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HomeMy WebLinkAbout121 Camp St #116 Building PermitsF; OF Yg9�0-i TOWN OF YARMOUTH YATTACNEEEE Ic APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By Fee $✓7 PERMIT NO. `�3 Date Building Owner'g �/r AT. Location j 2 �_C2gm? S �. Namey ,/ a 7-a�9 1- L e)-- 4 ZZ Type of Occupancy Z�5Ans i IV— New1X Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No tk Y WxAf t~¢o co cc W O O V m x JN W¢ U)o ° M CCQZo'W W � W !Q W x WO Z a O w L� LLl L Z J x LL LU co Lu 0 W w W V J y W rlv/IIIY Z a Q W>= W -j F- Q W Z x Z Q � ac cn a m a Z o O O Z W W 5 O o y W x f- .. IX x 0 0 x O u- D 3 o 0 0 M> o o. t- o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name -� —T Address 19 C f4AS 6 3-1 v n Al Al ► C M Business Telephone SD X — % 3 -7 3 E Name of Licensed Plumber orfier Check One: ❑ Corp. ❑ Partnership Ci Firm/Company JUN 2 3 2005 INSURANCE COVERAGE: Check One 113y I have a current liability insurance policy or its substantial equivalent. Yes ET*�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 ❑ Bond [I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check 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 Qj P, ::�mb D Signature o Licensed Plumber or Gasfitter 2Z1 S' 10% License Number TVDG 1If`GNCG- L 1 x jLCIT 115' 1 CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF THE 40B SPECIAL PERMIT. / DATE REGISTERED P OFE SIGNAL LAND SURVEYOR %�VpY 0" . so 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 NO A SPECIAL FLOOD HAZARD A EA / O��19e DATE REGISTERED PROFESSIONAL LAND SURVEYOR 20 10 0 GRAPHIC SCALE i= NOTICE Unles9 and until such time as the original (red) stomp of the re�pono;Me Professional Engineer, or Professional Land Surveyor oppeo,s on this plan: IN FEET ) (P) no p.ersnn or persons, Including any municipal or other -0':-- of�icids, muy rely upcn the information cantained herein; and 1 lIIC);1 = 20 f (0) this plen remains the property of Holmes & McGrath, Inc. AS—BUI PLA hoimes and mcgrath, inc. OF Mgss� OF L 116 civil engineers and land surveyors a��j" �o� MICHAEL PREPA ED F 362 gifford street t3 S r�RArr� MILL PO LLAGE Falmouth, ma. 02540 9 No.239MM Q IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC ` SCALE: 1"=20' DATE: lo-18—oq DWG. NO.: A2532A CHECK MILL POND VILLAGE CONDOMINIUM CAMP STREET, YARMOUTH, MASSACHUSETTS PURCHASE AND SALE AGREEMENT UNIT 116 SANDPIPER PART A: References: [Affordable Unit] The following terms which are capitalized and marked in quotations in this Part A shall have the meanings set forth below wherever such terms are used in Part B hereof, and this Agreement shall consist of both Parts A and B and all exhibits hereto: A. The "Date of this Agreement" is , 2005. B. The "SELLER" is: Villages at Camp Street, LLC, a Massachusetts limited liability company, with an address of 1660 Falmouth Road, Suite 25, Centerville, MA 02632, or its successors and assigns. C. The 'BUYER" is: Charles K. Bergin of 5 Marlin Way, South Yarmouth, MA 02664 D. Notice. Any and all notices or other communications required or permitted by this Agreement to be served on or given to any party hereto by any other party hereto shall be in writing and shall be deemed duly served and given when personally delivered to the party to whom it is directed, or in lieu of personal service, three (3) days after deposit in the United States Mail, first class and postage prepaid, or one day after deposit with a reputable overnight courier, addressed to the BUYER and SELLER at their respective addresses as listed above. E. The "Unit" to be conveyed hereby is: Unit #116 SANDPIPER, as such is further shown on the plans attached hereto as Exhibit A, which plans include a unit floor plan (Exhibit A-1) and a Designated Use Easement Area showing the Unit's Maintenance Easement Area and Exclusive Use Easement Area (Exhibit A-2). F. The 'Percentage Interest" in the Common Areas referred to in paragraph 2 of this Agreement will be determined upon the completion of the phasing in of the Phase of the Condominium containing said Unit and will be so determined in accordance with the provisions of the Master Deed described herein. See also paragraph 27 of this Agreement. y G. The "Purchase Price" referred to in this Agreement is: One Hundred Thirty Thousand and 00/100 Dollars ($130,000.00), which is calculated as follows: $130,000.00 (base price) + $ 0 (options and upgrades further described in paragraph I of this Agreement) PURCHASE PRICE: = $130,000.00 of which: $ 1,000.00 have been paid as a deposit as of this day, $ 0 have been paid previously, and $ 0 are to be paid at commencement of Unit construction $129,000.00 are to be paid at the time of the delivery of the deed in cash, or by certified, cashiers, treasurer's or bank checks. $130,000.00 TOTAL DUE H. The "Time for Performance" shall be at _1 l_a.m. on the 28th day of February, 2005, at the place referred to in paragraph 7 of this Agreement. I. Options and Upgrades. The following items will be included in or eliminated from the Unit to be delivered hereunder and the costs or credits thereof are included in the purchase price set forth in paragraph G hereof- J. Commission. A commission fee for professional services specified in this paragraph is due from SELLER to Housing Assistance Corporation,(HAC) but only if, as and when the SELLER receives the full purchase price pursuant to this Agreement and the BUYER accepts and records the SELLER'S deed and not otherwise. Commission Due: $2,386.00 GSDOCS-1282281-1 .2- . _ _ I Bibb-Eng-in�ing eopp_ CONSULTING ENGINEIz-p-S 716 I Comity Street. Tazmto� M4 02780 TCJ (508) 822-69344 Fag 50) �80 78I1 )rMz— cwhrw.@tiobetis�.�,e�.com No10 EMRS 1 1 48A 316TIQ: 1 I► ICl VI► PROJECT: Mill Pond Village W. Yarmouth, MA CLIENT: Gatewood Homes CONTRACTOR Client EOUIPIVIENT WORKING: None MEN WORKING: Rick Homes of Gatewood Homes Tim of Gatewood Homes WORK PERFORMED: DATE: 9/10/04 JOB NO.: 11118.010 FIELD TIME/TRAVEL TI114E• 4.25 hours In accordance with a request from the client, I arrived at the referenced job site at 8:45 Am to perform soil compaction tests. Upon my arrival I Rick Homes of Gatewood Homes who informed me that he needed compaction testin n lot 116. He informed me that he had placed a footing prior to compaction testing at the base o e footing and would like ' it tested. Rick added that the material to be tested was an original cut. He used the same material for filling inside the building area and needed a proctor test and sieve analysis. I performed a total of three compaction tests. I performed•two tests at base of footing and one at top of footing inside the building area. Percent compaction could not be calculated in the field because a proctor value had not yet been determined. I obtained a sample approximately 1.5 feet outside the south east comer of the building. Once testing was finished I packed up my equipment and left the job site with a soil sample for proctor testing and sieve analysis. Paul Fa2undes Lab Technician rtY.R1Y' P 'F x4('ry 4 w tibbEttS EnginEering cord_ S _ CONSULTING ENGINEERS 716 County Street, Taunton MA 02780 Tel. (508) 822-6934 Fax. (508) 880-7811 Field Density Test Report- Sand Cone Method (ASTM D1556) Client: Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Centerville, MA 02632 Date 09/14/2004 Project: Mill Pond Village Report # #8 Test No. Location of Field Density Test FD4254A Lot No.116, Southwest Comer, Footing Base Soils FD4254B Lot No.116, Northwest Comer, Footing Base Soils FD4254C Lot No.116, Center, Top of Footing Base Soils Tabulation Field Density Test Results Date: Test No. Proctor I.D. Req. % Obtained Meets Moisture Dry Wt Max Dry Optimum Compt Compaction Specs. Content P.C.F. Wt. PCF Moisture 09/10/2004 FD4254A PR4252E 95 100 Yes 5.7 125.5 125.4 8.2, 09/10/2004 FD4254B PR4252E 95 99.4 Yes 5.1 124.7 125A 8.2 09/10/2004 FD4254C PR4252E 95 98.2 Yes 5.6 123.2 125.4 8.2 Remarks: Walter P. daluska Laboratory Supervisor Paul Faaundes Laboratory Technician • d 'f:i%:I:f• ��f:vw::0: u+M•• ;..::: :iiin fn...vnf. tibbEtts En inEain co ::.;:+� ;;CONSULTING ENGINEERS 716 County Street Taunton MA 02780 Tel. (508) 822-6934 Fez. (508) 880-7811 Report of Aggregate Wet Sieve Analysis (ASTM C136) Client: Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Date: 09114104 Centerville, Ma 02632 Report No.: MA4252E Project: Mill Pond Village Material: Sandy Gravel Supplier. Location: 1.5' Outside S.E. Foot @ Base Specifications: Mass. State Specs. For Gravel Borrow, Type b (M1.03.0) Sampled By: Paul Fagundes Date Sampled: 9/10/2004 Tested By: K. Charbonneau Date Tested: 9/14/2004 ANALYSIS RESULTS Sieve Size _Weight Retained % Retained % Passing (Grams) 3 Inch 0.00 0.0 100.0 1Inch 276.33 15.9 84.1 1/2Inch 26.22 1.5 82.6 No.4 82.20 4.7 77.9 No.10 76.82 4.4 73.5 No.50 1023.77 58.8 14.7 No. 100 191.72 11.0 3.7 No.200 36.88 2.1 1.6 Pan 27.06 1.6 Remarks: Walter P. Galuska Laboratory Supervisor Sample Wt.(g) = 1741.00 Specification Gradation Limits Min. - Max. K. Charbonneau Laboratory Technician 100 90 80 4-1 _, 70 60 21 50 li 40 w U L ci 30 20 10 0 TIBBETTS ENGINEERING CORP. Graph of Sieve Analysis Results Using ASTM C136 1 1 1 Grain Size in Millimeters Job No. 10980.010 Gatewood Homes Mill Pond Village Report No.MA4252E Date: 9/14/04 10 100 TIPEETTS ENGINEERING CORP. Laboratory Density Relationship of Compacted Soil Usina ASTM D 1557• Prne-,-A tYG (� n...l_. n /A A /a11 . N D U c 0 a Z3 0 0 0 U ZI iu i I V -16 14 15 16 17 18 19 20 Job No. 10980.010 Percent Moisture Content Gatewood Homes, Mill Pond Village, W. Yarmouth, MA Report No. PR4252E (Oversize correction = 125.4 PCF) of - r� TOWN OF YARMOUTH Building Department BUILDING - - - - - - - - - - , (508) 398-2231 ext.261 PERMIT NO 6-05-240 PERMIT ISSUE DATE ; _ 8/17/2004 _ ; PROPOSED USE _ _ _ _ _ _ _ _ _ APPLICANT Frank Capra --------------- JOB WEATHER CARD ------------------------- - - PERMIT TO New Construction ' AT (LOCATION) 100121CAMPST#116 ZONING D R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C116 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE CONTRACTOR new construction: 2 baths, 3 bedroom, 1 greatroom, 1 kitchen as per plans dated =05/04. LICENSE 012430 REMARKS Capra, Frank 1600 Falmouth Road #25 AREA (SO FT) EST COST ($ $141,600.00 PERMIT FEE ($) $0.00 Centerville MA 02632 OWNER IVillages at Camp St., LLC WILDING DEPT BY 5087789669 ADDRESS Cent Falmouth Road, # 25 : `� Centerville I MA 102632 Certificate Issue Date��l� �� �� CERTIFICATE of OCCUPANCY'` - r Departmental Approval for Certificate of Occupancy and Compliance Inspector Date Permit Number Approv d By Remarks BUILDING PLUMBING/GAS Q ELECTRICAL y G ENGINEERING OTHER if / 10 De TING in Dy eacn amsign inaicatea nereon upon compieoon or its nnai mspecnon. a OF r` TOWN OF YARMOUTH Buildipg Department BUILDING ,- - - - - - - - - _ (508) 398-2231 ext.261 PERMIT NO B-05-240 _ PERMIT .. ISSUE DATE ; - 8/17/2004 _ ; PROPOSED USE APPLICANT Frank Capra JOB WEATHER CARD ------ -------------- - -- PERMIT TO 'New Construction ' AT (LOCATION) 100121CAMPST#1116 ZO% PeRIC R-25 SUBDIVISION MAP LOT BLOCK 1044.21A.C116 BUILDING IS TO BE: CONST LOT SIZE Bldg. Type: Residential new construction: 2 baths, 3 bedroom, 1 greatroom, 1 kitchen as per plans dated 08/05/04. REMARKS AREA (SO FT) EST COST ($ $141,600.00 PERMIT FEE ($) OWNER lVillages at Camp St., LLC BUILDING DEPT BY ADDRESS 1600 Falmouth Road, # 25 Centerville I MA 102632 INSPECTION RECORD USE GROUPI R•4 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector egr AW 5=/7-ate �o.0 �zr '` • MATTACMCLS 11 �4Owwrwf�� r� 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 ;Office Ilse Only,"'� Planning Board Informatio'n Assessors Department Inforimation` >'; -' C r �} sKxY Permit %J 1 i �tTY. r � Y '} di J 7 M' S Plan Type '�F �A xry nr � t�A 4• n}r+` tr 3 i1,'w )^ S� k .�+ �. � a aP `. NO;� __mate• _ S r C fi r C �� 'T � �. �� , �R � ire ✓ t ,+rt <.�. t S �, c,� <� ; ,� ••` � _ �� .�`'�`� r o w S x .is ,' 4�a T%-�, � a t # r' bPErmltFee $ �-�- �'=��,LJ�,%�� � �s3 ��.�� �� �� �.�.�,� - t�f�: >� ora rt � ,�, � � ,%nr�. � New•°i - k ..� ..i' , Yjy✓� s y �, �pd4�a �J (2 z p4y.{� .1 i 3., w r r-5. i - 1� .yy is -J F 'tY .i ': 13epasltiec d d� Hate p T Ld G } Y PA "1 R M v k iC ./ t t (' i b !• { t'S! `Y' PlantNo- f. f YT]} 3 ..1.'t3. ��. 'J [ ..Y f �' a< P F , i % '-C�et DUET: :•S� $'._ a-�` G �'_ � ,�-� �� 41 'QIti�� :f '« srA w, �, a�LutAreajsfj Froniage{ft �s� LotCoveia�e, -sin t TFis'Section`forAifice_�Llse'On':.�_�w�:h'�9;"tr x.�,��_` r»��"•Rf ��._,3��s.��^:�. Bulldtn P i �� Y ' = t � � im t�� .^ (i%%�'n Y C %�t4♦ �£� 2i% U' t-..�"i�X ai.ff »i�ci.y v �, �'�Li �+,Y t 9�}, Ger(Incate of uccupancy � J S wry.. ... { t`„4 tT2G i n•:• ""Fi. x Slgnattrre „ R+. � z ter; f r � - '�KH...z � `T ''rs Ny f5F •R � F � Btilyding LNhcial ¢� W�('T KY-*';�y.�t Lf3j ht is as notr�z f `` , ttrr. x .>Date, , .. t ,cegwred„ Section•, StterTciforrnafion Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: - a � 54 - I° f9�s� ` Zoning District Proposed Use 1.3 Building Setbacks. (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) i 5 rFloodZone fnformat3n :Y :` Oominents ' r ": k•r YF # yL i(f J � M1 i�j� �%',{_"."Tr� } +t `i i.0 S a � ��� N 1 i"�FY •+^i �� J Y Lt}'�XY A Public Private r4iPr.- S•`€}r�- `,Sectior}2 PropQrty OwnershlpLAuthorizgert_ 2.1 Owne of Record: A l L i �k� /vo(2 v > N me (print Mailing Address Ce,, V f P A� J� �7 ( Signature Telephone 2.2 utho�rize d Agent: �� � � 0 O � ✓� � ^ � i Nam (print) (`• F a Mailing Address Signature Telephone Fax Sectlon.S' "Coastrtletlo"n.5ervlces�n 3.1 Licensed Construction Supervisor. Not Applicable ❑ p f'� License Number �UI� ( 3a- O o.�Y�✓� O ddres • / Expiration Date Signature Telephonenn r, :3i1q,: !I 41141stered l�9_ me Imptouemerit ContNa tor,,„ I;�� C Company Name JUL 2 0 I Not Applicable ❑ p�q Address Lic rise Number r iration Date Signature Telephone rL- 9-75-99 1 of 2 OVER ._10 Section 4,.,Wo tkers';C �mpe satton,.,(,nsuiariCe,, f i airir`(M G i E:(6):,, xIt ,;�52;S 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 .......... ectian 5i3escnpt�on;o�Proposed„Work (cheGkalfappGcable) New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: c � Costs S'ectivn, 6Esftmatci':Go6striic#t0ir Item Estimated Cost (Dollars) to be Check Below ❑ Conservation -Commission Fling (d applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) completed by ermit applicant 1. Building . / 2. Electrical 3. Plumbing / Gas Z r 4. Mechanical (HVAC) o 5. Fire Protection ' 6.Total=(1 +2+3+4+5) ,0 7. Total Square Ft. (new houses & additions) Sectioh 7a twnerghortzatron To #tt Compfeted When= Owners e t r"Co,tractarA) Ites".forBurfdtn_,_,. iit s : 02 1 u a�owner of the subject property //,,,, hereby authorize 7�' tt 0� Y>h-e S t'f �--f� �P (-ice to act on m beh , in all matters elative to work authorized by this building permit ppfcation. Signature of Owner Date Sec [an 7b : Z7wrier/Ar fhonietl,"Ageni:Deciar..... I, 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. iowl Fie Print name / L / C) ((( Signature weer/Agent Date ►M 9-15-99 2 of 2 k O4't'gR,17 • `7 PLEASE PRINT: Job Location: _ TOWN. OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM Owner of Property: Construction Supervisor: Address: IU 100 Licensed Designee: (If other than Supervisor) Street Village Name License No. Phone No. h4l Name 2.15 Responsibility of each license holder: License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to*supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No If you have checked yea, please indicate the type coverage by checking the appropriate box.' A liability insurance policy � 7 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 the Mass eneral Laws, and that my signature on this permit application waives this requirement. /< Check one: Sign— iture of Owner or Owner's Agent Owner Al, Agent Signature: Building Official Approval: 1\ The Commonwealth of Massachusetts Department of Industrial Accidents OfAceoffevestfa foss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit city At.�tt'�/ U o �1� W611 0)-63�L- phone # 6-6)5-? / &-J K+ / C] I am a homeowner performing all work myself. I.am a sole proprietor and have no one working in any capacity I am an employer pro% iding workers' compensation for my employees working on this job. comnanv name: address - city- phone Of: insurance co. nolicy 0 1:9/1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below vvho have city: phone H: insurance co.. policy 0 company name, t•auure to secure coverage as required under Section ZSA of MGL 152 eaa lad to the imposidoa of criminal penalties of a One up to 51400.00 and/or. one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Age aiSI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Me of Investigations of the DIA for coverage verilladon. I do hereby certij under the pat.n&o1 d penalties of perjury that the injornutdon provided above is true and co ed k Signature�Lt�r..k Print name \ + 0.t1 1\ L.OIQ fDL Phone N7 /7� 77 aMcial use only do not write in this area to be completed by city or town of lclil city or town: YARMODTI; _ pet mitAteense ti nBuilding Department C31-1eensing Board check if immediate response is required 261 ❑Selectmen's Office pHealtb Department contact person: phone p: _ (508) 398-2231 eat. nOther. -1.Y 11 01" TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 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 Work Aa4ress is to be disposed of at the following location: �w►� i tn� ,1a (` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. Date BOARD OF BUILDING REGULATIONS 11-icense: CONSTRUCTION SUPERVISOR Number: CS 012430 Birthdate: 06/16/1940 Expires: 06/1612004 Tr. no: 25823 Restricted: 00 FRANK G CAPRA 40 COPPER LN. CENTERVILLE, MA 02632 Administrator 00 - 35,000 d enclosed space (MGL CA 12 S.601.) to - Masonry only 1 G -1 & 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 JA�P� RD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"M CER , Dowlirtg & O' Neil Insurance 07/101UJ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 INSURED INSURERS AFFORDING COVERAGE NAIC # Busy Bee, Inc... INSURER A. Hanover Ins. Company P.O. Box 50 . INSURER B: Safety Insurance Company . . East Sandwich, MA 02537 INSURERc: Associated Employers Insurance Compa ' INSURER D: COVERAGES TN;: DM IPIDe ne u,o„n..,.+...... NAMED VE ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT T WITHAREOSPECT O WHICH THIS CELICY IRTIIFICA ETMAY BE ISSUED OR DING 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. R NSR TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 'CLAIMS MADE D OCCUR X PD Ded.250 GEN'L AGGREGATE LIMIT POLICY PRO- JECT B AUTOMOBILE LL4BIUTY ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS AGE LIABILITY ANY AUTO 43PE175394 EXCESSIUMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe wider SPECIAL PROVISIONS below OTHER 06/14/03 I 06/14/04 [MA-CH oc AMAGE ED EXP 01/14/03 101/14/04 06/27/03 106/27/04 DESCRIPTION OF OPERATIONS / LOCATIONS I 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 ACORD 25 (2001108) 1 of 2 #30822 COMBINED SINGLE LIMk1T (Ea aeddm0(BODIL�YSIw))URYBODILYINJURY.(Per aetldenl) PROPERTY DAMAGE(Peraecidmt)AUTO ONLY. EA ACCIDOTHER THAN EAAUTO ONLY: EACH OCCURRENCEAGGREGATE SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL III DAYS WRITTEN 1NOTICE 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. AUTHORCMD REPRESFNTe'm,e ACORD CORPORATION 1988' P.01 J RD1. CERTIFICATE OF LIABILITY INSURANCE DATE(tAMgnyY) . AAODUCER iH1S C,� 3 cRTIFICATE IS ISSUED AS A MATTER OF INFORMATION XCShoa Inburance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 749. main Street, Suite#ff HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ostarville, Ma. 02655 ALTER THE COVERAGE AFFORDED 13Y THE P0UVE8 BELOW 50 R-d 20 - 9 01. j INSURERS AFFORDING COVERAGE 6URED Casper90n Overhead Doors INSLM A• -- INSURER B: SOX 517 wsuRER _ East Falmouth, KA 02536 rlsuacaD I INSURER 9- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PC ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE U WITH RESPECT TO WWI. IS SUBJECT 70 ALL THE TER. POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7 R TYPE OF INSURANCE POLICY R MSER OAT C YEFFECTNE POLICY EX►IRA rk GENERAL LIABILITY M COMMERCIAL GENERAL UABIUIY CLAIMS MADE OCCUR A — WP48352 03/2e/03 05/28/04 OEN'L AGGREOAIE LIMIT AfPLitS PER POLICY ,R O- LOC AUTOMOBLE LIABLITY ANY AUTO ALL OWNED AUTOS SCHEDUL FO AUTO5 WRCO AUTOS NON+OWNCD AUTOS" GAMOE LIABLITY A DOCCUR 0 CLAIMS MADE OlOUCTNXC HELEN>mDL >~_ WORKERS COMPENSATION AND EMPLOYERS LIABILITY OTHER BY Gateway ]tomes 1600 Fa"- utlii cad-, Suite 25X Centerville, MA 02632 778 5603 r ACORD ?S-S (71M THS MAY -f(CLUVONS CERTIFICATEANDCONNDf TK)NS OF SUCH UFO EKP(Any m, pr f rtR$ONKAADV INJURY SRf1A _nnn PfiODUCTS. COMP4:P AGO $ II-- 0.09�44.4 ,E4 IN SINGLE LIMITS COOLY DLKIRY _— tPerperson) i COOLY INJURY (PW .e4AW) 1 f (PHPERTYDAUAG fiftt"m) C ;��' F`CNOMMFIENCE LGOREGAT6 S S S /23/03 02/22/04 EL EACHACCIOENT ELEL=EA EW EL MSEASE • PCUCY DATE THEREOF. THE MISUIN0 INSURER WILL ENDEAVOR TO MAE DAYS WRITTEN NOHOETO.R(E.GERTIFIOATg.NOLDER-ILA��� - 90SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUR w Iftrft..e...— - ER. ITT AGENTS OR 0 ACORD CORPORATION 198E 1••w. .x'Cl, I HL I 7 I J A RIDER. RISK SPECIALISTS onLr INSURANCE AGENCY, INC. ALTU F.O.wx 115 CATAUMET MA 02534-0115 COMPANY nuaED _ A MONUMENT INSULATION, INC. gam', 223 COUNTY ROAD r BOURNE, MA 02532 �AW CCwANY TH16 !S TO CERTIFY T INDICATED, NOTWUTHI CERTIFICATE MAY BE rf" Of U MURANCE IERAL LVWUTy amr-7A1 LA CAM$ MADE ® O OwNe" & CONTRACTORS AMMOD.0 UADIMY jANY AM ALL OWMMAUMS SOiEOULEDAU;[6 MMM AUTCS N&4-0w AV= AWArna UMeREUAFCAM �WORKM>:OM.ENSATM AND UAw-" 1I 564 7272 P.01i01 DATL 05/03 n AC rsZA POLICIEBOFWS _., URANCE LISTED 80.0W HAVE G ANY REQUIREMENT. TEAM OR CONDITION oFe� ISSUED TO ANY NAMED ABOVE FOR THE POLICY P£fil CR MAY PERTA W, THE :NSLIRANCE AFFORDED BY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO I OP SUCH POLICIES. LIMBS SHOWN THE POLCIEB MCRIVED HEREIN IS WI'OCN THIS MAY HAVE BEEN REDUCED BY PAID CLW& SUaIECT TO ALL THE TERMS. �-F'WJCY NUMDUFA fDUcrarfa DA7EI�WDO/i7'ICMM FOUJ6YE04AIMON :p: DATE OIK=/Vn . t7Y:S LL1135745 N" j WC 782 61 72 GATEWOOD HOMES, INC 1600 FALMOUT'H ROAD 425 CENTERVILLE, MA 02632 508 778-5603 8/23/03 18/23/04 COMB9ro swaLE L UT Is � scogrlN.xmY 9/5/03 19/5/04 s II VWUW ANY OF THE ADOYE DOMBED ....$.R..._....>7.rY'v.,..y�a EIRIRAl DATE TN 1'oLUGE& BE CANCELLED mftow Mr •� ,� EAEOF, ME I& "C GOMrAW WILL ENDEOM To MAUL IDL "" WNTTEE NOTICE 70 7IIE CoMn"TE HOLDER NAMECTO••TpWQfi" DUT r'UW E;m MAd t: : , r�. MOCE &MALL IAIPCtsE NO 06Ud1 UADLLI7Y 0E-r.`7u1i::rOi�n. vX" rMM OO TOTAL P. 01 CERTIFICATE OF INSITR ACE • PRODUCER Passaro Leverone & Buckley Insurance Agency Inc P 0 Box 160 Dennisport, MA 1 2639 INSURED Patrick K Orcutt 6a P & S Concrete 37 Ladys Slipper Lane Mashpee, MA 02649 DATE BY COMPANIES AFFORDING COVERAGE A A.I.M. Mutual Insurance Co COVERAGES - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS 1ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR djT D CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, CT THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S[IB7ECfS TE TO O ALL THE WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co L TYPE OF INSURANCE POLICY NUMBER POLICY. EFFECTNE POLICY EXPMA7T DATE(MM/DD/YY) DATE(MM/DD/YY)LLHIT$ GENERAL LIAJ1II177 MMERCIAL GENERAL LIABILITY ENERAL AGGREGATE S IMS MADE�C PRODUCTSCOMP/OP AGG. t WNER'S & CONTRACTOR'S PROT. PERSONAL & ADV. INJURY S EACH OCCURRENCE S RE DAMAGE (Any o Tim) S UTOMOBIITi LIABILITY MED. EXPENSE (Any one penm) S NY AUTO COMBINED SINGLE IT S ALLOWNEDAUTOS " EDULED AUTOS BODILY INJURY �) f IRED AUTOS NON-OWNEITAUTOS BODILY INJURY Pa=ide ) S APACE LIABILITY PROPERTY DAMAGE S CESS LIABU ITY . MBRELLA FORM EACH OCCURRENCE S F(FR THAN UMBRELLA FORM GGREGATE S WORKER'S COMPENSATION AND EMPLOYERS' UABILTTY WCSTATU-X OTH- A THE PROPRIETOR/ R 600618-0120.3 10/21/2003 10/21/2004 ER S PARTNERS/EXECUTIVE INCL OFFICERS ARE EX EL DISEASE —POLICY LIMB f 1000 ow OTHER I EL DE. ISEASE—EA EMPLOYS I11()T)TNV1 Gatewoods Homes 1600 Falmouth Road 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 MIPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 111-2 _ ACORDM CERTIFICATE E OF LIABILITY INSURANCE DATE08(RIM ppliyyy) • ►ROOUCPR _ i082DQ3 JOAO-M-01AS• 508 672 2997 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OIgS INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER: THIS. EERTFfCA T-E DOES. NOT AddEND_ EXIELYQ 535 BRAYTON AVE A TER THE COVERAGE AFFORDED RV THE OR POL,ICiES BELOW. FALL RIVER, MA 02721 wsuREn INSURERS AFFORDING COVERAGE JOEL FERREIRA DEALMEIDA INSURERA: GRANITE STATE INSURANCE COMPFJJY I. W gq�j8_gg DBA EJJA CONSTRUCTION rIwRERe; NAUTf[fJS IFISCIRANC6 COMPANY• ��NE2F58p6 50-PICKERING ST. APT 17 NSUIRERC;—F_---- FAI I PIV=o AAe nn inn _ wEl lem... THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURCO NAMED ABOVE FOR THE POLICY AN.Y.REOILREMEIII T"M OR CONDITION OF ANY CCNTRAL" T OR QI DOCUMENT WITH RESPECT TO WHICH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRrBEDTIERER'tLq SI19;iE8T TUSPE T T WHIC I POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IR o0 - POLHC'HUMBF.R PO EFFECTNE POUCYEXrIMTION GENERAL UAOIUTY i X CCMMEHCLAL0tW9AALLbi&I NC275806 0612WO03 CAC O6/26R004 MEO I I f ANYAUTO ALL OWNED Autos SCHEBULEDAUTOS HIASD AUTOS NOMOWNEQAUTOS AGE UAI R,ITY ANY AUTO J OCCUR LCLAIMS uADE DEDucraLE I RETENTION j W OR NLRB W yRENEATAO "AM EMPLOYERS'LIAEILItY ANY PAOPEETORIcxauoCXCLUDEEX'dLiNE �rovqWP�rlccAAAEMEER eoT SPEy'I��Istli°0iowe s.w OTNBR 1PTR]IYOPDTERATMHZ/ tOCATIONS/YEMIGL IFICATS HO LDER GATEWOOD HOMES 1600 FALMOUTH RD. CENTER VILLE. MA 02632 WC- 49¢46-86- f rumba. I 1 Isms. 3. NOTWITHSTANOING E MAY BE ISSUEQ OR �.ONDIAQNg Or SUCH E 3- COMW m GHGlg VJT {Ee aetiGMl) II�f EODR.YIAIJVRY I WeIRs30n) --� I )BOMYIYIWJURY s PROPERTY DAMAGE wroaNcrTerAttroel.r t OTNER TWW AUTOONIY: s EHOVLDANY OFTHE AEOvi OCCRIBEO PI EE CANCS.CEStCFORpTHE Expobk" _ DATE TIIiREOF, THE KLNING NSURER WILL EHOLAVOR TO MAIL IP DAYS WRITTEN NOTICLTO'TRE'CERTIFICATjrHaWE"AMEDTO THE LEFS Ilux Mpoaf NO OBUOATIOH Of UABIUTY Of ANY KIND UPON THE WBURER, IT3 AOENTE ON —ATN-a' . UTHORGEDR ESEHTAT ......�� lY.11 raa 50B7900249 GOLDW ASSOC CD-CERTIFICATE of LIABILITY INSU.RANCE As DUCER GoLDbw t AzsocuTEs INSURANCE cm TMSCEBUFICATE14. TAtirAaTso TIM04CIAL SERVICES INC. 933 FALbaxm ONLY AND CONE-sRS Nt O R CJC�H S �N THE CE RD. ��ETM�IS CERTIFICATE NOT AMEND HYAMWS M 02601 AFFORDED-BY.THEp Phana:5O9-775-6020 2aZ7500-790-0249 ^'� MUMS AFFOR W R� CC6QERCE INSL4MCE CO ROONEY VLVANO 110 HOOLDDER CHANICPLL SY8TEb18. a ?ORIc$.Iir cxr�euvz_ MURMC: N' SARNSTAME JA 02668 a o safao. COVERAGES s „'E'er, CES OF Ls�m �iow way cs�sa ro ns ANY AROLIREMM, TEEM OR OO4CRatOFANY Ct rtA[;(pitrn wCUAbp NMfiD►S0IIE FOR THE POLM VF+Bmi+cr�Tzp. OiWRTRYAP10pY: MAY PERTA °OmA�rwrFwlwsrcrTowmm-rmTE�Y TW-r4R WdC&.rrorMMBYnerau�6 p ppa POLMS.AGGREGATELIM643wNwtYwvet� 11� crTa�utTreTotsa.Qa RTt �w►ca tELl7®9Y PADQAyg ptasaFs�,aH LTR TYOS CSC •�•• � � OETEFALLUaLAY !y1 VATE LMM a x LGUMWUPe¢mr AL8172 WM NAM ® O M OCCURAffAte Il/21/03 11/21/04 _a6F�g�ae 7 EXPVV °'Pw!aU i AA NNii4Y i c}M r tYe tRO. APPtP& PER AGGREGATE i �Y:Y JECT Loc AuiLMLOMELJAMUTY - - AOG f IIJY.HIrp f'"MILSlr JW.OIMt®AIIi05 -f SCMEOMEDAUr06' tRiEDA17T09 fiA:ir S .. 'Rf�OLMPflAtjr06• YxAAxY GARAGE LJABLITy VAMAGE ANYAUYO. . ONLY-EAAC=EW j i:NPP FiAACC f L%A9S.71Y ONLY: AGO f OOftR CLAMMAM OCCL*VWA :e i Tg i mni-+IS- S REroax P .icetERf CO W^r--ftAPO twm a3w i LLqRLZTY E AD 9727RU4903 TORT utars t 05/03/03 05/03/04 EACHApgppYYducdo f li awvaprw4 wt� E ecEASE-EAo�LoreE s 1i ELOKEASE-POUCYLur I ISO 001 mLTe.... GhTZIWOOD LC GATEfo X 5O8-77Lzaas8-56031600- . 0oi6tsa4tEt5kTlat�IOAaTpY�QOR.t�T10aANse+OprRvn�L:ui�BOIT,YEt tLNAuyM�E�i1anotL t�waatTrtgntYnYl.Efelva2rPT1u0aRtEl1T6oaAaO�oEPaTiIvi: aQtKt L FAI1�pTg g+OAD. wTRTa C&NTERV=U N► 02632 u -- r222West �, CERTIFICATE OF LIABILITY INSURANCE =DATE(MWDDW/YMyYND OR O' Neil Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION c. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Main St. PO Box 1990ALTER THE COVERAGE A ORDED BY THE POHOLDER. THIS CERTIFICATE DOES NOT LICIES BE OW. A 02601 INSURERS AFFORDING COVERAGE NAIC # Gutter Pro Enterprises, Inc. INSURERA: Travelers Insurance Company P.O. Box .1197 wsuRER B: Guard Insurance Group Plymouth, MA 02362 wsuRERc: INSURER D: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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. 'RA6tS uAIE MMlDD DATE MM/DD A GE5jABI:yL6"49H3118TCT03 11/07/03MMERCGENERAL LIABILITY 11,07/04 EACH oc RMAGE CLAIMS.MADE OCCUR MED EXP GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE S POLICY PET.LOC PRODUCTS-COMP/OP AGG S: AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Pwpe ) S HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (PNacddwt) S PROPERTY DAMAGE GARAGE LIABILITY P) S ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S EXCESS/UMBRELLA LIABILITY AUTO ONLY: A-- S OCCUR CLAIMS MADE EACH OCCURRENCE $ . DEDUCTIBLE B IWORKERS COMPENSATION AND GUWC44Q6Ej 11/07/03 11/07/Q4 EMPLOYERS' LIABILITY _ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / 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 ACORD 25 (2001/08) 1 of 2 #32273 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I.0_ DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE To DO SO SHALL '.E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED ACORD CORPORATION 1988 AUUKU,r CERTIFICATE OF LIABILITY INSURANCE LDA?2i2 0 PRODUCER (508) 994-9688 FAX (508) 991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RUTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 414 COUNTY STREET HOLDER: THIS CERTIFICATE DOES NOT AMEND, EXTEND OR NEW BEDFORD, MA 02740 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Fran Capra .... JNSURERA: Providence Mutual.. PO Box 664 INSURERS: OneBeacon West Hyannisport� MA 02672 INSURER C: Continental Cas.ua7 ty. Co _:.., . •. ._ .. _. —_ INSURER D.-- . ..... INSURER E .. COVFR&RFC _ 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 G SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED RI PAID CLAIMS. —SR TN T TYPE OF INSURANCE POLICY NUMBER POLICY EF�CTIVEDATE 12/13/2002 POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR CPPOO53131 00 12/13/2003 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Anyfire) one S 50,0001 MED EXP (Any one person) S . 5,00( PERSONAL & ADV INJURY S 1,000,00( - GENL AGGREGATE LIMB APPLIES PER: POLICY - JECT LOC GENERAL AGGREGATE $2 , 000y 000 PRODUCTS - COMP/OP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO CBXE4812S 02/14/2003 02/14/2004 COMBINED SINGLE LIMB (Ea accident) S ALL OWNED AUTOS X BODILY ,) INJURY $ 250,000 B SCHEDULED AUTOS HIRED AUTOS (Per accident) _ $ 500,.000 NON -OWNED AUTOS AUTOS .. .. _ PROPERTY DAMAGE . _(Per aaidenq 10 .00 GARAGE LIABILITY "kNY AUTO `•. � _... .AU7MZNLY-.EAACCIDENT. S OTHER THAN EA ACC AUTO ONLY: AGG S . . - EXCESS LIABILITY . - _. ... S OCCUR ❑CLAIMS MADE EACH OCCURRENCE S. AGGREGATE S S DEDUCTIBLE S RETENTION S TORY LIMBS t ER S C EMPLOYscoMPBILITY ONaND - EMPLOYER5 LIABILITY 559U6861X751603 03/22/2003 03/22/2004 E.L. EACH ACCIDENT S 500 , 000 EL DISEASE. EA EMPLOYEE S 500,0010 OTHER E.LfJISEAS'E'.POLjOYLIhII� t - 500-D00 DESCRIPTION OF OPERATIONSILOCATIONSfVEtIICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I I Anmm�.,AI ,.,.,. _.._—.--- ...� .. _—_-• Catewood Homes Inc 1600 Falmouth Road Ste 25 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 wRRTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF yRQN THE COMPANY -MS AGFNTs m'R RFVRCeC At . ACORD_ CERTIFICATE OF LIABILITY INSURANCE OPID A DATE,MM,DDIYYYY, - PRODUOER CIR 50 07 25 03 Sullivan, Garrity 6 Donnelly 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 HOLDER. THIS CERTIFICATE DOES ALTER HE COVERAGE AFFORDED OYT HE POLICIES IE Worcester MA 01615-0010 OLICCS BELOW. Phone:508-754-1767 Fax:508-754-1885 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER Hanover Insurance Cc 22292 INSURER B: Arch Insurance Com an Crowell Construction, .Inc. INSURER C: PO Box MA 02660 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH 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 GENERAL LIABILITY POLICYNUMBER DATE MM/DD DATE MM/DD OMITS EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR ZHN7007141 05/01/03 05/01/04 PREMISES Ea ocorance $ 100000 MED EXP (Any one person) t 5000 PERSONAL&ADV INJURY 11000000 GENL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE i 2000000 PRODUCTS-COMPIOPAGG $2000000 POLICY . `JECT LOC AUTOMOBILE UABILTTY COMBINED SINGLE LIMIT $ (Ea accident) A ANY AUTO .. ... ALL OWNED AUTOS ABN7001142 05/01/03 05/01/04 X BODILY INJURY $lOOOOOO (Per pmm) SCHEDULED AUTOS HIRED AUTOS - X X BODILY INJURY (Per accident) $ 1000000 NON -OWNED AUTOS PROPERTY DAMAGE $S0000O (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S A A. ONLY: AGO S IXCESSNMBRELLA LIABILITY EACH OCCURRENCE 3 OCCUR D CLAIMS MADE AGGREGATE S $ DEDUCTIBLE _ S RETENTION S $ WORKERS COMPENSATION AND B EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? IRWCIO0100 03/22/03 03/22/04 - TORY LIMITS ER E.L EACH ACCIDENT $S0000O — -ayCorder SPECIALW. P PROOVISIONS below - EL DISEASE - EA EMPLOYE $500000 E.L. DISEASE. POLICY LIMIT S500000 OTHER DESCRIPTION Fax OF OPERATIONS I LOCATIONS I VEHICLES #508-778-5603 I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION GATEWOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE IXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .10 DAYS WRITTEN Gatewood Homes _ 1600 Falmouth Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE —LEFT, BUT FAILURE TO DO SO SHALL Suite 25 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND -UPON THE INSURER, ITS AGENTS OR Centerville MA 02632 REPRESENTATIVES_ CERTIFICATE QF,,�IABILITY INSURANCE PRODUCER 508-398-6033 J;TEIMMYDDryYrn FAX SOS-760-1667 THIS CERTIFICATE IS-ISSUEOAS A M INFORMATION ' A771ed American Insurance Agency LLC 1 Atlantic Ave ONLY AND CONFERS No RIGHTS UPON OF So Yarmouth HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MA 02664 ALTER THE COVERAGEAFFORnpn ov Tu. --..-___ A 762 Falmouth Road Hyannis NA 02601 INSURERS AFFORDING COVERAGE MSURERt Arbella Protection Ins Company ::: wgDRER B' Hantfn..w ,vV A g Wb WERE: THE POLICIES OF INSURANCE LISTED BELOW JiAVE BEEN ISSUED TO ANY REOUIREMEN7; TERM OR CONDRION OF ANY CONTRACT' OR OTHER MAY PERTAIN, TH THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO'f WITHS7ANDIN !r INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S I WITH SUBJECT T POLICIES. AGGREGATE LIMITS SHOWN RESPECT TO WHICH THIS CERTIFICATE MqY BE ISSUED OR IN D MAY HAVE BEEN REDUCED BY PAID CLAIMS. 0 ALL THE TERMS. EXCLUSIONS TYPE OF INSURANCE AND CONDITIONS OF SUCH GENERAL LIABILITY POUCY NUMBER POLICY EFFE TWE POUCYEXPIRATIOH X COMMERCIAL GENERAL UABII 7500000371 12/13/2002 12/13/2003 FACNOCCURRENCE LIMITS CLAIMS MADE D OCCUR DAMAGE TO RENTED S 1 ODD, OI s CENLAGGREGATE LIMITAPPLIES p� X I POLICY I j2pa nLD� AUTO"OVILE Lweamr ANYAUTO ALL OY'I AUTOO ' SCHEDULED AUTOS HIRED AUTOS /'ION'OWNED AUTOS GARAGE LIABILTT 1 ANY AUTO :-WVMBRELLA LIABILITY OCCUR D CLAIMS MADE DEOucTIate WORKERS COMPENSATION AND EMPLOYERS -LIABILITY B ANY PROPRIETOp/pARTNERIEXECIITWE OFFICVVMEMBER EXCLUDED? J I VEHICLES I MED EXP (AI one P•IeB11 f SO PERSONAL A AOV INJURY S 5 1 000 GENERAL AGGREGATE S 2 000 PRODUCTS-COMPIOP AGO S nnn COMBINED SINGLE LIMIT Xf fcodeII) S BODILY evJVgy IPn081 S BODILY WI IPv.tod.ny S ( recddPn DAMAGE 1 4 AUTO ONLY - EA ACCID"I OTHER TNAN EA ACC f AUTO ONLT. AGO S EACH oGCURxENCE f AGCREGATt S S S V Evidence Of Insurance for work performed within the Insured's scope of normal operations S S - VY C C 6Ro11LD ANY, OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 0FIRATION DATE THEREON, THE ISSUING INSURER WALL ENDEAVOR TO MAIL Gatewood Homes .. 20 DAYS"WITEN NOTICE TO THE CERTIpCATI HOLDER NAMED TO THE LEA 1600 Fal "I Road #25 BuT FAR.URE TO MAIL SUCH NOTICE SHALL IMPOSE No OBUGATION OR LIABIUTv Centerville, NA 02632 OF ANY KIND UPON THE JNBURER, AS AOERT- OR REP AUTHOI RESENTA RESENTA IvM IICORD 25 (200i/08) FAX: (508) 778-S603 Q- ®ACORD CORPORATION 1988 CERT 2 F = CATE OF = NSURANCE --------------- Producer; SOUTHEASTERN INS AGCY HYANNISN ST MA 02601 Code: ------------------------- Insured: RJ BEVILACOUA FORESOTDALE MA 02644 Sub -code: Issue date: 7/22/03 noirigchtsiupontthesCertificateaholder. ThisnCertificatendoesnnotoamend, extend or alter the coverage afforded by the policies below. wNrANIES AFFORDING COVERAGE Lo Ltr A: ARBELLA PROTECTION Co.___ _--tu Ltr B: ARBELLA PROTECTION tu-- Co Ltr C: Lo Lt-------------------- r D: ARBELLA PROTECTION -- ---tutu-- Co Ltr E: COVERAGES This is to certify that policies of insurance listed below have been issued to the insured named above for the polic/ period indicated, notwithstanding any requirement, term or condition of aoy contract or other document with respect to which this certificate may be issued or may pertains the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of sack policies. Limits shorn may have been reduced by paid claims. ------------------------------------------------------town mar -have b---- educed by paid c Co I I ------------------ Ltrl Type of Insurance Policy I - Policy 1 -"-"-"--_-"—'- --A I EN---- ---=------------ ------------- -------------------------------------------------------------- ---------------- Policy number effective date fexpiration date) A I ENERAL LIABILITY All limits in thousands I Commercial general liability ' 8500010147 I 7/15/03 I 7/15/04 General aggregate �[ Claims made [ ) Occur I Products-comp/ops aggre : 2,000 Owner's 8 contractor's prat l I Personal/advertising inj: I I (Each occurrence: f0000 ---- ------ tutu_________________ _______________ I Fire damage: B IAUTOMOBILE LIABILITY — -- (Medical expense: --------------tutu-- 5 86852400001 1 2121103 -------------------------------------------------tutu-- I An onto I I 2/21/04 (Combined l Alt awned autos (Single limit: 250/500 l Scheduled autos I I Hired autos II (Per person�r i lNon -owned autos I l lSedily injury Garage liability I [Per accident): I --------- ----"" I Property damage: 500 ------------------ (EXCESS LIABILITY tutu""""""I I l -------------------tutu-- I Each -I Other than umbrella form Occurrence Aggregate ----------------------------- I D WORKER'S COMPENSATION -_---_--_tutu---"--- ----------------------------- 1 9088680403 l I - ---tutor---------------------tutu-- 4/27/03 I 4/27/04 (Statutory I_____________________________ l --------- EMPLOYERS' LIABILITY II I II 100 Each accident) -----__-_ - l l I I 500 (Disease -policy limit) 100. Disease —each. empleyeel.. OTHER tutu --------------------- I I I I ---------------- —---- —------------- ------------ -- --- _ 1— — -- �-------- -------------------tutu-- Description of operations/locations/vehicles/restrictions/special items: - CERTIFICATE HOLDER 1600WFALMOUTHSRD STE 35 CENTERVILLE MA 02632 4/89 CANCELLATION Should any of the above described policies be cancelled before the expiration date thereof, the issuing companT Will endeavor to mail fO days written notice to the certificate holder named to the left, but failure to mail such notice shall impose no obligation or liability of nay kind upon the company, its agents or representatives. _----------,tutu-- Authorized representative: -------"-""--- ___ JOAN M MARTIN JA - �.vrcuTM LtKTIFICATE OF LIABILITY INSURANCE E (MM/0DNYYn PRODUCGR LDAT1 0/7/03 Qowling.& & Neil insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ag)ncy, 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 INSURED INSURERS AFFORDING COVERAGE NAIC # Bayside Electrical Contractors, Inc. INSURERA. Travelers Insurance Company 372 Yarmouth Road INSURERS: Guard Insurance Group Hyannis, MA 02601 INSURER C: INSURER D: COVFRer_ec INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE PECT TO TERMS,, THIS II CLUB ONS AND MAY BE IS CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _TR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY DATE M/D pATE MID LIMA 16801484A82ACOF03 10/05/03 10/05/04 EACH OCCURRENCE 6 X COMMERCIAL GENERAL LIABILRY 1 OQQ QQQ DAMAGE TO RENTED CLAIMS MADE X OCCUR 3300,000 X OCP PERSONAL 6 ADV INJURY $100000( GEN'L AGGREGATE LIMIT APPLIES PER: - GENERALAGGREGATE $2 000 OOC POLICY 11 . PRODUCTS -COMP/OPAGG $2 OOO nnn A AUTOMOBILEUABIUTY 18102601W5611ND03 ANY AUTO 10/05/03 10/05/04 ALL OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) $ X NON -OWNED AUTOS BODILYINJURY X Drive Other Car ) S PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ ANY AUTO AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC S EXCESSAIMBRELLA UA13JUTY AUTO ONLY: qGG S OCCUR CLAIMS MADE EACH OCCURRENCE S ' AGGREGATE $ "DEDUCTIBLE $ RETENTION $ S B WORKEEMPLOY AND BAWC436910 t RS'UAeNSAT]ON EMPLOYERS LIABILITY 08/18/03 08/18/04 WC STATU- OTH. ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $100 000 H yes, describe under DESCRIPTION OF OPERATIONS, LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1600 Falmouth Homes DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL 1600 FBImOLIth Road Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAIL_ URGE TO DO so DAYS SHALL Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESFsrre.n� --wmu za (LUU1ro8) 1 of 2 #M31942 0 ACORD CORPORATION 9988 R�r�Ess: a1 s :ALCULATlON FOR PER_ AIT_COS7 TYPE OF Rpp �C / ADDITION Lire' 7C ORATIONS BATH �/6 ECERTIFICATt-o-F-7-0-&�Z ROOM Hl:cK WITH ROOF DEMOLITION bd° DEN DINING ROOM FAMILY ROOM FIREPLACE FOUNDATION ONLY GARAGE NO.OF BAYS GREAT ROOM KITCHEN OFFICE PORCH CLOS PORCH OPEN REROOFING SHED STrWAf. c wn, SUN ROOM HiEAtEp _ SUN ROOM UNHEATED SW11 NG POOL ASS -- SWIMpNG POOL INCH FF•V■ TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-077 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 116 Owner's Name: Villages at Camp St., LLC Owner's Addres 1600 Falmouth Road, # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 7/20/2004 Issue Date: Expiration Date L,ommenis: new construction: V44.4 1. I .U//� ZONING Al"MROVCM- 00 n i'L REVIEWED BY: WATER DEPARTMENT: DATE: N/A: L4 ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: ✓ 4. EALTH DEPARTMENT: DATE: N/A: 1/5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 7/30/2004 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) 21.1C116 Street 121 Camp St., #116 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 at Camp St., TT^ : 1600 Falmouth Rd. : Centerville, MA 02632 Temp Permit No.: Applicant Name: Applicant Phone: Building Location: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL T-05-077 Frank Capra 5087789669 00121 CAMP ST # 116 Owner's Name: Villages at Camp St., LLC Owner's Addres 1600 Falmouth Road, # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 7/20/2004 Issue Date: Expiration Date Comments: new construction: Map/Lot: 044.21.1.0 // REVIEWED BY:, 1 WATER DEPARTMENT:kL- 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: 7/30/2004 TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-077 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 116 Owner's Name: Villages at Camp St., LLC Owner's Addres 1600 Falmouth Road, # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 7/20/2004 Issue Date: Expiration Date Comments: new construction: Map/Lot: 044.21.1.0 //G REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: / C N/A: 5. BUILDING DEPARTMENT:3; DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: �P;7�nMD DATE: Date Printed: 7/30/2004 • EFFlgENCY RATING CERTIFlED ama Air Conditioning & Heating 92.6% AFUE MULTI -POSITION CONDENSING GASFURNACE GMNT SERIES $.rtC7EFM11L50TC,11R,IREf 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 burners • Convenient left or right hand connection for gas, electric service, combustion air and vent • Removable solid bottom block -off Oik � (/STEO�VI 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. Co., 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 www.goodmarunfig.co 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 0405 40,000 37,000 37,000 34,000 92.8 25-55 060-3 60,000 55,000 55,000 51,000 92.6 35-65 080-4 80,000 73,500 73,000 73,000 MIS 35-65 100-4 100,000 92,000 92000 85,000 926 40-70 12a5 120,000 110,000 111,000 102,000 s2s 40-70 BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA AVAILABLE FROM YOUR RETAILER. SPECIFICATION DATA Plpe4nnal r harnr s%riefirc 119J1/An r,2c cArvirp rv%nnarfinn'/" PDT Model Number Motor Blower Vent' Dia. Combustion* Air Filter Size In Perm. / Disp. Electrical Ship Weight HP Spd. Dia. Width FIA Max Fuse 040-3 1/3 3 10 6 2' 2' 290 / 580 52 15 170 060.3 1/3 3 10 6 2' T 290 / 580 5.2 15 180 0804 1/2 3 10 8 3' T 385/770 7.8 15 205 100-4 1/2 3 10 10 3' T 385 / 770 7.8 15 225 120 5 3✓4 3 11 10 3' T 4801960 9.2 15 1 265 -rvo[e: vent ana Comouston air alameiers may vary oepenaing upon vent iengtn. t:neCK witn instructions, which accompany the furnace. 28" A 581" 4" �198„� 48., �B� 48„ II 4 T i 4 1 8" - COMB. AIR INLET i 123" COMB. AIR INLET GASINLET 51„ 4 . VENT � e � I b i 27" LOW VOLTAGE 4" i ELEC. 104" Model GMNT A B Combustible Floor Base 040-3 a 060s 14" 12'W SBM14 080-4 17 Y2 16, SBM17 100-4 21' 19'W SBM21 1205 24 % 23' SBM24 SS-312D i i i i i • GASINLET ri i i VENT 208 ' ' Jill `LOW VOLTAGE CLEARANCES FROM COMBUSTIBLE MATERIALS IF Sides Rear Front' Vent To 1' 0' 3' 0' 1' Approved for line contact in the horizontal position *36' clearance for serviceability recommended. 2 CASED (U) COIL APPLICATION OPTIONS Furnace Model Number GMNT040-3 & GMNT060-3 GMNT080-4 GMNT100-4 GMNT120-5 Furnace Width 14• 17'h' 21' 24'/• Coil Model Number Coil Width U-18 14' X U-29 14' X U-30 17'V X(1) X(2) U-31 14' X U-32 17 Y; X (1) X (2) U-35 14' X U-36 171/T X (1) X (2) U-42 17'W X (1) X (2) U-47 17 Y' X U-49 21' X (1) X(2) U-59 21' X(1) X(2) U-60 24'/2 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 mix/match 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 040-3 MED 1210 1170 1130 1085 1040 980 920 860 LOW 895 880 870 840 825 780 725 680 HI 1360 1300 1250 1190 1135 1065 1000 930 GMNT 060-3 MED 1200 1170 1130 1080 1035 975 925 880 LOW 910 895 885 855 835 790 750 700 HI 1865 1800 1735 1660 1590 1510 1415 1320 GMNT 080-4 MED 1690 1645 1600 1545 1485 1410 1345 1245 LOW 1450 1400 1390 1360 1325 1270 1200 1125 HI 2010 1945 1875 1800 1715 1620 1510 1400 GMNT 100-4 MED 1725 1700 1670 1615 1550 1475 1375 1275 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 1 1545 1480 1415 LOW 1275 1215 1190 1145 1110 1 1055 985 925 Values indicated by shaded areas represent airflows that are too low for heating temperature rise. SS-312D 3 f NOTE: SPECIFICATIONS AND PERFORMANCE DATA LISTED HEREIN ARE SUBJECT TO CHANGE WITHOUT NOTICE 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. That's why we know... There's No Better Quality. Visit our web site at www.goodmamnfg.com for information on: • Goodman products • Warranties • Customer Services • Parts • Contractor Programs and Training • Financing Options SS-312D 4 r NpE BELOW ' 5 L.F. S 8' RR=1 45-00 L�0 p8 6'VT \p- .12' tP i P HOUSE o r (PLOVER) v `� FF = 29.0 FF=15 / 2e.7"' w w )T 115 5.3 10 S.F. 62.95' 1W CROP R SER�G� *N �? OSEO PRNO�SPERI �SPNOP 2g 0 fGW 1? LOT 116 3,705 S.F. 57.25' S81'47'' \a t-: a O I \ AFFORDABLE . 11�f-1PIV/I 1 SRO O L `L Le�O v g"95 FF �. G� n6y 458.71' u SS' ® SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. NOTICE Wass and until such time as the original (red) stamp of the sible Professional Engineer, or Professional Land Surveyor e on this plan: ,A) no person or persons, induding any munieipal 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. REVISED: 3-8-04 PLOT PLAN �.i holmes and mcgrath, inc. ,H ©F;;;q OF LOT 116 civil engineers and land surveyors a `� ssacy PREPARED FOR 362 gifford street ' c TI"OTH.Yh1. N MILL POND VILLAGE o snvros: ,� falmouth, ma. 02540 w©.aso7a IN CIVIL YARMOUTH, MA � 9�G ST JOB NO: 201197 DRAWN: LMC �. , SCALE: 1 "=20' DATE: 5-1-03 DWG. NO.: A2532 CHECKED: •f/t> ; "'' SEE SLEEVING 6 N07E BELOWB S9R�35 5 L.F. S 1ro �5 fryti �o Oti s� R=145.00 EO GE Q�'° ti9' L=50.08 A'b 5 i22Ln N too, i Gw a: f�5 \N� PROPOSED 2.3 w HOuSE o ,� i C? r (PLOVER) v a a' FF = 29.0 5.3 FF = 15 LOT 116 �, AFFORDABLE 2e.7 i °' �1 39705 S.F. w 5.3 rn: 57,25' ' ►T 115 „ 458.7 10 S.F_ 05, S81'4710 W Sa 0 NOTE: SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. NOTICE id until such time as the original (red) stamp of the ifesslonal Engineer, or Professional Land Surveyor a plan: ( IN FEET) tn) no person or persons. Including any municipal or other public officials, may rely upon the information contained herein; and 1 inch = 20 tt. (B) this plan remains the property of Holmes do McGrath, Inc. REVISED: 3-8-04 PLOT PLAN holmes and mcgrath, Inc. H OF OF LOT 116 civil engineers and land surve ors �`a�P� 414ssa PREPARED FOR y v os MILL POND VILLAGE 362 gifford street TIMOTHYA7, m IN falmouth, ma. 02540 5 No 4so d `<r CIViL YARMOUTH, MA JOB No: 201197 DRAWN: LMC°Fs�G'ste�°,'`� SCALE: 1 =20 DATE: 5-1-03 DWG. NO.: A2532 CHECKED:7ik> I t MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # MAscheck software version 2.01 Release 2 I I I Checked by/Date CITY: Barnstable 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 1600 Falmouth Road Unit #25 Centerville, MA. 02632 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 223 Your Home = 138 Area or Cavity Cont. Glazing/Door Perimeter R-value R-value U-value UA ------------------------------------------------------------------------------- CEILINGS 845 30.0 30.0 14 WALLS: wood Frame, 16" D.C. 1415 15.0 15.0 62 GLAZING: windows or Doors 93 0.340 0.340 32%- 27.1'- GLAZING: windows or Doors 80 40 0.086 3 DOORS ----------------------------------------------------------------------------- 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 74.4. Builder/Designer Date Massachusetts Energy Code MAScheck software version 2.01 Release 2 The Sandpiper DATE: 4-21-2004 Bldg.l Dept.{ use I CEILINGS: [ ] { 1. R-30 + R-30 Comments/Location { WALLS: [ ] { 1. Wood Frame, 16" O.C., R-15 + R-15 { COmment5/Location WINDOWS AND GLASS DOORS: [ 7 { 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 I For windows without labeled u-values, describe features: { # Panes Frame Type Thermal Break? [ ] Yes [ ] No { Comments/Location DOORS: C 7 I 1. U-value: 0.086 { comments/Location { AIR LEAKAGE: [ ] { joints, penetrations, and all other such openings in the building I 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: [ ] I Materials and equipment must be identified so that compliance can { be determined. Manufacturer manuals for all installed heating i 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. IL r I I I I I DUCT INSULATION: Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 :IRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+ 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYF To the Inspector of Wires: By this work described below. Location (Street & Number Owner or Tenant 111l//!! '' ''L C Owner's Address INFORMATION) led (9FFICE USE ONLY) By Fee: $ �aZ S Cf7i PERMIT NO. F_-C�J"IOOo'1 gives notice of his or her intention'to perform the electrical //_-1 J�l//- No. ;27�— !l S W In z 1^ 7 -z--- Is this permit in conjunction with a building permit? es Q No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd [ No. of Meters New Service /" Amps 2'0 Its Overhead Undgrd 91' No. of Meters_ Number of Feeders and Ampacity. Location and Nature of Proposed electrical Cmmnletinn of the fnllnwinv table may he waived by the Insnectnr of Wires No. of Total AM'o. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans Transformers KVA 41To. of Lightin12 Outlets No. of Hot Tubs Generators KVA Above n- No. of Emergency Lighting No. of Lighting Fixtures SwimmingPool rrid. rnd. Battery Units No. of Receptacle Outlets D No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches /07 No. of Gas BurnersInitiating o. of Detection an Devices Total No, of Ranges No, of Air Cond. Tons No. of Alerting Devices Heat Pmp Num er ons KW No. of Self -Contained No. of Waste Disposers Totals: — — — — Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers ry Heating Appliances KW g pp Secutiry Syystems: No. of Devices or ui valent No. of Water No. of No. of Data Wiring: Heaters KW Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND[] OTHER[3 (Specify:)�ZwriL Z17/U6o / • u (Expiration Date) Estimated Value of Electrical Work: (oy (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under tha pains and penal ' ,s of erjury, that the information on this application is true and complete. WNAM • _T LIC. NO. ee: I✓ sJ Signature 10 LIC. NO. u -' (If applica le ente "exeiitgt' i the licensepumber line.) Bus. Tel. No.: 6 /' Address- - Yh" tit j /I/%/l (/;l ,/'2�" G7 6 I%l�` Alt. Tel. No.: tea, —5­75F- `Ldf( OWNER'S INSURANCE WAIVER: I am aware at th6 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. [Rev. 04/00] TOWN OF YARMOUTH Building AT. Location APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ CIS PERMIT NO. Owner's Name_ Date --0 S - 356 Ile— O Type of Occupancy t_ New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ zZ OV 2 OZ Cn Z W3 W JW Q S N0. CC M N OW rAF W Q fBy LL ZZ 4. X O m M W y Q fA } Q Q N J Z to G It MJ U) O Z OQC O a 0: 0 LL IL 2 W Q H Q Q= (=A faJ_J Q Q O Q OJ OJ Q 2 2¢ Q O Q M F 0 �C J m 0 G C J S F rA LL O 7 C Q D: SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Address Z Check One: ❑ Corp. ❑ Partner I /Company { <- of Licensed Plumbe <A-MAKhOkut S INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes ❑ No ❑ If you have checked YES, please indicate the type of coverage by g the appropriate box. A liability insurance policy c inOther type of indemnity El 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 orOwner'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. Check on Qw6br ❑ Type of Licensed License Number �+ Journeyman ld' Master ❑