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121 Camp St #109 Building Permits
V7r, bbbletts EnginEe ing 716 CountyStree%Taur3onMA02780 OCT 2 05 D � CONSULTING ENGINEERS Tel. (508) 822-6934 Fax. (508) 880-7811 FieldDensity Test Report - Sand Cone Method (ASTM D1556) Client: Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Date: 10/7/2005 Centerville, MA 02632 Report No.: 5 Project: Mill Pond Village, West Yarmouth Test No. Location of Field Density Test FD5264A Unit #111 - NW Comer - Footing Grade - Sandy Material FD5264B Unit #111 - SE Comer- Footing Grade -Sandy Material FD5264C Unit #110 - NE Comer - Footing Grade -Sandy Material FD5264D . Corner - Footing Grade - Sandy Material FD5264E Unit #109 - No Center - Footing Grade - Sandy Material FD5264F Unit #109 - So Center - Footing Grade - Sandy Material - 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 1017/2005 FD5264A PR4252E 95 99.8 Yes 5.3 125.2 125.4 8.2 10/7/2005 FD5264B PR4252E - 95 97.7 Yes 5.9 122.5 125.4 8.2 1017/2005 FD5264C PR4252E 95 96.5 Yes 5.7 121.0 125.4 8.2 1017/2005 " FD5264D PR4252E 95 100 Yes 6.5 126.6 125.4 8.2 10/7/2005 FD5264E PR4252E 95 96.5 Yes 4.5 121.0 125.4 8.2 101712005 FD5264F PR4252E 95 96.2 Yes 5.4 120.7 125.4 8.2 Remarks: All tests met the specified minimum 95% compaction. M. White Wafter P. Galuska Laboratory Technician Laboratory Supervisor 1 Utim CONSULTING CIVIL ENGINEERS & LAND SURVEYORS tibbEtts EnginEEring corp' TT. CgNIC J A N+e DAILY REPORT OF CONSTRUCTIM PROJECT: Mill Pond Village Yarmouth, MA CLIENT• Gatewood Homes CONTRACTOR: Homes and McGrath EOUIPMENT WORKING: None MEN WORKING: Rick H. of Gatewood Homes WORK PERFORMED: DATE: 10/7/05 JOB NO.: 10980.010 FIELD TIME: ) 4.5 Hours TRAVEL TIME In accordance with a request from the client, I arrived at the referenced job site at apx. 9:10AM for scheduled compaction testing. Upon my arrival I met with Rick of Gatewood Homes who informed me that compaction testing would be needed at the base of the footings on lots 109, 110, and 111. He also informed me that he had previously compacted the areas with a vibratory plate. Rick requested that two compaction tests at footing base be performed on each lot. A total of six compaction tests were taken today. All tests passed the 95% compaction requirement according to site specifications. See attached report for detailed information on test locations. After testing was completed I informed Rick of all test results. I then packed up my equipment and left the job site. Paul Fasundes Lab Technician RE -INSPECTIONS I S. RE -INSPECTION - $26.00 2NDRE-INSPECTION - $30.00 3P-D RE -INSPECTION - $40.00 "y_y, JAN 0 4 2006 BUILDING DEPT. ALL OTBER RE -INSPECTIONS - $40.00 /d-1 DATE RECALL: ISSUED TO: REASON FOR RE- BUILDING DEPT.: � os / / S 5 / OCCUPANCY PERMIT: PLUMBING PERMIT: GAS: ELECTRICAL: FIRE DEPARTMENT: /d 2 i RE -INSPECTIONS 1 sl. RE -INSPECTION - $20.00 2ND RE -INSPECTION - $30.00 3RDRE-INSPECTION - $40.00 ALL OTHER RE -INSPECTIONS - $40.00 DATE: 06 DATE RECALL: ISSUED TO: REASON FOR RE- BUILDINGDEPT.: 13— 0S — /S S Z OCCUPANCY PERMIT: PLUMBING PERMIT: GAS: ELECTRICAL: FIRE DEPARTMENT: OTHER LOT 110EXISTING FOUNDATION �. Q Qe N o \OS�CV LOT 109 ;i. - (V /^ / h � M p / O I� 7 0' EXISTING y FOUNDATION N' • 3 ^ LOT 112 LU / 22. _ �•vj LLI N s ? V p 2005 0 a 3 _ 0 �S S86'_17"E !•— ) 68.88' ►1 By 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 17 DATE REGISTERED PR0 ESSIONAL LAND SURVEYOR NOTICE Unless and until such timeas t� 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 (8) this plan remains the property of Holmes k McGrath, Inc. L=3.37' I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS 9AESPECIAL PER , I ATEG� REGISTEREDF PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft AS —BUILT PLAN holmes and mcgrath, inc. ,�.=�F'�f�, OF LOT 109 ", `j`' �s .civil engineers and land surveyors X�..�' � y, PREPARED. FOR MILL POND VILLAGE 362 gifford street falmouth, ma. 02540 �'•� IN iN lo. YARMOUTH, MA JOB No: 201197 DRAWN: LMC SCALE: 1"=20' 'DATE: 9-28-05 DWG. NO.: A2539A CHECKED- p� LOT 110EXISTING s,4 FOUNDATION Qo� ,N , \ • S�'0 LOT 109. >> sillF ev N HjN 0, EXISTING FOUNDATION h; 22.2'- 1.1= — . _ • S86.50'17"E 68.88'• — 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 jSPECIAI FOOD HAZARD DATE 0 REGISTERE PR 0 ESSIONAL LAND SURVEYOR NOTICE 20 Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, Including any municipal or other public officials, may rely upon the Information contained herein; and (8) this plan remains the property of Holmes & McGrath. Inc. I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS 9�E � ESPECIAL PER REGISTEREDI PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE 10 0 20 ( IN FEET ) 1 inch = 20 M AS —BUILT PLAN holmes and mcgrath, Inc. "' �'' �'OF '41, OF LOT 109 civil engineers and land surveyors PREPARED. FOR 362 gifford street MILL POND VILLAGE Falmouth, ma. 02540 X N�� raa �zn 3 a YARMOUTH, MA JOB NO: 201197 DRAWN: LMC 9 r, SCALE: 1 "=20' DATE: 9-28-05 DWG. NO.: A2539A CHECKED- y. tij- TOWN OF YARMOUTH Building Department BUILDING (508) 398--1231 61 PERMIT NO 6- 05-;55i _ PERMIT ISSUE DATE ; _ 6/30/2005 _ ; PROPOSED USE --------- f- JOB WEATHER CARD APPLICANT 'FrankCapra _ PERMIT TO ;New Construction ; IAT (LOCATION) 100121CAMP ST Unit 109 ZONING DISTRICT R-25 Bldg. Type: Residential I SUBDIVISION MAP LOT BLOCK 044.21.1.C109 BUILDING IS TO BE: CONST TYPE 5-A USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 05/31/05 - Subject to REMARKS compaction &proctor tests. G O Py AREA (SO FT) OWNER ADDRESS EST COST ($ I$141,600.00 PERMIT FEE ($) 1$516.00 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 es 0 Camp St, LLC UILDING DEPT BY Falmouth Road # 25 - Centerville I MA 102632 PHONE 15087789669 Certificate Issue Date -20 a w G "CERTIFICATE of. OCCUPANCY Depart ental Approval for Certificate of Occupancy and Compliance I .........a... Ihfn Dcrmit Nnmhor Annrnvprl Rv. Remarks COMMA aUJM, IMEr/04 To be filled in by each division indicated hereon upon completion Of its final inspection. TOWN OF YARMOUTH Building E.)epartment BUILDING (508) 3z,.-2231 ext.261 --- - ___ _____; PERMIT PERMIT NO B-05-1551. ISSUE DATE ; _ 6/30/2005 _ ; PROPOSED USE APPLICANT .-Frank Capra ------------- JOB WEATHER CARD ------------ - - - - - - - - - - - - - - - - - - - - - - - - - - - - DCORAIT TrI Naw Construction ' AT (LOCATION) 100121CAMP ST Unit 109 ZONING DISTRIC R-25 . Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C109 BUILDING IS TO BE: CONST TYPE 5-A USE GROUP R-4 LOT SIZE - new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 05/31/05 - REMARKS Subject to compaction & proctor tests. AREA (SO FT) EST COST ($ 1$141,60U.OU I rr-ttml I rop t�p) w lv— I OWNER Villages ® Camp St, LLC BUILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville MA 02632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 �ak _5-158 7.17 6T70 FIELD COPY Note Progress - Corrections and Remarks �f MAMA MIT .1.f 1j,'. i 1-rVA-WiVAM; Dui. ' • If / -l`?- o6 ��.Q/�A v TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres TRANSMITTAL T-05-609 Frank Capra 5087789669 00121 CAMP ST Unit 109 Villages @ Camp St., LLC 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: /1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: /3. CONSERVATION: 74iEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date PLEASE NOTE Comments: Map/Lot: 044.21.1.0 new construction: ZONING APPROVED DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: DATE: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: q, W, � �l Q DATE:/ - 13 - ps Date Printed: 5/23/2005 LINE & I WU FAMILY UNLY - tIU1LUIINCa PEtiMI 1 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department H „.r. „«� 4' 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508)_398-0836 T tS-.+� < ���i ffCe�iSB �nty ,� � ..A. �� 'p a{�nln��0ara'�A�QcrfiailQn:a ,fSSSeSSDIS`yCiP,pad{nent IfTfRATE18�OR �,yc,x.. ya �-i.. � sy 3,�t „f.. � Y'L` _ A).t j} 61 ir'i.✓ '"'K Y. .L-a] � YA+SN ��' g 't*S�E S � � •'Of'C _{�. AlYase� tr' i re' fi KW'.I.t'� „, W+tf'rc X �y-is<Frt�•1r ]I t 9'l "Y/ Kt rwidP .f J✓+in'i.�i•31'ii 'lltlVrSPiI.�PiW� '4 11 �i2'^i"1 mtl it bLt ,y fhie4lVg�?' T'F$� 3 .T,Ett Y wx N KT F MAY A K 4i^) J n ���, n'.'�,�'i ,.i��+t ��] "��+km-Y"',7•�Y�� .t"`�'�}'%(E crJ(S.�^4`f Y✓ikt tlt�f�") .F�" i`-`N Q �tl� 1`$f�2t'6 I, 13�$'�+�=7 StL..fy'.yH-h'SN rib p'F �-!Sa'�it"'�=Y'�,, .�2 4 ns.>�0`�j✓`"�Tkrr<f;,,,,,t�,�mt„ysy}.J�¢,���3��.+W,'3�"��2.-°y47t`y� {�r'fTm zX'"ra.'"F�t3!.. 'St y�f`.DO.Sit���.e(i{,., Sr." .k 1 tl i r.rY i> 3i%5-317'4 S.Y('"�S)Yi..i Si5"+4 �yliJY uz N uTi. i6 :tea "t 4zea s Fronfa(�e �f< 4btCiwerae �8� ".. ,•, �.• � �o ),�; xt- $.y �� uLtZq `gN•"+rv''S. .tt T f�EUet, � �A�MY =(fit` ".i -i ✓ 'ltt'C.^-i+Si]T.Sb tltt x Lan Tiis" ldmtorG�"6ree exx rs ��'� ca ba thlrtl��f r F .< yert,t pVOccyupa�lc� w-.. °t.r 3.S`�5 �. �'3✓� v ,ep l�`r'��Y � .u.9 -t d+ eh w+ 2 'I#' ,��s x r,an ��>a`4L�!4• x a,t •a-. �r?s.. ;h�"w`4� r re isuaof**����� ��' 1"a� of aEl+�".�>a�"•,.? - � ,Da �. .. x m :'�. " w. �., -fin Seoia,;Sitti orpratfa;" Use Group: R 4 1.1 Property Address: _ 1.2 Zoning Information: - a S - ° � Is� ` L-ol�q Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L c. 40. S u ;' r iSa�.� t. a/' . a��•- T I+ii�Vrrv+.+•� '$+ '+Rs`%'ia!`3�$l�Y�.. A� S SnPape�t'C�nn ..P1AutlrEget 2.1 Owne{ o Record: , LLG C i(/C Qy (�/q J� Mailing Address t— N me�printk �— Signature Telephone N 2.2 uthorize Agent: J, � �- LXI1 � � n o Namg,(pdnt) (I0_. A Mailing Address fo-g, _ o Signature Telephone UM l ;1 I5 Not Applicable ❑ 3.1 Licensed Construction Supervisor. BI I!1 nit.-, P, -or By _ ✓� 3a- { � 1\ License Number O � o ✓�� O ddre r,77S,. GL� Expiration Date 6 v/ � �.�1� _0 Telephone S' nature •£v-Ys. �Y kw a .v b k-i 3 � •. t� T t � Resterpfe .pm[plroueri7ent tD D rap#otr; A 1 Company Name vevi PPlicabl License Number Address eY Expiration Date Signature Telephone 1— ;(�e.M 9- 15-99 1 of 2 OVER ecuorl �;vuut�ers ,[ ompensa GT frtsufa,�A.f�iday�i IVI C f c y132 5 T Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial -of the issuance of the building permit. _ Signed Affidavit Attached Yes ..... ... No . New Construction Cir I No. of Bedrooms Existing Bldg. ❑TC]Type ) ❑ Alterations ❑ Addition ❑ Accessory Bldg Demolition Other Specify: P fy: Brief Description of Proposed Work: I r ( f VI o� V1 91 Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kngs Highway& Historical Commission approval (if applicable) , asVwner of the subject property hereby authorize 06 VxA-C r to act on m beh , in all matters elative to work authorized by this building permVolcation. r -OL 011 Signature of Owner Date Seaton 7b� O ` er�1�`ut1_i�nzed`A�en# f5e`cl�ratii�ii • ff I n � rl�l' 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. [Al I;a�... F_AQ.r- Print name SignaAofedAgent . Date IN 9-15-99 2 of 2 T. a3a.\ 0 +o The Commonwealth ofMassaehusetts Department ojlndustrial Accidents Ones0/1AMMsdpstJess 600 Washington Street Boston. Mass 02111 Workers' Compensation Insurance Affidavit 2LA.)aa (� 0 1 am a homeowner performing all work myself. I.am a sole proprietor _-d halve no one working in any capacity I am an employerpro% iding workers' compensation for my employees working on this job. means• name: address: city - tehtrne q insurance co. ttolicv M am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below %%ho ha%e the folluaina workers• compensationpolices: city: phone N insurance en - policy N company name, address: city phone a Failure to secure coverage as required underSeetion 25A of MGL 152 can lead to the i upoaition of erimiall penalties of a tlae up. to S1.500 00 &a one vcan' imprisonment as well as civil peaaltles idlor s the form of a STOP WORK ORDER and a Act of S100.00 a day against me. I anderstaad'that a copy of this statement may be forwarded to the OAiee of investigations of the DU for. Coverage veriAntioa. I do-hrreby certi under thr p inr an rtalties ojpery'ury that the injorntation provided above is true and c rrect k Signature 2- e A Print name oRcial use only do not %rite in this area to be completed by city or town otfleial MENOMINEE city or town: YARMOIIT$ _ permit/license N nBuilding Department cheek if immediate response❑Lleensing Board is required 261 C3Selectmen's Otrce contact person: (]Health Department phone Nt _ (508) 398�2231 eat. nOther. -..Y .I.. II,, � C y r •�; : Lv k 1%-Jw1N.yr YARMOUTH .BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. /�,�, ,, / job Location: 2- 1 lld� lain A S� : yGIS� Num. berg Street - f Village Owner of Property - Construction Construction Supervisor. VA, na o So 8: — 9 669 Name IF License No. Phone No. Address: (e 00 Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shallwillfullyviolate 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 E( No ❑ If you have checked M, please indicate the type 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 1 of the Ma . Gener aws, andKat my si ture on th�' permit application waives this requirement. �__ t' it1 )5, 1�0� Check one: Signature of Owner or Owners Agent" Signature: Agent U Building Official Approval: At ,QF'Y`91� TOWN OF YARMOUTH o TACl1[ES 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 MAT Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ` S`f , Work Ad ess is to be disposed of at the following location:► Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. I. Commissioner f 1. 00 - 35j000"denclosed .space (MGL C.T1 &60L) t.4 - Masonry only- , f- tG.=:1-:&7Fariiiy:Homes Failure topossess:a current edition ofthe Massadiusetts`SUt Wiiding.Code, is- cause tor mvocationvfthis.license. _i �— DIG. SAFE.CALL CENTER: 1888) 344-7233 b�fif/eq Sto d,P' P � 05105/2005 14:09 50E-760rlJ667 EASTERN-INS..YARMOUTH PAGE 01 '�'(�[��'`� �+� T C C �/ �+ DATE(MWDD/YYYY) PRODUCER 508-3g8- 03E3 F O FAX 50E7600F LIAB��� FTHIS 31�����ED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND.CONFERS NO RIGHTS -UPON THE CERTIFICATE HOLDER. THIS CERTJFICATE DOES.NOTAMEND, EXTEND'OR 1 Atlantic Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. So Yarmouth NIA 02664, INSURERS -AFFORDING -COVERAGE NAIGIL' IN6URED Cape. Cod Custom Floors 762 Falmouth Raid IN$URERA: ACbella. Protection Ins Company IN3VRERB-' HaFiT0rTF•' INSURER Hyannis MA 0260 L _ INSPIRER W-- - INSUREME• COVERAGE THE POLICIES OF-INSURANCELISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMEO ABOVEfOR THE POLICY PERIOD INDICATED; NOTWITHSTANDIN ANY REOUIREMENL TERM 01 CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TD WHICH THIS CERTIACATE M&Y-AP mcnrrn mat MAY PERTAIN, THE INSURAM ZZ AFFORDED BY THE POLICIESDESCRIBED HEREIN tSSUB]ECTTO-ALL TMETERMS E%CLLIs10NSNVITIONS (IF SueH' POLICIES. AGGREGATF-LIMIT .SHOWN MAY HAVE BEER REDUCED -By PAID CLAIMS, - INAR DO' TYRE OFINSUR E .... ►oLICY NUMBER-... ..- Y FFECTWE 12/13/ZOQ4 ... POLICY EXPIRATION - 12/13/2005 _.. . LIMITS A GENERAL LIABILITY, ENE LIABILITY X CONMFRCIAL.. CLAIMS MADE X OCCUR t 7S000OD3Z3 GACHOCCURRENCE S. 1 000 00 DAMAGETORENTED 4 MED EXP IAny AM.PenOP) S SO, f. ' S ,OO PERSONAL} AOV INAM S 1, 00O O GENERAL AGGREGATE_ . S Z. 000 00 PRODUCTS-OOMPIOP AGG S Z 000,00 GEM AGGREGATE LIMIT POLIES PER X POLICY JPER� LOC _ AUTOMOBILE LIABILITY .... COMBINED SINGLE LIMIT (Es eccidw) ANY AUTO BODILY INJRY (wPenew) S.. ALL OWNED AUTOS - .. SCHEDULGD AUTOS � BOOMY INJURY (Pow ecddenll .i. HIREDAUTOS - . .. NON -OWNED AUTOS PROPERTY -DAMAGE (Per acs�dmll S GARAGE LIABILITY ANYAUTO - _ . ... - .... r,U'CO.ONLY-Eq.ACC10ENT- i - OTHER THAN EAACC AUTOONLYe_ AGG. !"' S EXCCZWURRELLA LIMA rrY X OCCUR Q C AMSMAC9L 460002928S ... 172/13/2004 1Z/13/2005- EACH OCCURRENCES" . . 1' Outs-ON AGGREGATE . s. 1,000 00 f. A S - - DEDUCTIBLE - X 'P/C STATU- ,_;, OTH, S RX RETENTION- S 10,00 WORKERSCOMPE119ATION A .-- EMPLOYERS LIABILITY ... O&WECKLIQOT- nj2S/2L004__ _DS.i2.S/2QOS OSVZS/ZOQS -OWTV2IIOfi- E4,EAC:N.ACC0r;NT... 5.... S00 OO B ANY PROPRIETOWPARTNEWE% CUINE OFFICEWMEMBER EXCLUDED? - f.L: DISEASE - EAEMPLOYE I' SOQ 00 E.LDISEASE-PDLX:YJJMn S..- iQQ., 1(ps, deTcnbe undw SPECIAL PROVISIONS belay " OTHER .. - DESCRIPTION OF OPERATIONS I LOCI TIOMS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT) SPECIAL PROVISIONS , dence-of Insurance Gatewood Homy; 1600 Falmouth #25 Centerville, _OZ632' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPOt�nOM➢ATE )rHEREOF THC-TSMXNG INSURER WILL ENDEAVONTO MAIL -10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FALURB TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATIOItOR-LIAMITY OFANY IONOUPOIPTHEINSURER. nSAGENTSGIREPRESENFYTVES" CORPORATION 188$ ACORD 25 (200I(0S). FAX: .(509>778-5603- - ®ACORD 9ACCIIDA - cuenw: Ttwjq -- ---- A ORDw CERTIFICATE OF LIABILITY INSURANCE 1o04104 "Y"" PRCOUCER Dowling 8 O'Neil Insurance Agency, Inc. 222 West Main St. PO Box 1990 Hyannis, MA 02601 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Assurance Construction, Inc. A/0 Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A. Travelers Insurance Company INSURER B: INSURERQ INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DA MIDDNYI POLICY EXPIRATION DATE IMMIDONY) 08/01/05 _ SITS EACH OCCURRENCE a1000000 A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FE OCCUR 16808387A9841ND04 08/01/04 - DAMAGE TO RENTED PREMI ES (Ea �cs) S300OOO MED EXP (Any are person) E5 000 PERSONAL 6 ADV INJURY E1 000 000 GENERAL AGGREGATE s2,000,000 PRODUCTS -COMP/OP AGG E2000000 GENT AGGREGATE LIMIT APPLIES PER: POLICY JEb LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Penton) E BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) E GARAGE LIABILITY ANY AUTO - AUTO ONLY. EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG $ E EXCESSIUMBRELLA LIABILITY OCCUR �F � CLAIMS MADE DEDUCTIBLE RETENTION E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? Des, tlesaibe untler SPECIAL PROVISIONS below EACH OCCURRENCE $ AGGREGATE E S E WC STATLL OTH• EIL E E.L. EACH ACCIDENT E E.L.DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ACORD 25 (2001103) 1 of 2 #35866 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN° UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRES w t .. •nnen nllODnDATY1M 'IGRA ti:i1/1:11. .. ... ,...,..0DATE, ,DDYY,ERTIFIC4TEOF N. URANCE 01-19 05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING & 0 NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 WEST MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 1990 COMPANIES AFFORDING COVERAGE HYANNIS MA 02601 COMPANY 22LGR A ST. PAUL FIRE AND MARINE INSURANCE COMPANY INSURED - / COMPANY HP L.O BUISNESS SERVICES INC tg5su oawc .is1rvdi B 118 WATERHOUSE RD COMPANY - SUITE E / C BOURNE MA 02532 f c�Gar (ut a 111 COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS L DATE (MM1DMYY) DATE (MMUID\YY) GENERAL UABILTY COMMERCIAL GENERAL UABIUTY CLAIMS MADE a OCCUR. OWNER'S & CONTRACTOR'S PROT. GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. S PERSONAL & ADV. INJURY S EACH OCCURRENCE S FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT S BODILY INJURY (Per Person) S BODILY INJURY (Per Accident) $ PROPERTY DAMAGE S GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: .................................... .................................... .................................... ..........., ........................ EACH ACCIDENT S AGGREGATE S EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE S AGGREGATE S A WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYER'S LIABILITY (LIB-4042637-2-04) 12-24-04 12-24 OS EACH ACCIDENT > 1�::. 100 000 THE PROPRIETOR/ X INCL DISEASE -POLICY UMIT $ -500, 000 OFF CERS ARECE Pq EXCL DISEASE -EACH EMPLOYEE S 100.000 COVERAGE RESTRICTED TO LEASED EMPLOYEES OF ASSURANCE EXCAVATION INC THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. Dates 5/5/3005 Time; 3=03 PM TO; 0 1506771115603 Cllenf8. 2Q358 - Page: 002.003 CAPECODREADY " A E, NYYY) .ACoRD- CERTIFICATE OF LIABILITY INSURANCE PRODUCER The F eltelberg Company 222 Milliken Blvd. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE -CERTIFICATE - HOLDER THIS CERTIFICATE DOES NOTAMEND, EXTENSOR - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O: Box 3220 Fail River, MA 02722 INSURERS AFFORDING COVERAGE NAIC N INSURED INSURER A: Acadia Insurance Companies Cape Cod Ready Mix Inc. INSURERS: Construction industries Compensation PO Box 3" Orleans, MA 02653 INSURER C: INSURER D: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTTANDING-" ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOAOTHER DOCUMENTWITH-RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUEU'OR- 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 BEEN RE X=M5YPAID CLAIMS, TYPE OFINSURANCE POLICY NUMBER POLICY F VE ATE NMrDDN'n P XPIRATION DATE fMM?DQrfn LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABIUTY CLAIMS MADE al OCCUR CPA0132468M _ 0BID 47M. 01"1Dt/08- - EACH OCCURRENCE $1000000 DAMAGE TO RENTED 5100 000 ME EXP(Any one Person) $5000 ERSONAL & AOV INJURY $1 000 D00 GENERALAGGREGATE S2 000.000 GEN-LAGGREGATEUMITAPPUES POLICY PER M PRO LOC PRODUCTS-COMP/OP AGG S2000 - A - aUTOMoeILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NWOMEDAUTOS MAA013246910 0/1 O1/054 - 01(O1/06 . (Ea=t Drt) LE OMIT (Ea acdmraJ . 51,000,000- BOOILYINJURY PH� P; S X X BODILY INJURY - (PBraCCtlBnQ $ X -PROPERTY DAMAGE". �a aa3dartJ . GARAGE LIABILITY .ANYAUTO - _". _ - AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGO S - - S A EXCESSAJMBRELLA LIABILITY _ X OCCUR CLAIMS MADE OEDUCiI&-E X RETENTION 50 MA0132470jO 01/01/05 _ 01/0i/06 _ EACH OCCURRENCE 51000000 AGGREGATE $ S S B WORKERS COMPENSATION AND EMPLO.`tERV UAaRRY- ANYPRCPRIETORlPARTNER/EXECUTNE OFFICERMIEMBEREXCLUDED? if va be wdw SPECIAL PROVISIONS below WC0009255 01/01/05 01/01/06 X STATU• OTH. E1. EACH ACCIDENT $500000- E1.DISEASE -EAEMPLOYE $500 000 E.L. DISEASE -POLICY LIMIT $50G 000- - OTHER DESCRIP Is OF OPERATIONS/ LOCATIONS [VEHICLES I EXCLUSIONS ADDED BrENDORSEMENr/SPECMPROVISIONS - Gatewood Homes Inc. " 1600 Falmouth Road Suite 25 Centerville-, MA 02632 I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION IERE9F THEISSUINGINSXiER-WILLENDEAVORTO MAIL �3Q„DAYS)NWMN. TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NOOBUGATTON OR -LIABILITY OF ANY XTND UPON THE INSURER, ITSAGENTS OR ACORD25(2001/08)1 of2 #S66995/M66526 AH1 v-ACORD CORPORATION 1988 05/•06/2005 09:3B 5OB4204474 EDWARD A GRAZLIL PAGE 02 T ` ACORD„; CERTIFICATE OF LIABtUTY. MURANCE.. PRODUCER T HIS R RIGAS HTS UPONRTHE CERTI�i �a A. (�mu11.In9xat= �YT ZL1C• THIS CERTIFICATE 'DOES NOT AMEND; E3ETEN6 TER THE LOYERAGEAFFORDED :BY THE POLICIES. BEU P:0 kCM 33/ ' i12�^tcI15 %aUs, MN 02648INSl1RERSAFFORDINGCOYEAAGE - - NAIL x - - _ ..-. INSURERA---!- M61eMED Ste[km ftld5 t `WWSLa7ER9.. 11NsuREAc. - 145 Cmnett Rd I-iNsi,R . m,,"tcx,s D a•IBIF>cu e ANY REQUIREMENT, ,TTLHM, VH LAJIVLA IIV" V' MAY PERTAIN, THE WN URANCEAFFORDED By THE POLICE POUCIES. AGGREGATE.UMRS SHOWN MAY HAVE BEEN AEC u+sR I vDLwY Ra t sALLIAMLOY ��COM4(EPCMIG,ENERAL LUU3C.ITY I CWM9 MADFOCCUR AIMOMDB0.E LKSLITY ANY AUTO Il ALL OYRJED AUTOS SCHEOUIEDAUTOS HVREO AUTOS NOWYNNEDAUTOS OARAOELIABIM ANY AUTO _ I 4 Emsesn-s_.CRELLA UABLLIYY I 1 maim- - Lj CLAW UADE DEoucr;l! RETENTION S WORKMCBMPENSATIONAMD.. EMPLOYERS'wBUM ANY PROFRtETOR PARTNER EXECL03W OFFICEWMELIBEP 6zCLUOED± N �eAYtN,MMuMMM� __ Gate Wood H=e^; Im- . CIO $21LPTadPrtbU Rte -M- Cmt=Alie, m cz%m F.4Y:. 1- 08-M-%03 O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING R OTHER DOCUMENT WITH AESPECTTo WtitCHTHIS CERTIRCATE .MAY BE ISSUED.OR-. ,gIBE'DNEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH wv nw.n nl AMAC ._ ' PREMISES (Eap.gMMEal . PERSONAL A ADY M.RIRT • GENEFAk 6GCREDATE 2 t 4f18!06 P ,eT9-CptKVD(�x00 r ► +0 ;- CDMBINC-0SIAIY.E IOAR lG sodA.In1 .. . BODILY NJURY - (vAr pMYoal S .- RODLY NJURv I (Pw YGaMD I.. AUTOONLY•EAAMDENT i. rnncaatww EAACC S__ _ ;AMG= TKJnF.- SHOULD ANY OF THE ABO'YE O ==ED POLICIES BC CANCELLED BEFORE THE EXPIRATION SATE RICREO . THE pOVWG-IMSURER vALL EMOEAvOR TO MAIL PAYS WRITTEN MOTILE WTtWE CERBRCATC HOLDER NAMCO TO THE Lerr. DUT FAILURE TO PO SQ SHALL IMPOSE A*4GLIGATION-O9 LIAMLLTY OF ANY. KIND MPON THE INSURM R'YA R REPRESENTATIVES. _ 1UTROWIMPKCPRESERTATIwC .. , ... C7 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE / rzoo ' PROQUCEIE .. Serial # A1530 ROBERT P. BIXBY, CPCU THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. BOX 830 -661 PUTNAM P01E ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GREENVILLE, RI 02828 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: NAT'L FIRE INSURANCE CO. OF HARTFORD INSURER B: VALLEY FORGE INSURANCE CO. HOLMES AND MCGRATH, INC. 362 GIFFORD STREET INSURER C-. CONTINENTAL CASUALTY CO. FALMOUTH, MA Q2540 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. sm Aoot TYPE OF INSURANCE POLICY NUMBER - PAY EFFECTIVE DATEimwppnno POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE pX OCCUR - - 1074082434 10/06/04 10/06/05 EACH OCCURRENCE $ 1,000 000 A AIS O paENTED ,I,e„ S FIRE 250,000 MED E)T « s 10,000 PERSONAL 3 AOV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000 000 PRODUCTS -COMPIOP AGG $ 2000000 GENL AGGREGATE LIMIT APPLIES PER' POLICY PRO- LOC El iga AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aocide^Q $ ANY AUTO ALL OWNED AUTOS BODILY MUURY rsm iPw pe) $ SCHEDULED AUTOS - HIRED AUTOS NON -OWNED AUTOS .. Tw accident)$ (Per acadellq GE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S OTHERTHAN EA ACC AUTO ONLY:, AGG $ ANY AUTO $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE s AGGREGATE $ $ $ DEDUCTIBLE s RETENTION f$ WORKER'S COMPENSATION AND EMPLOYERS! LIABILITY 2057445273 09/01/04 09/01/05 X T C STAIN OTH- EL EACH ACCIDENT S 1,000,000 B ANY PROPRIErOWARTNERIMM-CUTIVE OFFICERIMEMBER EXCLUDED? EL DISEASE -EA EMPLOYEE $ 1000000 EL DISEASE - POLICY LIMIT s 1,000,000 H yyeessdesaibe under SPE(.TAL PROYISIONS below C OTHER PROFESSIONAL LIABILITY AEA 00 43133 38 07/13/04 07/13/05 $1,000,000 PER CLAIM/ AGGREGATE DESCRIPTION OF OPERATIONSILOCATIONSNEHK:LESW(CLUSIONS ADDED BY ENDORSEMENT/SPECILL PROVISIONS AGGREGATE LIMITS ARE PER THE TERMS AND CONDITIONS OF THE POLICIES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN GATEWOOD HOMES, INC. ND{CETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, our FAILURETO DO SO SHALL 1600 FALMOUTH RD., STE. 25 CENTERVILLE, MA 02632 IMPS NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES ALIT REPRE ACORD 25 (2001/08) ^��^� ....,.r..r.. CAFMPROICERTPROS.FP5 A CORD LIABILITY INSURANCE !i DATEI14/05 n spa/as .CERT[FICAT.E.OF PROIt �DUCER . United Insurance Agency, Inc. THS CERnFIC ATE IS ISSLEDASA MATTER OF INFORMATION . ONLYAND COt ERSNOiLGFiIS t�ONTHIFIM0. ICAi OR - ►mom-THgCmr�ATEDOFS-NOFAMENO�;E%TS� 199 Main street ALTER THE COVERAGE AFFORDED BY 7HEFOLICI6 BELOW. INSURERS AFFORDING COVERAGE NAICA F.O. Box 101,3 Buzzarde Ray, MA 02532 INBUR® Patton $lootric, Inc_ INSURER A: ZUriCh NA ImuptFit:Liberty Mutual Ina_ CO. INSURER C'. 128 SCi.tua" Road MSURERD: Mashpee, MA 02649 :OVERAGES ANY ROEOWITEMENT TERM OR 'CONDITION OF ANY CONTRACTOR SOTHER FDOCUMENT WLTHRE$PECTTO WHIC".TH1$ GER.TIFICATEM0 BE IN&UREO NAMED ABOVE -FOR THF-POUCY PERIOD INDICATED. SSUED OR DIN MAY -PERTAIN -THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, 69CLUSINS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIOTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS"" - . roUOYESFTNE- awld utAiOM - LnRtis-. D' POLICYNUMBER EACH OCCURRENCE 2 D� 08Q OENERII)<.IAERJII S 300- DDO- oounuERCIALOENERatueaDr SCPa2a15399 7/30/04 '" '7/30/DS raEM1$Es ° CLAPAS MADE �OCCUR MED EttPI wM wwn f 10 00� - PERSONAIA ADV B7A)Rr f 1,,.00D..rQ0.0". GENERAL AGGREGATE f 2,000,000 �RODUCT$.CDNProPAGG i ,_Q00 .0 - GEN'L AGGREGATE LIMIT APPLE6 PER: ANV AUTO ALL 011WED-AUT06 ;CHEDULECAUTM .. 141REDAUTOS NON.cw4E0A1TO5. - ANYAUTO cretsSNNBRELLA LIABILRY OCCVR CLAIMS YIAOE DEDVCTME RETENTION f WORR BIS COMPENERION /GAP B EMILOVERS'LMaLITY OFFJM ICEREMER E%CUL URwECDTNE =7eA� EAwfI0ld10w .... iL SPECIAL PROV19 W S Feb+' OTHER Electrical M OLE UMIT CaNJIURYs f .BRY yIDRr y_.PAMAGE y{• EA ACCIDENT S OTHER THAN CAAOC 3 i AGO EAUTOVNLY:. EACH OCCURRENCE f i 6 500 i PRxutet - Gateway Homes, ITLC. WOULD ANY OF INC AUOVEOdCRIBED POLICESBECANCELLED BEPORl TNEE7IPIRATION 15D0 .&almouth Rd., unit 25 PATETNEREOFILL EMDEAYO .TNEISGUINGNSURER WgTOMAL Qr OAYSWRRTEN fax 508-778-5603 NOTICETO THECERTFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TODOBPBNAC 7 Centerville, Ma 02632 ImPOSENOODUGATIGN17UUHUIYOspNYuwDUPON TIREMIyuRMITSAMMSOR • a-• i_ - _ x DATE(MM/DD/YY) AGORD CERTIFICATE OF=LIABILITY INSaURANCE T.,. �., 9 15/04. PRODUCER Chatfield, Whitman &Young 549 Washington Street 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. P.O. Box 850963 COMPANIES AFFORDING COVERAGE Braintree, MA 02185-096 COMPANY A Harleysville Worcester'Ins Co INSURED t COMPANY Lawrence Robinson Masonry B 5 Fresh Hole Road Hyannis, MA 02601 COMPANY C COMPANY ' D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTVNTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH 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 PCLICY EFFECTIVE DATE(MMIDDIYY) POLICY EXPIRATION DATE(MMIDDNY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY - CLAIMS MADE aOCCUR CB 7E 32 32 9/07/04 - 9/07/05 GENERAL AGGREGATE E 2,000,000 PRODUCTS-COMP/OP AGG E 2,000,000 PERSONAL &ADV INJURY E 1,000,000 EACH OCCURRENCE E 1,000,000 OWNER'S& CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) E 100,000 MED EXP (Any we person) E 5,000 - AUTOMOBILE LIABILITY COMBINED SINGLE LIMB E ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) E SCHEDULEDAUTOS . HIRED AUTOS BODILY INJURY (Par accident) E NON -OWNED AUTOS - PROPERTYDAMAGE E GARAGE LIABILITY AUTO ONLY -EA ACCIDENT E OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT E AGGREGATE E EXCESS LIABILITY EACH OCCURRENCE E AGGREGATE E UMBRELLA FORM WCTATU- TH- TORY LIMITS OER E ' OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND - EL EACH ACCIDENT E EMPLOYERS' LIABILITY EL DISEASE -POLICY LIMIT E - THE PROPRIETOR/ INCL PARTNERS/EXECUTNE OFFICERS ARE: EXCL EL DISEASE -EA EMPLOYEE E OTHER DESCRIPTION OF OPERATONSILOCATONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER ` ° ' '' CANCELLATION` y .� »a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - Gatewood Homes EXPIRATION DATE THEREOF, THE ISSUING COMPANY WALL 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 LIABILI Centerville, MA 02632 OF ANY KIND UPON THE COMPANY EN111 9(1'�04SENTATrAs. AUTHORIZED REPRESENTATIVE Robert E. Chatfield AORU'25S (1195 <.3.� OACORD;CORPORATION 1988-=. a ACORD. CERTIFICATE OF LIABILITY INSURANCE Ro76 09-27-2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX AGENCY INC. 210706 P: (877)287-1312 F: (877)287-1315 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE 308 FARMINGTON AVE FARMINGTON CT 06032 INSURED - INSURERA:TWln City Fire Ins Co INSURER B: ' INSURER C: LAWRENCE ROBINSON MASONRY INC INSURER D: 5 FRESH HOLE ROAD INSURER E: HYANNIS MA 02601 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE POLICYNUMBER POLICY£FFECTIVE DATE(MmIpplyyj POL/CYEXPMAT/ON DATE (MMIDDIYYJ UM?S GENERAL LUSIL/TY EACH OCCURRENCE a FIRE DAMAGE (Any one fire) a COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—IOCCUR MED EXP IAny one person) a PERSONAL& ADV INJURY a GENERAL AGGREGATE a GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG a - POLICYEl PRO-FCT El LOC AUTOMOSMELIABLLITY ANY AUTO - COMBINED SINGLE LIMIT (Ea accident) 9 BODILY INJURY Parson) a . ALL OWNED AUTOS SCHEDULED AUTOS - °-(Per BODILY INJURY : (Pat accident) a HIRED AUTOS NON -OWNED AUTOS - PROPERTY DAMAGE (Per accident) _ a GARAGE LIABILITY AUTO ONLY . EA ACCIDENT a OTHER THAN EA ACC a ANY AUTO a AUTO ONLY: AGG EXCESS LIABILITY EACH OCCURRENCE $ OCCUR © CLAIMS MADE AGGREGATE a 8 a DEDUCTIBLE a - RETENTION - a - - WORXERSCOMPENSATIONAND X WC STATU- OTORY LIMITS TH- A EMPLOYERS'LMBWY 76 WEG NQ5620 09/06/04 09/06/05 E.L. EACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE $100, OOO E.L. DISEASE - POLICY LIMIT a50O 000 OTHER DESCRIPTION OF OPERATIONSAOCATIONS VEMCLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Those usual to the Insured's Operations. CERTIFICATE HOLDER I I ADDITIONAL JNsuRED;INSuRERLETTER. CANCELLATION 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 AUTHORIZED REPRESENTA E3T - ACORD 25-S (7/97) a ACORD CORPORATION 1988 12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC IM02 CERTIFICATE OF LIABttTYINSURANCE CSR _ TAVAN50 12 02 04 PNGDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 30LEZ AN & ASSOCIATES INSURAKME ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FIMNCIAL SERVICES INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 933 FALMOUTH RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HYAWIS MA 02601 Phones 568-775-6010 Faxs S08-790-0249 INSURERS AFFORDING COVERAGE NAICS INSURED INSUR6RA: MARYLAND CASUALTY COMPANY INSURER & RODNB:Y TAVANO DBA RI ECHANICAL SYSTEMS INSURERC: INSURER D: 110 EOLDBR LANE W BAHNBTABLE MA 02668 INSURER E CeVERAaFS THE POLICIES OF INSUUNCE LISTED BELOW HAVE BEEN ISSUED TO THE 1NUMED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEGT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSJRANCE AFFORDED BY THE POLICIES DESCRIBED HERfIry IS SIJWEGT 74 ALL THE TERMS. D(CLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE LWM SHOWN MAY HAVE BEEN REDUCED eY PAID CWM& LTR ;;aa TYPE OF INSURANCE POLCY NI1SteER DATE (mum E MMID _ LIMITS _ A GFNERALLUJMM X COMMERC�IALGENERAL LIABILITY CUJMS MADE ❑ OCCUR 000372088 11/21/04 11/21/05 EACH OCCURRENCE S 1000000 PREMISES Nmm ft) S 300000 MED FXP (Any one pelso,I) S 1000 0 PERsowucADVPUURY S1000000 _ GENERAL AGGREGATE - S 2000000 GFNL AGGRLGIITE LIBTAPPLIES PER. POLICY ! JE�CT LOC PRODUCTS -COMPIOP AGG s2000000 AUTOMOBRE: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULmAUT08 FORM AUTOS NOWON'N€DAUTOS .. - COMBINED SINGLE LIMIT (Ea eWdent) . S BODILY RuuRr (Pxperlvl) 3 BooS.r wIURY (PereTJEent) S PROPERTY DAMAGE (Per lcedmo S 0ARA0ELINRLIN ANYAUTO AUTO ONLY -EA ACCIDENT f—.. OTHER THAN uwCC AUTO ONLY: AGG 1 S EXCESSRD®R6LALMMUTT OCCUR CLAIMS MADE DEDUCTIBLE RETENTION . S FJICHOCCURtENCE S AGGREGATE S S .. S S - WORKERS COMPENSATION AND -EMPLOYERS LMBI.fEr ANY PROPMETOMIARTNERIEXECUTNE OFFIC:ERIMEMSERI1)ICLUOED? 'w4 c, p=0 irlGr SPECIAL PROVI$IQ�146ebw TORY LIMITS ER E.L EACH ACCIOFM S E.L. DISEASE -EA EMPLOYEE S El DISEASE -POLICY LIMB S OTHER CEStRIPTlOM CF pFSRA'TNCRi/LLYaT'fC0.'S/VENxLESfE7CL ` - 9T�LttIROYlSgN?-- CERTIFICATE 14OLEIFR CANCELLATION 1 G11R'TEGTAI] SHOULD ANY OF THE ABOVE DFJCRBEO POLICES BE CANCELLED BEFORE THE EXPIRATION DATETlEREOF. THE msum INSURERWILL ENDEAVOR TO MAIL 30 DAYSWRMYN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL ZM l OD-fi0-ASS Imo... FAX 508-778-5603 IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE*=RER ITS AGENTS OR 1600 FALMODTII ROAD SUITE 25 REPRESENTATIVESL AUTHO REPImENTATfM CMMIRVILLE MA 02632 II ACORD 25 (2001108) W AGORU CURPORATION T860., nAl5n ;_r eLA nax -zvz u aforzvvu av;uu eftun vv-tfvv% rax Duz-vul, cl- "ER.T. 'l iMmf FIC PROOLICER. TYr DATEj(NM M 05-06-05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFGRMATtOtJ- _ONiLV-AND- CONFERS-- NO,- RIGHTS UPO*-THE--CERTIFICATE- COLD14AN s ASSOC IN$.FIN HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 933 FALMOUTH RD ALTER-THECOVERAGE-AFFORDED-BXTREP6!)EaPtr-l()W RTE 29* HYANNIS MA 026012319 COMPANIES AFFORDING COVERAGE COMPANY 28HPP AmERrcAm zuRicH, rNsuRANrz'ccr'u'ANT- INSURED COMPANY TAVANO, RODNEY DBA s___ MECHANICAL SYSTEMS 201 CAPES TRAIL WLST"BARNSTABLE NA 02668 COMPANY COMPANY D. THIS Z TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR THE POLr-rFEPMD-- INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE -MAX flEISSUED OR -MAY PERTAIN, THE. -INSURANCE. AFFORDED. BY- THE POLICIES DESCRIBED HERMAS SLEJECT TO-ALLTHS TERMS. MUSSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTFOATETMMtDOcYY) TYPED F INSURANCE POLICY -NUMBER, POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL UABUTY =CLAIMS MADE = OCCU R. PRODUCTS-COMPIOP AGG. s PERSONAL & ADV. INJURY $ -EACHOCCURRENCE- OWNERS & CONTRACTORS PROT. FIRE DAMAGE (Any one fire) MEO.EXPENS5(ftaneperson) S AUTOMOBILE LIABILITY ANY -AUTO SINGLE BODILY INJURY ALLOWNEDAUTCS SCHEDULED AUTOS- (Per Perw). BODILY INJURY (Per Accident) $ HIREDAMS NON -OWNED -AUTOS PROPERTY DAMAGE $ IGARAGE,UABIUTY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: ANY AUTO EACH =[DrNrr AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND EMPLOYERS-LIAMLITY (IJB-7278A84-9-05) 05-03-05 05-03-06 STATUTORY LIMITS EACFfACCfDENT THEPROPRIETORI PAR INCL OISEASE-�POLICYLWT -15 50-0,000 OFFICERSRx X. EXC-L* - LQIHER DESCRIPTION OF OPERATIONS(LqCATI(>N&VEtQCLE&RE,STPACTIONS(SPEQAL•ITEMS THJS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. �4 'LFLC� .11, C�ERTI HOLDEW- . '.11. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 'EXPIRATION DATE THEREOF, THE ISSUING' COMPANY WILL ENDEAVOR TO MAIL G&TEWOOD HOMES INC 1600 FALMOUTH RD SUITE 25 CENTMA 02632 '10 DAYS" WRITTEN t4OM'ETO'TMtTRTtFICATEMaLVEFtrItANEDrCTHL' -LEFT,_aUT. MURF-TO- PMLSUCJi..NDTICE SHALL IMPOSE N u A N POSE 0. OB G TLO OR LIABILITY OF ANY KIND UPONTHE COMPANY, ITS AGENTS OR REPRESEI(MITem - If . .. . ........ AUTHORIZED REPREBENTATIVF . ........ . TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : May 31, 2005 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 21.1 Street 121 Camp St., #109 as shown on Assessors sheet/map # 44 Issuance of this Letter of Availability is subject to the following provisions/restrictions. (1) The property owner agrees to comply with all Federal, State, and Local Laws, Rules and Regulations as they pertain to the use of the Public water Supply. (2) The Yarmouth Water Department shall have exclusive rights as to the size, number, type and location of all water service lines, fire service lines or appurtenant items connected to the water distribution system. (3) The Yarmouth Water Department reserves the right to require, at the property owners expense, the installation of water mains and appurtenant items to meet water demand requisites within any structure relevant to this Letter of Availability. (4) This Letter of Availability will expire 180 days from the date of issue. I have read and understand the provisions/restrictions of this Letter of Water Availability. Owner (Sign) Reference Yarmouth4fiater Department r � �r OP TOWN OF YARMOUTH Ff Building Department _ Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-609 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 109 Owner's Name:. Villages @ Camp St., LLC Owner's Addres Owner's Telephone: 1600 Falmouth Road # 25 Centerville MA 02632 (508)778-9669 ' (OFFICE USE ONLY Recorded By: is Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date t,omments: new construction: REVIEWED BY: 1: WATER DEPARTMENT: ' DATE: {o� dS 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: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: U44.Z 1. I .0 DATE: Date Printed: 5/23/2005 • O 00 \ry LOT 110 NN v Qom �� \ \ C' S �O cb �' Gq o0� � �� o �• o Q .II Q: 6`9i CJAV O I 63 CIV Ov FV S F, CV rn /^ PROPOSED " WATER SERVICE \ti N 6 3, h '' . S86'50'17"E_ . 68.88' GRAPHIC SCALE 10 0 20 ( IN FEET ) 1 inch = 20 it. PLOT PLAN OF LOT 109 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA. SCALE: 1"=20' DATE: 1-5-05 LOT 109 DM• 1 L=3.37' NOTE: ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. NOTICE Urless and until such time as the original (red) stamp of tir- responslWo Prefesiional Engineer, or Profeasioral Land Serreper appears on th!5 plan: (A) no person or persons, including any municipal or ct,1, public officicls, may rely upen the information contained herrin; onC (S) this plan remains the prcperty of F'�.(na�ck, Mceruf:i. Inc. holmes and mcgrath inc. S' i civil engineers and land surveyors] T o 362 gifford street falmouth, ma. 02540 �\ l,a i 'lop;A� j 6 JOB NO: 201197 DRAWN: LMC DWG. NO.: A2539 CHECKED: Cs11f ADDRESS: TION FOR /Sol( — BSSY� 297. 2..�✓ a /a/ M MPD3328 MPD3530 MPD4035 33' fireplace w/opt. flush face 3S' fireplace w/brushed stainless 40' fireplace w/polished brass louver and door trim trim arch door kit Beauty, efficiency, convenience and reliability. Just some of what you'll find in our Lennox Merit® Plus Series direct -vent gas fireplaces. Our combo DV configuration, with both top and rear outlets, allows for top or rear venting (except. our 33" units which have either a top or rear outlet). Standard features include a deluxe pan burner that produces big yellow flames and glowing embers, brickaded interiors and Hi/Lo flame opera- tion. And, these models are even easier to warm to when you select one of our optional remote controls, or MPD4540 MPD4035 • Louvered face design • Charred split oak gas log set • Deluxe pan burner for big yellow flames and glowing embers • Charcoal black exterior powder coat finish • Realistic brickaded interior panels • Combo top/rear direct -vent outlets (except 3328 models, which have either a top or rear outlet) • Hi/Lo flame operation • Pre -wired for wall switch • Choice of standing pilot (works in a (ower failure) or pilotless electronic intermittent) ignition • Decorative polished brass or brushed stainless accessories (arch door kit, door trim, louvers, hood) • Wireless remote controls • Blower kits (including a temperature control version) - • Screen panel kit (heat guard) • Radiant panel kits (for a clean face look) is Series direct -vent gas fire aces utilize either (rigid) or Secure Flex IfleN11r) 4..5^ ter coaxial venting system, and include a A warranty. e to Lennox' ongoing commitment to quality, 1m, ratings and dimensions are subject to The fast two model number digits indicate frame width, the last two digits indicate glass width. All are A.EU.E: rated high efficiency vented gas fireplace heaters, terrified under ANSI Z21.88 and CSA 2.33-M99. MPD3530 MPD3328 DIMENSIONS (Rear vmt model shown) 3328 MODELS (this model comes as a top or rear vent only) _- Front Face 35,40 & 45 MODELS E11 Top (These models come with a top and rea =H C g g 1 4-frr' 1 Right Side - Front Face Top Right Side FIREPLACE & FRAMING DIMENSIONS MIS 331/8 30Y8 17 27Yz 33Ys 190/8 21't 10N 33Y4 33Y4 13 3530 351/8 32A 19 29Y2 354 2111A6 24Y8 12%6 35Y4 35Y4 16 4035 401A 37Ys 24 34Yz 401/8 2611h6 29h 14% .40Y4 401/4 16 4540 401A 371/s 24 3914 451/s 2611h6 343s 17%6 451/4 401/4 16 m� TYPICAL ROOM APPLICATIONS 3329T NG 17.500 45 64 62 Edition, such as elevation, wind,_vent configu- oice of fuel will affect the over appearance 3328T LP 17,500 49 66 64 3328R NG 17,500 53 63 61 HerseyQ20006711) wammkHersey W 3328R LP 17,500 55 66 64 C US 3530 NG 20,000 53 64 62. V[ 3530 LP 20.000 55 62 60 CM 4035. NG 27,000 59 69 67 4035 LP 27,000 60 69 67 4540 NG 29,000 59 69 67 4540 LP 29.000 59 69 67 'Intermittent ignition systems -tm^usA- 7892M a 2 0!�W, : Look for the EnerGufde — Gas Fireplace Energy _ MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck Software version 2.01 Release 2 CITY: 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 Sandpiper PROJECT INFORMATION: Mill Pond village Camp Street — V/k�t#1 b9 Yarmouth, MA 02673 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 223 Your Home.= 138 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 845 30.0 30.0 14 WALLS: wood Frame, 16" O.C. 1415 15.0 15.0 62 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. I I Permit # I I i I I checked by/Date I I I 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 ]4.4. Builder/Designer. Date Massachusetts Energy Code MAscheck software version 2.01 Release 2 The Sandpiper DATE: 4-21-2004 Bldg.l Dept.l use I CEILINGS: [ ] i 1. R-30 + R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 16" O.C., R-15 + R-15 I Comments/Location WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No comments/Location [ ] I 2. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] I 1. U-value: 0.086 Comments/Location_ AIR LEAKAGE: [ ] I joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures j shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between.the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. i I. ] C] I I C] I I DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" LOW pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- (=M rj+- Or. 0-3 1 PRODUCT SPECIFICATIONS GMS9/GCS9 SERIES 93% AFUE Multi -Position, Single-Stage/Multi-Speed Gas Furnace Heating Capacity: 46,000-115,000 BTUH - IMITEQ PAaiRS �_ LIMITED F1�C�M�v44§ WARRANTY �\ �v � QRIOEM.Y E1� sk.......® OrOOM Standard Features • Corrosion -resistant, aluminized -steel tubular heat exchanger and stainless -steel recuperative coil for maximum efficiency • Designed for multi -position installation—GMS9: upflow, horizontal right or left; GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a Norton® Mini -Igniter with patented adaptive learning algorithm to maximize igniter life • Aluminized -steel inshot burners • Energy -saving PSC, multi -speed, direct drive blower motor • Quiet, corrosion -resistant induced draft blower assembly • Integrated furnace control with improved diagnostics • Low voltage terminal blocks • Multiple flame roll -out switches, blower door safety switch, outlet air -limit switch and pressure switch for proof of combustion air • 40VA transformer for heating and air conditioning control service • Combination redundant gas valve and regulator • Top venting is standard; alternate flue/vent located on right side • Completely assembled, factory run -tested furnace for heating or combination heating/cooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent (1-pipe) applications 0I9I.10119 Air Conditioning & Heating The GMS9/GCS9 single -stage, multi -speed gas furnaces offer installation versatility. Cabinet Construction • Heavy -gauge, reinforced, fully insulated steel cabinet with durable baked -enamel finish • Attractive architectural gray paint finish • Foil -face insulation -lined heat exchanger compartment • Coil and furnace fit flush for easy installation • Convenient left or right connection for gas and electric service • Bottom or side air inlet (GMS9) • Removable, solid -bottom block -off (GMS9) Accessories • L.P. Conversion Kit (LPT OOA) • L.P. Gas Low Pressure Kit (LPLPOI) • High Altitude Natural Gas/L-P Kits (HANG11, HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter Rack (EFRO1) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Intemal Filter Retention Kit—upflow, (RF000180) • Intemal Filter Retent ion Kit—iownflow (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) SS•377D w ..goodmanmfg.com 6/04 Temp Permit No.: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL T-05-609 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 109 Owner's Name: Villages @ Camp St., LLC Owner's Addres 1600 Falmouth Road # 25 (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: Centerville MA 02632 (I M ( P Owner's Telephone: (508) 778-9669 MAY 2 4 2005 HEALTH D 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 DEPARTMEN : DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/23/2005 OF yq9 WITTACNEESE APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) OFiYARMOUT+ By IUU Fee: $ D7EC 2 05 J PERMIT NO. ' c.:!'�DiP ''i Pi� (PLEASE PRINT IN INK OR ZY_,�ALL INFOR2 To the Inspector of Wires: By this application the gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant [ i alz� 14:9Y A� Telephone No. Owner's Address �'�G f� Is this permit in conjunction with a building permit? Yes [7) No (Check Appropriate Box) Purpose of BuildinUtility Authorization No. Existing Service Amps Volts OverheadO Undgrd No. of Meters New Service ,Uy Amps ✓y/240 Volts OverheadO Undgrd 11' No -<, Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical rmmnln/inn nhhn%nllnwino tnhla.m, ho wni,rod In, the Inrno f^vmfW;. No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No, of Lighting Fixtures Above n- SwimmingPool md. md. No. of Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners and o. o Detection is InitiatingDevices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um er — — Tons — — KW — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent v yj Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. n 1 CHECK ONE: INSURANCE Q BONDO OTHER�Specify:) (Expiration ate) lam, Estimated Value of Electrical Work:_ ,�e (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th?y ns and penalties of perjury that the information on this application is true and complete. / RM NAME: cJ P LIC. NO. A ensee: Signature LIC. NO. =� (If applicable, enter `axey�pt" in the license, nymber 1' ) Bus. Tel. No.: �.D S ioJ Address: y C CC ,o7,4 f if t D / :% /GL Alt. Tel. No.: below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. ❑ Owner/Agent Signature Telephone y signature [Rev. 04/00] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 r OF Y4 = TOWN>,0 ARMOUTF W1MCNEESE7/_�. (PLEASE PRINT IN INK OR To the Inspector of Wires: By work described below. Location (Street & ber� Owner or Tenant Owner's Address (OFFICE USE ONLY) By Fee: $ �i /l PERMIT NO. E -cr6'- O '7y gives notice of his or her intention to perform the electrical N Is this permit in conjunction with a building permit? OrYes C3 No (Check Appropriate Box) Purpose of BuildingUtility Authorization No. Existing Service Amps / Volts Overhead Undgrd C] No. of Meters New Service • 1t5= Amps � // V` , olts Overhead❑ Undgrd Pr No. of Meters Number of Feeders and Location and Nature of Proposed electrical Work: Cmmnletinn ofthe following table may be waived by the Iruaector of Wires No. of Recessed Fixtures No. of Ceil: Sus . Paddle Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In- Swimming Pool gmd. Emd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um er — — ons — — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers ry Heating Appliances KW g pp Security Syystems: No. of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications wiring: No. of Devices or E uivalent Attach adaitional detail tJ destrea, or as requirea by the inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of samijjoAee permit issuing office. CHECK ONE: INSURANCE 0 r BOND C] OTHER (Specify:) Estimated Value Work to Start: I sections to be re certify, and �Inanden ' s of Atha VIRM NAME censee: w� vn i � (If applica ter " in the li en a number \� Address OWNER'S INSURANCE WAIVER: I am aware that tk Licer below, I hereby waive this requirement. I am the (chec one) Owner/Agent (Expiration Date) (When required by municipal policy.) Aance with MEC Rule 10, and upon completion. i J tia! - ti is application is true and complete r 1 LIC. NO. lure LIC. NO. l Bus. Tel. No.: Alt. Tel. No.: S�6] does not have the liability insurance coverage normally required by law. By my signature Q owner's agent. 13 Signature Telephone [Rev. 04/001 WPS - Permit Page 1 of 1 • ,%j NSTAR WPS - Permit • Work Order Information Utility AuthMO #: 01492855 Date: 12/142005 Company DONNA JONES Rep: Report By: YAR 121 CAMP ST UNIT 109 VILLAGES AT CAMP ST Status: PLAN Service: NEW Type: RES Nature of Work: NEW 100AMP UG SERVICE TO HANDHOLE #P080D SET ON PROPERTY LINE- TRANSF#P080 - NEW 1500 SO FT HOME IN RES DEV(MILL POND VILLAGE OFF WILLOW ST) - NO A/C - GAS HEAT & HW - ELECT RANGE & DRYER - SET METER Service information: There is no Service Information. Permit Information Permit #: E06-568 Meters: 1 Reseal (YIN): Y Date: 04/112006 Inspector. W10060 Description: Search betall = Contacts NSTAR Home WPS Lonon WPS Help Comments WO Request WPS News 0 � ir2 U 40 Copyright 2003 NSTAR, 800 Boylston Street, Boston MA USA. AN rights reserved. Reproduction in whole or In part of any graphics, Images, text or other content at this web site must be granted by NSTAR, Boston, MA, USA. Unauthorized modification of any Information stored at this site may result In criminal prosecution. http://www.nstaronline.com/apps✓wps/wpspermit.cfm7Page=Pennit&Unique={ts '2006-0... 4/11/2006 Commonwealth of Massachusetts official Use Only Permit No. 'fib Department of Fire Services Occupancy and Fee Checked LV BOARD OF FIRE PREVENTION REGULATIONS . 11/99] ve blank A ` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All mckto be pedormed in accordwce withthe Massarhusctts Electrical Code Qace 527 CMR 12.00 (PLEASE PRINTINIIVKOR1TPEALL INFVRMA770A9 Date: /h Z/ City or Town of: YAR 40UPH To the Inspector of Wires:. By this application the uadeisigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Namber) MILL -PC7ND VILLAGE, 121 Carnp St Bldg Owner or Tenant Gatewood Homes/ Jeff Sollows Telephone No. 508-7789669 Owner's Address .1600 Falmoutti Rd., Suite 250, Centerville, Ma. 0263.2 4191 Is tbis permit in conjunction with a building permit? Yes K] No ❑ (Check Appropriate Box) y Purpose of Building single family residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ go. of Marais I� D� � _� ,,., New Service Amps / Volts Overhead ❑ Undgrd ❑ No: of M�ttcis � v � Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Fire rstem (low voltage control with hac�kur battery. -centrall�rmoni ored. finenfeAe t efdw feffawinr table may be uiamedbv the Insaeetor ofWirea No. of Recessed Fixtures No. of Cell-Susp. (Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool d e d7ffBattery Uniitsency g No. of Receptacle Outlets No. of Oa Burners ' ME - ALARMS No. of Zones —1—' No. of Switches No. of Gas Burners' o. o etetxloa.an 7 Initiat:ia Devices No. of Ranges Tal No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eam Totalsp um er ors Detection/AlertinguDevices 7 No. of Dishwashers Space/AreaHeating KW Local 0 ® Other No. of Dryers .. Heating Appliances Kw yConn�iii SecuNot. Systems: st a br E ivalent o. o Water KW Santos o. o o. of Si Ballasts Data Wiring; No. of Devices or uivaleat No. H dmmassa Bathtubs y ge No. of Motors Tota! HP Telecommunications ?stag: No. of Devices or ivalent OTHER: AUad, adMimal daraflljd sired. or as reWrod by the &rpemr cfWtr= INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial cquivalem The undersigned certifies that such coverage is in force, and has exhibited proof of same to. the permit issuing office. CBECK ONE: INSURANCE ® BOND p OTHER O (specify-) Estimated value of Electrical woric $750.00 `tea (When required by municipal policy) Work to Stan: Inspections to be requested in accordance with NEC Rule 10, and upon completion. I cerdfy, under the pains and penalties of perjury, that the information on this application is true and complete FIRMNAME: Baltic Security, Inc LIC.NO.: 1178C Licensee: Jonas R Bielkevicius Signature 1 LIC. NO.: 499D •(yapplimbk, miter ."e tarTt.. in Addrims: ,PO Box .) 609 V W1'M b MbUtcnirt:L WArvJ!;x:.lamawarc required -by law. By my signature below, I hereby Owner/Agent Signature l 7 Bus. Tel. No.: 508-833-0996 . 02563 Alt. Td No.: 508-7 --3347 that the Licensee does not have the liability insurance coverage normally raw this requirement I am the (check one) ❑ owner ❑ owner's agent. Telephone No. PERMIT FEE. $ 40.00 CERTIFICATE OF INSURANCE SSUEDATE(MM/DD/YY) I05/06/1005 PRODUCER Harold H Williams Ins Agcy Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE 81 Bassett Lane Hyannis, MA 02601 INSURED Stephen M Childs 145 Caminett Road COTTER Y A A.I.M. Mutual Insurance Co Marstons Mills, MA 02648 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER10D INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO L,� TYPE OF INSURANCE POLICY NUMBER =DAT7E(MM/DDIYY) POLICY F.XPIRATIO DATE(MM/DD/YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE S PRODUCfS-COM IYOP AGG. $ PERSONAL&ADV. INJURY S LAIMS MADE[::1CCUR OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) f MED. EXPENSE (Any one person) f i AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ . SCHEDULED AUTOS HIRED AUTOS BODILYINIURY Per9Ce1I m) $ NON -OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE I $ :EXCESS LIABILITY MBRELLA FORM EACH OCCURRENCE f AGGREGATE S THER THAN UMBRELLA FORM A R A 'o KER'S COMPENSATION AND •MI'LOYERS' LIABILITY rHE PROPRIETOR/ INCL ARTNERS/EXECUTIVE 7015793012004 12/13/2004 I 12/13/2005 X EL EACH ACCIDENT $ 100 000 EL DISEASE -POLICY LIMIT S SOO 000 EL DISEASE -EACH EMPLOYEE 1 100,000 FFICERS ARE: X EXCL orHER Dh:SCit rTION OF 01-FItA1'IONSILOCATIONS/VEBICLES13PECIAL ITEMS CERTIFICATE HOLDER GateWDOd IIOmeS. Bell Tower Mall Rte 8 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 G APPLICATION FOR PERMIT TO 00 GASFITTING �' TOWN OF YARMOUTH F(OFFICE USE ONLY)By _._. _...---.-___---- _-_--_-.--------._.__.- i PERMIT NO... -- Date Building Owner'g//-_.,.. AT: Location Type of Occupancy_,25:41""-/_y__..__ New LX Renovation ID Replacement 01 Plans Submitted Yes `,_i No 5k I W to v tL m LU z us °mWcc N W H a < z 7 W a CCW cc U11w z CC W o Ch H z H z r ul q O > 0 LL g> Gyr7 QJ g LLi .+ , ¢ x O 0 U. O O 3 J !- SUB-BSMT. BASEMENT 1ST FLOOR 2NO FLOOR 7R0 FLOOR ;PRINT OR TYPE) Check One: Installing Company Name-✓ULT.=S11.�"? �.- Corp..-^.___ Address .--- Q_..__G... }fi _ .__s .._._.�-- -- ❑Partnership _ Q ,F �T �411t'/Vlam_._...—._..._ 3�...__.......iZ2/�_�ci�c�,.��_- 'rJ FirmlCompany.. i DEGAA N05- Business Telephone C� �?j I a-� BUIL `Tl: b. Name of Licensed Plumber orhtlCr INSURANCE COVERAGE: Chec`k� One 1 have a current i,abdrty insurance policy or its substantial equivalent. Yes t* No ❑ It you have checker, yes, please indicate t e type of coverage by checking the appropriate box. A habdrtd insurance policy Other type of Indemnify D Bond Cl OWNER'S INSURANCE WAIVER: I am aware tnat the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check One: uornei ❑ Agent ❑ Signature of Owner nr Owner's Agent 1 hereby certify that all of the details and information I have submitted Signature o Licensed (or entered) in above application are true and accurate to the best of Plumber or Gastitter my knowledge and that all plumbing work and installations performed 2,1 S j 0' under Permit issued for this application will be in compliance with all " -- --- pertinent provisions of the Massachusetts State Plumbing Code and License Number rvoc r rrcucra•