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121 Camp St #108 Building Permits
APPLICATION FOR PERMIT TO DO PLUMBING i New Plans Submitted YARMOUTH Renovation ❑ Yes ❑ No ❑ (OFFICE USE ONLY) Fee: $ 95'()0 PERMIT NO. P- O�3— 44 iO Name Type of Occupancy Replacement ❑ JN Z z W W w Y W Q = ~¢ _ z Y z 4a a LL z z a z z a 3 O X w V vn Z W m u~i y N W } w H rn !n Z G to O Z Q C� 0. Q R' 0 0 �y �/J� W O> O W O= Q N a 5 W Q 0 W z (q 0 0 y J z z 0 w 0 LL U d' 2 J J 3 Y OO rn O G Ix m 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Check One: ❑ Corp Address ZZ2 n I / ❑ Porfaership Fir Comp Business Telephone 71 � Name of Licensed Plumber/ Q�( 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. C Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 23ir 7 License Number Type: Master❑ Journeyman O 7.0, EXISTING 11 FOUNDATION 22.2'- 31.1 2�0• M � N LOT 109 68.88 b � LOT 108 F Z 26.0 L=3.37' W �- a in a LL 0 j� EXISTING N � o o ;V 6 ,:� FOUNDATION `� C6 toL,_, 0 6.2' Q w 21.0' — a Lo 22.1= 6.2 o 3 a l.. TN 2 toCIO N i' 71.53' N 0 00 LOT 107 I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREA.,/ - DATE REGISAREErPROFESSIONAL LAND SURVEYOR OTICE 2 Unless and until such time os the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, Including any municipal or other public officials, may rely upon the information contained herein: and (B) this plan remains the property of Holmes k McGrath. Inc. 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. DATE REGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 fL .7 AS -BUILT PLAN holmes and mcgrath, inc. AN oF,, OF LOT 108 civil engineers and land surveyors PREPARED FOR 362 gifford street c��`�MICHAEL�q�y�s a MILL POND VILLAGE falmouth, ma. 02540 McGRAM V IN No.2E9M YARMOUTH, MA JOB No: 201197 DRAWN: LMC SCALE: 1"=20' DATE:11-14-05 DWG. NO.: A2540A CHECKE PyPP.�'Iii �I i1ti� 1P�f rr�}M�-4a� mt�u''j{ { Yy+• I�a�i� • iib ts lc'i engiinq Corp. 4A+Y 1 ruI.PF ay�3r � A�an� a ""'+Ia 7 .r. ii.,, a !?-i!w 4yt CONSULTING ENGINEERS.0.:4... 716 CauntyStree% TeuricnMA 02780 Tel. (508) 922-6934 Pax, (508) 880.7811 FieldDens/ty Test Report - Sand Cone Method (AS TM 01556) Client: GateWood Homes .lot? No. 10980.010 1600 Falmouth Road, Suite 25 Dste; 11/18/2005 Centerville, MA 02632 Report No., 7 Project: Mill Pond Village, West Yarmouth Test No.. Location of Field Density Test FD5307A Unit #108 - NW Center- Footing Grade- Sandy Materiel FD5307B Unit 0108.- SE Center - Footing Grade - Sandy Material Tabulation Field Density Test Resu/ts Date: Test No. Proctor I.D. Req. % Obtained Meets Moisture DryM Max Dry optimum Conpt. CaTaction Specs. Content P.C.F. WI. PCF Moish>re 1118Y2005 FDWA PR4252E 95 95.3 Yes 4.0 120.5 126.4 8.2 11/812005 FD53079 PR4252E 95 955 Yes 4.6 120.7 126.4 8.2 Remartcs: _ All tests met the specified mini_mtim 95% c omp&CUon. Walter P. Galuska Laboratory Supervisor P. Fanundes Laboratory Technician NOV 2 3 2005 -J ONE & TWO FAMILY ONLY - BUILDING PERMIT �$ C APPLICATION TO CONSTRUCT, F{EPA!R, ;IENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING b Town of Yarmouth Building Department �' „ ..„°E, Z 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-0836 Section P=''Site lnfoiniatiori' Use Group: R-4 Type: 5-13 1.1 Property Address: 1.2_ Zoning Information: 21 G MP St rr�� Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required I Provided Required I Provided Required I Provided 1.4 Water Supply (M.G.L. c. 40. S 54) 1.5 Flood Zone Intormation x onnneum , t Public Private Zone BFE-`" 2.11 Pw r of Record, 7 /� / �/ Name �"�L _ Mailing Addres��tUi y - 7 78' 6 Signature Telephone Na ) MallingAddress��f�A/' Signature Telephone Fax ;li 3.1 Licensed Construction Supervisor. ,.bra-.y k c� Addr Signature Telephone 3.2'Registered Home.lrrtprovement `C Company Name Address Not Applicable r� -1 B AC;%\ .Expiration Date 1 r )II Not Applicable License Number Expiration Date /OF" Z Signature 9-15.99 Telephone 1 of 2 OVER ection 4 = Workers': CortipensationAnsurance Affidavit (M.G.L c. 152 525C (5)";, Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ......... No .......... Section 5,,, Description of Proposed Work(check alt applicable) New Construction No. of Bedrooms No. of Bathrooms Z Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: �' Section sm Estimdted Construction Costs Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �p 7. Total Square Ft. (new houses & additions) Section 7a �- Owner Authorization - `Owner,sAgentorConfractor,Applfe To be Completed When`', or -Building Permit .�": as owner of the subject property hereby authorize A;LAgl( to act on my behalf, in all mgkOrs relat, tow rk authorized by this building permit application. Sig tur of MwnerDate Section 7b - OwnerMithorizeedd Agent Declaration 1. 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. - //P PrintKame Sig a of O ner/ gent Date 9-15-99 2 of 2 M r TOWN OF YARMOUTH �INCGAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETrS02664-4451 Telephone (508) 398-2231, Ext 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 1 p Sf Work Ad ess is to be disposed of at the following location: n 04 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. ` Jb fze: b Signature of Applicant �l Date Permit No. k 3e PLEASE PRINT: Job Location: _ 1vWIN. UP YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Owner of property: Construction Supervisor: Address: ®p Licensed Designee: (If other than Supervisor) Street Village 669 Name License No. Phone No. Name 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 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 shallwillfullyviolate subsections 2.15.1, 2.1-5.2 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 LZ?( No ❑ If you have checked�es, 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 are that the licensee does not have the insurance coverage required by Cha to 1 o ass. al a s and that my signature on this permit application waives this requirement. /�, � _ Check one: of Mner or Owner's Signature: Owner ❑ Agent Building Official Approval: _A6"N The Commonwealth of Massachusetts Department of Industrial Accidents Ofllce olforestffstfiss 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit rinme7G4 2 0.) locution- / 6 o U V� �itil b ti` n /L& J V l_ (V 2<_1_ cit\ lV (� p ohnn ��� UQ 2 f -7 0 /Q / . fO HOC I am a homeowner performing all work myself. I_am a sole proprietor ,n a, ha\ a no one working in any capacity CD I am .an employer prop iding workers' compensation for my employees working on this job. mnany name: iddress- city- nhone a insurance co. eoliev # am a sole proprietor.:eneral contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e liia -nowilit-lila insurance Co.. 0C` # company name: Failure to secure coverage as required underSecnon 25A of MGL 152 can Ind to the Imposition of ertmiaal penalties of a one up -to SI.500A0 Z d/or one years' imprisonment as well as civil penaldei in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand'that it Copy of this statement may be forwarded to the OMCC of Investigations of the DIA for.eoverage verification. I do -hereby ceruff t er the sins ar a !ties ojpeijury that the information provided above is true and correm X Signature (� ate X g��X,>s Print name \-�t7—t• 1� l,011i V DL Phone # r �d official use only do not w rite in this area to be completed by city or town oflleial city or town: YARMOIIT$ permitAicenst # nBuilding Department 0cheek if OLiceusing Board immediate response is required 261 OSelectmen's Mee contact person: phone #: _ (5O8) 398�22Health Department31 eat. nOther ...... 11 1 . , , At GMS9/GCS.9..SER1ES. . 93% AFUE Multit-Position;- Single-Stage/Multi-Spee& Gas Furnace.. Heating Capacity;.. 46,000-115,000 BTUH �Mwr ��rr- ama .. CIV�. • air-CQncUtionin&& Heating The GMS91GCS9 single -stage, multi-vee&gas fumam offer installation.versatility, . Standard Features Cabinet CUMtractivn • Corrosion -resistant, aluminized steel tubular heat • Heavy -gauge. reinforced, fully insulated steel cabinet exchanger and stainless -steel recuperative coil for with durable baked -enamel finish - maximum efficiency • Attractive architectural gray paint finish • Designed for multi -position insta1!ktion--GMS9:' • Foil -face insulation lined heat exchanger upflow, horizontal right or left; GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a Norton® Miru•Igniter.with patented adaptive learning algorithm to maximize igniter life- • Aluminized•steelinshot burners • Energy -saving PSC,mull=speed, direct drive blower motor • Quiet, corrosion resistant induced draft ' blower assembly • Integrated furnace control. with•improved..... diagnostics • Low voltage terminal blocks • Multiple flame toll -out switches, blower door safety switch, outlet air limit switch and pressure switch for proof of combustion air • 40VA transformer for heating and air conditioning control service • Combination redundant gas valve and regulator • Top venting -is standard; alternate-fluc/vertrlomted -- on right side m Completely. assemble&bccont run:tested fuace.fm.....on _ . heating or combination heating/cooling applicati • All models comply with California NQx Standards • Suitable for direct vent (2-pipe) or non direct vent (1•pipe) applications 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 block.off (GM59),. Accessories L.P. Conversion Kit (LPT-OOA) LP --Gas LowPrc»umKit(LPLPOI) High Altitude Natural G2s/L.P. Kits (HANG11, HAN012, HALP10) " High Altitude Pressure Switch Kit (HAPS27) ExternalFiltecRack (EFROI). . Horizontal Concentric Vent Kit (HCVK) Vertical Concentric Vent -Kit (VCVK) ... Internal Filter Retention Kit—upi)ow, horizontal tRFC1OO180) ..... Internal Filter Retention Kit—downflow (RF000181) Thermostats ftwer Motors (CHT18.60. CH70TG, CHSATG, H10TWR) Z3770 WWwrp,irmntn(gram 7)4 " ` ` Y SPECIFI ATIONS ,PRQQLKT Nomenclature -'Z M s s 0 0 3 a a Goodman® Brand I .. _.... ... ...... ..... ev s n A: Initial Ret NOx B: tx RevlSiOn ,r Flow Direction N: Natural Gas C: 2^0 Revision M: UpflowlHorizantal...... D: Dedicated Downflow ... . _ . ...._. ....... ..... %i Low NOx C: Downflow/Horizontal . . a met Wi t ItHI'Air Flow _ _. A: 14" B. Description 17 - 5: Single Stage/Multi-speed 2*1" V: Two Stage/Variable-speed Maximum CFM ® 0.5" ESP APUE I...:...3:_1,ZtN2...., 8: 80b 4: 1.600 93 9 5:2,000 .. KBTUH 045: 45,000 070; 70,000 1- 090: 90,ODO _... 1150-11S,D00-- 140:140,000 r Y - PRODUCT SPECIFICATIONS GCS9 Dimensions LUT SME - V,Ew FROM inaNi SIDE VIEW av n GCSW453BXA 17yt" 16" 12e/." 11'h" GCS90703BXA IN" _. 16"........12°R.". .._ .__ t4Yt"..... 16" ..._. GCS90904CXA 2Y 19A, 16%" 18" 16" GCS91155DXA 24%" j1".._. ._. 20'/.'...... _ 21Sf"-... 19ch" .. urvrse. 23" L Installer must supply one or two PVC piing: one for combustimaic_(uptiopal) andone-ki-Owfloe outlet (required): Vent pipe must be either 2' or 3" in diameter. depending upon furnace input; numbnrofelbows, length of run andinetallation (I or 2 Pipes). The optional Correbu,tion Air Pipe is dependent on installatioWcode requirements and must be 2" or 3" diameter PVC. 2. Line voltage wiring can enter thtuugh the -right or lefrsFdeofehe rumace Uwr wluge wiring can enter thnovo the right or left side of furnace. 3. Conversion WE for high altitude natural gas operaclun ate available. Contact vour Goodman ducriburot or dealer kw details. 4. lnualler must supPly following gas line fittings, according to which mtrancr it used: Left —Two 90 elbow,. one cl6se ncppfe: straight pipe Right Straight pipe go teach gas valve Minimum Clearances to Combustible Materials C - Combustible: !(placed on eumbustibli floor, the Ban MUST be wood ONLY. NC - Non•Ctmtbustible: A wmbustible foot subbase must be used fw iosta8ation on combustible goofing NOTES: • for servicing or cleaning, a 36' front clearance is recommcndrd. • Vnit c'mnecrions (electrical. Not and drain) may necessitate greater cleoraneeathao.thesninimumek.ranges listed brow: • In all cases, accessibility deannce must take Precedence oven c)earaneq from the mcloaure where accesfibility clearanes an greater. 5 .a PRODUCT SPECIFICATIONS Blower Performance SpecificationsY !Iqf i;ttr to AMNSIMM WE_ HIGH 3.0 1052 1,318 1,260 1,207. G_5904538XA MED 2.5 t,214 1072 -•--•- 1,123 3` (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 '917 47" (MED-Hp... MED-LO 2.0 '981 53 -962 ' 54 943 55 56 Mt LOW 1.5 750 --•--- 730 ------ 714 ------ 692 ...... ;. �' :+.' F .r NIGK.. ...4.0.. t,9'0 - 4,674 •-3$.. ;,757 ..8- ..40• G_590904CXA MED 713^39 1,$50 40 1572 42 It-,667- 1,510 44 (MED-LO) MED•LO 3.0 1,439 46 1,412 47 1,370 48 1,327 50 . LOw.. LS 1183 '56. V.1551-'ST" 1't12 '59r' 1.109 60' HIGH 5.0 2,114 40 2,103 40 2,029 42 1,941 G 591155DXA MED 4.0 ?,47a ..51. 1,643 _ 52. .1,643 .52. 1.,577 . 54.. (MED-MI) • MED•LO 3.5 1,453 58 1,440 59 1,426 59 1,363 62 LOW 3.0.. 1 259 ..67. .7 239 _68-. 220 t81 ----.- �1 `J,. NOTES: I • CFM in chart is withuut filt r(s). Filters do nac sh p.w th dsis futnse e. but munt.>H.ptuvided..by the .itasallar."If the-fusnaceretluiraa twmrrru�n3. this chart assumae hods filteri are installed. .. 2. All fotnaces ship &, high speed confing. Insndler must adjust blower crr:dinx speed as needed. .3- For rrxsst jab. ah,,ur 400 CFM per tun ,vhcn cooling is desirable. 4. INSTALLATION 15 TO BE ADjV$TED TO OBTAIN TEMPERATURE RJSE WITHIN 'ME RANUS SPECIFIED ON THE RAT1140 PLATE. 5. The chart is fur inftrcmathm only. For sawilctof operatitm, external nutic pressure most not exeted value shown on +he sting pWc The shaded area indicates range. in excess of maximum static pressure :dl;med when heating. 0. The dashed ( ---- ) areas Indicate a ttmperatweT x nut reeomnsended { tl la rrw4Fe1 - 7. The above clout is fix U.S. furnaces installed at 0' • 3 OW% At higher altitude;. a properly de -rated unit will have api A x> tmtly the same temperature rise at .1 p, rticular CFM,, while ESP at the CFM will. be -lower'.... ` J M PRODUCT SPECIFICATIONS Accessories LPT-OOA L.P. Conversion Kit ✓ ✓ ✓ LPLP01 L.P. Gas Low Pressure Kit ✓ ✓ ✓ 1 HANG11 High Altitude Natural Gas Kit 1 1 1 1 HANG12 High Altitude Natural Gas Kit 2 2 2 2 14ALPIO High Altitude L.P. Gas Kit .. .. 3. ............ 3 ..... ..... 1 ..... _ . 3 _ HAPS27 Nigh Altitude Pressure Switch Kit 3 3 3 3 ..EERDt.. External Filter.Rack-...... .. ........ /....:... ..._ / ..... �..... - . <.._ DCVK40 Horizontal/Vertical Concentric Vent Kit (2") ✓ DCVK-30 Horizontal/VerticalEoncentrfcVentKtt(y,) _ ... ✓..... ✓. ✓ Available for this model (1) T,001'tii' 9, (2) 9,001'to 11!000' (.3) 7,001' to 11 ow Note: Ad frivillations above 7,000' require a pressure switch change: FrK i tsraflation in canasta, Pomaus are cenified only to 4,500. Dowafkrw floor Base: When the CwCS9 model is installed directly un a wood fluor, a downflow flout base must be wcd..TlstVe model numbe.u,,. arc! CY1517, CFB21 and GFBZ4. Thermostats CHT18-60 Cooling/Heating, Mechanical CH70TG Cooling/Heating, Digital, Non -programmable CHSATG .... Coolf"t"eatfng,_Meehantcat H20TWR Heating Only, Mechanical 7 BQ'ARD OE-._ BUILDING REGULATIONS >' License CONSTRUC-PONSUPERMSOR .. s ..._ Number Z5 Q4243t1 . »- BicdiMaai 6E_ 340 r: 6q�Ees 0�6T2©a6, Tr. na 25926 ReSYrided>:El�;> FRANK CAPRiF ` 4E7 COPPER CEMER1AELE. 4TA QZ632 commissioner .. 00 - 35;000-d enclosed space (MGC C.M-S:soeJ ttAaspm;R oofg $SIA €I-Fiy- Homes - .. Failure to possess a current edition of the t : Massadwsetti StitesB0i Ttng.-Cade: ' �'• is•cairsgfor•revocaUdrLbfEiis-Hcense. - 'F Y DIG. SAFE:CALL CENTER: j888) 344-7233 DATE (MWDDIYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 07/19/2005 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. MA 02601- INSURED INSURERAFirst Financial Insurance Filho, Antonio DBA BR ROOFING INSURERS Po BOX 1231 INSURER C: 136 Stevens St INSURERD Avannis MA 02601- INSURERS nnvFRAGFS NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICATtD. NU I WI I HZs IANUIN(a 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADO'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EXPIRATION DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED ) PREMISES occurrence S 100,000 MED EXP(Any one person) S 5,000 CLAIMSMADE OCCUR 491FOO2639 06/21/2005 06/21/2006 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 PROT LOC PODGY JEC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO BODILYINJURY (Per person) S ALLOVJNEDALTTOS / / / / SCHEDULED AUTOS BODILY INJURY (Per accident) S - HIRED AUTOS / / / / NON-OAMED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO / / / / S EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE S AGGREGATE -' S OCCUR _❑ CLAIMS MADE S S DEDUCTIBLE / / / / TAT- I _ - TORY LIMITS OER S RETENTION S WORKERS COMPENSATION AND / / / / E.L. EACH ACCIDENT $ EMPLOYERS LIABILITY TI ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMEMBER EXCLUDED? / / / % E.L. DISEASE- EA EMPLOYE S E.L. DISEASE - POLICY LIMIT S - If yes, describe under SPECIAL PROVISIONS below - OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS SIDING AND ROOFING. CERTIFICATE HOLDER CANCELLATION ( ) - (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 REP5tSEhTATrVES. AUTHORIZED REPRESEN_TATP4 ) CENTERVILLE ACORD 25 (2001108) t l INS025 (01CB).05 MA 02632- 5-1( l f © ACORD CORPORATION 1981 ELECTRONIC LASER FORMS, INC. - (800)327-0545 v\J Page 1 d. MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE Lie this corm to request a Certific-ate of Insurance from an Assioned Risk Pool Carrier. ' M Please provide all of the requested information, including the facsimile num ;errs; of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accurz:'l cu np eted, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, urthki two (2) business days of the care Sirs receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's cc;ntact information refer to the Certificates of Insurance section located in the Producer Comm'r, s'iysection of the Bureau's web;i:e (www. wr-nbma.oro). 1: Name, address, Name: -- Mailino Address:_ Physic'+! .Address: Pho 2. 2me, address, t Name: Mailing Address:, Physical Address:. Phone: one numberand h ;ne number and fa number of the INSUREb: Fax. number of the CERTIFICATEf-IOLDER: Fax: s 3. Name, address, contact person, telephone number and facsimile number of the PRODUCER: Name: Sarcl- i o r Insurance Acenc.yy Inc. Mailino Address: 12 Enterprise Road Hyannis, MA 02601 Contact Person: Q}yr_i_= Andrea_ Phone: 5088-790-1919 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: Effective Date: _- Expiration Date: _ 5. List any special requests for optional coverages I endorsements (see Page 2 for listing of coverages available in the pool and the ccnditions 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. Client 24383 - rage: UO2.003 r-eor�nnn�Anv - /�i��`�Q i'�•� ! �CinA OF- ite: n yKE I %.fMTEE I INSURANCE i.t6' RIU-9 INSURANCE DATE(MMIDD/YYYY) I.. b/w5A*-- PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Feitelberg Company ONLY AND CONFERS NO RIGHTS UPON THECER-TIFLCATE 222 Milliken Blvd. P.O. Box 3220 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR-- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fall River, inA 02722 INSURERS AFFORDING COVERAGE NAIC 4 INSURED Cape Cod Ready.6'�: Inc. , Po Box 3 INSURER A: Acadia Insurance Com anles INSURER B: Construction Industries Compensation P INSURER C Ort ans, 0265S INSURER D: INSURER E: C( THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTV rwT TANOw, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE33OR- MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BETSN REDUCMBY PAID CLAI:S- TR NSSE TYPE OF INSURANCE PODCYNUMBER POLICY EFFECTIVE DATE (MMODN'r POLICY EXPIRATION DATE (MM rDQrfY) LIMITS A GENERAL LIABILITY X COMMEROALGENERALLIABILITY CLAIMS MADE ® OCCUR CPA013246$tD- otf"105-. - 01/w/w _ EACH OCCURRENCE S1 000 000 DAMAGE TORENTED OF iC C ? on^a s100000 MED EXP ;Airy me pei n) $5 000 PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE S2 DDDODD GEN'L AGGREGATE LIMIT APPLIES PERL POLICY jcC LOG PRODUCTS - COMPjOP AGG S2 000 000 A ' _ AUTOMOBILE - LuewTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREG AUi CS NCN{WNEG.4UTCa^ MAAOt3246310 01/01/05 . 01101/06 ... COMBINED SINGLE LIMIT t-caacacerrt) S1,ODD,O BODILY INJURY S X X BODILY INJURY - =10m) S X T-ROPERTY DAMAGE �a arl 1 S GARAGE LIABILITY ANY AUTO - - AUTO ONLY- EA .4COCENT S OTHER THAN E4 ACC AUiOONLY: AGO S S A �. EXCEESSIUMBRELLALIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE , a_r-ENTION so CUA013247010 01/01/05 01/01/xi EACH OCCURRENCE S1 000000 AGGREGATF $ S S X S ..B WORKERS COMPENSATION AND EMPLOYER;T LIABILITY- ANYPRCPRIETORIPARTNER/EXECJTWE OFACERIMEMBER EXCLUDED? ItYes,:zswip9ur:� SPECIAL PROVISInNS blew WC0009255 - 01/01/05 01/01/06 JX qy rM. V=q - - El. EACH ACCIDENT S5D0ODO- E.L. gSEASE.EA'cMROYE :500 DOD EL.[ SEASE-FOUCY LIMIT soormw OTHER DESCRIPTION OF OPERATIONS / LOCATIONS (VEHICLES / EXCLUSIONS ADDED BTENDORSEMENT1 SPEC= PROVISIONS Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, LIA 02632 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF THSISSUING INSURER WILL ENDEAVOR TO MAIL " DAYSWRITTEN - E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL fE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR e mu v (zwuus) 1 Ot 2 1JS68995/LA66526 AH1- 0 ACORD CORPORATION 1988 \ --... _._ .. _. .. rHVG UG PACDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND .CONFERS M3 RIGHTS UPON THE CERTIFICATE d A. (I-mz211.Irtsea-e AgeMy, Itc. HOLDER_ THIS CERTIFICATE DOES NOT AMEND; EXTEND --OW D O , ALTER THE .COVERAGEAFFGFIDED :B Y THE POLICIES BELOW. [�. st¢5 t tll5, HA C2648 'iiYSURERS_AFFORDIi+iG.COY€RAGE kAiC# INSURED IIIVSUREaA--Llqd hTy �.L�.11s., 14!LLllmtt � � NSIlHERC , M. ! tcm • ils7 tMA 02S40INSURER Q. �—' - - - INSJR.-a e COVEHAGE5 THE POLIC!E5 OF:INSURANCE LISTED BELOW. HAVE SEEN ISSUED TO T92 INSURED NAMED ABOVE FOR THE POLICY PERIOD -INDICATED. NOTWITHSTANDING OF CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WWtCH THIS CERTIFICATE MAY -BE IS.SUEMOS- ANY REQUIREMENT,.TERM. OR CONORION ANY MAY PERTAIN, THE lNSURANG£ AFFORDED BY THE POLICIES-DESCRtSE"EREIN IS SUBJECT TO ALL THE !MRMS 'EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. ADGREGATELIMI.TS SHCVVN MAY HAVE BEEN REDUCED BY PAID CLAIM$. iN9n �A POLICTNUM9ER POLICY EFFECTIVE POLICYIEYPIRATIONI-- LIMITS Lin Mr, _. EACH OCCURT Rm E�ff IS!:., ,t[v}� GENERAL LIABILFY tlfrvd .. COMMSRCIALCENEAALLL\BtUTY ( , - ,�._ PREMISES(En,peewmee) . 2 - I �I CLAIMS MAD.' KK7oCCuR - MEB EXP(A.q._oneperepnL PERSONALBADVWJURY .., GENEBAEAGGREGATE 12}ycga��_ .. _-� A I GEAr ACGAEDATE GH Tr.?PLIESPEft• �O7 1I4/ L�/\/J 41'2 OEt1 PRODUCi9'-COMPTIO!, a 2- PRO - POLICY LOC F AUTOMOBILE LIASILITY I CONRINEDSINGLE UMIT T - ANY AJTO - - . Ill lEP er+danit- `A;L OWNED AUTOS i I l {<CHSDULEDAUTOS I BODILY INJURY g rj - ^ODrLY INJURY .I HIED AUTOS 1 4 NON-OWNEDAUTIDS -� —_ II tl ( �� Uen'I PRCPERTYO�IMAOE- 4Per ecdQenq S 4 f GAR40E UABKITY ( I ; AIITD ONLY-EAACCI^ENT rOTHERTHAN T. , .. 111 -. ANY AUTO- ( I I ,- EAACC }kUTOSiNLY', ,'AGO ¢ —. r S EXCESSAIMOMLLA UADIITY - i EACHOCCURRENCE 1 . ADGREGATE TI QCCUIT ... CLAUS BADE .f I i A DEDUCTIBLE - ` RETENTION 2 W'G pf4711 - QTH• 2 WORKEASCOMPEN"TIONAND... TORY aLti EMPLOYERTLIAMLITY E.LEACNACCIDENT ANY PROPRIET0WPARTNErFlxECU+6c OF-FIGERIMEMSEP SXCLWED? ( _IT t E:L. DISEASE -EA EMPLOYEE 2 , If Yee. eeB-Ab- Vntler SPECIAL PROVISIO --"WU . 11 E.L. D6EASE • POLICY LIMIT S OTHER I I F DESCA!PTIONOFOPERATIONS/LOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTf SPECIALPelOVISPJHS'-- ' GCtt I IrIGR 1 G fIULMCn � ---- - ' SHOULD ANY OF THE ABOVEOESCM5ED POLICIES BE _OANCELLED EXPIRATION QtEI7= rbIjei7`Ir-C` - SATE TIt RE05 THE IS3VW4-WSUAEA 1NILL ENDKAVOR Ta MAIL _DAYS WRITTEN o t`H t � CIO ell a-- - - NQTICF TATHE CERTIFICATE HOLOER NAMED TO THE LEFT. RUT FATUIRE TO DO SQ SN.ALL Rte LA-' - IMPOSE-IPUBUOASI00.O9I.LU5iLI!rY OF ANY KINT UPON THE INSDP.ER:' RYAGENT Gm1 ,c.rvgl REPRESE14TATNE3. 7 AUTMOWZED P.EPRESENTATIVE \ nkilOA0 CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) , ,, 0_ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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.I.M. Mutual Insurance Co A 145 Cammett Road LETTER Marstbns Mills, MA 02648 i 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 TYPE OF INSUMANCE LTRI POLICY NU IBER I POLICY I EFFECTIVE DATE•(MM/DD/YY) POLICY EXPIRATIO DATE(MM/DD/YY) LIMITS ,GENERAL LIABILITY GENERAL AGGREGATE S IPRODUCfSLOMP/OP AGG. I S �COMML'RCIAL GENERAL LIABILITY ,CLAIMS MADE[�CCUR - (PERSONAL&ADV. INJURY S 'OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE S FIRE DAMAGE (Any om lire) S L_J—J MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMB i S BODILY INJURY S ALL OWNED AUTOS SCHEDULED AUTOS (Per Person) I (BODILY INJURY !'S HIRED AUTOS - I j iNON_OWNED AUTOS i (Per wcidcnU iI (PROPERTY DAMAGE i S j—(GARAGE LIABILITY I (EXCESS LIABILITY EACHOCCURRENCE S AGGREGATE S FORM U� ((IMBRELLA kTHER THAN UMBRELLA FORM X w AiuToav 07HER YVORKER'S COMPENSATION AND I ACCIDENT S 100,000 A EL EACHi 1°NI1'LO1'EftS' LIABILITY A I 7015793012004 12/13/2004 12/13/2005 EL DISEASE —POLICY LIMIT S 500000 �IrHE PItOPRIE'r0R/ INCL ARTNERS/EXECUTIVE IEL DISEASE —EACH EMPLOYEE S 100,000 OFFICERS ARE: IX F.XCL I I OTHER � I I D I.SCRI VNO.N 01: 0I'ISItAI'IONS/LOCA7'IONS/YEIIICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO GateNvood I-1omeS 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. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID K DATE (MMIDD YI YY) CROWC50 06/06/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATION 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 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURERA ALEA NORTH AMERICA INS CO INSURER B: Hanover Insurance Co 22292 Crowell Construction, Inc. INSURER C: PO Box 309 INSURER D: So. Dennis MA 02660 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. LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) P PIRATI DATE (MM/DD/YY) LIMITS B GENERAL LIABILITY X I COMMERCIALGENERAL LIABILITY CLAIMS MADE X❑ CCCUR ZHN700714102 05/01/05 05/01/06 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurence) $100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRO - POLICY PRO- n LOC PRODUCTS - COMP/OP AGG E2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED Al1TOS HIRED AUTOS NON -OWNED AUTOS AFN7001142-02 05/01/05 05/01/06 COMBINED SINGLE LIMIT (Ea accident) $ BODILY person) - (Per person) $ 1,000,000 X X BODILY (Per accident) (Peramidenq $ 1,000,000 X PROPERTYDAMAGE (Per accident) $.500 000 / GARAGELIABILITY ANY AUTO _ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG I $ $ 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 WC1049858 03/22/05 03/22/06 I TORY LIMITS X ER E.LEACHACCIDENT $500,000 E.L DISEASE - EA EMPLOYEE $500,000 E.L DISEASE -POLICY LIMIT s500,000 T ER operty Section DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Subject to policy forms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION GATEWOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Gatewood Homes NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1600 Falmouth Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Suite 25 Centerville MA 02632 REPRESENTATIVES. A PRESEN T ACORD 25 (2001108) © ACORD CORPORATION 1988 I-. JiC • f F PRODUCER (508) 790-1919 THIS CERTIFICATE IS ISSUED AS A Sandpiper Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES 12 Enterprise Road ALTER THE COVERAGE AFFORDED E INSURED Oualberto, Paulo L.. 21 Quippish Rd THE DATE (MMIDQIYYYY) 06116/200S THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A19OVE FOR THE POLICY PERIOD INDICATED, NOTWITH4STANDING 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 POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERM-S. EXCLUSIONS AND CONDONS. OFSUCHPOLICIES, AGGREGATELIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R ADD'L INAMMI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE SATE(MMIDOMI POLIO UPIRATION TV MMJOO/Y LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE 00,000 1 l r 000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR ECP0427793TS - 11/20/2M4 11t20/20D5 DAMAGE TD RENTED PREMISES Eece ftw) i3 300,300 MM EXP An eneamon _ I6 10,000 PERSONAL A A V INJURY Is 1,000,000 ' 004CRALAOORMAT—C I i 2,000,000 GENL AGGREGATE POLICY LIMITAPPLIES PER: FC7ED LCC' PRODUCTS-COMPIOPAGO S 2,000,006 AUTOMOOILEUASILITY ANY AUTO / / / / COMSWED SINGLE LIMIT (EA xcidAlq. 5 BODILY INJURY (Par owsI l) , ALL OVMEO AUTOS SCHEDULED AUTOS I I I I .. HIRED AU705 NON-OWNcDAVTQB / I / I- ( BODILY INJURY (Per At., de" 15 { PROPERTY DAMAGE (Per accideeO 3 GARAGEL"ILITY L AUTO ONLY •EA ACGD'cNi � I ANY AUTO / OTHERTHAN EA ACC C S AUTO ONLY: A3 6 5 1 J EXC€mLIMBRELLA LIASLUTY OCCUR 171 CLAIMS MADE / I / / EAt IDCCURPPNCE �E AGGREGATE {S s DETtICGBLE S RETENTION 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCOUNT is ANY PROPRIETOWPARTNEWEXECUTIVE OPFICERRAEMBER EXCWDED? II Yee. 1Le6EPae 6Y dv / / / / E.L DISEASE - EA EMPLOYES E.L. DISEASE • POUCY LIMIT IS SPECIAL PROVISIONS b OTHER DC60; iPTION OF OPCRATIONWLCCATIGNWVL-HICLESIEXCLUSIONS ADDED BY ENDORSEMENTlSPECIAL PRDVIRIONS 7=12-OR, AIM =TZA11OR FAINTING (500) GAZ'Sin001D n03aio 1600 FAUdOUTY ;* OUT= 25 ,, INS02S (o oops SHOULD ANY OF THE ADCYE DESCRIBED POLICIES BE CANCELLW BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL • ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE , CEprF I rTE MOLDER NAMED TO THE LEFT. EUT FAILURE TO DO 90 SHALL IMPOSE NO OBSIOATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED R6PR€.StNTATNE ELECTRONIC LASER FORMS. INC. - (600I327-0145 ® ACORD Page i cc' ....................... [..,AdhwdDIDkID.;.-.�CERT[FiC:ATEOF INSURA (MW DWY) ...... ....... 06 —20-05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SANDPIPER INS AGCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 ENTERPRISE ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HYANNIS MA 02601 COMPANIES AFFORDING COVERAGE COMPANY 27BCN A HARTFORD UNDERWRITERS INSURANCE COMPANY INSURED COMPANY GUALBERTO, PAULO L B 20 FERN BROOK LANE CENTERVILLE MA 02632 COMPANY 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 LTFI TYPE OF INSURANCE . E POLICY NUMBER POLICY EFFECTIVE DATE (MMTMYY) POUCY EXPIRATION DATE (MM\DD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL LIABILITY CLAIMS MAOEF OCCUR. PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ OWNER'S & CONTRACTOR'S PFOT. FIRE DAMAGE (Any one flre) 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 AUTOS PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT q AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE S UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY THE PROPRIETOR/ F-7 PARTNERSIEXECLMV INCL OFFICERS ARE: rXj EXCL 11-22-04 11-22-05 STATUTORY LIMIT S EACH EACH ACCIDENT $ 100,0M 0 DISEASE—POUCY LIMIT S 500,000 DISEASE —EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIOUSNEHICLES/RESTRICTIONS/SPECIAL ITEMS .THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE � HOLDER ....... ..... ... .... ... . ............ . ............... ........ LLATION ... .. .... CANCELLATION ............ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL GATEWOOD HOMES 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1600 FALMOUTH RD SUITE 25 CENTERVINE MA 021332 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 ........... ... .... ........ .. ... . — 5A TION 199a< p n7 ACURg - CERTIFICATE. OF IL[ SURA CEE °ATE 08/0 M� PRODUCER $eLjEI I A1530 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BIXBY VdSURA►dCE AGENCY, 10 :. P.Q. BOX 830 - 651 PUTNAM PW . GREENVILLE, RI 02828 - ONLY -AND- CONFERS— NO R{GHTS UPON THE CERTIFICATE ' HOLDER: THIS CERTIFICATEDOES NOT AMEND. EXTEND- OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BISURERSAFFO COVERAGE NAIC# NscTeED Nstpmx NATCFIRE WSURANCECO. OFHARTFORD- HOLMES AND MCGRATH, IN, ;. INSURER B: VALLEY FORGE INSURANCE CO. 362 GIFFORD STREET FALMOUTH. MA 02540 wSuRE C CONTWENTAt INSURANCE CO. NSJRER D- �Is+REx-� COVERAGES THE.POLICIES-OF INSURANCE LISTED BELOW I AVEBEEN ISSIADSQT/IEYN5URED NAMEDAiBOVEFQRTHEPOLICY PERIOQ INDICATED. NQTWITHSTANDPIG ANY REOUIREb1ENT, TERM OR CONDITION OF WY CONTRACT CR"QTHER_ D PLT =31i RESPECT TQ NMICH-THIS CERTIFICATE MAY RE ISCI IFn QR MAY PERTAIN. THE INSURANCE AFFORDED BY IHE POLICES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH ... POLICIES. AGGREGATE LINTS SHOWN MAY W JE BEEN REDUCED BY PAD CLAIMS- LTR 4s" TYPE OF INSURANCE AMICYN{IMIWR EXXV=W nATFtmml)prm- FrlonAswMt Lrw5 � A GENERAL LIABILITY X COM:1C-P.GALGENERALLIA&LITY MAEX rOCM D EACH OCCURRENCE 1 000,DOO AMAG ORENT® f. FIRE2�O8� 10000 PERSONAL& ADV F4AATY f 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER POLICY PRO Fl LOC PRODUCTS -COMPIOP A6G f 2000,000' AUTOU06" LAW.rTY - - ANY AUTO COMBWED SINGLE LOAM (Ea aaaeer"I S' ALLOMMED AUTOS SCHEDULEDAUTOS BODILY INJURY (As pecan) S . HIRED AUTOS NON -OWNED AUTOS SOCILY INJURY (Per xcaenry S . PROPERTY DAMAGE _ GARAGE UABRJTY ALTO ONLY -EA ACCIDENT S ARYAUTO OTHER THAN EA ACC S' AUTOONLY AGO S EXC656&waQELLAt"tITT` OCCUR Cl CLAMS MADE EACXOCGUR E- f AGGREGATE S S DEOLCTYSLE 5 RETENTION S f B NVRIMR 5 COMPENSATION NA EM PROPFU TCLILIAWArr � CERIMEMBER RREXCLUD GXECUINE e yyeecaaccflbe anger SPEGbk FMIOVLSIONS erlrar 2(k 7445273- .. 0910t164 .. ... 09/otw X MC STATLL TM . Q EACH ACCIDENT s T QOQ 000 - EL DISEASE- EA EMPLOYEE S 1.000 000 Et DSEASE - POLICY Le1f1-. .. 1 000 000- OTHER C PROFESSIONAL LIABILITY AE4 00 43t 33 3a- . 71t3*5. 07/t3= T,000= PER CLAIM/. AGGRETGATE- DESCRIPTION OF OPEMTIONULOCATKN15rYEHICLESIF) 7U=ftS ADDED BY ENDORSEMORISPECIAL PROVISK)" AGGREGATE UWTS ARE PER THE TER WS AND CONDITIONS -OF THE POLICIES. CERTIFICATE HOLDER CANCEL L A -TICK SHOULD ANY OF THE ABOVE DESMIGEO POLICIES SE CANCELLED BCFDRETHE EXPIRATION GATEWOOD HOMES. DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS VVRIREN 16MFALMOUTHRD.,STE.'5 NpfRFTCrrWCFRTFICA HOMETfNAMEDTOTHELEFT.BUTFAILORETODaSUS a CENTERVILLE, MA 02632 IMPOSE NO OBLIGATION OR LIABUTY OF ANY KIND UPQN'THE WSURER, rTS AGENTS OR REPRESID"TWES AUT R ATry/E/J/�%�� Kbwmv ZY LCUV I/Vi) C:VMIROIC£RTPROS.FPS l / V ACORD CORPORATION 1898 • ACORD„ CERTIFICATE OF-LMBILIT-1F 114CE ). PRODUCER THIS CERTTFTCATEISISSLEDASA% YJnited InsuranceAgency,-'-InC..... .. - CNLYANE1CONWRSNO-Rr4HFS-UPOI 199 Main Street HOLDS THIS CERTIFICATEDOESNO P.O. Box 1013 ALTER THE COVERACEAFFORDED M Buzzards Bay, M 02532 TNSURMSAFFORDING COV6tAGE IN&IR ED IN60RMA: Zurictr'NA ' ' .. . Patton Electric, Inc. INBURERRI Commarca Insurance t 128 3cituata Road, INSURER O-Libor Mutual Ins. Mashpaa, MA 02649 INSURER D: DATEIMMIDDNYYYY) ®r - THE-POUCIES OF INSURANCE LISTED.BELOW.HAVE BEEN ISSUED_TO.TKF—MSURED. NAMED AgOVEfOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON OITION 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. - IN ' POLR:YNUMBER PQUCYfif Fmtz FDUCY 0 DN [IMfiS GENERAL LIABILITY _ EACHOCCURRENCE LIS 1' O00 000 A � COMMERCIALGENERALLIABILITY CL\M5 MADE Q OCCUR SCP424-15394 7/30/0-5 7/30/06 PREp11SE3 a E 300,G" E 10 000 MEO EXP(An OnO ,Sw PERSONALEADV WJURY S 1 , 00O,IICQ GENERALAGGREGATE E 2,000,000 GCMLAGGPrCATE LIMIT APPUESPER: PROS X POLICY E T tDC PRODUCTS-COMPRN+AGG is 2 OQO tOAJ2 AV ONIOSIULIABILITY ANYAli70 COM9wEO Suw U 14M (EA SWOON) B B ALL OVWAIED AUTOS SCHEDULEDAUTO6 YW9338 10/3/04 10/3/05 gnnu v INJURY (°"°�""D 100,0= HIRED AUTOS NON-OANEDAUTOS BILY (Pancelma)Rr 9 3U0,000- PROPERTYDAMAGE PIKI I*ft) E 100, 000. 4 61R AGZUA1%r (TY �ANYAUTO TOTHER AUTOONLY- EA -ACCIDENT- E THAN EAACC AUTO ONLY, AGG E s . I EXCUSAUMERLILLALA91LFTY 1pOCCUR CLAWSMADE. - EACH OCCURRENCE E AOOREOATE E DEDUCTIBLE IS E RETENTION S 4 NOWERSCOMPENZa IDN AMC WLSTATU- OTH- Y_L2 11 C EMFLOYEPZ LIA9LITY ANVPROPPETOR/PARTNER/D(ECUTI�E OFFICERfMEMBER E%LLUDEIR S EElALP0.0MSKbLS DObw WC23IS353049014 12/10/04 12110105 - � ELEAC ACCIDENT s 100 ORO EL DISEASE - EA EMPLOYEE ! 500,000 E.L DISEASE - POLICY OMIT E 100 000 OTHER D E6CRIP710N OF O iERATIONg/LOCAMINS/VENCLE57EJICCU310N3 gDDEp-6TENOQCS[NlNfif 8P[CML}ROyl9ptty.. . alaCtrlCal ' L.ItiK.SLAi1UN-- GataxOOd Homos SHOULD ANY OF THEASOVE DESCRIED POUCIC88C CANCELLED BEFORE THE EXPIRATION Fax No. (508) 778-5603 DATETHERME,TBEIRIUMa-INBURFAW ILL ENDEAYMTO MAIL . TO DAYBWRITTEN 1600 Falmouth Road NOTICE70 THE CERTIFICATENOLOCR NAMED TO TNELEFT, COTFNEURETaBCrEoBHALL- j Suite 25 _ IMPOSENOOSLIQATiON OR LiABIL17Y OF ANY KIND UPON THcINSUREi rSAGENTs Or, Cs3 tg:•ille, Ida 02632 �„K,�,, by 1--� (2001108) ®A RD CORPORATION 1988 r. DATE(MM/DD/YY) ; ACORD CERTIFICATE OF LIABILITY' INSURANCE 9/15/64 C PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chatfield, Whitman & Young ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 COMPANY - - Lawrence Robinson Masonry B COMPANY 5 Fresh Hole Road .Hyannis, MA 02601 C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) - POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 A COMMERCIAL GENERAL LIABILITY CB 7E 32 32 9/07/04 9/07/05 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,00o OWNER'S 8 CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) _ $ 100,000 MED EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS - - BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ ' GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ - UMBRELLA FORM $ OTHER THAN UMBRELLA FORM - WORKERS COMPENSATION AND - WC STATUY LIMITS E- H- OT TOR EMPLOYERS' LIABILITY _ EL EACH ACCIDENT $ EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL , PARTNERS/EXECUTIVE EL DISEASE - EA EMPLOYEE $ OFFICERS ARE: EXCL OTHER i DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/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 1600 Falmouth Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 25 Centerville, MA 02632 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY' OF ANY KIND UPON THE COMPANY ENTS QFr 0VRSENTA-nyL AUTHORMEREPRESENTATIVE Robert Chatfield .( , `.` .. .. y.. .'P :. ACORD 25-S 1/95 _. "' '_ : " , O ACORD CORPORATION 1988: ACORD,N CERTIFICATE OF LIABILITY INSURANCE R07O 6 pg_2DATF 7-2004 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 FARMINGTON CT 06032 INSURERS AFFORDING COVERAGE INSURED INSURERA:TWin City Fire Ins Co INSURER B: LAWRENCE ROBINSON MASONRY INC INSURER C: 5 FRESH HOLE ROAD INSURER D: HYANNI S MA 02601 INSURER E: 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. /NSR LTR TYPE OF INSURANCE PoL/CY NUMBER POL/CYEFFECT/VE DA TE lMM D Y POL/CYEXP/RAT/ON DATE MM/DD/YY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABIDTY CLAIMS MADE O OCCUR - EACH OCCURRENCE 3 FIRE DAMAGE (Any one fire] 3 MED EXP (Any one person] 3 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JE T LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - _I. COMBINED SINGLE LIMIT (Ea accident) 3 - BODIINJURY (Per peerson]rson; -. ' $ BODILY INJURY _(Per accident] 3- PROPERTY DAMAGE IPer accident) .$ GARAGE L/ABIL?Y ANY AUTO .AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ 3 EXCESS CIABBJTY OCCUR EDCLAIMS MADE DEDUCTIBLE - RETENTION 3 _ EACH OCCURRENCE S AGGREGATE 3 3 3 3 A WORKERS COMPENSA TION AND EMPLOYERS* LIABILITY 76 WEG NQ5620 _ 09/06/04 09/06/05 I WC STAID- OTR- E.L. EACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE $1 0 0 , 000 E.L. DISEASE - POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERA TIONS/LOLAT/ONSNEN/CLfS/EXLL US/ONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Those usual to the Insured's Operations. GATEWOOD HOMES 1600 FALMOUTH ROAD, SUITE 25 CENTREVILLE MA 02632 DULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ')RATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO .IGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 'RESENTATIVES. r.�.unu 40-01/Ia/I 0ACORD CORPORATION 1988 C;, R E'ER t IM i' OF `1,4qLUT ``su�� yEE GOLMER 1 THIS CERTIFICATE IIS MSUED A$ Fi NCI L SERVICES z Iavauicniv� b ONLY AND CONFERS NO RIGHTS �$2 TCT1T. SERVICES I9tC. HOLDER. THIS CERTIFICATE DOE .. 03 o qw T vnrwwv on ALTER THE CO_ ERJAN .E AFF OR., HYANNIS MA 02601 Phonet 508-775-6010 $ax:508-790-0249 INSURERS AFFORDING COVERAGE lN3U:.-�f INSURERA: MARYLAND CASUA2 Piimmmr TAVP-TO I INSURER B: DBA NIECHANICAL SYSTEMS I INSURER C: 110 E;OLDmAt 1.=T - � j W SAbNSTABLE KA 026e.a INSURER O: Ig U2 eSR As TAVAN50 12/02 04 A MATTER OF INFOR�9ATION UPON THE CERTIFICATE S NOT AMEND. EXTEND OR ED 3Y THE 9C`LIC!ES BE-1 0- - j I WUC I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ta,* EO TO VIE!NSURED NA)dE0 ABOVE FOR THE POLICY PERIOD INDICATED. NOT'NITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY P, THE M$JRANCE AFFORDED By THE POLICIES DESCRIB Ell HEKIN IS $VNECT TO ALL THE TERMS. POLICIES.IES. AGAGGREGATE EXCLUSIONS AND CONDITIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 LTR INSRO TYPE OF INSURANCE I POIJC-Y NUMBER DATE MD i. 9III "MIT 6TIIIS '000. GENERAL LiZXny COMMERCIAL C 00037zoas /041 OCCTC$U-RRENCE 0 CUi75 MADE C 1/21/0s yS00 � �MS, w� 0Q0 - MED EXP (" we ps)DATE 900 13.000 S PERSONAL iADV INJURY 10QQQQQM GENERAL AGGREGATE 32000000GENT AGGRLGATE� APPLIES PER: PERAOCOHV COMPIOP AGG S 20000a0YY POL1JP'C7 LOG ItI I _.. ... .. AUTOMOBILE: LIABILITY I ANY AUTO COMBINED SINGLE LIMIT I (Ea a=iDeDO $ I ALL OWNED ALM$ BODILY INJURY ftrparuan) • I 1 SCHEDULED AUTOS I I WIRED AUTOS BODILY INJURY i I NON-OA-mEO AUTOS j (ParatrJtt u PROPERTY DAMAGE , I I (PErawida t) _ S N OAR -Of LLA NLRY ANYAIn'O AUTO ONLY -EA ACCIDENT i-- ETHER THAN EA ACC s I I i UCESSWU17RELLA LIAuiLITT ! AUTO ONLY: AGG S ! 1 OCCUR CLAIMS MADE 1 I I EACH OCCURRENCE is --�� IS � I !AGGREGATE i' 1 DED 1CTISLE i I y S _I 5 S CCwENSgT10N AHD I I w EIgrLOY EWLOY _1 ERS LiABIJ-1' I T ORY LIMfiS I ER ANY PROPRIETORJI ARTNERJE)(ECUTIVE i �OFFICER'MEI�E4 UICLUCED? EL EACH ACCIDENT I y EL DISEASE - EA EMPLOYEd S y� Cas.�.Le unG;- I SPECIAL PROVISIONS belay - E.L OISFJ. LICY L!MI7 S SE-POoSSCRLP'ZN OTHER OF CERTIFICATE HOLEIER .....��..._._.. mZ-AAIIUVI.J Ho—p Lj 1:I1.: PAX 508-778-5603 1600 FAL:EOL'TH ROAD SUITE 25 CENTBRVILLB MA 02632 ACORD 25 01TRESI1A �- SHOULD ANY G THE AP-OVE OEY^.", wt-D —rIES BE CANCELLED BEFORE THE EXPIRATIOb DATE THEREOF, THE ISSUING INSURER WLL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT• BUT FALURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGENTS OR r aae��t.f/. C�ERT1F1;1 PRODUCER (j GOLDMAN & ASSOC INS FIN 933 FALMOUTH RD RTE 28 HYANNIS 28HPP INSURED TAVANO, RODNEY DBA: MECHANICAL SYSTEMS 201 CAPES TRAIL WEST BARNSTABLE MA 02668 MA 026012319 [ALTER HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER. THIS CERTIFICATE DOES NOT AMEND,. EXTEND OR THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE VA ryAMERICAN ZURICH INSURANCE COMPANY wmt` rvy B C l UMYANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BE�REDUCED BY PAID CLAIMS, 3 TYPE OF INSURANCE POLICY NUMBER POLIE POLICYEXPIRATION DATDATE (MM\DD\YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR. OWNER'S & CONTRACTOR'S PROT. MOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS GARAGE LAABIUTf 7 ANY ALTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYERS LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTNE INCL OFFICERS ARE: X EXCL OF (UB-727SA84-9-05) 05-03-05 1 05-03-OG GENERA -AGGREGATE S CTS-COMP/OP AGG.NAL & ADV. INJURY g CCURRENCE g MAGE (Any one fire) P g PENSE (Any one person) g ED SINGLE S BODILY INJURY (Per Person) S BODILY INJURY (Per Accident) S PROPERTY DAMAGE S AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY. EACH ACCIDENT g... AGGREGATE $ EACH OCCURRENCE S AGGREGATE $ EACH ACCIDENT g DISEASE-POUCY Uiv1T $ DISEASE -EACH EMPLOYEE Is THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ITIFI(`ATP Writ ncc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL GATEWOOD HOMES INC 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE .1600 FALMOUTH RD SUITE 25 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CENTERVILLE MA 02632 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / , t Temp Permit No.: Applicant Name: Applicant Phone: Building Location Owner's Name: Owner's Addres TOWN OF YARMOUTH a Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL iN e.• Frank Capra 5087789669 00121 CAMP ST Unit 108 villages @ Camp Street, LLC 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: �. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: ;�4.J-IEALTH 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 Comments: new construction: 044.21.1.C/0f- 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 t • �r oF, v TOWN OF YARMOUTH Building Department _ Town Hall e Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-069 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 108 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: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: �� DATE: N/A: 5. BUILDING DEPARTMENT? DATE: N/A: (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: new construction: AUG 2 4 2005 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: DATE: DATE: N/A: N/A: N/A: 044.21.1.0 /pg- DATE: Date Printed: 8/22/2005 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Aug 25, 2005 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 21.1 Street 121 Camp St., #108 as shown on Assessors sheet/map # 44 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as, to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand the provisions/restrict' ns of s Let f Water Availability. Owner / Reference Gatewood Homes 1600 Falmouth Rd., #25 Centerville, MA 02632 Yarm th Water Department TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-06-069 (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: N new construction: Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 108 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: _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: 044.21.1.0 //F DATE: Date Printed: 8/22/2005 r S MAscheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck software version 2.01 Release 2 Crn': Yarmouth STATE: Massachusetts HOD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Egret PROJECT INFORMATION: Mill Pond village 121 Camp Street Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design ASSOC. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Permit # Checked by/Date Required UA = 216 Your Home = 123 Area or Cavity Cont. Glazing/Door Perimeter R-value R-value U-value UA ------------------------------------------------------------------------------- CEILINGS 832 30.0 30.0 14 WALLS: wood Frame, 16" O.C. 1409 15.0 15.0 62 GLAZING: windows or Doors 87 0.340 30 GLAZING: windows or Doors 40 0.340 14 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 J4.4. Builder/Designer Data t Massachusetts Energy Code MAscheck software version 2.01 Release 2 The Egret DATE: 4-21-2004 Bldg.l Dept.l use I I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Locati I WALLS: [ ] I 1. wood Frame, 16" comments/Locati O.C., R-15 + R-15 WINDOWS AND GLASS DOORS: [ ] I 1. u-value: 0.34 I For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes Comments/Locatio [ ] I 2. u-value: _0.34 For windows without labeled u-values, Break? Yes # Panes Frame Type i Comments/Locatio [ ] NO [ ] NO DOORS: [ ] I 1. U-value: 0.086 I comments/Location i I AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1. Type iC rated, manufactured with no penetrations between the inside of the recessed fixture and.ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled. 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. C] C] I DUCT INSULATION: Ducts shall be insulated per Table 74.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing I air and water systems. TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off.the heating and/or cooling input to each zone or floor shall be provided. i I HVAC EQUIPMENT SIZING: [ ] i Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. I HVAC PIPING INSULATION: [ ] I HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): I I I I I I I ( C ] I I I I I I I I I 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.): HEATED WATER TEMP (F): 170-180 140-160 100-130 PIPE NON -CIRCULATING RUNOUTS 0-1" 0.5 0.5 0.5 SIZES (in.) I CIRCULATING 0-1.25" 1.0 0.5 0.5 ----NOTES TO FIELD (Building Department Use Only) MAINS & RUNOUTS 1.5-2.0" 2.0+" 1.5 2.0 1.0 1.5 0.5 1.0 SEE SLEEVING NOTE BELOW AUG 1 6 2005 D GRAPHIC St./-��� _'S! Q: LOT 109 N 63 r- _ 86'50'17"E I PROPOSED 68'88' _ N 4" SEWER LATERAL WATE SERVICE PROPOSED HOUSE M EGRET of FF = 23.5 3 U) EGW = 14 U N PROPOSED DRIVEv'AY — S8$:()4.'12 N r 71.53' 14, PROPOSED HOUSE SWAN '-VT±1 08 27S.F. M I 1 M co LOT 1071v) 1 L=3.37' ® SEEWWEER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. rrOTWE Unless and cntil such tlme o3 the original (red) ;tamp of tx responsible. Profes+ionnl En �inoer, cr Professional Land Surveyor oppoors on thi3 plan: (A) no person or p^rsons, Including any municipal or aP:nr public off.dale, may rely upon the information contained hnrr; IN F�,,' .� ) (8) thi; pl-in remnins the prnperty of H�ilrn.es & MA G-nrh, - 1 inch = 20 M PLOT PLAN hoimes and mcgrath, inc. 'N'A" °`'f� s OF LOT 108 civil engineers and land surveyors TI� g y .T � ,�Oi NY M. N f PREPARED FOR SANTOS MILL POND VILLAGE 362 gifford street d NO.45078 falmouth, ma. 02540 s CIVIL IN.�FF �,/STEF�� YARMOUTH, MA JOB NO: 201197 DRAWN: LMC n SS/0 ALEN�'\ SCALE: 1 "=20' DATE: 3-23-05 DWG. NO.: A2540 CHECKED: ski `h TOWN REID E3UL_I'L�jult',IrG. 0 5 2006 Bu�ld.nqDEPT. AT. Location..... New(X Flans Submitted Renovation YesL_ No!� . APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY! Fee: 5._..._.. _ _ � �"-----•-- __ i PERMIT NO..Gr- b7.---005 .----- .........__:_... Owner*$ Name/A Replacement C? Type of Occupancy__: t0 [�*__---- T y n rcc W ' lt7y cc 0 � 0'Vf �N„ (6 Z u: � � j w } � � � !-: !1W�xW •� N dye z= Q Wz� a O♦. U 11 y r 0 IeL�I rn i W _j 1= 7 ¢ F a t9 0 Y t� J t SUB-BSMT. BASEMENT 1ST FLOOR 2Na FLOOR _ 3RO FLOOR IPRiNT CR 1YPE} :- - - Check One- Instaliing Company Narne UGi�,�'._�}. 1�'� 1� �,. C.. CGr Ad��driiess .---� Cl...... GL4.. .��_ _. ... 47 Partnership _.__...._ _._..--_-..._.._ __..-.—•_--._ _i4y,.AA%N_.lS..___ __ .. r'1_l�_....,.,.-�..2..feQ�.__..._.__... -ur-'Firm/Company....._..._.........._ .. Q�s..7-.`_i _ -- Business Telephone - - -- -- Name of Licensed Plumber of Lei.__--.._.1-__....._.--.--__.---.__----- .._._..__.. INSURANCE COVERAGE; Check One I have a current I;abarty +nsurance policy or its sunstarival ea'(Jvalent. Yes �No J It you have checked yes. please !nd cat2 t 1e type of Coverage by Check;ng the appropriate box. A liability ,nsurance pol;:y Other t;'pe of;ndemnily C] Bond �. OWNERS INSURANCE WAIVER ! am awdre t»et me !;cen ee does not have the insurance coverage required by Chapter 142 o' the Mass General Laws. and that my s, riature cm this pe trrt app!rcation waives this regcirernent. Check One, Owner Agent S,gnaturei of Owner or Owner's Agen! t hereby certify that all of the details and Information f have sy omitted ` Signature o Licensod (or entered) In above application are true and accurate to the best of Plumoer or GasPhOr my knowledge and that all plumbing work and installations performed l S under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and License Number .. _ ... Tvac r 1"WCa•