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HomeMy WebLinkAbout121 Camp St #102 Building PermitsTOWN OF YARMOUTH Building AM Location New IX Plans Submitted RECEIVED UG 17 2006 Renovation ❑ Yes ❑ No lk APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) Fee: -- PERMIT NO., Cam' —tom% — ---- Date %471 owner'g Name( A%` 4!$ie s ,7-"- Type of Occupancy - — Replacement ❑ � x W y 7Q`1 Z W Q m N W F44- QFQ W I. W O n a C t' N - rA t7 U W = y W Q¢ O p W Q W J J Q Q S F Q } O IL m W 2 U. Q Z M, I= ~i N O O 0 0 S W O G 0-1 0 X�� tL F O SUB•BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) "�� Check One: Installing Company Name -�✓VG T {-s��n,j�1 M tT�17_ ❑ Corp. Address _ G_t s i _ _. __ ❑ Partnership ��4A111�Li''� Q7Z-�c��-- N1 Firm/Company—-_-------- Business Telephone -15-7QF_ Name of Licensed Plumber or INSURANCE COVERAGE: COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes &�No ❑ If you have checked yes, please indicate t e type of coverage by checking the appropriate box. A liability insurance policy a 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: - - -- -- - -- - - ---- — - --------.—. Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted Signatureo Licensed Plumber or Gasfitter (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 License Number pertinent provisions of the Massachusetts State Plumbing Code and TVDF 1 if•GNCF- 1 a / LOT 102 LOT 101 ess9 EXISTING FOUNDATION ti ss3g , LOT 103 h I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD ARFjkr DATE REGISTERED PROFESSIONAL LAND SURVEYOR NOTICE 20 Unless and until such time as the original (red) stomp of the responsible Professional Engineer, or Professional Land Surveyor appears on this pion: (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein: and (8) this plan remains the property of Holmes dr McGrath. Inc. ' EXISTING FOUNDATION 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 J5" - DATE REGISTERED PIROFIESSIONAL LAND SURVEYOR GRAPHIC SCALE 10 0 20 60 ( IN FEET ) 1 inch = 20 ft AS —BUILT PLANSL holmes and mcgrath, Inc. ;��-� . - OF LOT 102 rlsCMn� PREPARED FOR civil engineers and land surveyors 362 gifford street p.+,cGRArH MILL POND VILLAGE IN falmouth, ma. 02540 0� Rf _< �rct'n CI YARMOUTH, MA JOB NO: 201197 DRAWN: LMC 9- SCALE: 1"=20' DATE: 12-15-051 DWG. NO.: A2546A CHECKED - : OF ,r TOWN OF YARMOUTH ` Buuding Department BUILDING (508) 398 2231 ext.261 � = PERMIT NO �:=B:Os=4as=�-------_-_-_-_; PERMIT .� ISSUE DATE ; - 9/29/2005 - ' D USE _ _ _ _ APPLICANT 'F�rankc- - - - _ _ _ _ _ _ _ _ _ JOB WEATHER CARD -Fran- PERMIT TO 'New Construction ' AT (LOCATION)- 00121 CAMP ST Unit 102 } ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE O BUILDING IS TO BE: CONST TYPE1 5-B I USE GROUP I R_4 new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 08/29/05. REMARKS AREA (SO FT) EST COST ($ I$141,600.00 PERMIT FEE ($) 1$516.00 OWNER lVillages @ Camp Street, LLC gp(tDING DEI nBY ADDRESS 1600 Falmouth Road # 25 /,/ 1) 4 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 MA 02632 Certificate Issue Date - �� CERTIFICATE of OCCUPANCY) Departnidntal Approval for Certificate of Occupancy and Compliance InenP&nr Date Permit Number Approved By , Remarks /5/Ile 111110002_M ELECTRICAL To be filled in by each division indicated hereon upon completion of its final inspection. OF '�� TOWN OF YARMOUTH }Building Department BUILDING ,r (508) 398-2231 ext.261 PERMIT NO _B-06-446 : PERMIT - ISSUE DATE ; 9/29/2005 ; PROPOSED USE _ _ _ _ _ _ _ . _ _ APPLICANT Frank Capra JOB WEATHER CARD --------------------- ------------ PERMIT TO ' New Construction ; AT (LOCATION) 100121 CAMP ST Unit 102 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1044.21A.C102 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 greapdFNchen as per plans dated 08/29/05. 3EMARKS ( ?- ) ,REA (SO FT) EST COST ($ $141, PERMIT FEE OWNER Villages 0 -Camp Street, LLC BUILDING DEPT BY ADDRESS 1600 Falmouth Road # 25 Centerville1 MA 102W2 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector Z �S - � 16 LT - lo. . oG in � r,�G 0 �RONE & TWO FAMILY ONLY - BUILDING PERMIT p APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i • ,� e (� Town of Yarmouth Building Department ` MATTACMEES 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 %euse ly /L/ },i�tanning Permit No.Uate 1a- =G FeeC' Deposit Recd. $ Dated Net Due Board Information ✓I eMap ccrsement Date Recording Date Plan Na Other Assessors Department Information: Lot Ma Lot Old Ne41'v/6Perrnit 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Per i m r: Date Issued: Signature' O -2' / - OS p� cy�Jj Certificate of Occupancy' is is not required' Building Official Date Section 1 - Site Information Use Group: R-4 Type: 5-B 1.1 Property Address: 21 ee �, 1.2 Zoning Information: P, " Ias"ee-2 0 Z Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided F— 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments:, Zone: BFE: ' Section 2 - Property Ownership/Authorized Agent 2.7 wp r of Record: Mailing Addres¢��J ice^/yv,ramQ�i1� �// T. Name(sib_ "�p(J Di l Ayr�.5 A�C V ^ EO Signature Telephone 2.2 AuthorizgdrAgent: Na print ss�,v`f�I rl�I� + g� Signature Telephone j Fax L 11 6 Z 5 Section 3- Construction Services /r NG C PT 3.1 Licensed Construction Supervisor: /Aq_ r Not Applicable ❑ �C'j License Number 0 oC.i AddrOf �G Expiration Date A pp Signature Teleph _ „ 3.2 Registered Home Improvement Contractor: Company Name (f : SEP Z J _ Not Applicable License Number Address Signature Telephone Expiration Date 9 - 15 - 99 1 of 2 OVER I;L""� a a Workers Compensation Insurance affidavit must be completed and submitted with this application. rFailure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ..ef'.1 No .......... Section? 5 - Description of Proposed Work '(check 'all aoolicable)' New Construction Existing Bldg. ❑ No. of Bedrooms No. of Bathrooms Z Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: P fY: Brief Description of Proposed Work: if 5j'"10 le e - I hereby authorize my behalf, in all r I rela to Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property authorized by this building permit application. Date to act on 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. - 016 IM rnnrname /l Sig a of O nor/ gent Date 9-15-99 2 of 2 Ir i } }� lvwiv.ur YARMOUTH .o ^�-••• BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT - job Location: Owner of Property: Construction Supervisor: Address: '0 .� Licensed Designee: (If other than Supervisor) Street Village _4=T-- " S LL c �. ' P oa S2>8 - -)119669 Name License No. Phone No. ivame 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures 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 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 12( No ❑ If you have checked y- s, please indicate the type coverage by checking the appropriate box. A liability insurance policy � 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 2 o ass. al a s, and that my signature on this permit application waives this requirement. Check one: Signat re of ner or Owner's Agen Owner ❑ Agent Signature: Building Official Approval: k EN■ 6 1 The Commonwealth of Massachusetts Department of Industrial Accidents ofllee of lsvestfostfsss 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit A 4--b ►�, 0 I am a homeowner performing all work myself. 1 am a sole proprietor _rd ha%e no one working in any capacity vt4—C 1 am .an employer pro% iding workers' compensation for my employees workin¢ on this job. comnanna am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following worker• compensation polices: city phone insurance m address a - n phone Y rauure to secure coverage as required under Section 25A of MGL 152 cart lead to the imposition of erimLai penalties of; time m .to SI one yef this imprisonment n well a civil peoaldd in the form of a STOP WORK ORDER and a fine of Slf�Om day igainat ma I mode dmd'that00 oa copy of thh statement may be forwarded to the Office of Investigations of the DIA for. coverage veriticadom. I do hereby terrify} er rhr aint a e !ties of perjury that the information provided above is out and correct: Signature Print name �CL V official use only do not Trite in this area to be completed by city or town official city or town: YARMODTIJ permittlicense M _ nBuilding Department ❑ check if immediate response is required Oldeensiog Board 261 OStiectmen's Oniee contact person: phone N: _ (508) 398-2231 eat, ❑Healtb Department pother 5 TOWN OF YARMOUTH BUILDING � 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026; 51 GAS Telephone (508) 398-2231, Fxt 261 — Fas (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at l 5+ WorkAAAress is to be disposed of at the following location: r\ oO-V/-,t 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. GMS9/GCS9. SERIES 93% AFUE Multi-Tositionv Single-Stage/Multi-Speed Gas Furnace-.. - . Heating Capacity; . 46,000-115,000 BTUH Standard Features • Corrosion -resistant, aluminized -steel tubular heat exchanger and stainless -steel recuperative coil fox maximum efficiency • Designed for multi -position installation—GM59':' upflow, horizontal right or left GCS9: downflow. horizontal right or left Energy -saving, reliable Hoc Surface Ignition system, featuring a Norton* Mini•Igniter.with patented adaptive learning algorithm to maximize igniter life- • Aluminized steel inshot burners • Energy -saving PSC iriulu-speed, direct drive blower motor • Quiet, corrosion resistant induced -draft blower assembly • Integrated furnace control -with -improved -- diagnostics • Low voltage tetminal blocks Multiple flame toll -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 • Topvenang-isstandard; alrei tale-fh,e/venrlocated- -- on right side • Completely. assembled.factocy runatested furnace.fot.. heating or combination heating/cooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent (I -pipe) applications air-CundWorrtnrg &}teatirrg. The GMS9/GCS9 single -stage, multi=spee&gas fierrram offer- installation.versatility, . . Cabirtet Constractiotr • Heavygauge, reinforced, fully insulated steel cabinet with-durabkbaked-enamel Amish - • 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 arid electric service • Bottom or side air inlet (GMS9) • Removable. solid -bottom blockroff (GM59)- Accessories • L.P. Conversion Kit (LPTOOA) L: P.-Gar Low- Pressum Kit (LPLPO 1) • High Altitude Natural Gas/L.F. Kits (HANG11. HANG12, HALP10) - • High Altitude Pressure Switch Kit (HAPS27) • ExternatFamllack4EFROU • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent.Kit(VCVK)... Internal Filter Retention Kit—upilow, horizontal (RF000180) ..... • Internal Filter Retention Kit—downilow (111,000181) • Thermostats Slower Motors (CHT18.60. CH70TG. CHSATG, H2OTWR) $$ 3iil) wwwgoodmanmfscom 6/04 PRO D!IQT SPECIFICATIONS Nomenclature 8 WO 3 a. E a". Goodman® Brand Air Flow Direction tk UpflowlHonzwtat. . D: Dedicated Downf(ow C. Downftow/ Horizontal a in A Wi th Ht Flow 14" [A: B B. 17A" Description Desr C C. W : Single Stage/Multi-speed S. ST, D; 24VV' V : TWO Stage/Variabie-weed Arur I [ 3:-1,200.. 4; 1,600 5: 2,000 045,45,000 070; 70,000 090: 90,000 I 15:. 1 15,OOOL- 140:140,000 2- i PRODUCT SPECIFICATIONS GCS9 Dimensions LEFTa1DE . . ve!w NEvr new 310E view - aY a'A �I• aN IFivv noe rPIPE iRtihMNMR) 'Y• vLNTrLpvc rove ruts CONDENSATE r "1 Low VOLTAGE LowvoLTAGE �! +L.lus"itcAt. Hoke L J MO" vaLTAGe ELECTR-cA1 NOTE . ORAar .... ... .. . . TRAe 2 11.7 310E MAW LINE b Is lrr NOLKS ♦ANDAAO r.Aa II/f2 . ,,. s t Isl Q FaDFG nAlaEa 013eNAMEAy Nr Y.•Pvc I ELacTaXAL Note pLlO1AMs... . IRIaNT OR .. MGNVOLTAca- t@rT a�0e1 ELlcTRIG4 Holt TERNATE. r• to ata kocATI N IOGAtiWr 2 "at • .., ALTERNATC If>q • Ale wx"Lwcaa o 1AW to ant tN rWgL . .AMM BIDE a. It N 1� tttXEa a u a YA 1 ypy µTtRnATE GAa GC590e5JBXA 17%" 16" lZa/." U'h" IV GCS90703BXA 17yr" t6"..... _.. ..t2.;-. ... 1 ...... 16" GC590904CXA GCS91155DXA7 2Y 24341, 1W ... 22'._. 16'/." ... _ 20'/."-..... Is" - 2714"._... 19%0 .. �• l Installer must supply one or Iwo PVC pipes: one for eombustWmatt(uptionap and orK krt thellof audit (required). Vint pipe must be etcher 2" or )" in diameter, depending upon furnace input; numberof elbows, length of run ancrinst insrion (1 or 2 pipes). The optional Combwher Air Pipe is dependent on insallationkode requirements and must be 2' of 3' diatnetet PVC. nori e voltage wising can enter through al gas I Link or lefrstdeofthe furnace Low vuftzge wiring camentes through the right or left side of furnace. 4. Conversion kits for high dcttude natural gu operation ate available. Contact your C)oodman distributor or dealer fta details. tnstallet must supply firllowing gas line fittings, according to which cntrance.iaused : Left-T-N. 90 elbows, acre close ritpple: straight pipe Right -Straight pipe to teach gas valve Minimum Ctear aces to Combustible Materials C - Combustible. If placed on tumbustible (bog, chi floor MUST be wood ONLY. NC - Noo•Combustiblr. A combustible floor subbase must be used fw installation on combustible Roaring NOTE5: • For strvicing or cleaning, a 36' front clearance is recommended. • Unit amriccnona (electrical. Rue and drain) may necessitate greater clearances thao.cha m{nitnumekararsEa hued below: • In all raw, accessibilttr clearance must take precedence over cleams"ea from the enclosure white accesaibitity clesreoces are greater. 5 i .PRODUCT SPEC, IFICATIO S Blower Performance Specifications kr .. IM i s F HIGH 3.0 1,352 , .1,318 1,260 •: •--: 1,202 G_S904538XA MED 2.5 1,214 1-,172 ...... 1,123 --•-•- 1,064 ...... (LOW) MED-LO 2.0 997 •..... 994 •-•--- 960 35 923 36 • LOW.. - 1:5.. -757 ..- 44_...753- 44-- 734 . 45 . -704•- -47' HIGH 3.0 1,449 36 1,409 37 1,326 39 1,273 41 G 590703BXA MED 2.5 1,192 43 1,172 44 1,141 45 1,094 47 " +5 (MED-Hq' ' MED-LO ' 'Z.0 •981 53 062 "54 943 55 '917 56 LOW 1.5 750 730 1 ------ 714 692 G_590904CXA . NIGH... MED ...4.,0 • • 1.5 1-,970 1,713 •----• 39 t,474- 1,650 •-35 - 40 1;757. 1,572 ..35 - 42 1-,66,7- 1.510 . -40• - _ 44 R'. . - (MED-LO) MED•LO 3.0 1,439 46 1,412 47 1,370 48 1,327 50 S ft ;•'•�31 'LOW" "2.5 1 T8) '56'" l"155' "'57-. 1 tZ2 59" i 108 4.. HIGH 5.0 2,134 40 2,103 40 2,029 42 1,941 G 591155OXA , µED 4.0 1,p7a ..51 1,643 _ 52. 1.643 .52. 1.,527 ..54.. IMED-HI) MED•LO 3.5 1,453 58 1,440 59 1,426 59 1,363 62':- LOW ..3.0....1 254 67. . ] 239 68... 22Q ..70. - 1 181 ---•-- NOTES: I. CFM in chart 6 withuut filter(s). Filter& do not ship.nith this furnace. but must lxs.pnrvukd.by the'iastAIIm if the-laxnarm requires twtr reh toss this chart assumes finch filters are installed. . -- 2. All farness ship w high speed cooling. Installer most adjust blower cospling speed as needed. .l. Fav nxsst jobs. almur 400 CFM per tun when cm-Aing is desirable. 4. INSTALLATION 15 TO BE ADJUSTED TO OBTAIN TEMPERATURF. RISE WIT111N 1 Hk RANCE SPECIFIED ON fHE RATING PLATE. 5. The chart is fare Inkxmatku, tidy. For sacisfacmrl operatiem, external antic pre.~e most not exeeed value shown nn 111c •sting plate The shaded area indicates tangs, br excess of maximum static pressure idluwed when heating. 6. The dashed ( ---- ) ar'cas indicare a tesnperanueeixnut reersmsnended faft7no4el._. 7. The above chart is fin U.S. furnaces installed at 0• • 2A00-. At higher altitudes. a pn'lxrly de -rated unit will have aplmuuuately the same temperature rise at a pnrticu(ar CFM,. while ESA at The CFM wdl bthtwer.... - ` J 'PRODUCT SPECIFICATIONS Accessories LPT-DOA ✓ L.P. Conversion Kit ✓ ✓ LPLPOI L.P. Gas Low Pressure Kit ✓ ✓ ✓ ✓ HANG11 High Altitude Natural Gas Kit 1 1 1 1 HANG12 High Attitude Natural Gas Ket 2 2 I 2 ' HALP7D High Attltude L.P. Gas Kit ] . .... 3..-. 1. 1- . HAPS27 High altitude Pressure Switch Kit 3 3 3 3 ..EMI.. External Ffleer.Rack-...... _ ........ ✓. ... _.. ..... ♦ ....-. ✓..... _ -_ DCVK-20 Horizontal/Vertical Concentric Vent Kit (2-) ✓ ✓ DCYKJO Horizonta lYM+cat EatcentricVeMxiC (}^)- -- -- ✓ Available for this model _ (1) 7,D01"to 9,90000 (2) 9,001' to I l'Wo' (5) 7Al, to ILo00' Note: All Installations above 7,000'tequire a pressure switch change. For ho atlatiorrin Canada, furnaces ua certified only to 4.500'. Dewtiliow Floor Base: When the GCS 9 inoticl Is installed directly on a wuod floor, ■ downflow flout. base must be used..Thtza model rutnb=, am! CFR17, CFB21 and G71524. Thermostats u J 7 ` BOARD OF. BUILDING -REGULATIONS r License-:. CON&TRFJCTION�SEJPERViSOR. . . �. Numbeiti OtZ430- - Birthda%0 Exiurer 6MOO6• Tr. no: 25926. Resin>OI� .�; FRANK G CAPRA�" ` v 46 COPPER LC t CEUTERNALLE, MA 02532� - - Commissroner i 00 - 35;000 ctenclosed-space - (MGL C_112SMLJ - IA- Masoilry only ' -{ TG'I!+-iZFa riiI' , oines ' Failure to possess aKaurentedifion of the - .I MassaclwsepsSWMBuildingCode: -'• is cause f6r revocation of this license. ; j_ i DIG SAFE:CALL CENTER: 1888) 344-7233 n 7/19/2005 A'CORDT, CERTIFICATE OF LIABILITY INSURANCE 0MIDD7/105 PRODUCER (508) 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 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601- INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERAFirSt Financial Insurance Filho, Antonio DBA BED ROOFING INSURERS Po BOX 1231 INSURER C: 136 Stevens st INSURER D: Hyannis MA 02601— INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMtD AbL)Vt rUK MC ruin..' r¢rnj . --.. — I REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICYNUMBER DATE(MMIODfYY) DATE(MM/DD/YY) EACH OCCURRENCE $ 1,000,000 A GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) 491F002639 06/21/2005 06/21/2006 MEDEXP(An one person) S 5,000 � CLAIMS MADE OCCUR PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 71 POLICY PRO- LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLEUMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILYINJURY (Per Person) S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) S NON-0WNEO AUTOS •. I I / / PROPERTY DAMAGE (Per accident) $ 0GARAGEUABIUTY AUTO AUTO ONLY• EA ACCIDENTANY OTHERTHAN EA ACC AUTO ONLY: AGG S S EXCESSIUMBRELLA LIABILITY / / EACH OCCURRENCE S AGGREGATE S OCCUR CLAIMS MADE _ S $ / / / / DEDUCTIBLE '• j RETENTION $ WORKERS COMPENSATION AND / / / / _ TORY L MITS ER S E.L. EACH ACCIDENT S EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? / / / % E.L DISEASE - EA EMPLOYE S E.L. DISEASE- POLICY LIMIT Is If yes• describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS SIDING AND ROOFING. ' CERTIFICATE HOLDER VF11Yl CL IIVIY ( ) - (508) 778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,- THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT GATEWOOD HOMES FAILURE TO DO SO SHALL IMPO O OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1600 FALMOUTH RD SUITE 25 INSURER, ITS AGENTS OR REP SENTATNES. - - AUTHORED REPRESEN T CENTERVILLE MA 02632- ACORD 25 (2001108) Y10© ACORD CORPORATION 1981 fQp,,�- INS025(ofae).cs ELECTRONIC LASER FORMS. INC. - (800)927-0545 Page t of i; MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE q,se this fora to request a Certificate of Insurance from an Assigned Risk Pool Carrier. M Please provide all of the requested information, including the facsimile numbzrs) of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accur2Jel!y ccmipieted, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, tc thkit bNo (2) business days of the parr:-?s receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrfier's contact information refer to the Certificates of Insurance section located in the Producer Comm=-.i'iysecticn of the Bureau's web_ e (wifN. wcrbma.org). I. Name, address, teI phone number and facsimil nub number of the INSURED: Name: V'1' P- R (�60�1.n1 Mailing Address: Physic[ .Address:___ _ Pho _ Fax: 2. ame, address, felephcne number and dcsimfle number of the CERTIFICATE HOLDER: Name: WRJf /- -- Mailing Address:Physical Address: Phone: Fax: 3. Name, address, contact person,telephone number and facsimile number of the PRODUCER: Name: Sandtpi Insurance AQericvv inc. MailinaAddress: 12 Enterprise Road Hyannis, MA 02601 V F Contact Person: Cb_ri q Qr 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 been issued, you must attach a copy of the Notice of Assignment. Policy Number: �W/(C����_� Effective Date: _�Z`-f C; - �.� Expiration Date: Y77 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 infcrmation (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. Date: 5/5/2005 Time: 3:02 PM To: @ 15087785603 Client_ 24389 Page: 002-003 rreor-rnrocAnv - 'li AGRD C.LRTltcl A t =" YF LI.,ABt� ',NSU'-ANVE�V f QDATE FIt-9,M,DO/YYVn PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Feielberg Company ONLY AND. CONFERS NO RIGHTS UPON THE. CERTIFICATE- 222 Milliken Bivd. HOLDER; THISC€RTI€ICATEDOES NOTAMEND E` TEND�OR- P.O. Box 3220 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fail River, MA 02722 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A- Acadia Insurance COr41 anleS Cape Cod Ready.Mix Inc. INSURER B: Construction Industries Compensation PO Box 399 ' INSURER C: OriPans, UA, 02SSA INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN.DWf - ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR -OTHER DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUEUOR- MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN RED iron BY PAID CLAIMS. LTR NSA TYPE OF INSURANCE POLICYNUM13ER POLICY EFFECTIVE POLICYEXPIRATIONDATE LIMITS A GENERAL UABILITY CPA0132463t0- 01/0t/05-. 0tj0t/08 EACH OCCURRENCE Si 0013000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S1000W MEOEXP"mepffon) $5000 a.41Ms'MADE.�X OCCUR . . PERSONAL & ADV INJURY Si DOO 000 GENEPALAGGREGATE $2 DO@000 .. GEN•L AGGREGATE LIMIT APPLIES PER POLICY"; LCC PRODUCTS - C]MP(OP AGG S2 000 O00 - A _ AUTOMOBILE -LABILITY ..ANY AUTO MAAo13246310 01/01/05 01101/06 - COMBINED SINGLE LIMIT (Ea accio3rrcj S1,WORM ' ALL OWNED AUTOS SGHEDULDAUTOS BODILY INvav S X X HIRED AUTOS NCN{VYNED.4UTOS BODILY INJURY - Pe aciaadj S X PROPERTY DAMAGE S GARAGE UABILITY AUTO ONLY • EA ACCIDENT S ANY AUTO - OTHER THAN EAACC S S . ALTO ONLY: AGO A EXCESSIUMBRELLAUABILm X OCCUR. C AIMS MADE CUA0132470J0 01/01/05 01/0110o EACHOCOUPRENCE - 000000 AGGREGATE S S , B 4DEDUCTIBLE X RETENTION so WORKERS COMPENSATION AND EMPLOYERS' I Aa(alw- WC000925S - - 01/01/05 01/01/06 S X . 4Y TAir Oi4 v S . E.L. EACH ACCIDENT S500 000- ANY PP.OPRIETCR/PARTNER(EXECUTNE OFFiCENMEMBER EXCLUDED'i E1.DISEASP.EAEMPLOYE - SSW OW If Yes Ceiba once E.L.CISEASE-POUCYUMIT S$0001sA- SPEC7ALPPOVISInNc_bdl_ OTHER OESCRIPTIONOFOPERATIONS(LOCATIONS(VEHICLES/EXCLUSIONSADDEO BI'ENDORSEMENFI SPEC7At PROVISIONS l�ROT1CIn nTR un, nvn Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, MA 02632 Amenee 1eti� s. . I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 'EREOF THE ISSUING WSURER WILL ENDEAVOR TO MAIL gyp_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, FTS AGENTS OR • • —r-�wR�nn�co AH1 0 ACORD CORPORATION 1988 05/06/2005 09:36 5084204474 EDWARD A GRAZUL PAGE 02 ... AY'MI i�ri -CERTIFICATE V i.l1 M� �'f. INSLR:LI .. ON_ 1�(M4VC-,DmT �Ai (/.�� r/�' yw( .......7} �) ■ }yam .T��{ �Gy ( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION { CONFERS NORIGHTS UPON THE CERTIFICATE rAccuc€A ONLY AND Gm711I.Insaaz �xYe Itr-- HOLDER. THIS CERnF,1CATE'oaES tiOT AME#D; E3EF6N84 THE POLICIES BELOW. A. ALTER THE-COVERAGEAFFOSD_D,BY . [�-BrSttZ75 dLiS, MA C2648 WSURERS.ALF,yF,OORDING-COVSRAGC _ I NA1C# �— ._—_.—. —_• INSURER A:.- `��y, �l�_�t�11+g.. _. ,_ 1NSUPfO • II 111 IN509EA S' j - I Ids 1 .. .ste_ INSUAEfIG. ._ - 145 CcTtti ICI�y� NStiRCAD•. ytt�yt, Macste>Rs I' Lils, l'ri VLS7+U INSUPEb E: COVERAGES - THE POt1CIE5 OF-tN3UPANCE LISTED BELOW HAVE rEEN ISSUED TO TH'e INSURED NANIED ABOVE FOR T'c'.E POLICY PERIOD 1r401CATED. NOTLMTHSTANDING WITH RESPECT TO WHICH'THIS CERTIMATE-M"., BE ISSUED-OA-. ANY REOUtREM£NT, •TERM. CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT BY THE POLr4ES D@SCRtBEDNEREIN IS SL'BJEG7 TO ALL THE 7yIZUiS. 'eXCLUSIOt' .AND CONDITIONS OP SUCH MAY PERTAIN, THE')NSUP.ANC£.AFFDRDED POLICIES. AGGREGATEUMITS SHOWN MAY HAVE BEEN REDUCED HY PAID CLAIMS. - - POLICY EFTECYIVE FOUCV £XPA7AilONI LIMITS ' IH9Rf POLICY NUMBER vATEImI EACH OCCURRENCE ..�Ir_�_ GEIIEAAL L148ILiTY .... _ j 5E TO-AFFITEIT... PREMISE£ (EgoCeu!MICBI . y .isMIMERC1AlGENERAL LL\BAJTY MEO€Xr (Aq..aeePe�eoeL��.yyyyji_ �J CLAIMS MADE OCCUR If .. PERSONAL 6 ADV INJURY EO GENEMAGGAEATE .. ....' 4}2806 voTscoMvcrxor, �sZ� _ A a£NtiAGGAfeaLMrAPPLIES PER' .. . PRo- ioc't POLICY Al3TOMDBtLE LIAOIUTY CDNBINEOSIN01-F LIMIT Ci I( ANY AUTO III I BODILY INJURY y I AI.L OWNED AUTOS (Pppamom SCHEOULrDAUTOS HIREDAUTDs jjj k apDDILYINUPY I l• 9(]Ci�Ami } i .NON -OWNED AUTOS k I r' PROI'`RTYDTJAKo - (Pwwclde ) I F ) ALLTfl ONLY -SA ACUDEM S _ �OTHERTHAN EAACC S GARAOEUABILRY Y I ' ANY A4TO AUTOONLYI A03 _! 12 IrI ETCE3SA7518net l e UABILLTY I I IF,ACHOOCUAR£NC' T F ! - I_7 CLAIMS RAOC ' I AC3G?EGAR O'CCUFr DEDUCTIBLE - f y RETENTION S I WOgrAru >�g rTORY L:F:I, I . WCAXEAS EMPLOYER71.1ASUM COMP&CM710MAND... C.LEACH ACCIDENT - IS ANY OF.FICF111MEM60 � PMOPRIETOPIPARTNEMEXECUTive EXCLUOED7 I E_L; OfSEASE-EA EMW,OY£E 5 y IN" ft"Ab"md" I - E.L. DISEASE • POUCY LIMIT SPEgAL PROVIStemil lw I mFER CateWCCd IbTE53 IMc Rte'Ll7 - . . Cfl1`L=?7-[1/i�p2Y��ty��n'p � C2�f/J�.i32 FAX: 1 PLC-/ 1 V JLW /SPECALrAOV(S0"_ -' ;gNLZLLAT - — SHOULD ANY OF THE ABOVEOESCRIBED POLIO= OF PANCELLED DEr-ORE: NE FXPI=AnON DATE THEAEOF THE ISSWNG-WSUAEA WILL DOFAVOR TO MAIL _DAYS WRITTEN NOTICE TZTHE CE.RUpCATE HOLDER NAMEO TO THE LEFT. 9UT FARURE TO DD SQ SHALL IMPOSE NO-O&LIC=jON.aII LLA®LRY. OF, ANY. X ND 11POH THE 1450 - - IFS-A6`NTfr@N AEPAE.AENTATNES. .. _ 1UTXO�D PEPAESEWAT^E .. ,.._ ion • ` ' - " CERTIFICATE OF INSURANCE ISSUE DATE(M MID D/YY) Q5106/2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Harold H Williams Ins Agcy Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 81 Basset Lane P- POLICIES BELOW. Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE INSURED Stephen M Childs COMPANY A.I.K. Mutual Insurance Co A 145 Cammett Road LETTER Marstbns Mills, MA 02648 I _COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO N LTR' T•)'1=OF iNSi4L? .CE POLJCY NU.".SEER POLICY EFFECTIVE POLICY EXPDRATIO I DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS - .G_AL LIABILITY - - I i _ !GENERAL AGGREGATE 1 f I COMMERCIAL GENERAL LIABILITY I PRODUCTS-COMP/OP wGG. I S CLAIMS MADEF—bCCUR !PERSONAL@ ADV. INJURY I f I�OWNER'S& CONTRACTOR'S PROT. EACH OCCURRENCE 5 I—J I IPIRE DAMAGE (Any one (irc) f MED. EXPENSE (Any one person) f IAU1'OhIO1SILE LIABILITY 11—MANY AUTO - HALL COMBINEDSINGLE i E ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS NUN -OWNED AUTOS . I I IBODILYINE (Per xciden) GARAGE LIABILITY I I (PROPERTY DAMAGE 5 I 'EXCLSS LIABILITY -{ EACH OCCURRENCE f ' i011IRrLLA FORM I AGGREGATE $ HER THAN UMBRELLA FORM 'WORKER'S COMPENSATION AND ?MPLOYERS'LIABILITY X w AruroRv THER EL EACH ACCIDENT I f 100,000 A )rhlE PROPRIETOR/ OPR' 7015793012004 112/13/2004 12/13/2DD5 INCL �'ARTN XECUTIVE I EL DISEASE --POLICY LIMIT 5 D00 000 JOFFICERS .ARE: IX FXCL I . IEL DISEASE-EACI'I EMPLOYEE f 100 p0Q OTHER UI%SCRII9'ION OF UI'IiliAl'IONS/LOCATIONSIVEIHCLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE GateWood Homes EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Bell Tower Mall Rte 8 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. - Centerville, MA 02632 AUTHORIZED REPRESENTATIVE AGOR�,D CERTIFICATE OF LIABILITY INSURANCE OP ID K DATE(MMDDMYY) CROWC5D 06/06105 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sullivan, Garrity & Donnelly ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 508-754-1767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Institute Rd - PO Box 15010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester MA 01615-0010 Phone:508-754-1767 Fax:508-754-1885 INSURED Crowell Construction, Inc. PO Box 309 So. Dennis MA 02660 INSURERS AFFORDING COVERAGE NAIC # INSURERA: 'ALEA NORTH AMERICA INS CO INSURER B: Hanover Insurance Co - 222S INSURER C: INSURER 0: 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. LTRINSRI TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) PDATE (MM% OIYY LIMITS $ GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F X� OCCUR ZHN700714102 05/01/05 05/01/06 EACH OCCURRENCE $1,000,000 PREMISES (Ea occurence)Y $100,000 MED EXP-(Any one Person) S 5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG 52,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS AFN7001142-02 05/01/05 05/01/06 COMBINED SINGLE LIMIT (Ea accident) $ BODILY$ (Perrperson) 1,000,000 X X BODILY (Per accident) (Per accidenq $ 1,000,000 X PROPERTY DAMAGE (Per accident) $ 50O 000 r GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? I/ yes, describe under SPECIAL PROVISIONS below I WC1049858 i 03/22/05I 03/22/06 TORY LIMITS I X ER E.LEACH ACCIDENT $SOO OOO r E.L DISEASE -EA EMPLOYEE $SOO,000 E.L. DISEASE - POLICY LIMIT $500, 000 B OTHER Property Section DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Subject to policy forms, conditions and exclusions. �r "I,^ I C nwV wcR GANL:tLLA I IUN 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 Suite 25 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Centerville MA 02632 REPRESENTATIVES. ACORD 25 (2001/08) rn Amon nnoon=Arrn&l 1a0a .JON 16 '65 e4:03PM SANDPIPER INS i AC-38Dnn CERTIFICATE OF LIABILITY INSURANCE PRODUCER (E08) 790-1919 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS Sandpiper Iris. Agency, Znc. HOLDER. THIS CERTIFICATE DOES 12 Enterprise Road ALTER THE COVERAGE AFFORDED 9 MA 02601- Gualberto, Paulo L.. 21 Quippish Rd MA 02699- rnv�aeraac P.112 OATE(MMIOD/YYYY) THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW rrSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE PWCIES DESCRIBED HERE1N.13 SUBJECT TO ALL TH! TERMS. EXCLUSIONS AND CONDITIONS. OF SUCH POLICIES. A6GREGAT'E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R ADO'L r:A H TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MAVDO/YY PoLICY EEPIRATION OAt MAVOOII' LIMITS A GENERAL LIABUTY X COMMERCIALOc MALLIABILITY CLAIMS MADE ❑ OCCUR SLP04277931-5 - J / 11/20/2004 / / ll/2U/2005 EACH OCCURRENCE is 1,000,000 OANA9ETORENTED ➢RCN SE9 Ea mevteer� 300 000 3 , VIED EXP JMy one amen i 10,000 PERSONA &A IN S 1,000,000 OSNERAL AOOR=ATa Is 2,000,000 GEVI, AGGREGATE UMR A.PPUE^a PER, POLICY m LOC PRODUCTS-COMP/OP AOG S 2,000,000 AUTOMOSILLLIABILITY ANY AUTO ALL OVMIZ0 AUTOS SCHEDULEDAUTCO HIRED AUTOS NON -OWNED ACT04 J I / J J / / / J / J / / / COMBINED SINBL£ LINT (E4 ucieenB. S I I RODLY INJURY (Pet Lb v* f ecclLr iwupY 'P. ede" s PROPERTY DAMAGE (Perscelaen0 3 ( 6V1AGE'!UTY ANY AUTO I / / / IAUTO ONLY .EAACCIDENT If OTHER THAN EA ACC AUTO ONLY; AN; IS f I EXCESS/UMSRELLA LIABILITY I OCC ''R CLAIMS MACE. DEDt:CTIBLE RETENTION f J / I{ / / I / / / / _ EACH OCCURRENCE is AGGREGATE f f g WORKERS COMPEN3ATI0NAN0N- EMPLOYERB' LIABIL ANY eROPRIETOP7PART'001 ECVTIVE OFFiCERNIEBER EXCLUDED2 If ye. eeeerae ;glee, SPECIAL PROVISION& b.b - / J / / E.L. EACH ACCIDENT is DISEASE -?•A EMPLOYE f E.L. DIBEAIIE • POLICY LIMIT S OTH9R r / r r DEe'CRIPTION OF OPERA110NSJLCCATION6h'tHICLs'SIE,aCLUBION6 AOOEO HY ENOORdEMENTJBFECW. PROMBIDNS T:ITLRIOP, A= XXT=1IOR -.AZVTZNG (500) 779 uFLSs2riOD iTCbiso 1600 SA:."Ot= ;* -ViT£ 25 ACORD 25 (2001102) 61,, INS02S ro,Deps MA D2632- SHOULD ANY Of THE ABOVE DESCRIBED POLICIE6 BE CAN="Bp BSFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL • ENOEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CE7;I Ti HOLDER NAM© TO TYE LEFT, BUT FAILURE TO DO EO SHALL IMPOSE NO OB910ATION OR LIABILITY Of ANY KIND UPON THE REPR£SENTATiVE ELECTRONIC LASER FORMS, INC. - MM327-0145 43 ACORD Page 1 c4' r/ R IFIC DATE (MMWD\YY) .. ................... .......... . OG-20-05 ....... % PRODUCER SANDPIPER INS AGCY INC 12 ENTERPRISE ROAD .......... THE 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 27BCN A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY GUALBERTO, PAULO L B COMPANY 20 FERN BROOK LANE CENTERVILLE MA 02632 C COMPANY D :COVERAGES ... ...... .. ......... THIS — I , S T . 0 ... CERTIFY . THAT .. . . THE PO . LICIES 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 REDUCEBY PAID CLAIMS. CO LTFI TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE DATE (MNNDOkYY) POLICY EXPIRATION DATE (MMDDXYY) LIMITS GENERALLIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL LIABILITY CM PERSONAL & ADV. INJURY S CLAIMS MADE = OCCUR. OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 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 AUKS BODILY INJURY (Per Accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S r-1 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UB-0243B48-0-04) 11-22-04 11-22-05 STATUTORY LIMITS EACH ACCIDENT S 100 000 THE PROPRIETOR/ INCL PART NERS/EXECUTNE OFFICERS ARE: X EXCL DISEASE—POUCY LIMIT S 500,000 DISEASE —EACH EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE. HOLDER. .. .. CANCELLATIOti ......... ....... . .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MALL GATEWOOD HOMES 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1600 FALMOUTH RD LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR SUITE 25 CENTERVINE MA 02632 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE .. .......... ....... .. ........... FID 2S-S::{3/93). ...... .... _.v ....... .. .. .... ........ ............ m .. .... 99:1. . ..... O elt 1 u DATE @RNOOIYY) ACORD - CER-TIFICATEF-�: -O�:I INSURANCE.. D6,o2 eGQ5 PRODUCER Selid S A1530 BIXBY INSURANCE AGENCY. !PA :. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONVf -ANT} CONFERS-' NO- RfGIfrS UPON THE CERTIFICATE . HOCD£Tt TMS CERTIFICATE DOES NOT AMEND. EXTENT? OR _ P.O. BOX 830 - 651 PUTNAM PRCI - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GREENVILLE. RI 02828 MUR£RS AFFIX COVERAGE NAIL# INSURED NSTJRER A: NAT'C FIRE WSURANCECO. OF HARTFORD' .. .. INSURER B: VALLEY FORGE INSURANCE CO. HOLMES AND MCGRATH, IN,'. *mREac- COFtTtNENTAt INSURANCE CO. ' 362 GIFFORD STREET 1PISURER D: FALMOUTH. MJj 02540 . orslRECF: COVERAGES THE.POLr-M%.CF INSURANCE LISTED BELOW I AVEBEEN 1554LDSQTHE NSURED.NAM@ABOVE.FORTHE.POLICY PERIQQ INDICATED. NOTWITHSTANDING ANY REOLMEMENT. TERM OR CONDITION OF WY CONTRACT MO.TMM DOCtAAEDIT IlM ni RESPECT TO.4YMCKTHtS CERTIFICATE MAY BE ISSUED._OR _ MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES OESCREED HEREIN LSSUB,iECT TO ALL DIE TERMS. EXCL W.%3NS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN VAY W VE BEEN REDUCED BY PAID CLAM. NiP1 aL1K TYPE OF INSURANCE POLK:YNCIMBER mmv= - �AOM LIMITS GOWRALUABIUTY EACH OCCURRENCE S 1000,000 AMAG OREN7ED Y FIRE-2%,= X CCMMERGALGENERAL LIABILITY a EF$occuR 1D DDD A CLAIMS WADE QX 10.408243 10/D604 10/6/5 PERSONAL&ADVlNS Y S 1.000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE UMIT APPLIES PER PRODUCTS- COMP+OP AGG s 2 OD0,00(` PRO LOC P JC! M AUTOMOBILE LIA8111TT ANY AUTO CCMUrt fiD SNME LRRL (Ea 0 r BODILY INJURY p-P—) S - ALLOWNGD AUTO SCHEIXAEDAUTOS SCLW-Y PAX)RY (Pa� e"o 5 . HIRED AUTOS - NON -OWNED AUTOS - PRCFEHTY OAM AGE ' S }-EA - GARAGE LIABRY R AUTO ONLY ACCIDENT S OTHER THAN EA ACC S' ANYAUTO S AITOCNLY AGO EXCES6M118RB1JrEWILITM OCCUR QCWALS MADE EACHOOCURREF s AGGREGATE S. S s DEDUCTIBLE s RerumoN $ WORKER'S COMPERSATMN AM X we STA711 NrFF B EMPLOYERS' LIA80.rrY ANY PROPRIETOPPARrWRIEXECUTIVE OFzCERAAEMBER EXCLUDED' r yyaa.. A L PRo under SPEEML PROYl5KK85 2a 7445273- 091DW04 .. ... 091Dt105 _ EL EACH ACCIDENT . $ T 000.00D.. Et DISEASE - EA EMPLOYEES 1,000,000 Et DISEAW - POLICY LMT" 1000000-- OTHER C PROFESSIONAL LIABILITY AE% DO 431 33 3a- 7113105- 07tt3) t.000 0 PERCLAIhU. AGGRETGATE- DESCRIPTION OF OPERATZONSILOCATKINSNENKIESfO CLUSICKS ADOFD BY ENVORSOK114TRPEgM. PROVISIONS AGGREGATE LIMITS ARE PER THE TER WS AND CONDMONS-OF THE POLCES. CERTIFICATE HOLDER CANCELLATION SNMX13 ANY OF THE ABOVE DESCXR18ED POLICIES 0£ CANCrUEO BEFORE THE EXPIRATION GATEWOOD HOMES 1600 FALMOUTH RO., STE. ' S DATE THEREOF, THE TSs m WWRFR WILL ENCEAVOR TO MkX DAYS WRITTEN MOrCE4TRECER FXMVKGCDER'NAMEDTO THE LEiT. WrFAML RE TODOSQSmr m CENTERVILLE, MA 02632 ` IMPS No OeLIGATICH OR LWMJTY CF ANY IONO UPON'THE INSURER. ITS AGENTS OR REPRESFNLATWS. AGUKU 25 I2UGTAU3) C:*7APR010ERTPROS FPS 0 ACORD CORPORATION 1988 0 DATEIMMIDD/YYYYI AC.ORD... 4F-LMILITY INSURANCE .CERTIFICATE .. 8'/2/OS PRODUCER United Insurance Agoney-,--2ne,-- - 199 Main Street P.O. Box 1013 THIS CEFMFZATE IS ISSIED AS A M ATTER OF INfaRMATION OWYANB-CONFEMNORrCKMUPONTHECEFETWICATE... . HOLDER THIS CERTIiiCATEDOESNOF , "M,, EATETDOR ALTER THE COVERAGEAFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 9 Buzzards Bay, MA 02532 INSURED PattoO Electric, Inc. 128 Scituata Road . Mashpeo, H& 02649 INSURLT. N Zurtctr NA . - .. - . NSUR CommarCEI Insurance Co. INMRC:-Li Mutual -Ins. co, IVNSU2 SURLR2'-... - THE -POLICIES OF INSURANCE LISTED. BELOW.HAVEPFFN ISSLED.TO.THEWSURED NAMEDA90VEFOR THE POLICY PERI00 INDICATED. NOTWITHSTANDING ANY REDUUREMENT, TERM OR CONOITON OF ANY C'OUTRACT OR OTHER OOCUMENT 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN POLICY NUMBER POUCY EF PECIl4E POLICY EIPI. ON - UMiTS GENERAL LIABILITY FACNOCCURRENCE $ 110001000 A COMMERCIALGENERALLIAMUTY $CP42415399- 7/30/05 7/30/06 P*EanEs , d 300,Q$0 CLAMS MADE a OCCUR MEO Exp(Anymqqffsm $ 10,000 PERSONLLSADVINJURY S 1,000,-000- _ - GENERA LAGGREGATE S 2,000,000 GWL AGCgCDATE LIMIT APPLIES PER! PRMUCTS- COMPIOP AGO $ X POUCY PEei LOC AUTOMOBILE LIABILITY COWJLNED SINGLE LAIILT d ANYAUIO ME =6e1N) Alt OIM+ED AUTOS B SOHEDULEDAVTOS YW9338 10/3/04 10/3/05 Pnnn Y INJURY (PWpvam) t ICFO 0Or NIREDAUTOS NON-OwNEDAUTOS (PDILY INJURY } 3QO 00& ' PROPERTY DAMAGE (Pwa Idw* = 109, uaa i GARAGE LUIBRJTY AUTOONLY-CAACCIDENT- is - AN YAUTO - OTHER THAN EAACC d d . AUTO ONLY. AGG EICESSIUMBR£LLALLMILITY EACH OCCURRENCE Is �ED OCCUR CWMSMADE. A10AEGATE d _ g DEDUCTIBLE d RETENTION d i WORKEISCOMPEN2UION AND VC ATU- OTN C�)Lp�'L ANYPgpiETCR1PAATNGR/7CECUTAWC231S33049014 2(1004 12flOI0 OFFICEAMEMBEEXCLUDED? 5L.ECHACCIDENT ASRy S 100 ORO E.LDgEA•FAFAPLOYEE _ ! 500.000 X - E.LDISEASE•POLEYLAIIT T 100,000 Wbft. OTTER D BrCRMTiONOPOPERAT(DNS/LOCA110RS/VOIL[EETF7iCCU310tfSADDED'II►END CRSERIENT/Bp[CML PROylII1O(17.... S1EeetrSCa1 CF TTIFPC ATC LYI1 MW Gatowood Homes Fax No. (508) 778-5603 1600 Falmwth Road Suits 25 Cantavilla, Ma 02632 SHOULD AVY OF THEASOVE DESCRIBED FOUCIE$BE CANCELLED BEFORE THE EXPIRATION DAIETx@tIDf, TNEI!"U 0.VtSUBER.YY ILL EN DEAYORTO MAIL . 10 DAYSWRITTEN -NOTIC ETD THE CERTIFICATE HOLDER NAMED TO THELEPr, DOTFAKURETQDQB?iriFALL j IMPOSENOOSLIGATION OR LIA ILITYOF ANY KING UPON THEINSUREJL THE IUIENTE OR ACORD 25 (2001108) ®A , RO CORPORATION Y.. - ID I AT.CORD CERT(FfCATE:OF LIAB1 - 'INSURANCE DaTE(MMDDm� 9/15/04 i „ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER 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 A Harleysville Worcester Ins Co INSURED Lawrence Robinson Masonry COMPANY B 5 Fresh Hole Road Hyannis, MA 02601 COMPANY C COMPANY D i COVERAGES OD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERT 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 LTD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDr(Y) POLICY EXPIRATION DATE (MM/DOlYY) LIMITS GENERAL AGGREGATE. s 2,000,000 A GENERAL UASILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—xl OCCUR OWNER'S & CONTRACTOR'S PROT CB 7E 32 32 9/07/04 9/07/05 PRODUCTS - COMP/OP AGG s 2,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Anyone fire) $ 100,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEOULEDAUTOS - HIRED AUTOS BODILY INJURY _ (Per accident) $ NON-OWNEDAUTOS PROPERTYDAMAGE $ AUTO ONLY - EA ACCIDENT s GARAGE LIABILITY ANY AUTO ' _ OTHER THAN AUTO ONLY: _ EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLAFORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EACH OCCURRENCE $ AGGREGATE $ 4VC STATU- OTH- TORY LIMITS ER s -. - EL EACH ACCIDENT $ EMPLOYERS' LIABILITY EL DISEASE - POLICY LIMIT $ THE PROPRIETOR! INCL RS/ PARTN EEXECUTIVE. OFFICERS ARE: EXCL I i EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATEHOL'DER CAN _CELLATION 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 LIABIU3Y Centerville, MA 02632 OF ANY KIND UPON THE COMPANY ENTS 0RESENTA S- AUTHORIZED REPRESENTATIVE Robert E Chatfield ACORD 25S (1195) r oACORD CORPORATION 1988', ACORDW CERTIFICATE OF LIABILITY INSURANCE R076 09-27-2004 PRODUCER PAYCHEX AGENCY INC. 210706 P: (877)287-1312 F: (877)287-1315 308 FARMINGTON AVE FARMINGTON CT 06032 THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED LAWRENCE ROBINSON MASONRY INC 5 FRESH HOLE ROAD HYANNIS MA 02601 INSURER A: Twin City Fire Ins Co INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR LTR TYPE OF INSURANCE POL/CYNUMBER POLICY EFFECTIVE DATE MM/DDYY POLICY EXPIRATION DATE (MWDD1YYj LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP IAny one person; $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEOT LOC PRODUCTS-COMP/OP AGG S AUTOMOBILE UABILI7Y ANY AUTO ALL OWNED AUTOS SCHEDULED -AUTOS HIRED AUTOS NON -OWNED AUTOS _ _ - --Per COMBINED SINGLE LIMIT (Ea accident) a - BODILY INJURY (Per person) $ - BODILY INJURY accident) S PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO AUTO ONLY . EA ACCIDENT 9 OTHER THAN EA ACC AUTO ONLY: AGG 3' S EXCESS LIABRITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ - j _ I EACH OCCURRENCE S AGGREGATE S S 9 e - A COMPENSATION AND EMPLOERSL/ABILITY 76 WEG NQ5620 09/06/04 096/05 /0 X WC STATUTH- O E.LEACHACCIDENT $100 000 E.L DISEASE - EA EMPLOYEE $10 0 I 0 0 0 E.L DISEASE -POLICY OMIT $500 000 OTHER I DESMP77ON OF OPERA TIONS20CA7'/0NSNEN/CLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECWL PROVISIONS Those usual to the Insured's Operations. r rcR." LAIVLCLLH I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE 00 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE GATEWOOD HOMES HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO 1600 FALMOUTH ROAD SUITE 25 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR r REPRESENTATIVES. CENTREVILLE MA 02632 A UTHORMED ATZa a_ 4— `CORD G5-S I /lti /) ® ACORD CORPORATION 1988 �12/02/04 13:36 FAX 5087900249 COLDMAN ASSOC [a02 AC _ r-iC- AT--E.__O_ r— ---- .7 "I„., 4__-r TAVAN50 _ 12 02/04 PRODUCER THIS C':P.T.'.FICAT E M ISSUED AS A v.ATTER OF INFORMATD`M "" `�4 & nS:>v�sirib� irauicABiGs I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FI2LYCIAL SSItVICBS INC. HOLDER; THIS CERTIFICATE DOES NOT AMEND, EMEND OR 933 ? .L.' ^!^ 3 Rn. Al -TER THE COVEPAGE AFFC)ROSD 9Y TF'.S DO,L-IES SELO:Y- AYANNI9 MA D:!6D1 Pliona1508-775-6010 7ax-.508-790-0249 INSURERS AFFORDING COVERAGE INAICA INSURED INSURERA: MARYLAND CASUALTY COMPANY PDnmmy T*AVA„*TO INSURERS: DBA REECHANICAL SYSTEMS INSURER C: 110 EOLDZR L=3 W BASNSTABLB MA 02658 INSURER D: INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TT:RM OR CONDITION OF ANY CONTRACT OR OTNGR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE$CRIQED HEREIN 1$ $y!})ECT TO ALL THE TERMS; Fic.CLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRD ! TYPE OF INSURANCE GENERAL LU.BAJTY X COMME11CIALGENERALLIABILTTY CLfJMS MADE OCCUR I POLICY NUMBER I 1000372088 I GATE MMA) 11/21/04 DATE MMlD 12/21/05 - LIMBS EACH OCCURRENCE ' I S 1D00000 PP Mln-siracml,ance) 1 $ 300000 I MED EXP (Am ane Pelson) 1310000 I PERSONAL & ADV INJURY i S 10D0000 GENT AGGREGATE LIMB APPLIES PER: F-jPOLiCY 7� jPFgcT- LOC GEIl AGGREGATE j 2000000 PRpCUCTS-COMPIOPAGG Is 2000000 AUTOMOB": LU MLfTY - .. r ANY AUTO I COMBINED SINGLE LIMrT cE. acdeenq j ALL OWNED ALTOS I�w L) RY j I SCHEDULEDAUTOS I HIRED AUTOS BODILY LY_L'RY ( (PefaCLlaenq S I I CpN�WR €D AUTOS I u I I I PROPERTY DAMAGE I (PM aCCICanp S i — I1OAAA06 I LWRUTY ANY AUTO I I AUTO ONLY -EA ACCIDENT i— OTHER THAN EAAGC AUTO ONLY: AGO EACH OCCURRENCE ( I EXCEsaA lvo>�,LA LIAWLTf7 Lj OCCUR � CLAIMS MADE I I j i S S AGGREGATE S iI 1 i !7 _71- � CEDUCTf.",l.E R TENT)ON , S .ER� ii`!pRX=.RS COW EH5ArON AND twpt.oYERS' LAB11TY TORY LIMBS ... ANY PROPRIETOPWARTNERIEXECUTAIE I OFFICERRl.E:'18ER EXCLUDED? E.L EACH ACCIDENT j I` j .Y :esal.'.eW44- SnolaIAL PROVISJQ IS bebw OTHER i E.L DISEASE - EA EMPLOYE E.L DISEASE -POLICY UMR S S I I I.ca.:71Tii01.'OF pr�........b/L...r.. ....-oi �X«L�S/r......-..........._-...-........--...-....�C..:.:.?�'7�-%-- , CERTMICATE WnLfIFA L.wwrmlvva'T avaa3$ INC-- FAX 508-778-5603 1600 FALMOUTH _LOAD SUITS 25 CMMITIRVILLB MA 02632 2S (2001108) SNOULO ANY CFTHE ABOVE DEB..^°,'..ED POLX:Z3 BE CANCELLED BEFORE THE EXPIRATTO DATE THEREOF, THE LSSUWG INSURERWILL ENDEAVOR TOMALL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TD THE LEFT, BUT FALURE TO DO SD SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY NINO UPON THE INSURER ITS AGENTS OR J• - MAScheck COMPLIANCE REPORT Massachusetts Energy code MAScheck Software version 2.01 Release 2 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 Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design ASSOC. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Family, Detached (Non -Electric Resistance) Permit # Checked by/Date Required UA = 223 Your Home = 138 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 32 GLAZING: windows or Doors 93 0.340 0.340 27 " GLAZING: windows or Doors 80 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 ' 'Mas'sachusetts Energy code MAscheck software version 2.01 Release 2 The sandpiper DATE: 4-21-2004 Bldg.l Dept.1 use I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Location I WALLS: [ ] I 1. wood Frame, 16" O.C., R-15 + R-15 I Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No comments/Location [ ] I 2. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] I 1. U-value: 0.086 comments/Location AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building i 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 I 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 i difference and shall be labeled. I - VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I 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.): HEATING SYSTEMS: Low pressure/temp. LOW temperature steam condensate COOLING SYSTEMS: Chilled water or refrigerant PIPE SIZES (in.) TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 201-250 1.0 1.5 1.5 2.0 120-200 0.5 1.0 1.0 1.5 any 1.0 1.0 1.5 2.0 40-55 0.5 0.5 0.75 1.0 below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE 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) 0 ADDRESS: /a/ �'.ctir�.S•e -3� ALCULAT10N FOR PERMiT C� d� T .s Y OF r, .TOWN OF YARMOUTH � Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: Applicant Name: Applicant Phone: Building Location Owner's Name: Owner's Addres T-06-063 Frank Capra 5087789669 00121 CAMP ST Unit 102 Villages @ Camp Street, LLC 1600 Falmouth Road # 25 Centerville MA 02632 r Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1034 Net Owed: ($50.00) Application Date: 8/15/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 /D Z new construction: ZONING APr ROVED k ljs- REVIEWED BY: A. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: /3. CONSERVATION: ✓ . HEALTH DEPARTMENT: BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE N/A: N/A: N/A: N/A: N/A: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 8/22/2005 OF kTOWN OF YARMOUTH � Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-063 Applicant Name: - Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 102 Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1034 Net Owed: ($50.00) Application Date: 8/15/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: �. �S 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: 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 S. 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., #102 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 62632 Yar t Wat r Department of TOWN OF YARMOUTH i` Building Department _ Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-063 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 102 Owner's Name: Owner's Addres Owner's Telephone: Villages @ Camp Street, LLC 1600 Falmouth Road # 25 Centerville MA 02632 (508)778-9669 REVIEWED BY: 1 _ WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 1034 Net Owed: ($50.00) Application Date: 8/15/2005 Issue Date: Expiration Date PLEASE NOTE SIGNATURE OF APPLICANT: comments: new construction: DATE: p N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: U44.21.1.G Date Printed: 8/22/2005 W. LLOT �O1/cow '2 rl yo J17 to 45 o cn V APo �8 4 Sq't'Op✓✓S' SFO � • Ory .T• . C� . p�pFR ss OT 102 /OT 10 gs, ,3lg. 3 ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. GRAPHIC SCALE SEE SLEEVING NOTE BELOW r. 1... WE 20 10 0 20 60 linits, nrd uctll such time as _`hn ori,inul (rA I) slanp of ;.. rep[ -+negate Proree_lonal rngneer, cr Professicnal lend Suneycr o-,paars on this clan: (A) no psraen or pnr,;,:ns, Inraudiry any municipal or ath- tut-; r` i m y reiv u r hn 'rhmutian conned h•,r n IN FEET r _mains lhr pi-,-p-;rty cf Holm s & tArCr t 1 inch = 20 ft. PLOT PLAN holmes and mcgrath, Inc. dNX,"o►,.w'..rf. OF LOT 102 civil engineers and land surveyors PREPARED FOR TIMOTHY"Al. cv� 362 gifford street snnros F MILL POND VILLAGE falmouth, ma. 02540 No.45078 y C VIL STEPS ��s N yoF 9F� o YARMOUTH, MA JOB No: 201197 DRAWN: LMC ,DNA SCALE: 1 "=20' DATE: 3-23-051 DWG. NO.: A2546 CHECKED: -fag C t � Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Permit No. P ^ O b - 9 a5 Occupancy and Fee Checked IaS,0 b . Zev.11/991 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), III CMR 12.00 EASEPRINT ININKORTYPEALL INFORMATION) Date: 4/12/2006 City or Town of: YARMOUM MA To the Inspector of Wires: his application the undersigned gives notice of his or her intention to perform the electrical work described below. (Street & Number) 121 CAMP ST., UNIT102 or Tenant GATEWOOD HOMES Telephone No. O er's Address 1600 FALMOUTH RD, UNIT 25, CENTERVILLE, MA 02632 [� a Is is permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Boa) o pose of Building SINGLE FAMILY DWELLING Utility Authorization No. 1514552 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: WIRE HOUSE, INSTALL SERVICE Cmmnletinn nfth¢ fnllnwina tnhlo may ho wnivod by tha lnonormr of Wirno • I RN No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ InEl rnd.Zr;nd. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Togs No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons — No. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water KW Heaters No, o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER Attach aaaitional aetatl iJ aestreq 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:) 10/31/2006 Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under thepains and penalties of perjury, that the information on this application is true and complete - FIRM NAME: PATTON ELECTRIC INC 42 1LIC. NO. Ai5542 • Licensee: RICHARD PATTON Signature LIC. NO.: afapplicable, enter "exempt" in the license number line.) Bus. Tel. No508 539 0200 Address: PATTON ELECTRIC INC. PO BOX 1525, MASHPEE, MA 02649 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. S 125.00 Signature Telephone No. WPS - Permit Page 1 of 1 0NSTaR" • WPS - Permit • • Work Order Information UtilityAuth/WO #: 01514552 Date: 04/12/2006 Company JESTINA LABRECK Rep: Report By: YAR 121 CAMP ST UNIT102 VILLAGES AT CAMP ST Status: PLAN Service: NEW Type: RES Nature of Work: NEW 100AMP UG SVC TO HANDHOLE - XFORMER #25-223 - HANDHOLE VISABLE - MILL POND RES DEV - CROSS ST IS BUCK ISLAND RD -1200 SQ FT - NO A/C - ELEC RANGE & DRYER - GAS HT & WATER - NO JACUZZI - PENDING INSP..... Service Information: There is no Service Information. Permit Information Permit #: E06-925 Meters: 1 Reseal (Y/N): Y Date: 08/25/2006 Inspector: W10060 Description: Search Detail Contacts NSTAR Home WPS Loaon W_P.S_Help Comments WO.Request WPS News 691 '� �� b 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.comlapps/wpslwpspermit.cfm?Page=Permit&Unique= { ts_'2006-0... 8/25/2006 • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) TOWN OF YARMOUTH By Fee: $ CZLC2� ev-V� PERMIT NO. E" O% — 1510 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:. To the Inspector of Wires: By this application the undersigned gives notice of his or her work described below. I Location (Street & u er) Owner or Tenant ,t Owner's Address w ` Is this permit in conjunction witl�,a building permit?�s ONo (Check Appropriate Purpose of Building es\C�c�_ Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd 0 New Service LMD Amps (?A / _2Nb Volts Overhead❑ Underd;3 Number of Feeders and Location and Nature of Proposed electrical Aonttb perform the electrical �Phon EC ° > A G 1 4 2006 syN0. No. of Meters_ No. of Recessed Fixtures No. of Ceil: Sus . Paddle Fans No. of Total Transformers KVA No. of LightinjZ Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In; SwimmingPool md. rnd. No. of Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o etect 0 an Initiating Devices No. of Ranges No. of Air Cond. TotalTons No. of Alerting Devices No. of Waste Disposers Heat umpp Totals: Num er — — Tons — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection 171 Other No. of Dryers D' Heating Appliances KW g PP SecNo. Syystems: No, of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. SURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides roof of liability insurance including "completed operation' coverage or its substantial equivalent. The undersigned certifies that such coverage is in rce, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND C) OTHERC] (Specify:) (Expiration Date) Estimated Val f ctrical Work: (When required by municipal policy.) Work to Start�S t O Ins cti s to be requested in accordance with MEC Rule 10, and upon completion. I certify, under t9c plt and pe It of perlImy, that the information on this application is true and complet RM NAME LIC. NO. . censee: k Alk Signature LIC. NO. (If applicable, " xem a license ber line.) Bus. Tel. No.: Address- +� Alt. Tel. No.: S OWNER'S INS IJRANC WAIVER: I am aware that the Lic nsee doe not have the liability insurance coverage normally require by law. By my signature below, I hereby waive this requirement. I am the (check one owner owner's agent. Owner/Agent Signature Telephone [Rev. 04/00] APPLICATION FOR PERMIT TO DO PLUMBING Ij TOWN OF YARMOUTH Building —�ny AT: Location �f'V� _ DD (OFFICE USE ONLY) B- _ Fee: $ `7 cl � ab ao . PERMIT NO. f — 0b —7 � f Date �20�_ Owner's,y� ✓`-'� Type of Occupancy New.O/ aon ❑ Replacement[] 0i Q..kMi#fnH VPs 1/// nrI �t14649 zy a Z Y F > t0 Y J N !- V H Z M m N ma ui ce OJ m W rn w= a w y Y 9 a z a 3 OJ x v z m m rn w� ►- a ul z c to CD Z m a U. w O F w �+ a U) c y O a 4 m a m �i w a s=yy_ ° z Q m Y a a o o en a0: z z Wo:aoa� W 1w- o L) _ 0 J ao 2 F U) LL 0 7 0 m 0 Y J m M G SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name L Check One: ❑ Corp. Address f-tN Z4b«Al 4X ❑ Partn hip it Compa Business Telephone %77 Name of Licensed Plumber ii/To/ L/bO S 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. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owneror Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner Agent ❑ Signature of Lic sed Plumber Type: 2 7519" 7 License Number J Journeymamf Master ❑