HomeMy WebLinkAbout121 Camp St #115 Building Permits�� OF Y,g93
TOWN OF YARMOUTH
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APPLICATION FOR PERMIT TO DO GASFITTING
(OFFICE USE ONLY)
By
Fee: $ �(
PERMIT NO. "
Date
Building �+ Owner'g
AT: Location r? C t'� S T
Type of Occupancy / l
New LY Renovation ❑ Replacement ❑ If
Plans Submitted Yes ❑ No t'
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SUBIBSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name
L] �+-�UGTS ^ �� /���1 ►^� ITEJ�
Address 1 C 44AI E 15
f4epqNiyis MA 026,a1
Business Telephone
Name of Licensed Plumber o#er
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent. Yes f�I'No ❑
If you have checked yes, please indicate t e type of coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity ❑
Check One:
❑ Corp.
❑ Partnership
Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed
under Permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Signature o Licensed
Plumber or Gasfitter
e
2, 1 S E0%
License Number
Tvoc 11r.=NQr.-
142 of
\1A1 8
_ /
=105.00
L 127
R 71
omit" PAY
R_145.0U
C=49 8g� L�0 08!. w
o I o
F13.64 6.9'
�o o EXISTING
o W FOUNDATION
W j N
)N fJ�
q; ,
LOT 114 I OT 115 2
_\ f
S81'47'10"W
I CERTIFY THAT,THE FOUNDATION IS
LOCATED ON THE LOT AS SHOWN, AND
THAT ITS LOCATION CONFORMS TO THE
MINIMUM SETBACK REQUIREMENTS OF
THE 40B SPECIAL PERMIT.
6ah19 zrs�f
DATE REGISTERED PROFESSIOWAL
LAND SURVEYOR
NOTICE
Unless and until such time as the original (red) stamp of the
en^,,ns'.b!e Profes<ional Engineer, or Professional Land Surveyor
appears on this plan:
(A) no person or persons, including any municipal or other
officals, may rely upon the information contained herein; and
(a) this p!on remains the property of Holmes & McGrath, Inc.
EXISTING
FOUNDATION
T.
a\ LOT 116
I CERTIFY THAT THE FOUNDATION IS
LOCATED IN FLOOD PLAIN ZONE C
AS SHOWN ON FLOOD INSURANCE RATE MAP
COMMUNITY PANEL NO. 250015 0005D
AND THAT FLOOD PLAIN ZONE C IS NOT A
SPECIAL FLOOD HAZARD AREA.
DATE REGISTERED PR FES ZONAL
LAND SURVEYOR
GRAPHIC SCALE
( IN FEET )
1 inch = 20 M
AS —BUILT PLAN holmes and mcgrath, inc. ,,�°"'a`F"°�•.
OF LOT 115 civil engineers and land surveyors Mlctt�LS'y�
PREPARED FOR o &
M362 gifford street
ILL POND VILLAGE
IN falmouth, ma. 02540 '8 McGRATH N
No. Z 7
YARMOUTH, MA JOB NO: 201197 DRAWN: LMC OFF 9
SCALE: 1 "=20' DATE: 10-18-04 DWG. NO.: A2533A CHECKEDY`0L ,
GIL
tec tibbet#s engineering core_
CONSULTING ENGINEERS
716 CountyStreat. Tom ton?AA 02780 Tat. (308) 822-6934 Fax. (5M 880 MI
Report of Anr'e9ate-Wet9ieve Afw1ysh (ASTNFEt3P
Client:. Gatewood Homes Job No. 10980.010 �l
1600 Falmouth Road, Suite 25 Date: O&V7N2
Centerville, MA 02632 Report No.: MA2126B
-Project: - ilAiU Pond Ydla ei- -----
Material:
Location: Onsite Stockpile
Specifications:
Sampled By: P. Fagundes Date Sampled: 518M
Tested By: M. White Date Tested: 5/7/02
-----------------____::�______________=_�_______
ANALYSIS RESULTS
Sieve Size Weiaht Retained % Retained % Passino
(Grams)
11nch
0.00
0.0
100.0
1/21nch
27.20
1.4
93.6
No.4
31.08
1.6
97.0
No.10
45.97
2.4
94.7
No.20
285.35
14.6
80.0
No.40
773.28
39.6
40.4
No.50
364.90
18.7
21.7
No.100
346.46
17.8
4.0
No.200
45.87
2.4
1.6
Pan
31.55
1.6
Remarks:.
Walter P. Galuska
Laboratory Supervisor
Sample Wt.(g) = 1951.66
Specification Gradation Limits
Mln. - Max.
SEP 2 S 2004
- ---------=-----!as====
M_ Wt
Laboratory Technician
V;-�- /1,5-//3
T
Cj
CZ
TIBBETTS ENGINEERING CORP.
Grdph of 8iev� Analysis Results
Usina AASHTO T21 & T11
100
90
80
b, 70
3 60
50
LZ
40
30
20
10
0
.01 1
Job No. 10§80.010
Mill Pond Villogib
Report No. MA212W Date: 5/07/02
1 10 100
Groin Size in Millimeters
r
G/ FWOO D
=1:1 O M E S =
1600 Falmouth Road, Suite 25
Centerville, MA 02632
jspalt@bellatlantic. net
Rick How,
p/508-778-966
f/508-778-560
5078 -
AP
000000 tcc- b- b et s EnginEs�ing Corp.
CONSULTWG aIGIN=RS
716 County S`��t; T=it=n MA 02780 Tel (508) 822-6934 Fax (508) 880-
E-MzU— �-wb@obKtseering.com l i
TECHNICIAN'S DAILY REPORT_OF CONSTRUCTION
PROJECT: Mill Pond Village DATE: 9/16/04
W. Yarmouth, MA
CLIENT: Gatewood Homes
CONTRACTOR: Client
EOUIPMENT WORKING: None
MEN WORKING: Rick Howe of Gatewood Homes
WORK PERFORMED:
JOB NO.: 10980.010
FIELD TEVUYTRAVEL TIME:
5 hours
In accordance with a request from the client, I arrived at the referenced job site at 11:45
Am to perform soil compaction tests. Upon my arrival I met with Rick Howe of Gatewood
Homes who informed me that he needed compaction testing on lots 113 to 115. I noted that the
test areas were previously compacted with a vibratory plate.
I performed a total of four compaction tests. One test failed on lot # 114. A retest was
taken after re -compaction. All other tests passed the minimum 95% compaction according to
industry standard. See attached report for further detailed test information.
Once testing was finished I packed up my equipment and left the job site.
Paul Fagundes
Lab Technician
SEP 2 7 2004
1
tibbEtts EnginEaing corp.
` ` 3 CONSULTING ENGINEERS
716 CountyStree%Tatut=MA02780 Tel. (508) 822-6934Fax. (508) 880-7811
FietdDensity Test Report - Sand Cone Method (ASTM D1556)
Client: Gatewood Homes Job No. 10980.010
1600 Falmouth Road, Suite 25
Centerville, MA 02632 Date 9/16/2004
Project: Mill Pond Village
Test No. Location of Field Density Test
FD4260A
Lot # 113-Footing Base -Center -Sand
FD4260B
Lot# IWooting Base -Center -Sand
FD4260C
Lot # 114-Footing Base-Z Left of Center -Sand
FD4260D
Lot # 115-Footing Base- Center -Sand
Report # #2
SEP
Tabulation Field Density Test
Results
Data: Test No.
Proctor I.D.
Req, % Obtained
Meets
Moisture
DryWt
Max Dry
OpWmn
Compt. Compaction
Specs.
Content
P.C.F.
Wt. PCF
Moisture
9116/20M i 3 FD4260A
'PR4252E
95 95.6
Yes
6.5
119.9
125.4
8.2
12004 // y FD4260B
L
PR4252
No
6.4
118.2
125.4
8.2
/2004 i/i FD4260C
PR4252E
95 96.9
Yes
5.7
121.5
125.4
8.2
9/16/2004 iI j—FD4260D
PR4252E
95 100
Yes
7.9
126.4
125.4
8.2
Remarks: All test areas met the specified minimum compaction of 95%.
t .✓ Paul Faaundes
Watter,P. Galuska Laboratory Technician
Laboratory Supervisor
aF TOWN OF YARMOUTH Building Department BUILDING
_ - - - - - - _ - - , (508) 398-2231 ext.261
PERMIT NO B-05-239 _ PERMIT
.� ISSUE DATE ;_ 8/17/2004 _ ; PROPOSED USE
APPLICANT _Frank Capra- - - - - - - - - - - - - - - - - - - JOB WEATHER CARD
PERMIT TO ' New Construction '
AT (LOCATION) 100121CAMPST#115 ZONING DISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C115 I BUILDING IS TO BE: CONST
LOT SIZE
new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans
REMARKS dated 08/05/04.
AREA (SO FT) EST COST ($ I$117,024.00
OWNER lVillages at Camp St., LLC
ADDRESS 11600 Falmouth Road # 25
Centerville I MA 102632 1 5z
PERMIT FEE ($) 1$427.00
.DING DEPT BY
5-B USE GROUP R-4
CONTRACTOR
LICENSE 072430
Capra, Frank
1600 Falmouth Road #25
MA 02632
Certificate Issue Date � // ��y� `CERTIFICATE of OCCUPANCY
Departmental Approval for Certificate of Occupancy and Compliance V
Inspector
Date
Permit Number
Approved By
Remarks
BUILDING
92
PLUMBING/GAS
ELECTRICAL
ENGINEERING
OTHER41j/
4�
�sds
d
To
be filled In by each di
ion indicated hereon upon completion of its final inspection.
Pq
TOWN OFYARMOUTH Building Department gIJILDING
(- - - - _ _ _ _ (508) 398-2231 ext261
PERMIT NO B-o5-239 -- __ PERMIT
ISSUE DATE ; _ 8/17/2004 _ ; PROPOSED s
APPLICANT Frank Capra - - - - - JOB WEATHER CARD
------------------------
PERMIT TO ' New Construction '
AT (LOCATION) 100121CAMPST#115 ZONING DISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C715
LOT SIZE I
BUILDING IS TO BE: CONST TYPE 5-B USE GROUPC
new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans
REMARKS dated 08105/04.
AREA (SO FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00
OWNER lVillages at Camp St., LLC BUILDING DEPT BY
ADDRESS 1600 Falmouth Road # 25
Centerville I MA 102632
INSPECTION RECORD
CONTRACTOR
LICENSE 012430
Capra, Frank
1600 Falmouth Road #25
Centerville MA 02632
5087789669
FIELD COPY
Date
Note Progress - Corrections and Remarks
Inspector
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3/-05�
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ONE & TWO FAMILY ONLY - BUILDING PERMIT
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
'4 Office`Us6 Only '
Plarining Board Ir formatioria
Assessors`Department Inforraton' s �
Ptankiype
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Sectro>„ SIteCnforrriatar; Use Group: R-4 Type: 5 B
1.1 Property Address:
1.2 Zoning Information:
CA
L,o ���,�_ 1 4S—L�
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 e. 40. S 54)
1S EloodZone•Ibfomtano ft Oorggients r
i �8 1 d'.i^-r'4i�
Public
".^'rydS P% { Fi i` "t+•.,
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Private
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,t35p`Zt)Lie°t
;Sectiii)i ZPropely Owpeiship"'lAutorizei'Agetit'
2.1 Owne of Record:
N me�print� Mailing Address C•y,, of �� v�
lc \94
Signature \ Telephone
2.2 uthorize Agent: /Innw'
n a� IM L s [ 0 0 --x ..� � GAr
Name (print) (� P A Mailing Address
Signature Telephone Fax
.107 io0, `donstructtpn` SerYtc6s*
3.1 Licensed Construction Supervisor.
No li
P ((0./(�
e
Lice um
r ff IIn.
(1� 3a
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o
Address�
Expiration Date
S ature� Telephone
3 2 E3egsteredfHarne ffrip
Company Name '!)
t
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Not Applicable ❑
Address
License Number
-- -
Expiration Date
Signature TBf�pt�sr�'-
7
L,ml
9-15-99
1 of 2
OVER
..: . -�
ecttan,4-Wdk+�rs':CompeiisatiDr3 fnstiian�eAffldavtt"MLa(52 Y
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial f the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Sectl{in i? .DescliptionTof Proposed Wo`ii(; (checkafl,apjilicaf fe
New construction No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ 1 Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
`I - fv�'
f
W`t 4" V 4
Costs
SQcfot 6 'lvstrriatetl fofistriacforr
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
❑ Conservation -commission Fling
(if applicable)
❑ Old Kings Highwayi£ 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)
6 ,
7. Total Square Ft. (new arouses & adchons)
7j
Section 7a fJwnerAuthorrcatrori
fwines� entw€�ntractoclp lfes.#orSuitdtn�Permit
?To be Gompfeted INher,
.„;
( " 0 ,/a`s owner of the subject property
hereby authorize J L� �"" 'e S 0.�—K ` O-P I�i� to act on
m beh , in all matters elative to work authorized by this building permit ppl'cation. -
C O
Signature of Owner Date
Secfian 7b ..,Owr erlAtitliorized`A jent'[76 laratian=
t a %-, 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
Signature of dvrdedNgeint _ Date
Y
9-15-99 2 of 2
of fq�'�r
TOWN. OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: I
Job Location:
Owner of Property: V"��L Village
(L C
Construction Supervisor: (%R a190
Name License No.
Address: 0 o h" �v"tqt
k Licensed Designee:
(If other than Supervisor)
2.15 Responsibility of each license holder:
o$ 7�3 9607
Phone No.
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 Anylicensee who shall willfully violate subsections 2.15.1, 2.152 or 2.15.3 or anyother 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 yet, please indicate the type coverage by checking the appropriate box.
A liability insurance policy 31-� Other type of indemnity ❑ Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of th ss. Genie 3l L s, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
Signature: Building Official Approval:
The Commonwealth of Massachuseas
Department of Industrial Accidents
offles 0/1"es9lifffis
600 Washington Street
Boston. Mass. 02111
Workers' Compensation Insurance Affidavit
citN Uk- W11 q Z phone
1 am a homeowner performing all work myself.
1. am a sole proprietor _nd hale no one working in any capacity
0 1 am an employer pro% iding workers' compensation for my employees working on this job.
company name,
aJdress: -
city: phone a•
insurance co. noliev 0
191/1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below ho ha%e
cif: —phone 4-
insurance co. - policy 0
company name,
•
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a one up.to SI,500 00 and/or
one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Bob of3100.00 a day against me. t anderstand'that a
copy of this statement may be forwarded to the OBice of Investigations of the DIA for coverage verification.
/ do.hrreby crrr`i under p36&70�1Mt
d penalties ojprrjury that the information provided above is tnre and correct
k Signature Tc
Print name 7—CL rp, PhoneN
ofricial use onh do not write in this area to be completed by city or town ofAcial
city or town: YARMUDT$ _ .permMieense 0 n8uilding Department
pLleensing Board
cheek irimmediate response is required 261 C3Stlectmen's OMce
contact person: phone M; _ (508) 398 -2231 eat. Health Department
mOther
BUILDING
TOWN OF Y A R M O U T H ELECTRICAL
GAS
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664.4451 pLUMBING
Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365
SIGNS
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
Iconducted at ;, \ `� '
Work Aa4ress
is to be disposed of at the following location: � � I�✓r� 1/�S
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
j--le
Signature of Applicant Date
Permit No.
✓xe TOoi�Yino�uoea :.�✓4�a9JaC'%t�deiid
F BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
4;
Number: CS 012430
?� Birthdate:0611611940
Expires: 0611612004 Tr. no: 25823
Restricted: 00
FRANK G CAPRA
40 COPPER LN . 6
CENTERVILLE, MA 02632 Administrator
00 - 35,000 d enclosed space
(MGL CA 12 S.60L)
to - Masonry only
1 G -1 8 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
DIG SAFE CALL CENTER: (888) 344-7233
A RDa CERTIFICATE OF LIABILITY INSURANCE °ATE(MNVOWY"
07/18/03
DUCER THIS CERTIFICATE IS ISSUED AS A M
IDowling, & O'Neil Insurance' ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAATTEE
Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
222 West Main St..PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Hanover Ins. Company
Busy Bee, Inc... INSURER B: Safety Insurance Comoanv
P.O. Box 50 .
East Sandwich, MA 02537
COVFRAT;FS
INSURER D:
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
PDATE OLICY EFFrnVE
PMIDDIM OLITE EXPIRATION
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
'CLAIMS MADE OCCUR
PD Ded:250
OHN643998501
06/14/03
06/14/04
EACH OCCURRENCE
Si 000 000
DAMAGE TO RENTED
MED EXP (Any one person)
$300 000
$15 000
X
PERSONAL aADVINJURY
$1 000 000
GENERALAGGREGATE
$2 000 000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY JET LOC
PRODUCTS-COMPPOP AGG
$2 OOO OOO
B
AUTOMOBILE
LIABILITY
AUTO
WNED AUTOS
DULED AUTOS
DAUros
WNEDAUTOS
3175394
01/14/03
...
....... '
-
01/14 004
- ,...: ...
COMBINED SINGLE LIMIT
(Ea accident
$
BODILY INJURY
(Per Person)
$100,000
BOOILYINJURY.
(Per acc ent)
•_
S3OO OOO
,
PROPERTY DAMAGE
'(Peracddmt)
$100,000
U1011.ITY
tXCESSfUMBRELLAUABIUTY
... ....
AUTO ONLY -FA ACCIDENT
SUTOOTHER
THAN EA ACC
AUTO ONLY ' AGG
S
S
C
MBRELLA UABILnYEACH
R CLAIMS MADE
CTIBLES
NTION S
WORKERS COMPENSATION AND
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ANY PROPRIETOR/PARTNER/EXECUTWE
OFFICERAMEMBER EXCLUDED?
S yes. describe under
SPECIAL PROVISIONS below
OTHER
WCC5002932012003
06/27/03
"
06/27/04
OCCURRENCE
S
AGGREGATE
SS
We STATU- OTH-
S•
E.L. EACH ACCIDENT
$100 000
E.L. DISEASE - EA EMPLOYE
S1 OO,000
E.L. DISEASE - POLICY LIMIT s500,000
DESCRIPTION OF OPERATIONS I LOCATIONS A VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Operations performed by the named insured subject to policy conditions
and exclusions.
i
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
GateWOOd Homes DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I n DAYS WRITTEN
1600 Falmouth Road Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SOSHALL
Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES. - ,
ACORD 25 (2001108) 1 of 2 #30822 - �x
US - 0 ACORD CORPORATION 1988
...._ ,-". v - 141.-
P.O1
CERTIFICATE OF LIABILITY INSURANCE °"T=IlIMOO/YT)
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
2 cshea insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE..
MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Ont vil e, street, Suite#A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oatervills, Ma. D2655
50 9-A 2 0 - 9011 INSURERS AFFORDING COVERAGE
P16URED Caflpersoa Overhead Doors INSURERA�CicnaT T
INSURER @�-
Box 517 INSURER C!
East Falmouth, MA 02536 INSURER
COVERAGE'S fYSURER E:
THE POLICIES Of INSURANCE LISTED BELOW HAVE$
ANY REOVIREMENT. TERM OR CONDITION Of ANY C
MAY PERTAIN. THE INSURANCE AFFORDED By THE P
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEE
TGt"NEURAL
TYPE OF INSURANCE VOL
LIABILITY
MERCIAL OENERALLIABIUIY
CLAIMS MADE OCCUR
-PP48352
�N'L AGGAEOAI E LIMITTLI AI[$ PEA:
AUTOMOBILE LI.WILm
_ LAVI
OS
TOS
IOS
GARAGE UABIUTY
OCCUR CLAIMS MADE
OEDVCTIOLC
WORKERS COMPENSATION AND
EMPLOYERS LIAMILITY
A
iN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLKW PERIOD INDICATED. NOTWITHSTANgING-
VTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
,IC7ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
REDUCED BY PAID CLAIMS.
I NUMBER �POUCY EFFECTIVE POLICY EXPIRA ION '
QATE IY D D TE L.MlOQ/YYI LSMTB
Gateway Xomas
1600 FaZ-outfi Moad-, Suite 2gg
Centerville, MA 02632
778 5603
ACORD 25.3 (7rsT)
EACH OCCURRENCE —ISM( fE
c uwwAUr. i one Sro) S 5.09
MED EXP(AIMw OWUL) S
05/28/03 105/28/04 PLASONAL&ADVIN"Y SrnA Ann
I.000.000
fE�.a�aw)...�_�.•
S
i BOOS.Y INJIMY •.
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LIPFIpFaoe)
f
BODCY BLMRY
(PW oCGSw)
f
AUTO ONLY. EA ACCIDENT
f
OTHER -THAN- _ E_A ACC
f
AUTO ONLY; AGO
f
EACR OCCURRENCE
f
AOOREGA
$ -
/22/03. r2/22/04 EL•EACHACCIDENr
EL�EMPLOY f
DATE THEREOF. THE MsUING INSURER WB,L ENDEAVOR TO MAR _.-
1D_ DAYS WRTI7EN
NOHOE-TB-TNE-CERTIFICATgypLDE 60 gNALL
IMPOSE NO OBLIGATION OR LIABILITY Of ANY KIND UPON THE INSURER, ITS AGENTS OR
0 ACORD CORPORATION IS88
I l
• .• TH18 �
RIDER. RISK SPECIALISTS ONLY
HOLDi
INSURANCE AGENCY, INC. ALTER
P.O.BO% 115
CATAUMET MA 02534-0115 Oompmr
Daum A I
MONUMENT INSULATION, INC. rmy
223 COUNTY ROAD
BOURNE, MA 02532 COMPAW
c
COWANY •
THIS 13 To r >__
C6T1Fr THAT THE PAUCIEs OF WSURANCa USTED BELOW HAvE
WDICATED•NOiWITHSTANDWG 6EEAI ISSUED TO o-e<,n.•,w...5:.
CERTincATE MAY BE MSUED OR MAY PERT M THE RSZ yY AFFORDED 8Y NT, TERM OR CONDMON OF ANY CONTRACT OR THEq DOCUI
£XCUlSIONS AND CONDITIONS OF SUCH POUCIiS. UMRS SHOWN MAY HAVE BEEN POLCT.3 DESCRfBED. HEF
LTM TYRE Of IMBUNANCE ` REDUCED BY PAID C1AIMg,
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8/23/03 8/23/04 EACH
rOMOBA,E UAa LRy
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B P"MOM MWEMM!W
� H s+a WC 782 61 72
GATEWOOD HOMES, INC
1600 FALMOU*TE ROAD 02.5
CENTERVILLE, MA 02632
508 778-5603
9/5/03 I9/5/04
M
1 51� 554 7272
p.01i01
11lor in-1
ADWE FOR THE PoUCy pER=
IS SMECT TO ALL TTO HEC�g
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IL IL INE YS MNITTEN NOTICE ro THE CE MMATE HOLDER NAWM TQTNCC►T;
7O K4&
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llmuic `-�^'rw ells ON AEPe�
TOTAL p.01
CERTIFICATE O'F INLRATCE.
PRODUCER
Passaro Leverone & Buckley
Insurance Agency Inc
P 0 Box 160
Dennisport, MA 02639
INSURED
Patrick K Orcutt
Aa P & S Concrete
37 Ladys Slipper Lane
Mashpee, MA 02649
COMPANIES AFFORDING COVERAGE
A A.I.M. Mutual Insurance Co
• _""' J u RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEBN ISSUED TO TAE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,. NOTWITHSTAI.IDp,IGANY REQUIltEMENT TERM OR CONDTTION OF ANY CONTRACTOR OTHER
CERTIITCATE MAY BE ISSUED OR MAY PERTAIN, TAE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIt�IlT'S SHOWN MAY HAVE BEEN REDUCED BY pgID CLAIMS WrfH RESPECTTO WHICH THIS
HEREIN LS SUBIECT TO ALL THE TERMS,
TYPE OF INSURANCE POLICY NUAS]SER POLICY EFFECTIVE POLICY EXPIItA170 '
DATE(MM/DD/YY) DATE(MM/ppJYy) 'LiM1TS GENERAL Lunn rry
UMMERCIAL GENERAL LIABILITY
1MS MADE
WNER'S & CONTRACTOR'S PROT.
UTOMOBILB LLIBMXry
NY AUTO
ALL OWNED AUTOS
EDULED A UTOS
IRED AUTOS
NON-OWNED'AUTOS
ARAGE LIABILITY
CESS LIABILITY
MBRELLA FORM
THiJZR THAN UMBRELLA FORM
WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY
A ITNE PROPRIEI'oRJ _ (� 6006151012003 110212003 10212004
o er.m I IINn
Gatewoods Homes
1600 Falmouth Road
Centerville, MA 02632
ERALAGGREGATE
9UCTS-COMP/OP AGG.
ANAL & ADV. INJURY
i OCCURRENCE
DAMAGE (Any one fim)
EXPENSE(Any one p—_
IINED SINGLE
BLYINJURY
Person)
IR.Y INJURY
=idm)
PERTY DAMAGE
{OCCURRENCE
2ECATE
WC STATU- L ITS X C
QPY
MLACCIDPNr -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, TIMMAIL ISSUING COMPANY WILL ENDEAVOR TO
LEFT 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 BIND UPON THE COMPANY.
REPRESEITS AGENTS OR
NTATIVES.
AUTHORIZED REPRESENTATIVE
J ER 508 572 2997 THIS CERTIFICATE IS ISSU
JOAO-M-DIAS. ONLY AND CONFERS NO
DIgS INSURANCE HOLDER: THIS' CmTw;"l
535 BRAYTON AVE ALTER THE COVERAGE AF
FALL RIVER. MA 02721 INSURERS AFFORDING nnvf:
INSURED
JOE'L FERREIRA DEALMEIDA
DBA EJJA COkSTRUCTION
50-PICKERING ST. APT 17
FALL RIVER, MA 02720
RANITE STA
NUTICUS-nv:
3..ncn c:
COWRAGE3
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
ANX.RF-WIREMENT, TERM OR CONDITION OF ANY CCNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DE3CRIBED?IEREK*kS'SH9;IE6T TO ALL: TH6.TERMS, I
POLICIES. AGGREGATE LIMITS SHOWN UAY HAVE BEEN REDUCED BY PAID CLAIMS.
VSR w PO f"CCTNG POLICY E"IRATION
POIP�'NUMBER
GENERAL UASKLITY
X COYMERCIALOtwxfALW00.1TY NC275580E GC
i 06J26/2003 06/26f2004
I CLAIMSMADc 7OccuR I
LEta
E CG�LACCRECATE UMITAPPLIES PER:
DATE (M3NODIYYYY)
=08=03
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E MAY BE ISSUED OR
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S Y,00@;000-
GATEWOOD HOMES
1600 FALMOUTH RD.
CENTER VILLE. MA 02632
2S(2001/081
SHOULDANY OF THE ABOVE DUCRIam roLRxS at CANCE.YEo•REFORLTNO CMMAggN-
DATE THEREOF. THE ISSUNG N3VI= WILL ENORAYOR TO MAL 10 DAYS WRITTEN
MMWK- OTNE'COMFIGATlHOLDE*MAAWDTO THE LEFT, INIL EAAlIRET� nn en �..
UP039 NO OBLIGATION OR LI"W" Of ANY RWO UPON 1'HC INSURER, IT] AGSNTR OR
......w+ .u.i1 rAd 5087900249 GOLDMAN AssOC
ACo CERTIFICATE OF LIABILITY INSURANCE
3 GOLDMN s AsscclAns Imm= rtss.c�FCAr(3J
F210611CIAL SERVICES INC. ONLY AND CON FsRS 1
933 FAL I X V, M RD. ALTER THE IS CFRTIF
HYANNIS NA 02601 COYERA�
Pa�C A:502-775-5020 F�:SO0-790-0249 MURERS AFAy=Muc
ANO
>> NECH MICAL SYSTEMS.
110 mt jam
W' S7�RMOSDTABLS !4L 02668
a
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CATEWOOO Limes INC
FAX S08-779-5603
1900 FAIls]OT - IUWU>..
CENTBRVnIX MA 02632
11/21/03 L 11/91/04
OS/03/03 1 05/03/04
GATZIPM-j SNOUWAIMOFTM
(1 0ATtnN3tEOF. T E
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s 300
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001
11 !'TM LIEU 1 1 CRI'K
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODIYYI' PRODUCER 11/14/D3
Dpwli lg & O'Neil Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Hyannis, MA 02601
Gutter Pro Enterprises, Inc.
P.O. Box .1197
Plymouth, MA 02362
INSURERS AFFORDING COVERAGE
Guard Insurance
NAIC #
COVERAGES INsuRER E:
THE
ANY POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED A
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.OR
JR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY
A
DATE MM/DO DATE MDEXPIRATION GENERAL LIABILITY MI TY LIMITS1680459H3118TCT03
X COMMERCIAL GENERAL LIABILITY 11/07/03 11/07/04 EACH OCCURRENCE $1 DDD DDD
- DRMMI i0 RENTED
CLAIMS.MADE X OCCUR S300DDD
MED EXP (ay one pers ) s5 000
PERSONAL & AOV IN.II IRY e4 AAA ......
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBREL;:t
OCCURDEDUCTIBLE
RETENTIONB WORKERS COMPENSATI6E5
EMPLOYERS' LIABILRYANY PROPRIETOR/PARTNOFFICERIMEMBER EXCLer
P CIALSPROVcnbe IS ONS bell
OTHER
11/07/03 111/67/04
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDENDORSEMENT/ SPECIAL, PROVISIONS
ED BY
Operations performed by the named In subject to policy conditions
and exclusions.
Gatewood Homes
1600 Falmouth Road, Suite 25
Centerville, MA 02632
ACORD 25 (2001/08) 1 of 2
#32273
AGG
.COMBINEDSING
Me LE LIMITYBODILY UR S
S
BODILY INJURY
(PwWddent) S
(Per PROPERTY DAMAGE s
AUTO ONLY - EA ACCIDENT s
OTHER THAN EA ACC E
AUTO ONLY:
S
EA
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
In DAYS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do So SHALL
N
MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
2EPREsvure�...«
AUTHORIZED
0 ACORD CORPORATION 1988
A.c;vKu�, CERTIFICATE OF LIABILITY INSURANCE DATE(MM,OD/YY)
PRODUCER 07/22/2003
(508) 994-9688 FAX (508) 991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
RU77(OWSK2 & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
NEW COUNTY STREET HOLDER. THIS CERTIFICATE ALTER THE COVERAGE AFFORDED BES Y THM OOLICCE BEtn w
NEW BEDFORD, MA 02740
INSURERS AFFORDING COVERAGE
PO Box 664 'SERA Providence Mutual
West`Hyannisport, MA 02672 INSURERS: OneBeacon
.. INSURER Ct Continental Casualty: Co ._:...
. ... ._. INSURERD:—_
OVERAGES uJSURER e
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEOR
EN 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 CERTIFlCATE MAY D
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BE ISSUE
IXCLUSfONS AND CONDITIONS SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
GENERAL LIABILITY
P
MERCUIL GENERAL UABIUTY
CLAIMS MADE XD OCCUR
A
t
REGATE LIMIT APPLIES PER;Y - 'CaCT LOCLE UABIUTY CBXE48125
LTO
WNED AUTOS
DULED AUTOS AUTOS
WNED AUTOS
GARAGE LIABILITY
"ANY AUTO .
"FMPLOYERSUABILMY
Y. _CLAIMS MADEEsENSATION AND S!BIUTY
OF
CERTIFICATE
Catewood Homes Inc
1600 Falmouth Road Ste 25
Centerville, MA 02632
OCCURRENCE S
1,000,00
FIRE DAMAGE (Airy one fire) S
50,00
MED EXP (Any one person) f
$ , 00
PERSONAL 3 ADV INJURY S
1,000,00
GENERAL AGGREGATE S
2, 000., OOI
PRODUCTS - COMPIOP ADD S
2, 000, OOI
02/14/2003 OZ/14/2004
COMBINED SINGLE LIMIT S
(Ea acddenq
BODILY INJURY
(Per person) S
250, 00(
BODILY INJURY
(Peraoeldenq S
500100(
PROPERTY DAMAGE ' .. $
l?er.aweng
- .. _... .
. .
100 .00U
.AULO.ONLY..EAACCIDENT. S
. - . �. ... OTHER THAN .. EA ACC S
AUTO ONLY: AOC, S
' .. EACH OCCURRENCE s.
AGGREGATE I S
$
S
E.L. EACH ACCIDENT S
EL DISEASE - EA EMPLO S
EL DISEASE. POLICY LRdiY Y ..
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 SMALL IMPOSE NO OBLIGATION OR LIABILITY
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID A DATE(MM/DDNYYY)
PRODUCER
CROWC50 07 25 03
Sullivan, Garrity & Donnell y
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
508=754 1767
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Institute Rd - PO Box 15010
END OR
ALTER HEHIS COVERAGE AFFORDED BHOLDER. CERTIFICATE DOESOY THE POLICAMEND,E ES BELOW.
Worcester MA 01615-0010
Phone: 508-754-1767 Fax: 508-754-1885
INSURERS AFFORDING COVERAGE
INSURED
NAIC #
INSURER& Hanover Insurance Co
22292
INSURER87 Arch Insurance Company
Crowell Construction, Inc.
INSURER C:
PO Box 309
So. Dennis MA 02660
INSURERD:
COVFRATAPS
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
MAY BE ISSUED
OR
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.
TYPE OF INSURANCE
POLICY NUMBER
DATE MM/DD
DATE MM/DD/YY
LIMITS
L LIABILITY
MERCIAL GENERAL LIABILITY
ZHN7007141
05/01/03
05/01/04
EACH OCCURRENCE
S lOOO000
CLAIMS MADE X I OCCUR
PREMISES EKE
a omaence
S 1000Q0
MED EXP (Any one person)
135000
PERSONAL d ADV INJURY
11000000
GREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2000000
PRODUCTS -COMPTOP AGG
$2000000
ICY .:JET LOC
EALrrO
BILE LIABILITY
AUTO .'
ARN7001142
05/01/03
05/01/04
COMBINED SINGLE LIMIT
(E°eCad�)WNED
AUTOSEDULED
BODILY INJURYSSOOOOOO
(Per person)D
AUTOS
AUTOS
BODILY INJURY
(Per accident)
$SOOOOOO
-OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
S SOOOOO
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
S
ANY AUTO
OTHER THAN EAACC
$
AUTO ONLY: AGG
S
EXCESSNMBRELLA LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
S
DEDUCTIBLE
$
RETENTION S
S
WORKERS COMPENSATION AND
S
B EMPLOYERS' LIABILITY
TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUT7VE IRWCI00100 03/22/0 003/22/04
OFFICER/MEMBER EXCLUDED?
E.LEACHACCIDENT
$500000
— :Myogi descrbeunder -
EL DISEASE - EA EMPLOYE
$500000
SPECIAL PROVISIONS bebw '
OTHER
EL DISEASE, POLICY LIMIT
$500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
Fax 0508-778-5603
CERTIFICATE HOLDER
Gatewood Homes
1600 Falmouth Road
Suite 25
Centerville MA 02632
GATWOO I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOP
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .1 O DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER ITS AGENTS OR
t"4v-ny CERTIFICATE OF LIABILITY INSURANCE
DATE fMNVOONYYYI PRODUCER 508-398-6033 FAX SOS-760-1667 07/21/2003 Allied -American Insurance Agency LLC JAH
THIS'GERTIFlCATE tSISSUEQAS A MATTER OF INFORMATION
'1 At9antic Ave 9 y ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
OLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
So Yarmouth Mq 02664 LTER THE COVERAGE dIrcnOmII, s.. �.._ __.�. _
--r- a.uaLOm doors
762 Falmouth Road
Hyannis MA CZ601
INSURERS AFFORDING COVERAGE
INSUTA: ArEella Protection I
c
I NAIC #
COVER A S wsuRER I-
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POCKY PERIOD INDICATED. NOTWITHSTANDIry
ANY RERTAIN. HE I TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURAIJCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID N R DD CLAIM$,
TYRE Of INSURANCE � POUCT'NUMBER POLICY EfFE TWE POLICY EKPIRATION , GENERAL LLABILITY 7S00000371 12/13/2002 12/13/2003 FaGN oecuRR);NCe LIMITS
X COMMERCIAL GENERAL ERLIABILITYf 1 000 , 01
CLAIMS MADE OX GCCUR AMACE TO RENTEO S
A 50, OL
MCD EXP
CENt AGGREWTE LSUIrAPPUE) PER;
X POLICY JECT n.LDC
AUTOMOBILE LIABILITY
ANYAUTO
ALL OWNED AUTO)
SCHEDULEDADTOS
RMAUTMS
NON-0WNEOAUTOS
GARAGE LIABR,IW
ANY AUTO
°'ur KELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B ANY PROPRIETOgPARTNER/EXECUTWE
OFFILERIMEMSER EXCLUDED,
1-7 of Pusan) S
PERSONAL A ADY INJURY S 1
GENERAL AGGREGATE S 2
PRO OUCTS•COMPIOPAGG f 7
COMI SINGLE LIMIT S
IEa acddslal
!AUTO
Y*4AMV
rson) f
PLURY
pdMq f
RTY DAMAGE f
cdmi)
NLY-EA ACCo$NT S
THAN EA ACC f
NLY;A00 S
CCURRENCE S
AGGREGATE S
El.EACHACCVENT S
EL DISEASE • EA Fh ne a
x lm
U
Evidence of Insurance for work performed within the Insured's scope of normal operations
C LOJ
L C
SMOUID MfY OF TNEABOVi OP3CRIDED POLICIES DE CANCELLED
BEFORE THE
EXPIRATION DATE THEREOP, THE ISEUM P4URERMTLL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTMCATE HOLDER NAMED TO THE LEFT,
GatewoOd Homes.. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION OR LUBILm
1600 Falmouth Road >p2$ OF ANY KIND UPON THE INSURER Rl AOEiVTl OR REPRESENTATIVES.
Centerville, MA 02632
A'UT"ORV-Sp RESENTA
4CORD 25 (2001108) FAX: (508) 778- 5603 Q'
OACORO CORPORATION 1988
CERT 2 P' 2 (=ATE (:DP' 2 NSURALVCE
Producer:
SOUTHEASTERN INS AGCY
641 MAIN ST
HYANNIS MA 02601
Code: Sub -code:
------------------------
-------------
Insured:
RJ BEVILACOUA
P 0 BOX 628
FORESTDALE MA 02644
Issue date: 7/22/03
---------------------------------
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 belcv.
----------------------------------
COMPANIES AFFORDING COVERAGE
Lo Ltr A: ARBELLA PROTECTION
-------------------------------
Cc Ltr B: ARBELLA PROTECTION
Lo Ltr C:
------------------------------
Co Ltr D: ARBELLA PROTECTION
Lo Ltr E;
COVERAGES
This is to certifyr that policies of insurance listed belov have been issued to the insured named above for the Palic' pperiod
certificateameribesissuedgoraoayePgerta®e�ttheeinserancedefforded
brythenpoliei
exclusions, and conditions of such policies. Limits AM
or other es describeduhereinwith
sebject to ellctheh4erms
may have been
---------------------------------------------------------------------------P
reduced by paid claims.
---------------------------- '
Ltrl Type of Insurance I I Policy
"�"--------�--""'--'"""'--------- y number leffective date
I - Policy --"-�--"------��""'"-'"
lex iration date)
_Polk
A 16ENERAL LIABILITY _ -� -----------------------------------------------------
8500018147
All -limits in thousands
_
If Commercial general liability ` I 7/15/03
I 7/15/04 (General aggregate; 2 000
I[ If0 Claims made ( ) Occur
II{ uvner's 8 contractor's Prot I
Products-comp/ops aggrey:
I Personal/advertising in):
(Each
I I I
------------ ---------
occurrence: 11000
Fire damage: f00
I
B IAUiOMOct
I
------------------------------------------------------------------------1
a LIABILITY 1 86852400001 I 1/21/03
An auto
Ali
Medical expense: 5
expe---------------------------
I 2/21/04 (Combined
ovned autos
Scheduled autos I
(Single limit: 250/500
Bodily injury
Hired autos I
Per person):
Bodily
I
Non-ovned autos I I
Garage liability
Injury
(Per accident):
I
---i----------------------- —
(EXCESS LIABILITY "---'---
I lProperty damage: 500 1
I[
[[ jj--------------------------------)
Other than umbrella form 1
---------------------
Each
Occurrence Aggregate
D I HORKER'SCOMPENSATIONI908680403-----I ----4-/27/03 ----I---4—/1-----
A
----IS-t-e-t-u-t—or---------------- ----------
-----------___—______EMPLOYERS'
LIABILITY
I.
f0
(Each accident)
----"--------------- - - I I
OTHER
f --------------i--------------i---------
I 500 (Disease -policy limit)
100_ Disease-policy
emggeej�..
I 1 ------ —--- —------ —-------- —---------
------------ ------------------
Description of operations/locations/vehicles/restrictions/special items:
_ '" I-'---______________
CERTIFICATE HOLDER
CANCELLATION
ISheuld any of the above described policies be cancelled before the
GATEHOOD HOMES expiration date thereof, the issuing company rill endeavor to
1600 FALMOUTH RD STE 35 I mail f0 days vritten notice to the certificate holder named to the
CENTERVILLE MA 02631 left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.
------ i
-----------------------
I Authorized representative: -------________.
--------- ------- _------- —_ I JOAN M MARTIN
------------------------------------
UtKTIFICATE OF LIABILITY INSURANCE
DATE (MMID01YYyy)
PRODUCER 10/17/03
Dowii/Tg & O' Neil Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR
222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis, MA 02601
INSURERS AFFORDING COVERAGE
NAIC #
Bayside Electrical Contractors, Inc. INSURERA: Travelers Insurance Company
372 Yarmouth Road INSURERS: Guard Insurance Group
Hyannis, MA 02601 INSURER C:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING
OR OTHER DOCUMENT WrrH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED A
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO MAYBE
POLICIES. AGGREGATE LIMITS SHOWN D OR
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ALL THE TERMS, EXCLUSIONS AND IONSISSUED
SUCH
LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRFXPIRATION
/DD
16801484A82ACOF03 10/05/03
DATE LIMITS
X COMMERCIAL GENERAL LIABILITY
10/05/04 EACH OCCURRENCE $1 OOO 000
CLAIMS MADE O
DAMAGE TO RENTED
OCCUR
$300 GOD
MED EXP (Any one person) $5 000
X OCP
PERSONAL &ADVI--j-- 51000000
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE $2 DDD DDD
POLICY JE 0' LOC
PRODUCTS. COMPM AGO $2 000 ODD
A AUTOMOBILE LIABILITY 18102601W5611ND03 10/05/03
ANY AUTO
10/05/04
COMBINED SINGLE LIMB
ALL OWNED AUTOS
(Ea acddenl) $1,000,000
X SCHEDULED AUTOS
BODILY INJURY
X HIRED AUTOS
(Pwpersan) S
X N6N-0WNED AUTOS
BODILY INJURY
X Drive Other Car
(Peracclaeoq s
GARAGE LIABILITY
PRO
R ARTY DAMAGE s
(Pff)
ANY AUTO
AUTO ONLY • EA ACCIDENT s
OTHERTHAN EA ACC S
EXCESSIUMBRELLA LIABILITY
AUTO ONLY. AGG s
OCCUR CLAIMS MADE
EACH OCCURRENCE s
AGGREGATE s.
'DEDUCTIBLE
_
RETENTION s
s
B WORKERSCOMPENSATION* AND BAWC436910
s
EMPLOYERS' LIABILITY 08/18/03
DS/18/D4 WC STATU• OTH.
ANY PROPRIETOR/PARTNERIEXECUTNE
OFFICER/MEMBER
EXCLUDED?
E.L. EACH ArrInPn .4 nn nnn
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Operations performed by the named Insured subject to policy conditions
and exclusions. -
Gatewood Homes
1600 Falmouth Road Suite 25
Centerville, MA 02632
•. wnu cD (zuuvDB) 1 of 2 #M31942
.... wvr ur FHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do 50 SHALL
DAYS N
:E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AFNTAT
LS0 ACORD CORPORATION 1988
�fT`� TOWN OF YARMOUTH
�g Building Department
_ s Town Hall
°t Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-05-076
Applicant Name:
Applicant Phone:
Building Location:
Owner's Name:
Owner's Addres
Frank Capra
5087789669
00121 CAMP ST # 115
Villages at Camp St., LLC
1600 Falmouth Road # 25
Centerville MA 02632
Owner's Telephone: (508) 778-5603
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 702
Net Owed:
($50.00)
Application Date: 7/20/2004
Issue Date:
Expiration Date
Comments: Map/Lot: 044.21.1.0 //
new construction:
ZONING APPROVED
BY:
P�REVIEWED
✓ 11. WATER DEPARTMENT:
DATE:
N/A:
✓ 2. ENGINEERING DEPARTMENT:
DATE:
N/A:
CONSERVATION:
DATE:
N/A:
�3.
✓ 4 HEALTH DEPARTMENT:
DATE:
N/A:
BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/30/2004
i
CF TOWN OF YARMOUTH
r
Building Department
_ Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-05-076
Applicant Name: Frank Capra
Applicant Phone: 5087789669
Building Location: 00121 CAMP ST # 115
Owner's Name: Villages at Camp St., LLC
Owner's Addres 1600 Falmouth Road # 25
Centerville MA 02632
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 702
Net Owed:
($50.00)
Application Date: 7/20/2004
Issue Date:
Expiration Date
Comments: Map/Lot: 044.21.1.0 H 57-
new construction:
Owner's Telephone: (508) 778-5603
[ o
REVIEWED BY:
1. WATER DEPARTMENT: DATE:
2. ENGINEERING DEPARTMENT: DATE:
3. CONSERVATION: DATE:
4. HEALTH DEPARTMENT: DATE: IG G%
5. BUILDING DEPARTMENT DATE:
6. FIRE DEPARTMENT: DATE:
PLEASE NOTE
COMMENTS:
N/A:
N/A:
N/A:
N/A:
N/A:
N/A:
AUG 0 2 2004
HEALTH DEPT.
RECEIPT OF COPY: SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/30/2004
a
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date of Issue : Aug 4, 2004
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.lC115 Street 121 Camp St., #115
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. i
(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 at Camp St., LL
1600 Falmouth Rd.
Centerville, MA 02632
TOWN OF YARMOUTH
Building Department
= Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BBUILDING PERMIT
TRANSMITTAL
Temp Permit No.: T-05-076
Applicant Name:
Applicant Phone:
Building Location:
Owner's Name:
Owner's Addres
Frank Capra
5087789669
00121 CAMP ST # 115
Villages at Camp St., LLC
1600 Falmouth Road # 25
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 702
Net Owed:
($50.00)
Application Date:
7/20/2004
Issue Date:
Expiration Date
Comments:
new construction:
Map/Lot: 044.21.1.0 lIS
Centerville MA 02632
Owner's Telephone: (508) 778-5603 '
REVIEWED BY:
1: WATER DEPARTMENT DATE:
2. ENGINEERING DEPARTMENT: DATE:
3. CONSERVATION: DATE:
4. HEALTH DEPARTMENT: DATE:
5. BUILDING DEPARTMENT: DATE:
6. FIRE DEPARTMENT: DATE:
PLEASE NOTE
COMMENTS:
N/A:
N/A:
N/A:
N/A:
N/A:
N/A:
RECEIPT OF COPY: SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/30/2004
` j --v :I-.�
,949i /0
''c O
o �
SEE SLEEVING L�
NOTE BELOW 0
� 70
Q R=105.00 L 12 �� LF . S
0
S PROPOSED SEWER MAIN S $� 5V
5
8" SDR-35 45 L.F. \
PROPOSED 4"1 3�
SEWER LATERAL
R=145.00 2
C'4g.8s _ L�0.08
_ � N. � ,t35
r7
PROP SED
WATE SER CE 6. �g 5
ROp05 o a�
' Np
19. 4 i22 ' � `� N `SP D
�
20.
POSED o �1
o PROPOSED IO P HOUSE
�! HOUSE w rn. j PLOVER) y'
(OSPREY) ;' `''� j LOT 116
39705 S.F.
6.3' w rn. 25'
W LOT 115 3 57'$
6.3' 19.5•• 3,510 S.F. 62.95' \ �� v;e�
114 ! ��� o2ooQ
3 S.F. 58.31' S81'47'10"W
NOTE:
R E C Ems. I V r- - ® SEWER LA HALL BE
SLEEVED IN ACCORDANCE
GRAPHIC SCALE AUG 0 2 2004 WITH TITLE V IF WITHIN
1OFT. OF. WATER MAIN.
20 10 0 20 �.
�frT mil Vat 9f OPt less and until such time NOTICE
original (red) stamp of the
enable Profassional Engineer, or Professional Land Surveyor
appears on this plan:
(A) no person or persons. Including any municipal or other
( IN FEET public officials, may rely upon the Information contained herein; and
1 inch = 20 M (B) this plan remains the property of Holmes & McGrath, Inc.
PLOT PLAN
holmes and mcgrath, inc.
OF LOT 115 civil engineers and land surveyors
PREPARED FOR
MILL POND VILLAGE 362 gifford street
G, J
IN
falmouth ma. 02540
YARMOUTH, MA
JOB N0: 201197 DRAWN: LMC
SCALE: 1 "=20' DATE: 5-1-03 DWG. NO.: A2533 CHECKED: T*u j E
L1
- <.
MAScheck COMPLIANCE REPORT I
Massachusetts Energy code I Permit #
MAscheck Software version 2.01 Release 2 I I
I I
Checked by/Date I
I I
CITY: Barnstable
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 Plover
PROJECT INFORMATION:
Mill Pond village
1600 Falmouth Road
Unit 25
Centerville, MA. 02632
COMPANY INFORMATION:
Northside Design ASSOC.
141 Main Street
Yarmouth Port, MA. 02675
COMPLIANCE: PASSES
Required UA = 237
Your Home = 133
Area or -
Cavity Cont.
Glazing/Door
Perimeter
R-Value R-Value
U-Value
UA
-------------------------------------------------------------------------------
CEILINGS
823
30.0 30.0
14
WALLS: wood Frame, 16" O.C.
1588
15.0 15.0
70
GLAZING: windows or Doors
97
0.340
33
GLAZING: windows or Doors
40
0.340
14
DOORS
20
0.086
2
-------------------------------------------------------------------------------
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
Data
Massachusetts Energy Code
MAscheck software version 2.01 Release 2
The Plover
DATE: 4-21-2004
Bldg.l
Dept.l
use
CEILINGS:
[ ] I 1. R-30 + R-30
Comments/Locati
I
WALLS:
[ ] I 1. wood Frame, 16"
I
Comments/Locati
O.C., R-15 + R-15
WINDOWS AND GLASS DOORS:
[ ] I 1. u-value: 0.34
For windows without labeled u-values, deslribeafeatures: C 7 No
# Panes Frame Type
Comments/Locatio
[ ] I 2. U-value: 0.34
For windows without labeled U-values, describe features:
i # Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Locatio
DOORS:
[ ] I 1. u-value: 0.086
Comments/Location
i
AIR LEAKAGE:
[ ] I joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. when
I installed in the building envelope, recessed lighting fixtures
I shall meet one of the following requirements:
i 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
I more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
�,I I
difference and shall be labeled.
VAPOR RETARDER:
[ ] I Required on the warm -in -winter side of all non -vented framed
I ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
1 [ ] I Materials and equipment must be identified so that compliance can
i I 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
I marked on the building plans or specifications.
i
EFFICIENcr
[=M]
runNc / /
cERTFIED \`` CL
- ama V
Air Conditioning &Heating �,ik < Ui
92.6% AFUE
MULTI -POSITION
CONDENSING
GAS FURNACE
GMNT SERIES
nARRAla7Y',�t" $•Kj�����yjpM]EY.
Description / Application
• All models design certified by ITS to be in
compliance with ANSI Z21.47 and CAN/CGA
2.3 (Canada) safety standards
• Completely assembled, factory run -tested
furnace, for heating or combination heating/
cooling application
• For utility room, closet, alcove, basement or
attic application
• Vertical or horizontal venting with 2" PVC for
40k, 60k, and 3" PVC for 80k, 100k and 120k
• Capable of multi -position installation — upflow,
downflow or horizontal
• For direct vent (2 pipe) or non -direct vent
(1 pipe) installations
Construction
• Heavy gauge, reinforced, wrap -around insulated
steel cabinet with durable baked enamel finish
• Tubular heat exchanger (Primary)
• Bottom or side air inlet
• Aluminized steel inshot bumers
• Convenient left or right hand connection for gas,
electric service, combustion air and vent
• Removable solid bottom block -off
Standard Equipment
• Energy saving PSC, multi -speed, direct drive
blower motors
• Quiet operating, sound isolated blower
assembly
• 40VA transformer for heating and air
conditioning control service
• Combination redundant gas valve and regulator
• Integrated furnace control with diagnostics
• Blower door safety switch
• Energy saving Hot Surface Ignition system
• Multiple flame roll -out switches
• Outlet air limit switch
• Pressure switch for proof of air
• Complies with California NOX Standards
• Completely insulated cabinet
• Corrosion resistant 294C secondary heat
exchanger that extracts energy from the gas
and converts it to usable heat
• Quiet, corrosion resistant plastic induced
blower assembly
• Drain kit contains vent screens, drain trap,
hoses & clamps
Optional Equipment
• L. P. Conversion Kit (LPT-01)
• Concentric Vent Kit (CVK-00)
As an Energy Star Partner, Goodman Mfg. Go., L.P., has determined that this product meets the Energy Star guidelines for energy efficiency
Information contained herein is subject to change without notice.
Made in the USA by:
Goodman Manufacturing Company, L.P.
SS-312D 2550 North Loop West, Suite 400 - Houston, Texas 77092 GMNT Series 10/01
wwwgoodmamnfgcom
PERFORMANCE RATINGS
Model
Number
GMNT
Natural Gas
Input
BTUH
Natural Gas
Output
BTUH
Propane Gas
Input
BTUH
Propane Gas
Output
BTUH
DOE
AFUE
Temp. Rise
0403
40,000
37,000
37,000
34,000
92.6
25-65
060.3
60,000
55,000
55,000
51.000
92.6
35-65
080-4
80,000
73,500
73,000
73,000
9z6
35-65
1004
100,000
92,000
92,000
85,000
92.6
40-70
120-5
120,000
110,000
111,000
102,000
1 92.6
40-70
BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA
AVAILABLE FROM YOUR RETAILER.
SPECIFICATION DATA
Model
Number
Motor
Blower
Vent*
Dia.
-
Combustion*
Air
FilterSizeln
Perm. / Disp.
Electrical
Ship
Weight
HP
Spd.
Dia.
Width
FLA
FMax
use i
040-3
1/3
3
10
6
r
r
2901580
52
15
170
0603
1/3
3
10
6
2'
r
290 / 580
52
15
160
0804
1r2
3
10
8
T
3'
3851770
7.8
15
205
1004
12
3
10
10
3'
3'
3851770
7.8
15
225
1205
314
3
1 11
10
3'
3'
480 / 960
92
15
265
`Note: vent ana COMDUS➢O" air UNXIIt rcls Islay valy ucNanunly aarv...a:.....,..y.... __.._. _, _._._..
accompany the furnace.
28" A 58"
4.. 198.. 6.. 6 47..
r =�4,.. 8
3^T �.� I 4
4 1
COMB. AIR INLET
i
GAS INLET
51„i
4
.
VENT
i
p
0
27"
101.
1
4"
LOW VOLTAGE
'
ELEC.
104'
13.
Model
GMNT
A
B
Combustible
Floor Base
040-3 & 060-3
14'
12'/�
S13M14
0804
17 /.
16'
SBM17
1004
21'
19 Ys
SBM21
1205
24'h.
23'
SBM24
SS-312D
i
123^ COMB. AIR INLET
8
201"
GASINLET
LOW VOLTAGE
rl CAewuler-c Conlu rr%UR11CTIRl F IUTATFRIAI S
Sides
Rear
Front*
Vent
Top
1'
0'
3'
0'
1'
Approved for line contact In the nonzomal posnlon.
*36' clearance for serviceability recommended.
2
4 " . - -LASED (U) COIL APPLICATION OPTIONS
FurnaceModel
Number
GMNT040-3 &
GMNT060-3
GMNT080-4
GMNT100-4
GMNT120-5
Furnace Width
14•
17'/a*
21•
24'/='
Coil Model
Number
Coil Width
U-18
1 14'
X
U-29
14"
X
U-30
17'W
X (1)
X (2)
U-31
14'
X
U-32
17'/i
X(1)
X(2)
U-35
14'
X
U-36
17 Y:'
X (1)
X (2)
U-42
17 %'
X (1)
X (2)
U-47
17'/'
X
U-49
21'
X(1)
X(2)
U-59
21'
X(1)
X(2)
U-60
24'/s
X(1)
X(2)
U-61
24Y2*
X(1)
X(2)
U-62
21'
X (1)
X (2)
(1) Using the factory installed bottom cabinet filler plates
(2) Discard bottom cabinet filler plates
Due to the rating miximatch of various coils with outdoor units it is important to match the furnace air flow for the
total system capacity. Refer to furnace, heat pump and/or condensing unit specification sheets.
AIRFLOW DATA
CFM - NO FILTERS
MODEL
STATIC
.1
.2
.3
.4
.5
.6
.7
.8
HI
1370
1315
1260
1200
1140
1070
1000
925
GMNT
MED
1210'
1170
1130
1085
1040
980
920
860
040-3
LOW
895
880
870
840
825
780
725
680
HI
1360
1300
1250
1190
1135
1065
1000
930
GMNT
MED
1200
1170
1130
1080
1035
975
925
880
060-3
LOW
910
895
885
855
835
790
750
700
HI
1865
1800
1735
1660
1590
1510
1415
1320
GMNT
MED
1690
1645
1600
1545
1485
1410
1345
1245
080-4
LOW
1450
1400
1390
1360
1325
1270
1200
1125
HI
2010
1945
1875
1800
1715
1620
1510
1400
GMNT
MED
1725
1700
1670
1615
1550
1475
1375
1275
100-4
LOW
1430
1390
1350
1315
1285
1245
1160
1070
HI
2360
2325
2300
2170
2125
2045
1945
1850
GMNT
120-5
MED
1815
1750
1710
1660
1600
1545
1480
1415
LOW
1275
1215
1 1190
1145
1110
1055
985
925
Values indicated by shaded areas represent airflows that are too low for heating temperature rise.
SS-312D
3
NOTE: SPECIFICATIONS AND PERFORMANCE DATA LISTED HEREIN ARE SUBJECT TO CHANGE WITHOUT NOTICE y
Quality Makes the Difference!
All of our systems are designed and manufactured with the same high quality standards regardless of size or efficiency.
Our designs virtually eliminate the most frequent causes of product failure. They are simple to service and forgiving to
operate. We use the highest quality materials and components available because if a part fails then the unit fails.
Finally, every unit is run tested before it leaves the factory. Thats why we know...
There's No Better Quality.
Visit our web site at www.goodmanmfg.com for information on:
• Goodman products
• Warranties
• Customer Services
• Parts
• Contractor Programs and Training
• Financing Options
SS-312D 4.
BUT — I
'9
8s
SEE SLEEVING
.9
0, ,l _ NOTE BELOW
O R=105.00 L 127 71
'u�tu SEWER MAIN $'
SDR-35 45 L.F. S
PROPOSED 4'1
SEWER LATERAL
R=1 45.00
C'4g 8i
I
PROP SED
WATE SER
CE
19.
7"
,12
i
20'
PROPOSED
HOUSE
o
o PROPOSED
`! HOUSE
rn.
IZ
0
L4
i
rn (PLOVER)
Un
(OSPREY) GO
i
(Aj
tJ f
FF 29.0
FF _ 15
FF = 29.0
GW= 15
Cn
4�
26.7"/
% 0
6.3'
W.3
w
w
I
LOT115
6.3' 19.5',,
114
39510 S.F. 62.95'
to
3 S.F.
'
ORDABLE 58.31'
g81'47'10"W
u
\J.
17YI'"
PROP US 0
NO `pERi
�SPNOP g 0
4�W 15
LOT 116 A
3,705 S.F.
57.25'
S81'47' 1 1
NOTE:
`11A OF yq
MICHREt SEWER LATERAL SHALL BE
`T
god
� N SLEEVED IN ACCORDANCE
GRAPHIC SCALE
WITH TITLE V IF WITHIN
` Rio.
$o 1 OFT. OF WATER MAIN.
20 10 0 20
ass 9f6f5 �° Q�`a NOTICE
S°
I fpD Unless and until such time as the original (red) stamp of the
responsible Professional Engineer, or Professional Land Surveyor
IN FEET
( )
appears on this plan:
(A) no person or persons, Including any municipal or other
1 inch = 20 M
public officials, may rely upon the information contained herein; and
(B) this plan remains the property of Holmes & McGrath, Inc.
REVISED: 3-8-04
PLOT PLAN
holmes and mcgrath, inc.
OF 414S
OF LOT 115
PREPARED FOR
civil engineers and land surveyors
P�j"
o��� s'�y
MILL POND VILLAGE
362 gifford street
TIMOTHYM.
o SANTOS i
IN
falmouth, ma. 02540
NCIVIL e
civic y
YARMOUTH, MA
JOB NO: 201197 DRAWN: LMC
SCALE: 1 "=20' DATE: 5-1-03
DWG. NO.: A2533 CHECKED:,,
n�
9FF1Cf-S1�EolVILY
PROPERTYAi3ClRE5S: /P/�ixor�/'
ALCULATION FOR PERMIT COST TYPE OF ROOM ETC NO
290.76 ADDITION
ALTERATIONS
BATH
BED ROOM � Z
CERTIFICATE OF OCCUPANCY
COMPUTER ROOM
DECK OPEN
DECK WITH ROOF
DEMOLITION
DEN
DINING ROOD
7 c f FAMILY ROAM
z FIREPLACE
FOUNDATION ONLY
.GARAGE NO.OF. BAYS
GREAT ROOM
KITCHEN
i
MUD ROOM
OFFICE
'` PORCH CLOSED
PORCH OPEN
REROOFING _ .. .
SHED
ST{3RAGE AREA
SUN'ROOM HEATED
SUN ROOM UNI-IEATED
SWIMMING POOL ABUV`E GRO
SWIMMING POOL INCROUND
WINDOW REPLACEMENT � !E]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
����u � TICE USE ONLY)
Il B
MAY 2 3 005 Fee: $ /07— �'AD -715
")trio � PERMIT NO. _2--05—IO
(PLEASE PRINT IN INK OR TYPE ALL N) Date: S%Z 3ly5--_
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention o perform the electrical
work described below. /� / S�[ L h I . t I
Location (Street & Number) A f' L �r /�7� / ��jifQ U 7 h
Owner or Tenant
Owner's
q PC iGJOI/,
&
n('
!r/ei1j(e J,`r,41
No. s ork 77Y — 96j� I
Is this permit in conjunction witlya building permit? ITYes 0No (Check Appropriate Box)
Purpose of Building 4/4� Utility Authorization No.
Existing Service U Amps / Volts OverheadQ Undgrd No. of Meters
New Service /dW Amps e Volts Overhead Undgrd 2l� No. of Meters_
Number of Feeders and Ampacity �a / r i /J le
Location and Nature of Proposed electrical
Afto. of Recessed Fixtures
No. of Ceil.-Sus . Paddle Fans 6
" VY f/4G lltJ CL/V/ U YY{/CJ
No. of Total
Transformers KVA
qqll�o. of Lighting Outlets
No. of Hot Tubs D
Generators KVA
No. of Lighting Fixtures
No. of Receptacle Outlets �2
Above In -Emergency
Swimmin Pool rnd. md.
No. of Oil Burners
Lighting
Batte Units
FIRE ALARMS No. of Zones
No. of Switches 7
No. of Gas Burners (
o. of Detection an
Initiating Devices U�
No. of Ranges
TotalZY
No. of Air Cond. U Tons
No. of Alerting Devices
No. of Waste Disposers (�
Heat Pump
Totals:
um er
Tons
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local ❑ Connection 0 Other
No. of D
Dryers
ry 1
Heating Appliances KW
Security Systems:
No. of Devices or Equipvalent
No. of Water
Heaters %Qr KW
No. of No. of
Si ns Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
firracn aaairionai aetaii if aesired, 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 a permit issuing office.
CHECK ONE: INSURANCE BOND OTHERC] (Specify:) Z, C
t (Expirati Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certify, under the ins and penalties of perjury, that the information on this application is true and complete
WNAME: hen % LIC. NO. . �� 3 J- 5
ee: S' Signature _ LIC: NO.
(If applicable, elder "exempt" in the 1�6 k Y - /) 15
Address: P-I 5 C 15 i - - PCPIz4 Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature
below, I hereby waive this requirement. I am the (check one) owner
Owner/Agent
Signature
[Rev. 04/00]
owner's agent. 0
Telephone
F3? OF Yg9�o�i
TOWN OF YARMOUTH
I =
"T AC EESE
UNIT
APPLICATION FOR PERMIT TO DO PLUMBING
(OfF E USE ONLY)
By ,
Fee: $ c1S, c )
PERMIT NO. f --oS
Date
g Owner's lA[rl f cwvy/J f if wv % .
ocation Name
Type of Occupancy
New Renovation ❑ Replacement ❑
Plans Submitted Yes ❑ No ❑
zFA
Z
Y=
FQ-
W
W
W
N
J
Q
r
M
cc
Z
N
W
w
2
N
2
c)
in
LLZc7Q.o
Z
z
xZ
v
o
m
N
c
Z
o
a
Oo�ccU.w=
Z
Y0J
a
Y
a
wYwO
u.
s
°°a¢°aQaaT
Lu
o2
X
J
m
o
O
O
J
in
LL
G
Q
m
0
SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name
Address OZ
Business Telephone
of Licensed
Check One:
❑ Corp.
❑ Part ship
I%r/,Company
Plumber nM DI! AtIf ► W WJOUCS
INSURANCE COVERAGE: I have a current liability insurance policy s substantial equivalent. Check One: Yes ❑ No ❑
If you have checked YES, please indicate the type of coverage by c cking 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 voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted
(or entered) in above application are true and accurate to the best of
my knowledge and that all plumbing work and installations performed
under Permit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws.
Type:
Master ❑
Journeyman. 11