HomeMy WebLinkAbout121 Camp St #111 Building Permitsto L-
' \ �]7 •' Office Use �Only
LI1C Q:t1I11II1[1I11UCII[ti1 lit _1is;3!3a 6115Ett5 Permit No.
1rtIclrtlnrnt of PuGti[="afctlt Occupancy E Fee Checked
BOARO OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 119Z (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO K
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 0
(PLEASE PRINT IN INK !R TYPE Ail, NFORMATION) Date
City or Town of_,J' To the Inspector of Wires:
The udersigned applies for a permit to perform the electr' al work desc ibed below.
Location (Street & Number) � J�
Owner or Tenant p
Owner's Address ' /gyo`L/ J`Ior '���GL C�fp7�lU(IC�Tel. No, !
Is this permit in conjunction with a b ilding p rmit: Yes Cl,---No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps
,�tt Volts Overhead ❑ Undgrnd ❑
New Service AmpT;77_J ,��``� l' Volts Overhead ❑ rUndgrnd ET`
Number of Feeders and Ampacity
f
Location and Nature of Proposed Electrical Work
_40., , i_...,,_ O.,
No. of Meters
No. of Meters
r�
ri
No. of Lighting Outlets (�
I No. of Hot Twos
No. of Transformers Total
KVA
No. of Lighting Figures l�
Swimming Pool ACove In-
grnd. ❑ grnd. ❑
I Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
I No. of Oil Burners
Battery Units
No. of Switches
p
( N s i uPe t{�
FIRE ALARMS No. of Zones
No. of Detection and
/`7�
No, of Ranges / -
f A r oral
r
Initiating Devices U4
No, of Disposals
1
I No 1Ne�E to al TOl
Pumas Tons
No. of Bouncing Devices
No. of Self Contained
BtJ1LU
No. of Dishwashers I
SCa a/Area Heat KW
DetectioNSounding Devices
Mupaf
❑Other
Local Connctin etion
❑
No. of Oyrs ei/
I
Heaeina Devices KW
No. of No. of
Low Voltagi
�//
No. of Water Healers(` KW 1
Signs Ballasts
wiring
No. Hyero Massage Tubs I
No. of Motors Total HP -
Securicy System
OTHER:
�I
G]I
INSURANCE COVERAGE: Pursuant Io the recw,renents of Massachusetts general Laws
C1
have a current Liability Insurance Policy Including Compleled Operations Coverage or its substantial -equivalent. YES G NO O l
a
C
have Submitted valid Drool of same to the OthCe. YES G NO rn It you have/she'cke/C YES. please"inaeale the type of coverage by
aDDr to bps. �C /� t'1 CC
V 'v-'L`7�
INSURANCE
INSURANCE G �pND G OTHER G (Please SOeCify)
CE
(Expiration Date)
CHECK APPROPRIA2= BOX: I have Worker's Compensation Insurance ❑ I have no Employees ❑
Estimated value of Electrical Work S Gel a
Work 10 Star, lnspee'..on Oa:e Recwesied: Rougn Final
Signed unCer the ties of perju �/
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FIRM NAM= U `, l /U� LIC: NO.
`
1 1-4
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n
Licensee -. Signature LIC. NO
jj
A
Sb� LlO�
�e a D�
�r Bus.
Address—�`GI��Gi %�°P7-� Tel. No.
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OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or as substantial equivalent as re.
_
quired by Massachusetts General Laws. and that my signature on this permit application waives this requiremenl. Owner Agent
(Please check one) .
Telephone No PERMIT FEE S -
(S.gnature of Owner or Agent)
•
WPS - Permit
Werk Order Information
AM
,IVSTAR
WPS , Permit
Page 1 of 1
Utility AuthMO #: 01492030 Date: 12/082005 Company DOROTHY MADDEN
Rep:
Report By: YAR 121 CAMP ST UNIT 11 tVILLAGES AT CAMP ST /P080D
Status: PLAN Service: NEW Type: RES
Nature of Work: NEW 100 AMP U/G IN U/G DVLP- HH# P080D-1200 SQ FT, ELEC STOVE &
DRYER
Service Information:
There is no Service Information.
Permit Information
Permit #: E06-533 Meters: 1 Reseal (YIN): Y Date: 04/112006
inspector. W0060 Description:
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it'•
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http://Www.nstaronline.comlappslwpslwpspermit,cfm?Page=Permit&Unique= f is '2006-0... 4/11/2006
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEQ, 527 CMR 12.00
TOWN
(PLEASE PRINT IN INK OR TYP
To the Inspector of Wires: By this
work described below.
I tiLocation (Street & N ber
Owner or Tenant
, Owner'SAddress
�1J
(OFFICE USE ONLY)
(ARMOUT 1) By �l,
c Fee. $ t S - VU �L
/
02 2006 'Iv,i PERMIT NO. t" '— G6 ^ /
INFORMATION) ! Date:
itlorrthe undersigned gives notice of his or her intention to perform the electrical
__ Telenhone No.
Is this permit in conk tion with a building permit? 4 Yes C]No
utility
Purpose of Buildin��h
Existing Service Amps / Volts OverheadEl
New Service Amps L2fl / Z:�gVolts OverheadO
Number of Feeders and Ampacity Z
Location and Nature of Proposed electrical
(Check Appropriate Box)
Authorization
Undgrd C3 No. of Meters
Undgrd 2-�' No. of Meters I
Com letiono the ollowin table m bewaivedb the Inspector ohires
No. of Total
No. of Recessed Fixtures
No. of Ceil: Sus . Paddle Fans
Transformers KVA
No. of Li htin2 Outlets
No. of Hot Tubs
Generators KVA
Above n-
❑
No. of Emergency Lig ting
No. of Li htin Fixtures
SwimmingPool rnd. md.
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
go—.—oT Detection an
No. of Switches
No. of Gas Burners
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
Heat Pump
Num er
ons
_ _
No. of Self -Contained
No. of Waste Disposers
Totals:
— —
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal Other
Local Connection
No. of Dryers
Heating Appliances KW
Secutity Systems:
No. of Devices or E ui valent
No. of Water
No. of No. of
Data Wiring:
No. Devices or Equivalent
Heaters KW
Signs Ballasts
of
Telecommunications Wiring:
No. Hydromassage Bathtubs
No. of Motors Total HP
No. of Devices or Equivalent
Rrracn aaautunut actutt y eteaireu, Ur uo rcyuucu uy .nc an..�w.v. J .... .
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.
CHECK ONE: INSURANCE 2" r BOND ❑ OTHERC] (Specify:)
E D t
Estimated
Work to Start: c7 "
I certify, unde th s and
RM NAME.
` censee:
(If applicahlevAp "e f
\� OWNER'S INSURANCE WAIVER: I am aware that
below, I hereby waive this requirement. I am the (ct
Owner/Agent
Signature
[Rev. 04/001
( xpuanon a e)
(When required by municipal policy.)
to be re(,est d i accordance with NEC Rule 10, and upon completion.
in rm tion on this application is true and complete.
C17 r I LIC. NO. (
_Signature LIC. NO.
tuber i e.) Bus. Tel. No.:
�� Alt. Tel. No.: SCES _ _
e Licen a does not have the liability insurance coverage normally required by law. By my signature
ieck one) owner owner's agent. Q
Telephone No.
40
0
Commonwealth of Massachusetts official use only _ 6
Permit No.
Department of Fire Services
Occupancy and Fee Checked
vu,
BOARD OF FIRE PREVENTION REGULATIONS . 11/991 veblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
code 4z m iz o0
Art wmkto be puformed in ==du= withthe u mssa=Mu Bkchrcal (MEN.
(PLEASEPRWTIYRNKORTYPEALLBYTORMATlONJ Date: / h4or-
City or Town of: YARM( UM To the Inspector of Wires:
By this application the undersigned gives notice of bis or her intention to perform the electrical work described below.
Location (Street & Number) MILL pcNDyIL AGE, 121 Cazp St Bldg #
OwnerorTenant Gatewood Hanes/ Jeff Sollows Telephone No.508-7789669
Owner's Address .1600 Falmouth Rd., Suite 25, Centerville, Ma. 0263.2 1,
Is this permit in conjunction with a building permit? Yes X❑ No ❑ (Check AppropriaL
Purpose of Building single family residence Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.
New Service Amps / Volts Overhead ❑ Undgrd ❑ No`
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Fire
•c
- - .- !`n.....lef:.», nftbi fn//n.uino hrhli mm, he iwfivo�$v thz 7nme.•rnr a�Wix_t
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
gh g
Swimmin pool ove ❑
g d. d.
o. o ergency g
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE. ALARMS
No. of Zones —1—
No. of Switches.
No. of Gas Burners
o. of Dptewon.and7
Initiating Devices
No. of Ranges
Ttal
No. of Air Coud. Tons
No. of Alerting Devices
No. of Waste Disposers
Totals:
• um er
ons
ntained
Detection/Al oertin Devices 7
No. of Dishwashers
Space/AreaHeating KW
�� C1=giu ®Other
No. of Dryers ..
Heating Appliances �'
ecunty ystems:
No. o evices 6rEquivaleut
o. of Water KW
Heaters
o o. a
Ballasts
Si Ballasts
Data Wiring.
No. of Devices or uivalent
Na H •drvmassa a Bathtubs
y g
No. of Motors Total HP
mmunrcatts o ?ring
No. of Devices or ivalent
OTHER:
Attach oadfCa" daiaft fduusdor as regWrad ay Memrparor yr wins.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and bas exlubited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND 0 OTBER El (Specify-1
Estimated Value of Electrical Work $750.00 required municipal cpuahon
(When reel by Pal policy.)
Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I ca*, under the pains and penalties of perjury, that the information on this application is true and cmnplete
FYRMNAME: Baltic Security, Inc LIC.No... 1178C
Licensee: Jonas R Bielkevicius Signature .- LIG NO.: 49
(Ifapplicvble,aner'=mpt"in the Gccuenrany lure 02563 Bus. Tel. No.! 508-833-0996
Address: pO Box .1609. 5=owic. r �• Alt. TeL No.: 508��6-3347
OWNER'S INSURANCE WAIVER .1 am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑ owner's agent
Owner/Agent
Signature. Telephone No. PERMIT FEE. $ 40.'00,
APPLICATION FOR PERMIT TO 00 GASFITTING
►y r (OFFICE USE NLY)
X
Uw
TOWN OF YARMOUTH I B
Fee:
PERMIT NO._. _ G-66_
Building �^ -ram Owner';
AT: Location - __� 2.._�. �2QC►a--1-- _— Name�ry� �1Y1-F-�`�
Type of Occupancy��l l
New LX Renovation ❑ Replacement ❑
Plans Submitted Yes'No N(
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SUB•BSMT.
BASEMENT
1ST FLOOR
2N0 FLOOR
3R0 FLOOR
MRINI OR TYPE1 Check One:
Installing Company NameCorp....---
Address _._ II22 p ��t7 .i1_.._.G..1 �i - _._`�_ .._.__ -- D Partnership _
V_rloirmlCompany. -DEC Y/4J 2905—
f3ustness Telephone �~ 7-�"�'-�.�"�Z'"—_..._M__ .. ��!'
'� o T_ �►-+� _ L, i' -!�1 Ste. Bl11LCli,?5 u.
Name of Licensed Plumber ordersy---------
INSURANCE COVERAGE: Check One
1 t,ave a current i,ab4dy insurance policy or as substantial equivalent. Yes & No ❑
it you have checker yes, please indicate t e type of coverage by checking the appropriate box
A liatility 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. Klass. General Laws, and trial my s!gnature on this permit application waives this requirement
ChecK One:
Owner ❑ Agent L�
Signature of G vner or Owner's Agent
I hereby certify that all of the details and information i have submitted Signature o licensed
(or entered) in aoove application are true and accurate to the beat of Plumber or Gastitter
my knowledge and that all plumbing work and installations performed 2, 5 ) 45'
under Permit Issued for this application will be in compliance with ail
ertinent provisions of the Massachusetts State Plumbing Code and License Number
p g , D � rvor t rrcucc.
RE -INSPECTIONS
RE -INSPECTION - $20.00
2m RE -INSPECTION - $30.00
3RDRE-INSPECTION - $40.00
ALL OTHER RE -INSPECTIONS ,.$40.O
a-/
DA
DATE RECALL -
ISSUED
To:
REASON FOR RE -
INSPECTION:
BUILDING DEPT.:
OCCUPANCY PERMIT:
PLUMBING PERMIT:
GAS:
ELECTRICAL:
FIRE DEPARTMENT:
OTHER
�s vros 7W
ru TOWN OF YARMOUTH Building Department BUILDING
• (508) 398-2231 ext.261
�= PERMIT NO :B:oS-;553 ----------
ISSUE DATE 6/30/2005 PROPOSED USE ------ PERMIT
ISSUE DATE PROPOSED USE _ _ _ _ _ _
a... � ; _ 6/30/2005 _ ;
APPLICANT Frank Capra
----
JOB WEATHER CARD
PERMIT TO ; New Construction
AT (LOCATION) 00121CAMP ST Unit 111 Z IOG DI RICT= Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C111 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
LOT SIZE O
new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 06t02105.
REMARKS Subject to compaction & proctor tests.
\REA (SO FT) EST COST ($ $141,600.00 PERMIT FEE
OWNER I Villages ® Camp St., LLC ILDING DEPT BY
ADDRESS 1600 Falmouth Rd # 25
Centerville MA 02632
CONTRACTOR
LICENSE 012430
Capra, Frank
1600 Falmouth Road #25
Centerville MA 02632
5087789669
Certificate Issue Date / oo `-CERTIFICATE of OCCUPANCY-1,
Departmental Approval for Certificate of Occupancy and Compliance
.. __�!a •L....L�. A..w.......d D.. Damarlec
W1
r
ENGINEERING
To be filled in by each division indicated hereon upon completion of its final inspection.
of
TOWN OF YARMOUTH
PERMIT NO B-05-1553_
Building Department
(508) 39.8-2231 ext.261
BUILDING
PERMIT
ISSUE DATE ; _ 6/30/2005 _ ;
PROPOSED USE _ _ _ _ _ _ _ _
_ _
..........
APPLICANT Frank Capra
- - '
JOB WEATHER CARD
------------------
PERMIT TO ; New Construction '
AT (LOCATION)
00121CAMP ST Unit 111
ZON DISTRICT=
Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C111
BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
10
LOT SIZE
new construction: 2 baths, 3 bedrooms, 1 greatroom, 1 kitchen as per plans dated 06/02105.
REMARKS Subject to compaction & proctor tests.
AREA (SQ FT) EST COST ($ [$141,600.00 I PERMIT FEE ($) 1$516.00
OWNER I Villages 0 Camp St., LLC I BUILDING DEPT BY
ADDRESS 1600 Falmouth Rd # 25
Centerville I MA 102632 s %?-� 7 76
INSPECTION RECORD
CONTRACTOR
LICENSE 012430
Capra, Frank
1600 Falmouth Road #25
Centerville MA 02632
5087789669
FIELD COPY
.:Note
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CJNh & I WU FAMILY ONLY - t3U1LUIN(a Pt_KMI I
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APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 • Yarmouth, MA 02664-4492
Tel: (508) 398-2231 x261 • Fax: (508) 398-0836
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Secttpnl ,'items?atin Use Group: R-4 Type: 5-B
1.1 Property Address:
1.2 Zoning Information:
S -
I°� D�s� �`
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required Provided
1.4 Water Supply (M.G.L c. 40. S 54)�
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Public Private
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2.1 Owne of Record:
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N me�Pnnt Mailing Address Cet-, vttk 01
Al \ IL1
Signature Telephone
2 2 utho0ri0 Agent: / �
ItXe/1
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Name (print) a Mailing Address
z�rrn.14-y�y. r�"OS�77��GGG 6
Srignature / Tele hone nn F
Se.Ct1011 3 Gorastrcl t " erainces4
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3.1 Licensed Construction Supervisor.
Not plicable ❑
t % DING DEPT
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tense Number
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Address
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Expiration Date
S gnature Telephone
Company Name _
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License Number
Address ti 2P! C-Pl . -
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Expiration Date
Signature Telephone
7
9-15-99
1 of 2
OVER
sec#o=4 � l�okers'��o>�pe�sa}ican; f�sT�ra�cf;�;�a>�li�{�f�G 3��� 752�G�c,
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fa
to provide this affidavit will result in the denial f the issuance of the building permit.
Signed Affidavit Attached Yes ........:. No ..........
�`eltt4n- t3escptsan Mot check ali aplii%a51e}
New Construction CBr I No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ I Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
l�
[ (V, r� V1 U4
�,�, ._,__ ,,,�, . • �� �� -ram _ .,
�S�G�tQTi�K E»'strriat?� GaFIStrUCtiOI1�CDS�S',
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)
7. Total Square Ft. (new houses & adddions)
3
$BCtltlit �i�YreAfC7t0112afIfln08C)ii1plE#ECli%I%_t�eTl`
t3wnet�s� 2nor,Cp�t�actorAp �es.#o�.i�wtcitrt�Pe�ttt>t4
.
-
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hereby authorize
as owner of the subject property
C0 r to act on
m beh , in all matters elative to work authorized by this building permit ppl-elation,./ 10
Signature of Owner Date
ecttora�"�bl��ONne€'/Aitfaortz2d`Agent�I�ectaratian
ItAj� �`C! , as Qwner/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.
Print name
Si nature f Owner/Agent
Date
w1-I♦
IPA
i;
9-15-99 2 of 2
- r�'���s o
y
1 ..I w 1N Ur YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT- I
Job Location:
Owner of Property:
Construction Supervisor:
Address: / 15-0 ° O
.� Licensed Designee:
(If other than Supervisor)
Street �� Village
�}- CAL', LL c
P r!'� Daly So b --� � a- 9669
j Q ( Incense No. Phone No.
OAtCLA-0- kh A oaG
r �
2.15 Responsibility of each license holder:
License No.
2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration,
repair, removal or demolition involving the structural elements of building and structures onlypursuant to
the state building code and all other applicable laws of the commonwealth, even though he, the license
holder, is not the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any
violations which are covered by the building permit.
2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.1-5.2 or 2.15.3 orany 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 1Y No
If you have checked yet, please indicate the type coverage by checking the appropriate box.
A liability insurance policy _ Other type of indemnity ❑ Bond
OWNER'S -INSURANCE WAIVER: am ware that the icensee domes not have the insurance coverage required by
Chapte 2 of the . Gener w d my nature on this permit application waives this requirement.
one::
Sign ure of Owner or Owne Agent Owner/-� �9
Signature: Building Official Approval:
• _r
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451
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 ` p
Work Ad4xess J^ t
is to be disposed of at the following location: �� L✓►�In �l'd l
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
�z 6
Signature of Applicant Date
Permit No.
' U/i ..�{'ladtllLCIXIdB�4
BOARD OF BUtLDING-REGULATIONS
License_, CyONSTRUGTIQRSUPERViSOR. . .
Numbe,�
` (112430
- ;
xUZ BiflMt .95 —tS40
y� ;
0Er1 6i2p06. Tr. no: 25926-
Rest_ r
FRANK GAPR c ��i`
40.: COPPER
CENTER161LLE'mok .0263� Cortunissioner
f.
00- 35;OOdd endosed,spaw
(MGL C.112.S.60L) - r
-r _ IG.=:fB:ZFapu'Iy.Homes .
Failure:topossess;a ourient.edidonofttre
Ma ssachusetlsState:BaUd'gg.Code, - -
} is-cause:for:revow on.of9iisicense. i
i
ti
DIG.SAFE:CALL CENTER: 1888) 344-7233
e■
The Commonwealth of Massachusetts
Department of Industrial Accidents
ONCOollmsVISVORS
600 Washington Street
Boston. Mass. 01111
Workers' Compensation Insurance Affidavit
9-.
I am a homeowner performing all work myself.
I am a sole proprietor _r..', halv a no one working in any capacity
[am .an employer prop idina workers' compensation for my employees working on this job.
any na
sic
address.
city:
phone q
insurancr co.
nnliry tl
am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e
the followina workers compensation polices:
city:
nhnn u
insurance co..
noli . M
company name:
address -
city,
' Anne tt
ratlure to secure coverage as required under Section 25A of MGL I52 can lead to the inapaition of criminal peaattlea of; Doe op.to SI.Soo.00 aad/or
one years' imprisonment as well as aril penaltied is the form of a STOP WORK ORDER and r Dae of SI00.o0 a day against me. i noderstand'that it
copy of this statement may be forwarded to the Otrce of Investigations of the DIA for.eoverige verification.
I do •here%cf' paint and penaldis of perjury that the information provided above is true and correct.
k Signature ate X
Print name L, D,%�a phoneX_L
official use only do not w rite in this area to be completed by city or town official
city or town: YARMODT$ _ permi0lecase it mBuildint Department
(] cheek if immediate response is required pUcensing Board
❑selectmen's Office
contact person: 2ex OHealtb Department
phone#;_ C508) 398-2231 est. mother.
05105/2005 14:091 508-760-1-667 EASTERN-INS-.YARMOUTH PAGE 01
ILAODR � CERTIFICATE
OF LIABIUTY I-NSURANCE
DATE (MMIDDIYYYY)
as/os/2005
PRODUCER 508-398-6033
Eastern Insurance Gr
1 Atlantic Ave
So Yarmouth MA 02664
FAX SOS-760-1667
up LLC
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS -UPON THE CERTIFICATE -'
...HOLDER. THISCERTIFICATEDOESNOTAMEWEXTENWOR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURER$ -AFFORDING -COVERAGE
*L.
INBVRSD ape Cad Custom
762 Falmouth Raid
Hyannis MA 0260
..
Floors
INSURERA: Ar a la. Protection Ins Company
INSUKR B Hartford....
ws qa —
INSVRER D'-... .
KAUr.ZI
THE POLICIESOF=INSURANCE
ANY REQUIREMENT. TERM OF
MAY PERTAIN, THE INS
POLICE$. AGGRECATF-uma7
LISTED SELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVEPOR THE POLICY PERIOD INDICATtD: NOTWITHSTANDIN
CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY-RE-ISS Ert Q
AFFORDED SY THE POLTCIESDESCRteeD HEREIN ISSUBJECTTO-ALL TI`e TEAMS €TMLUSIONS RNO CONMTION3 OF'$UE4+
.SHOWN MAY HAVE BEENREDUCED.SYPAW CLAIMS, .
tNSR
DD
-. - .TYPE OFJNSUR
E - ...
POLICY NUMBER....
_ I Y FFECTWE
12/13/2004
POLICY EXPIRATION
-
12/13/2005
_. LIMITS
GENERAL LIABILITY
7S000003Z3
.EnchoccuKnNce.
S. 1 000 00
DAMAGE TO RENTED
S SQ 0
X T COMMERCIAL GENEf
kL LIABILITY
MED EXr(Any one.PeWn) -
.f. -S,00
CWMS MADE
X_ OCCUR
PERSONAL] AOV INJURY
S 11000-,
A
_ ..
GENE LAGGREGAT!-
S 2 000 OO
.. .
GEMAGGREGATEIIMIT
POLIES PER
PRODUCTS -COMPX)PAGG
S 2,000,000
X POLICY JPE O-
_ LOC
AUTOMOBILE LIABILITY
ANY AUTO
'
COMBINED SINGLE LIMIT
(Ee BttNenU
i
BODILY INJURY.
(PbrPenw)
S-..
ALt OWNED AUTOS
SCHEDULED AUTOS
-
BODWY*UURY .-
(Pow occident)
.f.
HIRED AUTOS
NON -OWNED AUT03
-.
..
PROPERTYDALIAGE
(Peraa�dwl
- S
GARAGE LIABILITY
- _
-
AUTOONLY-EAACCWENT-
t
OTHER THAN EA ACC
s
ANY AUTO
...
S
-
-
AUTOONLYI L ' AGO
SXCCSV MRReLLA LIAO
.'
EACH OCCURRENCE
s-1' � 00'ON
AGOAEGATE .
S. 1,000 00
X OCCUR Q
IVSMgpE
" 460002929S
12/13/20a4-
12/I3/2005
s
A
S
DEDUCTIBLE
X RETENTION- S
1QIQQ
..
WORMS'COMPEMB.&MM AN.
_.
O&WECK0007
OS/Z5/2'004--
WZSjZ0QS
X WcsrATu , . OTH
EL EACNACC IDENT...
500DD 5....
EMPLOYERS' LIABILITY
-0S/2S/200S-
-as/uV2nafi.
B
ANY PROPRIETOWPARTKPJU
OFFICERIMEMBEREXCLUDED7
CUTNE
-
-
l.L: DISEASE-EAEMPLOVE
i" 50Q 00
Rye a, Epclibe wdar
SPECIALPRONSIONS below
l.LDISCA3!-POLICYJJMIT
5...
OTHER ...
..
DESCRIPTION OF OPERATIONS) LOC.
Evidence -of Insurance
TIONSIVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
"
Y' rAurcl I ATInu
SHOULD ANY OF THE ABOVE DE3CRISED POLICIES BE CANCELLED BEFORE THE
•
EXPIRATION➢ATE JNERPDfL. THEI3SIANG INSURER WILL ENDEAVORTO MAIL
-10- DAYS INWITEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE LEFT.
Gatewood HOmev
BUT. FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLIGATiONORLIABILITY
1600 Falmouth AJ
#2S
OFANYWNGUPOITTHEINSUtMffYAGEWYCYWREPRESEUrATME---
Auruoal .RaseNTATve
Centerville,KA
-02632'
ACORD 25 peall08). FAX: .(508)778-5603-- (/ v ®ACORD CORPORATION 1988
Y`1'nnli!• -IRA44A
2ASSURANCECO
'—AORD,a CERTIFICATE OF LIABILITY
INSURANCE
iooa/ a°m""
PRCOUCER
Dowling & 0' 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:
INSURER C:
INSURER D:
INSURER E:
rime
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
POUCYNUMBER
DATE IMMIDDFFECTIVE MIDDTIVE
POLICYNYI DATE( M DNY)
LIMBS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F—XI OCCUR
16808387A9841ND04
08/01/04
-
08/01/05
EACH OCCURRENCE
E1000000
DAMAGE TO RENTED
$300 DOD
MED EXP (Any tine person)
E$ 000
PERSONAL E ADV INJURY
E1 000 000
GENERAL AGGREGATE
s2,000,000
GENT AGGREGATE LIMIT APPLIES PER
POLICY PE O- LOC
PRODUCTS-COMP/OP AGG
E2000000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per parson)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANYAUTO
AUTO ONLY - EA ACCIDENT
E
OTHER THAN EAACC
AUTO ONLY: AGO
E
E
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
-
EACH OCCURRENCE
E
AGGREGATE
E
E
E
E
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
Fps, describe under
SCIAL PROVISIONS below
WC LIMIT OEEL
E.L. EACH ACCIDENT
E
E.L. DISEASE - EA EMPLOYEE
E
E.L. DISEASE - POLICY LIMB
E
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 (2001108)1 of 2 #35866
LID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ID_ DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
iE NO OBLIGATION OR LIABILrrY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
LS1 ® AUUKU L.UKL'UKA I AUK T7oo
.:::..:............... ........... .. .
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
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 HYANNIS MA 02601 COMPANIES AFFORDING COVERAGE
-
COMPANY
22LGR A ST. PAUL FIRE AND MARINE INSURANCE COMPANY
INSURED COMPANY
HP BUISNESS SERVICES INC Ass u,- a.nce eonslruc. i B
118 WATERHOUSE RD COMPANY
SUITE E � C
BOURNE MA 02532 I tlL9�/�CYI.A.� Lv"C'L�P1Jl.a-
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.
i TYPE OF INSURANCE I POLICY NUMBER I DATE (M�IXTm I DATE (MWDI m "I LIMITS
GENERAL
LIABILITY
OMMERCIAL GENERAL UASILITY
CLAIMS MADE a OCCUR.
& CONTRACTOR'S PROT.
GENERAL AGGREGATE
Is
PRODUCTS-COMP/OP AGG.
$
PERSONAL & ADV. INJURY
$
ROWNER'S
EACH OCCURRENCE
$
FIRE DAMAGE (Any one fire)
$
MED. EXPENSE (Any one person)
S
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
_
COMBINED SINGLE
LIMIT
$
BODILY INJURY
(Per Person)
S
BODILY INJURY
(Per Accident)
$
PROPERTY DAMAGE
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
S
OTHER THAN AUTO ONLY:
....................................
....................................
....................................
EACH ACCIDENT
S
AGGREGATE
$
EXCESS LIABILITY
UMBRELLA FORM
-
EACH OCCURRENCE
$
AGGREGATE
S
A WORKER'S COMPENSTATUTORY LIMITS
EMPLOYER'SUABILI7YSATION AND (LIB-4042837-2-04) 12-24-04 12-24-OS
' EACH ACCIDENT $ $ 100 00 O000
THE PROPRIETOR/ X INCL DISEASE -POLICY UMIT $ 500.000
FARTNERS/IXECUTIVE
OFFICERS ARE: IXCL 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.
AUTHORIZED REPRESENTATIVE
Dates 5/5/2005 Time: 3:02 PM To: ® 15097785603
G1lent#:24359
Paget 002-003
CAPFCOtJRFARV
ACOR_ D- CERTIFICATE OF LIABILITY
INSURANCE
D 'YYY"
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Feiteiberg Company
222 Milliken Blvd.
P.G: BOX3220
ONLY AND CONFERS NO RIGHTS UPON THECERMFiCATE
HOLDER THISCERTI€ICATE'DOES NOTAMEND EXTENDOR-
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fall River, MA 02722
INSURERS AFFORDING COVERAGE
NAIC N
INSURE
INSURER A: Acadia Insurance Companies
Cape Cod Ready MbL Inc.
PO Box 399
Orleans; MA 02653
INSURER B: Construction Industries Compensation
INSURER C
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHSTMDWG-
ANY RWUIREMENT, TERM OR CONDITION OFANY CONTFACTOR-OTHER DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUEOOR-
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED-BYPAUD CLAMS.
TYPE OFINSURANCE
POLICY NUMBER
POUCYEFFECTIVE
DATE [MMJ)DIrn
POLICYEXPIRATIONLTR
DATE fMMA)DIM
LIMA
A
GENERAL I'A UTY
X COMMEROALGENEPALLIANUTY
CLAIMS MADE
CPA013246810-
Ot/Ot/HS-.
'
0110t/O6
EACH OCCURRENCE
$1000000
DAMAGE TO RENTED
$100 DDD
MED EXP(Artymepw+ )
$5.000
-PERSONAL 6 ADV INJURY
$1 000 DDO
GENERALAGGREGATE
S2 D68 DDD
GEM- AGGREGATE
POLICY
LIMIT APPLIES PER
PRO-
F-1ECT LOC
PRODUCTS - coMP/OP AGG
s2o00
A
_
auroLIOBILEUAMUTY
ANY AUTO
ALLOW NEDAUTOS
X SCHEDULED AUTOS
X HIREDAUTOS
X NON-OWNEDAUTOS:
MAA013246$10
01/01IMS
-
01101M .
'
COMBINED SINGLE UNIT '
lEa=Mam
51,000,000 '
BODILYINJJRY
Pe P& y
S.
BODILY INd1RY -
OPERTYDAMACE.
�aaatderrcJ
GARAGE LIABILITY
ANY AUTO
_
_
AUTO ONLY -EA ACCDENT
S
OTHER THAN EA ACC
AUTOOMr. AG3
S
6
A
ExcEssAmw%LLA LIABILITY
X OCCUR CLAMS MADE
...
DEDUCTIBLE
X RETENTION so
CUA013247010
-
01/01/05
01/01/OB
EACH OCCURRENCE
S1000000
AGGREGATE
S
S
-
S -
B
WORKERS COMPENSATION AND
EMPLOYERL Lldat6lTY- ..
ANY PRCPRIETCRIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
d
3PEQZP. OVI O Sbebvr
WC0009256
- -
-
01/01/OS
-
01/01/106
..
X WGSTATU- OTH.
- - .
EL. EACH ACCIDENT
T+ri 000-
-EL DISEASE - EA EMPLOYE
400,000
El. DISEASE POI JCY LIMIT
6500000---
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I'VERCLESlEXC1D90NS ADDED erENOORSEMEW1 SPECRK PROVISIONS'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Gatewood- Homes Inc. THEREOF THE ISSUING INSURERAMILL ENDEAVORTO MAIL 'Ul DAYSWRRTEN.
1600 Falmouth Road Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SO SHALL
Centerville; MA 02632 MPOSENooeLIGILTIONORLIABIUTYOr-ANYPONDUPONTHEINSURER,ITSAGENTSOR
ewvnvea Lew/ual 7 -OTY NT56899s/M6WZ6 AH1 O-ACORD CORPORATION 19a9'
05/06/2005 09:38 5084204474 EDWARD A GRAZUL PAGE 02
ACORR - CERTIFICATE OF UABIUTY.
MoouceR
��
`Fj�y.^�J��
A G�aa11.In9La2vre T Imo•
P:0 RAC 337 '
Manum Mills, Ma C2648INSURERS.AFFORDINGOOVERAGE
onttlNNAarrrvl
INSURANCE. 05/ta/Tr
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
UPON
ONLY AND .CONFERS NO RIGHTS UPON THE CERTIFICATE
ALTER THE �OVERAGFE AFFORDDED :-09
B THE PPOOVOT U'CIES HfiMLOW
-_NAIC+C
_
wsuREo
Ste�ai QYTIds
145 Camett �
Marstcxls Mills, VA 02648 •
wsuAEas--; M 12a-C30abt' Ili•.
WSUFlEA9:..
N��
tHS�,FERnc
� wsuaFae
—
_ ----
,, �•� 6NDULD ANr OFTHE ABOVE neeCmnlO rOLICN!3.0l GwHCELLED OFiORE.TNF pe9�wwTwH
Gate 67ad 1k:111 jT im.... 9ATt TMENIOF: THE �!R VBLL INEA DVOR TO YA0. PAYS M70TTEN
Glo Pall Tam tbu . - H07Mg TQTHE CVnMCAT! HOLDER HAN{O TO THE LEFT. our FA0.UrE TO DD Sa SHALL
.. Rte -233--- - RaPOSE UGAUM-OR WORM OF. ANY. KM.UPON THE INSDREXRSAGVff9 ell
_
Calt�lle, MA 02632 PINMESENTATM13.
FAX:. 1-508-778-5603 AuTNDw.wrlrnESENTAT^a -. 1...
25(2001/08a-_- .
ACORDCERTIFICATE OF LIABILITY INSURANCE
° 10 zs` rzo'a
PRODUCER 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 PIKE
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
GREENVILLE, RI 02M
INSURERS AFFORDING COVERAGE
NA"
INSURED
INSURER A- NAIL FIRE INSURANCE CO. OF HARTFORD
INsuRER e: VALLEY FORGE INSURANCE CO.
HOLMES AND MCGRATH, INC.
INSURER C- CONTINENTAL CASUALTY CO.
362 GIFFORD STREET
INSURER D_
FALMOUTH, MA 02540
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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS-
e6rt
TYPE OF INSURANCE
POLICY NUMBER -
POLICY EFFECTIVE
EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
S 1,000,000
DAMAis O ENTED
S FIRE ZSO,000
X COMMERCIAL GENERAL LIABILITY
A
CLAIMS MADE ❑X OCCUR
1074082434
10/06/04
10/06/05
MPRED EXP tAny one
$ 10,000
PERSONAL S ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000 000
GENL AGGREGATE LIMIT APPLIES I M
PRODUCTS- COMP/OP AGO
S 21000 000
POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
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09/01/04
09/01/05
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AEA 00 43133 38
07/13/04
07/13/05
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DESCRIPTION OF OPERATIO NSlLOCATIONS SiICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIIL PROVISIONS
AGGREGATE LIMITS ARE PER THE TERMS AND CONDITIONS OF THE POLICIES.
1
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.
1600 FALMOUTH RD., STE. 25
CENTERVILLE, MA 02632
NOTICE TO THE CERTIFICATE 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
REPRESENTATIVES
ALIT REPR
1
ACORD 25 (2001/08) l /' ® ACORD CORPORATION 1988
C.TMPROICERTPROS.FP5 /
CERTIFICAT.E.OF LIABILITY INSURANCE
DATSIMMAODAYYTI
S,/4/05
THIS CERTIFICATE IS 13SLEDASA MATTEROF INFORMATION
d Insurance Agency, Inc.
nBuzzards
ONLYANDCONFERSNORIGHTS UPONTMECERTFFICXT-E- -
ain Street
ALLTERFECW�GEAFFOR�BYTANEPPOLICIEXBB9-0w•Box
101.3
Bay, MA 02532
INSUFMtSAFFORDING COVERAGE NAICA
INSURER k Zurich NA
INSURED
Patton Electric, Inc.
.. .
INEURER8:Liberty Mutual TRZ- CO.
129 Scituate Road
INSURER C'.
Mashpee, MA 02649
INSURERO:"
OVE RAUes
OVEFOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN tSSVEO TO THEINSUREO NAMED Al
ANY REOUTREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO IAMICH.THtSCERTIFICA-WM4Y -BE ISSUED OR
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ay Homes RI , unit ZS PATETNEREOF. TutmuDNOINSURER WILL GNJ)R*ORTOMAL �Qr DAYSwRRTEN
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s AG(�%D `'CERTIFICATE
OF LIABILITY
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z DATE(MMDD/W)
9 15 04:
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Chatfield, Whitman & Young
I
549 Washington Street
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
COMPANY .
Lawrence Robinson Masonry
B
5-Fresh Hole Road
COMPANY
Hyannis, MA 02601
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, 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
_
POLICYNUMBER
POLICYEFFECTIVE
DATE(MUMMY)
POLICY EXPIRATION
DATE(MMIDY)
WY
LIMA
GENERAL
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GENERAL AGGREGATE
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CB 7E 32 32
9/07/04
9/07/05
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EACH OCCURRENCE
$ 1,000,000
OWNER'S& CONTRACTOR'S PROT
-
FIRE DAMAGE (Any one fire)
S 100,000
MED EXP (Any me person)
$ 5,000
AUTOMOBILE
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ANY AUTO
COMBINED SINGLE LIMIT
$
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(Per Person)
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DESCRIPTION OF OPERATIONS/.00ATIONSAIEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER-,w
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Gatewood Homes
1600 Falmouth Road
Suite 25
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 ,DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Centerville, MA 02632
BUT FAILURE TD MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABI
OF ANY KIND UPON THE COMPANY__FF@ *EM VlrlpeaSENTA S.
AUTHORIZED REPRESENTATIVE
Robert R. Chatfield
ACORD25S(1195) ,. ,. _:? ��� ,-..>� ._ .._''•..,. =
-` +r-- -
, , ., �: ,.r:,* __._ :_ -. �:.=oRQCORPO '198$T
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ACORD,N CERTIFICATE OF LIABILITY INSURANCE. Ro 6 09-27 2004
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
PAYCHEX AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
210706 P: (877)287-1312 F: (877)287-1315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
308 FARMINGTON AVE INSURERS AFFORDING COVERAGE
FARMINGTON CT 06032
I INSURED
LAWRENCE ROBINSON MASONRY INC
5 FRESH HOLE ROAD
F
L.0 V t:NAUCJ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTNE
DATE MM D
POLICY EXPIRATION
DATE MM D
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
a
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a
COMMERCIAL GENERAL LIABILITY
MED EXP (Any one parson)
a
CLAIMS MADE DOCCUR
PERSONAL& ADV INJURY
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8
GEN'L AGGREGATE LIMIT APPLIES PER:
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9
17
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(Ea accident)
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76 WEG NQ5620
09/06/04
09/06/05
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OTHER
D£SCRMTION OF OPERA TIONSAOCATIONSNEMCLESJEXCLUSIONS ADDED BY EAVORSEMENTISP£CDIL PROVISIONS
Those usual to the Insured's Operations.
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 110 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
GATEWOOD HOMES
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1600 FALMOUTH ROAD, SUITE 25
REPRESENTATIVES.
CENTREVILLE MA 02632
AA&TWRIZEDREPRESENTAA
ACORD 25-S (7197) - A�.unu �.ai nr�nrrr w,v , aw
)L
12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC 02
'AC ORD CERTIFICATE OF LIABtL[Tif,MURA- NC--E o°i4 --
TAANS12 ao
GOLDMAN & ASI;OCIATaS INSURANCE THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
FINANCIAL S81tVIC83 INC. HOLDER: THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
933 FALMOUTH RD. ALTER THE COVERAGE AFFORDED. BY THE POLICIES BELOW.
BYANNIS MA 0:1601
PhOUS1568-775-6010 Faxs1508-790-0249 INSURERS AFFORDING COVERAGE NAIC#
INSURED
INSURERa MARYLAND CASUALTY COMPANY
INSURER B:
RODNP:Y TAVANCI
DHA bOECHANICAL SYSTE KS INSURER C:
W1BASNSTASLBLANEMA 02668 INSUREaa
THE POLICIES OF NSUQAWZ USTEO BELOW HAVE BEEN IMEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY RGgUIRCAiNT. TTRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE IN$JRANCE AFFORDED BY THE POLIM DFSCRIKD HE" IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN RFD C_FD BY PAID CLAIMS.
LTR IN3Rl TYPE OF INSURANCE POLICY NUMBER DATE AMID DA MMVD _ _ LIMITS_
A
GENERALLUJRIJTY
Y COMMO3CIALGENERALLABILITv
CLI'AMAW ❑ OCCUR
000372088
11/21/04
11/21/OS
EACH OCCURRENCE
S 1000000
PRE'mLsEs
13300000
MEDEXP("mepemol)
f 10000
PERSONAL& ADV NUURY
$ 1000000
GENERAL AGGREGATE
3 2000000
GEM AGGRL13ATE LIMIT APPLIES PER:
PRODUCTS -COMPIOP AGO
32000000
POLICY ! JPF�CT LOC
ALITOMOBRII:
LLA9RITY
.. ..
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COMBINED SINGLE LIMIT
(Ea oWdent)
S
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fParPerwn)
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COMPENSATION AND
79APLOYER6'LIABIJTY
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DESCRIPTION CF OPEEi'TGNSJLCUTX.X9YVENICI=a/ETD - y-�AtRpeyplgMq--...
aRT—AlloOD-fi0MES INC"'
FAx 508-778-5603
1600 FALMOUTH ROAD SUITE 25
C82MRVT'LLS MA 02632
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATETHEREOF. THE ISSUNG INSURM TALL ENDEAVOR TO MAIL 30 GAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY LOND UPON THE INSURER ITS AGENTS OR
ACORD 25 (2001108) "" OFACORD-CORPOWITION-U .,
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05 0 6 OS
THIS CERTIFICATE M ISSUED AS A MATTER OF INFGRMATtOt4,,
ON - AND- CONFERS- No - R4GHTS UPOM - THE--CERTjFjcATs__
GOLD14AN & ASSOC INS FIN
933 FALMOUTH RD
.HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALrER-THEcmERAGeAFraRomEff-Tuap6EE94-;ti:inw
RTE 28,
HYANNIS MA 026012319
COMPANIES AFFORDING COVERAGE
COMPANY
26HPP
. . A, AmzRrcAJq'ZURICH'TNSURANCE -COME'=
INSURED.
COMPANY
TAVANO, RODNEY IDEA
B
MECHANICAL SYSTEMS
201 CAPES TRAIL
WLST"BARNSTAZLE MA 02668
COMPANY
C_ -
COMPANY
D.
CG1fERAGEs
THIS aTOrCERTlFY THAT THE POLICIES OF INSURANCE LISTED BUM HAVE BEEN ISSUED TO THE INSURED NAMED ABOVETOR THE PolicrpEricir
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE --MAY BE ISSUEUL OR -MAY PERTAIN, THFJI`,MURANCF_ AFFORDED_ BY_THE_ POLICIES. DESCRIBED HEREIN AS SUELIECT TO -ALL -THE TERMS,
EKLUSIONS-ANO CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTF
TYPE -OF INSURANCE.
POLICY-NUMOEEL
POLICY EFFECTIVE
UATEVMD")__
POLICY EXPIRATION
DATEMBRMyf
r
LIMITS
GENERALUABIUTY
GENERAL AGGREW. E
3
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=CLAIMS MADE =O'CCUR.
PRODUCTS-COMP/DPAGG,
PERSONAL & ADV. INJURY
EACRO=RT?FNCE'
OWNERS a CONTRACTORS PROT.
FIRE DAMAGE (Any one fire)
$
MEO. EXPENSE(Any one person)
$
AUTOMOBILE LIABILITY
-77-
ANY -AUTO
COMBINED SINGLE
�UMIT-
ALL OWNED AUTOS
...
BODILY INJURY
SCHEDULED AUTOS-
(Per Person) .
3.
HIREOAUTCS
N0N.OWNEa_AUTOs_
BODILY INJURY
(Per Acdclard)
$
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$
IGARAGEJJABIUTY
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
S
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
UMBRELLA FORM
AGGREGATE
OTHER THAN UMBRELLA FORM
A
WORKERS COMPENSATION AND
EMPLOLYERSLUABILITY
(UB-7278AB4-9-05)
05-03-05
05-03-06
STATUTORY LIMITS
EACHACCIDENT
S 100-1 000
THEPROPRIETORI
PARTNERS/EXECUTIVE INCL
Rx-
DISEASE -POLICY LIMIT
$ 50-0,000
OFFICERS ARE: EXaL
DISSASE—EACWEMPLOYSc
-& QU
ER_..
I
DE$CMPTION OF OPERATIONWLOI:ATIONS/JVEHCLESiRESTPACTION$iSPFCIAL ITEMS'
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
FRI
CANCEE 'r
SHOULD ANY OF THE ABOVE DESCFUBEQ POLICIES BE CANCELLED BEFORE THE
'EXPIRATION
DATE THEREOF, THE ISSUING' COMPANY WILL ENDEAVOR TO MAIL
GATEWOOD HOMES INC
1600 FALMOUTH RD SUITE 25
-10 DAYS' ' WlUrEN NOTMTTO-rttEceRnFnnrmtoEFtffmw-raTme
-LEFE,_ELUT. FAtLURE_T0_ MAlLSUQHNDTlrE SHALL IMPOSE No OLSLLGATIQN OR
CENTERVILLE MA 02632
UABIUTY OFANY KIND UPONTHECOMPANY, FTSAGENTSOR REPRESENTATIVES:
AUTHORIZED REPRESENTATIVE
v
RW RaEss: sAe
:ALCU,i N FOR PER,Mit COST `
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11116,19
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., #111
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
: Villages O Camp St., LLC
: 1600 Falmouth Rd:, #25
: Centerville, MA 02632
�'e& , Z-�L'
Yarmouth Water Department
• TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-05-611
Applicant Name:
Frank Capra
Applicant Phone:
5087789669
Building Location:
00121 CAMP ST Unit 111
Owner's Name:
Villages @ Camp St., LLC
Owner's Addres
1600 Falmouth Rd # 25
Centerville MA 02632
(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:
Owner's Telephone: (508) 778-9669 L
REVIEWED BY:
1. WATER DEPARTMENT: DATE: / N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT:
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
Date Printed: 5/24/2005
--V
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-05-611
Applicant Name: Frank Capra
Applicant Phone: 5087789669
Building Location: 00121 CAMP ST Unit 111
Owner's Name: Villages @ Camp St., LLC
Owner's Addres 1600 Falmouth Rd # 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
' n[9@F90WM F2)
Owner's Telephone: (508) 778-9669
HEALTH DEPT.
REVIEWED BY:
1. WATER DEPARTMENT:
DATE: N/A:
2. ENGINEERING DEPARTMENT:
DATE: N/A:
3. CONSERVATION:
DATE: N/A:
4. HEALTH DEPARTMENT:
DATE: N/A:
5. BUILDING DEPARTMENT:
-—/
DATE: N/A:
6. FIRE DEPARTMENT:
DATE: N/A:
PLEASE NOTE
COMMENTS: _
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 5/24/2005
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-05-611
Applicant Name:
Frank Capra
Applicant Phone:
5087789669
Building Location:
00121 CAMP ST Unit 111
Owner's Name:
Villages @ Camp St., LLC
Owner's Addres
1600 Falmouth Rd # 25
Centerville MA 02632
'
Owner's Telephone:
(508) 778-9669
(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:
ZONING APPROVED'
REyIEWED BY:
L,1/WATER DEPARTMENT:
DATE:
N/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
v'4. HEALTH DEPARTMENT:
DATE:
N/A:
1
5. BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT:
DATE: / ` 13.05-
Date Printed: 5/24/2005
Mt-ussIu MPD3530 MPD4035
33' fireplace w/opt. /lush face 3S' fireplace w/brushed stainless 40' fireplace w/polished brass w
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
polished brass or brushed stainless trim options.
MPD4540 MPD4035
Standard
• 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
power 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 fireplaces urine either
(rigid) or Secure Flex Iflew"b1e) 4.5'
ter coaxial venting system, and include a
:d warranty.
e to Lennox' ongoing commitment to quality,
Ins, ratings and dimensions are subject to
at nonce.
ditions, such as elevation, wind vent configu-
oice of fuel will affect the overall appearance
HerseyQ20006711) Wer,oek Hersey
C Fez US
The first 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, certified
under ANSI Z21.88 and CSA 2.33-M99.
MPD3530 MPD3328
DIMENSIONS (Rear vent model shown)
3328 MODELS (This model comes as a top or rear vent only)
I I a61-1
D
A e D
3/18"
Front Face
35,40 & 45 MODELS
Right Side
Top
(These models come with a top and rear vend
Front Face Top Right Side
FIREPLACE & FRAMING DIMENSIONS
35M
351/s
321/s
19
291t 351/8 211A6 2478
12%6
351/4
351/4
16
4035
401/8
374
24
341A 401/s 2611A6 29h
14L'A6
.401/4
401/4
16
4540
401/s
374
24
391t 451/s 2611A6 343s
17%16
451/4
401/4
16
3328T NG 17,500
45
64
62
3329T
LP
17,500
49
66
64_
3328R
NG
17,500
53
63
61
3328R
LP
' 17,500
55
66
64
3530
NG
20,000
53
64
62.
3530
LP
20,000
55
62
60
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
Look for the EnerGuide
r.. ct...a.. F..n.r.v
TYPICAL ROOM
APPUCAnONS
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software version 2.01 Release 2
CITY: Yarmouth
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 4-21-2004
DATE OF PLANS: 04/21/04
TITLE: The Sandpiper
PROJECT INFORMATION:
Mill Pond village
Camp Street —
Yarmouth, MA 02673
COMPANY INFORMATION:
Northside Design Assoc.
141 Main street
Yarmouth Port, MA. 02675
COMPLIANCE: PASSES
Required UA = 223
Your Home = 138
I
Permit #
I
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checked by/Date
Area or Cavity Cont. Glazing/Door
Perimeter R-value R-value U-value UA
----------------------------
---------------------------------------------------
CEILINGS
845 30.0 30.0
14
WALLS: Wood Frame, 16" O.C.
1415 15.0 15.0
62
GLAZING: windows or Doors
93
0.340
32_
GLAZING: windows or Doors
80
0.340
27 '
DOORS
40
0.086
3
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed
building design described
here is
consistent with the building plans,
specifications, and other
calculations
submitted with the permit application. The proposed building
has been
designed to meet the requirements of the Massachusetts Energy
Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HvAc equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and 34.4.
Builder/Designer Date
Massachusetts Energy Code
MAScheck Software version 2.01 Release 2
The Sandpiper
DATE: 4-21-2004
Bldg.
Dept.
Use
I
I
I
I
I
I
[]
[]
CEILINGS:
1. R-30 + R-30
Comments/Locati
WALLS:
1. wood Frame, 16" O.C., R-15 + R-15
Comments/Location
WINDOWS AND GLASS DOORS:
1. U-value: 0.34
For windows without labeled u-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
comments/Location
2. U-value: 0.34
For windows without labeled U-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
DOORS:
1. U-value: 0.086
Comments/Locati
AIR LEAKAGE:
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
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.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
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
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I. 7
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
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.):
HEATING SYSTEMS:
Low pressure/temp
LOW temperature
Steam condensate
COOLING SYSTEMS:
chilled water or
refrigerant
PIPE
SIZES
(in.)
TEMP (F)
2" RUNOUTS
0-1".
1.25-2"
2.5-4"
201-250
1.0
1.5
1.5
2.0
120-200
0.5
1.0
1.0
1.5
any
1.0
1.0
1.5
2.0
40-55
0.5
0.5
0.75
1.0
below 40
1.0
1.0
1.5
1.5
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+"
170-180 0.5 I 1.0 1.5 2.0
140-160 0.5 I 0.5 1.0 1.5
100-130. 0.5 I 0.5 0.5 1.0
----NOTES TO FIELD (Building Department Use Only)------
PRODUCT SPECIFICATI
GMS9/GCS9 SERIES
93% AFUE
Multi -Position,
Single-Stage/Multi-Speed
Gas Furnace
Heating Capacity:
46,000-115,000 BTUH
W IMBED 1 PARiS
LIM IT EO
=NE�ii allLW?GE WARRANTY _4
. u4 E k num® 3
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 fumace 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 fumace for
heating or combination heating/cooling application
• All models comply with California NOx Standards
• Suitable for direct vent (2-pipe) or non -direct vent
(1-pipe) applications
Air Conditioning & Heating
The GMS9/GCS9 single -stage,
multi -speed gas furnaces offer
installation versatility.
Cabinet Construction
• Heavy -gauge, reinforced, fully insulated•steelcabinet
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 (LPLPOl)
• High Altitude Natural Gas/L.P. Kits (HANG11,
HANG12, HALP10)
• High Altitude Pressure Switch Kit (HAPS27)
• External Filter Rack (EFR01)
• Horizontal Concentric Vent Kit (HCVK)
• Vertical Concentric Vent Kit (VCVK)
• Internal Filter Retention Kit—upflow, horizontal
(RF000180)
• Internal Filter Retention
Kit—downflow
(RF000181)
• Thermostats Blower Motors
(CHT18-60, CH70TG,
CHSATG, H20TWR)
SS•377D www.goodmanmfg.com 6/04
�P S /
%
0ik'�O�� pOSF�
°F
00 \ 9S 4
PROPOSED
/ WATER SERVICE
AREA
SF�F� SFD
�q)r
LOT 110��
20 10 0
A
AV
i� - � - �9�4• r3
y ^�
.\ 3 /ry
GRAPHIC SCALE
( IN FEET )
1 inch = 20 fL
PLOT PLAN
OF LOT 111
PREPARED FOR
MILL POND VILLAGE
IN
YARMOUTH, MA
SCALE: 1"=20' DATE: 1-5-05
727
LOT 112
ry
E, L SEWER LLA'-T—E•RAAL SHALL -BE
f•
SLEEVED IN ACCORDANCE
3 I WITH TITLE V IF WITHIN
f ; 10FT. OF WATER MAIN.
LQ--CE
..,��ir, 944C'Onless and until such time as the original (red) stamp of the
responsible Professional Engineer, or Professional Land `jirveyor
appears on thia plan:
(A) no person or persons, Including any municipal or other
public offfctals, may rely upon the information contained herein; and
(8) this plan remains the property of Holmes & McGrath, Inc.
holmes and mcgrath, inc.?" �_• ��N
civil engineers and land surveyors
362 gifford street
falmouth, ma. 02540
J /
JOB NO: 201197 DRAWN: LMC (�
DWG. NO.: A2537 CHECKED: y,,,_j � Jo
IN
0
s
LOT110 sass.
EXISTING
FOUNDATION
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
SPECI L FLOOD HAZARD E
99
DATE REGISTERED KOFESSIONAL
LAND SURVEYOR
NOTICE
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.
EXISTING
FOUNDATION
4011
12
112
01
i /?� a �8• EX
FOP
h
1 CERiiFY THAT THE FOUNDATION IS
LOCATED ON THE LOT AS SHOWN, AND
THAT ITS LOCATION CONFORMS TO THE
MINIMUM SETBACK REQUIREMEN
THE B SP CIAL PE
.9 ATE REGISTEREV PRRFESSIONAL
LAND SURVEYOR
GRAPHIC SCALE
10 0 20 60
1 inch = 20 ft. __._
AS —BUILT PLAN
holmes and mcgrath, inc.
�`,n MA9f9��
OF LOT 11
civil engineers and surveyors
o� MICH AEL
�y
PREPARED FOR
_land
362 gifford street
MCGRATH
H
MILL POND VILLAGE
Falmouth, ma. 02540
289E8
x
IN
9 O
EC
YARMOUTH, MA
JOB No: 201197 DRAWN: LMC
�O
SCALE: 1"=20' DATE: 9-19-05
DWG. NO.: A2537A CHECKED•
PGS
CERTIFICATE OF INSURANCE
ISSUE
05/06ATE(MM/°D/YY)
/2005
PRODUCER
Harold H Williams Ins Agcy Inc
81 Bassett Lane
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.
COMPANIES AFFORDING COVERAGE
COMPANY A.I.M. Mutual Insurance Co
LETTER A
INSURED
Stephen M Childs
145 Cammett Road
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 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
LTR
TYPE OF INSURANCE
POLICY NUMEER
POLICY EFFECTIVE
DA1'E(MM/DDlYY)
POLICY EXPDRATIO
DATE(MM/DD/YY)
LIMITS
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
LAIMS MADE�CCUR
OWNER'S& CONTRACTOR'S PROT.
GENERAL AGGREGATE
S
PRODUCTS-COMP/OP AGG.
S
PERSONAL&ADV. INJURY
f
EACH OCCURRENCE
f
FIRE DAMAGE (Any one fire)
f
MED. EXPENSE (Any one Person)
f
AU'1'OA1O1I(LE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
CHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
INED SINGLE
LIMIT
S
(Per
BOnl�NJURY
$
BO
(Per
S
PROPERTY DAMAGE
I S
A
;EXCESS LIABILITY
MBRELLA FORM
THER THAN UMBRELLA FORM
'ORI:EIR'S COMPENSATION AND
MI'LOYCRS'LIABILITY
rHE PROPRIETOR/ INCL
ARTNERSIEXECUTIVE
FFICERS ARE, X EXCL
7015793012004
12/13/2004
12l13/2005
EACH OCCURRENCE
$
AGGREGATE
S
X A
EL EACH ACCIDENT -
f 100,000
EL DISEASE —POLICY LIMIT
f 5nn 000
EL DISEASE —EACH EMPLOYEE
S 100000
O"THER
I)ISCRI I.1'ION OF 01'I7RAI'IONS/LOCATTONS/VEIDCLES/SPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
-
GateW00d I1orneS -
Bell Tower Mall Rte 8
Centerville, MA 02632
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
/�—w�
RE -INSPECTIONS
In.- RE -INSPECTION - $26.00
2ND RE -INSPECTION - $30.00 V
3RD RE -INSPECTION - $40.00
VAY005
By 66
ALL OTI ER RE -INSPECTIONS - $40.00
DATE: S // o G
DATE RECALL:�S ! 0 6
ISSUED
REASON FOR RE-
BUILDINGDEPT.: C3
OCCUPANCY PERMIT:
PLUMBING PERMIT:
ELECTRICAL:
FIRE DEPARTMENT:
OTHER