HomeMy WebLinkAbout121 Camp St #117 Building PermitsTOWN OF YARMOUTH
Building �CAM?
AT. Location
oT 7
New [X
Plans Submitted
Renovation ❑
Yes ❑ No t'
APPLICATION FOR PERMIT TO DO GASFITTING
(OFFICE USE ONLY)
By
Fee: $
PERMIT NO.
Replacement ❑
Date
Owner'g
Name -(&—a 47 �tJhfT e 5.7—
Type of Occupancy Z5%m / l/
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) '��
Installing Company Name -� �UGTS ,� f /, t^'t 1TE17
Address G 14AS E S 7r
+byPc Nevis rylA t22 &ar11
Business Telephone SD FS -7 3 7 — 3 % S fit'
Name of Licensed Plumber or N
Check One:
❑ Corp.
❑ Partnership
INSURANCE COVERAGE: Check One
I have a current liability insurance policy or its substantial equivalent. Yes Er*�No ❑
If you have checked yes, please indicate t e type of coverage by checking the appropriate box.
A liability insurance policy R Other type of indemnity ❑
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
Signature o Licensed
Plumber or Gasfitter
21 S E4a'
License Number
TVDP 1 IrFNCP•
458.71'
GRAPHIC SCALE
( IN FEET )
I inch = 20 ft
7
I CERTIFY THAT THE FOUNDATION IS
LOCATED ON THE LOT AS SHOWN, AND
THAT ITS LOCATION CONFORMS TO THE
MINIMUM SETBACK REQUIREMENTS OF
THE 40B^SPECIAL PERMIT.
DATE REGISTERED P OFE SIONAL
LAND SURVEYOR
OCT 0 2004
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 NAT A
SPECIAL FLOOD HAZARD ARE
C.� )92c��f
DATE REGISTERED OROFIfSSIONAL
LAND SURVEYOR
NOTICE
Unless and until such time as the original (red) stamp of the
responsible Professional Engineer, or Professional Land Surve)_+r
appears on this plan:
(A) no person or persons, including any municipal or other
public officials, may rely upon the information contained herein; and
(8) this plan remains the property of Holmes & McGrath, Inc.
AS —BUNT PLA' holmes and mcgrath, inc. �`�" OF �.9ss ,
OF L T 117 civil engineers and land surveyors o�`' �aicwo'`yo"t
PREPAR F 362 gifford street Z B.
MILL POND LAGE S M RATH f
IN #almouth, ma. 02540 na
YARMOUTH, MA
JOB N0: 201197 DRAWN: LMC
SCALE: 1"=20' DATE: 10-18-04 DWG. NO.: A2531A CHECKED,�((,�/J ����' .100
of I•
TOWN OF YARMOUTH
_ - - - - - _
I
Building Dzpartnnt
(508) 398 2231 ext.261
BUILDING
PERMIT NO B-05-241_ _
- - -
ISSUE DATE ;- 8/17/2004 - ;
APPLICANT _Frank Capra- - - - - - - -
PROPOSED USE
- - - - - - - - - - - 2
PERMIT
JOB WEATHER CARD
PERMIT TO New Construction ;
AT (LOCATION)
100121CAMPST#117
ZONING DISTRIC R-25
Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C117 BUILDING IS TO BE: CONST
LOT SIZE
5-13 1 USE GROUP
new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans
REMARKS dated 08//05/04.
CONTRACTOR
LICENSE 012430
Capra, Frank
1600 Falmouth Road #25
AREA (SO FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 Centerville MA 02632
OWNER IVillages at Camp St., LLC UILDING DEPT BY 5087789669
ADDRESS 12600 Falmouth Rd, # 25/=/
Centerville I MA 102632
Certificate Issue Date ��/ �o 6,5 CERTIFICATE of OCCUPANCY;!
Departmental Approval for Certificate of Occupancy and Compliance
Inspector
Date
Permit Number
Approved By
Remarks
BUILDING
�ds eZ
PLUMBING/GAS
g
ELECTRICAL
Y
ENGINEERING
OTHER
Z
To be filled in by each dividio6 indi ated hereon upon completion of its final inspection.
10
v
OF
r� TOWN OF YARMOUTH Building Departlr4rit BUILDING
(508) 398 2231 ext.261
PERMIT NO : _ B-o5-?41- - - - - - ; PERMIT
ISSUE DATE ; _ 8/17/2004 - ; PROPOSED USE _ _ _ _ _
APPLICANT Frank Capra ------------- JOB WEATHER CARD
PERMIT TO ' New Construction '
AT (LOCATION) 100121CAMPST#117 Z ISTRIC R-25 Bldg. Type: Residential
SUBDIVISION MAP LOT BLOCK 044.21.1.C117 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4
LOT SIZE CONTRACTOR
new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundryroom, 1 livingroom as per plans LICENSE 012430
REMARKS dated 081/05/04.
Capra, Frank
1600 Falmouth Road #25
AREA (So Fr) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 Centerville MA 02632
OWNER IVillages at Camp St., LLC BUILDING DEPT BY 5087789669
ADDRESS 12600 Falmouth Rd, # 25
Centerville I MA 102632
INSPECTION RECORD
FIELD COPY
Date
Note Progress - Corrections and Remarks
Inspector
_��
-
�� YAR'tr
- G
T
0 • MATTACIIC[S
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
x i Office Use Only '"r ` " Ptanrnng�8oard'lriformatiort Assessors DepartmEntinformahon � ,' '� z t� t
Y # t
: ¢ JartType` � � F
Permit No " ..ate r
s� EndorsemeMDa{e , Y
Permit fee .............'
i b s S 5 ti d JY r Y� ,('itfl ti 4
ecardfilgDate,'�'
nDeposWR8c.!d. $
Y 2 3Y aY XS e' nJYW� �q'{' 3i .i Eci �+ ,' i� r S v✓}.:
t oaf`s � *' .«a
a i L ti- t Sv a
r{ - poi i a s � Fionta e ti LbYCo�Bta eM
Net Dt�e $ t7th�r ` e a f Y t .9r(J s �:��: 9,
:'� _Tfi's Section for Office=Use'Oni~ "'
lu
Bui18 6' wj Per .. um
.r rt ^tu x i t as t 3+TM a
't ,
X z f' ;Gertlficate &-E7ccupancy y ;
SK [ 1Y4^ Y i "a# F i 5✓ �,.' + [+" 1 P"VC �� it YrYj {Y.
I naiure _ F d _ '# !$ fu 5 e+ A'S AL r ;Y i s'• Y A 4
x SY �s r ,i , is'nof re cared i'T
Sectrotrl Sits Tnformatiori" Use Group: R-4 Type: 5-B
1.1 Property Address:
a 154 -
1.2 Zoning Information:
90-51 QML-J�`
L—o i 1-7 Rh&.SA
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
1.4 Water Supply (M.G.L. c. 40. S 54)
Public Private
1 5 Flood Zone Irforntation _ . +' 4 , rkComme� ri r �s z x
Agen
<SectloR�2� ` Ptaperty OwiershipfAutfinrized
2.1 Owne Record: of �l
ut 1- ta, llacv, R
N me print} Mailing Address (/i' k key
M- -
Signature Telephone
2.2 uthoUri� d Agent: L C
A.-- l [/ 0 0 [ d�
Name(print) (gyp.^ P a Mailing Address
j S�771' o $- — 6
gnature Telep one Fax
Section�S.._Construc rbi Se�v�ces> _ �',
3.1 Licensed Construction Supervisor.
� r."�5�1
Not A ITbie t t5
License b
&16— �a
O, f�o✓
\V� 1��%.
� Ill(
Address
•.Zi r- 77�'—Q�G f
Expiration
d f! rQ
_�
Sign tore Telephone n
3,2�F{egisterecJ�f�ome';Irrtpro�errie_ �at<`Coi�tr'actor.,'''
� '� L ,' ii! -
Company Name u f,l I J
u JUL 2 O 004
Not Applicable ❑
License Number
Address ' NG _
By
Expiration Date
Signature Telephone
/i7
7
6e-M
9- 15-99
1 of 2
OVER
Section �% ,.,Workers'.�ompeiisat<or}�`(risrjand�.Affidavlf:{MG �c�1�2 S25G{ej:i �,
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
to provide this affidavit will result in the denial f the issuance of the building permit.
Signed Affidavit Attached Yes .......... No ..........
Se"et[o , _$ . flescnpt(anpof 'ropgsad l7f%ptk (checleaU apgGca to '
New Construction No. of Bedrooms No. of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type
Demolition
Other Specify:
Brief Description of Proposed Work:
c
`
I
V� ('vs &� V1
Q
,,Section ''stimatd Constriictort:
Cods:.
Item
Estimated Cost (Dollars) to be
completed by permit applicant
Check Below
❑ Conservation -Commission Filing
(if applicable)
❑ Old Kings Highway& Historical
Commission approval
(if applicable)
1. Building
O o
2. Electrical
r 2i0
3. Plumbing / Gas
4. Mechanical (HVAC)
5. Fire Protection
&o
6. Total = (1 + 2 + 3 + 4 + 5)
o o
7. Total Square Ft. (crew houses & additions)
Secioft7a OwnerAtifhrtri�a#ior
Ownet"sA en#;or,.Co�ttracto�,Ap ices-iitirBuildtn
,obo-ComptetedWher
"-P�erm�t. ��:
I, 1V C�
hereby authorize CM8= kV013 A IlL r>K-e- S
as owner of the subject property
�P rim to act on
m beh , in all matters elative to work authorized by this building permit ppl'cation.
r CL T -
Signature of Owner Date
Section, 7b ;Owner/AlithddiedA je t Declaration'
I, t/VN to ,asQwner/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 ame
\ ry
Signature of Owner/Agent
_ C)
Date
9-15-99 2 of 2
k
OF iAR,�
3�c
PLEASE PRINT:
Job Location: _
TOWN.OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
Owner of Property: V `
Construction Supervisor:
Address: (,.a 00
Licensed Designee:
(If other than Supervisor)
Street Village
C� f�yLL
� a o ;08- -9669
Name License No. Phone No.
�- � �lilP � i�- , 5�'f� a-�- C�„`�r✓,1�:� � A as G 3�
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 licenseewho 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 E( No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.'
A liability insurance policy al*� 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 o e Mass. Gepsme [- and that my signature on this permit application waives this requirement.
C ec one:
E�o ^mod-
Signature of Owner or Owner's Agent Owner Agent
Signature:
Building Official Approval:
aN—
The Commonwealth of Massachusetts
Department of Industrial Accidents
Omce ollsve ffosofis
600 Washington Street
Boston. Mass. 01111
Workers' Compensation Insurance Affidavit
I am a homeowner performing all work myself.
I_am a sole proprietor _c,'. ha%e no one working in any capacity
0 1 am an employer pro%idino workers' compensation for my employees working on this job.
comnanv name:
address'
city: phoneq•
insurance co. policy. is
[/1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors Iisted below %, ho hase
cry: phone N-
insurance co. - policy!!
company name:
Failure to secure coverage as required under Section 25A o(MGL 152 can lad to the imposition o(erisatul penalties of a fine op to 51,500.00 sodfor.
one years' imprisonment as well as civil penalties is the form of a STOP WORK ORDER and a flue of 5100.00 it day against me. I anderstamil'that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veriBades.
l do.hereby cent y unde the pa' and penald,ei of perjury that the information provided above $true and acoornet�
k SignatureDate
Print name C, V DL Phone N J: "
official use only do not write in this area to be completed by city or town otBeial
city or town: ynxrsoUT$ _ permit/license 0 nBuilding Department
C31.1censing Board
C3 check if immediate response is required 261 C3Seleetmen's Office
C31H[ealth Department
contact person:
phone At _ (SUOJ 398—"J L eat. riOther.
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 fromtheproposed work/demolition to be
%
conducted at 1 ` ��" o J+•
Work AA4ress
is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Applicant
Permit No.
Date
onyinaivaea � a , .
iBOARD OF BUILDING REGULATIONS
'ILicense: CONSTRUCTION SUPERVISOR
Number. CS 012430
;gt- Birthdate: ub/16I1940
Expires: 06/1612004 Tr. no: 25823
Restricted: 00 ,
FRANK G CAPRA
40 COPPER LN, r
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 ails license.
DIG SAFE CALL CENTER: (888) 344-7233
gr
LRIDER.
�»wwwa:..:::w� tmen xivarva e, Je'"' Jsnr .� a,
I THIS I
ONLY
RISK SPECIALISTS IJANCE AGENCY, INC.ox 115
ET MA 02534-0115 COMPAW
A1
MONUMENT INSULATION, INC. s`
223 COUNTY ROAD
BOURNE. MA 02532 ObMPANT
COWuar
THis is To CEA _... - -.
TIFY THAT THE POLICIES OF INSURANCE L13TE7 BELOW HAVE BEc^N "
BaDICATED, NOTWTTH6TANDBaG ANY REQUIREMENT. TEAM OR CONDITION OF 3EEANY ISSUED TO THE INSURED
CERTIfiCAic MAY of ISSUED OR MAY PERTAIK THE INSL'P,f„yC7: AFFORDED BY CONTR crHE OOTHER DO
E%CLU310N6 AND CONDITIONS OF SUCH POLICIM LIMFM SHOWN MAY HAVE SEsN REDUCED BY PAID CLAM
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Lp l TYPL of UIBURANCE POLILYNOMBEA POLACY2PPECTIVE POLs6vcw ATm
O£IKMAL UAW" DATs 1MMwD/YrI DATE p1eVDDrrp
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8/23/03 8/23/04
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GATrgfOOD HOMES, INC
1600 FALMOUM ROAD 025
CENTBRVILLE, MA 02632
508 778-5603
9/5/03 14/5/04
1 -`^ 564 727-D
r-�
ABOVE FOR THE POLICY pEFEOD
r WITH RESPECT TO WHICH THIS
IS SUBJECT TO xLL THE TERMS.
Comam D SMU! Uwr s
AUTO OWY.EAArm 13
BNDOID ANY OF THE ABOVE DASMXED PC=E$ BE CANC01.0 sQORE THE
001N 1700 DATE THEREOF. T11E ISSDIMc COMPANY wu EN umm To MALL
0AT3 MIBTTEN NOTICE To THEBUT CII1OflGTE HoIDER MAtIFd'TQ'Tp�pjT�
yArW ryE > �t�w �sluLL > P E No osUMTwM as uABlum
TOTAL P.01
CERTIFICATE OF W" SI } 10E
PRODUCER THIS CERTIF iCATE IS ISSUED AS E
Passaro Leverone & Buckley CONFERs N0 RIGHTS UPON THE c
Insurance Agency Inc
P 0 Box 160
Dennisport, MA 02639
INSURED
Patrick K Orcutt
6a P & S Concrete
37 Ladys Slipper Lane
Mashpee, MA 02649
DATE (MM/DD/YY)
COMPANIES AFFORDING COVERAGE
A A.I.M. Mutual Insurance Co
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LiSfED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO VE FOR THE POLICY PERIOI
INDICATED, N MAYBE
ISSUE O ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
CERTIFICATE MAY O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE DOCUMENT WFTH RESPEcrTO WHICH THu
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED LIDESCRIBED R IS SUBJECT TO ALL THE TERMS.
TYPEOFINSURANCE POLICY NUAIBER POLICY EFFECTIVE POLICY EXPDRo
DATE(MM/pD/YY) DATE(MM/DD/l'Y) LIM=
AMERCIAL GENERAL LIABILITY
DiAIMS MAD
J
'NER'S & CONTRACTOR'S P�ROT_._
LE LIA UM
AUTO
OWNED AUTOS
MULED AUTOS
D AUTOS
OWNE(YAUTOS
kGE LIABILITY ,
fMBRELLA FORM
THAN UMBRELLA FORM
A
RKER'S COMPENSATION AND
PLOYERS' UABarry
PROPRIETOR/ INCL
TNERSJEXECUTIVE FFF---111
Gatewoods Homes
1600 Falmouth Road
Centerville, MA 02632
6006181012003
1021/2003
1021120U4
ERAL AGGREGATE S
)UCPSCOMP/OP AGO. S
OVAL & ADV. INJURY - S
(OCCURRENCE S
DAMAGE WW arc Bn:) S
EXPENSE (Any one Person) S
LINED SINGLE
S
.Y INJURY
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idd ) S
DAMAGE S
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E S
S
S
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAII 10 DAYS WRISTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LLIBILII'Y OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES. .
AUTHORIZED REPRESENTATIVE /) _
ACQRD. CER a FICA g E OF LMI.UIiY INSURANCE �T=��DD„�Y,
rxooucEx 508 672 2997 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
DI
AFI INSURANCE
ONLY AND CONFERS NO RIGHTS UPON 'THE CERTIFICATE
OIAS INSURANCE HOLDER: THI&- CE3�Ti> SATE DOES NOz AAdEND- E]CiEl1Q OR 535 BRAYTON AVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
FALL RIVER. MA 02721
RlauaEa INSURERS AFFORDING COVERAGE JOEL FERREIRA DEALMEIDA "SURE"^ GRANITE STATER <N�WSO_
C 8
DBA EJJA CONSTRUCTION M1M�R r. NAUTICUSIIRSURAINCE COMPANY-�NE2]5806-
50-PICKERING ST. APT 17 HSURERQ
FALL RIVER, MA 02720 a15URERo
COYE RAGES II+SURER E:
THE POLICIES OF INSURANCE. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
AW.REQIIIREMEN'r. TERM OR CONDITION OF ANY CCNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRJBFD7fERExy 145UB TO ALF
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TI+E�RMS. EONS.ANQ CQNDITIQNg OF SUCH
>R OP
P.OU!-rwvmaER PO EFFECTIVE ►OUCYEXPIRA *Rl
GENENALUABxATY .LPaT3
X COMMERLTALOGweaALLaBLm NC27580E uCHOCCLmRCNCE :
00/26/2CO3 0612612004 Om cu a � O s 100,000 GAIMSMAOG � OCCUR I.
I MEOEXP(APy"PsI ) IS �
v PQRSONALaAUv IN.7uRY ..141.000,000
GEN'LACCREGATE UUMAPPLIES PER: I T�RALA'OGRE'GAn' iY 21000.000.
POLICY .LOG I PRODUCTS. COUP,pP A7G . S 2 000 OW
I''A�UTCUOBLE UASAM
I 'ANY AUTO
II ALL OWKWAUTpg
�{j��� SCHEBULEDAUTOS
1 "��°S
IL NONAWNEOAUTOS I
_-
- GARAGE Wa1I.tTY
ANYAUTO
eXCE3SWIaRELL�A- -U�A91Ury
J OCCUR ..: l,_ 1 CUUMS MADE
ae=TIBLe
RETENTIOII s
W9a RCRLCOYREN6ATWNµO
EAPLOVERS•UAgaily WC" 4S�-46-8S"
A W CROPRIETOA/PARTNENIa^dL;TNt
OmemwEMaER EXCLUDEDT
GATEWOOD HOMES
16W FALMOUTH RD.
CENTER VILLE. MA 02632
C0lwwta C. wIr
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S
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PROPCR DAMAGE
t7v;' i
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A0TODmY7E#71CCiDEHT` ,T.
OTKE_%THAN • EA.I.CC I S-
AUTOONLV: T�
SROULD ANY OFTW A/Ove O CMS=Pp, I aB j� ORPTM!C;PIRApaI�
DATE THERSOF. THE ]$SUNG a13vmM Wx.L ENOBAVOR TO MAR 10 DAY3 WRRTEN
lgRCETOTNE C0"W6C MJfOtDE*A,MFpTO THE LER„ I=TAK "W -
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1600-FALMOM ROAD-
CZNTXRV=IZ MA 02632
11/21/03 11/91/04
05/03/03 ( 05/03/04
GATYR .VsHOL�D"I"iH ",Ill;
D&TETHERECIF, THE MUMn
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s
001
20 oAn"ATTm
ZmwTonoavwW.L
RM DaAOEM OR
CERTIFICATE OF
• PRODUCER
LUU I I C1CT'LC
LIABILITY INSURANCE
8: O'Neil Insurance
=DATE(MM.maNyDowling
THIS CERTIFICATE IS ISSUED AS
Agency, Inc.
222
A MATTER OFINFORAIATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES
West Main St. PO Box 1990
NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED
Hyannis, MA 02601
BY THE LI
POCIES BELOW,
INSURED
- INSURERS AFFORDING COVERAGE
Gutter Pro Enterprises, Inc.
- INsuRERA: Travelers Insurance Company NA1C #
P.O. Box.1197
INsuRERe: Guard Insurance Group
Plymouth, MA 02362
INSURER C:
INSURER 0:
COVERAGES
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ACT O TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
MAY PERTAIN, THE INSURANCE AFFORDED BY THE ED.
TO WHICH THIS CERTIFICATE BE ISSUED OR
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS..
POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
LTR NSR TYPE OF INSURANCE POLICY NUMBER
A GENERAL LIABILITY 1680459H3118TCT03
POLICY EFFECTIVE POLICY EXPIRATION
DATE MrDD DATE M/D
DATELIMITS
X COMMERCIAL GENERAL LIABILITY
11 /07/03 EACH OCCURRENCE $1 OOO OOO
CLAIMS.MApE OCCUR
DAMAGE TO
MISES M. iw._. tlmn nnn
6 ADV
LIMIT
. u I u IJWLE LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT
ALL OWNED AUTOS
(Ea accident)
S
SCHEDULED AUTOS
BODILY INJURY
HIRED AUTOS
- (Per prim)
S
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
S
PROPERTY DAMAGE
GARAGE LIABILITY
(Per accident)
5
ANY AUTO
AUTO ONLY - EA ACCIDENT
S
EXCESS/UMBRELLA LIABILITY '
OTHER THAN EAACC
AUTO ONLY:
S
OCCUR CLAIMS MADE
AGG
EACH OCCURRENCE
S
S J
AGGREGATE
5
DEDUCTIBLE
_
RETENTION S
E
B WORKERS COMPENSATION AND GUWC440685
EMPLOYERS'
S
LIABILITY
PROPRIETORIPARTNIDT
11/07/03 11/07/04 WC STATLL pTM-
S
OFFICER/MEMBER EXCLUDEANY
CUTIVE
d Yes. describe under
EJ_ EACH ACCIDENT
5100,000
SPECIAL PROVISIONS below -
OTHER
EL DISEASE - EA EMPLO
51 00,000
DESCRIPTION OF OPERATIONS I LOCATIONS L VEHICLES / E)(CLUSIONS ADDED
Operations performed by the naBY ENDORSEMENT / SPECIAL PROVISIONS
med 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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRrrrEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT; BUT FAILURE To 00 SO SHALL
IMPOSE NO OBLIGATION OR UABIIJTY OF ANY 16ND UPON THE INSURER, ITS AGENTS OR
ZE➢RFQ=v A� —
AUTHORIZED
ACORD CoRPORAT►oN 19881988
AC:UKll,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YY)
PRODUCER' (508) 994-9688 FAX (508) 991- 5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION2003
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
'NsuRED.t-rank Capra, JNSURERA: Providence Mutual.
PO Box 664 INSURER a OneBeacon
West-Hyannisport, MA 02672
. cx wsuRERc Continental Casualty. Co _:...
_.. ..
-•-- -- INSURETtk—_ .
.. .. _. INSURER E . .
COVFRArFs
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
HER IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
INSR
LrR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
GENERAL LIABILITY
X
PP0053131 00
12/13/2002
12/13/2003
UNITS
EACH OCCURRENCE
$ 1,000, 001
COMMERCIAL GENERAL LIABILITY
-
FIRE DAMAGE (Any w e fire)
S 5O 001
CLAIMS MADE O OCCUR
weMED EXP (Any e parson)
i 5,004
A
PERSONAL a AOV PWRY
s 1,000,001
GENT. AGGREGATE UMIT APPLIES PEz
- -
GENERAL AGGREGATE
$ 2, 000, 00(
PRODUCTS .COMproPAGG
s .3 A00,00(
POLICY -
JJECTT LOC
AUTOMOBILE LIABILITY
CBXE48125
02/14/2003
02/14/2004
ANY AUTO
COMBINED SINGLE LIMIT
(Ea a=denq
S
ALL OWNED AUTOS
BODILY INJURY
(Per person)
$
B
X SCHEDULED AUTOS
HIRED AUTOS
250, OOC
BODILY INJURY
(Peraceidenq
$
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-
.
_�. -. ....
500,.000
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S
-
..
_(Per a -.Idea
100
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-
..
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-
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S
j
woRlaaRscomPENSAnoNAND 559UB861X751603 03/22/2003 03/22/2004 WC STATLL
EMPLOYERS'U ABIUTY TCRY LIMITS
C EL EACH ACCIDENT $ - S00,000
. __.... E.L. DISEASE • EA EMPLO $ 500 , 000
-
OTHER EL DI$EAS�• POLICY UNIT ' " .. 500_ 1)QO
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED-, INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Gatewood Homes Inc
BUT FAILURE To MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABMM
1600 Falmouth Road Ste 25
Centerville, MA 02632
OF NTHE COMPANY trs AGENTS ItEPRESIENTATIVE&
_
AUTHORIZED RI ]A�TLV��E
ACORO 25S nran
�
® CORD CORPORATION 1988
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OPID A DnYY,,
PRODUCER DATE(MMID
Sullivan, Garrity &Donnell CROWC50 07 25 03
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 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Worcester MA 01615-0010 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone:508-754-1767 Fax:508-754-1885
INSURED
INSURERS AFFORDING COVERAGE
INSURER A. Hanover Insurance Co
NAIC #
-- -
Crowell Construction, Inc.
INSURER.: Arch Insurance Com an
22
292INsuRERc:
PO Box 309
So. Dennis MA 02660
INSURER V.
COVERAGES
INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
MAY PERTAIN. THE INSURANCE
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OFINSURgNCE POLICY NUMBER
OF SUCH
GENERAL LIABILTry
DATE MM/DD DATE MM/D LIMITS
A X COMMERCIAL GENERAL LIABILITY ZHN7 Q 07141
CLAIMS MADE X❑ OCCUR
EACH OCCURRENCE
05/01/03 0- PREMISES
01/04
$10 Q Q Q Q 0
o
Eaence
S 10QQQQ
MED EXP(Any a Pwwn)
35000
'
PERSONAL S ADV INJURY
SSOOOOOO
GEN'L AGGREGATE LIMIT PER
'.PRO.-
GENERAL AGGREGATE
S2000O00
POLICY • LOC
.
PRODUCTS.COMPK)PAGG S 2000000
AUTOMOBILE LIABILITY -
A ANYALrro • ' .. ABN7001142
ALL OWNED AUTOS
COMBINED SINGLE LIMIT
05/Ol/03 05/Ol/04 (Eaaccklenl)
s
X SCHEDULED AUTOS i
X HIRED AUTOS
BODILY INJURY
(Per Pm )
31000000
X NON -OWNED AUTOS
BODILY INJURY
(Per acpdem)
$1000000
GARAGE LIABILITY -
(Per aEcceeM)DAMAGE
$500000
ANY AUTO
AUTO ONLY - EA ACCIDENT
S
OTHER THAN EA ACC
S
EXCESSIUMBREL LA LIABILITY
AUTO ONLY:
AGG
S
OCCUR CLAIMS MADE
EACH OCCURRENCE
S
_
AGGREGATE
$
DEDUCTIBLE
$
RETENTION S
S
WORKERS COMPENSATION AND
B EMPLOYERS LIABILITY
$
ANY PROPRIETORIPARTNER/EXECUTNE IRWCI00100
OFMCER/MEMBER EXCLUDED?
22 O3 TORY LIMITS ER
O3 03/22/04
/ / E.LEACHACCIDENT
— -SyEeCIALPRO Mer
SPECWL PROVISIONS Debw
S 5000QQ
0T1fER
EL DISEASE. EA EMPLOYE
S 5000QO
ELDISEASE.POLICYLIMIT
SSQQQQ0
Fax #508-778-5603
TE HOLDER
CANCELLATION
-� GATEWO7DATE
Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC
Gatewood Homes. EOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .1O DAYS 1600 Falmouth Road THE CERTIFICATE HOLDER NAMEDTO THE LEFT, BUT FAILURE TO DO SO SH LLSuite25 OBUGATION OR UABILIfy OF ANY KIND UPON THE INSUCenterville MA 02632 REq rrsaGENTsoR
...—
25
CERTIFICATE QF LIgBIIITY INSURANCE -
PRODUCER 508-398-b033 FAX SOS-760-1667
bAre (MMroDIYYYY)
,71
AT] led American Insurance Agency LLC
1 Atlantic Ave
THIS CERTIFICATE IS-tSSUEO AS A MATTER OF INFoR2MAT OON
ONLY CONFERS NO
SD Yarmouth NA 02664
RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AM> ND, EXTEND OR
ALTER THE COVERAGE
AFFORDED BY THE POLICtE3 BELOW.
INSURED pe o Custom Floors
INSURERS AFFORDING COVERAGE
762 Falmouth Road
INSURER A: Arbella Protection Ins Compan NAiC B
Hyannis NA 02601
INSURER Hartford y
INSURER CI
INSURER M.
A 5
01R e
r_QO
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 7HE POCKY PERIOD WDICATED. NOTWITH$7A,I,IpI15
ANY REOVIREMEN7 TERM ORC ONDRION OF ANY CONTRACTOR OTHER
MAY PERTAIN, TH)r INSURANCE AFFORDED BY THE POLICIES DESCRIBED
r%
DOCUMENT WITH RESPECT TO WEICH.THIS
POLICIES.
INSR
HEREIN I$ SVATH
CERTIFICATE MqY BE ISSUED OR
AGGREGATE UMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TO ALL THE TERMS. EXCLUSIONS
b AND CONDITIONS
TYPE OF INlINANCE POLICY NUMBER
GENERAL LIABILITY POLICY
OF SUCH
POUCY EFFECTIVE POLICY
7S00000373 12/13/200Z 12/13/2003 EACNOCCURRENCE LIMITS
X COMMERCIAL GENERAL LIABILITYS
CIAIMS MADE D OCCUR -
1 000,00
DAMAGE TO RENTEO S
A
_
50,00
MO EXP(Awy oft pn ) s S,00
-
OWL AGGRFGATEppLRRSNp�n'APPLO PER:
PERSONAL ACV f 1 O ID,00
GENERALAGGREGATE
X POLICY JG T LOC
S 2 000,00
PRODUCTS-COMFYO AGO f
2 000 00
AUTOMpDILE LLADRJTY
ANYAUTO
ALL OWNED AUTOS
IBINGD SINGLE LMR S
cakL-0
SCHEDULED AUTOS
BOOBY INJURY
HIRED AtIT05
(Pd P.noA) s
NON -OWNED AUTOS
BODILY INJURY
-
(PU FcoAonry S
GARAGE LIABILITY
IPWi� DAMAGE S .
ANYAUTO
AUTO WILY. EA ACCmRNT S
EXCESSIDMBRELLA UABRAT
OTkeRTHAN EA ACC S
AU�O ONlY' AGO s
OCCUR O CLAMS MADE'
GUCN OCCURRENCE S
AGGREGATE S
DEDUCTIBLE
S
RETENTION S
S
YVDRKERaCDMPEILITY AND OBWECKLI007
EMPLOYERS`
EMPLOYERS LIABILITY
05/2S/2003 OS/ZS/20OM1 X WCSTATI oTN- S
B ANY PROPRIECOR/pARTNER/E%ECU7IVE
OFFICERIMEMSER EXCLUDED?
II YAA Eeac**jm
SPECK PROVISIONS Eelpr
EL EACH ACCIDENT S 100, 0OO
FL DISEASE • EA EMPLOYE S
OTHER
100, OOO
EL DISEASE • POLICY LIMIT S SOD, OOO
DESCRIPTION of OPEIiATIDN8/ LOG7R)NS l VEHICLES / EXCLUSR7N! ADDED BYENDDDtFURNf..-......
Evidence of Insurance for work performed within the Insured's scope of normal. operations
Gatewood.Homes..
1600 Falmouth Road Y25
Centerville, MA 02632
4CORD 25 (2001/08) FAX: C508) 778-5603
SHOULD ANY OF THE ABOVS DESCRIBED POLICES BE CANCELLED DEFORM THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDGAVOR TO MAIL
1O OAT! WRITTEN NOTICE TO THE CERTIFICATM HOLDER NAMED TO THE LEfT,
BUJ FAR.URE i0 MAIL MUCH NOTICE lNg1,L IMPOSE NO OBLIDATION OR LIABIL)Ty
OF ANY KIND VFON 7HE INSURER, RS AOENT! OR REPRMSENTATNEi
A�I>:ED�RESENTATIv€ ^
v v OACORD CORPORATION 1988
CERT 2 F 2 CATE OF 2 NSURANCE
Producer:
SOUTHEASTERN INS AGCY
641 HYANNISN ST MA 02601
Code:
Insured:
RI 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 below.
COMPANIES AFFORDING COVERAGE
Sub-ccode:`---~'I--A —Co Ltr A -~ ARBELLA PROTECTION �—
Co Ltr B:— ARBELLA PROTECTION
--------------- - —
I------ Co Ltr C--=----- —_-
Co Ltr D: ARBELLA PROTECTION
Co Ltr E:
COVERAGES
This is to certifyp that policies of insurance listed below have been issued
to the insured named above for the polic//
certificateumayibesissuedgornmayegertainittheeinsurancedafforded by thenPolicies
exclusions_ conditions
other documentthis
subject to all thehterms
_ —and of such policies. Limits shorn may have been
--- —~------------
terms,
reduced by paid claims.
_
------------------------------------------------------------
Type of Insurance I
__�-_-_I Policy number leffectiveydate
'
►expiration datel All limits
A I ENE RAL LIABILITY -"""'---"'-'"--
I Commercial general liability l 8500018147 l 7/15/03
in thousands
_
l 7/15/04 lGeneral aggregate: —�~ 2 000
�[) Claims made [ j Occur
Owner's 8 contractor's Prot I I
Prodacts-comp/ops aggre9: '
I (Personal/advertising in):
--"-'—""—"---~------------ l I
I Each occurrence: 11000
Fire damage: f00
B
l
PUT
MOBILE LIABILITY - ���"--"-"-�-"'--�---""""""_"- --------------------------------
I 86852400001
I I 2/21/03An auto
All
Medical expense: 5
► 2/21/04 (Combined
owned autos I
Scheduled autos
Single limit: 250/500 l
lBodily injury
l
Hired autos l l
j(Per person): 1
liodily
l
Non -owned autos l
Garage liability
iajur
[Per ecciden l
f):
I
(Property
1
(EXCESS LIABILITY
I damage: 500
----~— -- _—"-____________
I
I Other than umbrella form I 1
--------------------_____------
l l Each
Occurrence Aggregate
I
--------- ---______----------------__—_~
D WORKER'S COMPENSATION l 9088680403 l 4/27/03
I
_ �_ "
4/27/04 I------------
EMPLOYERS' LIABILITY I
i
lStatutorr
100
------------
Each accident)
(Disease
I I
---------------------------------I-- OTHER
l -----------i-------------i-----------------
500 policy limit)
l 100_ Diseaae-each em
I
I I
Description of operations/locations/vehicles/restrictions/special items:
l
~---'-'----- "'---`-----"—
CERTIFICATE HOLDER CANCELLATION
Should any of the above described policies be cancelled before the
GATENOOD HOMES I expiration date thereof, the issaing comPant will endeavor to
1600 FALMOUTH RD STE 35 I moil f0 days written notice to the certificate holder named to the
CENTERVILtE MA O2632 left, bat failure to mail such notice shall impose no obligation or
liability of any kind upon the -company, its agents or representatives.
IAuthorized representative:
------ -----__ "I JOAN M MARTIN JA
-----------------------
-n�wrvu- ULKTIFICATE OF
LIABILITY INSURANCE
PIZODUCER -
LDOA:Z^I°�
7/03
DoWling & O'Neil Insurance
Agency, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
222 West Main St. PO Box 1990
HOLDER. THIS CERTIFICATE*DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY
Hyannis, MA 02601
THE POLICIES BELOW.
INSURED
INSURERS AFFORDING COVERAGE NAIC #
Bayside Electrical Contractors, Inc.
INsuRERA: Travelers Insurance Company
372 Yarmouth Road
INSURERB: Guard Insurance Group
Hyannis, MA 02601
INSURERC.'
-
INSURER D-
COVERAGES
wsuRER E
THE POLICIES OF INSURANrF I Ms cv
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CIU INIz INSURED NAM THE POLICY ERTIFICATE E MAY BE ISSUED OR DING
ED ABOVE FOR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IXC ERTIFIS AND 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 UABIUTY DATE MID DATE MM/D LIMITS
X COMM
16801484A82ACOF03 10/05/03 10/05/04 EACH OCCURRENCE S
ERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 OOO OOO
CLAIMS MADE O OCCUR - s300 000
MED EXP tMv. .� ee Ann
J OCP
GEN'L AGGREGATE LIMIT APPLIES PER
& ADV
A A1OO&BILE18102601W561IND03
MA
10/05/03
10/05/04A7T0 COMBINED SINGLE LIMIT
OWNED AUTOS
den
$1,000,000ALL
X
SCHEDULED AUTOS
BODILY INJURY
X
HIRED AUTOS
(Perpemon)
S
X
NON -OWNED AUTOS
BODILY INJURY
X
Drive Other Car
(Peraeddent)
S
PROPERTY DAMAGE
GARAGE LIABILITY
(Per accident)
$
ANY AUTO
AUTO ONLY -EA ACCIDENT
$
OTHER THAN EA ACC
$
EXCESSJUMBRELLA LIABILITY
AUTO
AUTO ONLY. AGG
S
OCCUR CLAIMS MADE
EACH OCCURRENCE
f
AGGREGATE
f
DEDUCTIBLE
f
RETENTION S
$
B WORKERS COMPENSATION AND BAWC.436910
EMPLOYERS' LIAEIUTY
08/18/03 O8I18IO4 WC STATLL OTH-
f
ANY PROPRIETOPJPARTNER/EXECInTVE
OFFICERJMEMBER EXCLUDED?
E.L. EACH ACCIDENT
e'I nn nnn
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADOED BY ENDORSEMENT/SPECIAL PROVISIONS
Operations performed by the named insured subject to policy conditions
and exclusions. -
^^�c�LI111V1Y -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Gatewood Homes DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
1600 Falmouth Road Suite 25 �0_ oars WRITTEN
_ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSU
RER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
C
M%,UKU 29 (2001108) 1 of 2 #M31942
ACORD CORPORATION 1988
RD- CERTIFICATE
OF LIABILITY INSURANCE DATE(^M°D�
07/18/03
O' Neil Insurance '
r222West
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
c.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ain St..PO Box 1990
ALTER THE COVERAGE AFFORDEDE POLICIES BELOW.
y,A 02601
wsuREO
INSURERS AFFORDING COVERAGE . NAIC #
Busy Bee, Inc...
wsuRERA: Hanover Ins. Company
P.O. Box 50 .
INSURERB: Safety Insurance Company . .
East Sandwich, MA 02537
INSURERc: Associated Employers Insurance Compa
'
INSURER D:
COVERAGES
INSURER E:
THE POLICIFC r11= wci ipt Nl •o f S ` ...•.--- .
ANY REQUIREMENT, TERM OR CONDITIOw'vN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE POLICY CERTIFICATE MAY BE ISSUOD INDICATED. ED 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.
'LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MMID DATE MMlDDn'Y LIMV
A GENERAL LIABILITY OHN643998501 06/14/03 - 06/14/04 EACH OCCURRENCE
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
'CLAIMS MADE O OCCUR
X PD Ded.250 MED EXP (Any one pemm)
PERSONAL d ADV INJURY
GENT AGGREGATE LIMIT APPLIES PER
GENERAL
GENERAL AGGREGATE
S2 000 000
POLICY PRO. LOC -
PRODUCTS - COMP/OP AGG
S2 O0O O00
B AUTOMOBILE LIABILITY 3175394 -7
01/14/03 01/14/04
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
ALL OWNED AUTOS
X SCHEDULED AUTOS
BODILY INJURY
X HIRED AUTOS
(Perpemw)
$100,000
X NON-OWNEDAUTOS
.. . BODILY INJURY.
(Pwac.cidenq
S3O0 000
,
' '....: ... PROPERTY DAMAGE
(PWaceidwd)
S100,000
GARAGE LIABILITY
. -. .... ...
.
ANY AUTO ...
+ ..
AUTO ONLY - EA ACCIDENT
S '
OTHER THAN EA ACC
S
EXCESSIUMBRELLA LIABILITY
AUTO ONLY: AGG
S
OCCUR � CLAIMS MADE
EACH OCCURRENCE
S '
C WORKERS COMPENSATION AND WCC5002932012003 06/27/O3 EMPLOYERS'LIABILITY 06/27/04
T'
ANY PROPRIETOR/PARTNERIEXECUT WE
OFFICEWMEMBER EXCLUDED7
If yes• describe wider
SPECIAL PROVISIONS b
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Operations performed by the named Insured subject to policy conditions
landC::
ons.
ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Gatewood Homes DATE THEREDF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
1600 Falmouth Road Suite 25 _ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE
TO DO SO SHALL
Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/OS) 1 of 2 #30822 - �—
KJS O ACORD CORPORATION 1988
,.ACORD,. CER f_ IFICA i E OF LIABILITY INSURANCE003
ImODOCER
DATL 1ftMfOOryYI
_
+�
wCSht,:. Insurance AgeIICy, Inc.
THIS CERTIFICATE IS ISSUED AS A MATT FORMATION
ONLY AND CONFERS NO RIGHTS UPON OTHENCERT! CASE.
749 Maid Street, Suite#A
MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY Ttf!< POLICIES BELOVI.
Osterville, Na. 02655
508-d20 2_Uj
INSURERS AFFORDING COVERAGE
F.funeD CaspersOII Overhead Doors
rNsua;R A' Ne.t�o foraE {,�� T�Q
Gi8nR6
.Li►t..LiC.Z'"�""_ �Q •
'
. .
INSURER @
BOX 517
INSURER I,
East Falmouth, MA 02336
INSVA
COVERAGES
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE13EEN ISSUED TO THE INSURED NAMED ABOVE FC
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPO
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IGR
T TYPE OF INSURANCE POLICY NUMBER OFOI.IL Y EFFECTNE POw C
GENERAL LIABILITY
COMMERCIAL OENERAL UASIUIY
CLAIMS MADE LXl OCCUR
A
A
E POLICY PERIOD INDICATED. NOTWITHSTANOIICs
) WHICtt THIS CERTIFICATE MAY BE ISSUED OR
TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
R 1
=-S1—f LIMITS
NP448352 05/28/03 05/28/04
OEWL AGOREOAI E LMIT ATRLItS PLR
POLICY �" - LpD L.
AUTOMOBILE LIABILITY
un AUIO
ALL OWNCOAVTOS .
SCHEOUL ED ALMS
WRCO AUTOS
NON-0WNCD AUIOS
GARAGE LIABILITY
OCCUR CLAMS MADE
OLDUCTIDLC
NgtENZION-
WORKERS COMPENSATION AND
EMPLOYERS LABRtTY
OTHER
Gateway Homes
1600 Fa.Z " Oad- Suite 2S5t
Ccntsrvills, M 02632
778 S603
r
ACORD 2S.S (7197)
EACNoceuRaENCEIs 50.04 Bfu�-
COOLY YUUAY
GODLY INJURY =
( PIN Pmoo" ftRTY DAMAGE S
_ E�ACD s
EACH OCCURRENCE S
02l22/03. 02/22/06 EL EACl/ACCIOENr
EL OISEILSE . EA EMPLOY S
L. DISEASE •POLICY LAAT f
SAA.AOA._
12, Q�_
00A. 600..
DATE THEREOF. THE IfSUINO INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTENNOHCC4 . NE-Gl!
QDO AO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE IN" .ZI% RY AGENTS OR
0 ACORD CORPORATION T8D8
PROPERTY ADDRESS: /1%c!ll&W L
CALCULATION FOR PERMIT COST TYPE OF R ETC NO
4�a s
gag, zSo.7a ADDITIon
AA'. Ht�Arlons
BED ROOMEE
Z
CERTIFICATE OF OCCUPANc-v
FANtiLY
7 Z FIREPL
TION ONLY
NO. OF BAYS
RY ROOM
OFFICE
PORCH CLOSED
PORCH OPEN
REROOFING
SHED
_ SUN ROOM UNHEATED
SWMAWNG POOL ABOVE GRC
Of Y�
r�rnG"i'se
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
Temp Permit No.:
T-05-078
Applicant Name:
Frank Capra
Applicant Phone:
5087789669
Building Location:
00121 CAMP ST # 117
Owner's Name:
Villages at Camp St., LLC
Owner's Addres
2600 Falmouth Rd, # 25
Centerville MA 02632
r
Owner's Telephone:
(508) 778-9669
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 102
Net Owed:
($50.00)
Application Date:
7/20/2004
Issue Date:
Expiration Date
Comments: Map/Lot: 044.21.1.
new construction:
ZONING rPROVED _
REVIEWED BY:
v'RWATER DEPARTMENT:
DATE:
N/A:
2 V . ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
✓"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
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
Temp Permit No.:
Applicant Name:
Applicant Phone:
Building Location:
Owner's Name:
Owner's Addres
Owner's Telephone:
TRANSMITTAL
T-05-078
Frank Capra
5087789669
00121 CAMP ST # 117
Villages at Camp St., LLC
2600 Falmouth Rd, # 25
Centerville MA 02632
(508) 778-9669
REVIEWED BY:
1. WATER DEPARTMENT:
2. ENGINEERING DEPARTMENT:
3. CONSERVATION:
4. HEALTH DEPARTMENT:
5. BUILDING DEPARTMENT.
6. FIRE DEPARTMENT:
COMMENTS:
RECEIPT OF COPY:
(OFFICE USE ONLY
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 102
Net Owed:
($50.00)
Application Date:
7/20/2004
Issue Date:
Expiration Date
PLEASE NOTE
SIGNATURE OF APPLICANT:
Comments:
new construction:
Map/Lot: 044.21.1.0 //']
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
DATE:
N/A:
U i 0 2 2004
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
S. 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) 21.1C117 Street 121 Camp St., #117
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., Ll
: 1600 Falmouth Rd.
: Centerville, MA 02632
Temp Permit No.:
Applicant Name:
Applicant Phone:
Building Location:
Owner's Name:
Owner's Addres
TOWN OF YARMOUTH
Building Department
Town Hall
Yarmouth, MA 02664
(508) 398-2231 ext.261
BUILDING PERMIT
TRANSMITTAL
T-05-078
Frank Capra
5087789669
00121 CAMP ST # 117
Villages at Camp St., LLC
2600 Falmouth Rd, # 25
Centerville MA 02632
Owner's Telephone: (508) 778-9669
(OFFICE USE ONLY
Recorded By: Ic
Permit Fee:
$0.00
Deposit Rec:
$50.00
Payment Type:
Check ChkNo.: 102
Net Owed:
($50.00)
Application Date:
7/20/2004
Issue Date:
Expiration Date
Comments:
new construction:
Map/Lot: 044.21.1.C// 7
REVIEWED BY:
1. WATER DEPARTMENT;.
DATE:
N/A:
2. ENGINEERING DEPARTMENT:
DATE:
N/A:
3. CONSERVATION:
DATE:
N/A:
4. HEALTH DEPARTMENT:
DATE:
N/A:
5. BUILDING DEPARTMENT:
DATE:
N/A:
6. FIRE DEPARTMENT:
DATE:
N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF APPLICANT:
DATE:
Date Printed: 7/30/2004
Ix
9�6
\va.
tk
• � Q ��G� ti9h 'I
(Fu.
1``';flit
sOo
eR ?�GOPA�� g`L
`Q�.ti15
ROPOSE a� • Z
P NOvp�PERI � �\NN
J
\Nk
g3
, 3-
'I
• 0�
LOT 117
6,336 S.F.
lx
Fc
AFFORDABLE
LOT 116
77.63'
0
1 O W
3, 705 S.F.
— s81'47
57.25'
458.71' NOTE,
R E C 9V e D ® SEWER LATERAL SHALL BE
SLEEVED IN ACCORDANCE
GRAPHIC SCA Aug 0 2 2004 WITH TITLE V IF WITHIN
1OFT. OF WATER MAIN.
20 10 0 20
Water Dep60 NOTICE
Vorm�!!'h unless and until such time as the original (red) stamp of the
responsible Professional Engineer, a Professional Land Surveyor
appears on this plan:
IN FEET
(A) no person or persons, including any municipal or other
public officials, may rely upon the information contained herein; and
I inch = 20 M
REVISED: 3-8-04 (1) this plan remains the property of Holmes a McGrath. Inc.
REVISED: 2-19-04
PLOT PLAN
holmes and mcgrath, inc.
j„ of Al
OF LOT 117
civil engineers and land surveyors
sgcy
PREPARED FOR
362 gifford street
TIMOTHYM. GR
MILL POND VILLAGE
SANTOS
M
IN
falmouth, ma. 02540
No.45078
CIVIL
YARMOUTH, MA
JOB NO: 201197 DRAWN: LMC
�0 9FC'/STEREO ``��
SCALE: 1"=20' DATE: 5-1-03
DWG. NO.: A2531 CHECKED: T7ue
SIG
, - e.-
I
MAScheck COMPLIANCE REPORT I
I
Massachusetts Energy code I
Permit #
MAscheck software Version 2.01 Release 2 I
I
I
I checked by/Date
I
I
CITY: Barnstable
I
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 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" D.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 J4.4.
Builder/Designer,
Date
Massachusetts Energy Code
MAscheck software version 2.01 Release 2
The Plover
DATE: 4-21-2004
Bldg.l
Dept.l
use I
I
I
C ] I
I
I
I
C ]
C]
C ] I
I
I
I
C 7 I
I
I
I
I
I
CEILINGS:
1. R-30 + R-30
Comments/Locatio
WALLS:
1. wood Frame, 16" O.C., R-15 + R-15
Comments/Location
WINDOWS AND GLASS DOORS:
1. u-value: 0.34
For windows without labeled u-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
comments/Location
2. u-value: 0.34
For windows without labeled u-values, describe features:
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
DOORS:
1. u-value: 0.086
Comments/Locati
AIR LEAKAGE:
joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. when
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type Ic rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.'
2. Type IC rated, in accordance with standard ASTM E 283, with no
more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the -ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing u-values must be clearly
marked on the building plans or specifications.
•
EFFICIEN
• • • • RATING
cERnF1EL k
/
10amla C C I�
Air Conditioning &Heating
LISTE� [ISTEO
92.6% AFUE
MULTI -POSITION
CONDENSING
GAS FURNACE
GMNT SERIES
U W
MEJ1i fXCl7. e"r
EARM1LSNiYlRMTEY
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
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 29-4C 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.goodmanmfg.com
PERFORMANCE RATINGS
Model
Natural Gas
Natural Gas
Propane Gas
Propane Gas
DOE
TemP• Rise
Number
Input
Output
Input
Output
AFUE
GMNT
BTUH
BTUH
BTUH
BTUH
040-3
40,000
37,000
37,000
34,000
926
25-55
060-3
60,000
55,000
55,000
51,000
926
35-65
0604
80,000
73,500
73,000
73,000
92.6
35-65
100.4
100,000
92000
92,000
85,000
92.6
40-70
1205
1 120,000
1 110,000
1 111,000
1 102,000
92.6
40-70
BEFORE PURCHASING THIS APPLIANCE, READ IMPORTANT ENERGY COST AND EFFICIENCY DATA
AVAILABLE FROM YOUR RETAILER.
SPECIFICATION DATA
cnara
tl Model
Number
MotorW -.,,
Motor
Jl 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
1
060-3
113
3
10
6
2'
2'
290 / 580
52
15
1800
0804
1/2
3
10
8
3'
3'
3851770
7.8
15
205
1004
1/2
3
10
10
3'
3'
385 / 770
7.8
15
225
120-5
314
3
11
10
3'
3'
480 / 960
9.2
15
265
I'__"___.._�a
L.....H. l4...wb
•u4i.
incin vFinnc
which
'Note: vent ana CORIDUSuuFi di wuanaLcw uiay vo, y .,..F..........y •.p.... _..... ._..�_... -..---- ----- ---- -
accompany the furnace.
28" A 58"
4„ 198„ B4$„
48
�
4
COMB. AIR INLET
GAS INLET„
4
VENT
• � 4
LOW VOLTAGE ' I 4
ELEC. i 1
104
1.3
Model
GMNT
A
B
Combustible
Floor Base
040-3 & 060-3
W
12'/s
SBM14
0804
1 17'%
16'
SBM17
1004
1 21'
19'/s
SBM21
1205
24'h.
23'
SBM24
SS-312D
i
123- COMB. AIR INLET
B
i
i
i
' GAS INLET
P9
i
VENT
i
i
i
i
i
201.,
LOW VOLTAGE
'
8 ELEC.
CLEARANCES FROM COMBUSTIBLE MATERIALS
Sides
Rear
Front
Vent
Top
1'
0'
3'
1 0'
1 T
Approved for line contact in the horizontal position.
*36" clearance for serviceability recommended.
2
\I.
CASED (U) COIL APPLICATION OPTIONS
Furnace Model
Number
GMNT040-3 &
GMNT060-3
GMNT080-4
GMNT100-4
GMNT120-5
Furnace Width
14"
17'V
21'
24'i"
Coil Model
Number
Coil Width
U-18
14'
x
U-29
14'
X
U-30
17'W
X(1)
X(2)
U-31
14"
X
U-32
17Y'
X(1)
X(2)
U-35
14"
X
U-36
17Y:'
X(1)
X(2)
U-42
1715V
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 Y:'
X(1)
X(2)
U-61
24'/z
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
16M
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
1545
1480
1415
LOW
1275
1215 1
1190 1
1145
1110
1055
985
925
Values indicated by shaded areas represent airflows that are too low for heating temperature rise.
SS-312D
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. Thais why we know...
There's No Better Quality.
Visit our web site at www.goodmanmfe.com for information on:
• Goodman products
• Warranties
• Customer Services
• Parts
• Contractor Programs and Training
• Financing Options
SS-312D 4
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53
LOT 116
AFFORDABLE
3, 705 S.F.
'
57.25'
GRAPHIC SCALE
10 0 20
( IN FEET )
1 inch = 20 ft"
PLOT PLAN
OF LOT 117
PREPARED FOR
MILL POND VILLAGE
IN
YARMOUTH, MA
SCALE: 1 "=20' DATE: 5-1-03
lx
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LOT 117
6,336 S.F.
77.63'
S81.47'10"W
458 MOTE:
o�
OF LI's a ® SEWER LATERAL SHALL BE
' MI MICHAEti� SLEEVED IN ACCORDANCE
o. WITH TITLE V IF WITHIN
-t o:�s�$ 1OFT. OF WATER MAIN.
�sipNe o S ROTICE
Unless and until such time as the original (red) stamp of the
responsible Professional Engineer, or Professional Land Surveyor
appears on this plan:
(A) no person or persons, Including any municipal or other
public officials, may rely upon the Information contained herein; and
2EVISED• 3-8-04 (8) this plan remains the property of Holmes & McGrath, Inc.
ZEVISED: 2-19-04
holmes and mcgrath, inc. \a��titN 1)F
civil engineers and land surveyors r/
362 gifford street TIMOTHY M. o SANTOS
v No.78 u,
falmouth, ma. 02540 � _ CNIL
JOB NO: 201197 DRAWN: LMC
DWG. NO.: A2531 CHECKED: 77m.1-5;W
LOT 116
3,705 S.F.
57.25'
GRAPHIC SCALE
( IN FEET )
1 inch = 20 ft.
PLOT PLAN
OF LOT 117
PREPARED FOR
MILL POND VILLAGE
IN
YARMOUTH, MA
SCALE: 1"=20' DATE: 5-1-03
rr
S81'47 10 W
NOTE:
® SEWER LATERAL SHALL BE
SLEEVED IN ACCORDANCE
WITH TITLE V IF WITHIN
10FT. OF WATER MAIN.
NO-TICE
Unless and until such time as the origincl (red) stamp of the
responsible Professlonal Engineer, or Professional Land Surveyor
appears on this plan:
(A) no person or persons, c Including an muni i I
public officials, may rely upon th
REVISED: 3-8-04 (8) this plan remains the p
2EVISED: 2-19-04
holmes and mcgrath, Inc.
civil engineers and land surveyors
362 gifford street
falmouth, ma. 02540
JOB NO: 201197 DRAWN: LMC
DWG. NO.: A2531 CHECKED: -n„
e
y pa or other
information contained herein; and
roperty of Holmes & McGrath, Inc.
N `P�1H 0
TI MOTHY'A.
o`s SANTOS
NO. 45073
CIVIL
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00
(O^�FFr CE SE ONLY)
. 1�.
TOWN OF YARMOUTH B )A&V -1z3�
1 r}Q
Fee: $ 2S
PERMIT NO. ' /S 2—
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention
work described below. % cJ h
Location (Street & Number) /j ��i !�� p (A
Owner or Tenant G elt*
Owner's
e /ZC.
ILL C/h
perform the electrical
Is this permit in conjunction with a building permit? LT Yes 0 No (Check Appropriate Box) T
MAY 0 2 2005
Purpose of Building r,,•,ri l' by zxt Utility Authorization No.Existing Service Amps/ Volt�dCl Undgrd C3 No. 'et
New Service " Amps c�2 YG /tea Volts Overhead Undgrd 9�r No. of Meters
Number of Feeders and
Location and Nature of Proposed electrical
AdWo. of Recessed Fixtures
- ••••
No. of Ceil.-Sus . Paddle Fans
•— ..... ......". wvw — — --c s„c.... GLfVI ul I... rd
No. of Total
Transformers KVA
qllKo. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures ��
A ove n-
SwimmingPool mbd. � rnd.
No. of Emergency Lighting,
Baue Units
No. of Receptacle Outlets L
No. of Oil Burners
FIRE ALARMS
No. of Zones
of Switches
BurnersNo. '
No. of Gas Burners
o. o Detection an
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers 0
Heat Pumpp
Torals:
um er
ons
—
— —
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Municipal
Local Connection Other
No. of Dryers 5, O
Heating Appliances KW
Secutity Systems:
No. of Devices or Equilivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
of
No. of Motors Total HP
Telecom Wiring:
No. of Devicesnsor uivalent
rtrracn aaamonat aeraa g aesirea, 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 _Pe permit issuing office. /
CHECK ONE: INSURANCE BOND[] OTHER (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: �G/rLt> (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 pains and penalties of perjury, that the information on this application is true and complete. �—
*NAME: sJ �c/I Ch L'or LIC. NO.; 3� 3 a
see: i ' 41r G Signature LIC. NO.'
(If applicable, enter "exempt" in th icense number line.) Bus. Tel. No.:
Address:_ eY1" Gt.rlvxl/� �jj lj1Cl� Alt. Tel. No.: SO16cl R0 —C7.9L
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's agent.
Owner/Agent
Signature Telephone
[Rev. 04100]
OF yq9
_ x
Y�TTICHEESE
�4 " o
TOWN OF YARMOUTH
UN r I
4:7- ll7
Building
cation
Flyw1
❑/
V 2 4 Z004
Plans Sub itted
Renovation ❑
Yes ❑ No ❑
APPLICATION FOR PERMIT TO DO PLUMBING
(OFFICE USE ONLY)
Fee: $ 7S.06 7
PERMIT NO. 62 SOS JS�
Date
Owner's
Name —
Type of Occupancy ! /� m
Replacement ❑
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE)
Installing Company Name
Check One:
❑ Corp.
Address 4 5 /-/V / gclyy ❑ Partnership
!/s/ L—�(•[ ^7 it /Company
Business Telephone �T `Z ! S — ame of Licensed Plumber =�%
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 the " g 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.
2! --3r�7
License Number _
Type: Master❑ Journeyman0�