chatfield, Whitman & Young 549 Washington Street P.O. Box 850963 Braintree, MA 02185-096 INSURED Lawrence Robinson Masonry 5 Fresh Hole Road Hyannis, MA 02601 CO LTR A �+ p � 4 DATE (MMIDDIYY) I : �NSURANCE 9/15/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND S NOHOLDER. TH SONFECERT FICATE TGHTS HE NOTO AMEND, EXTENDATE OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. coMAPANY Harleysville Worcester Ins Co COMPANY B COMPANY C COMPANY D JERAGES _ ; _ --n: 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 POLICIESCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS.EREIN IS SUBJECT TO ALL THE TERMS, POLICY EFFECTNE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE (MMA)DIYY) � DATE (MM/ODM') COMMERCIAL GENERAL LIABILITY I CB 7 E 32 32 CLAIMS MADE a OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY 7 ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS'LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCI OTHER DESCRIPTION OF Gatewood Homes 1600 Falmouth Road Suite 25 Centerville, MA 02632 9/07/04 9/07/05 GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG i 2,000,000 PERSONAL&ADV INJURY $ 1,000,000. EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Any we fire) S 100,000 MED EXP (Arty we POMM) S 5,000 COMBINED SINGLE LIMIT $ BODILY INJURY (Per persm) $ BODILY INJURY _ (Per accident) y PROPERTYDAMAGE $ AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY: EACHACCIDENT $ _ EACH EL EACH ACCIDENT S EL DISEASE - POLICY LIMIT $ EL DISEASE - EA EMPLOYEE S .-,.:CANCELLATION f �-- y SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TD THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGAT10N OR LIABIU OF ANY KIND UPON THE COMPANY ENTS SENTA S. AUTHORIZED REPRESENTATIVE Robert E. Chatfield OACORQCORPORATION 19 ACORD;' CERTIFICATE OF LIABILITY INSURANCE ROT 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 INSURED INSURERA:TWSn City Fire Ins Co INSURER 8: LAWRENCE ROBINSON MASONRY INC INSURER C: 5 FRESH HOLE ROAD INSURER D: HYANNI S MA 02601 INSURER E: GUVtHAUtS 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 OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE MMVD/YY POLICY EXPIRATION DATE (MMIDDIYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE S FIRE DAMAGE (Any one fire) a MED EXP (Anv one person) a PERSONAL & ADV INJURY S GENERAL AGGREGATE S PRODUCTS - COMWOP AGG S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PILOT LOG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED -AUTOS HIRED AUTOS NON -OWNED AUTOS ' - COMBINED SINGLE LIMIT (Ea accident) a _ BODILY INJURY IPer person) a 4BODILY INJURY -(Per accident) a PROPERTY DAMAGE- h (Per accident) a GARAGE LL481UTY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGO S 9 A EXCESS LIABILITY OCCUR ID CLAIMS MADE DEDUCTIBLE RETENTION 4 WORKERS COMPENSA TION AND EMPLOYERVUABILITY 76 WEG NQ5620 - 09/06/04 - 09/06/05 EACH OCCURRENCE S AGGREGATE 9 S a ' X WC I IMII- OTH- 4 1 E-LEACH ACCIDENT $1OO 000 E.L DISEASE - EA EMPLOYEE $10 0 , 0 0 0 E.L DISEASE - POLICY LIMIT 1 a5 0 0 0 O 0 OTHER DESCRIPTION OF OPERATIONS20CAT70NSIVEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTIS➢EpAL PROVISIONS Those usual to the Insured's Operations. ULH I IhI(,A I t MULUtH IAnnl//neat maurteu; rrvaurtcn ac„crt: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE 00 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE GATEWOOD HOMES HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1600 FALMOUTH ROAD, SUITE 25 REPRESENTATIVES. CENTREVILLE MA 02632 AUTHORAFD RE➢RESENTA ACORD 25-S (7/97) " AUUHU UUHYUHA I IUIN IVao 12/02/04 13: 36 FAX 5087900249 GOLDMAN ASSOC 1002 .• ,4CaRD CERTIFICATE Or LIA-BI PRODUCER WLI =,- ec AS>O�IA3ES IirauA�AivCis - FlUNKCIAL SSitVICES INC. 933 F:;:,MODTH RD- HYANNIS MA 02601 Phonse508-775-6010 Yax:508-790-0249 RODNPv TAVANO DBA NOECRANICAL SYSTEMS 110 FOLDER LAMA W BA527STABLE MA 02669 n eYE L�mrnvwr i l � CSR AS. TAVANSO 12/02 04 THIS CERTIFICATE S SSUED AS A MATTER OF WFOOVIATION OILY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOS NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE; POLICIES BELC:e:. I INSURERS AFFORDING COVERAGE I NAIC A INSURERA: MARYLA= CASUALTY COMPANY INSURER L',LJV tKALvt5 THE POLICIES OF INSU?ANC< LISTED BELOW HAVE SEEN 1SW ED TO mE 1NSUP.ED NAMED ABOVE FOR TY.E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREM6NT, T931M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSJRANCE AFFQROE13 BY THE PQLICIE$ DESCRIBED HEREIN I$ 5UNF-cT TO ALL TH5?ER!115. EXCLUSIONS AND CONDRIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TR INSRO A T PEOFINSURANE GENERAL - II X COMMEIZCIALGENERALUABILRY 1 7 OCCUR POLICY NUMBER 000372088 DATE MO 11/21/04 DAE Mwv - LIMITS EACH OCCURRENCE I S 100- 0000 11/21/05 I PRFMIwS(EaIXLu2Mz) I 3300000 LIED FXP(Any We We ) I S 10000 PERSONALS ADV INJURY I f 1000000 CUJMS MADE 1 GENERALAGGREGATE S 2000000 GENL AGGREGATE LIMIT APPLIES PER!I PROOVCTS-COMPIOP AGG E 2000000 POLICY ! ,J�-�D7 LOD AUTDMOWL.L'. LIABILITY I COMBINED SINGLE LIMB (Ea aulyent) f ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per Ptrsan) I SCHEDULEDAUTOS I I HIRED AUTOS NO?I�N'?IEO AUTOS BODILY INJURY (Per accident) ! I ! I PROPERTY DAMAGE I (Per aeddVII) f H `QARAD£LANLITY ANY AUITD ( ( I AUTO ONLY -EA A£[IOENT f-- OuT THAN EAACC AUTO ONLY: AGG f f �!!-EXCIES&VIORELLAIJAM TTY Ir OCCUR C MADE 1---'! EACH OCCURRENCE I f I AGGREGATE ! Y = FCLtiMS �--yl DE-,JCTlSLE I - JWOR.KERSCOMPENSATION AND 'EMPLOYERa LIIABI-RY I i I TORY LIMBS E"i, EL EACH ACCIDENT I f 4ANY PROPRIETOiLPARTNER/EXECUTNE OFFICERIMEMSERUICLUDEDT E.LDISEASE -POEMPLOYE f ElDISEASE-PCLxY LIMIT f Yye6, dew-I.`wlrZ SPECIAL PI2OVISII?BLS belw OTHER DESCRIPTION GOF-wST..N-21L.^.CAr-=IYScN.=LESf:.................... ..-......,•--.�......�C....:.'R>r": N7- uwrsuvv`u aaiLe3S Zas% FA$ 508-778-5603 1600 FAL3ti u= ROAD SUITS 25 c=TIIRVILLE MA 02632 ACORD 25 (20011091 SHOULD ANY OF THE AWVZ DESCRIBED POLICES BE r NCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMEO TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGENTS OR iMv 119.�!!i�CERTJFICAT 8UR ANCE.... X ..... .............. .. . ......... .......... 0 b-OG-05 / THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P§ODUCFR GOLDMAN & ASSOC INS FIN 933 FALMOUTH RD 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 RTE 28 HYANNIS MA 026012319 COMPANY 28HPP A AMERICAN ZURICH INSURANCE COMPANY INSURED COMPANY TAVANO, RODNEY DBAr B COMPANY MECHANICAL SYSTEMS 201 CAPES TRAIL WEST BARNSTABLE MA 02668 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 POLICY NUMBER DATE EFFECTIVE (MM\DDNYY) POLICY EXPIRATION DATE (MM\DD\YY) LIMITS GENERAL LIABILITY CENERALIAGCREGATS - $ PRODUCTS-COMP/OP AGG. $ COMMERCIAL GENERAL LIABILITY COMMERCIAL PERSONAL & ADV. INJURY S I CLAIMS MADE F1 OCCUR. EACH OCCURRENCE $ M�CWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT BODILY INJURY (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: .......... ANY AUTO EACH ACCIDENT p AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-7278A84-9-05) 05-03-05 05-03-06 STATUTORY UMTS . ............ EACH ACCIDENT $ 100 000 THE PROPRIETOR/ F___l INCL PARTNEFIS/EXECLnIVE DISEASE—POUCY UMM 52000 DISEASE -EACH EMPLOYEE 020:000 OFFICERS ARE: bi EXCL OTHER DESCRIPTION OF OPERATIONS/LOCAnONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOL .. ..... ....... .... ... DER.; .......... ................. . ... ......... . ................... .. I—.. CELLATION ... .................. ...... .......... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE GATEWOOD HOMES INC LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1600 FALMOUTH RD SUITE 25 CENT ERVILLE MA 02632 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. . . ....... .. .. ... . .. ...... AUTHORIZED REPRESENTATIVE ....... .... ... .... AbORr PROPERTY ADDRESS: � AL.CULATION FOR PERMIT COST an b(1 711 2S/.6-- 1� Sgq,6 TYPE OF R ETC NO ADDITION ALTERATIoNs BATH Z , BED ROOM CERTIFICATE OF OCCUPANCY COMPUTER ROOM DECK OPEN DECK WITH ROOF DEMOLITION DEN DINING ROOM FAMILY ROOM FIREPLACE FOUNDATION ONLY GARAGE NO. OF SAYS GREAT ROOM KITCHEN LAUNDRY ROOM LIVING ROOM MUD ROOM OFFICE PORCH CLOSED PORCH OPEN REROOFING SHED STORAGE AREA SUN ROOM HEATED SUN ROOM UNHEATED SWIMMING POOL SWIMMING POOL iNC, MUND WINDOW REPLACEwExr O F TOWN OF YARMOUC H +011 Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-061 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 100 Owner's Name: Villages @ Camp Street, 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: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 8/15/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.C/Od new construction - Affordable: ZONING APPROV D 4/0 0411— REVIEWED BY: WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: ✓4. HEALTH 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: 8/22/2005 OF r� TOWN OF YARMOUTH Building Department ~ Town Hall Yarmouth, MA 02664 (508) 398.2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-061 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 100 Owner's Name: Villages 0 Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville F MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 8/15/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction - Affordable: AUG 2 4 Z005 HEALTH DEPT. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT. DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 8/22/2005 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Aug 25, 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., #100 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 th Water Availability. Reference Gatewood Homes 1600 Falmouth Rd., #25 Centerville, MA 02632 Ya u h ater Depar en r of t. TOWN OF YARMOUTH Building Department ►. Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-061 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 100 Owner's Name: Villages 0 Camp Street, 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: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 8/15/2005 Issue Date: Expiration Date Comments: new construction - Affordable: REVIEWED BY: 1. WATER DEPARTMENT: DATE: 2. ENGINEERING DEPARTMENT: DATE: DATE: DATE: DATE: DATE: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: N/A: N/A: N/A: N/A: N/A: 044.21.1.13 16d DATE: Date Printed: 8/22/2005 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck Software version 2.01 Release 2 I I CITY: Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Egret PROJECT INFORMATION: Mill Pond village 121 Camp Street Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Permit # Checked by/Date Required UA = 216 Your Home = 123 Area or Cavity Cont. Glazing/Door Perimeter R-value R-Value U-value UA ----------------------------------------------------------- CEILINGS 832 30.0 30.0 14 62 WALLS: wood Frame, 16" O.C. 1409 15.0 15.0 0.340 30 GLAZING: windows or Doors 87 40 0.340 14 GLAZING: windows or Doors 40 0.086 3 DOORS ------------------------------------------------------------------------------- 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 Massachusetts Energy Code MAscheck software version 2.01 Release 2 The Egret DATE: 4-21-2004 Bldg.1 Dept.l use I CEILINGS: [ ] I 1. R-30 + R-30 i Comments/Locati I WALLS: [ ] I 1. wood Frame, 16" Comments/LOcati I O.C., R-15 + R-15 I WINDOWS AND GLASS DOORS: [ ] I 1. u-value: 0.34 I For windows with labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Locatio [ ] I 2. U-value: 0.34 For windows without labeled U-values, describal eafeatures: [ ] No # Panes Frame Type Comments/Location DOORS: [ ] I 1. u-value: 0.086 comments/Location AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when I 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. I 2. Type iC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. VAPOR RETARDER: C ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing u-values must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table 74.4.7.1. DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I 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: [ ] I 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. I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 78004R 1310 and 74.4. I SWIMMING POOLS: [ ] I 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: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the.following levels (in.): I PIPE SIZES (in.) 1 I HEATING SYSTEMS: TEMP (F) 2 RUNOUTS 1.5 1.1.5 2..0 I LOW pressure/temp. 201-250 1.0 1.5 1.5 2.0 I LOW temperature 120-200 0.5 1.0 1.0 1.5 I steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or, 11 40-55 0.5 .5 .1. refrigerant below 40 1.0 1.0 1.55 1.55 CIRCULATING HOT WATER SYSTEMS: [ ] I insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) I NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" Oi 0-1 0.5 1.1.5.0„ 2.0+ I 170-180 I 0.5 1.0 1.5 0.5 140-160 0.5 1.5 1.0 I 100-130 0.5 I ----NOTES TO FIELD (Building Department Use Only)------------------------- RECEIVED o 4sa i b AUG 10 2006 BUILDING DEPT. By: RE -INSPECTIONS 1ST RE -INSPECTION 2NDRE-INSPECTION 3 OR MORE DUPLICATE WEATHER CARD DATE: % I 10 0 - $40.00 $50.00 $25.00 ADDRESS: lob I Ca'lp SL- " (00 ISSUED REASON FOR - RE -INSPECTION: \/o*,Q:- j2t J 5 a�) �oUC c& 6_ 0 6-414 BUILDING DEPT.: ELECTRICAL: FIRE DEPARTMENT: GAS: OCCUPANCY PERMIT: PLUMBING PERMIT: . OTHER: 4' ipOSED ` OUSE SPREY = 2.4.0 = 14 45.00' S84-23'45"W LOT 101 NOTE: ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 1OFT. OF WATER MAIN. GRAPHIC SCALE ?4o T icr, 20 10 0 20 60 Unless r,.,d i:,,r ch tine " thF rc�pcnsiGlg r ro�3::ic,� ,� ,bngin:ar, or sicnol 1_G.ld Sora}cr oppecrs cn thislon: (A} no psr_cn or parsons, including any monicipoi or ctrrr pu ;i ofscials, mod r=iy upon tha informatinn contoined herz`•i; ,,. , ( IN FEET) (6) U);s pl.n 1 alns th+ prnpsi+y of Holmes 1 inch = 20 ft_ PLOT PLAN hoimes and mcgrath, Inc. OF LOT 100 °r TI,140THyM f civil engineers and land surveyors a° 0 SANTOS PREPARED FOR 362 gifford street i No.4so7e N MILL POND VILLAGE CIVIL IN falmouth, ma. 02540 No IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC 1Fss/0 AL 4N�\ SCALE: 1 "=20' DATE: 3-23-05 DWG. NO.: A2548 CHECKED: OU> r RE -INSPECTIONS 1" RE -INSPECTION 2NDRE-INSPECTION 3 OR MORE DUPLICATE WEATHER CARD DATE: ADDRESS: ISSUED TO: REASON FOR I E-_51N&P BUILDING DEPT.: FIRE DEPARTMENT: GAS: OCCUPANCY PERMIT: PLUMBING PERMIT: OTHER: 2(/ r /o 73 oa - $40.00 $50.00 $25.00 w�lu-Z��