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Home My WebLink About121 Camp St #128 Building Permitsof TOWN OF YARMOUTH Ruiiding Department BUILDING f + ~ �(506) 398 2231 ext.261 = PERMIT NO B-05-1032_ - PERMIT K ISSUE DATE ; _ 3/10/2005 - ; PROPOSED USE -------------_--- JOB WEATHER CARD APPLICANT -Frank Capra _ PERMIT TO ' New Construction ' AT (LOCATION) 1001211CAMPST#128 ZONING DISTRIC R25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK I44.21.1.C128 BUILDING IS TO BE: LOT SIZE CONST TYPE 5-B USE GROUP R-4 new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans dated REMARKS 03/03/05 and BOA # 3546. AREA (SO FT) EST COST ($ 1$148,896.00 PERMIT FEE ($) 1$543.00 OWNER IVillages @ Camp St., LLC UILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville I MA 02632 CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Certificate Issue Date '&44� a 2 r----CERTIFICATE_of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Insnecter Date Permit Number Approved By Remarks rem �►��► ENGINEERING e MINOR ,, ;MI- To be filled in by each division indicated hereon upon completion of its final inspection. • OF TOWN OF YARMOUTH 'su-8) 39 Department BUILDING . (506) 39$231 ext.261 " PERMIT NO _ B:05-1032_ . - - - PERMIT .g ISSUE DATE ; - 3/10/2005 - ; PROPOSE= _ _ _ _ _ _ _ APPLICANT -Frank Capra - - - - - - - JOB WEATHER CARD PERMIT TO ' New Construction------------ ' AT (LOCATION) 00 221CAMP ST # 128 ZONING DISTRIC R25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 144.21A.C128 BUILDING IS TO BE: CONST TYPE USE GROUPEA4 5 B LOT SIZE O new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans dated REMARKS 03/03/05 and BOA # 3546. AREA (SO FT) EST COST ($ 1$148,896.000 PERMIT FEE ($) u$543.000 OWNER Villages Camp St., LLC BUILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville MA 02632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Note Progress - Corrections and Remarks Inspector /Date E� o a— � 04's — f z < s eD k.. ONE & TWO FAMILY ONLY - BUILDING PERMIT C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ' y Town of Yannouth Building Department XATTACXCEC 1146 Route 28 • Yarmouth MA 02664-4492 lr�el: (508) 398-2231 x261 • Fax: (508).39M836 ��IaraningHbara3nfioranatfort� Assessdrs Departmentdrlfo�rnation � t s ,. u �'" a9 Aype . »,SCR sC a t s,t-ot :� tot �- � �ertlllt.�0 y { i !w.✓ a .} aF+ 4 � v^R .5. 1 3 "; t f Y/,*Y � � i tK rtl (� h/s A.£ s,yJ t r E a 7 a '. ✓iECbrilinj,'-flate`t � � i k ;a_ ,k ..: .o-.. _ s `i Y35 � i ��'pS[, ys L(SeptiSi41�CJrll. e 0.l ��d ay5 4 `rt4 �yF �Ian,Nb 3>•i1 Ty.',.ry"�y F 'L d �(# �t- '� y{ f'.,� l 4t L. SF i itz'.'E ,,..� .fi...S � f, ( � NetDtle x� tither F r ,' x f z Lbi7lrea(st) " rogtageftj `c' LoYCoverage ,<3: ..,..x,.« -; ,unr /�T] )fiyYeEF fY.3' YSi �(•'Y aLrs+:.v 'f^p OYlillii! ..ri�...1 I 11l GI.�rkY #y ., ii ',�..1}4kK s .� »U4tJSVGd..4.-+'i fyQtlJre 37' •l •. �Y+ ry 13tn(dl °•Oforal ',€ 4 : w lM1 Y ; iA(Y`-u .f•kkr$(N M1,4 �1$�Qt� `"j ]' y rQ./��ilreUr 4 5 p LatP.. - ow"11 Site Irr ormafiot s Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: . aCAS I` L..o E Zoning District Proposed Use 1.3 Building Setbacks. (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water SuPPIY (M•G.L c. 40. S 54) �S k'yIoodZ neAnforrnat(on ' s a Corzfinenfs L a '^t �s a .Yi y.'t s P w •*•cx. F r f 1 Public Private Zonef Secton'2 ,�*P.opecty6.wn�rsf�plAuthorized Agent, 2.1 Owne of Record: \1 loot e tt't S�- (Lc, 40" F. > N meme fpMailing Address C 4, � V (�/9 J2 �iveel- Signature Telephone 2.2 utho�rizOe Agent:LL yK 5 0 O C. ✓ Name"t) (`•p�A pp & Mailing Address Signa ut re Telephone Fax Section S ,construction Services`- 3.1 Licensed ConstructionSupervisor. Not Applicable ❑ 0.�- License Number I I, („✓I 3 a' O `(/� o ✓�� ddress 715 j Expiration Date Signature elepho a r� V 3 2`F3egisterecl home'a;rnprgvt rent�piraofor<,' Company Name r,l � J" � uMAR 1 O 20 U{I II ► f o No livable ❑ Li a Number Address 1 _' FED i tion Date Signature elep_ one rL- 9 - 15 - 99 1 of 2 OVER Sectign 4 - W,arkers' Campensaon�lnsiaraifce Aff"idavit'(M.G L'c:�:152 5'25G; (6) ', Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure tokorovide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes Y... No .......... Section 5=`[3escrtptlori of P,ro}ibsed yalp• (. eck all,appiicable)' New Construction No. of Bedroo s No. of Bathroo s Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type T'r� Demolition Other Specify: Brief Description of Pro osed Work: S� p r v✓�dUrl�Q SeCtioh fi `15stim, ked'ConstruGtlon Chi ifl 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 QlirO 2. Electrical 3. Plumbing / Gas %(J 4. Mechanical (HVAC) 7 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) ; -Z. 4 p 7. Total Square Ft. (new houses & additions) Section 7a awnerAuthonzation Owner's Agent 'r Co"traciorApplies Tci`b"e Completed.When #or Buitdin "Kermit ' '-' ,Lf I, 0- hereby autho ize &-OL `" Wood tMes as = of the subject property d e r`k AfO� to act on ors e , ' all m lative to work authorized by this building permit application. Signature r Date Section;7b -'O Agent Declaration fwn�er/Aiitharized I, &� 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. Print na ' natur of O er gent e Date 9-15-99 2of2 rt 1 ►4 — ±' 0,0 7 The Commonwealth of Massachusetts Department of Industrial Accidents Of/Ice o//evestlpstJi�s 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit o f d 4, �,, I am a homeowner performing all work myself. Lam a sole proprietor and have no one working in any capacity 1 am .an employer prop iding workers' compensation for my employees working on this job. company name - address: city: Rhone u insurance co. tfQliev N CgAl am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below "ho ha%e the follot.ing worker;* compensation polices: city: Dhoneft insuran m co Rolie+ At comnanv name• address• Failure to hsecure coverage as required under Section 25A of MGL 152 care lead to the impositloa oterimiW ptaaltlea otra Age op.to 51�00 00 and/or one yea' imprisonment as well as civil penaltles is tAe form of a STOP WORK ORDER gad a fine ofS100.00 a day against mt. I maderstand'that a copy of this statement may be forwarded to the Me of Investigations of tht DIA for coverage veriBeadoa. l do -hereby eerri&- rider the pains k Signature Print name 'perjury that the information provided above is true and meet: Oate X ✓�� official use only do not write in this area to be completed by rite or town ofBeial city or town: YARMOTJT$ _ permitAicense p Building Department cheek if immediate response ❑Lleeasing Board ❑ panne is required 261 ❑Selectmen's Office contact person: health Dep artment phone B: _ C508j 398 -2231 ❑ est. nOther. a r k =}0 1vwiN car YARMOUTH C r��,, ;sF;y BUILDING DEPARTMENT i' CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: I Job Location: Owner of Property: V 1 4— Construction Supervisor. Name Address: 00 �l r Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: i� Da1 ,icense No. Village o Sod:? 9669 Phone No. n✓, �� !� A as 6 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 Anylicensee who shall willfullyviolate subsections 2.15.1, 2.1-5.2 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 ygs, please indicate the type coverage by checking the appropriate box.' A liability insurance policy Er Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapt7 of the Mass. Gen Laws, and that my signature on this permit application waives this requirement. Check one: Signature Signature: Owner ❑ Agent ACJ— Building Official Approval: IF .0- TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664.4451 Telephone (508) 398-2231, Ext 261 — Fax (508) 398.2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at l ` D S . Work Aciaress is to be disposed of at the following location: ► % I �^X ✓ I^� `C d �` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Date Permit No. t# 18434 2ASSURANCECO r Cllen A QNPt CERTIFICATE OF LIABILITY INSURANCE 10/04/Iia°""" PR CER Dowling 8 O'Neil Insurance Agency, Inc. , ' 222 West Main St. PO Box 1990 Hyannis, MA 02601 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPORTHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Assurance Construction, Inc. A/O Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A.- Travelers Insurance Company INSURER B: INSURER c INSURER O: INSURERE.' L.0 V CrLRUMQ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH - POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - INSR DI NSR TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE DATEMMIDD POLICY EXPIRATION A MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 16808387A9841ND04 08101/04 08/01/05 EACH OCCURRENCE S1000000 DAMAGES ( RENTED s300OOO MED EXP (Any we Per M) S$ 000 CLAIMS MADE O OCCUR PERSONAL& AOV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPL' ES PER: PRODUCTS-COMP/OP AGG S2000000 POLICY JPEO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Es accident) S ANY AUTO BODILY INJURY (Per Person) s ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per acciderd) s HIRED AUTOS - NON -OWNED AUTOS rRORTYDAMAGES arPEactidxa) GARAGE LIABILITY AUTO ONLY-EAACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGG S ANYAUTO S EXCESSNNBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR ❑ CLAIMS MADE S $ DEDUCTIBLE s RETENTION S WC STATIC OT1-6 ER WORKERS COMPENSATION AND El EACH ACCICENT S EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTVE OFFICER/MEMBER EXCLUDED? EL . DISEASE - EA EMPLOYEE S F1. DISEASE- POLICY UMIT $ Ky nes, desalt viler SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn.- Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 .-.v V..0 rr trrr ..rr, 1 VI G TJJVVV LD ANY of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IE NO OBLIGATION OR LIABILITY OF ANY KIND UPCN THE INSURER ITS AGENTS OR AUTHORIZED REPREs 4TATIVE . �. n ArnRn CORPORATION 1988 * : M:--44• I RA4A 2ASSURANCECO O D,r CERTIFICATE OF LIABILITY INSURANCE 10,04/0 °"Y11 PRC05UCER Dowling 8r O'Neil Insurance Agency, Inc. 222 West Main St PO Box 1990 Hyannis, MA 02601 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 71HE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Assurance Construction, Inc. A/0 Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A: Travelers Insurance Company INSURER B: INSURERc INSURER D: INSURER E v THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY. PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POUCYNUMBER DATEIMMFDEDCTWE POUCYfM DAATE MMM/DI pT10N LIM ITS A ' GENERALLIAeIUTY X COMMERCIAL GENERAL LIABILITY 16808387A9841ND04 08/01/04 08/01/05 EACH OCCURRENCE s1000000 DAMAGE IFMISE ,E erefKVI S3000O0 MED EXP (Any we person) $5 000 CLAIMS MADE 5XI OCCUR PERSONAL d AIM INJURY $1 000 000 GENERAL AGGREGATE s2.000.000 GENL AGGREGATE LIMIT APPL' ES PER: PRODUCTS -COMPIOP AGG s2000000 POLICY 7 JEa LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea a=dwd) $ BODILY INJURY (Per Person) S ALL OWNED AUTOS SCHEDULED AUTOS _ BODILY INJURY (Per acdders) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Par aedden0 $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S OTHER THAN EAACC S ANY AUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR CLAIMS MADE S _ $ DEDUCTIBLE s RETENTION S WC STATU- OTH- WORIO:RRSCOMPENSATION AND T F 1 EACH ACCIDENT s EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEEI s EL DISEASE -POLICY LIMIT S M yes, deserbe older SPECIAL PROVISIONS belay OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 L) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10._ DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY IGNO UPON THE INSURER. ITS AGENTS OR AUTHOR® REPRES ACORD 25 (2001/08) 1 of 2 #35866 LS1 . C, A%;UKU Lwrcrvrv+Uvn -Iaoa �1t18JY7_u �jLRTIFIW}"L'T�,OF LIABILITY INSURANCEDATE(MM/DOiYY) 0/4104 PtUDucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 191A8Lt3A aJl TT,v,rffxDe ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. $SC 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR M=Stcns Mi11cI PA 02(AS ! ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. j INSURERS AFFORDING COVERAGE INSURED I - Y�.,.y&=jt _- j INSURER A: `It]e PX0jjdSrre r4 Th,81., F+1i-2 T11S.' m_ ..Tl12IIC2C1 `'�-++�uLil m. / =T�. i INSURER S: � j & (�lHl}t� 43 >: Arrey.'s Iarre - S Q-Ylt�Vj 1.�P i INSURER C: MA 026:i2 r .. .. _. _ ...._.. ... . 1 INSURER D: - INSURER E: 7 C fiV PR eRPC _ 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 -'HIS 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. [NSA.._. _ ___ LTH TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION DATE MMIDO/YV AT /MM/DO/VY OMITS GENERAL LIABILITY I vv.nn . M CDNINItRCIAL GENLiRAL LIAE.LITY i I EACROCCURRENCE i $ 1 0� <. tow I • CLAIMS MADE jiiX; OCCUR FIRE CA RAGE (Any ona lue) , S t-- ..... _. _. (. _ /�(�/� .50 �A•o MED tZXP (Any we, Perwnl _. j S $I WO PERSONAL & AOV INJURY j S I ow 000 ! A GENERAL AGGREGATE : S 210wl 000 OL:M'L AGGREGATE LlNll f APPLIES PER: M 0005933 04 10-05-M i 1 D-05-04 FDUCTS - COMP/OP AGG i S.._ _ 2R �I 000 w POLICY 1 _02 ! CP00005933 05 1 0-5-04 i .. _ 1 0-5-05 AUTOMOBILE LIABILITY j ANY AUTO ! i COMENEO SINGLE LIMIT $ (Ea aca,ianq ALL OWNED AUTOS j .._•___ .-. --- ._ -. I 'SCHEDULED AUTOS i • BOOK/ INJURY $ (Perpason) - HIRED AUTOS I NON -OWNED AUTOS I BODIL INJURY S I (Per accident) I ' PROPERTY DAMAGE I (Per accident) GARAGE LIABILITY. ..•j' y ,I _ ANY AUTO q,,- LAUTO ONLY -•EA ACCIDENT IS OTHEF THAN _ EA ACC 1 S ! i AUTO ONLY: .AGG LS.••.. EXCESS LIABILITYI EACH OCCURRENCE • § ' OCCUR j CLAINIS MADE ' _ ... _.. __.. .._ I AGGR=GATE is _ , OEOVCTItlLE- ' REI'ENiION WORKERS COMPENSATION AND I MC STATU- OTW EMPLOYERS' LIABILITY I TORY LIMITSj__ ER i _ -- " I ! 04-01-04 EL EACH ACCIDENT_ i S 04-01-05 -- - 100000' _ T B TuM 001630 EL DISEASE - EA EMPLOYEE S —___. _..__._..... . 100,000 I ' i E.L DISEASE - POLICY LIMIT j S SOOI 0W OTHER I • j I i DESCRIPTION OF OPERATIONSILOCATIONS/VENICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER y ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Gatewood Homes SHOULD ANY OF THE ABOVE DESCRIBED POLIZIES BE CANCELLED BEFORE THE EXPIRATION 1600 Falmouth Rd. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL Centerville MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF A►Y KIND UPON THE INSURER, ITS AGENTS OR 5 0 8-%% 8- 5 6 0 3 REPRESENTATIVES.' AUTMOOZED REPRESENTATIVE ACORD 25-S (7197) 0 ACORD CORPORATION 1988 A'CORD ,CERTIFICATE OF LIABILITY INSURANCE °ATE,MMroD 11/01/2004 PRODUCER (509'?540-2400 FAX (508)289-4111 THIS CERTIFICATE IS ISSUED AS A PATTER OF INFORMATION Mttrrfty & Mac0onal d Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 406 ]ones Road 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.,. INSURERA: Arbella Protection Insurance P0. Box, 1551 :: j INSURER B: Liberty Mutual Ins: Corp - -' Mashpee;'-MA' 02649 INSURERC: INSURER D: : • ._. ... . _ 6DdjINSURER E. _. ._ ... THE POLICIES OF INSURANCE LISTEDBELOWHAVE 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, EXCLUS ONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MFFEC DATE EXPIRATION LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY' CLAIMS MADE F1 OCCUR 8500028756 08/14/2004 08/14/2005 EACH OCCURRENCE S 1, 000 00 PREMISES Ea oecurence $ 100,000 MED EXP (Any one person) S 5,000 PERSONAL 3ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER POLICY JET -IOC PRODUCTS - COMP/OP AGG $ 2,000,0(K : AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ` COMBINED SINGLE LIMIT (Ea accident) S BODILY INJU?Y (Per Perm) S BODILY IN.IU?Y (Per accident) S PROPERTY.CAMAGE accident). ..(Pec GARAGELIABILfTY __. .. __.___. __. ANYAUTO __...._...___..... . ...... _ .... .. _- .. _. _.. -AUTO ONLY -EA ACCIDENT - EAACC OTHERTHAA AUTOONLY:___.._.. _AGG S - EXCESSIUMBRELLA LIABILITY OCCUR. a CLAIMS MADE DEDUCTIBLE RETENTION S EACH'OCCURRENCE _.. S. __ ..... AGGREGATE S S $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTNE OFFICERIMEMBER EXCLUDED? d yes. descibe under SPECIALPROVISIONS telm WCS31S317310033 10/05/2004 10/05/2005 - 1 TORV LINITS I ER E.L.EACH ACCIDENT $ 100,000 EL DISEASE- EA EMPLOYEE S 100 , OOO E.L. DISEASE • POLICY LIMIT S SDO , O OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POUCI=S BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSUFER WILL ENDEAVOR TO MAIL Gatewood Homes, Inc. _III DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Paula BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPCSE NO OBLIGATION OR LIABILITY 1600 Falmouth Road, Suite 25 OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE A(:UKU ZS (Z001108) ©ACORD CORPORATION 1988 ' Client#: 18434 2ASSURANCECO OPDa CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 10/04/04 PRCIDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling 8: O'Neil Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED Assurance Construction, Inc. A/O Assurance ExcavaUOn, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURERA Travelers Insurance Company - INSURERS: 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 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 LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POUCYNUMBER VE POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY 16808387A9841ND04 08/01/04 08/01/05 EACH OCCURRENCE E1000000 X COMMERCIAL GENERAL L34BILrrY DAMAGE TO RENTED $300000 CLAIMS MADE a OCCUR MED EXP (Airy ona penes) $$ 000 PERSONAL8ADVINJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEM AGGREGATE LIMIT APPLIES PER: PRODUCTS-DOAIP/Op AGG E2000000 - POLICY PRO- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea aWdant) S . BODILY INJURY (Per person) E ALL OWNED AUTOS SCHEDULED AUTOS • BODILY INJURY (Per accident) S HIRED AUTOS NON.OWNEO AUTOS PROPERTY DAMAGE (Per accident) s • GARAGE LIABILITY AUTO ONLY. EA ACCIDENT S OTHER THAN EAACC S ANY AUTO S AUTO ONLY: AGO EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE E OCCUR CLAIMS MADE - AGGREGATE S S S DEDUCTIBLE S RETENTION It WORKERS COMPENSATION AND WC STATU- I OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/D(ECUTNE EL EACH ACCIDENT $ DISEASE. EA EMPLOYEE S OFFICERIMEMBER EXCLUDED? nyea ALPRdescrbunder SPECIAL PROVISIONS below PROVISIONS E.L. DISEASE -POLICY LIMIT E OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named Insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 LO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL .1 n DAYS WRITTEN :E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL iE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHOR® ACORD 25 (2001108) 1 Of 2 . #35866 LS1 :iD ACORD CORPORATION 1988 .ACQRD. CERTIFICATE OF LIABILITY INSURANCE DATE (hiM/DDIYY) Q/4/04 PR(JpuLtR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION $3ez L ,A- Gravel TTY4T nce ONLY AND CONFERS- NO RIGHTS UPON THE CERTIFICATE P-O- gy,c 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, -EXTEND OR Mm5tlYls Mi11s, NPR 02b48 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i - INSURERS AFFORDING COVERAGE INSURED . PIIP�CrjCl Z:taxE tim (b. r M,-. i INSURER A: Pi>7_ zidmm Miami nm.ins cb INSURER 8. � Pi>��y & (��ty 43 �i111IY��S IaOt r .. -_ ' Q.'llrP'([ri 11a YA 026M i INSURER C:. ... _. _ ...._.. ... .._ . INSURER D: -' I INSURER E: LUVCHAUt5 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 MAY PERTAIN. OR 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. LTH TYPE OF INSURANCE I POLICY NUMBER I POLICY EFFECTIVE PDAT y1M0I R/YYON LIMITS ` N GEERAL LIABILITY 1 . COMMERCIAL 3ENIiRAI LIAE.UTY) I EACH OCCURRENCE I S - ' 1 r 000, OQQ i ir._....._. :CLAIMS MA -LIE OCCUR FIRE DAMAGE (Any one ore) ' S _.. . MED EXP I:Any ona Deisonl .. S tG +/ Oco - — - I I LPERSCNAL a ADV INJURY j S • 1 AQWF QQ A r•T�-� y� •�� ! i -- EFAL AGGREGATE 5 ___. 21 Ur WO OEN'L AGGHEGATE LIMI r APPLIES PER: I GO 0005933 04 0005933' 1 O-0.�03 1 O-QS-O4 I PRO• 7 _ ... .. .. :- . i PRODUCTS-_COMP:_OP AGG 5 2j WO WO POLICY, _oc I CP00005933 05 10-5-04 i 10-5-05 ; AUTOMOBILE LIABILITY i ANY AUTO I j I I COMBINED SINGLE LIMIT 5 (Ea amdant) ALL OWNED AU'IUS ' SCHEDULED AU COS I�VI)URY 15 ersw `; HIRED AUTOS i - I I _._._... ....__.___... .. ' 1 NON -OWNED AUTOS I I BODILY INJURY I (Per acciaanq 5 I 1 ' . PROPERTY DAMAGE I (Per accidant) ; S GARAGE LIABILITY ' ... .;- - i 1 ., ,, t AUTO ONLY - EA ACCIDENT i 5 .... ANY AUTO EA ACC) 5 _ "AGG [AUTO I I 1.5.... ONLY: . EXCESS LIABILITY (EACH OCCURRENCE OCCUR j CLAIMS MADE I AGGREGATE i UEDUCTI8LE �5 �RErENTION $ WORKERS COMPENSATION AND WQ STA7U• OTH•; EMPLOYERS'LIABILITY I TGRYLIMITER."- 11 04-01-05- EL EAVH ACCIDENT_ 5EL------ - - ow - B EL DISEASE_ EA EMPLOYEE 5 100,000 ' I E.L. DISEASE - POLICY LIMIT 15 5OOr O00 OTHER I 1 I I I i _ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Gatewood Homes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1 600 Falmouth Rd. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Centerville MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF AIfY KIND UPON THE INSURER, ITS AGENTS OR 5 0 8- 7 7 8- 5 6 0 3 REPRESENTATIVES. AUTHO D REPRESENTATIVE ACORD 25-S (7/97) 0 ACORD CORPORATION 1988 A'CORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDA*Y" 11/01/2004 PRODUCER- (508) 540-2400 FAX (508) 289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1406 Jones Road 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:::.. INSURERS: Liberty MutuaY Ins: Corp Mashpee; :'MA` 02649 INSURERC: _ INSURER 0: INSURER E: . THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY. PERICD 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWD P OLICY DATE EXPIRATION LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR 8500028756 08/14/2004 08/14/2005 EACH OCCURRENCE $ 11000,000 PDAMAGE TO REMISES Ea oNTED S 100,000 MED EXP (Am one person) $ 5 OO PERSONAL &ADV INJURY S 11OOO , OOO GENERAL AG3REGATE $ 2,000,00C • - GEN'L AGGREGATE LIMIT APPLIES PER POLICY JECOT 10C PRODUCTS-=OMP/OPAGG S 2,000,00( AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Ea accident) $ ALL OWNED AUTOS SCHWULED AUTOS - BODILY INJURY (Per person) S HIREDAUTOS NON -OWNED AUTOS - BODILY INJURY (Per accident) S . PROPERTY. DAMAGE . - -- -AUTO ONLY- EA ACCIDENT S- -ANY hAGELIABILITY AUTO . ... ..._.. EAACC S .AUTO ONLY:. __.._.. _AGG -S-'"' IXCESSlUMBRELLA LIABILITY OCCUR. a CLAIMS MADE EACH -OCCURRENCE AGGREGATE. . S DEDUCTIBLE S RETENTION 5 S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC531S317310033 10/05/2004 10/05/2005 TNUYLArU ER EL EACH ACCIDENT S 3.00, 000 B ANY PROPRIETORIPARTNERIFJCECUTNE OFFICER/MEMBER EXCLUDED? II yes. describe waver SPECIAL PROVISIONS beIM orHER E.L.DISEASE- EA EMPLOYEE S 100,000 EL DISEASE. POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Gatewood Homes, Inc. Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 L4 (GVV I,Vol SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 .DAYS wRTREN 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 INSURER, ITS AGENTS OR REPRESENTATIVES. las MacDonald ©ACORD CORPORATION 1988 ' Cliontilk IAA_ d 2ASSURANCEC0 %A ORDn. CERTIFICATE OF LIABILITY INSURANCE 1004/0 °"m' PRO6UCrR Dowling & O'Neil Insurance Agency, Inc.HOLDER. Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE THIS CERTIFICATE DOES NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERR Travelers Insurance Company Assurance Construction, Inc. A/0 Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER B: INSURERc INSURER D: INSURERS 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 A1141) CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE POUCYNUMBER POLICY EFFECTIVE -DATE POLICY EXPIRATION DLTR ITS A GENERAL LIABILITY 16808387A9841ND04 08101/04 08/01/05 EACH OCCURRENCE 51000000 DAMAGE TO RENTED 5300 000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any or person) S$ 000 CLAIMS MADE O OCCUR PERSONAL 6 ADV INJURY $1 00O 000 GENERAL AGGREGATE 22 000 000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 32000000 POLICY PRO. LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Es eccidwt) S BODILY INJURY (PIA P-) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S HIRED AUTOS NON-0WNED AUTOS PROPERTY DAMAGE (Per accident) S a GARAGE LIABILITY AUTO ONLY- EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO S AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE S S DEDUCTIBLE S RETENTION $ WC STALM OrR WORIERRS COMPENSATION AND E.L. EACH ACCICENi S EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE E.L DISEASE. EA EMPLOYEE S OFFICERIMEMSER EXCLUDED7 If" s, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY FNDORSEMENT/ SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. rrerorwrr unf nre rAMf`rl 1 ATIAM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Gatewood Homes, Inc. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1_ DAYS NRnTEN Attn:• Paula NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1600 Falmouth Road, Suite 25 IMPOSE NO OBLIGATION OR LIABILITY OF ANY WHO UPON THE INSURER ITS AGENTS OR Centerville, MA 02632 REPRESENTATIVES. AUTHORIZED REPRESSPTIVE ACORD 25 (2001/08) 1 of 2 #35866 LS1 0 ACORD CORPORATION 1938 ACa'RE' CER IFICATE OE LIABI ITT INSU ANCE OATE(MM)0D)YY) P�;UIZ.-9 , - 0/4/04 E SLd A C 11 TnvTrani� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. B>c 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR NBLSSCnCg Mills? ! O2643 ALTER THE COVERAGE AFFORDCD BY THE POLICIES -BELOW. INSURERS AFFORDING COVERAGE INSURED .Pn>�1Ebuid icaCb: TIIC. I.INSU_RERA:! PJ l.Fim_ns.:m, 43 T {"„a. I$ I�C2 r _ INSURER B. Sz;,E�. t� ie& �4laitj Q�1liwrrillo INSURER C: +y2prty �"-�`.lr •-•. 02632 - — . I INSURER D: INSI wcaa LUVtHAGES - l-HE 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, EY,CLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSk LT, TYPE OF INSURANCE POLICY NUMBER I POUCY EFFECTIVE POLICY EXPIRATON - DATE MMIDDlYY AT IMM/D Y LIMITS GENERAL LIABILITY 1 OUI EACH OCCURRENCE . COMMERCIAL GENERAL I.IAEJJTY WW f _FIRE DAMAGE (Any wa I, ry� CLAIMS MADE i-M. OCCUR i _. _- - .. r-S. -50C wo MED EXP (Any ale pe,aon) + S 1T OQO A L;EWL AGGREGATE LIMI f APPLIES PER: � GO 0005933 04 FRO. POLICY, I IF�T - i _Oc I CP000059:;'4 B AUTOMOBILE UASILITY i ANY AUTO ALL OWNED AUTOS SCHEDULED AU COS i 1 HIRED AUTOS I NON -OWNED AUTOS GARAGE LIABILITY, • 1 ' ANY AUTO I i . EXCESS LIABILITY ) 1 OCCUR I CLAIMS MADE UEDUC'TIULE REIENTION 5 ' WORKERS COMPENSATION AND EMPLOYERS* LIABILITY OTHER I��7{Yl t.l j ! I i 1 O-QS-03 I 14"05'04 10-5-04 I10-5-05 1 PERSONAL & ADV INJURY GENERAL AGGREGATE PRO_OJCTS-_COMP,'OP AGG , S j 5 S 1 Awlow 21OOO1000 , I ! ) COMBINED SINGLE LIMIT I i (Ea accident' j I•. 6001LY INJURY ' IPer person) ' 5 BODar IwURr I (Per asidanl) ) PROPERTY DAMAGE (Per aocidan() i S . _. •r rl �, ..,�,,, i-AUTO ONLY -EA ACCIDENT. OTHEF. THAN _EA ACC ! S (.AUTO I...... . ONLY: AGG 1 S I EACH OCCURRENCE • S____ ._... ._ j AGGREGATE .S _ I 5._- .. __. _... S 1 WC STATU- OTH-; _I TORY LIMITS_EFLI 04-01-04 04-01-05 EL EACH ACCIDENT_ j $ 100)_000. - E.L. DISEASE_ EA EMPLOYEE S 100,000 I EL DISEASE - POLICY OMIT j S SOD, OOO DESCRIPTION OF OPERATIONS/LOCAT10T15/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I C MULL) 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 OACORD-•O• ATE A`CORD . CERTIFICATE OF LIABILITY INSURANCE °11/01°2004*'' n �11/Ol/2004 PRODUCER (508) 540-2400 FAX (508)289-4111 Murray & Macflonal d Insurance Services 1406 Jones Road Falmouth, MA 02540 Douglas MacDonald THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Tracy Howerton. PO. BOX..1551:_.:; Mashpee; -MA 02649 INSURERA: Arbella Protection Insurance INSURERS: Liberty Mutual' Ins:torp - INSURERC: INSURER D: INSURER E GOVEHAGE5 + - -- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD. INDICATED.1 NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMfD roucy EXPIRATION DATE MWD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 8500028756 08/14/2004 08/14/200S EACH OCCURRENCE S 1,000,000 PREMISES Ea omaence S 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY QJET 'LOC PRODUCTS-=OMPIOP AGG S 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS - - NON -OWNED AUTOS • - .. - COMBINED SINGLE LIMIT (Ea accident). $ BODILY INJURY (Per pen'0n) S BODILY INJU?Y (Per accident) S PROPERTY.CAMAGE S. , .-.(Pecaccident).' _ . _. GARAGE LIABILITY -..... ANY AUTO ....AUTOONLY:.__ -_...___..__.. _ ._._ .. _ .. ._ .. .. ._. -AUTO ONLY •EA ACCIDENT S•. .. __... OTHER THAN - EAACC ._.. ..AGG S - -S -..... _ .... _. EXCESSIUMBRELLA LIABILITY OCCUR a CLAIMS MADE DEDUCTIBLE RETENTION S FACH'OCCURRENCE --' $ -- - -- AGGREGATE, ' $ S S - S B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes. describe under . SPECIAL PROVISIONS belm - WC531S317310033 10/05/2004 10/05/2005 TORY LINKS luill- ER E.L. EACH ACCIDENT $ 100,000 EL DISEASE- EA EMPLOYE S 100,000 E.L. DISEASE -POLICY LIMIT S S00,.000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Gatewood Homes, Inc. Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 AI.UKU ZO (ZUUT/ULI) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 .DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS O,R REPRESENTATIVES. as MacDonald @ACORD CORPORATION 1988 CERTIFICATE OF LIABILITY INSURANCE PI:ODuOER Q THIS CERTIFICATE IS ISSUED AS A MATTER OF $�nBLd.A.GC3911 TnaTrarra ONLY AND CONFERS NO RIGHTS UPON THE P.O. ESY 337 HOLDER. THIS CERTIFICATE DOES NOT AMEN( Mmst m Mills, M 02648 ALTER THE COVERAGE AFFORDED BY THE POI In9u RED AnPJ�y?,ra,,n,,�rn 43 �•....� 's Iane _ Gazer rille, M 02632 t5 j INSURERS AFFORDING COVERAGE I wsuaeRA. gp i�iw5L1 i]c>? Mjb-Bl Fire Ins.• OJ. INSURER .y 8: ..Sxyem Prcpert & �lty INSURER C: - • -• I INSURER D: - I INSURER E: DATE (MHV00lYY) '4/04 INFORMATION CERTIFICATE ,_EXTEND OR THE -POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR MAY PERTAIN, INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EKCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTH TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLEXTI PIRAON ' I - DATE MM/DD/YY DAICYT !MM/D NY LIMITS GEI•Ic'RAL LIABILITY COMMERCIAL oENkiRAALwL LIAE,UTY I EACH OCCURRENCE ((W�/�� yy� • MADE jXX: OCCUR I :FIFE JMAGE (11yonelraJ S .A_f-_ G�Kp040CLAIMS .•n' MED EXP (Any one Perwnl .. i S 51 /Yll1 I PERSONAL&ADV INJURY is I AQ001.01I1`! S^�^! A I GENERAL AGGREGATE ; g 2` �' Gt.N'L AGGHEGATE LIMI F APPLIES PER: � GO 0005933 04 1 O-05-M I 10-05-04 POLICY, I 1 1 i _OC i CP00005933 05 pR0_CUCTS • COMP.•OP AGG ; 5 10-5-04 110-5-05 - ) 2,000,000 AUTOMOBILE uneluTv ANY AUTO j i COME. NED SINGLE LIME T § (Ea acci Tang ALL OWNED AUTOS-- SCHEDULED AUTOS I i I I ! BODILY INJURY I (per mow) § HIRED AUTO)- . NON -OWNED AUTOS ' 1 BODILY INJURY (Peracioanq § I . ' ! 1 PRORZRTY DAMAGE I I (Per acaanc) § _ GARAGE LIABILITY ' ANY AUTO � _ Ir AUTO ONLY --EA ACCIDENT § ...-_-._ _.._ .___ _. r._...._.. .. OTHEF THAN _.4CC 1 § I I AUTO ONLY: AGG I §..... . EXCESS LIABILITY I :OCCUR I CLAIMS MADE i I I I EACH OCCURRENCE • § ..... _. .__. AGGREGATE - § ._ I ULOVOTIBLE I"SE FENTION ;WORKERS EMPLOYERS' LIABILITY ION AND I MC STATUS ' O ' ' TORY LIMI7Sj_i ER E.L. EACH ACCIDENT ! § 100�000- 04-01-04 04-01-05 - EL DISEASE. 000 B rM WI ...__EA EMPLOYEE II100 -_._..... .,_._. ..- ... _ W__.. V OTHER I E.L DISEASE - POLICY LIMIT I $ I I 500, 000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/gPECLOL PROVISIONS CERTIFICATE HOLDER 11 ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Gatewood Homes SHOULD ANY OFTHE ABOVE DESCRIBED POL CIES BE CANCELLED BEFORE THE EXPIRATION' 1 600 Falmouth Rd. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Centerville MA 02632 IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5 0 8- 7 7 8- 5 6 0 3 REPRESENTATIVES. - AUTOO D REPRESENTATIV ACORD 25-S (7/97) 0 ACORD CORPORATION 1988 A'CORD". CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYM 11/01/2004 PRo UCER (508)540-2400 FAX (508)289-4111 Murray& MacDonald Insurance Services 406 Jones Road Falmouth, MA 02540 Douglas MacDonald THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Tracy Howerton.,, P0. Box..155t.. Mashpee;'-NIA" 02649 _. .. "'::': ••., ...:• /II LCYXIX.C.WYn INSURERA Arbella Protection Insurance INSURERB. Liberty Mutual Ins:Corp - - INSURER C: INSURER D: .:. ... ... , INSURER E:....___.. ` COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD INDICATED: NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADWN NS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE (MWDDfM LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR 8500028756 08/14/2004 08/14/200S EACH OCCURRENCE S 1,000,000 PREMISES Ea occurence S 100,000 MED EXP (Any one pawn) S 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , 000 , 0O GEN'L AGGREGATE LIMIT APPLIES PER POLICY 7 JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY ANY AUTO 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) $ PROPERTY AMAGE accident). - _. .. __.. .. ... . -.(Pec GARAGli UABILfr( `.. _. ____. .. ANYAUTO ,...ALTO .__..__.... ___.. .... .... ._ .. • -...: .. ._ .. .. _. -AUTO ONLY -EA ACCIDENT S•- ._..-. OTHER THAN - EAACC ONLY_ ._.. _AGG S - -S _.. _.. _ .... _. ExOESSNMBRELLA LIABILITY OCCUR. 7 CLAIMS MADE DEDUCTIBLE . RETENTION S EACH'OCCUP.RENCE S -- - - -- AGGREGATE- S S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? If yes, describe under ROVISIONS below SPECIAL -PROVISIONS WC531S317310033 10/05/2004 10/05/2005 I TORY LINITs I I ER E.L. EACH ACCIDENT S 100,000 E.L. DISEASE -EA EMPLOYEE S 100,.000 F-DISEASE -POLICY LIMBS 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I 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. TO .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Paula BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Falmouth Road, Suite 25 OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 Dou las MacDonald ACORD 25 (2001/08) :5ACORD CORPORATION 1988 • Client#: 18434 2ASSURANCECO • ©R.M CERTIFICATE OF LIABILITY INSURANCE ? ;o04/04 PRCOUCFR Dowling & O'Neil Insurance Agency, y 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. 222 West Main St PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA Travelers Insurance Company Assurance Construction, Inc. A/O Assurance Excavation, Inc. _ 550 Willow Street West Yarmouth, MA 02673 INSURER B: INSURER C ' _ INSURER 0: ' INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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. IN5RLTR NSR TYPE OF INSURANCE POLICY NUMBER PATE ( MID rM EXPIRATION POLICY DATE D LIMITS A GENERAL LIABILITY 16808387A9841ND04 08/01/04 08/01/05 EACH OCCURRENCE $11000.000 DAMAGE TO RENTED PREMISE Ire � $300000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR MED EXP (Any one person) $$ 000 PERSONAL d ADV INJURY $1 000 000 ' GENERAL AGGREGATE - s2,000,000 GENL AGGREGATE LIMIT APPLES PER PRODUCTS -COMPIOP AGG s2000000 POLICY JEa LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Es accident) s BODILY INJURY (Per moon) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) s HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ . GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC s ANY AUTO It AUTO ONLY: AGG EXCESSIUMBRELJA LIABILITY EACH OCCURRENCE s OCCUR CLAIMS MADE AGGREGATE S S S DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION AND WC STAB OTII- EL EACH ACCIDENT S EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/DECUTVE E.L DISEASE - EA EMPLOYEE s OFFICERIMEMBER EXCLUDED? H yes, dese be under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT s OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 1 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1EREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL I n DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO So SHALL NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGENTS OR ACORD 25 (2001108) 1 of 2 #35866 LS1 E ACORD CORPORATION 1988 .rL Ill_ u CERTIFICATE OF LIAE310 ITY INSURANCE /4/04 DAIE(MhVDD/YY) 0 Paouucea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i dArG l MIsLm izram ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. B:x 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR N13I5t�[s Mills, hYi 02648 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOIAI. ' INSURERS AFFORDING COVERAGE INSURED I American Ebl�C1 Ib. Inc. ! INSURER am-idaciz . MAIni FSxe.1m. m. 43 INSURER B: � P-�7 & �4Hlty y�"'+�Y INSURER C: QMtErnrille, MS 02632 i INSURER D: uas ]APR P. _ _. ` . HALit�> TH" 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 MAY PERTAIN, OR 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 - ..... _ _ _ LTH TYPE OF INSURANCE POLICY NUMBER ' POLICY EFFECTIVE POLICY EM/XPIRATION ' DATE 'MM/ D/YY I DAT IMDO/YY __ LIMITS - GENERAL LIABILITY . CUNINIk RCIAL C+ENLiRAL LIAEILTY I I i I EACH OCCURRENCE OOO, OOO ii CLAIMS bIAUE j : OOCUR j I FIRE DAMAGE (Any one nre) r S_ _.. _._._. .+L+p I I MED EXP (Any one perwn) S G ow - — - I PERSONAL Y ADV INJURY 5 ! I G_EN_ERAL AGGREGATE Is 21 OW, 000 . OHN'L AGGREGATE LIMI T APPLIES PER:I GO 0005933 04 10-0'rQ3 � 10-t�r04 i PRODUCTS _COMP;OP AGG' S. 2, OW� 000 POLICY, f _Oc I CP00005933 05 10-5-04 i 10-5-05 AUTOMOBILE LIABILITY I ! ANY AUTO I I j i COMBINED SINGLE LIMIT I{ (E2 2CCiadruJ § ALL OWNED AUTOS I 1 .. • __.. . _. ._ — ._ -. ! " SCHEDULED AUTOS i j �. ! BODILY INJURY j (Pei perwn) § HIRED AUTOS . NON -OWNED AUTOS ! i I I BODILY INJURY (Per 6=ioenq S i ... I PROPERTY DAMAGE (P dG-iC2nQ I § GARAGE.LIABILITY, , . .•• ;`�.' I .. - n�_ ,'. LAUTO ONLY - EA ACCIDENT L§..._.. ANY AUTO .1 EA 13 .. . OTHER THAN _. .ACC I.AUTO - - I I AGG I.S.... ONLY: . EXCESS LIABILITY i I ' OCCUr CLAIMS MADE EACH OCCURRENCE • 5 AGGREGATE IS DEDUcribLE S RETENTION WORKERS COMPENSATION AND Wl. STA TU- EMPLOYERS' LIABILITY I - TORY UMIT,jEIi,T. I 04-01-04 04-01-05- ELEA..HACCIDENT 1§ - _100 000 _ / B EL DISEASE - EA EMPLOYE§_ 1, 000 00 yam" 630 1`E.L DISEASE - POLICY UbllT j § SOOr ow OTHER I I II 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 1 ADDITIONAL INSURED: INSURER LETTER: CANCFI I ATIr)M 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 UABILTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 25-S 0 ACORD CORPORATION 1988 A'CORD CERTIFICATE OF LIABILITY INSURANCE M DATE(MM/D-DryypO 11/01/2004 ONPRUC (508) 540-2400 FAX (508)289-4111 Mu,r�x, & MacDonald Insurance Services 406 Jones Road Falmouth, MA 02540 Douglas MacDonald THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Tracy Howerton:,. PD. Box.1557;,_.,; - Mashpee;_-MA. 02649 ' - _ INSURER A: Arbella Protection Insurance INSURERS: Liberty Mutual Ins:Corp - INSURERC: INSURER D: INSURER E ...____.. .. .. .... ...� 'COVERAGES` -. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD.INDICATED_ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. 1 LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY DATE MFF DATE EXPIRATION LIMITS A GENERAL LIABILITY -COMMERCIAL GENERAL UABLITY CLAIMS MADE ❑ OCCUR 8500028756 08/14/2004 08/14/2005 - EACH OCCURRENCE $ 1,000,000 DAMAGE i u REN j Fu$ PREMISES Ea oecurence 100,000 MED EXP (Any one person) S 5,000 PERSONAL 8 ADV INJURY 5 1,000,000 GENERAL AG3REGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY JEo- _LOC PRODUCTS-•COMP/OPAGG S 2,000,00 AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS _ NON -OWNED AUTOS • COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Perperson) S BODILY INJURY (Per accident) S PROPERTY.GMAGE .(Pecacadent)_' : S. , __.. .. ... .. GARAGE LIABILITY ANYAUTO . .. .._. .. - .' .... .. _ _.._. -AUTO ONLY -EA ACCIDENT OTHERTHAN - EAACC AUTO ONLY AGG S - $_ _.. _ .... _. EXCESSNMBRELLA LIABILITY OCCUR - OCLAIMS MADE DEDUCTIBLE RETENTION S - EACH -OCCURRENCE -- S AGGREGATE S_ S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? I ym desaibe under SPECIALPROVISIONSbelow WC531S317310033 10/05/2004 10/05/2005 TORYLIUITs ER E.L. EACH ACCIDENT S 100,000 E.L. DISEASE -EA EMPLOYE1 S 100,00 E.LDISEASE -POLICY LIMB S SOO,QQ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS a Qc Ilrwn I""w"wQrc Catewood Homes, Inc. Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ' EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. as MacDonald ACORD 25 (2001108) @ACORD CORPORATION 1938 t t Clienldk 1R&IA -1Ac¢n0AAlrern 4 ORDn CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 10/04/04 PRCPUCER Dowling 8: O'Neil Insurance Agency, Inc. . ' 222 West Main St. PO Box 1940 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. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED Assurance Construction, Inc. A10 Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A. Travelers Insurance Company INSURER B: INSURER a INSURER D: INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DA - MIDD POLICY EXPIRATION DATE MM/DD LIMITS A GENERAL LIABILITY 16808387A9841ND04 08/01/04 08/01/05 EACH OCCURRENCE s1 000 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑J( OCCUR DAMAGE TO RENTED 5300 OOO MED EXP (Arty one person) 15,000 PERSONAL 3 ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLES PER: PRODUCTS -COMPIOP AGO s2000000 POLICY PRO. LOC AUTOMOBILE LIABILITY ANY AUTO (Ea awiddmt) :E LIMIT $ BODILY INJURY (Per Person) S . ALL OWNED AUTOS SCHEDULED AUTOS - BODILY INJURY (Per=dent) $ HIRED AUTOS NON -OWNED AUTOS - PROPERTY DAMAGE (Per accident) $ - GARAGE LIABILITY ALTO ONLY- EAACCIDENT S OTHER THAN EA ACC $ ANY AUTO S AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY OCCUR. CLAIMS MADE EACH OCCURRENCE S AGGREGATE $ S S DEDUCTIBLE S RETENTION $ WORKERS COMPENSATION AND WC STATIC OTH• TORY EMPLOYERS'LIABILITY E1 EACH ACCIDENT S ANY PROPRIETORIPARTNER/DMCUTYE EL DISEASE. EA EMPLOYEE S OFFICER/MEMBER EXCLUDED? I yes, describe under E.L. DISEASE -POLICY LIMIT S SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS Operations performed by the named Insured subject to policy conditions and exclusions. Gatewood Homes; Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1EREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL I0._ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR ACORD 25 (2001108) 1 of 2 #35866 LS1 a ACORD CORPORATION 1988 •��. 117Du 'CERTIFICATE OF LIABILITY INSURANCE DATE(h1M,DD/YY) 0/4/04 PRDgycEh ^ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1 A Grail IrsLimrice ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. B:cc 337 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. bsi: .--- Mills, l cr, M 02648 i INSURED An>�Z m. , Inc. 43 FiAaWlS IaOB I Qmba:yj11e, MS 026M Fael^..PIZ j INSURERS AFFCFIDING COVERAGE I �y�� [INSURER A_ `'+ r,1V:[ MTha2.I.' m. INSURER B; �rdJ & Casce1ty INSURER C:. .. _._ ...._.. ... _.__ . i INSURER D: I INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH -HIS 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH CLAIMS. _.__ -_ LTH TYPE OF INSURANCE POLICY NUMBER 1 POLICY EFFECTIVE POLICY EXPIRATION ' I DATE MM/Dp/VV DAT IMM/DD/YY LIMITS GENERAL LIABILITY ; EACH OCCURRENCE S 1 wryYo(� (�(�o/� COMMERCIAL GENERAL I.IAE.UTY i I i_FIRE jWIJAVIAJ DAMAGE (Any one are) S- 5QIwo . I ClAMl3 M.4UE i; OCCUR MED EXP (Any one perwn) S �� I t PEASJNAL 8 ApV INJURY l 4.0w, 0 • I i GENERAL AGGREGATE ; S 20 0Wy WO L;r.N'L AGGREGATE LIhII f APPLIES PER: GO 0005933 04 10--05-03 10-05-04 ; PRO_DUCTS - COMP,'OP AGG is 2 000 ' 1F'T POLICY, P1O I _Oc 1 CP00005933 05 10-5-04 i 10-5-05 I `�` AUTOMOBLLE LIABILITY I j COMBINED SINGLE LIMIT $ .ANY AUTO I (Ea 2mden) ALL OWNED AUTOS i ..___._ i I ' SCHEUULEU AUTOS i I ', ! BODILY INJURY : $ (Per Person) , HIRED AUTOS I . NON -OWNED AUTOS ! I BODILY INJURY (Per so:iaenq S PROPERTY DAMAGE S (Per amdenc) GARAGE LIABILITY ' AUTO ONLY • EA ACCIDENT_ is ..ANY AUTO ' I ., r .. .. ,.....__.. ... r._...._.. EA ACC I $ .. OTHER THAN ... - I AGG IS-• .AUTO ONLY: EXCESS LIABILITY ; I EACH OCCURRENCE • $ ' OCCUR I j CLAIMS MADE - AGGREGATE _—. .. _ I $ .._ ... UEOU%fIULE _$ RE fENTION WORKERS COMPENSATION AND I VIC STATU- OTH-- EMPLOYERS* LIABILITY - TORY UMITS)__ERj. 04-01-04 04-01-05 EL EACH ACCIDENT , $ -- I 100 two B i EL DISEASE - EA EMPL_ _ OYE $ ....._... 1001000 I 6M 001630 I E.L. DISEASE _ POLICY UMIT i OTHER I I 1 I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENOORSEMENT(SPECIAL PROVISIONS � CERTIFICATE HOLDER y 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 TILE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25-S (7197) ©ACORD CORPORATION 1988 A'CORq: CERTIFICATE OF LIABILITY INSURANCE DATE 11/O1/2004 Munray�& MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC # INSURED Tracy Howerton. INSURERA: Arbella Protection Insurance PO. Box. 1551:;., INSURERS: Liberty Mutual Ins. Corp - Mashpee;-MA 02649 ..._.. .... INSURERC: _. INSURERD: .:. ._ ... .. INSURER B ...._—.. _. _ ... _. _. _._ .. 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. I LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY FXFIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY LLI COMMERCIAL GENERAL UABTY CLAIMS MADE ❑ OCCUR 8500028756 08/14/2004 08/14/2005 EACH OCCURRENCE E 1,000,00 PREMISES Ea omaence S 100,000 MED EXP (Ary we person) S 5,000 PERSONAL & ADV INJURY S 1,000,000 " GENERAL AGGREGATE E 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMPIOP AGG S 2,000,000 - - AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMB (Ea accident $ BODILY INJURY (Per �pn) $ BODILY INJURY (Per accident) S PROPERTY -DAMAGE -.. E. . GARAGELIABILITY ANYAUTO .._.AUTO _ -- -AUTO ONLY -EA ACCIDENT OTHER THAN EA ACC ONLY:.__ ._.. _.AGG E - ..E _.._ _ .... _. EXCESSIUMBRELLA LIABILITY OCCUR. a CLAIMS MADE DEDUCTIBLE RETENTION S EACH -OCCURRENCE -• y __ ..._ AGGREGATE. S S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/IXECUTNE OFFICERIMEMBER EXCLUDED? If yes. descdbe under SPECIALPROVISIONSbe! w WC531S317310033 10/05/2004 10/05/2005 TORY LIMITS ER E.L. EACH ACCIDENT $ 1QQ ,QQQ E.L. DISEASE- EA EMPLOYEE S 100,000 E.L. DISEASE -POLICY LIMIT S 500,.00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 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, Gatewood Homes, Inc. Paula BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Falmouth Road, Suite 25. OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 Dou las MacDonald ACORD 25 (2001108) vAl.UMLI I'IjMrvrva I Ivn woo Clionlil- 1Rd.'td eAcennwun1Tnn FAO RD. CERTIFICATE OF LIABILITY INSURANCEPRq6U DATE(M�D 0/04/04 CER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling & O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR , 222 West Main St PO Box 1930 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Travelers Insurance Company Assurance Construction, Inc. INSURER B:INSURERc A/O Assurance Excavation, Inc. 550 Willow Street INSURER D:INSURER West Yarmouth, MA 02673 E: cu THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON 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. NR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION ATE (MMfDDrYYI LIMITS A GENERALU421UTY 16808387A9841ND04 08101/04 08/01/05 EACH OCCURRENCE. S1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx� OCCUR DAMAGE TO RENTED PREMISES (F� s3000OO MED EXP (bry ene pveon) $$ 000 PERSONAL &ADV INJURY 51"000000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLES PER PRODUCTS-COMP/OP AGO $2 000 000 POLICY PEa LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Par P—) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS - NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT S OTHER THAN EA ACC S ANT AUTO S AUTO ONLY: AGG IXCESSAIMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE $ S S DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION AND WC STATU-KrrS OTH- EMPLOYERS'LUIHIUTY EL EACH ACCIDENT S ANY PROPRIETOR/PARTNER/D(ECUTVE OFFICER/MEMBER EXCLUDED? gym a under E.L. DISEASE- EA EMPLOYEE S EL DISEASE - POLICY LIMIT S SPUAL PROVISIONS below LL PR OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Operations performed by the named Insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n 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 AUTHHCRt= RREEP^R ^-�^� -� A.,.,. "vv/ T OT ,4 83OStiti I LS1 E ACORD CORPORATION 1988 t ACi�Yl 3.... ��'��gV�� V� LIABILITY INSURANCE DAfE(MhUDDIYYJ ,eR4'A4cEr► / 4 / 0 4 THIS CERTIFICATE R) ISSUED AS A MATTER OF INFORMATION F G�11 TT�"�^'� ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P-0 BZDC -37 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I"barst%o Mi11cr M 02W I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. j INSURERS AFFORDING COVERAGE - INSURED INSURERA:PII iiYY1Ym1r. Sfl-T)e agviP MkU1 FSxelm. m. 43RrINSURER Biis IaiE Q(ErS y & Qk-A81ty _ Qm_eOri to MA - INSURER C: ! INSURER D: COVERAGES I INSURERE: - - - - l"H'c' POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTH TYPE OF INSURANCE POLICY NUMBER POLICEFFECTIVE ICY EXPATI Y E POLIRON ATE NIM/00/YY I DAT IMM/ O/YY LIMITS GENERAL LIABILITY I VW.n� I EACH OCCURRENCE i g . M COMMERCIAL i ENkiFal LIAE.LITY i I :- i 1 � 000,000 i FIRE DAMAGE (Any ona ara) 15 Cn IrV��y�r�Y CLAIMS bIAU� E : OCCUR! I t. ..... __. .. r. _ Q WO ! M_ED EXP (:Any ana Perwn) _ _ i y -!/ .. _ . . ( ' PERSO A err"hl'L AGGHEGATE LIMI f APPLIES PER GO 0005933 04 - POLICY, 1FIF' i _Oc I CP00005933 0 M. AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS I SCHEDULED AUTOS i - HIRED AUTOS I NON -OWNED AUTOS I GARAGE LIABILITY ' ANY AUTO i EXCESS LIABILITY - OCCUR I j CLAIMS MADE UEOUCfIBLE HEI'FNTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER ! MAL 8 ADV INJURY ! i I G_EN_ERAL AGGREGATE ; g _ 1 L000J .l 21 0QT 000 10-05-03 j 10-05-04 1PROCUCTS-_C_OMPIOPAGG 4.�_. ; S 000 . 10-5-04 i 10-5-05 j .21000y SINGLE LIMIT i (Ea i = (Ea accdanan l) 5 r. BODILY INJURY ' $ j I (Per Person) , ! BODILY INJURY $ (Per aeiaent) j PROP_RTY DAMAGE , (Per aciaear) ; S I rAUTO ONLY -EA ACCIDENT I S i I.AUTO OTHER THAN EA ACC ! $ ONLY: AGG 5-- _ " - � I j AGGR'GATE IEL EACH ACCIDENT ! S 1 OOf ow,04-01-04 04-01-05 -- -E.L. DISEASE - EA EMPLOYES $ 100, WO E.L. DISEASE - POLICY LIMIT 1 S 500, 000 i - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENOORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDERt ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Gatewood Homes SHOULD ANY OF THE ABOVE DESCRIBED POL'CIES BE CANCELLED BEFORE THE EXPIRATION 1 600 Falmouth Rd. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL __ DAYS WRITTEN Suite 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SHALL Centerville MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5 0 8- 7 7 8- 5 6 0 3 REPRESENTATIVES. • AUTOO D REPRESENTATIV ACORD 25-S (7/97) 0 ACORD CORPORATION 1988 ACORD ` CERTIFICATE OF LIABILITY INSURANCE TM DATE,MMma"n ' 11/01/2004 PROWUCRK (508) S40-2400 FAX (S08) 289-4111 a & pMacDonal d Insurance Services N+� 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. INSURERA: Arbella Protection Insurance PD. BOX,1551.,- ' INSURERS: Liberty Mutual Ins.,Corp ...Mashp_ee; -MIA 02649 - INSURERC: - . •.... •.. , ...� , (/ I Lf-�XJIU..L:/Yh INSURER D: .. .-. ... - . INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. NSR LTR AD NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMID POLICY EXPIRATION DATE MMID LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR SS00028756 08/14/2004 08/14/200S EACH OCCURRENCE S 1,000,000 PREMISES En o rence S 100,000 MED EXP (Any One person) S 5,00( PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE S 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEa LOC PRODUCTS - COMPIOP AGG $ 2,000,00( AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMB (Ea accident) S BODILY INJURY (Per P—) S BODILY INJURY (Per accident) S PROPERTY DAMAGE _ S. GARAGELIABILIT'Y ANY AUTO ..__...._... _____...... _ ._.._ .. .. .. - .. ._. -AUTO .ONLY -EA ACCIDENT T- ._.-. OTHERi' EAACC AUTO ONLY:__ ._.. -AGG S .. -S- . _ .... _. EXCESSM1JMBRELLA LIABILITY OCCUR a CLAIMS MADE DEDUCTIBLE RETENTION $ - EACH'OCCURRENCE _. S. __ ..._ AGGREGATE $ ' S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIEfORIPARTNERIEXECUTNE OFFICEWMEMBER EXCLUDED? I yes. descnbe under SPECIALPROVISIONSoelaw WC531S317310033 10/05/2004 10/05/2005 TORY LIMBS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYEE$ 100,000 E.L. DISEASE -POLICY LIMIT S 500,.00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /'VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS vLf\I It'w I nwLw"r% Gatewood Homes, Inc. Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. Id ACORD 25 (2001/08) PACORD CORPORATION 1988 - - ✓ls6 V6i/�/EO�ill O�✓IiOCG{Q- J BOARD OF BUILDING -REGULATIONS Licenser. CONSTRUCTIONSUPERVISOR. yq Numbs 01-2430 E pin O6Y€6I20Qfi' tr. no:2592fi FRANKG CAPRfF` 49COPPER CENTERVILLE, MA Os1632 commissioner 7. 00 - 35,000 d enclosed space (MGL C.112 S.60L) 1A -Masonry only 1G-18-ZFamily Homes Failure to possess a'curtent.edition of the Massachusetts StateBulding. Code is cause for revocation of Otis license. ;I Jt 3 i Y '— DIG SAFE CALL CENTER: (888) 344-7233 t:y PROPERTY ADDRESS: /671 a -/ :ALCULATION FOR PERMIT COST TYPE OF ROOM ETC �L S ADDITION % / q ZS/. 6r ALTERATIONS BATH BED ROOM CERTIFICATE OF OCcupAm 1;4 ggq,� WITH FOUNDATION ONLY GARAGE NO, OF BA GREAT ROOM CLOSED OPEN ROOM HEA REPLACEMENT 2- 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-05-432 Frank Capra 5087789669 00121 CAMP ST # 128 Villages CAA Camp St., LLC 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,ommems: new construction: REVIEWED BY: 1 WATER DEPARTMENT: "; DATE: �j 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: 44.Z 1. I.V1 DATE: Date Printed: 2/24/2005 O F TOWN OF YARMOUTH (7/, Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT B TRANSMITTAL Temp Permit No.: T-05-432 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 128 Owner's Name: Villages @ Camp St., LLC Owner's Addres 1600 Falmouth Road # 25 (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: 44.21.1.C1 Centerville MA 02632 Owner's Telephone: (508) 778-9669 ALTH DEPT. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: 3 N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: " RECEIPT OF COPY: SIGNATURE OF APPLICANT: GDaL) `j CQ,,DATE: 3 0 0 Date Printed: 2/24/2005 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., #128 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., L] : 1600 Falmouth Rd. Suit4 : Centerville, MA 02632 Im EPZ • 23' L=3.8� 1.07' ' 1 i LOT 4� E_51 I_ MIN• o ', ` 53.70' W .. n•Arl 46 W 54.83' NpSE PR0 9 0 SEAIE9 WAER SERVICE 54.83% I — N82 0'46°E L-37 _OT1129 32 PROPOSED t J I� HOUSE PROPOSED P J (SANDPIPER) HOUSE FF = 31.0 (EGRET) I GW = 16.0 FF GW=160 24.4' V 1 t 1, LOT 127 -� w LOT 128 J V 5 S _ GRAPHIC SCALE ( IN FEET ) 1 inch = 20 fL PLOT PLAN OF LOT 128 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA SCALE: 1 "=20' DATE:12-29— �� SEWER LATERAL SHALL BE SLEEVED IN ACCORDANCE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. rp holmes and mcgrath, inc. civil engineers and land surveyors 362 gifford street falmouth, ma. 02540 JOB NO: 201197 DRAWN: LMC DWG. NO.: A2515 CHECKED: -/*y Y' TI MOTHY N1 r, SANTOS y No 45078 0. CIVIL U—Mrj-Oroo-3 N GMS9/GCS9 SERIES 93%AFUE Multi -Position, Single-Stage/Multi-Speed o. Gas Furnace Heating Capacity: 46,000-115,000 BTUH av /'j� m - multi -speed gas furnaces cl installation versatility. .....® C ...... Standard Features • Corrosion -resistant, aluminized -steel tubular heat exchanger and stainless -steel recuperative coil for maximum efficiency • Designed for multi -position installation—GMS9: upflow, horizontal right or left; GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a Norton® Mini -Igniter with patented adaptive learning algorithm to maximize igniter life • Aluminized -steel inshot burners • Energy -saving PSC, multi -speed, direct drive blower motor • Quiet, corrosion -resistant induced draft blower assembly • Integrated 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, offer 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 (EFR01) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Internal Filter Retention Kit—upflow, (RF000180) • Internal Filter Retention `" "J Kit—downflow (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H2OTWR) SS-377D VAM goodmanmfg.com 6/04 r PRODUCT SPECIFICATIONS Nomenclature G M S T 070 3 T N. A Goodman® Brand Revision A: Initial Release M: Upflow/Horizontal D: Dedicated Downflow C: Downflow/Horizontal H: Hi Air Flow S: Single Stage/Multi-speed V: Two Stage/Variable-spee AFUE 8: 80% 9: 90% M 045:45,000 070: 70,000 090:90,000 115: 115,000 140:140,000 Nox B: 1' Revision. N: Natural Gas C: 2'd Revision X. Low NOx Cabinet Width A: 14" B: 1 Ti" C: 21 " D: 24W Maximum CFM Cil 0.5" ESP 3: 1,200 4: 1,600 5: 2.000 2 (7- C � PRODUCT SPECIFICATIONS Performance Ratings GMS90453BXA 46,000 42,8D0 37,200- 93.0 3.0 35-65 GMS90703BXA 69,000 64,400 55,800 93.0 3.0 35-65 GMS909D4CXA 92,000 86,000 74,400 93.0 4.0 35-65 GMS91155DXA 115,000 106,500 93,000 93.0 5.0 35-65. GC590453BXA 46,000 42,800 37,2D0 93.0 3.0 1 35-65 GCS90703BXA 69,000 64,400 55,800 93.0 3.0 35-65 GC590904CXA 92,000 86,000 74,400 93.0 4.0 40-70 GCS91155DXA 115,000 106,5D0 93,000 93.0 5.0 40-70 For altitudes above 2,000', reduce input rating 4% for each 1,000' above sea level. DOE ARJE based upon Isolated Combustion System (ICS). Specifications 01� A IN UPI- asa VP GMS90453BXA 10" x 7" 1 1/31 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" 112 4 2- 4 376 752 8.9 75 158 GMS91155DXA 11" x 10" 3/4 4 2- 5 470 940 12.2 15 175 GCS90453BXA 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 1 9.0 15 135 GCS90904CXA 10" x 10" 1/2 4 2- 4 376 752 8.9 15 156 ,GC591155DXA I11-x70",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 optionsil Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC. 2 Minimum Circuit Ampaciry = (1.25 x Circulator Blower Amps) + ID Blower amps. 3 Maximum Overcurrent 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. 3 PRODUCT SPECIFICATIONS ` GMS9 Dimensions b1�7fARG - — 314 aR u 4 3/4 {.�iB SB� �{ W IDISCHARGEAIR) 21/16 VENDFLUE PIPE ISCHAR R INTAKE PIPE T PVC �` L MR I 7 PVC ALTERNATE ALTERNATE 1�7 O 211116 MR INTAKE LOCATION GAS SUPPLY II CONDENSATE STAND ARDGAS ' HOLE Q DRAIN TRAP SUPPLY HOLE HIGH VOLTAGE w134-PVC ALTERNATE DISCHARGE ELECTRICAL HOLE 18/4 4//B OCATION (RIGHT OR LOCATION LEFTSIDE 3014 4U LEFT SIDE) HIGH VOLTAGE DRAIN LINE 2 9H8 1 ELECTRICAL HOLE 1112. HOLES 7 118 2 y6 RIGHT SIDE r TRAP �- DRAIN Sre 21IM _ DR RAIN DRAINLINEE T301 1B 3H6 Q LOW VOLTAGE I LOWVOLTAGE 14 ELECTRICAL HOLE I 19 16 e . AI 1134 ELECTRICALHOLE SIDE CUT-0UT 134a 1134 16 3213H 1y4 SIDECUf-0UT L j L J 3—� eo--2ocK-0vr " EorroNIwocKO,n� LEFT SIDE FRONT RIGHT SIDE VIEW VIEW VIEW GM590453BXA GMS90703BXA 17i" 16" 12%" 12%" GM590904CXA 21" 19'h" 16%" 14%- GMS91155DXA 241h" 23" 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 900 elbows, one, dose nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials BROWN"ME _ _ e�ag r'ni 09 afu2 �itr.°8 U flow . 0"1 0" 3" C 0" 1" Horizontal 1 6" 1 0" 3" C 0" 4" C = If placed on combustible door, 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 bases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. 4 C r PRODUCT SPECIFICATIONS 'GCS9 Dimensions LEFT SIDE FRONT RIGHT SIDE VIEW VIEW NEW 3/4 112 RI2.=PIPE 1 LOW VOLTAGE I ELECTRICAL HOLE�� L J 2 Is HIGH HIGH VOLTAGE ELECTRICAL HOLE DRAIN TRAP 26IB�.1(y LEFTSIDE R /�-- 16V2 STANDARD GAS SUPPLY HOLE 16 5R—a� UNFOLDED FLANGES FOLDED FLANGES bISCHARGE AIR 9 V2 3.4 VENTIFLUE PIPE RN AIR) 2* PVC — 21MS CONDENSATE DRAIN TRAP 134+ w ate PVC DISCHARGE (RIGHT OR LEFTSIDE) 61/8 / 26 6 JF 21V16w d UNFGLDI EDGES I FOLDED FLANGES DISCHARGE AIR =,,.W HIGHVOLTAGE ELECTRICAL HOLE L ALTERNATE 'L-+ D LUE -i LOCAT ON f ALTERNATE AIR INTAKE LOCATION f 2 SIB DTRAeF14 RIGHT SIDE DRAIN LINE HOLES 316+I ALTERNATE GAS SUPPLY HOLE ISD CHARGE `JllAIR r , GCS90453BXA 1731" 16" 12%" 141h" 16" GCS90703BXA 1734" 16" 12%" 141h" 16" GCS90904CXA 21" 19111" 16%" 18". 191A" GCS91155DXA 2*1" 23" 20%" 2m— 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 installation/code 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 kits for high altitude natural gas operation are available. Contact your Goodman distributor or dealer for details. 4. Insraller must supply following gas line fittings, according to which entrance is used: Left —Two 904 elbows, one dose nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials s1 tmdAes. ONE garai`4pt Bn !a =' d Downflow 0" D"1 1"1 NC 0" 1" Horizontal 6" 0"1 1" C 0" 4" C = Combustible: If placed on combustible floor, the floor MUST be wood ONLY. NC = Non -Combustible: 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 a�yy 19 y0k t � � E�dertial 4atic rEsYti Iff&lis` 7 a.tilr�olt7rrt A y "A"N" ors s' eye sr fia,asi� "� 7 k< {five r @y)07S �'A $s4t 3c'd7±4i O �s xrb�f 1r0,T x0 8 �tPP s P _ t15 15i , Lt NIA RIS,E? LF1Vl INS E ryCFM 21S., �Cf,M• AlL �FM G_590453BXA HIGH MED 3.0 2.5 1,352 1,214 ------ ----•- 1,318 1,172 -•---- -•---- 1,260 1,123 - •--- ----- 1,202 1,064 --038 953,: 59,; (LOW) MED-LO 2.0 997 --•--- 994 ------ 960 35 923 36 LOW 1.5 757 44 753 44 734 45 704 47 b ISa 1 38P HIGH 3.0 1,449 36 1,409 37 1,326 39 1,273 41 194 < $ 1"o? G S907038XA MED 2.5 1,192 43 1,172 44 1,141 . 45 1,094 47 -913§ (,904 793 (MED-HI) MED-LO 2.0 981 53 962 54 943 55 917 56 LOW 1 1.5 750 ------ 1 730 1 ------ 714 --•--- 692 HIGH 4.0 1,970 ------ 1,874 35 1,757 38 1,667 40 G_S90904CXA MED 3.5 1,713 39 1,650 40 1,572 42 1,510 44 :A3e J2 1ijB .19 (MED-LO) MED-LO 3.0 1,439 46 1,412 47 1,370 48 1,327 50G6� iJ56; LOW 2.5 1,183 56 1,155 57 1,122 59 1,108. 60 =01�93 '81fi. iIGH 5.0 2,134 40 2,103 40, 2,029 42 1,941 44 %M tang G591155DXA MED 4.0 1,678 51 1,643 52 1,643 52 1,577 54 1f8173; d 33(MED-HI) I MED-LO 3.5 1,453 58 1,440 59 1,426 59 1,363 62 LOW 3.0 1 259 67 1 239 68 1 220 70 1 181 ------ 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 blower cooling 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 indicases ranges in excess of maximum static pressure allowed when heating. 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. i (71 PRODUCT SPECIFICATIONS Accessories °�`ii L.P. Conversion Kit '?►04 LPT-OOA ✓ ✓ ✓ <�1's5D ' LPLP01 L.P. Gas Low Pressure Kit ✓ ✓ ✓ ✓ HANG11 High Altitude Natural Gas Kit 1 1 1 1 HANG12 High Attitude Natural Gas Kit 2 2 2 2 HALP10 High Attitude LP. Gas Kit 3 3 3 3 HAPS27 High Altitude Pressure Switch Kit 3 3 3 3 EFR01 External Filter Rack ✓ ✓ ✓ ✓ DCVK-20 Horizontal/Verticat Concentric Vent Kit (2") ✓ ✓ DCVK-30 Horizontal/Vertical Concentric Vent Kit (3") ✓ i ✓ Available for this model (1) 7,001'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 4,500'. Downflow Floor Base: When the GCS9 model is installed directly on a wood floor, a downflow floor base must be used. Those model numbers are: CFB17, CFB21 and CFB24. Thermostats ♦W„- . :: m � .x.. s7;��M e^ +r `-.'r#irr:.} w.� Y�w=f x �-n.�.rF':'�'z Yw;�,rtrfir .��^sr< Y. r r'":1'- it ,i. Cooling/Heating, Mechanical CHT18-60 CH70TG Cooling/Heating, Digital, Non -programmable CHSATG Cooling/Heating, Mechanical H20TWR Heating Only, Mechanical 7 Temp Permit No.: TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT TRANSMITTAL T-05-432 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 128 Owner's Name: Villages 0 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: ZONIM3 APPROVED REVIEWED BY: J 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: 3. CONSERVATION: " HEALTH DEPARTMENT: /5. BUILDING DEPARTMENT: V 6. FIRE DEPARTMENT: COMMENTS: DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE N/A: N/A: N/A: N/A: N/A: N/A: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 2/24/2005 A J MAScheck.COMPLIANCE REPORT Massachusetts Energy code MAscheck software version 2.01 Release 2 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 Egret PROJECT INFORMATION: Mill Pond village Camp Street Yarmouth,:MA. COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 1 COMPLIANCE: PASSES Required UA = •216 Your Home = 123 Permit # checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 832 30.0 30.0 14 WALLS: wood Frame, 16" O.C. 1409 15.0 15.0 62 GLAZING: windows or Doors 87 0.340 30 GLAZING: Windows or Doors 40 0.340 14 DOORS 40 0.086 3 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. Builder/Designer, Date Massachpsetts Energy code MAscheck software version 2.01 Release 2 The Egret DATE: 4-21-2004 Bldg.l Dept.i use I I I C 7 I I I I C l J I I C 7 C7 CEILINGS: 1. R-30 + R-30 Comments/Locati WALLS: 1. wood Frame, 16" O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: 1. U-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. u-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No, Comments/Location DOORS: 1. u-value: 0.086 comments/Locati AIR LEAKAGE: joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I I I I C] )UCT INSULATION: Ducts shall be insulated per Table 74.4.7.1. )UCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 34.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): PIPE SIZES (in.) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 LOW temperature 120-200 0.5 1.0 1.0 1.5 steam condensate any 1.0 1.0 1.5 2.0 COOLING SYSTEMS: chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F): RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------ OF yq9 _ x MAAMCHEE$E �A,N TOWN OF YARMOUTH U�1t <0--/2g �h JUL 1 g zUU3 New 01.401 DEPT. lanS Renovation ❑ Yes ❑ No ❑ APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ D mil• PERMIT - YV - Date'20015,_ Owner's ©CJ� Name Type of Occupancy Replacement ❑ 66 Z l� I I y to N O W (� W 0 Y J 0 Q V Z Q Z Z � O O y W CC 2 o Z y W F w °c ►- x~ x �n a rn Z Z a Z 3 X 0 N Co y CC Lu¢ Cl) W¢ ui z 0 a y 0¢ a s ic O u 6 V Z¢ S = ?i O Lu Y N 0 F J Q Y 0 W G LL Y W W Q H Q C Q 2 y y Z= Q a O. OJ OJ Q Q 0 a Q¢ OC ¢ O Q H O Y J M W 0 0 J 2 F fA LL C7 :3 0 Q OC m SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Check One: ❑ Corp. Address ❑ Part Ip C� Fir Compan Business Telephone 27 7 1 M Name of Licensed Plumber WA d vQS INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Y s ❑ 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. C 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. 2y5rg7 License Number / Type: Master El Journeyman APPLICATION FOR PERMIT TO DO GASFITTING i (OFFfCE USE ONLY) TOWN OF YARMOUTH �<__- � OCT + Fee: $_ ---- -� ri. ERMIT NO.Buil ing Owner Date _ Al: Location Type of Occupancy_��____ New CY Renovation O Replacement C1 Plans Submitted Yes No Ik 105 W us FA a ►a' {L ¢ W y 2 Z 8 ~r W ( W d CC _ �� W Z <WSEWO~aaaa98 a N W W J Z a t Q S M Q Y% W Q m W > ►' LA- O> =8N_. ,J W /•�C�/ I¢ z O O= u r3 3 O b W o ¢ a O SUB•BSMT. BASEMENT tST FLOOR 2ND FLOOR 3RO FLOOR iPRINI OR TYPE) Check One: Installing Company NameZtJG.- Corp. AddressPartnership---_�:—.. -----•-----.- _ ..- --- _m�9._ _.__..Q_..zs� 1.�---------. BusinessTelephone --_7_•.Z•-.3L-_._—___._ I w' Name of Licensed Plumber of r INSURANCE COVERAGE: Check One I Nava a current cab ity insurance pol-cy or its substantial equivalent. Yes E'F�No 17 if you nave checkers yes, please indicare t e type of coverage by checking the appropriate box A l,aLility insurance poiicy Other type of indemnity (1 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 0 Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information i have submitted Signature o Licensed (or entered) in above application are true and accurate to the best of Plumber or Gast+tier my knowledge and that all plumbing work and installations performed 2 �S under Permit issued for this application will be in compliance with all ------ - ---------•-- pertinent provisions of the Massachusetts State Plumbing Code and License Number .. ... - Tvnc r rr•cucc. a 0 `N Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. G -66 - 0179 u,p BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JU.S. [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 SE PRINT IN INK OR TYPE ALL INFORMATION) Date: 07/25/2005 ity or Town of- YARMOUTH, MA To the Inspector of Wires: this a ication the undersigned gives notice of his or her intention to perform the electrical work described below. Locat' (Street & Number) 121 CAMP ST.,UNIT 128 'O r or Tenant GATEWOOD HOMES, INC. Telephone No. 508 778 9669 ner's Address 1600 Falmouth Road #25, Centerville, MA 02632 Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Box) Purpose of Building RESIDENTIAL Utility Authorization No. 1463420 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1 Number of Feeders and Ampacity 2/100 Location and Nature of Proposed Electrical Work: WIRE HOUSE Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Lighting Outlets 8 No. of Hot Tubs Generators KVA No. of Lighting Fixtures 8 Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o Emergency Lighting Batte Units No. of Receptacle Outlets 30 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches 10 No. of Gas Burners o. o Detection and Initiating Devices No. of Ranges 1 No. of Air Cond. Total Tons No. of AlertingDevices No. of Waste Disposers eat Pum Totals um er - ors-- ''--"—" o. o e m - ontae Detection/Alerting Devices 6 No. of Dishwashers 1 Space/Area Heating KW Local ❑ unlcipal ❑ Other Connection No. of Dryers 1 Heating Appliances KW Security Systems: No. of Devices or Equivalent o. of Water 1 KW 4.5 Heaters °' ° o. ° Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: 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 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. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) 10/31/2005 (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: PATTON Licensee: RICHARD PATTON Signature • (If applicable, enter "exempt" in the license number line.) Address: PO BOX 1525, MASHPEE, MA 02649 OWNER'S INSURANCE WAIVER: I am aware that the Lice required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: A 15542 Zajac�L (Z�LIC. NO.: Bus. Tel. No., 508-539-0200 Alt. Tel. No.: 774-353-6878 not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE. $ I25.00 • - Commonwealth of Massachusetts "tom use L'uy Permit No. E'db 1Z% Department of Fire Services Occupancy and Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS . 11/99j veb APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK1jy All woricto be ped'o®ed in accordance with the Massachusetts Electrical Cade (MEC), 327 CUR (PLFA.SEPRIMYRN KORTYPEAUBMRWYYOA9 Date: / ''cfo 4 - i a��) City or Town of: YAR 4OUrH To the Inspector of -#res: ° Zp0 1 By this application the undersigned gives notice of his or her intention to perform the electrical work ed below. // Location (Street & Number) MEM POND VILLAGE r Camp Street /SL041.#\%� OwnerorTenant Gatewood Homes/ Jeff Sollows Telephone No. 508-7789669/ Owner's Address 1600 Falmoutn Rd., Suite 25, Centerville, Ma. 0263.2 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 ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) wi h baring? battery, centrall-monitored. ('nmele8e>t oithe follawinQ table may be inziV&'hV tha Iruneetor Of W!Me No. of Recessed Fixtures u (Paddle) Fans No. of Ce1 Ssp• � al o: of otA Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Ab.Lightin Swimming Pool d e d. BatteryUniits�cy g No. of Receptacle Outlets No. of Oil Burners FIREALA No. of Zones —1— No. of Switches No. of Gas Burners o. o7. etecuon an 7 Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat p Totals: um err ons o. o ontame Detection/Alerting Devices 7 No. of Dishwashers Space(AmaHeating KW Local Cotnn ion ®Other No. of Dryers .. Heating Appliances KW •o. ecunty ystems: No. of Devices brEquivalent o. of Waterr Heaters o o. a Signs Ballasts Data Wiring: No. of Devices or Eauivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications of oiaug: No. of Devices or E ivalent OTBEI2: • Attach aaatuamw aetati (r destre4. or ai regwred by the lnipector ofWim - 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 equivalem The undersigned certifies that such coverage is in force, and bas exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTMM ❑ (Specify:) Estimated Value of Electrical Work $750.00 (Expiration ate (When required by municipal policy) Work to Start: Inspections to be requested in accordance with IvIEC Rule 10, and upon completion. I cero, under the pains and penalties of perjury, that the information on this application it true and complete FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C Licensee: Jonas R Bielkevicius Signature _' . " LIC. NO.: 499D (IfappU=ble, enter "exempt" in the licensenwttbe . Bus. TeL No.- 508-833-0996 Address:_ PO 'Box .):;609 Sandwic 02563 Alt. Tel. No.; 508-7776--3347 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 OwnedAgent Signaturie. Telephone No. PERMITFEE:S 40 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) f0FLYARIVIONTH By 5 I II I Fee: $ A� AUG Fee: PERMIT NO. (PLEASE PRINT IN INK OR-TYPE-ALL=INFORALWON) Date:. To the Inspector of Wires: By this application the undersigned gives notice of his or her work described below. Location (Street & Nu Owner or Owner's Addre Is this permit it nPurpose of Buil (206 with a building permit? U -Yes Existing Service Amps / Volts New Service ll0 Amps Number of Feeders and Ampacity 2 Location and Nature of Proposed electrical N rci (Check Appropriate Authorization No. Undgrd C] •24-gk 1E perform the electrical ,No. of Meters No. of Meters Co m letiono the following table may bewaivedb the/ns ectoro Wires of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA IlTo. of Lielitine Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. rnd. No. of Emergency Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners and o. InitiaLin Do ing D n evisces No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number — ons — — K — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal Q Other Connection No. of Dryers tY Heating Appliances KW g PP Security Systems: No. of Devtces or Equipvalent 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 Telecommunications Wiring: No. of Devices or uivalent 6 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 roof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to a permit issuing office. HECK ONE: INSURANCE BOND OTHER (Specify:) Estimated Valu f ctn Work to Start: 0 I certify, unde th p i and F� NAME: L. see: .�►.� �_ .� plicablfl®rX "eykftt' OWNER'S INSURANCE WAIVER: I am aware t below, I hereby waive this requirement. I am the Owner/Agent Signature [Rev. 04/00] (Expiration Date) (When required by municipal policy.) to be requ to in ccordan ith MEC Rule 10, and upon completion. y, t �h� of rm tion on t s application is true and comp let Signature NO. Signature LIC. NO. m line.) Bus. Tel. No.: Alt. Tel. No.: t1i9 — — the c see does not have the liability insurance coverage normally required law. By my signature ec one owner D owner's agent. D Telephone FILE COPY DRIVEWAY PKvrv"-' NS2'40' 46 L_37 "E 54.83 .08 _ 36.9017.93' 36 R L=23'06' N i. LOT 127 I L-OT--128 \�N 0 9.4 13.5 c 18.5' � 32.0 N 1 EXISTING fl N cJ FOUNDATION EXISTING o rn• o 19 5 W1 rn FOUNDATION 1 , = 25.0 i EXISTING 55. FOUNDATION ,Z.y$� 4.6'� `1 _ �N80'2 ' J 54 ' � ad 1� •Ng •21'42E i0' ^ JUN 1 2005 By 0� I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAzARD AR /o OS DATE RE STERED PROFESSIONAL LAND SURVEYOR NOTICE Unless and until such timessaathe 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 (B) this plan remains the property of Holmes do McGrath, Inc. I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS 06�� THE 408 SPEC�ER to /o D.S ATE GI RED PROFESSIONAL AND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft. holmes and mcgrath, inc. .� ,tt+ - s"' AS —BUILT PLAN !)F �t4 � OF LOT 128 civil engineers and land surveyors o�s�" SyPyG� PREPARED FOR 362 gifford street E�+0i 1 MILL POND VILLAGE sTrar:F� falmouth, ma. 02540 N0.2029t IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 6-10-05 DWG. NO.: A2515A CHECKEDi/, , N