Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
121 Camp St #106 Building Permits
OF Yg9�o� TOWN OF YARMOUTH _ s M�TiRCHEESE tOM,IU O t i7 6�. APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) Byl ��.,,,\\ Fee: $ �J VU PERMIT NO. Date Building ,,, /� Owner's! '-J" i AT: Locatio � �V' �� Name //new Type of Occupancy L`� , ,/ New❑•— Renovation ❑ Replacement ❑ Plans Submitted Yes No ❑ - . ®�VZ Vrj. r' W y J rn } Q V Q N 0 f7 rn rY D' N OJ Z v� y W N F y W 2 } _ Q IX W to N Y Z _ y a LL Z Z a Z 4. p H X P U O W O D W Q fn Q W Vl -� Z Y. W LL W U> H O= n' 0 0 2 W F LL O Y1 ( 2 P F Y J m o o O g _ Z O N O LL D o¢ 3� m 0 a=i 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Check One: ❑ Corp. Addresses /�/l�T!� ❑ Part p i!/!{Z j / % %� Fir ompa Business Telephone r-?-- a� l�8 Name of Licensed Plumber � �����> INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes�o ❑� 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. Check on Owners Agent ❑ Signature of ownerorOwner'sAgent I hereby certify that all of the details and information I have submitted —� (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type: License Number Master❑ Journeyma I LOT 107 . _ S88 :09'22"E Ui 76.55' — 30.1=— EXISTING 1.0. FOUNDATION a 1 N LOT 106 '0 07; r15'2 EXISTING °0 n FOUNDATION 0 ao, rn • \ to r \� z LOT 105 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 EA. A4tl 30 ZGP96 DATE REGISTERED PROFESSIONAL wT LAND SURVEYOR Unless and until such time as toriginal (red) stamp of the e responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein; and (8) this plan remains the property of Holmes & McGrath, Inc. AS —BUILT PLAN OF LOT 106 PREPARED.FOR MILL POND VILLAGE IN YARMOUTH, MA 1"=20' DATE:11-21 DEC (0j 2005 1 CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN. LO-V �Ivmlo / DATE REGISTERED P OFE ONAL LAND SURVEYOR GRAPHIC SCALE 10 0 20 6 ( IN FEET ) 1 inch = 20 fL holmes and mcgrath, inc. civil engineers and land surveyors 362 gifford street falmouth, ma. 02540 JOB NO: 201197 DRAWN: LMC DWG. NO.: A2542A CHECKED: OF e. McGRATH H No. 289M ).31 1 4 rc� s � tibbletts S to ~ 716 CoruityStreet TeurtonMA02790 Nov gin 'Fring Corrp_ CONSULTING ENGINEERS TeL (509) 822-6934 Fax (508) 890.7811 FieldDensity Test Report - Sand Cone Method (ASTM D1556 Client: Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Date: 11/3/2005 Centerville, MA 02632 Report No.: 6 Project: Mill Pond Village, West Yarmouth Test No. Location of Field Density Test FD5307A Unit #105 - N Center - Footing Grade - Sandy Material FD5307B Unit #105 - S Center - Footing Grade - Sandy Material FD5307C Unit 0106 - SW Comer - Fooling Grade - Sandy Material F05307D Unit #106 - NE Corner - Footing Grade - Sandy Material FD5307E Unit#107 - W Center - Footing Grade - Sandy Matenal FD5307F Unit #107 - E Center - Footing Grade - Sandy Matenal Tabulation Field Density Test Results Date: Test No. Proctor I.D_ Req. % Obtained Meets Moisture Dry Wt Max Dry optimum Compt. Compaction Specs. Content P.C.F %M. PCF Moisture 11/3/2005 FD5307A PR4252E 95 99.3 Yes 8.2 125.5 ' 126.4 82 11rK2005 FD53078 PR4252E 95 99.6 Yes 6.9 125.9 ' 126.4 8.2 11/3/2005 FD5307C PR4252E 95 97.6 Yes 66 123.3 ' 126.4 8.2 1113/2005 FD5307D PR4252E 95 994 Yes 7.6 125.7 ' 126.4 8.2 11/3QW5 FD5307E PR4252E 95 99.0 Yes 6.6 125.1 ' 126.4 8.2 116/2005 FD5307F PR4252E 95 98.2 Yes 6.5 124.1 ' 1264 8.2 Remarks: All tests met the specified minimum 95% compaction. ' Corrected for Oversize Particles in accordance with ASTM D-4718. M. White Walter PWalter P. Galuskaa Laboratory Technician Laboratory Supervisor ONE & TWO FAMILY ONLY -.BUILDING PERMIT -:I A�y� pC APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department MATTACMCES 1146 Route 28 • Yarmouth, MA 02664-4492 . Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 office Use Only Planning Board Information Assessors Department information Permit Note an Type F' ' Map iar a L /� r / Endorsement Date �-- Date O New ordtng 1 4 Property Dimensions Deposit Rec'd; $ ate Ian No k L tot Area '- s "=` 'Fronts e ft ~f Lot Coverage ,± .Other Section for'Office'Use Onl , - BuildmIssued. - Slgnature rs - -_snot :,Budding Official ate., .. _required Section_ = Site Inform'ati onsl Use Group: R-4 Type: 5-13 1.1 Property Address: Si 1.2_ Zoning Information: GR-AyP r 62l ? Zoning District Proposed Use Lly q" �Q�j 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) 1z5. Flood Zonelnformation ; a Comments Public Private Zone. Section .2'-<Property :Ownership/Authorized Agent 2.1 wp r of Record: Mailing Address,�,��rv�ld�, M ou 3 Name (� - 7 Signature Telephone 2.2 Authorized -Agent, tecekcQ,a S/� ` _ Mai dres Na print) ,,.,. Signature Telephone FaS I1' b SEP 2 Section 3 =:`Construction Services` 3.1 Licensed Construction Supervisor: Ap le ❑ License ber W 4-1 ' �+r✓IGMi���IG �Expiration Date ��p QQ 4Addr.,, ge Telephone 3 2 Registered Horne improvement'k.ntr�edictdr:, p pyCompany Name3 u '_ -�j "U License Number . Address Expiration Date nvco BUILDING DEPT. Signature 113Y Z a 9-15-99 1of2 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 ..,P-'1 No .......... New Construction,I No. of Bedrooms N% I No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: r I Check Below I ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) , as owner of the subject property hereby authorize to act on my behalf, in all mg1ters rela ' e to w rk authorized by this building permit application. d� Sig tur of wner 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. . rant name Sig a of O ner/ gent � tsl Date 9-15-99 2 of 2 61 X 3; .. "0 l v W 1N . Ur YARMOUTH �s BUILDING DEPARTMENT CONSTRUCTION SUP(EERVISOR FORM T: Job Location: PLEASE PRINI oc CA l/ln (i Street Owner of Property: V '- Construction Supervisor: O Address: 0 Licensed Designee: (If other than Supervisor) Name Name 2.15 Responsibility of each license holder: Village LL G 00L 1 o So b 669 ise No. Phone No. ankCr A Da 6 License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder -shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked fames, please indicate the type coverage by checking the appropriate box. A liability insurance policy 3 Other type of indemnity ❑ Bond OWNER'S INSUBAKE WAVER: 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: Sign at re of ner or Owners Agen Owner ❑ Agent Signature: Building Official Approval: wu� Oe The Commonwealth of Massachusetts Department of Industrial Accidents Of esofluestlpstbis 600 Washington Street Boston, Mass. o2111 Workers' Compensation Insurance Affidavit O 1 am a homeowner performing all work myself. O 1 am a sole proprietor zr:-4 halve no one working in ari capacity I am .an employer pro% iding workers' compensation for my employees working on this job. mnanv na 0 7 -g addr"s- city- insurince Co. am a sole proprietor. general contractor, or homeowner (circle onel and have hired the contractors listed below ttiho ha%e the following workers compensationpolices: citti • phone # insurance co.. oelira # company name, address: suy tthoee kadure to secure coverage as required under Section 25A of MGL 152 as iead to the impaaition of erimiaal penaltlea ot; Dae ap.to S1�".w and/or one years' imprisonment as well ss civil penalties in the form of a STOP WORK ORDER and r flne of S100.00 a day against ma I anderstand'that a copy of this statement may be forwarded to the Once of investigations of the DU for. coverage veriQatioa. t do here by cerrif}• er the sins a e !ties of perjury that the information provided above is true and correct. k Signature ate Print name olricial use onl%' do not %rite in this area to be completed by eiry or town oiflefal city or town: YARMOUT$ rmiNiccaae M !x nBuilding Department check if immediate response QLleensiog Board L7 posse is required 61 OSelectmen's Office (508) 398�2231 contact person: 2eat❑Health Department phones:_ . pother. r TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398-2231, Ext.261 — Fat: (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 proposed work/demolition to be conducted at 121 Work Ad ess is to be disposed of at the following location: n 04 O Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date �r PRO TIO GMS9/GCS9 .S.ERTES _ 93% AFUE Multi -Tositionl;- Single-Stage/Multi-Speed- Gas Furnace.. Heating Capacity: 46,000-115,000 BTUH ri MIY� tr I- air-CQndWorling7& H-eatin9-\ The GMS9/GCS9 single -stage, multi-speecl-gas furnaces offer- installation versatility.. Standard Features Cabineceorrstracti°rr • Corn)aiOn-resistant, aluminized -steel tubular heat • Heavy -gauge, reinforced, fully insulated steel cabinet exchanger and stainless -steel recuperative coil for with durabkbaked-enamel frnish - maximum efficiency • Attractive architectural gray paint finish • Designed for multi -position installation--GM59" • Foil -face insulation -lined heat exchanger upflow, horizontal right or left; GCS9: downflow, horizontal right or.left • Encrgy-saving, reliable Hot Surface Ignition system, featuring a Notion* Mini -Igniter with patented adaptive learning algorithm to maximize igniter life- • Al.tminized-steel ioshot burners • Energy -saving PSG, mull -speed, direct dire blower motor • Quiet, corrosion -resistant induced -draft blower assembly • Integrated furnace control -with improved_.... diagnostics • Low voltage tttminal 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 • Top venring-is standard; alterrtatrfluelvenr located .. on right side • Complctcly.assembled.factory-run-tested furnace. for.. -. heating or combination heating/cooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent (l-pipe) applications compartment Coil and furnace fit flush for easy installation Convenient left or right connection for gas anJ electric service Bottom or side air inlet (GMS9) Removable; solid -bottom block -off (GM59)- Accessories L.P. Conversion Kit (LPT--00A) ►-LP-Gas LowPrc»umKit(LPLP01) High Altitude Natural Gas/L.F Kirs (HANG111 HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter. Pack .(EFROI). • Horizontal Concentric Vent Kit (HCVK) • VerticalCormentricVent-Kit(VCVK).. internal Filter Retention Kit—upflow, horizontal - (RF000180)..... • Internal Filter Retention Kit_dOwn(low _ (RF000I81) • Thermostats Brower Motors (CHTIS-60, CH70TG. CHSATG, H10TWR) 55.377D www.govdmanmfg.com 6/04: PRQQ!jQT SPECIFICATIONS Nomenclature q 9 8 . a 070 . 11 � A' Goodman® Brand ev & on A:Anitlal Ael NOX Revision ---- Afir-now Direction W: Natural Gas I I C. 2" Revision Ik Upflowl"onzanud.. D: Dedicated Downflow X-.* Lcr�4 NOx C. Downflow/Horizontal —Cabinet Widt ft. HI Air Flow A: 14- B: 1N� Description esr C. V 2 S: single Stage/Multi-speed P; 2411" V: Two Stage/Variable-weed c Box 9: 90% Maximum CFM 0 0.5" ESP .. . 3:-1,200.. - 4:1.600 5: 2,000 V KBTUH 045'. 45,000 070: 70,000 090,. 90,ODD 115!.145,000- 140:140,000 PRODUCT SPECIFICATIONS GCS9 Dimensions UE,EEIE . VIEW a "'a 309 VIEW r YS �i a WwR�CMVE F 11 VTMT3*pvr E aliner W 4"TErtow voLRAW IR,rOL ME yeMaM WCta. ZCTRK.L IroLE UCNaaDi.... ...KNIRIO"T OR MGM VOLTACa- La.TSim) rELECTRICAL noLr L Mc" IC^t"I . LEOT Vo;.TA e E DRAW_ »+{ I ... .... rep _. MaLEa s rOLDaD RArtoEt OISCIMRDEaM watt It vie a>n rRu4 GCS90453BXA iTh" 16" 123h" 14 i" 16" GCS90703BXA 17h" . 16Y.... 12'/.". 1414".. . 16" GCS90904CXA 21" 191R" 16sA" 1s" 1915" GCS91155DXA wrrV tee_ 24>i" Z3" ._. 20'/."...... 21*4" 23" I Installer must supply one or two PVC pipes: nnc for combuulunair_(upKnrta{) andotre(ut the Aoe' outlet (requited): Vint pipe rnwt be either 2' mr 3" in diameter. depending uptsn furnace input; numberof elbows, length of run antiinstallation (1 or 2 pipes). The optional Combustion Air Pipe is dependent On tnatallationkode requirements and must be 2" of 3• diameter PVC. Z. Litro voltage wiring cEm enter thtougla thtrightof lefrskkof the fumace Crawl voltage wiring camenter thn'wgh the right tsr left side of furnace. I Ctmversion kits for high altitude natural gas operation ate available. Contact your Goodman distributor or dealer fix details. 4. Imcillet must supply following gas line fittings, according to which entnncefiused: Left—Twt. 904 elbows, me close nipple; straight pipe _ Right -Straight pipe to teach gas valve Minimum Clearances to Combustible Materials C - Combustible: If placed ran Combustible awl. the flour MUST be wood ONLY. NC - Noo,Combustible: A combustible floor subbase must be used fur installation on combustible flooring NOTES:' • Fur servicing or cleaning, a 36" front clearance is recommended. • Vnit coomcnons (electrical. flue and drain) may mece331tare greater clexancuchao.tba mtaimumekarancp lkced below: • In all nso, accessibi ity citaraoce must take Precedence over.cleaft"#1-from the enclosure where accessibility cleapemcs are greater. 5 •'r A PRODUCT SPECIFICATIONS Blower Performance Specifications W AW&c11iF f, - F r, ,.,....,., HIGH 3.0 1,.352 ,-.,-• 1,118 ._•-r•• 1,260 .•---.. 1202 G_5904536XA MED 2.5 1,214 ...... 1,172 •••... 1,123 1,064 (LOW) MED-LO 2.0 997 994 •----- 960 33 923 36 :., LOW.. ..1:5_ ..757... 44-...753' 44. 734 43. -904- 41 HIGH 3.0 1,449 36 1,409 37 1,326 39 1,273 G 5907038XA MID 2.5 1,192 43 1,172 44 1,141 45 1,094 47 s :: (MED•Hf)' MED-LO 2.0 -981 53 96Z 54 943 55 917 56 - T LOW 1.5 750 ---•- 730 ------ 714 •••--- 692 ••+••• .cuGH... ...4,0• • 1,970 •----- 1s74. --35 1;757 ..3b- 1-,66,7--401- G_590904CXA MED 3.5 1,713 39 1,650 40 1,572 42 1,510 44 (MED-LO) MED-LO 3.0 1,439 46 1,412 47 1,370 48 1,327 50 ;� 7210 !. LOW.. "Z.5' 1 T83 '56' 1'155' -.5T- 1'1Z2 59' i 109 GO ,.. HIGH 5.0 2,134 40 2,103 40 2,029 42 1,941 44 1 ..- y!,4... G S91155DXA , MED 4.0 1,4711 ..51 1,643 _ 52. 1.643 .52. 1,577 ,... 54.. (MED-MI) MED•LO 3.5 1,453 58 1,440 59 1,426 59 1,1 b2 1 . LOW ..3.0... 1 Z59 ..67. 1 739 _65-- 220 -70.. -1 1 _ 4{t� NOTES: I. CFM in chart is vrirhout fdter(s). Filccrs do tax aldp.pith.thn furnace. hue mlut 1%;+ruviikd by the iwcAlhm If the.ftur>aEe requires two reruSn3. this than assumes hods filte✓a are installed. 2. All furnaces ship as high speed conling. Installer mum udjslrt blower cn,rlinq speed as needed. 3. For blast lobs. ahtur 400 GFM per tun when ciloling is da+irable. C INSTALLATION IS TO BE ADJUSTED TO OBTAIN TEMPERATURF, RISE WITHIN 'ME RANC;E SPECIFIED ON rHE RATING PLATE. 5. The chart is &,r Irdtxvimint, only. For sactsfacrory operaticm, external static pressure mom not exceed value shown Im Ibe •sting plate- The shaded area indicates ranges In excess of maximum static presmitc dILnved when heating. 6. The dashed ( ---- ) areas indicare a reeurnmended fnrr or?nt4el... 7. The above clout is hn U.S. furnaces installed at C' • 2A00'. At higher altitudes. a proptrly de•ratcd unit will have appn Ainiately the same tempernturr riot 31 a particular CFM,, while ESP at tilt CFM willbe1mcf...... - ` J PRODUCT SPECIFICATIONS Accessories LPT-OOA L.P. Conversion Kit ✓ ✓ ✓ LPLPOi L.P. Gas Low pressure Kit ✓ ✓ ✓ r HANGt 1 High Altitude Natural Gas Kit t 1 t 1 HANG12 High Altitude Natural Gas Kit 2 2 2 2 HALPIO High AItitude L.P. Gas Kit ] . .. .._. _. 3..... ..... 1. .. 3_. HAPS27 High Attitude Pressure Switch Kit 3 3 3 3 .EEROt.. External Fllter.Rack. • ..... ✓.... _ . ..... ✓ r..... _ . �._. _ . . 0CVK40 Horizontal/Vertical Concentric Vent Kit (2") ✓ ✓ DCVK-30 Horizontal /VerticalEoncentrlcVet*Ki!(9^)- ✓..... ✓. ✓ Available for this mndel (1) 7,001,10 9,Q00' (2) 9,001' to I1,,000' (3) 7,001' to I S A00' Novo: All installatiow above 7,000' tequire a pressure switch dtangt.. Fm inst, atiorrin Onath, farttaces are cenified only to 4.500'. Downflow floor Base: When the GC' 9 lnodel is installed directly oil a wood floor, a downflow floor, Ease mustbe oued..Those trusdet nutnbesl�, are: CFB17, CFB21 and OFB24. Thermostats 7 BaARQ OF,, BUILDING-REGULA'T)ONS License: C;ONS-TRUGTIONSUPERMSOR . . Nurnbe� =43a B+rt!562 '-0E—T9 iE • 06MM006, Tr: no; 25926 . RestriEfed>1: FRANK G CAP. Z j 4aCOPPER"LPk CEN:TEMALLE. BRA 0263 Commssioner . ........ ` a 00-35;000cf.enctosed..space )rvGLC: ilrssot)' . 4A- BQasp�r� onlg _ �! $G=4=KEFaE1f®rHomes Failuretopossessa+arrentedition of the Massa ¢kwsett35t2fBuld-mg'Code, .i is-cause:forrevocatiaiiihisRcense." DIG SAFE.CALL.CENTER: 1888)'344-7133 ACORD, CERTIFICATE OF LIABILITY INSURANCE 07/19/2 0 PRODUCER (508) 790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sandpiper Ins. Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601- INSUKtKJ ArrUKLAIVaa l Vvcr.... INSURED INSURERAFirSt Financial Insurance Filho, Antonio DBA BR ROOFING INSURER B: PO BOX 1231 INSURER C: 136 Stevens st INSURER D: Hyannis MA 02601— INSURERS COVERAGE$ .. .._..___.__..._.,..�.. ,.,,n,crnunn.irnnry THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU LU NAMtu AOvvc rvm I nc `!� — - --- - - 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 ADO'L POLICY -EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMlDD/YY) DATE (MM/DD/Yh A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 —DAMAGE —TO RENTED $ 100, 000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea accurrencel ❑ 491F002IS39 06/21/2005 06/21/2006 MEE) EXP (Any one pemon) $ ,000 CLAIMS MADE GCCUR PERSONAL 8 ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' PRODUCTS-COMP/OP AGG S 2,000,000 / / / I POLICY PRO- JECT LOG AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMB (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS HIRED AUTOS - BODILY INJURY (Per accident) 5 - NON -OWNED AUTOS •- / / / / PROPERTY DAMAGE (Per accident) $ AUTO ONLY -EA ACCIDENT S OTHERTHAN EA ACC AUTO ONLY: AGG S 0GARAGELIABILITY ANY AUTO $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR tF1 CLAIMS MADE $ DEDUCTIBLE ' I RETENTION $ WORKERS COMPENSATION AND / / / WC STATU- OTH-- TORYLIMITS ER S E.L EACH ACCIDENT S EMPLOYERS LIABILITY ANY PROPRIETORIPARTNER/ECECUTIVE OFFICERMIEMBER EXCLUDED? / / / % E.L DISEASE - EA BAPLOYEE S E.L. DISEASE- POLICY LIMIT S If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS SIDING AND ROOFING. CERTIFICATE HOLDER VM'YI.GLLM , ". ( ) - (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. - AUTHORIZED REPREST CENTERVILLE MA 02632- EN A{�,CORD 25 (2001J08) © ACORD CORPORATION 1981 I T, INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (8C0)3274545 Page 1 of: MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE 4,se this form to request a Certificate of Insurance from an Assigned Risk Pool Carrier. Please provide all of the requested information, including the facsimile nurnbeA.$) -Of theperson or persons to whom th.e Certificate of Insurance; should be issued. If this form is fully and accur:-=11! co-lpieted, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, vtitFdr ;•,vo (2) business days of the car=ejs reesipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. Tb obtain each carriers crntact information refer to the Certificates of Insurance section located in the Producer Con�r tr;;xs4y5ection of the 8ureau's web;; e (Nnncw. wcnbma.org). 1: Name, address, tel-phone numberand facsimil number of the INSURED: �n Name: —_ � V�� L t\ _ +fi1�666_ 1 n H C( Mailing Address: �� Physic,! Address:_ Pho . �. -- -- -- Fax: — - 2. ame, adoress, telephone nu//m�� b//er and acsimile number of the CERTIFICATE HOLDER: Name: _ _ _ Mailing Address: L � ' C C-0 Z7 Physical Address:— Phone: Fax: 3. Name, address, contact person, telephone number and facs,mile number of the PRODUCER: Name: Sard_r�r Insurance Aaeric=�~, Inc. MailinoAddress: 12 Enterprise Road Hyannis, MA 02601 Contact Person:, Chris cr 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,r ? 3 / ) — 0 a ---- Effective Date: _�) `/1 Expiration Date: iw/ .—'tea 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. Date: 5/5/2005 Time: 3:02 PM TO: @ 15087785603 Page: 002-003 Clientw 2435E CAPECODREADY MLL',RD., fr,LERTIFICATE OF: L1ABjU y 3N-s�+.3RhLNVE DATEy S..mYrl PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The FeRelberg Company 222 Milliken Blvd. 0�'"Y AND CONFE.4S NO RIGHTS UPON THECERTIFICATB HOLDER: THIS CERTIT9CATEDOES NOTAMEND; EXTEND OR- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. F.D. Boer 3220 Fall River, MA 0-4722 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Acadia Insurance Companies Cape Cod Ready. 'A x Inc. PO Box 399 Orlaa„s, RAA 02553 INSURER B: Construction Industries Compensation INSURER C INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WfTH$TAN-OI G- ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR -OTHER COCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUEUOA- MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE L AITS SHOWN MAY HAVE BEEN RECDGE L5Y PAID CTAIMS.- 7R NSR TYPE OF INSURANCE POLICYNUMBER POLT fMM/DDfYYE POU ErMM1 0frf) LIMITS A GENERAL LASILITY CPA013246StD- D1(Ot/tl5'. 01/at/w EACH OCCURRENCE S1000000 X COMMERCIALDAMAGE TO RENTED,GENERALLABILITY a , i7 0, S100 000 MED EXP ,Arty me perwr) S$ 000 CLAIMSMADE EJOCCUR PERSONAL 8 ADV INJURY S1 000 D00 GENEPALAGGREGATE S2 0M000 GEN'L AG AFGATE UMIT A_PPUES PER PRODUCTS - COAGG 00MP/OP E2 0OOO - POLICY 20- LOG A - AuioMoBILEuteturt ANY AUTO MAA013246$10 01/01/05 01/01/06 COMBINED SINGLE LIMIT �a acacenlJ S1,pD0,,^ . BODILY INJURY per Ne l S ALL OWNED AUTOS SCHECULED AUTOS X X BODILY INJURY ;peramteml S l HIREDAUTCS NON-OVJNEDAUTCS - X PROPERTYCAMAGE . (P�x aa3cm(j _S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN =A A(--S ANY ALTO - S ALTO ONLY: AGG A EXCESSAJMBRELLALIABILITY 21 OCCUR CLAIMS MADE CUA013247010 01/01/0$ 01/01/06 EACH OCCURRENCE Si 000000 AGGREGATE S S RDEDUCTIBLE S - X S DETENTION S D B WOR(ERSCOMPENSATION AND WC00=55 01/oi/@5 01/01/06 X ICSTA.r D_nH EMPLO.YERT UAB%jr ANYPROPRJETCR/PAFTNEP/EXECJTIVE - - EL.EACHACCOENT S5oo000- E.L. DISEASE - EA EMPLOYE E 600,000 OFFICER/MEMBER EXCLUDED? EL.LTSEASE-FCICYUMIT S$00000- caECAL ParjVSI0.NS telrw OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS fYEHICLES (EXCLUSIONS ADDEO BYENOORSEMEN 1 SPECTAt PROVISIONS Gatewood Homes Inc. 16W Falmouth Road Suite 25 Centenfllle, MA D2632 ) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 4EAEOF,THEISSIANG INSURER WILL ENDEAVOR TO MAIL -'M DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBUGATICN OR UASIUTY OF ANY KtND WON THE INSURER, ITS AGENTS OR ..o.vw vl�wlrpo) 1 012 #S68995/M66526 AH1 0 ACORD CORPORATION 1988 05/06/2005 09:38 5BB4204474 EDWARD A GRAZUL PAGE 02 rRc" EA THIS CERTIFICATE IS ISSUED AS A MATTER OE INFORMATION ONLY AND .CONFERS NO RIGHTS UPON THE CERTIFICATE Ord A. Clrnn i1.Inss-a—ce AVMY, ItC. HOLDE»- THIS CERTIFICATE DOES /NOT AMEND; EXTEND-a�- ALTER THE-COVERAGE.AFFOPGED.BY THE POLICIES. BELOW. Mums hills, Ma C2w trLSURE3is AFFCR>±ING-rDVEAAGE NAIC B INSUREDIFI$LIRER J� Ste�im�L,,,lds �INSURER B: �- - 145 Ca=tt Pbad aJ INSURERC.. _mm-uxs Fills 'MA CTD48 - . - � INSWRL-R C•_ - _ I - .— _ ' INSUR=A E COVERAGES ...„ructnun,n,r_ I THE POtnIE50F.INSUAANCE LISTED BELOW HAVE T07H2 tN511HED Nnnftu Aawt WITH wn,.rcr._:L,...rv�•w FESFSCTTO WWCH •-.•�----•-•---------_ THIS £ERTIFICATE:MAY-BE _ ISSUED -OR-. ANY REQUIREMENT, MAY PERTAIN, TERM. OR CONDITION OF ANY CONTRACT.OR OTHER DOCUMENT THE' INSURANCE.AFFORDED 8Y THE POLICES DCSCRM3 "EREIN IS SUSJEC:r TO ALL 7HE !MRMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ACOREGATE-UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ I 11CLICT NUMBER POLICY EFFECTIVE LIMITS POLICYEXPIRATION it iLTA EACH OCLTIRRENCE ST,F r . GENERALLIASILAY " PREMISE COMMERCIAL LIABILITY .�.- r MP CLAIMS MADE OCCUA IF I MED E%R(AIL�V,l/MYY1�i_ �I I I PERSONALSAOYIN.IURY A 1 '}IF ... .. ttt • ' �O£NL AGGAEOAfELIMRAF PLIES?ER• o� I4/28/05 �80 6ENEBAEAGGAEOATE I PRDOUCTH'•COMP OP AQr .• - S _ S[L IFJ POLICY PRO- �DO AUFOMD91LEL7A87LTFY I � COMBINED SINOLE LIMIT lEP faNaory ; I ANY AUTO—II-- l I �ALLOWNEDAUTOS I * I BODILY INJURY I }4 {vxwrca.i S I SCHEOULEOAUTOS HIRED AUTOS ( S I BODILY INJURY Ikenq NON-O6vkECAUT05 I � ' - PwCFE TYDaNPtCjE PRCPER lP,r ecGd=m, I S I AUTO ONLY- EA ACCIDENT S, ,. GARAGE LIABILITY I �OTHC14THAN EAACC AIVY AUTO i �. AUTO ONLY; AGO 45__ I S �• I �HOCCURR£NC^ S £SCESSASI.tEREW L'IAjDILITY I CLAIMS MADE rCCC14T L• I S OEDUCTIBLE RETENTION S I S WORKERS COMPENSATION AND... I 4 TO _Lk-'iu ,Eg EMPIOYEA3'LIADILITY (. E.LEACNACCICENT - - ANY PROPRTT0WPARTtNC7dEXF=w OF-PICFR/MEMBEAA%CLUOEDT 4 R PoJ. aeecd w unEer SPECtAI PAOYIStONSaeImS E.L. DISEASE • POLICY LIMIT OTHER r I r I OESCRIPMON OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECALPA0Vf9IO" CERTIFICATE HOLDER UANGML -Al turn' SHOULD ANY OF THE ABC VEDESCAIBE2 PCLICIPS BE 9ANCELLED BErCwE jHC 2nPI?ATION Cx2Jte' ti HM�3�,� >r - LATE RIEAE# THE ISSWNG-IN5t1REA A`ALL. END+,VGA :O R:::L DAYS .VFMFN CfO &�p1L.J. AL L-t1.LL - NCT[CL• TQTHE CERTjRcATE HOLDER NAMFO TO THE LEFT. OUT FAIL•JAE TO DO SQ SHALL Rte LA" ry� IMPOSE-N6 CeLI0ASICN-Cp AIABWTY. OF. ANY. K ND UPOH THE INS7F.ER: RYAfsENT9'BA-- Gmtt�f.�'+a[�le? I -A �v.:� RE?AE9EN74TIVES. _ Y eYY:. 1'-i..� /!ti AUT707M`9 HtPAESENTATIVE L , 196E CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Harold H Williams Ins Agcy Inc DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81 Bassett Lane Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE INSURED Stephen M Childs COMPANY A A.I.M. Mutual Insurance Co 145 Cammett Road LETTER Marstbns Mills, MA 02648 I j 1 COVERAGES THIS IS TO CERTIFYTHAT 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 TYPE OF (NSCB_±NCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATIO LIMITS LTRi I DATE(MM/DD/YY) DATE(MM/DD/YY) ,GENERAL LIABILITY I (GENERAL AGGREGATE S I COMMERCIAL GENERAL LIABILITY - I PRODUCTS-COMP/OP AGG. S ,CLAIMS MADE=)OCCUR I PERSONAL&ADV. INJURY I S OWNER'S& CONTRACTOR'S PROT. EACH OCCURRENCE S 1FIRE DAMAGE (Any one fm) $ MED. EXPENSE (Any one arson) I $' 1A 0111LE LIABILITY COMBINED SINGLE I AUTO - LIMIT S HALL ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) INJURY i' I HIRED AUTOS NON -OWNED AUTOS I i (BODILY (Per xcidem) I E GARAGE LIABILITY j (PROPERTY DAMAGE i S j11X'C�L•SS LIABILITY I EACHOCCURRENCE S NAIIIRFLLA FORM - AGGREGATE I S )OTHER THAN UMBRELLA FORM j woimr•R'S COMPENSATION AND wC: STATuTORY OTHER X q It➢1 PLOYERS' LIABILITY I 7015793012004 12/13/2004 12/13/2005 EL EACH ACCIDENT S 100,000 EL DISEASE —POLICY LIMIT S - 500,000 A jrHE PROPRIETOR/ INCL PARTNERS/EXECUTIVE I DISEASC- TEACH EMPLOYEE S 100,000 OFFICERS ARE: IX I FXCL JEL �OT11ER I i I i I DFSCRII•I'!ON OF 01-F.liA7'IONS/LOCATIONS/VEIIICLES/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 NOTICETO 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. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 OP ID K ACORD CERTIFICATE OF LIABILITY INSURANCE CROWcso DATE (MM/DOIYWY) 06/06/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O RIGHTS UPON THE CERTIFICATE Sullivan, Garrity & Donnelly ONLY AND CONFERS N 508-754-1767 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. 10 Institute Rd - PO Box 15010 Worcester MA 01615-0010 Phone:508-754-1767 Fax:508-754-1885 Crowell Construction, Inc PO Box 309 So. Dennis MA 02660 INSURERS AFFORDING COVERAGE INSURERA: ALEA NORTH AMERICA INSURER B: Hanover Insurance INSURER C: INSURER D: INSURER E: we] NAIC # 292, 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. S LTR )NSR B TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE F X❑ OCCUR POLICY NUMBER ZHN700714102 - p FE IVE DATE (MMIDD/YYI 05/01/05 POLI PIRA O DATE (MM/DD/YY) 05/01/06 LIMITS EACH OCCURRENCE $1,000,OOO PREMISES(Eaoccurence) $100,000 MED EXP-(Any one person) s5,000 PERSONAL &ADV INJURY $1,000,000 GENERALAGGREGATE $ 2 , 000 , 000 PRODUCTS - COMPIOP AGG $2, OOO, OOO GENT AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUfOS HIRED AUTOS NON -OWNED AUTOS AFN7001142-02 - 05/01/05 O5/O1/06 - COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 1,000,000 X BODILY INJURY (Per accident) $ 1 , 000 , 000 X X PROPERTY DAMAGE (Per accident) s500,000 GARAGE LIABILITY ANY AUTO - AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC AUTO ONLY: AGG $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ A WORKERS COMPENSATION AND - EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below wcl049858 03/22/05 03/22/06 I UIH_ TORY LIMITS X ER E.LEACHACCIDENT $500,000 -EL DISEASE -EA EMPLOYEE $50O 000 E.L. DISEASE - POLICY LIMIT 1 $ 5 0 0 , 0 00 B OTHER Property Section T�_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Subject to policy forms, conditions and exclusions. V GI�IIrIVM,L IIV VY�,� 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 REPRESENTATIV�EScc.,r ACORD 25 (2001/08) © ACORD � %J#U}gN 16 '05 04:03PM SANNDPIPER INS ap ■p �J P.112 CERTIFICATE OF LIABILITY Y INSURANCE OATS {MhY00/YYYY1 I!.. 06l16 2005 4aNtt PRODUCER (BOG) ^90-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 'Sandpiper Ins. ario Zns. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE !Agency, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rvannia 13L 02601— INSURERS AFFOR00'JG COVERAGE NAIC 9 Gualberto, Paulo L.. 21 guippish Rd MA 02640- rnvpaaRoe THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, INOTWTHSTANDING ANY REQUIREMENT, TERM OR CONOITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICI_S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS. OF SUCH -POUCIES- AGGREGATE LIMITS SHOVW MAY HAVE BEEN REDUCED BY PAID CLAIMS. - INepIN6_PL TYPE DP INSURANCE POLICYNUMBER 9ATEYMMI9DlYYFFTIVEtmxNPHgWYTION y LIMITS A GENERALLWSAJTY I / / / / EACH OCCURRENCE i 1,000,000 X COMMuRGALOENERALLIABILRY CLAIWA MADE OCCUR 3CP042T793Y5 11/20/2004'Y1i20/?005 YRAVAQETO EMI9ES E�t�ul-nre a 300,000 MED EXP A"ene amen S 10,000 ?ERSCNA S INJURY 4 1,000,000 GENE.RALAOGRE s 2,000,000 GENL AGORS)AT6ppLRIMQIT APPLIES PER: pRcc=s.COMpYJp AOG S 2,000,000 POLICY .Tar LOCI J I I 1 I I AUTOMOBILE LIABILITY ANY AUTO f / % COMSINEO SINGLE LIMIT (EA xcidetM1l_ $ ROOILY INJURY A" OWNED AUTOS 9CHEDULEDAUTOB I HIRED AL706 NON-OWN'cD AUT08- / / / / BCCILY INJURY ;Pet amde't+J S PROPERTY DAMAGE tPet ecclaen0 CARAGELIABILITY IAUTO ONLY. EAACCCENT 1$ ANY AUTO - / / / I I OTHER THAN EA 3 II AUTO ONLY; A30 EXCEZSlUMORELLA I,IASILITY AGGREGATE S OCCUR CLAIMS MAD£ s DEDIJCTISLE RETENTION S LVORXERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACOCENT S ANY PROPRIRORIPARTN1iR15XECJTIVS - E.l 019EASE - MA EMPLOYE S OFFICE4UMEWPER EXCLUDED? if r-S. os";0e un� / / / / E.L DISEASE • FOL;CV LIMIT S SPECIAL PROVISIONS H OTHER DESCRIPTION OF OPERATION ILOCAI ION&NE—RICLEWEXCLUMONS ADDEO BY ENDORSEMENT/SPECIAL PROY1610NS (509) 779-56 GATEWCOD 210=2 1600 SA;WL^I$ RD -.UiT£ 25 CENTrRVILLE MA 02632— SHOULD ANY OF THE ABOVE DESCRIBED POLICIEW BE CANCELLW SEFORE THE EXPIRATION DATE THEREOF. THE ISSUIN�GG' }(INSURER WILL -ENDEAVOR TO MAIL 10 GAYS WRITTEN NOTICE TO TH.E CE�FICpTE HOLDER NAMED TO TYE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OB310ATION OR LIABILITY OF ANY KIND UPON THE Ku 35 13vullull ! — T 0 ACORD CORPORATION 1991 INS02S IDtoelDs ELECTRONIC LASER FORMS, INC. • (41=7-MAIS Pape I at., I ... .. ` ��:1®, CERTIFIC�4TE ClF ®:d ATE (MWDD\YY) INSUR i`10E 06-20 05 .:. paooucER 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 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 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MWDD\Yy) POLICY EXPIRATION DATE (MWDD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE S PRODUCTS-COMP/OP AGO. S COMMERCIAL GENERAL LIABILITY PERSONAL & ADV. INJURY g CLAIMS MADE a OCCUR. EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S BODILY INJURY (Per Person) $ ALL OWNED AUTOS SCHEDULED ALROS BODILY INJURY (Per Accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY . EA ACCIDENT S OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE S AGGREGATE S UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (LIB-0243648-0-04) 11-22-04 11-22—OS STATUTORY LIMITS -^" ---—� -—--� EACH ACCIDENT $ 100,000 THE PROPRIETOR/ INCL PARTNERS/EXECLITNE DISEASE —POLICY LIMIT S 500,000 DISEASE —EACH EMPLOYEE S 100,000 OFFICERS ARE: X I EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECULL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TOTHECERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE Ht]LDER GANCELE11T10N 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 CENTERVINE 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 ACDRD 2S-S {3/93j :.. �A RATION i90:' Aug-02-05 01:25P P_02 A WaKI It -ILA t i OF L 1L[TY I NSU NCE 08102fi005 PRGbUC Serial * A1530 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION fUX2Y INSURANCE AGENCY, IN.. OWY"AND_ CONFERS... NO RWJfFS, UPON 'THE' CERTIFICATE.. P.O. BOX 8" - 861 PUTNAM PIKI HOLDER. THIS CERTW=Te DOES NOT AMEND. EXTEND- OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GREENVILLE, Rt 02828 ..... - �1SURERS AFFC>RIYG COVERAGE NA= INSURED - PmAERA: NATTFYREINSDRANCECO.OFHARTFORD- . HOLMES AND MCGRATH, IN,' INSURER B: VALLEY FORGE INSURANCE CO. 362 GIFFORD STREET REac.' COPtTMfENTAt INSURANCE CO. FALMOUTH. MIA 02540 INSURER O: aa[ REx COVERAGES THE.POLICES.OF WSURANCE LISTED BELOW 1 AVEBEEN=Lft.IQTHEMURED.NAMInABOVEFOR.THEPOLICY PERIOD INDICATED, WD WITHSTANOMC ANY REAUlRE' JIMT. TERM OR CONDITION OF VVY CONTRACT C&.OTNERL DOCUMW =Ui RESPECT Ta VAIIQLTHIS CERTIFICATE MAY BE Iss IFn OR MAY PERTAIN, THE INSURANCE AFFORDED BY TIE POLICES DESCRIBED HEREIN 6SUBJECT TO ALL THE TERMS, EXCLUSIONS AND `- CONDITIONS OF SUCH POLCMS. AGGREGATE L"TS SHOWN MAY W VE BEEN REDUCED BY PM CLAIMS. 1+61 A®b TYPE OF IN3VRANCE PCLICYN[Pmes F3mCfAAF F>agitAol► LIMITS GENERAL W.BIUTY - EAAMH� o�Hro s 1 000,000 X CCMAIERGALCENEPALLIA8RITY s F RE 250;080- A CLAIMs MADE Q oeeux W 4082434 10106104 10/06/05 A® EXP — S 10 000 PERSONAL SAW 14 NV s 1,000,0Qt7 ' GENERAL AGGREGATE S 2,000,000 AGGREGATE LIMIT APPLIES PER GENT. PRODUCTS- COMPIOP AGG s 2 000,00U' POLICYPRO LOC Au OMOS&E L1Amrry ANY AUTO (Dab SRJGLE LIMri (Ea ocatlenB F ALL GINNED AUTOS SCHEDULEDAUTOS GC LY IMJLIRY S . fp8C YMN4JURY s . HIRED AUTOS NON-OWNEDAUTOS - PROPERTY DAMAGE - 3 GARAGE UAMITY - AUTO LILY -EA ACCIDENT S AR7AUT0 OTHER THAN CA ACC S' AUTO ONLY AGG S E CE66AW8ffEL Art1A91LITY OCCUR ID CLAMS FA[`la(Yr, s AGGREGATE S MALE K DEDUCTIBLE _ S RETENTION $ _ S EMPLOY 3SILLAI NSATYXiNA WC STATIC TH- EMPLGYERS' 1M91LYlY %� ' 20' 74452.73' 8 OFFiCERTi @EXCLUDED? ESE D�iR%C .. ... O$/UTRiS- EL EACH ACCIDENT S T QQQ QQD MdeccMm u r EL DISEASE • EA EMPLOYEE IAL PROVmONS b a .. Et DISEASE.POLICYL"f'- .. 1 QDD000.. OTHER C PROFESSIONAL LIABILITY AE4 00 43T 33 38_ . 7113M 0711a -,00 = PER.CLNW. DESCRIPTION OF OPERA7MONyLOCATgti,JypM7c. � 1USK:IAGGRETGATEN3 AOO[O � ��[ PROVLSIONS AGGREGATE LUdITS ARE PER THE TER VAS AND CONDITIONS -OF THE POLJGES. CERTIFICATE HOLDER C NCF11 aTX3k SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEF- RE THE EXPIRATION GATEWOOD HOMES' DATE THETIEOF, THE RSIANG INSURER WILL ENDEAVOR TO MAA._OAYSVVRITTEN 1600FALMOUTHRD..STE.:5 ETaTT CERT:IpREHQDET7RAA1mTOTRELEFT. BUT FAMUHET000SvsxArz CENTERVILLE, MA 02632 - @APOSE NO OBUGATICN OR UASILRY OF ANY KIND UPON THE INSURER, ITS AGENTSOR - REPRESENTA . s AU R Trip vnv 6V ILYV ims) C'TMPMCERTPRO.S.FPS ` Q ACORD CORPORATION iota , DwiEfMMroD YYYYI ACORD,. CERTIFICATE OF-LIABILITYINSURANCE , 8/2/OS_ PR&u cn THIS CBMFC ATE IS ISSUED AS A M ATTER OF INFORMATION United Insurance Agsncy-,--Isc, OWYAMI-CONWJZ&NORraHMUPONTHECERTIFICATE_ wain Stre LERHVERIGEATEDOES EXTEND ATTI Box 1013 BOT EOLP.O. COERAAFFORDEDYTHPPOLICIES BELOW. " Buzzards Hay, r1A 02532 INSWERS AFFORDING COVERAGE NAIC M NwR n INSDROrk zurtctr NA Patton Electric, Inc. NSURER& Commerce Insurance Co. 12s $C1tu$t0 Road. INSURERC:'Li> : Mutual •ins. 'Co MashPea, 02649 ;xA MSUREA O: NSUREfiE..... rrn/ FDA r_�c THE -POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED- TD.7HEWSUREII NAucn JIgOYEFQR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOItIREMENT, TERM OR CONDITION CF ANY CONTRACT OB OTHER DOCUMENT WLTH 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. INSRPOUCLEFfm POUCYNVMSER UkE IVUCTEIP DN GENERALL.IABiUTY UMR? EACNOCCURR.ENCE Is T 000 000 ]{L_X COMMERCIALGENERALUABILRY SCP42415339- 7/30/05 7/30/06 P*EAmEs erxarerAe f 300,000 CLAMS MADE � OCCUR f 10,000 MED EXR(An ono erem PERSONAL; ADV INJURY S 1,000,.000. GENERAL AGGREGATE S 2,000,000 G%M'LAGGRCOATE LJMIT APPLIES PER: PRDOUCTS• COMPAP AGO 3 2- ]( POLICY E T LOC A. Cn AUYCM001LE LIABILITY ANTAUTO Comgk4 Dftiw LAUT f (EA NLIBNX) ALLOMNEDAUTOS B SCHEDULED AUTOS YS4933s 30/3/04 10/3/05 RnrRYANJURY f 100,000 HIRED Au7os NON-OxNEDAUTOS BODILY INJURY (Pw"Claem) Ig 300',000- PROPERTY DAMAGE Mw=Idare) = loS,00a LIABILITY IGARAGE '1ANYAUTO •�EpOCCUR CLAIMSMAOE. AAILITIVIfAACCID11111, DEDUCTIBLE RETENTION ;WORXERSCOMPENMION ANO Tog C EMPLOYERS'LDPROPP R)PAY ANYCFR,M9M8RIPARLUDED•(ECUTILE WC231$353049014 12/10%04 12110105 E.L.EACHACCR)ENT OF FICERdVIE MBER EXCLUDED? E.LDISEASE•CA EMPLOYEE _ *lot da "& �=Eeevr X CECIAL .. "500,000 T OTHER D B9CRN'TIO NCFOPERATION;/LOCASIONsfVEXLLESTF7ICtL31011SAppEDETpIpp 11((fT./})p¢C}pL PRCVMONS.... rslACtrlCal CERTIFICATEHOLOFA Gatauood Homes Fax No. (50e) 779-5603 1600 Falmouth Road Suits 25 C9 LtgviL2, Ma 02632 ACORD 25 SHOULD ANY OF THEASOVE DESCRIBED POUCIE8SE 0ANCELLEO BEFORE THE EXPIRATION J1A HERF➢F. THEI31DRtD.INBURMWILL ENDEAVOR.TO MAIL . 0 DAYSWRTT7EN -NOTIC E TO THE CERTIFICATE HOLDER NAMED TO THELEfT, SOTF'AIEURETQrffaw SHALC I MFOSEi)0 DSLI6A1Ib'li OR LiA6R.RY OF AHY RIND UPCN SHE {NSURESi•, i B AO'cNTH OR C. l4CORD CERTIFICATE OF ' _ DATE(MM/DD/YY) LIABiL1TY";INSURANCE "�' ��� 9/15/04 Y ISISSUED AS A MATTER OF INFORMATION PRODUCER Chatfield, Whitman & Young 549 Washington Street P.O. Box 850963 RTIFICATE ND CONFERS NO RIGHTS UPON THE CERTIFICATE . THIS CERTIFICATE DOES NOT AMEND, EXTEND OR [;ALT;ERTHECOVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Braintree, MA 02185-096 COMPANY A Harleysville Worcester Ins Co INSURED COMPANY B Lawrence Robinson Masonry 5 Fresh Hole Road Hyannis, MA 02601 COMPANY C COMPANY D t 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 POUCY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) - POLICY EXPIRATION DATE (MM/DO/YY) LIMITS GENERAL AGGREGATE $ 2,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE [i] OCCUR OWNER'S B CONTRACTOR'S PROT CB 7E 32 32 9/07/04 9/07/05 PRODUCTS - COMP/OP AGG $ 2,000,000 PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1, 000,000 FIRE DAMAGE (Any one fire) $ 100,000 MED EXP (Arty one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY _ (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE $ AUTO ONLY - EAACCIDENT $ GARAGE LIABILITY ANY AUTO ' OTHER THAN AUTO ONLY: EACHACCIOENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND WC STATUS OTH-:.- TRYLIMITS ER". $ EL EACH ACCIDENT $ EMPLOYERS' LIABILITY - EL DISEASE - POLICY LIMB $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL 1 EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS f CERTIFICATE HOLDER ,.. r _ - a,. v..- n .. , ' ._CANCELLATION_ 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 LIABILITY Centerville, MA 02632 OF ANY KIND UPON THE COMPANY ENTS 6) SENTATI S. AUTHORIZED REPRESENTATIVE Robert E. Chatfield I ACORD 25-S (1/95) _ - ON 1988"< - QACORD CORPORATi f t ACORD,. CERTIFICATE OF LIABILITY INSURANCE Ro 6 09-27-2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION PAYCHEX AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 210706 P: (877)287-1312 F: (877)287-1315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 308 FARMINGTON AVE INSURERS AFFORDING COVERAGE FARMINGTON CT 06032 INSURED INSURERA:TWln City Fire Ins Co INSURER B: LAWRENCE ROBINSON MASONRY INC INSURER C: 5 FRESH HOLE ROAD INSURER D: HYANNIS MA 02601 INSURER E: V THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES 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 POLICY NUMBER POLICYEFFECTIVE DATE MM/DD YY POLICY EXPIRA TION DATE MM D/YY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) S PERSONAL& ADV INJURY $ GENERAL AGGREGATE a GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROT LOC PRODUCTS - COMP/OP AGO AUTOMOBASLIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS _ - .. -I`-BODILY COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY � (Per person) S INJURY _(Per accident) f - - $ PROPERTY DAMAGE- (Per accident) $ GARAGE LLABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG s - S EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S _ - i EACH OCCURRENCE $ AGGREGATE $ $ $ $ A COMPENSA TION AND £MPLOYERS'UABWY 76 WEG NQ5620 09/06/04 09/06/05 X WC STATUIJM�IT- OTR- TORYWORKERS E.L. EACH ACCIDENT $100, 000 E.L. DISEASE - EA EMPLOYEE $10 O , 0 0 0 E.L DISEASE - POLICY LIMIT s5 0 O O O O OTHER DESCRIPTION OF OPERA TIONS20CA TIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROWSIONS Those usual to the Insured's Operations. rcoT�or�n-re.11'Co I I f-AA(T`CII ATIIIAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE GATEWOOD HOMES HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1600 FALMOUTH ROAD, SUITE 25 REPRESENTATIVES. CENTREVILLE MA 02632 AUTHOR2ED REPRESENTA 1V� ACORD 25-S 17197) 0 ACORD CORPORATION 1988 12/02/04 13:36 coy 5087900249 GOLDMAN ASSOC R 02 ii f�Jd Ri 7: I'vA 9 OF Li iLi i NC�,=. TAVAN50 12/02/04 (PRODUCER I THIS C=1FICA E 1SMSUE AS A "rTTER OF!" __LA'AT:O`: GCT•^' ee «S �O�I«isS Ireauai�irGa ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINAXCIATl S$ItVIC35 mmc. HOLDER -THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 933 F".T.3 01'T3 .1'.n. ALTER THE COVERJAGE AFFORDED BYT4E POLX.'ES BELOW- HYAN27IS MA 02501 29LenaESOB-775-5010 FaX-508-790-0249 INSURERS AFFORDING COVERAGE iNAIC� INSURED INSURERA: MARYLAND CASUALTY COMPANY INSURER e: EOn?dP7 TAV? DBA MECHANICAL SYSTM4,9 INSURER C: 110 l:CLI) I'i"'ia INSURER 0: I PI SAFNSTASLE MA 02662 - ___- INSURER E UYCHAGC3 THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN MSUEO TO THE INSURED NAMED AP.OVE FOR THE POLICY PERIOD INDICATED. NOT.YITHSTANDtNG ANY REQUIREMENT, TERM OR CONDITION OE ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESGAIBFD HEREIN IS SVNIgCT TO ALL THE TERFA$; 4SCLUEi4NS AND CONORIONS OF SUCH POLICIES AGGREGATE LIMITS SHOY/N MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR INsRq TYPE OF INSURANCE I POLICY NUMBER I DATE MM111 1 DA E MF1D LIMITS GENERAL LVaXnY I EACH OCCURRENCE I S 3.000000 A X CO,MERCLALGENERALLIAOUTY CL/JMS MADE � OCCUR 000372088 11/21/04 11/21/05 P�MI 9(^�cmrence1 19300000 MEDFXP(AeYale9ei"xwl) I S 10000 PERSONAL A ADV INJURY 131000000 GENERAL AGGREGATE S 2000000 - G&VL AGGRLGATE LIMIT APPLIES PER: PRODUCTS - COAIPIOP AGG I S 2 0 0 0 00 O POLICY � ..:EPCCTT LOC ! - AUTOMOR"! LIABILITY ANY AUTO COMBINED SINGLE LIMIT IEa accident) .. j S I ^oCC,TLY INJURY 1Per Pets9lt) S j I ALL OWNEDAUTOS SC} I.ULED AUTOS HIRED AUTOS NON -OWNED AUTCS BODILY dL t) - IPer e[ ddent) S I I PROPERTY DAMAGE I iPerameenq S —� ' OARAGE LIAUILiN - AUTO ONLY - EA ACCIDENT J- - ZANY AUTO I OTHER THAN EA ACC AUTO ONLY: AGG S S E7[CESSNMBRELILA LIABILITY LJ OCCUR C CLUNS MADE I EACH OCCURRENCE I5 AGGREGATE is IS •_. I IEI.E I —� F j_.RERENTION • S - .... .$ . S I I !!! f WOPKE.RS C0—__R5ATIO4 ANp ANY PR PRI LOFVIIAY ANY PROPRIETORlPARTNER>FXECUTNE OFFICERWV.E-ASrR aXCLUDEDT I eas�-.s OD' SPEC1'AL PROVISIONS below I DRY LIn.'fiS ER 1 E.L EACH ACCIDENT Is E.L. DISEASE - EA EMPLO nm S E.L. DISEASE -POLICY LIMIT S OTHER f :.r ..,,.. v' v7-1` 1'.^..C.'S / L...�....-..G / 1.-.......91:.....w.:.:.0 ....:.-..-..........-....-... 1:.: C.:..:- I SHOULD ANY OF THE ABOVE DE'..0 wED POIL7CRIS EE CANCELLED BEFORE THE EXPIRATION I) I DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN tNOTICE TO THE CERTIFICATE BOLDER NAMED TO THE LEFT. BUT FAL RiE TO DO SO SHALL rAx 508L 78-56 IJA I: FAX SO$-7T$-5503 IMPOSE NO OBLIGATION OR LIP.SILSTY OF ANY qND UPON THE INSURER, ITS AGENTS OR SSOO FALMOIIT8 ROAD SUITS 25 REPRESENTATIVES. C�7T:9RVILLB MA 02632 I AUTOO REPRESENTATIVE A $SA8jNLUIACORD 25 (2001108) - 3fACOHHITCORPOSiATION1888. CERTIF1. .. . ........ . CATE ...... - 0 -06-05 ............. . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GOLDMAN & ASSOC INS FIN HOLDER. THIS CERTIFICATE DOES NOT AMEND,. EXTEND OR 933 FALMOUTH RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RTE 28 HYANNIS MA 026012319 COMPANIES AFFORDING COVERAGE COMPANY 28HPP A AMERICAN ZURICH INSURANCE COMPANY INSURED COMPANY TAVANO, RODNEY DBA: B MECHANICAL SYSTEMS 201 CAPES TRAIL WEST BARNSTABLE MA 02GG8 COMPANY c COMPANY D ....... . .. . ..... .... .. 4., .. ........ 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 LTFI TYPE OF INSURANCE POLICY POLICY EFFECTIVE DATE (MMDD\YY) POLICY EXPIRATION D LIMITS I . GENERAL LIABILITY GENEP.AL AGGREGATE $ PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL LIABILITY CLAIMS MADE = OCCUR PERSONAL & ADV. INJURY $ EACH OCCURRENCE S OWNERS & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per Person) S BODILY INJURY (Per Accident) $ HIRED AUTOS NON -OWNED ALTOS PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: ....................................... . . .......... . . .... . .... ... ANY AUTO EACH ACCIDENT $ P AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY (UE-7278AS4-9-05) 05-03-05 05-03-06 STATUTORY LIMITS .. ....... EACH ACCIDENT S 100,000 THE PROPRIETOR/ F_7 PAF.'NEASIEXECUTiVE INCL DISEASE -POLICY UMT S 500,000 DISEASE —EACH EMPLOYEE $ iOO'OOOOTHER OFFICERS ARE: �_xj EXCL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HEILDER......... . . .. .. ... ......... ............ - .... . . ...... 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 1600 FALMOUTH RD SUITE 25 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CENTERVILLE MA 021332 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MOREss: /a/ Crams-Ve :AcuuTIO! FOR PERMS zila/ aaS" 2�r.. /Y� S/6. /`ll1 boo VA- O F TOWN OF YARMOUTBuilding Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-067 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST'Unit 106 Owner's Name: Villages 0 Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: Vl. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: HEALTH DEPARTMENT: _ V 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 Comments: Map/Lot: 044.21.1.0 new construction: ZONING APPROVED DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: N/A: N/A: N/A: N/A: N/A: DATE: Date Printed: 8/22/2005 0 Temp Permit No.: Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH. Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL T-06-067 Frank Capra 5087789669 00121 CAMP ST Unit 106 (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: Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 ' G3MRD Owner's Telephone: (508) 778-9669 AUG 2 4-ZO05 HEALTH DEPT. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: �J 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 Y 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., #106 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 Yarmouth W er Department of OF V TOWN OF YARMOUTH •' Building Department Town Hall qy a Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-067 (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 Applicant Name: Frank Capra Comments: Map/Lot: 044.21.1.0 /& new construction: Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 106 Owner's Name: Villages @ Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778(508) 778-96699 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 MAscheck COMPLIANCE REPORT I Massachusetts Energy Code MAScheck Software version 2.01 Release 2 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 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 Required UA = 223 Your Home = 138 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value ------------------------------------------------------------------------------- U-Value UA CEILINGS 845 30.0 30.0 14 WALLS: Wood Frame, 16" O.C. 1415 15.0 15.0 62 GLAZING: Windows or Doors 93 0.340 32 GLAZING: Windows or Doors 80 0.340 27 DOORS 40 ------------------------------------------------------------------------------- 0.086 3 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. Builder/Designer Date i Massachusetts Energy Code MAscheck Software version 2.01 Release 2 The Sandpiper DATE: 4-21-2004 Bldg.l Dept.l use I CEILINGS: C 7 I 1. R-30 + R-30 I Comments/Location •I WALLS: C 7 I 1. wood Frame, 16" O.C., R-15 + R-15 I Comments/Location I WINDOWS AND GLASS DOORS: C J I I. U-value: 0.34 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location C ] I 2. U-value: 0.34 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: C 7 I 1. U-value: 0.086 I Comments/Location I AIR LEAKAGE: C ] I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. when I installed in the building envelope, recessed lighting fixtures j shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I 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 I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. VAPOR RETARDER: [ 7 I Required on the warm -in -winter side of all non -vented framed I ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ 7 I Materials and equipment must be identified so that compliance can i be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly I marked on the building plans or specifications. I r i DUCT INSULATION: C ] I Ducts shall be insulated per Table 34.4.7.1. DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections Of Supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: C ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: C ] I Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and 74.4. I I SWIMMING POOLS: C 7 I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: C 7 I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" 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: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I I CIRCULATING HOT WATER SYSTEMS: C 7 I Insulate circulating hot water pipes to the following levels (in.): i I 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+" I 170-180 0.5 I 1.0 1.5 2.0 i 140-160 0.5 I 0.5 1.0 1.5 I 100-130 . 0.5 I 0.5 0.5 1.0 I ----NOTES TO FIELD (Building Department use Only) SEE SLEEVING NOTE BELOW \ PROPOSED WATER SERVICE PROPOSED, DRIVty,AY Li o I LOT 107 S88-09-22"E Ln 76.55' ti 30, n [� O p� k, 4,� p tD O pJ� Q0 N N Q�Z // // N A `V \SS��2 \" �irnn ��to LOT 10 N5,912t S 0,7; Mal o o� \ ai ti LOT 105 NOTE: ® LATERALSEWER SL EVEDIN ACCO DAN B WITH TITLE V IF WITHIN 1OFT. OF WATER MAIN. OF 30.1 GRAPHIC SCALE a�s,'�a�srER�sJF� "} DNA! LAND NOTICE20 10 0 20 60 unlst3 cnd until =uah Ume os the origijol (red) st,rp at re.a ion ib!e Proasional Engheor, or Professional _and Surge}vr aCPear^. an ilds ^.Iar.: (A) no peraon or persons, ircluding any nnurklpul or ih,r f iriaia niv rely is n t a ;nv rr-oti i ntii &d h r IN FEET ([') re, .c s r, , rry. t!y n( 1 inch = 20 M PLOT PLAN holmes and mcgrath, inc. °- ""OF LOT � S PREPARED1F�OR civil engineers and land surveyors " TiM, THY10. 362 gifford street S %Tcs MILL POND VILLAGE NC.45078 falmouth, ma. 02540 civic r IN �OF 9FGISTEF YARMOUTH, MA JOB NO: 201197 DRAWN: LMC �` Ir'nIONA" :SCALE: 1 "=20' DATE: 3-23-051 DWG. NO.: A2542 CHECKED: -1w.,s D�— I' :. IPRC'Pp,EL r�R1v'EE'✓AY fn 6.3 � w 1.— 6.3' 5—y co % — — �� 11 LOT 107 S88 :09'22"E i` 76.55' SEE SLEEVING NOTE BELOW PROPOSED WATER SERVICE NOTE: ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 1OFT. OF WATER MAIN. GRAPHIC SCALE 20 10 0 20 30. O 0-0 Q� Nd ,d ytl N CV 444� .\ rn LOT 106 \sS 5,912t S.F. R, 7Jq U>,, Or; 00 LOT 105 30.1' OF \, �11L AUGI b U 2005 D _ ,or 60 Prof,,.A-n..l En)1ne r or Professional Land -urve�w J■ eppeors on this plan: (A) no peron or per ons 1nc!udn3 any municipal or fh--r / puS'ro off! , --. a, may py lv 9 5, inrnn:. atien con 1 ei ,rr 2t i IN FEET (R) th's r -n r_i mq .ti_ p,,,rt, of Holm z 1 inch = 20 fk OF LOT OT AN holmes and mcgrath, inc. 4��zH °f afrysc civil engineers and land surveyors PREPARED FOR ; TIMOTHYM. r MILL POND VILLAGE 362 gifford street s s.,n5os 01 � No 45078 rn IN falmouth, ma. 02540 g 9 CIVIL a YARMOUTH MA OFF° GSTEP� JOB N0: 201197 DRAWN: LMC CALE: 1"=20' DATE: 3-23-051 DWG. NO.: A2542 CHECKED: -yam PG TOWN Bu' ding AT: Location.. J-._.OT NewiY Plans Submitted j o JUL 0 5 2006 BUILDING DEPT. APPLICATION FOR PERMIT TO DO GASFITTING _ .._.�.__....__ -• (OFFICE USE ONLY} Fee: g _.. -..... __ .1 - -- PERMIT NO.-r-_QZ_-ofl--_- Date��• ��_.____ Namel�����►L.�.4�4F1-�� -- Type of Occupancy_-t5VI"*--•-- Renovation Replacernent C? Yes E- NO .Fk r N W = F ui ' II �L r W Z N W �I r ( ¢N V ` 8 0® �y� ((AA C= j(` I N IX . (� .J 11 a m w us a t Lu a W W y W 9 Q S i= Min z W 1�- OqC m W H 8$ H W = h tt `< WI> ¢ W j 2 Q a< 5 5 W 0 s s 0 1 s� 3 o 0 0 cc is SUB-BSMT. BASEMENT 1ST FLOOR 2NO FLOOR 3R0 FLOOR rPR;N't CA TYPE! I Check One: Rtstaliiny Company Name�-i�� �G.T�_'._li.�1 r!t 1_��'�._ C] Corp. ..__..._____-..__....___..---•._ _.. ----- - Address _.__t 8'...._G3L4.. ,`�___ _-.._---.�....�____._ Partnership__...._----_-•-.----_.._.._..--_.._.._--- _} V- Firm/Company_..._..---•...._ Business Telephone'-—�-•7-.-�.`"t. Name of Licensed Plumber ortCr _---..._.' Q- �.___._...--•---__--_•---___..-.__..-_..._. _. INSURANCE COVERAGE: Check One I nave a current I+ability insi:ran;e policy or its sunstani;al equivalent Yes Ci Ado J It you ha ie checker: yes. please lntt -cat2 t ie type of coverags by checking the appropriate box. A liability unsurance policy C`ther type of indemnity [I Bond OWNER'S INSURANCE WAIVER ! ant aware treat me !;censee does not have the insurance coverage required by Chapter 142 0' the Mass General Laws. and that my s•gnature an this permt application waives this regcirement Check One: _ Owner t 7 Agent ` S,gnatuiti of Owner or Owner's A3en! � 9 i hereby certify that all of the details and Information I have sybmitted — Signature o Licensed (or entered) In above application are true and accurate to the best of Plumber or Gasi tter my knowledge and that all plumbing work and Installations performed under Petmlt Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Lrvocoi rJcmiucec-