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121 Camp St #125 Building Permits
C!� TOWN AT: Building New [X -YARMOUT 1 AUG 2 • 200' Renovation ❑ Plans Submitted Yes ❑ No fk APPLICATION FOR PERMIT TO DO GASFrMNG By Fee: $ .�.1 PERMIT NO. (OFFICE USE ONLY) Date Namer�L��it&t A7'e%W sT �— Type of Occupancy Replacement ❑ If N Y cc Uj to cc W °c cc FO U 2 m tx y �c .J 9 WW o US a = 0LL! = W p C O z Q co W III J z Q G F rA m Z O ¢ J y uJ dc O cc i O 0= LL 5 3 o cal g Chi ¢> a SUB•BSMT, BASEMENT 1ST FLOOR 2ND FLOOR 3RO FLOOR (PRINT OR TYPE) Installing Company Name-t�UlG7S' }/jf h1 IT�'1i Address —__i (L— G I1 SAS E 'T�— _— Check One: ❑ Corp. ❑ Partnership L"J Firm/Company us Hess a ep one Name of Licensed Plumber o, r —_ __', odd __may_ L_A M G7- INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes f3-*�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 ❑ 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 appilcation 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 2..15 { ' License Number TVOF 11r`CNQC- FILE U I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A JiAwSPECIAL FLOOD HAZARD A ��REGISTEREPROSSIONZATE AL LAND SURVEYOR NOTICE Unless and until such time as the original (red) stamp of the responstble Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons. Including any municipal or other public officials, may rely upon the information contained herein; and (8) this plan remains the property of Holmes k McGrath. Inc MAY I CERTIFY THAT THE FOUNDATION . IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO jHE MINIMUM SETBACK REQUIRE NTSC THE 5�IAL ER ATE REGISTERED PROWSSIONAL LAND SURVEYOR GRAPHIC SCALE 20 10 0 20 60 1 inch = 20 fL AS —BUILT PLAN holmes and mcgrath, inc. OF -►+ ' OF or . QS`�•, PREPARED T125 civil engineers and land surveyors MicHaEL�cy� MILL POND VILLAGE 362 gifford street p. falmouth, ma. 02540 M-.fRATH IN 9 No. o� YARMOUTH, MA JOB No: 201197 DRAWN: LMC SCALE: 1 "=20' DATE: 5-4-05 DWG. NO.: A2512A CHECKEDV*/* ti v APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN 7 YMPOV,10-1 D JUL 15 2005 (PLEASE PRINT IN INK OR TYF To the Inspector of Wires: By this work described below. (OFFIC912406 N�1 � 6 By&(.:L �V� tu-j Fee: $ 1 LC�; 4± PERMIT NO. �E— 0 b - 036 BUILDING DEPT. ��.L INFORMATION) Date: )p ication the undersigned gives notice of his or her intention to perform the electrical Location (Street & Number) 42 C am �� ��//�aa�l�i!/fie �n i 17 Owner or Tenant GCl/C Gt/D d I/ /�il)a i hC Telephone No. Owner's Address Y& i -/r J S' A=el f e�Ylz .�,r.��,��� lYn �r t�CiWe Is this permit in conjunction with a building permit? L� Yes O No (Check Appropriate Box) �^ Purpose of Building �t.�,�/ �1�t.rr��� r Utility Authorization No. l Z/Z /c 9 Existing Service /Amps / Volts .14'Overhead Undgrd [I No. of Meters New Service O a Amps !� 11 �d Volts Overhead[] Undgrd O' No. of Meters d Number of Feeders and Location and Nature of Proposed electrical Completion of the following table may be waived by the Inspector of Wires of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA o. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. ❑ md. No. of Emergency Lighting Batte Units No. of Receptacle Outlets ylJ No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners r o. o Detection an Initiatin Devices vi) "%L No. of Ranges / Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um er — — Tons — — KW — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local C3 Connection Other No. of Dryers ( Heating Appliances KW Secutity Systems: No. of Devices or ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent v 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 th permit issuing office. / CHECK ONE: INSURANCE BOND C] OTHERCI (Specify:) �/� fGjD `Z /V �irfy (Expiration Date) ( Estimated Value of Electrical Work: �t SG d (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 }�s and penalties of perjury, that the information on this application is true and complete. 3 S NAME: J7'c�yifc� C/Z t Lf� f LIC. NO.-% Lee: pa m 2 Signature �t��,.� LIC. NO. (If applicable, enter "exempt" in the license gumber line.) % Bus. Tel. No.;S'61? Address• l �lG4 �,,r re-(/{ /%rf ilk ✓�/%/.� Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner owner's agent. Owner/Agent Signature Telephone [Rev. 04/00] • Commonwealth of Massachusetts Official useOfily Department of Fire Services Permit No. Ocarpancy and Fee Che BOARD OF FIRE PREVENTION REGULATIONS . 11/99j ve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W0�, ,/ All workto be performed in accordance with the Massachusetts 1lectricat Code (MEC)� 527 MM r (PLEASEPRINTLV=ORIYPEALLDMORMAY70iV Date: OS City or Town of: YAPMUTH To the Inspector of Wirer. � - 1po By this application the undersigned gives notice of his or her intention to perform the electrical work describ .below. D Location (Street & Number) mi:E T, pcmymLAM, 121 Camp St Bldg # Owner or Tenant Gatewood Homes/ Jeff Sollows Telephone No. tZ9 Owner's Address 1600 Falmouth Rd., Suite 25, Centerville, Ma. 02632 Is this permit in conjunction with a building permit? Yes X❑ No ❑ (Check Appropriate Box) Purpose of Building single family residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Uadgrd ❑ Na of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ Na of Meters Number ofFeeders and Ampacity Location and Nature of Proposed Electrical Work Fire Alarm System (low voltage control panel) withbanktm bat: -Eery. cen ra 1 1 v n-on i for o. of Recessed Fixtures No. of Cerl-Susp. (Paddle) Fans r4o. of Total Transformers KVA a of Lighting Outlets [No. No. of Hot Tubs Generators KVA of Lighting Fixtures SwimmingPool grrd e . d. erriits Batte II ergency g a of Receptacle Outlets No. of Ohl Burners FIRE.ALARMS No. of Zones -I-- No.of Switches No. of Gas Burners NE—ofpetectionand 7 Initiating Devices Na of Ranges tal Na of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers t p Totals:I um er. ors o. o ontam Detection/Alertinfr Devices 7 No. of Dishwashers Space/Area Heating KW Local 0 Municipal nn�ion ®Other No. of Dryers .. No. of Water Heaters KW Heating Appliances Xr o. Signs Ballasts Security ystems: No. No. of Devices brE ivalent _ No. of Devices orEquivalent No. Hydromassage Bathtubs No. of Motors Total HP - =)mmun:caticns - irinE N w= aawam= aermr ry aavreq, or as required by thelnspeetor ofWirm INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work- may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CIECK ONE: INSURANCE (3BOND p 01HM 0 (Specify:) Estimated Value of Electrical Wodc $750. 00 (When required munici li (Expuahon Dare b3' Pal po �c3'-) Wort- to Start Inspections tobe requested in accordance with MEC Rule 10, and upon completion. Icertify, and;thepains and penalties ofperjury, that the information on this application is true and complde FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C Licensee: Jonas R Bielkevicius Signature LIC, NO; 499D (IfaN able enter "erarrpt"in the licauemanjie lme) 02563 Bus Tel. 508-8— 33-0996 Address: 1?O 'Box .1609 Sandwtc . Alt. TeL Na: 508-7 -33 7 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 OwnedAgent ❑owner's agent Signature. Telephone No. PERMIT FEE. $ 40.00. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) u LL, -I - Fee: $ cY5 A L I� AUG G 4 4 �� PERMIT NO. (PLEASE PRINT IN INI4TJR TYPYALL INFb"TION) Date: Z::�} `sj b r To the Inspector of Wires. By tt— t� is appltca[1z3n tncuhdersigned gives notice of his or her intentidn tb perform the electrical work described below. __yyam� Location (Street & ber:-# I 1 Z� �l lq�(�S o� C�cJl1yP C�1 Owner or Tenant I C (P— .. Ire No. Owner's Address Is this permit in conju tion with a building permit? �es ❑No (Check Appropriate Box) // Purpose of Building_. oep � Utility Authorization No.�i�(0 Or:> 16 Existing Service Amps / Volts Overhead Undgrd No. of Meters New Service lbt) Amps I?A / CyoIts OverheadQ Undgrd No. of Meters Number of Feeders and Ampacity icx� Location and Nature of Proposed electrical Work: ('mm�l,tinn nfth. i'� Ilnwin,.tn6le.,,.,.,6e..t..,,d 1.. A. I«...,,......, ,.ttxr.-... of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. o Total Transformers KVA o. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool rnd. md. Q No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. ot Detection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat mp Totals: Num er — — ons — — W — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local Connection Other No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or E ui valent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP I Telecommunications Wiring: No. of Devices or Equivalent 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 permit issuing office. CHECK ONE: INSURANCE a OND[71 OTHER (Specify:) (Expiration Date) Estimated Value of 1 'ca]Xork: (When required by municipal policy.) Work to Start: o Inspe tionWone e ted ' cordance with MEC Rule 10, and upon completion. I certify, and the a ns and p n ' s of 'Na`� to n on this application is true and completg. LWNAME. J LIC. NO. l f ee: atur LIC. NO. (If applica r " e in the ice se n) Bus. Tel. No.: Address• �� Alt. Tel. No.: OWNER'S INSU CE WAIVER: I am aware thae does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (cwner ❑ owner's agent. Owner/Agent Signature Telephone No. [Rev. 04/00] r OF r TOWN OF YARMOUTH 'V l Building Depallment BUILDING (508) 398 2231 ext.261 PERMIT NO B-05-1035_ PERMIT ISSUE DATE ; 3/10/2005 ; PROPOSED USE _ _ _ _ _ _ _ _ _ _ _ APPLICANT 'Funk Capra_ _ _ - - _ - _ - _ JOB WEATHER CARD PERMIT TO New Construction ' ------------ AT (LOCATION) 100121CAMPST#125 ZONING DISTRIC R25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDING IS TO BE: CONST TYPES 5-13 1 USE GROUP new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundry room, 1 livingroom as per plans REMARKS dated 03/02/05 and BOA # 3546. AREA (SO FT) EST COST ($ $117,024.00 PERMIT FEE ($) $427.00 OWNER I Villages @ Camp St., LLC 5BUILDING DEPT BY ADDRESS 1600 Falmouth Road # 25 Centerville I MA 102632 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 Certificate Issue Date__ :_. - "' - CERTIFICATE of:OCCUPANCY- Departmental Approval for Certificate of Occupancy and Compliance Inspector . Date Permit Number Approved By Remarks WHO To be filled in by each division indicated hereon upon completion of its final inspection. of r TOWN OF YARMOUTH Building t5eparttMent BUILDING _ _ _ _ _ _ _ _ _ - , (508) 398-2231 ext.261 '- PERMIT NO _ =: __ -1035 _____ PERMIT ISSUE DATE _ 3/10/2005 _ ; PROPOSED SF APPLICANT Fran --k Capra ------ JOB WEATHER CARD PERMIT TO ' New Construction ' AT (LOCATION) ZONING DISTRIC R25 Bldg. Type: Residential 100121CAMPST#125 SUBDIVISION MAP LOT BLOCK 44.21.1.C125 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 kitchen, 1 laundry room, 1 livingroom as per plans REMARKS dated 03/02/05 and BOA # 3546. AREA (SO FT) EST COST ($ I$117,024.00 PERMIT FEE ($) $427.00 OWNER I Villages ® Camp St., LLC BUILDING DEPT BY ADDRESS 1600 Falmouth Road # 25 Centerville I MA 102632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector r Q �J ONE & TWO FAMILYONLY- BUILDING PERMIT • �� - C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING �F O y Town of Yarmouth Building Department N �"^CKEE 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508).398-0836 J .c v'`� �,,,, Mr z{"'1st"'9v y.£ •�i y t{ PeT,•��ej 'tJJttID3t°+ dt�, k4 ,,, .QutsrE,,�E.,}�F�j'ervi'k -.+. X # �.3 ,n Etn1Jt F 2 l y i f 4 i }F i j Dep081tdr x y r pY s "^s`�w{1 ♦♦;�..,,+A+# 3 Q£ IK S IYti1,IJY{it+�^.4+yli..t�., lF 3. kt..a e •e,s; uJ? R._ tx �.--..,Ter;t...a;� wt -t 1 q�oarc�lnfo�riattoraf 3'Janype x .�radorsemerrX•.�ate '— a4 T RN Y an No i "vva�4A't, herrFronfageft)-- u-w r { ..t u. - .. } ,. i ssessors Department information ���-,. , ,, ,,.. a ; �,> k a i l�aP* iat,r r s ,dp ji yq 'Fi rY 1(� ri j 1 /Yu < mY{ V6 Y 3 i A Property Dimensions �; y -. e. ra E -# J 3 1/.E' tr i-O"3rv1 f G t q A� M1'}x 9 £ yy �a 1 ,L`otoverage 14 IS"aSECilon! ce i..15E;".Q(1l �l9lqlilill °Pe >luerF �� x M At k �* wJ 4 a� 3 �rE.rv.{' Q t,.- t X ..nx t 11 j%S +i'1•,� /�i S ii II�,Y,Y N� '"L'H ��733.�.°i.+g f f5ik ��* w. fi� i � /� ry.,f�..j/V�1/a�+ �/./}�.�!.�k §/� •'E 3 3`i �. �. R`�5L . �[ F�G�I�IV �LGYV�VYUp�nl.y .1 Y. � - 1 .,�. R i.. Section 7,`SlteJnfafitatioti Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use L_0 1.3 Building Setbacks. (ft) Front Yard Side Yards i Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 64) Public Private 7 5 FloiyodZone Jntormaf#on £. u ` �, E` tt:omrnellts xk , s ., - �,=.a.,,= Mal ,v w •T;,r-..�..,. iiRi� Sectlon'2;,Pope"rid Owr�ersFilp/Anihoted Aged# 2.1 Owne of Record: Qsc�p Neme 4p� r, r\ > Mailing Address Ce ,, r V i° u (M,4 of Signature Telephone 2.2 uthorize Ageot: GOvht s l 00✓ lll�[y1 Na�rint) Mailing Address S gnature Telephone1n124,&,1k5x2 nil Secflon� 'Gonstruc iorrServices 3.1 Licensed Construction Supervisor. r 3 Not Applicable ❑ License Number O ` u✓ ddres t - Expiration Date t7 Sigrfature Telephone Regis3'eTe borne`' n3provement;Cz nira' ` Company Name Not Applicable ❑ Address License Number Expiration Date Signature Telephone (fie.; m l 1 of 2 OVER V Section 4=Workers'-Compensationf 1n's'&r'd_n'6e Affidavit :(M.Gt:,'c. 152 S 25C (6)] W6rkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes..Z�.. No .......... Section 5" escrip ton, of Prdpd.sed,Wo.f K-_(cbeck aU_a0pl1;abI6)J New Construction No. of Bedrocks I No. of Bathroos Existing Bldg. C3 Repair(s) El Alterations ❑ Addition ❑ Accessory Bldg. El Type -N-P Demolition Other Specify:, Brief Description of Pro osed Work: LS_ % C. CL YIA\x I V�' &0 �J� V'1 - 0', dloh':& lm6f6dC6fis WonZ5ot!� Item. Estimated Cost (Dollars) to be completed by permit applicant Check Below Conservation -Commission Filing (if applicable) Old Kings Highway & Historical Commission approval (if applicable) 1. Building 2. Electrical 3. Plumbing/ Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =(11 +2+3+4+5) 9 t7 00-6. 17. Total Square Ft. (new houses & additions) 90 Sec . ti6r�-7a3'-;OwnerAuth6dzation,'z,,',,,To or,'C'o".'n'trdctotAp0JJes be Completed Wh'ep,,, for B uAdifig Per ml PAA 11 h AJ6'&& J_�J'N V\ ` 0, V��' f��'P_ V— hereby authorize 00 vvie Is &Awier of the subject property k fw to act on 0LJ,,4 Zhalf Aatte2l Aeo&rkhorized by this building permit application. Signature of owner Date Section ,,7b\"�Owner/Authorized Agent Declaration� 1, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. t7 i4t Print rge, 001, naV_,o� ZZ-7 Sign�atLke'of L1caner/Agent Date 9-15-99 2 of 2 k 1 v W IN . UP YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. I /^ job Location: Num. ber` Street Owner of Property: V S Construction Supervisor: a Name License N Address: 0 0 l Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: Village �NWAM License No. 9669 No. oaG= 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures onlypursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 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 alteration, repair, removal of demolition as regulated by section 109.1.1 in construction, reconstruction,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 ye, please indicate the type coverage by checking the appropriate box. A liability insurance policy C30'0� Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by ChaPt of the hiG al Laws, and that my signature on this permit application waives this requirement. 7e ^ Check one: Signature of Owner or Owner's Agent Owner ❑ Agent Ac— Signature: Building Official Approval: �'-1 The Commonwealth of 3fassachusetts Department of Industrial Accidents Offes0l1"estlOstbss 600 Washington street Boston. Mass. 01111 Workers' Compensation Insurance Affidavit 0- ❑ I am a homeowner performing all work m}•self. ❑ I_am a sole proprietor and ha%e no one working in any capacity ❑ I am .an employer pro% iding workers' compensation for my employees working on this job. comnanv name- tides- city: nhnn� N ins u an M CB/I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below oho have the following workers' compensation polices; city: nhon� N imurance co. Q91ie. s company name: phoee a address - city: Failure to secure coverage as required underSeetion 25A of MGL IS2 rat, lead to the impoaidon of erimitsal pen ildes of a line up.to SI.S00.00 and/or one yc> rs' Imprisonment as well es eivil penalties in the form of a STOP WORK ORDER and it fine of SIDO-00 a day'against me. I aaderstiad that a Copy of this statement mar be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby Gunder the pal an a es of perjury that the information provided above is true and rreti k Signature ate (� •-7fig— / Print name one K G' oRcial use Doll do not w rite in this area to be completed by city or town offleial city or town: YARMOUT$ _ petYaiNicease M MBuilding Department ❑ check if immediate response is required Ql.ieensing Board pSClectmen's Office �conro. ct person: 261 OHealtb Department phone N; _ (508) 398-2231 eatMother TOWN OF YARMOUTH BUILDING ELECTRICAL 1146ROUTE28 SOTHYARMOUTH MASSACHUSETTS02664-4451 GAS U Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ` p Work Ad ess is to be disposed of at the following location: r\ Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. F,.,e7 140* -� - Signature of Appli&nt Permit No. d 'U� Date 0 e oPoanmco�uirealC/s o✓i�irarariivaelCa f BOARD OF BUILDING -REGULATIONS License: CONSTRUCTION 'SUPERVISOR. NumberZ& 012430 Exptces 087:€6i20Qfi Tr. no: 25926 Restn'�>�d-E1F�,z, FRANK CAPRX 46.60PPERLN�" CENTERVILLE, MA 0'2632 -- - Commissioner ' 00 - 35,000 d enclosed space (MGL C.112 S.00L) _ to - Masonry only 1G =1- & ZFamily Homes Failure. to possess a current.edition of the Massadmetts State. Building. Code is cause for revocation of this license. ;{ 1 DIG SAFE CALL CENTER: (888) 344-7233 " 'i ACORD CERTIFICATE Off' LIABILITY INSURANCE DArE (MNVDD/YY) �/4/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BlaoLdA Grail TnammnCe ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. lix 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR M3sYus Mills, NFL 02648 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE wsuseD I Ty,.�.:[%- a 'P _ M&Lal. Fire Im.- QD- INSURER A: LtoyiY . }ilS11CaC1 i37IYY ]LY1 Cb, InC, i INSURER e: SXAms & past3alty INSURER C: - -' INSURER D: — j INSURER E- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING A.NY 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 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH INSk_.__ ._ LTH TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY N EXPIRATIO I DATE bIM/DD/YY AT fMM/DD/VY LIMITS GENERAL LIABILITY i yyyy� EACH OCCURRENCE . lui CUhINItiRCIAL GENERAL LIAE.LITY R. s ' I I FIRE DAMAGE (Any one tire) $ _.. ..._...... ry� CLAIMS MADE OCCUR I E I._ sVSlN I MED EXP (Any one person) S _. ..I �� OW 1 I I PERSONALS ADV INJURY i $ /�/�/Y .1FOWf.00 GENERAL AGGREGATE j g A GhN'L AGGREGATE LIMI I APPLIES PER: CFO 0005933 04 FPRODUCTS - COMP,'OP AGG 1 S 2i 000� 000 POLICY , I PI30- . JFCT I _Oc CP00005933 05 1 0-5-04 11 0-5-05 AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMI r $ ANY AUTO i (Ea accident) ALL OWNED AUTOS ' BODILY INJURY SCHEDULED AUTOS i I 1 (Per person) HIRED AUTOS I ! I I BODILY INJURY- a ; NON -OWNED AUTOS (Per acciaent) - I �- I PROPC-RTY DAMAGE (Per amioent) ($ GARAGE LIABILITY, AUTO ONLY- EA ACCIDENT I S _..._.. .. ANY AUTO A ACC I $ OTHER THAN' _E.. L..... I.AUTO . I I ONLY: AGG I S EXCESS LIABILITY I EACH OCCURRENCE S ' OCCUR 1 j CLAIMS MADE I � __ ..... _..__.. AGGREGATE is ._. .._ ... • 1 UEUUOr1ULE I - riE IEN iIUN : WORKERS COMPENSATION AND WC STATU- I1'_ OTH- TORY LIMITS � ER EMPLOYERS'LIABILITY I 1 - _1 ---- EL EACH ACCIDENT_ $ - 100 000 ' 1 104-01-04 04-01-05 - I EL DISEASE: EA EMPLOYEE $ 100,000 B TM 001630 i I I_._... E.L DISEASE - POLICY LIMIT I $ ._. 500r 000 OTHER I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 7 ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Gatewood Homes 1600 Falmouth Rd. Suite 25 Centerville MA 02632 508-778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR RD 25-S (7197) ACORD CORPORATION ACORD` CERTIFICATE OF LIABILITY INSURANCE w DATE(MW°°"'"") 11/01/2004 PRODUCER (508) 540-2400 FAX (508)289-4111 Murray 81 MacDonald Insurance Services 406 Jones Road 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. Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC # INSURED Tracy Howerton INSURER A: Arbella Protection Insurance PO Box 1551.:,j wsuRERe: Liberty Mutual Ins:Corp - Mashp_ee;-MA 02649 INSURER C: -- ° . INSURER D: -- -- - INSURER E: -. _.. .. ._ ... _.•- -. _.._ . 'COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD" NSRE TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE MWDD POLICY EXPIRATION DATE MWDD/YY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR 8500028756 08/14/2004 08/14/2005 - - EACH OCCURRENCE S 1,000,000 PREMISES Ea occvrence S 100,000 MED EXP (Any one person) S S,000 PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY F JEGT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTYDAMAGE. (Per.acaident). ._. S __.. ... ._. - - GARAG1i UABIJTY -... ..-_..._. ._. ANY AUTO __...._...__._. _._ ._. ._ .. . -.: _. - -.... - -AUTO ONLY - EA ACCIDENT OTHERTHAN .. EAACC AUTO ONLY:.__ _-- -AGG S .. - .S__-.. EXCESSIUMBRELIA LIABILITY OCCUR 0 CLAIMS MADE DEDUCTIBLE RETENTION $ EACH'OCCURRENCE --' S- '--' AGGREGATE - $ - S $ - $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETORIPARTNERIEXECUTE OFFICERIMEMBER EXCLUDED? If yes. describe under SPECIALPROVISIONSbe:ow WC531S317310033 10/05/2004 10/05/2005 TORY LIMITS ER E.L.EACH ACCIDENT S 1QO,OQ E.L. DISEASE - EA EMPLOfj S 100,000 E.L. DISEASE -POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS l.Ml\ V GLL/11 1 V I\ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI IF BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Gatewood Homes, Inc. I 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Paula BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGAT10N OR LIABILITY 1600 Falmouth Road, Suite 25 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ©ACORD CORPORATION 19BI1 MARSTONS MILLS MA 02648- (508) 1 - DATE (MM/DO THIS 04 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_ COMPANY A MERCHANTS INS CO OF COMPANY B COMPANY C COMPANY D THIS ................EN..�.�.x...w:xxvn•.v:xw:s[..:[.:v:.nC::i:.:iiL:fiJ?ii+:iY.:»:i::::i:<i�:i::>j:?4i%ii::Jr::isi)%:iiiY:si_::ii�:Y::iiF:::i:::Q:;�i:ii', IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED; NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE' POUCYNUMBER POUCYEFFECTIVE POLICYEXPIRATION LTR DATE (MMMDNY) DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY GENERAL AGGREGATqs 6 0 0 0 0 0 X COMMERCU(LGENERAL LIABILITY CCP8567749 04/28/04. 04/28/05 PRoODCT3- comp/op AGG I S 6 0 0 0 0 0 CLAIMS MADE OCCUR PERSONAL & ADV INJURY 111300000 OWNERS s CONTRACTORS PROT EACH OCCURRENCE s3 0 0 0 0 0 FIRE DAMAGE (Any one fire) Is MED EXP (Any one Person) s 5 0 0 0 AUTOMOBILE LIABILITY ANYAUTO / / / / COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per acdden4 $ PROPERTY DAMAGE S GARAGE LIABILITY - ANYAUTO ' / / _ AUTO ONLY -EA ACCIDENT S OTHER THAN AUTO ONLY: ............................. . EACH ACCIDENT E AGGREGATE S EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM .. / - / EACH OCCURRENCE S AGGREGATE 5 a WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPFtlETOW IN(.1 PARTNERSAMCUTIVE OFFICERS ARE. EXCL OTHER - _ RY MITS R 7::: ' EL EACH ACCIDENT EL DISEASE - POLICY LIMIT S EL DISEASE- EA EMPLOYEE E lE5CFUPTION OF OPERATIONS/LOCATION ELECTRICAL WIRING Gatewood Homes Inc. 1600 Falmouth Road Ste 25 Centerville MA 02632 ITEMS SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY_ ITS AGENTS GM MFPAM MTAT m yT.- y E , ' W. ISSUE DATE(MM/DD/YY) t CER�TT' FG INSx � CE i<rt.«sue.,3 ?,wS'u7 _].,,, eis. 7 fit; xi. w•.., _, �. .-,.»... rh `.kaY'..sV.:.. .^s +j4 ¢k +S_. :,.'>"m i,. g,.;rx2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Harold H Williams Ins Agcy Inc DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 81 Bassett Lane COMPANIES AFFORDING COVERAGE Hyannis, MA 02601 INSURED Stephen M. Childs COMPANY A.I.M. Mutual Insurance Co 145 Cammett Road A Marstons Mills, MA 02648 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREbMNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICYERPIRATIO LIMITS L DATE(MM/DDNY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE S PRODUCT'S-COMP/OP AGO. - S COMMERCIAL GENERAL LIABILITY PERSONAL R ADV. INJURY S EACH OCCURRENCE S OWNERS @ CONTRACTOR'S PROT. FIRE DAMAGE (Any one fre) S - ED. EXPENSE (Any om person) S AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT BODILY INJURY S ALL OWNED AUTOS CHEDULED AUTOS - (Perpx ) BODILY INJURY S HIRED AUTOS ON -OWNED AUTOS (Per=idcn0 PROPERTY DAMAGE S ARAGE LIABILITY LESS LLABD.iTY EACH OCCURRENCE $ AGGREGATE S BRELLAFORM "F,,zr ;_ ER THAN UMBRELLA FORM WORKER'S COMPENSATION AND - OTH- X WRY LIMITS TO 4 EMPLOYERS' LI.ABIL'I'Y - S 10 , A 7015793012003 12/13/2003 12/13/2004 THE PROPRIETOR/ INCL EL DISEASE —POLICY LIMIT S 500000 PARTNERS/ECECUVIM $ 100,000 OFFICERS ARE: X EXCL EL DISEASE —EA EMPLOYEE OTHER DESCRIPTION OF OPERATIONS/LOCATIONSh'EMCLIS/SPECIAL ITEMS CERTIFICATE�HOLDER,�,.,. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO GATEWOOD HOMES, INC. `1 --. MAIL 10 DAYS WRI'1TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1600 FALMOUTH ROAD, SUITE 25 LIABILITY of ANY JC[ND UPON THE COMPANY, ITS AGENTS OR t REPRESENTATIVES. " nvrxoRlzED REPRESENTATIVE CENTERVILLE, MA 02632 :35_F�G.rot CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYY1) PRODUgER 8 /2 /2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON .THE CERTIFICATE 749 Main Street, Suite#H HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Osterville, Ma. 02655 508-420-9011 INSURED Casperson Overhead Doors Box 517 East Falmouth, MA 02536 COVFRAAFC INSURERS AFFORDING COVERAGE INSURERA: WOrcester.Insurance INSURERB: National Grange INSURER C: - INSURER D: E NAIC# THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT .TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITSSHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. MSR PD LTR NSRD TYPE OF INSURANCE POLICY NUMBER POLICY ATEMEEFF TIVE DATE MM�I p TION LIMBS GENERAL LIABILITY CE EACH OCCURRENE 1,000 OO X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OX OCCUR PREMISES Ea o ccure E 100 00 AMEDEXP(Anyonepwr ) E 10 , OO CB 2LT1973 05/28/04 05/28/05 PERSONAL &ADV INJURY E 1 000 00- GENERAL AGGREGATE S 2 000 001 GENT AGGREGATE LIMIT APPLIES PER POLICY JET PRODUCTS-COMP/OPAGG S 2,000 OOI LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT E (Ea accident) ALL OWNED AUTOS ' SCHEDULED AUTOS BODLYINJURY E (Per Person) HIRED AUTOS NON-OWNEDAUTOS BODILYINJURY (Pe acctdent) E PROPERTY DAMAGE ' (Pwwddent) $ GARAGE LIABILITY ANYAUTO AUTO ONLY- EA ACCIDENT E OTHERTHAN EAACC S . . AUTOONLY: - EXCESSIUMBRELLA LIABILITY AGG E OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE - S ' DEDUCTIBLE E RETENTION $ . $ WORKERS COMPENSATIONAND E W A EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNEWExEQiTrE X TORYLIMfTS ER CP48352 02/22/04 02/22/05 B OFFICMVWMBER EXCLUDED? E.L. EACH ACCIDENT E 500.000 Ifyes.desaibeunde SPECIAL PROVISIONS below EL DISEASE - EA EMPLO E 500 000 OTHER F—L DISEASE -POLICY LIMIT $ 5O0 000 DESCRIPTION OFOPERATIONS /LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Gatewood Homes, Inc. 1600 Falmouth Rd., Ste. 25 Centerville, MA 02632 ACORD25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES At TTN(1ROCT1 ecoo crrr,t—� _ ©ACORD CORPORATION 1 aW-HP CERTIFICATE OF LIABILITY INSURANCE DATB(MM/DDff" 08/02/2004 PRODUCER (781)431-9800 FAX (781)431-0222 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Cochrane & Porter Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES END,OR CID Renaissance Alliance Ins. ALTER THE COVERAGE AFFORDED BOY THEE POLICCCIIEESEND BE OW. 981 Worcester Street Wellesley, NA 02482 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: OneBeacon American, Ins. Co. 20621 Cape Cod Ready Mix, Inc. INSURERB: Commerce Insurance Company 34754 - 300 Cranberry Highway INSURERC: Zimmerman Specialty Insurance ZSIOOI Orleans, MA 02635 INSURERD: INSURER E THE POLICIES OF INSURANCE! ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE fMMfDDfYY1 POLICY EXPIRATION DATE (MM1DD1YYI LIMITS GENERAL LIABILITY - CBR817036 01/01/2004 01/01/2005 EACH OCCURRENCE S 1,000,001 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR DAMAGE -70 RENTED S 100,001 MED EXP iAny one person) $ 5' o0) A PERSONA_ L ADV INJURY $ i , 0OO , 00( GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE UMIT APPLIES PER PRODUCTS - COMP/OP AGG E 2,000,00( POLICY JECT LOC AUTOMOBILE LIABILITY ANYAUTO XY9014 01/01/2004 01/01/2005 COMBINED SINGLE LIMIT (Ea accident) S 1,000,00( BODILY INJURY (Per persoul $ ALL OWNED AUTOS SCHEDULED AUTOS X B HIRED AUTOS NON -OWNED AUTOS X BODILY INJURY (Per amderY) $ X PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY BE9744481 01/01/2004 01/01/2005 EACH OCCURRENCE S 1, 000, 000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 C IR S 10,000 - S DEDUCTIBLE S RETENTION S WORKERS COMPENSATION AND WC ST.ATU- OTH- EMPLOYERS LLABIUTY ANY PROPR!ETOR/PPRTNER'EXECJT:VE E.L. EACH ACCIDENT S El. DISEASE - EA EMPLO $ OFFICEWMEMBER EXCLUDED? H yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCA-ncNs / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS `CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Gatewood Homes, Inc. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER TO THE LEFT, 1600 Falmouth Rd. BUT FAILURE TO MAIL SUCH NOTICE SHALL PA NO OBLIGA OR LIABILITY - Suite 25 OF ANY KIND UPON THE INSURER, ITS AGENTS CR ES IVES. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE ' 4ACORD 25 (2001108) ORD CORPORATION 1988 acoRQ CERTIFICATE OF LIABILITY INSURANCE DATE (MANDD/YY) ' 08/02/04 PRODuct.:RR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Fel et (berg Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222 Milliken Blvd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 3220 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fall River, MA 02722 INSURERS AFFORDING COVERAGE INSURED. Cape Cod Ready Mix Inc. INSURER A: Construction Industries Compensation _. PO Box 399 INSURER B: Orleans, MA 02653 INSURER C INSURER D: ' INSURERS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED Of MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI POLICIES. AGGREGATE LIMITS SFInWN MAY 14AVF RFCM DFnI 1r=M RV DMn nr An,D INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M/DD/YY POUCY EXPIRATION DATE M/DD/YY LIMITS GENERAL LIABILITY I COM M ERCIAL GENERAL LIAB ILRY i CLAIMS MADE OCCUR —I GENT. AGGREGATE LIMITAPPLIES PER: POLICY PRO. LOC EACH OCCURRENCE E FIRE DAMAGE (Any one fire) Is MED EXP (Any one person) S PERSONAL 3 ADV INJURY _ E GENERAL AGGREGATE E PRODUCTS-COMPIOPAGG S EE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accdent) E r1 BODILY INJURY (par person) E BODILY INJURY (Per accident) S r 1-4 (Per PROPERTY accident) DAMAGE Is — 1 tt���""""'��I i A I i I I GARAGE LIABILITY ANY AUTO F)CCESS LIABILITY - OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER WC0009254 01/01/04 01/01/05 AUTO ONLY - EA ACCIDENT E OTHER THAN EA ACC AUTO ONLY: AGG EACH OCCURRENCE E E $ AGGREGATE E E E WCSTATU- I OTH- X E EL EACH ACCIDENT s500,000 E E.LIS- E.MPLUMYER E50O,00 EDISEASE P L LI 500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS rcrntnrATc unr nr.. I Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, MA 02632 SHOULD ANYOFTH E ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -In DAYS WRITTEN NOTMETOTHE CERRRCATE HOLDER NAMED TO THE LEFT, BUTFAILURE TODOSOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR • 1 —1 — mva, rvvnrwaV�r CL3 0 ACORD CORPORATION 1988 Aug-03-04 02:42pm From -A I G 973-316-6903 T-270 P - 002/1102 F-481 PRODUCER Dias Ins Agency Inc 535 Brayton Avenue Fall River, MA 02721 Eba Carpentry Inc IGO West Main Street, St I() Hyannis, MA 02601 -IN �4T 7; R 1 AS A MATTER OF: INFORMATION T" THIS CE ONLY AND C ONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. i� C HOLDER. TI- IS CERTIFICATE DOES NOT AMEND, EXTEND OR L ALTER R T LTER THE- AFFORDED By THE POLICIES BELOW- %'w'wrANAFFORDINACE --rCOMPAMY A GRANITEIr-b STATE INSUINGRANCEiiUCOMRPANY ....•. ...... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED :FLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING ANY RECIL REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY B ; ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED THE... POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E =LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By pAjO CLAIMS. UABRAY' C Group I 7/24/2004. 7/24/2005 Owy. MY LVAITS CIDENT $1.000.00 POUCY Lror 3 I.ODMOO CERTIFICATE HOLDER CELLATION GATEWOOD HOMES SHOULD ANY OF " ABC /E DESCRIBED POLLIES BE CANCKI I En BEFORE THE CELLAT'O Al N OC , 0 �"J� 1600 GALMOUTH ROAD, SUITE 25 OVRATION DATE THERE W. THE ISSUING COMPANY WXL ENDEAVOR TO MAX. 10 CENTERVILLE. MA 02632 wm 4 -T. mjcm k c :C)L Cp DAYS WRMTEN NOME 7 "M CFRTWCATE MOLDER NAMED To THE LEFT. BUT : I FFALURETO MAIL SUCH h' 'TCE SHALL IMPOSE NO 09UGATION K 0 L OR UABLITY OF ANY KNO UPON THE COL 'ANY. M3 AGENT; OR FtEpRESj;NTATpE& AUTHORIZED REpRI SEWATTVC v .., cv u-a su..au em JVOI JUU44y UULU3W ASSOU - 001 E �,0--OEA C-FNTIF18CATE O.9 1 !ABI !TYINS'..,RA6 rP'=. CSR AD OATE(IOADIDYTTTf .. PILL -fa ..�....50 0S 23 04 G THIS-CERTWlCC GOLI7MiLN & ASSOCIATES INSURANCEf.lS4SWED�iSt MArmR-CFINFORM sRA 8I=N*CIAL SERVICES INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTFCATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,_W-END OR . ALT€R-TJ49 eoiAR.AS£ PFF9RBEa8 ,,� ^•:• HYAtw'IS = 02601 Phoms:508m775e60.10 l+e::508=780e0299 "'8L'.:€ 8' - I 008� 1 I�tvA Oxs Im anr-• TTea gX&CM M-L 02562 ,� n rU'FORAa,na CarRAGE INSURER A: ESSEX INSURANCE ea MMURER B: AIDE ba'7i 'LI AL INSU-i& r:sLlREac: INSUP_ R O INSURER E: MAIC.C. THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN t=CD TO THE WSMW NAMED ABOVE FORTHE POLICY PERIOD WDICATEM NOTMTNSTANDING ANY II L'L...ME.R• TERM OR CONDSTION OF ANY CONTRACT OR OTHER DOCL.AENT WISH RESP�d.`T TO WHI(yl THIS CERTIFICATE MAY BE LSSL)ED OR MAY r-AAG THE INE LIMITS BYTEEELr..$DESCRIBED tl�.'VIS;,.1P„aCT TO ALL TCE TDt--% EX,^LIAIG:$ AM CONCITKM OF SUCH IMIT SOWN MAY POLICES. AGGREGATE LBIITS SNOW N NAY HAVE iN-"J4 REDUCED BY PAID CLAIMS LTR TYPE OP MSURAAICE POLSCY NUMBER DATE DA _m uAais A GENERAL LLAML/7Y S eaL+ntmcw GENEILILLUBILITY CLAIMS MADE ®OCCU0. 3C282718 12/12/03 12/12/04 EACH OCCURRENCE s 1000000 PRE Sl(Eaoaa,eneal 350000 NED EKP IAnyq pe ) S 5000 Pt RsONALaAovrAAIRY 510000o0 GENERALAGGREGATE s 200'OiT" G kAGGREGATEUMVTAPRJESPEIt IPOLICY a& Loc PROOI.•"'TS-COMP/O►AGG 51000000 AUTOM09LE LYBLSTY ALLOWNCAUTO ALL OWNGD AUTOS SCHEDULEDAUTOS IBRFDAUTOS NAe!-Di#NE9 Alfa . I COMBINED SINGLE UMST IFi t=ll rWP sTafaLlllltxr S EOOILYIIi.s/RY tPraccCntl s I PROPERTY DAMAGE S I�--'^S LSa6.•LITY H ANYAUTD E7cC.F�' 11_. UAelIJI1! OCCUR CUUMS MADE OEDLCnELE RETEMMU s I I - AUTO ONLY -EA ACCIDENT $ OTHER -THAN EA aCr auto oNLr. � EACH OCCURR_NGE I s s s A6-REGATE i s 8 rrORNeLea DOAQENSILTIGI AND E4iLOYERY L1AZZ.11Y ANY -0WCErmsmmrnm ve,I�curn, OVFec��m-MER��� sPEGAL 'ROVt$IpN$odw ER— MAUN C7016018012004 01/03/04 01/03/05 TORY LIMITS ER E.LEAc"AccmENT s l00000 E.L DISEASE -EA EMPL s 10Q006 EL DISEASE -POLICY LIMIT S 500000 . DE$CRiPTIDN('liOP@FiAflCYi73/I.OEk710N3/YeriE13/EXCtUSiuiiS AuDc�i 6Y EiiBiaRSENEhT/SPECW.FROi7LSiON9 - {.'cR,rRA,G --nF.7 w...w-.. s I QATZWOOn HOMS I;,•C PAX S0E-178-5602 lean &=z"%^uT.— no= csnrrsxviz,is MA 02632 G&q, Mo I •OIJI-0 kuY OF THE ABOWE_MEZC—M POL=S BE CA:.=ED TII`P�.�. ^^-. DATE THE.REDF THE MSIJ!NG IsuPEB WILL ENDEAVOR TO MAIL 30 DAYS WMTTEN NAT16ETO THS 6ERTMATE HOLDER NAMED TO THE LEFT, BW FALL RE TO DO BG 5144LL. WPOSE NO OBLIGATION OR LIABILITY OF ANY NAND UPON T14E 044RER, IM; AfTENTE OR d/4/U4 Y:JILI:Jb FM 4154 ® 02/03 COR4 CERTIFICATE OF LIABILITY INSURANCE DATE • PRODUCER (508) 540-2400 FAX (508)760-1988 - Murray & MacDonald Insurance Services 406 Jones Road Falmouth, MA 02540 os/o4/zooa 04/2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE- HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Douglas MacDonald INSURED TRACY HOWERTDN PO BOX 15s1 MASHPEE, MA 72649 INSURERA: Hartford Fire Ins co 19681 INSURER 8:.Liberty Mutual Ins Corp INSURER C. INSURER R INSURER E. rnvcoAr_rc THE POUCIES OF INSUR,4YCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCEAFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS R DI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR - 08SBAI R7945 10/02/2003 10/02/2004 UMff3 EACH OCCURRENCE j S00. DAMAGE TO RENTED j 300 MED EXP (My we PNatiA) j 10. PERSONAL&ACV INAIRY t Soo GENERAL AGGREGATE t 1, 000.F L&UT APPLIES PER GEN POLICY POLICY PFO- JP'T LOC PRODUCTS -COMPIOP AGG t 110001000 AUTOMOBILE LWBIUTYP ANr Auro COMBINED SINGLE LIMB (Ea actldeny t ALL OWNED AFROS BODILY INJURY SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per Wed ) t NON-0WNED AUKS PROPERTY DAMAGE (Pw acWenQ j GARAGE LIABI IrY ANY AUTO AUTO ONLY -FA ACCIDENT t OTHER THAN EA ACC t AUTO ONLY: AGG, j E 1 OCCUR MBRELLA LIABILITYLIABILITYEACH OCCUR C CWMS MADE OCCURRENCE j AGGREGATE j t DEDUCTIBLE t RETENTION S t WORKERS COMPENSATION FIND FJNPLOYERS' LULR BY WC1315317310021 10/05/2003 10/05/2004 WCY I WIT F B ANY PROPRETOR,PARTNEWD(ECUTIVE OFFICERIMEMBE-R EXCLUDED? E-LEACH ACCIDENT j 1D0, E.L. DISEASE -EA EMPLOYE t 100 ITyc deaniDs=Iw SPECIALPROVISIONS WM _ E.L. DISEASE • POLICY LIAR j 500 OTHE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATF NnI nca Gatewood Homes Jeffrey Sollolls 16 Falmouth Road Suite 25 Centerville, M4 02632 ACORD 25 (2001108) FAX: SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _lO _ DAYS wRTTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER ITS AGENTS AUTHORIZED REPRESENTATIVE 1515 OACORD CORPORATION 1988 r+ln-w-crJEJ•I o� • p K 1 VtK K 15K bl- tC 1 RL 1 STS 1 508 564 7272 P. 01 /02 ACORDR. ��i• IFi�AiT&," 1a� �T u ......:.......eSnw.-w�,e.....w..,..«.««.a..w.w. �.r.. . , <a - ...,a, saea s aax� 0 7 2 8 / 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RIDER RISK SPECIALISTS HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR e1TFR .THE _CnVFLTA IELAFFORDED BY THE. POLICIES BELOW. INSURANCE AGENCY, INC. COMPANIES AFFORDING COVERAGE P.O.BOX 115 CATAUMET MA 02534-0115 C INSURED 3COTTSDALE INSURANCE COMPANY _ --_....... _ MONUMENT INSULATION, INC. 8 AMERICAN HOME INSURANCE COMPANY 223 COUNTY ROAD COMPANY BOURNE, MA 02532 C COMPANY D -•GALL » .�, awN . »: e w ...:;. r.M `...a..: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESGNMD-MEREW _M_SUB.IEC2.T.0_ALL7HP TFRMC EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co TR TYPEOF INSURANCE POLICY EFFECTNE_. _._. LTR POLICY NVMeDI DATE (MM/OD/YYI DATE MM/DOlYY) tomrs- GEREIiAL LIABILITY GENERAL AGGREGATE SI, 000. 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS • COMPIOP AGO. F5 O 01000 _ CLAIMS MADE a OCCUR PERSONAL a ADV INJURY 1500; 000 2 - OWNER'S III CORTRACTORSMOT CLS1001705 3/30/04 3/30/05 EACH OCCURRENCE S5000000 PIPE DAMAGE IAAY ARIA NAI 15 0 , 0 0 0 AUTOMOBILE LIABIIm PIED EXF IAnv aIA oerrOAi S$ 0 0 0 ANY AUTO COMBINED SINGLE LIMIT F-ALL OWNED AUTOS -• SCHEDVLEo AUTOS BODILY INJURY 1 IPW BNFOAI HIRED AUTOS .• . NON -OWNED AUTOS BODILY INJURY F IPv .mAmRl PROPERTY DAMAGE i.. GARAGE W101UTr ANY AUTO ' AUTO ONLY. IA ACCIDENT z _ OTHER THAN AUTO ONLY: �- - EACH ACGpENT F E ICESS LIABILITY AGGREGATE 1 EACH OCCURRENCE 1 UMBRELLA FORM --... . AGGREGATE OTHER THAN UMBRELLA FORM - ... 1 WORIER9 COMR'ENSATION AND X W 6TATLL OTH- ;:„;�„..;. EAIFLOYERC LIABIu7T - ..............:>::...•.:.. R-..u�..._�- B THE PROPRIETOR, EL EACH ACCIDENT ROB PARTNERSIXECUTNE X mC: WC 768 29 54 3/5/0-4-'- 3/5/05 EL DISEASE• POLICY LIMIT 'P5-!}0-..BQA-- OFFICERS APE: EXCL - UC .... OTHER CiOISEASE-FA EMPLOYEE 1100.000 SHOULD ANY OF THE ABOVE DESCRIBED POUMS BE CANCELLED BEFORE THE GATEWOOD HOMES EXPIRATION DATE THERFDF, THE ISSUING COMPANY..INILL-EBIOEAVOR TO MAIL 1600 FALMOUTH ROAD #25 10 DAYS WRITTEN. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CENTERVILLE, MA 02632 BUT FAILURE TO MAY. SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Imo UPOeI TAP Pnm.av ,.� ..-_. __ ------ . V J. JJJL:D 6ULI)MAV ASSOC �CO14E! I.'.ERTIFICATE OF LIABILITY INSURANCE csR A8 n PRODUCER GOLDN7LN & ASSO 7ATS5 IN$TJRANCg THIS CERTIFICATE IS ISSUED AS A MA VANS 0 0 B 02 04 F�uCIAL SMM :CBS INC. ONLY AND CON TTER INFORMATION 933 FALMOLTH It ).. HOLDER. THIS CERTIFC RI DOES HTS PON THE AMEND. HYA2� aS M. 02611 ALTER THE COVERAGE AFFORDED BYTHE POLICIE�4 BELOW. PhOne:506--775-6D10 FaxeSpg_7g0-0249 n�UREo INSURERS AFFORDING COVERAGE HNSURERA: CODdIdBRCE IN NAIC# ROONSY TAVANO SURANCB CO IU7-AA DBA NZ17iANICAL SYSTEMS 1NstrRERa: ZURICB-AMM-1-CAN INS CO 110 HOl DSR LANE INSURER Q. IN 9ARtI 'TABLE MA 02668 INSURER D: A THE POUCKS ANY REOUIREMQOFIT,LfBT'EO BELOW HAYS SEQJ EL4UEp TO THE INSURED NAMED Tom OR MAY CAN OF ANY CONTRACT OR OTHER DOCUMENT WRryRESPECT TO A9OVE FOR WHR:H----- L'CY HLPCtRT BiOHCATED. NOTWHTHSTANDING POUCICS AGGRFGAATTEULip ITS SHOW ROFa a THEPOVE oeFS ODEESMSEO �HN.IS u181ECT THE Tcoue�c�...CERTFHGTE N4YBE 195UED OR GEMP-W UABA TY x CCLOAERco LGENEiALLIABRTTY CWAL• MADE ® OCCUR GENLAGGREGA 'E LIMIT ArPUP� pC� FO� JJEC-r LOC AUTON 3ME LY Sarry AN/AUTO AU. ONNEC AUTM SC iE ULFI AUTOS HPEDAUT S NCNOWNE 'AUTOS GARAG E UAINU Y AN r AUTO EXCEWAXOREI LA LpBLLITY OCCUR ❑ CLAWS MADE DEXICTIBL RErENTHDN S "IIEMPLOYERS' J ON wN0 B ANY PROPRErORlPAR TJERlE7HF AnWE OFFICSWAM6 SER EXC .UDM? SPECIAL�!HSIONS I doy. rV jtl f CANCELLATION C*ATSWO0 SNOULDAMOL WDESMUEDMJCIMBe MNC�., DATE THEREOF.N INSURER NR1 BEFORETHEEl[PStATip,yFFAX' EWOI ID HCERS INC ENDEAVORTOMALS - DAYS WRITTEN NOTCETO TE TE HOLDM NAMED TO THE LEFT. SHALL SOH:-778-5603 IIPDSE HO OSUGATION OR BUi FAIU1RETO DO bO00 F'.Id(OUTS ROAD uAeILrtY OFANY q ro uPtvl THEINSUREKRSI[GETTSOITNTEW ILLS DMA 02632 wREPREs�:r�TVEs Ic-1 'OF ►,y TOWN OF YARMOUTH Building Department = Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-431 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 125 Owner's Name: Villages @ 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: $50.00 Payment Type: Check ChkNo.: 811 Net Owed: ($50.00) Application Date: 2/14/2005 Issue Date: Expiration Date Comments: Map/Lot: 44.21.1.C1 new construction: ZONING APPROVED REVIEWED BY: /1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: �4 EALTH 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: 2/24/2005 of 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-05-431 Frank Capra 5087789669 00121 CAMP ST # 125 Owner's Name: Villages @ 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: $50.00 Payment Type: Check ChkNo.: 811 Net Owed: ($50.00) Application Date: 2/14/2005 Issue Date: Expiration Date comments: new construction: FEB 2 8 2005 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: p� - CkX,�,�ATE: 44.21.1.C1 Date Printed: 2/24/2005 PROPERTY ADDRES,S%j0 ft ALCULATION FOR PERWC -T TYPE OF i2 �. �yV�• 862. 290•76 ADDITION a-TMRArIONs �I BED ROOM CERTIFICATE OF COMPUTER ROO1 Mvu KUUM , OFFICE PORCH CLOSED PORCH OPEN REROOFING SHED STORAGE AREA SUN ROOM HEATED SUN ROOM tiNH�q'�D SWIMMING POOL ABOVE -- SWIMMING NO TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : Mar 1, 2005 Letter of Water Availability 1. Single Family Dwelling X 2. Duplex Family Dwelling 3. Condominium Dwelling 4. Commercial / Industrial 5. Other (Specify) Reference; Massachusetts General Laws Chapter 40, Section 54 To : Town of Yarmouth Building Inspector Please be advised that the Town of Yarmouth Public water supply is available to service lot/parcel(s) 44.21.1 Street 121 Camp St., #125 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. Reference Owner (Sign) : Villages at Camp St., LLC : 1600 Falmouth Rd. Suite 25 : Centerville, MA 02632 ' Ya outh ater Department �L of TOWN OF YARMOUTH Building Department = Town Hail Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-431 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 125 Owner's Name: Villages @ 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: $50.00 Payment Type: Check ChkNo.: 811 Net Owed: ($50.00) Application Date: 2/14/2005 Issue Date: Expiration Date k,omments: Map/Lot: 44.21.1.C1 new construction: REVIEWED BY: L 1 TER DEPARTMENT: T- DATE: � 3 ON/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: PLEASE NOTE COMMENTS: DATE: DATE: DATE: DATE: N/A: N/A: N/A: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/24/2005 • 1 /iI. �I!I I� ROP pSED SEWER MpgN—SERSEATERAE C) p W W U1 L� 0 W 2S o Z OC _ � W I(J1 N N t � Opp D 25 .32 rn F NOUS II I N (P�OVERi \ 5 5' 31, ,OPOSED r . o FF - 31.0 HODS T + 1T^ GW 16 i0 0 (EGRE) c o L=6.80' cW �316 R=105.01 I L=10.12' ( '� rn 3w 0-T 1 6- S. �� C 55 :00� -800 21,4 2" F,-� 7 IJ L0 Fv 66.3 o U NOTE• U / SEWER LATERA---SHALL BE oFu�'' ® SLEEVED IN ACCORDANCE GRAPHIC SCALE '� ±raj jS� WITH TITLE V IF WITHIN 10FT. OF WATER MAIN WlC53H TH 20 10 0 20 _• ur• u" 3 �ao� spa o� "tANOjjSJ"f rr' _;r ' r r.+ .r +ir m•,m >r :.'_r IN FEET 1 inch = 20 it REVISED: 6-28-04 PLOT PLAN holmes and mcgrath, inc. OF LOT 125 civil engineers and land surveyors TiMOT'r.Y M. PREPARED FOR Z,SANTOS MILL POND VILLAGE 362 gifford street No.4507b A. falmouth, ma. 02540 y �� Ivr IN �� G STtip YARMOUTH, MA JOB NO: 201197 DRAWN: LMC esSNAkni SCALE: 1 "=20' DATE:12-29-04 DWG. NO.: A2512 CHECKED:- 5;p, ' ,�,J t Lmh)+- Oho-3 GMS9/GCS9 SERIES. 9A AFUE Multi -Position, Single-Stage/Multi-Speed Y oaca. Gas Furnace Heating Capacity: 46,000-115,000 BTUH u WARRAem-TE ED ITE' P II D3 ARAM -. N[AT mthR 4fk 1YARRA NIY av, EN, mrikyngm Standard Features • Corrosion -resistant, aluminized -steel tubular heat exchanger and stainless -steel recuperative coil for maximum efficiency • Designed for multi -position installation—GMS9: upflow, horizontal right or left; GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a.Nortoe Mini -Igniter with patented adaptive learning algorithm to maximize igniter life • Aluminized -steel inshot burners • Energy -saving PSC, multi. speed, direct drive blower motor • Quiet, corrosion -resistant induced draft blower assembly • Integrated furnace control with improved -diagnostics • Low voltage terminal blocks • Multiple flame roll -out switches, blower door safety switch, outlet air -limit switch and pressure switch for proof of combustion air • 40VA transformer for heating and air conditioning control service • Combination redundant gas valve and regulator • Top venting is standard; alternate flue/vent located on right side • Completely assembled, factory run -tested furnace for heating or combination heating/cooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent (1-pipe) applications Air Conditioning & Heating The GMS9/GCS9 single -stage, multi -speed gas furnaces offer installation versatility. Cabinet Construction • Heavy -gauge, reinforced, fully insulated steel cabinet with durable baked -enamel finish • Attractive architectural gray paint finish • Foil -face insulation -lined heat exchanger compartment • Coil and furnace fit flush for easy installation • Convenient left or right connection for gas and electric service • Bottom or side air inlet (GMS9) • Removable, solid -bottom block -off (GMS9) Accessories • L.P. Conversion Kit (LPT-OOA) • L.P. Gas Low Pressure Kit (LPLPOI) • High Altitude Natural Gas/L.P Kits (HANG11, HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter Rack (EFROI) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Internal Filter Retention Kit—upflow, (RF000180) • Internal Filter Retention Kit--downflow (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) SS•377D www.goodm2nmfg.con` 6N4 PRODUCT SPECIFICATIONS Nomenclature G M S 8 070 3 A N A Goodman® Brand Revision A: Initial Release M: Upflow/Horizontal D: Dedicated Downflow C: Downflow/Horizontal H: Hi Air Row IS: Single Stage/Multi-speed V: Two Stage/Variable-speed. 8: 80% 9: 90% .; NOx B: 1n Revision N: Natural Gas C: 2nd Revision X: Low NOx Cabinet Width A: 14" B: 17'k" C: 21 " D: 24'fi" Maximum CFM Ca 0.5" ESP 3: 1,200 4: 1,600 5: 2,000 045:45,000 070: 70,000 090:90,000 115: 115,000 140: 140,000 2 (7- C - H PRODUCT SPECIFICATIONS Performance Ratings P 9 GMS90453BXA 46,000 42,800 37,200- 93.0 3.0 35-65 GM590703BXA 69,0D0 64,400 55,800 93.0 3.0 35.65 GMS90904CXA 92,000 86,000 74,400 93.0 4.0 35-65 GMS91155DXA 115,000 106,5D0 93,000 93.0 5.0 35-65. GCS90453BXA 46,000 42,800 37,200 1 93.0 1 3.0 35-6 GCS90703BXA 69,000 64,400 55,800 93.0 3.0 35-65 GCS909D4CXA 92,000 86,0D0 74,4D0 93.0 4.0 40-70 GCS91155DXA 115,000 106,500 93,OD0 93.0 5.0 40-70 I For altitudes above 2,000', reduce input rating 4% for each 1,000' above sea level. 2 DOE AFUE based upon Isolated Combustion System (ICS). Specifications I INI 'Al MR, MINE 01 -1 ze j R r pounds i51 GMS90453BXA 10" x 7" 1/3 4 2" 2 288 576 9.0 15 132 GMS90703BXA 10" x 8" 1/3 4 2' 3 282 564 9.0 15 135 GMS90904CXA 10" x 10" 1/2 4 2- 4 376 752 8.9 15 158 GM591155DXA 11" x 10" 3/4 4 2" 5 470 940 12.2 15 175 GC590453BXA 10" x 7" 1/3 4 2. 2 288 576 9.0 15 132 GCS90703BXA 10" x 8" 1/3 4 2- 3 282 564 9.0 15 135 GCS90904CXA 10" x 10" 1/2 4 2- 4 376 752 8.9 15 156 GCS91155DXA 11 " x 10", 3/4 4 2" 5 470 940 12.2 15 175 I Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (I or 2 pipes). The optioruil Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC- 2 Minimum Circuit Ampacity = (1.25 x Circulator Blower Amps) + ID Blower amps. 3 Maximum Overcurrmt Protection refers to maximum recommended fuse or circuit breaker size. NOTES: • All furnaces are manufactured for use on 115 VAC, 60 Hz, single phase electrical supply. • Gas Service Connection W.FPT • Important: It is required to size overcurrent protection device and wires properly and make electrical connections in accordance with the National Electrical Code and/or all existing local codes. PRODUCT SPECIFICATIONS GMS9 Dimensions 6— AIR s f aR l 8/4 �19518 ;:k R 3/4 W4 (DISCHARGEAIR) 21/15 VENTIFLUE I AIR R INTAKE PIPE Z' PVC �, �J 2 PVC ALTERNATE ALTERNATE 7 211/18 AIR INTAKE LOCATION GAS SUPPLY O CONDENSATE STANDARD GAS HOLE DRAIN TRAP SUPPLY HOLE w/314'PVC 4V3 ALTERNATE HIGH VOLTAGE DISCHARGE VENT/FLUE ELECTRICAL HOLE 1314 (RIGHT OR LOCATION 40 LEFTSIDE) LEFT SIDE 3 iN HIGH VOLTAGE DRAIN LINE - 249n8 1 ELECTRICAL HOLE RIGHT SIDE 112 I� 23 HOLES 1B 25R DRAIN DRAIN LINE _ DRNN y8 TRAP HOLES r TRAP 211N 01/ 1 3H8 Q ( LOW VOLTAGE T2 LOW VOLTAGE 14 ELECTRICAL HOLE 1B 18 0. 11314 I El ECTRICALHOLE SIDE CUTOUT 7 8/4 11 34 16 3213/1 40-1314 SIDE CUT-0UT L J 1- J I o BOTTDM KNOCK-0UT LEFT SIDE FRONT RIGHT SIDE %am VIEW VIEW 171/2" 16" GM590453BXA GMS90703BXA 12%" 12%" GM5909D4CXA 21" 191h 16%" 14%" GMS91155DXA 241h" 1 23" 1 203/e" 18%" NOTES: 1. Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (1 or 2 pipes). The optional Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC. 2. line voltage wiring can enter through the right or left side of the furnace. Low voltage wiring can enter through the right or left side of furnace. 3. Conversion kits for high altitude natural gas operation are available. Contact your Goodman distributor or dealer for details. 4. Installer must supply following gas line fittings; according to which entrance is used: Left —Two 902 elbows, one close nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials _ U flow 0"1 eat X I.to . . _ aifflA ,� i b�+�,-ram"„., .1••! a . '_ I3orrn �? .,.. ,�n�s..:. :Fc `r r x op� �. � .:. 0" 3" 1 C 0" 1" Horizontal 1 6" 1 0" 3" 1 C 0" 4" C = If placed on combustible floor, the floor MUST be wood ONLY. NOTES: • For servicing or cleaning, a 36" front clearance is recommended. • Unit connections (electrical, flue and drain) may necessitate greater clearances than the minimum clearances listed below. • In all cases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. 4 (7 PRODUCT SPECIFICATIONS GCS9 Dimensions LEFT SIDE FRONT RIGHT SIDE VIEW VIEW VIEW 3// 112 R 2 PIPE r I ,PVC LOW VOLTAGE - I 1 3A ELECTRICALHOLE L J HIGH VOLTAGE ELECTRICAL HOLE DRAIN TRAP 25" LEFTSIDE t: DRAIN LIN HOLES1712 STANDARD GAS J • 41'8 SUPPLY HOLE 91, 1 I 8 3N VENTIFLUE PIPE :TURN NR) 2' PVC 21/18 - CONDENSATE r LOWVOLTAGE DRAIN TRAP t wf a14' PVC ELECTRICAL HOLE DISCHARGE (RIGHT OR HIGH VOLTAGE LEFT SIDE) ELECTRICAL HOLE ALTERNATE L VENTIFLUE J 28 6 61/8 217H6 LOCATION + ALTERNATES 197R AIR INTAKE LOCATION + 25M DRMN 18 .. TMFC - RIGHT SIDE O 14 DRAIN LINE HOLES 13MI 28114 I i1 18 3/4 yg�� 7 I ALTERNATE LT RNA E GAS OIrC UNFOLDED FLANGES AIR FOLDED P.ANGES DISCHARGEAIR GCS90453BXA 171h" 16" 12%" 141h" 16" GCS90703BXA 1714" 16" 12%" 141h" 16" GCS90904CXA 21" 1911" 16%" 18" 191A" GCS91155DXA 24%" 23" 20%" 21'A 23" NOTES: 1. Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (1 or 2 pipes). The optional Combustion Air Pipe is dependent on installationkode requirements and must be 2" or 3" diameter PVC. 2. Line voltage wiring can enter through the tight or left side of the furnace. Low voltage wiring can enter through the right or left side of furnace. 3. Conversion ldts for high altitude natural gas operation are available. Contact your Goodman distributor or dealer for details. 4. Installer must supply following gas line fittings, according to which entrance is used: Left —Two 902 elbows, one dose Cripple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials L P nhoti fles wgie k-.+ •par rronl r `Bo 't` " ue .+, .. .-.:.n-1 Downflow 0" 0" 1" NC 0"1 Horizontal 6" 0" 1" C 0" 4" C = Combustible: If placed on combustible floor the floor MUST be wood ONLY. NC = Non-CDmbustible:.A combustible floor subbase must be used for installation on combustible flooring NOTES: • For servicing or cleaning, a 36" front clearance is recommended. • Unit connections (electrical, flue and drain) may necessitate greater clearances than the minimum clearances listed below. • In all cases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. 5 PRODUCT SPECIFICATIONS Blower Performance Specifications Sy f1PB r%Q a, 11i fiA RISE¢ f?V! 'i11SE' fF) R)%x i-1- 0 $RISEt 1 fiA{Y 15E., j FPS rCF�14 FM y HIGH 3.0 1,352 - ---- 1,318 - -••- 1,260 ------ 1,202 --y G_S90453BXA MED 2.5 1,214 ---•- 1,172 -•--- 1,123 ------ 1,064 --� p859T (LOW) MED-1-0 LOW " 2.0 1.5 997 757 -•-- 44 994 753 ------ 44 960 734 35 45 923 704 36 47 1i0a .19,E[A8D�$;; 93 F.4 9114 438 �393 HIGH 3.0 1,449 36 1,409 37 44 1,326 1,141 39 1,273 1,094 41 47 G_S907036XA MED 2.5 1,192 43 1,172 .45 'b4 (MED-Hp RED-1-0 2.0 981 53 962 54 943 55 917 56B3a 7tl LOW 1.5 750 ----•- 730 ------ 714 ------ 692 ------ . �62k13 1.4m ©Z' HIGH 4.0 1,970 ------ 1,874 35 38 1,667 40 llp �1;�]$2 G_590904CXA MED 3.5 3.0 1,713 1,439 39 46 1,650 1,412 40 47 11,757 1,572 1,370 42 48 1,510 1,327 44�3 50 (MED-LO) MED-LO LOW 2.5 11.183 56 1,11 55 57 1,122 59 1,108, 60 01( _93 Cfiyi HIGH 5.0 2,134 40 2,103 40 . 2,029 42 1,941 44R$33 54 7489� 23 »6Z? G 591155DXA MED 4.0 3.5 1,678 1,453 11,2591 51 58 1,643 1,440 52 59 1,643 1,426 52 59 1,577 1,363 623 . (MED-HI) MED-LO 7y$ y2`7B205, P 82 1 I's LOW 3.0 67 1 239 68 1,220, 70 1,1811 ------ NOTES: 1. CFM in chart is without filter(s). Filters do not ship with this furnace, but must be provided by the installer. If the furnace requires two returns, this chart assumes both filters are installed. 2. All furnaces ship as high speed cooling. Installer must adjust blowerrooling speed as needed. 3. For most jobs, about 400 CFM per ton when cooling is desirable 4. INSTALLATION :S TO BE ADJUSTED TO OBTAIN TEMPERATURE RISE WITHIN THE RANGE SPECIFIED ON THE RATING PLATE. 5. The chart is for information only. For satisfactory operation, external static pressure must not exceed value shown on the rating plate. The shaded area indicates ranges in excess of maximum static pressure allowed when hearing. 6. The dashed ( ---- ) areas indicate a temperature rise not recommended for this model. 7. The above chart is for U.S. furnaces installed at 0' - 2,000'. At higher altitudes, a properly de -rated unit will have approximately the same temperature rise at a particular CFM, while ESP at the CFM will be lower. M PRODUCT SPECIFICATIONS Accessories :,... �e ��.,v . '` ��,esc . o' , ;� ��e• " a� �(Y��3B�i1� w �G�5�9(i�036� G S � h '� ar ✓ LPT-OOA L.P. Conversion Kit ✓ ✓ ✓ LPLP01 L.P. Gas Low Pressure Kit ✓ ✓ ✓ i HANG11 High Altitude Natural Gas Kit 1 1 1 1 HANG12 High Altitude Natural Gas Kit 2 2 2 2 HALP10 High Altitude L.P. Gas Kit 3 3 3 3 HAPS27 High Altitude Pressure Switch Kit 3 3 3 3 EFR01 External Filter Rack ✓ ✓ ✓ ✓ DCVK-20 Horizontal/Vertical Concentric Vent Kit (2") ✓ ✓ DCVK-30 Horizontal/Vertical Concentric Vent Kit (3") ✓ ✓ ✓ Available for this model (1) 7,00l' to 9,000' (2) 9,001' to 11,000' (3) 7,00l' to 11,000' Note: All installations above 7,000' require a pressure switch change. For installation in Canada, furnaces are certified only to 4500'. Downflow Floor Base: When the GCS9 model is installed directly on a wood floo; a downflow floor base must be used. Those model numbers are: CFB17, CFB21 and CFB24. Thermostats . `�Yi sue-:• '�De Lion .,iR,3•` {,-s, ���' �` �**.`� Ei-'A3 `d- �.• CHT1B-60 Cooling/Heating, Mechanical CH70TG Cooling/Heating, Digital, Non -programmable CHSATG Cooling/Heating, Mechanical H20TWR Heating Only, Mechanical C LOT 2 \\�• ,4' 1 R�30 p0 ` E,21.67�> S SEWER MAIN -SEWER �ATERA` ROPO SEp N o 0 v— ,_ -7 0 oo R a 3 ,v. O �36.g1 J_ �,127 0, 'I N---►�- �- -� �- W 1 I 26 � N 1 O'T 1. pRopGSEG 1 Z5 32 00 ri 1 � N rn (1p OPUS 0 Hokjse J N = 3A'0 A I - . 0, FF _ p GW 16 FF - 3�'0 Im N N , R 60 =15 00 c 16 GW 1,�`�0 \� c .�/. V 21` 6.3 L=10.12' C L-O 126 66.31 0 `VU - 1EP\`N OF R, ® SEE EAR LATERAL SHALL BE SLEEVED IN ACCORDANCE s WITH TITLE V IF WITHIN GRAPHIC SCALE •• , , p, o y 10FT. OF WATER MAIN. e f0. a S b 20 10 0 20 9 Try a ( IN FEET 1 inch = 20 fi" REVISED: 6-28-04 PLOT PLAN holmes and mcgrath, inc. ;� / OF LOT 125 civil engineers and land surveyors `a PREPARED FOR 362 ifford street v TI(fcrl, r ;, 9 s.auro5 MILL POND VILLAGE Falmouth, ma. 02540 N 4s.D78 IN CIVIL YARMOUTH, MA JOB NO: 201197 DRAWN: LMC Fps SCALE: 1 "=20' DATE:12-29-04 DWG. NO.: A2512 CHECKED:? o `\ 36 9� \\w �� �\ S70.38 LOT 2 � \ ;�. �., , E,55.36 \\ '3 OO L.21.67' S 41 WER MAIN --�pROPOS�ATERAE U -j POSED SE SEWER RO o N 7j R 4CL 3� a N L-53 r �►�--- \ I W c m . N LET •�_ z �N Np SE D 125 Q P r*1 rn .32 O cp 1 tQLN �P�OVE 0) \ 5 5' 31' I OSED J .O= � ff ,- OPUSE p L °' rn (EGRET) 1 ON ' ,6 N L=6.80' 0 R=105. = � FF \ 16 11'��10' �� '` 0 GW a. 21' 6.3 L=10.12' 0Qf � 26 LA`1 a LO LD 61.23 2 55 00, ` N80'21,427E • {,l, 'A OF '179,�SC r � `o MICHAEI yes ® SEWER LATERAL SHALL BE B. . SLEEVED IN ACCORDANCE GRAPHIC SCALE 20 10 0 20 ( IN FEET ) 1 inch = 20 ft ' PLOT PLAN OF LOT 125 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA SCALE: 1"=20' DATE:12-29- �„ ? N WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. y 7 \on 9f� c c yV `�►► �0 � ._ ,r r��N (r ', to ' ,f:e i I u r REVISED: 6-28-04 .4. holmes and mcgrath, inc. \ civil engineers and land surveyors TI10THYM 362 gifford street ' 450' No. falmouth, mo. 02540 CIV:L A OF ST JOB NO: 201197 DRAWN: LMC FSS/ jAtE�'% DWG. NO.: A2512 CHECKED:- "` LOT 2 Y R�'30 00 , ` 2'► 67'> S / TERAL 4" p SEWER ul MAiN �_PSEWER LP. ROPOSE o w � � J 0 W —� rl R�2S O Q p0 i a R 1 c N SOT � z 1. PROPOSED 125 .32 m rn s HOUSE t N rn (PLOVER) " 5.5� 31 E '090SE0 .HOUSE 1rn 0w - (N EGRET) L=6.80' N o FF . 3t.o \\ R=105.00 o 1. ��0' GIN- 11 e•3 L=10.12' 6 w LOT 12 W 6A.23�- 55 ;p01, I. 0 � SEWER L CIE `N OF a,� A L SHALL BE U�SSas SLEEVED ACCORDANCE � WITH TITLE V IF WITHIN GRAPHIC SCALE .q Iy s 10FT. OF WATER MAIN. i 20 10 0 20 8978 cl- 20 �oqN �U FG, A TERE� Qa�4 qc caljz irj,,nc,i (rtelr Lc i .,ur.-.;tr Z LP, FE INET 1 inch = 20 fk REVISED: 6-28-04 PLOT PLAN holmes and me rath, Inc.%p = ''• OF LOT 125 civil engineers and land surveyors 9 Y ,' G PREPARED FOR 362 gifford street TJ N10 : ,• , o S`N MILL POND VILLAGE falmouth, ma. 02540 "° `civicIL IN 9 9 p YARMOUTH, MA JOB NO: 201197 DRAWN: LMC Li ss10rr LE�� SCALE: 1 "=20' DATE:12-29-04 DWG. NO.: A2512 CHECKED:? LOT 2 �z 55.35' ` R�30'00 `,21.67 1 1, 3'Z OJ1 OpOSED (SE GR1)31.0 m rf � G16 , LOT 26 ;g1 419 _PROP OSHA FERAL P NpVSE D Cp�OVERi FF , 31.0 ON ' 16 R�2 C 4 S 90 �W I-pT A25 R a U p c J O m 1 3i CL O Q \. 0_ � N �N' O v o W f c S m � Y 4M I 10 G J L —.r11 66•I o OF NOTE: ,1l`J �1H MgSf9 ® SEWER LATERAL SHALL BE Miclimy `y� SLEEVED IN ACCORDANCE GRAPHIC SCALE WITH TITLE V IF'WITHIN IN289 10FT. OF WATER MAIN. 20 10 0 20 $��Fs 9fsi�o } rein upI ^r • - ( IN FEET) : n i r 1 inch = 20 ft REVISED: 6-28-04 PLOT PLAN holmes and mcgrath, inc.�';;' OF LOT 125 civil engineers and land surveyors `ice PREPARED FOR (s.' TI'_OTW'-, SAYTOS MILL POND VILLAGE 62 gifford street I ��. No 4,078 ,r IN falmouth, ma. 02540 CIVIL YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1 =20 DATE:12-29-04 DWG. NO.: A2512 CHECKED:-Y,yq a) O O) w 61.23, 31 L=6.80' — R=105.00 L=10.12'- c L MAScheck COMPLIANCE REPORT I I Massachusetts Energy code I Permit # MAscheck software version 2.01 Release 2 I I i Checked by/Date I ' I I CITY: Yarmouth STATE: Massachusetts HOD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Plover PROJECT INFORMATION: Mill Pond village Camp Street Yarmouth, MA. COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 �z COMPLIANCE: PASSES Required UA = 237 - Your Home = 133 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ----------------------------------- CEILINGS 823 30.0 30.0 14 WALLS: wood Frame,"'16" O.C. 1588 15.0 15.0 70 GLAZING: windows or Doors 97 0.340 33 GLAZING: windows or Doors 40 0.340 14 DOORS 20 0.086 2 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations, submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HvAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and 34.4. Builder/Designer Data Massachusetts Energy code MAScheck software version 2.01 Release 2 The Plover DATE: 4-21-2004 Bldg.l Dept.l Use I I CEILINGS: [ ] I 1. R-30 + R-30 Comments/LOcati I WALLS: [ ] I 1. wood Frame, 16" Comments/Locati O.C., R-15 + R-15 WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.34 I For windows without labeled u-values, describe features: # Panes Frame Type Thermal creak? [ ] Yes [ ] No Comments/Location [ ] I 2. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/LOcatio DOORS: [ ] I 1. U-value: 0.086 I Comments/Location AIR LEAKAGE: [ ] I ]oints, 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 i 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: [ ] I 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 and cooling equipment and service water heating equipment must be provided. insulation R-values and glazing u-values must be clearly marked on the building plans or specifications. I TOWN OF YARMOUTH Vol l2-s Plans Submitted Renovation ❑ Yes El No❑ APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ �� PERMIT NO. Date Owner's Name — Type of Occupancy Replacement ❑ z Z ii y y N a v Z Z W W yY O Z Cn a¢ N= N 2 h- 2 U Al S y z Q to O L+- Z cs Z y Z acc \ W N ? c M rn Z¢ a or o a ` FW- wW°c V> O F 2 a N IL O rA Z Z W F O (U 2 O 7 F Z O CC CC 0 Z Y J OQD N G O J S H N LL 0 7 C Q S m 0 MT. A E T 1 FLOOR 3RD F OOR (PRINT OR TYPE) Installing Compal Business Telephone Check One: ❑ Corp. ' ❑ Partnership ❑ Fir mpan Name of Licensed Plumber, o 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 checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type: Master ❑ Journeyman