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Home My WebLink About121 Camp St #134 Building Permitst _ , 1 FILE 0 S MAT A a [3 C TOWN OF YARMOUTH P1S U ILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 Phone: 508-398-2231 ext. 261 Fax: 508-398-0836 Facsimile Cover Sheet FILE COPY TO: Jeff Sollows, Gateway Homes FAX NO. 508-778-5603 DATE: March 29, 2006 FROM: James D. Total pages, including cover page: 2 SUBJECT: Villages at Camp Street Drain Pipe COMMENTS: 1�y Jeff I have been advised by the Town Engineering Dept that a catch basin drain pipe has been damaged as a result of excavation. It is currently exposed. Because of its proximity to the footing of unit 134, I am requiring certain steps be taken to ensure the integrity of the pipe and adjacent foundations. These steps are detailed in the attached memo to Rich Anctil dated March 24, 2006. It is imperative this matter be addressed. Mr. Anctil provided a copy of this memo to Rick Howe this morning. cc: Rich Anctil FMAY0RE -INSPECTIONS I S7. RE -INSPECTION - $20.00 J 2� RE -INSPECTION - $30.00 3RDRE-INSPECTION - $40.00 ALL OTBER RE -INSPECTIONS - $40.00 ADDRESS: DATE: S s�-- DATE RECALL: 6 6 ISSUED TO: REASON FOR RE - INSPECTION: -— BUILDING DEPT.: OCCUPANCY PERMIT: PLUMBING PERMIT: GAS: ELECTRICAL: FIRE DEPARTMENT: OTHER 91 MEMO ciao To: Jim Brandolini, Building Commissioner 1 From: Richie Anctil, En ' ring Hivisca ��, Subject: Dwell' g 134, Mill Pond Estates, WY "o" o � Date: Septe 05 During July, a drainage pipe which runs between dwelling 134 and 133 was damaged while excavating for foundation work for dwelling 134 (see attached photos and locus). Although the contractor has promised cooperation regarding the repair of this pipeline, the trench was filled in without the necessary repair. In an effort to insure that the entire line is re -excavated and 5spaired under this department's inspection, we request at this time that an .permit not be -granted, far.duellingAU-until the repairs are complete and accepted by both this department and the site owner's engineer, Holmes and McGrath, Inc. Please see me should you have any questions or comments. XC: Rick deMello, Town Engineer Raul Lizardi-Rivera, Holmes and McGrath, Inc. Crowell Construction W. holmes and mcgrath, inc. x' civil enginand land surveyors / 362 Gifford Streerseet falmouth ma. 02540 508-548-3564 • 800-874-7373 • FAX 508-548-9672 email: mcgrath@holmesandmcgrath.com April 19, 2005 Town of Yarmouth James Brandolini, Building Commissioner 1146 Route 28 South Yarmouth, MA 02 Dear Mr. Brandolini, RE Drain Pipe and unit on Lot 134 Please find enclosed a revised Unit Plan for Lot 134 at Mill Pond Vil- lages on Camp Street in Yarmouth, MA. The revised Unit Plan shows a revised drainage easement widened at the rear of the unit to include in the easement the as built location of the reset drain pipe. The easement has been expanded to include the location of the pipe as built. I enclose a report from Tibbetts Engineering Corp., which describes the soil bearing capacity of the existing soils at the Building on Lot 134. We designed the drainage system. The pipe as now installed is encased in concrete. The pipe system as specified by us was to be watertight and wa- ter proof. We have directed that the pipe be encased in concrete to provide additional assurance that the pipe is water tight and water proof. My opinion is that there is suitable space and suitable precautions taken so that the existence of the pipe will not affect the foundation at the referenced site. We certify that our Engineer, Raul lizard -Rivera observed the completed installation of the pipe as built. The pipe was repaired and constructed ac- cording to good practice. As constructed, the pipe should not have any poten- tial for leaking. The additional concrete encasement to be added provides more than adequate protection. If you have any questions, please call or write me. Sincerely Holmes an Michael B. McGrathy P.E. President LEACHING PIT PIPE ADS DRAIN o, 47 5264\ 0400000 /2 �Fc� �v Ig0, LOT 133/�� BULKHEAD ' �o. 10 Q'; EXISTING N��N 0,5' iq QHOUSE �� A, ENCLOSED �09' FIREPLACE 195,Igo, ryN V Spy ,�� Mom, 1.0, .pN F C, LOT 134�� 20• � " F,hS AROAO M �F �R�'AYc /CONC.LOT SFp 45 p PAD R4*1OS_ no j�lp C, TELE.. O -r —63o - OLD EASEMENT. •S0 LINE / 0 nDM `REVISED EASEMENT O (13 S.F.) - v /Q` LOT 134 /^ /� EXISTING EASEMENT LINE /x I EASEMENT DETAIL SCALE: 1=10' GRAPHIC SCALE 1 inch = 20 rt. 135 UNIT PLAN holmes and mcgrath, inc. N OF Mgss9 OF LOT 134 civil engineers and land surveyors oa Nucw►� °yam PREPARED FOR 362 gifford street d o M�RATH y MILL POND VILLAGE falmouth, ma. 02540 y No. 2B378 IN YARMOUTH, MA JOB NO: 201197 DRAWN: LMC01 SCALE: AS SHOWN DATE: 4-13-06 DWG. NO.: A2520A CHECKED: •-Apr 13 06 06:30a Gatewood Homes (508)778-5603 p.l 11EC:tibbe is Engineering cwp. CONSULTING CIVIL ENGINEERS & LAND SURVEYORS April 7, 2006 TEC Job No. 10980.010 Gatewood Homes 1600 Falmouth Road — Suite 25 Centerville, MA 02632 Attn.: Mr. Rick Howe Re: Mill Pond Village, Unit 134 (drainage pipe leak) Dear Mr. Howe, In accordance with your request, Tibbetts Engineering Corp. sent a representative to the above referenced site on April 3, 2006 to observe the existing conditions. A report of our observation ; and field-testing is attached. While on site we excavated to the footing depth and sampled the in -site soilz. The soils were also tested for bearing capacity using a hand held penetrometer. The results a nged from 1 to 2 TSF indicating the sand is well compacted. The range of results is not unusual for -.lean granular fills, as it is typically difficult to obtain uniform results due to granular nature of the soils. We did not observe any obvious cracking of the foundation concrete. Upon returning to our laboratory, the soil sample was tested for grain size d stribution by washed sieve analysis (see MA096A attached). Research of our files indicated that the results are similar to tht; test results we obtained in September of 2005. The soil is classified as "SP" in the Unified Soil Classific ation System. It is rated in the Engineering Use Chart prepared by the U.S. Bureau of Reclamatic n as "Pervious" with a "Good" shearing strength and "Very Low" compressibility when compacted and saturated. To summarize, the soils were sandy, consisting of "Medium and Fine Sand, Little Coarse Sand, LittlE! Fine Gravel". We had tested this soil for compaction on September 7, 2005 and found the fill in Uni:134 had been installed to 96.1 % compaction using a maximum dry density of 1: 5A PCF with an opti nur moisture content of 8.2%. Due to the clean granular nature of this material, water can percolate qt ickly through the soils. If any additional hydraulic compaction did occur, it should have been a minimal amount due to the dense condition of the fill. The foundation system includes a concrete footing that distributes the building loads over a larger area of fill, which should also limit localized settlement potential at the leak area. Please feel free to contact me in our Taunton office if you have question:; or desire any addit onal services. Sincerely, •TIBBETTS ENGINEERING CORP. !moo Christopher M. White, PE Civil Engineer/ Lab. Director CMWlkbr Kbr\\MCAMy Documents\MS Office files\MS Word Files\Chris White\10980.010 -Letter to Howe - Gatewood re -Water Leak 4-7-06.doc 716 County Street, Taunton, MA 02780 Tel. (508) 822-6934 Fax (508) 880-7811 E-Mail: hr@tibbettsengineedng.com ' Web Site: www.tibbeUsengineering.com .f1pr 13 06 08:30a Gatewood Homes (500)778-5603 p.2 F tbbetts engineaing carp. CONSULTING ENGINEERS 7100a yft#4Tma mMAM710 Tot, (JOP)MOM Pa. (101D8817s11 TEC'HNI TAWS nAILY REPORT PROJECT: Mill Pond Village Yarmouth, MA CLIENT: Gatewood Homes CONTRACTOR: Homes and McGrath EQUIPMENT WORKING: 1 Mini -Excavator I Vibratory Plate Compactor MEN WORKING: Rick Howe of Gatewood Homes, Several Laborers WORK PERFORMED: DATE: 4/3/06 JOB NO.: 109W.010 FIELD TIME: ) 3 Hours TRAVEL TIME In accordance with a request from the client, I arrived at the referenced job site at apx. 12:OOPM, for scheduled bearing capacity tests on unit #134. Upon my arrival I met with Rick of Gatewood Homes who informed me that the drainage pipe on the side of the unit had leaked and he needed testing to ensure that the bearing capacity of the soil was not compromised due to the leaking water. Upon visual inspection, I noted that the area was excavated down to the top of the drainpipe on the side of unit 9134. The footing grade was still about 3' below the excavated grade. I also observed the foundation wall in the excavated area to look for any damage caused by the leaking water. There did not appear to be any damage to the foundation wall. One of the laborers and I dug a test pit on opposite sides of the foundation until the footing was exposed. Using a hand held pentrometer, I performed bearing capacity tests in both test pits. Both test pits had a bearing capacity that ranged from 1.0 — 2.0 T/ft.z at footing grade. 1 obtanied a sample of the soil at footing grade for a sieve analysis in the laboratory. After testing was completed I informed Rick of the test results, packed up my equipment and left the job site. * Back at the laboratory I researched past field density tests. There was a corpaction test taken on this lot on 9/7/2005, with a 96.1% compaction result. Matt Rebello Lab Technician nril 13 06 08:31a Gatewood Homes (508)778-5603 p.3 tibbetts Engineung corp. E. CONSULTING ENGINEERS 716 County Street, TaurlonlMA 02780 Tel. (508) 822-69:_A Fax. (308) 880-781'. Report of Soil Grain Size Analysis (ASTM D 422) Client: Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Date: 04107106 Centerville, MA 02632 Report No.: MA6096A Project: Mill Pond Village (Drainage Pipe) Material: Well -Graded Coarse to Fine Sand Supplier. Client Location: Onsite Specifications: None Provided Sampled By: M. Rebello Date sampled: 4/3/2006 Tested By: C. Cordeiro Date Tested: 4!7/2006 ANALYSIS RESULTS Sieve Size Weight Retained % Retained % Passing (Grams) 3/4Inch 0.00 0.0 100.0 1/2Inch 168.53 10.7 89.3 3/8Inch 24.22 1.5 87.8 No.4 76.82 4.9 83.0 No.20 447.55 28.3 54.7 No.40 419.92 26.5 28.1 No.100 377.62 23.9 4.3 No.200 32.55 2.1 2.2 Pan 34.99 2.2 Remarks: J�)4 11 - .. -, �'� - '/ Walter P. Galuska Laboratory Supervisor Sample Wt.(g) = 1582.20 Specification Gradation Limits Min. - Max. C. Cordeiro Laboratory Technician TIBBETTS ENGINEERING CORP. Graph of Sieve Analysis Results Using ASTM C136 100 90 • 60 50 40 30 20 10 0 .01 .1 1 Grain Size in Millimeters Job No. 10980.010 GotewQod Homes Project: Mill Pond Village (nrninnnP Pinp) Report No. MA6096A 10 100 0 al Ct M E 0 0 a x 0 3 M kftft VOO LOT 133 a LEACHING PIT PE 2PADS DRAIN /� l2 4cti 7 S28~\ ,90 BULKHEAD cv 6�. CO. V. 6/ n' EXISTING �/NQln 6!•, .Ny ��/i HOUSE / h��, ENCLOSED FIREPLACE 9,0 . S0' C FX/SA M Rq�,v 'ti Q SyF�NG I - OLD EASEMENT S' LINE / �0'//� \ REVISED �M / /oa EASEMENT _ O (13 S.F.) v / LOT 134 / ^ /EXISTING EASEMENT LINE ICSMIZ= I EASEMENT DETAIL SCALE: 1=10' UNIT PLAN OF LOT 134 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA AS SHOWN DATE:4-1 T 'N •o 134/y LOT f7' PADC Pa 1 inch = 20 ft holmes and mcgrath, inc. civil engineers and land surveyors 362 gifford street falmouth, ma. 02540 JOB NO: 201197 DRAWN: LMC 06 DWG. NO.: A2520A CHECKED: 135 C tectibbetts engirwEring corp. CONSULTING CIVIL ENGINEERS b LAND SURVEYORS April 7, 2006 TEC Job No.10980-010 Gatewood Homes 1600 Falmouth Road— Suite 25 Centerville. MA 02632 Attn.; Mr. Rick Howe Re: Mill Pond Village, 6nlf 134 (drainage pipe leak) Dear Mr. Howe, OR o T � APP -4, 9 2006 In accordance with your request, Tibbetts Engineering Corp. sent a representative to the above{ referenced site on April 3, 2006 to observe the Existing conditions. A report of our observations and field-testing is attached. While on site we excavated to the footing depth and sampled the in -site soifs. The soils were also tested for bearing capacity using a hand held penetrometer. The results ranged from 1 to 2 TSF indicating the sand is well compacted. The range of results is not unusual for clean, granular fills, as it is typically difficult to obtain uniform results due to granular nature of the soils. We did not observe any obvious cracking of the foundation concrete. Upon returning to our laboratory, the soil sample was tested for grain size distribution by washed sieve analysis (see MA096A attached). Research of our files indicated that the results are similar to the -test.. results we obtained in September of 2005. The soil is classified as "SP" in the Unified Soil Classification System. It is rated in the Engineering Use Chart prepared by the U.S. Bureau of Reclamation as "Pervious" with a "Good" shearing strength and "Very Low" compressibility when compacted and saturated. To summarize, the soils were sandy, consisting of "Medium and Fine Sand, tittle Coarse Sand, tittle Fine Gravel". We, had tested this soil for compaction on September 7, 2005 and found the fill in Unit 134 had been installed to 96.1% compaction using a maximum dry density of 125.4 PCF with an optimum moisture content of 8.2%. Due to the clean granular nature of this material, water can percolate quickly through the sous. if any additional hydraulic compaction did occur, it should have been a minimal amount due to the dense condition of the fill. The foundation system includes a concrete footing that distributes the building loads over a larger area of fill, which should also limit localized settlement potential at the leak area. Please feet free to contact me in our Taunton office if you have questions or desire any additional services. Sincerely, TIBBETTS ENGINEERING CORP. GhnstopherPE Civil Engineer/ Lab. Director CMWlkbr Kbr%MC:1My DocumentslMS Office lileMMS Word fileslChns Whitet10980.010 - tetter to Howe - Gatewood re -Water teak •-7-0t1.doc 716 County Street, Taunton, MA 02780 Tel. (508) 822-6934 Fax (508) 880-7811 E-Mail: hr@tibbettsenglneering.com Web Site: www.Nbbettsengineering.com r4EC tibbetts rnginie�ng corp_ CONSULTING ENGINEERS 716 County Street, Tawton MA 02780 Tel. (309) 933-6934 Paz. (308) 390-7A11 Report of Soil Grain Size Analysis (ASTM D 422) Client Gatewood Homes Job No. 10980.010 1600 Falmouth Road, Suite 25 Date: 04107M6 Centerville, MA 02632 Report No.: MA6096A Project_ Mill Pond Village (Drainage Pipe) Material: Well -Graded Coarse to Fine Sand Supplier. Client Location: Onsite Specifications: None Provided Sampled By: M. Rebello Date Sampled: 4/3/2000 Tested By: C. Cordeiro Date Tested: 4/7/2006 ANALYSIS RESULTS Sieve i Weight Retained % Retained % Passing (Grams) 3/41nch 0.00 0.0 1M.011 1/21nch 168.53 10.7 89.3 3/81nch 24.22 1.5 87.8 No.4 76.82 4.9 83.0 No.20 447.55 28.3 54.7 No.40 419.92 26.5 28.1 No.100 377.62 23.9 4.3 No.200 32.55 2.1 2.2 Pan 34.99 2.2 Remarks: Walter P. Gatuska Laboratory Supervisor Sample WL(g) = 158220 Specification Gradation Limits Min. - Max. C. Cordeiro Laboratory Technician TIBBETTS ENGINEERING CORP. Graph of Sieve Analysis Results Usina ASTM C136 100 90 80 70 60 50 40 30 20 10 0 .01 Pro' 1 Report No. MA6096A 1 - 10 M Grain Size in Millimeters No. 10980.010 Gatew od Homes ect: Mill Pond Village (Drainage Pipe) Tibbetts Engineering core. CONSULTING ENGINEERS 716 eawy Svcµ TMvaon MA U790 TOOOe)e]]AVla►u. (:Ot)etO Tfff PROJECT: Mill Pond Village Yarmouth, MA CLIENT: Gatewood Homes CONTRACTOR: Homes and McGrath EQUIPMENT WORKING: I Mini -Excavator I Vibratory Plate Compactor MEN WORKING: Rick Howe of Gatc%vod Homes. Several laborers WORK PERFORMED: DATE: 4/3/06 JOB O.:1o980010 FIELD TIME: 13 Hours TRAVEL TIME In accordance with a request from the client, I arrived at the referenced job site at apx. 12.00PN1, for scheduled bearing capacity tests on unit #134. Upon my arrival I met with Rick of Gatewood Homes who informed me that the drainage pipe on the side of the unit had leaked and he needed testing to - ensure that the bearing capacity of the soil was not compromised due to the leaking water. Upon visual inspection, 1 noted that the area was excavated down to the top of the drainpipe on the side of unit 4134. The footing grade was still about 3' below the excavated grade. 1 also observed the foundation wall in the excavated area to look for any damage caused by the leaking water. There did not appear to be any damage to the foundation wall. One of the laborers and 1 dug a test pit on opposite sides of the foundation until the footing was exposed. Using a hand held pentrometer, I performed bearing capacity tests in both test pits. Both test pits had a bearing capacity that ranged from 1.0 — 2.0 TJR.2 at footing grade. I obtained a sample of the soil at footing grade for a sieve analysis in the laboratory. After testing was completed I informed Rick of the test results, packed up my equipment and left the job site. Back at the laboratory I researched {last field density tests, There was a compaction test taken on this lot on 9/7/2005, with a 96. I%compaction result. Matt Rebell* Lab Technician ry CATION �90 o /r O ' � ' ry� k I s . 0...41) 6.4 0 JCVy fob Nh 2 2O'6' LOT 133 0� /9 EXISTING EXIS1 /R 5 FOUNDATION a 3 FOUND 983, �• 12� �90•'� o o , 'c y '^ AROp°SFO LOT 134 ' LOT 135 A. I GEKIII-T IMAI IMt rUunUA11UN la LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C I NOT A SPECIAL FLOOD HAZARD A �ATE � R GISTEREb P OFESSIONAL LAND SURVEYOR NOTICE 20 Unless and until such time as the original (red) stamp of the responsible Professional Engineer, or Professional Land Surveyor appears on this plan: (A) no person or persons, Including any municipal or other public officials. may rely upon the information contained herein; and (B) thls plan remains the property of Holmes & McGrath. Inc _ PAUG 05.00 0 1 201' 1 w _ I BUILDING DEPY. I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREM OF THE 40B SPECIAL PERMIT. ATEREGISTERED PROFESSIONAL LAND SURVEYOR GRAPHIC SCALE 10 0 20 ( IN FEET ) 1 inch = 20 ft AS —BUILT PLAN holmes and mcgrath, inc. ''`ZN OF �gf"ti OF LOT 134 civil engineers and land surveyors �oc`a�MIII EL�'`y� PREPARED FOR 362 gifford street M�AAi1i y MILL POND VILLAGE falmouth, ma. 02540 y N0.2q» Q 0 IN �"ss 9FCIS R ` YARMOUTH, MA. JOB NO: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 7-29-051 DWG. NO.: A2520A CHECKEDy6#4,'- OF 1, TOWN OF YARMOUTH ;Builift Department BUILDING _ _ _ _ _ _ _ _ _ _ , (508) 398-2231 ext.261 PERMIT NO 6-05-1557_ - PERMIT ISSUE DATE ; _ 6/30/2005 _ ; PROP E _ _ _ _ _ _ _ _ _ .' APPLICANT Frank Capra - - - - - - - - - - ' JOB WEATHER CARD (P) PERMIT TO ; New Construction ' IAT (LOCATION) 100121CAMP ST Unit 134 ZONING DISTRI R-25 Bldg. Type: IResidential I SUBDIVISION MAP LOT BLOCK 1044.21.1.C134 I BUILDING IS TO BE: LOT SIZE CONST TYPE 5-B USE GROUP new construction: 2 baths, 3 bedrooms, 1 diningroom/familyroom, 1 fireplace, 1 one bay garage, REMARKS 1 livingroom, 1 kitchen as per plans dated 6/09/05. Subject to compaction & proctor tests. CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 AREA (SO F) EST COST ($ I$169,536.00 PERMIT FEE ($) 1$617.00 J Centerville MA 02632 OWNER I Villages 0 Camp St., LLC ILDING QEPT B 5087789669 ADDRESS 1600 Falmouth Road # 25 Centerville I MA 102632 Certificate Issue Date 27 ay CERTIFICATE of OCCUPANCY Departmental Approval for Certificate of Occupancy and Compliance Insaector Date - Permit Number Approved By Remarks ffe m IPIP win _W�i�_!, - s To be filled in by each division Indicated hereon upon completion of its final inspection. I 1' -r TOWN OFYARMOUTH Suilding Department BUILDING ' (508) 398-22 ext.26 PERMIT NO B-05-1557_ I� e.. • ISSUE DATE ; _ 6/30/2005 _ , PROPOSED U PERMIT ----------------- JOB WEATHER CARD ankC Capra PERMIT TO ; New Construction APPLICANT Frrank ' AT (LOCATION) 100121CAMP ST Unit 134 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C134 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 diningroom/familyroom, 1 fireplace, 1 one bay garage, REMARKS i livingroom, 1 kitchen as per plans dated 6/09/05. Subject to compaction & proctor tests. AREA (SO FT) EST COST ($ I$169,536.00 I PERMIT FEE ($) I$617.00 OWNER Villages 0 Camp St., LLC BUILDING DEPT BY ADDRESS 16M Falmouth Road # 25 Centerville I MA 102632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Note Progress - Corrections and Remarks i MEMO To: Jim Brandolini, Building Commissioner SEP From: Richie Anctil, Engineering Division Subject: Dwelling 134, Mill Pond Estates, WY Date: September 7, 2005 During July, a drainage pipe which runs between dwelling 134 and 133 was damaged while excavating for foundation work for dwelling 134 (see attached photos and locus). Although the contractor has promised cooperation regarding the repair of this pipeline, the trench was filled in without the necessary repair. In an effort to insure that the entire line is re -excavated and repaired under this department's inspection, we request at this time that an occupancy permit not be granted for dwelling 134 until the repairs are complete and accepted by both this department and the site owner's engineer, Holmes and McGrath, Inc. Please see me should you have any questions or comments. XC: Rick deMello, Town Engineer Raul Lizardi-Rivera, Holmes and McGrath, Inc. Crowell Construction COP P CONSULT NG 0IL1L ENGINEi;RS S (AND SURYEMRS OF 1� Mill Pond Village Yarmaith, MA GzWwood Homes �QL�1T$ACT01t: Homes and McGr.tth 1 .A : 9/7/03 JOB NO.: 10930.010 In accordance with a request 8nm the client, I arrived at the referenced job site at apx. 8:OOAM for scheduled compaction testing. Upon my arrival I met with Rick of Gatewood Homes who informed me that compaction testing would be needed at the base of the footings on lots 11 , and 34. e informed me that he would get an excavator and dig two test pits an lots 133 134 the a of tlto building at (voting depth. Rick requested that two compaction tests at 6e performed on each lot. A total of six compaction tests were taken today. All tests taken did meet, or . exceed 95% compaction. See attached report for detailed information on test l0ceti0n3 and resuts. After testing was completed I informed Rick of all test results, patted up my equipment and left the job site. P. Fastundes Lab Technieise 716 County Street; Ta,nton, MA 02780lei. (708) 822-n34 Fax (,,r%08) 880-781 i E-M211: hr@fbbettsengineering.carr f Ubbetts engirewing carp. 716 ComtyS*"% Tmvt=MA M780 CONSULTING ENGINEERS Tel. (509) 822-6934 Pat. (5011) 290-7311 ..• Homes Job No. 10960.010 iJl Fakr=th Road, Suite 25 Datir 917105 CentoMile, MA 02632 - 1 i.• fir. ��• / •, c: • 1�.�/ �p - FD5250A lot #133 - Norlh Center - Ban of Footlltp - Sandy Gmai FD52WS lot #133 - Sonib Cerder - Baee of Fooft - Sandy Gravel FD5250C lot #134 - Nora Gaoler - Saae of Foo" • Sw* Gravel FD5250D lot #134 • t'wA Cesar Bass of Foo" • Sandy Grevat FD5250E A M 12 - East Cw& - Base of Foo ft - Sandy Qave1 FD525OF lot #112 • West Cantor - Base of F006v - Sandy Or" - .#bula�n, Bad Dam& Test Resr= Deix Teat No. P-mb 1.0. Rsq. % t)t><si W Meats MOMM DIM Max Dry openium COMI Com wOm Spam Cor W P.C.F. Wt. PCF Atd9m 91712005' F05250A PR4252E 95 98.8 Yes 4.7 1219 125A 82 9/7P1005 FD52508 PR42M 95 963 Yao 39 12D.7 125.4 82 W712005 205250C PR4252E 95 98.1 Yes 4.1 120.5 1264 82 917I200fi F05M PR4252E 95 95.7 Yee 42 1200. 125.4 82 9V7J2005 FD5250E PR425M 95 99.6 Yea U 124.8 125.4 82 917/2005 FD525DF PR4252E 95 97.0 Yes 4.2 121.6 125A 6.2 Remarks: Test area met the spedNW Mlnlmum CWrp@CM of 1?5%. Comsctecl for Oven ize PartIc4es In s000rdarm with ASTM D-4718. / f r 4PSIOUISrl'ami WaitLaboratory T6fticlan Laboratory Supervisor Page 1 of 1 Brandolini, Jim From: Brandolini, Jim Sent: Monday, March 27, 2006 10:36 AM To: Anctil, Richie Cc: deMello, Rick Subject: 121 Camp St Unit 134 Richie: As per our conversation of last week, because of the drainage pipe condition, I will withhold the Certificate of Occupancy for Unit 134. Further, for Building Code purposes I am going to require an engineer's certification on the following: 1. Footing soil bear capacity is remains adequate. Of this pipe has been leaking it could undermine the soil). 2. Location of the pipe in relation to this unit and others if applicable will not jeopardize the foundation systems should the pipe fail in the future. 3. Certify the pipe repair. I am taking this action pursuant to Building Code Section 102.2, entitled "Matters Not Provided For" Finally, because he is the permit and license holder, the General Contractor bears the responsibility to provide this. Jim 3/27/2006 - TOWN OF YARMOUTH Building Department _ Town Hall qr a Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-616 Applicant Name: Applicant Phone: Building Location: Owner's Name: Owner's Addres (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Frank Capra Comments: Map/Lot: 044.21.1.0 5087789669 new construction: 00121 CAMP ST Unit 134 Villages @ Camp St., LLC 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 ' ZONING APPROVED , REVIEWED BY: vil WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: WA: CONSERVATION: DATE: N/A: /3. v 4�. HEALTH DEPARTMENT: DATE: N/A: //5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: \t -� DATE - I3 ' C)S Date Printed: 5/24/2005 LINE & I WU FAMILY UNLY - t3U1L1J1N(a FhKMI I APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING C y Town of Yarmouth Building Department F „ATTIC„[CS 1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508);. 398-0836 i.Yr: j 1 tF -;,,,3< ��,Offic�'i)se,Dnly'wrt,�,��-.;a.� �. lanrnng=Boarcj�ltiiarmapa� Assessors,�eparttnervrt)vinforroatroa�' a '�, s=i' ,�7 ``r'-f+t'+.J- - 'i, �y .•^ rt F�f �¢ 7 Lt' FEF`:.i uiYr�A, JSl y..fi•Y[x -Y,: h �PErlTlfl;�A.+ `lfbf r .,�„�^i'.k R - =CA.3��tryry�-��k +i � F�t`2 �[Ti'� P �`.J ,� ��.d J`rh'�^�+f'tk'�xnv�+Y""�'� ys+� m..� Y.7� .�;w.lt�y�. 3Y,ix a 1 }A•.'? Y-. ♦ }.�' A ,XK'� L ` k I' �P �lht`�^Qr•.�$' ,,•Nt i74h yY rq Jai f sF �14�{^ YYl�i.31 q l+'{ � � . 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AT^lt�wsa'i<'c Y..{' tY'si.''l.}"�f'^,_tM;S•:.�`.i.'.�llhFQ3.PtIi"irN tQeleia.rsSi:`.; Ky' Bj�+-'{+t .^ = k } {"^:n�a. 1 aN.�.{...�"j"� C i+ Y„�Aiijl ;S,y".fJ.l } l4yac.yYY-'+'{TXt,µ'iiTfa `iSiY+v�.} r.l ;� '� rty.2�l p Y'`niipSlP,�✓ y'$o � �q � S� {il4�^�•{•.r[`�`Tt, -r.l �$$ ��:aY UGEAil-w .FufAi' N'='"M 4� n ,'F'u�ii'#nJH''- ''Yf.JM it VKy fI.:aY' War ✓+l .Tf� .j�41 gel^ }f'. 1 _ N,p,�.,.y -* "f,•R q' ;[' 't.. t'-'C }„4' ✓ i ,� of Xr-M x `,--;••„ilfiw-',»e' t.�. r"�'- +[it +.Y • }�i�'# ' uprac A�9�y� a .�qS"^•Y' �ytirC}IYnz'LM RI^y'�R.'eY6 F-.aS e ..+Y �� a?,��jl I�YUiUJafiy9 aeeS3eclNviw R, YCk.1. 4.;k,�'+3 S '' J" err 1$Sr�Qtaa°*c.'Y�'7NI 3r@Ct Ife,,,/ f: y.: hNN.= IJ-� X. IurP4'3' 5ei dog .:ite i` d4atton Use Group: R-4 Type: 5-B 1.1 Property Address: 1.2 Zoning Information: L o t 3 L/ Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water SuPPIY (M.G.L c. 40. S 54) ;" e rT2n,s v�,1'++ " Y,'+.„S..< r •zA x �<*+�'. -r. Public Private n'' iyye'T`4'', t'� t�bra�d�ge{ xSec�o�-2"3`-�r9`� �tt��wners�uptA 2.1 Owner off Rrd eeo: 11 o(2 ll tL(, , Nime �print� Mailing Address U4, of M� p� A) \ �1 Mys-a 1, z--e- Signature Telephone 2.2 utho�ri0 4 Agent: 5� 01� oC mG 5 Name (print) (" a.,� a Mailing Address -lie718 _R — 5 lo 6 Si one eef)o . _� �-Qlas3rt3ct(p �'ervacesl ryE D J 3.1 Licensed Constructions Supervisor. U N Z VJ Not Applicable ❑ v�L y License Number O o a�� ddress 7,7Q.. l j -, ! Expiration Date gnature Telephone Re�tsterel orp ; [illprouement Gpn ac,ot y ` ; Company Name LI t t. ' � _ �� Not Applicable i -T. License Number Address g_, -- -- Expiration Date Signature Telephone big 9 - 15 - 99 1 of 2 OVER Y �ctton�-�ROrisex��or7p�nsa�►tit'►.fits�fancEr �fi#,iaitvlt,�Nl,.l:.�c.°if32s �G,{Ej~ � Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit willresult in the denial f the issuance of the building permit. Signed Affidavit Attached Yes ... ..:..:. No .......... Se�ctttisci, lesetptriitt nFroposed k or z heckala "licabie New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: 1 Vt1 f v, V 1 k4 ec�[o1;..5 titirrra#dGonsfruption host Item Estimated Cost (Dollars) to be Check Below completed by permit applicant ❑ Conservation -Commission Fling (if applicable) ❑ Old Kings Highway& Historical Commission approval (if applicable) 1. Building. / 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7. Total Square Ft. (new hales & add�Gas) Sec#�d11 1a 0G45111 prl rinzaho To e mQllat6�#Wherr weer s en rnC, n &f6_p0,les, orBuiidinglert7t+ ; I,Al Z CIr , as owner of the subject property hereby authorize rAk1&J00 -e r to act on m beh , in all matters elative to work authorized b this building permit ppljdation. - / OL - 03 r Signature of owner Date `Sect[iiii(f�b"'��nit eCkApih�raze�d�lg�n�T?ecfara#ieri° flelC-J I, , as Qwner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Fe Print name Signature of Owner/Agent Date u 9-15-99 2 of 2 s_N t x A %-/ WIN yr YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT; _ Job Location: I Z- G fM Num, berms Street _ I Owner of Property: v SDI . Construction Supervisor. (/—A, Name License Address: Licensed Designee: (If other than Supervisor) 2.15 Responsibility of each license holder: A1110� , Village LL G aII o Sob- -96� No. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures 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 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. . 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 1 No If you have checked Mes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond OWNER'S_INSURANC A m aware that the licensee does not have the insurance coverage required by Chapte 152 oft a ner L s, and that my signature on this permit application waives this requirement. Check one: Signature of Owner, or Owneff Agent Owner od� Agent Signature: Building Official Approval: G r -4 x ti N■ The Commonwealth of Massachusetts Department Of Industrial Accidents Ofllce of /evesl/Ostlsis 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit of c� U2fir am a homeowner performing all work myself. am a sole proprietor =::d ha%a no one working in any capacity I am -an employer pro%iding workers' compensation for my employees working on this job. company name - address: city: tthQne a U 7)7g-U insurancr ca. nolicv # �I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who ha%e the rollowing workers' compensation polices. . cin" phone # insurnnecco_. —noliev # company name: address - city: phone r Failure to secure coverage as required underSectios 25A of MGL 152 an lead to the imposition of crindaal penalties of; rase up -to S1400 0t1 and/or one years' imprisonment a well is civil penaidei iti the form of a STOP WORK ORDER and a Ate of SI00A0 a day against me. I andersand'tbat z COPY of this statement may be forwarded to the O�i�e of Investigations of the DIA for. coverage veriAatioa. e I do-herehy Berri nder the p ns and Signature Print name ro—✓1. k of perjury that the information provided above is erne and correm � Date X sJ--/Z - 0 Lj N official use only do not %rite in this area to be completed by city or town official city or town: YARHODT$ _ permit/license p M9uilding Department check if immediate response ❑1Scensing Board p posse is required 261 C3Sclectmen's omee contact person: QHealth Department phone #: - C508) 398-2231 est. Mother r js4 t TOWN OF YARMOUTH 1146ROLTTF-28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, ExL 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 GJAA C5 Work Ad4rew t I is to be disposed of at the following location: 7CQI I—'\ �✓'y�� d ` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. -iIZ. D Signature of Applicant Date Permit No. psi' • sa4- ' C74- BOARD: OR BUILDING -REGULATIONS License. C�ONSTRUCTiORSUPERMSOR. . . Numbe�.t:5.; 042430 . 06i 6ii2006. � Tr. no: 25926 Restnifeda i y�=moo FRANKG. CAPW. ,,: — — 4YiCOPPER LN CENTERIALLE. MA.02631 Comraissfoher `F. 00 - 35;006 G enclosed:space (MGL C,Tl2:S:60L) IA- Masopry onlg _ - 1G':1, B:TFamily Homes _. i Failureto possess:acu mnt..edition of the - MassachusettsStat-� 6ulding.Code . is cause lor revocatioiiof hs license. t DIG. SAFE:CALL.CENTER: (888:) 344-7233 i EASTERN -INS... YARMOUTH PAGE 01 05105/2005 14:09 508-760-L667 fi R *AC M CE TIMCATE OF LIAB1UTY INSURANCE as%os%zoo' PRODUCER .508-399-6033 Eastern Insurance Gr Atlantic Ave FAX 508-760-1667 up LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS -UPON THE CERTIFICATE' ETHDOES TPOLICIESXTEOI ALLTRHECOVEGE AFFORDED BY E W. So Yarmouth MA 02664 INSURERS AFFORDING COVERAGE. INSURED Cape. Cad Custom Floors 1NSVRERA: Arbella. Protection Ins Company tNIVRER-W- HartforCF 76Z Falmouth Rod INSURER C - Hyannis MA 0260 . INSURER 91.-... . INSURERE: - THE POLICIES Or -INSURANCE ANY REQUIREMENT. TERM OF MAY PERTAIN, THE INSURA14C POLICIES, AGGREGATE LIMIT LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INDICATED: NOTWITHSTANDIN CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY.RF rcertcn nit E AFFORDED BY THE POLICTESAESCRME'D HEREIN ISSUB7ECT=ALL TnETERMS EXCLUSIONS C:NDCO TIONS OF"SUCI+ SHOWN MAY HAVE BEENREDUCED.BY PAID CLAIMS, . ... INSR DO' IYAE Oi1NSUR E - .... IOUGY NUMBER.... • FFECTWE .... POLICY EXPIRATION _ _.. LIMITS _ A GENERALLIABWTY_ J( COMMERCIAL GENE CW MS MADE LIABILITY X_ OCCUR 7S00000373 12113/2004 ... 12113/20OS .. .. _ GACHOCCUMMNCE S. 1,000,000 DAMAGE TO RENTED _ So,QO MED EXP (Arty "N WSOP) _S $ ' S'00 PERSONAL} ADV INJURY S 11000_, GENERALAGGREGATE.. s 2,000,000 GENT. AGGREGATELM(T X POLICY i"ERT MPLIES PER _ LOC PRODUCTS - COMP/OP AGG S 2,B00,000 AUTOMOBILE LIABILITY ANY AUTO ALLOWNEDAUTOS SCMiDULEO AUTOS HIRED AUTOS NON -OWNED AUTOS - _ _ .. ' - ... COMBINED SINGLE LIMIT IEa ecdditn) BODILY INJURY (PerP*MW) BODILY INJURY (Pet fCLlOfPt) PROPERNDAMAGE (Pfracii0P4T S GARAGE LIABILITY ANVAUTO - - _ _ - . ... .... .AUTOONLY -EAACCX)EW- t - OTHER THAN EA ACC AUTQONLY! AGO - $7 S A EXCESSMURReLLA wB X' OCCUR E3C DEDUCTIBLE 'X RETENTWN- S A1M$MADE_ 10e QQ 460002928E ... .. '12/13/200--4 .- ... 12/13/2005- .. EACH OCCURRENCE 1- AGGREGATE . $- 1,000,000 F. L 5.. B WORKERSCOMIENSATIONA EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEPIU OFFICER/MEMBER EXCLUDEW Nyee, ee,,; Sd- SPECIALPROVISIONSDNew -_. CUTWE - O8WECKLI007- Q5/ZS/2,Q04- QS/.Z.S�2005. C, WZ.ILA7.QQS X. �sTATU} OTH- rlefty ELFJIGHAGCEANT... S.-. Soo Qo E.L: DISEASE-EAEMPLOYE i S0000 C.LDISCA�E-PDLX:YIBLR S... SQ0{ OTHER ... DESCRIPTION OF OPERATIONS I LOM deuce of Insurance MONSI VEMCLES I FXCLUSIONS ADDED BY EADORSEMENTJ SPECIAL PROVMIONS " CERTIFICATE HOLDER N - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ' EIVIRILTION➢ATE TLIEREOF. THE- ISSUING N$IRER WILL ENDEAVOR TO MAIL -10- DAYS wRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Ga tewood Homes BUT FAILURE TO MML SUCH NOTICE DHALL IMPOSE NO ODLIGAPON-ORLIABILLTY 1600 Falmouth NJ #25 OF ANY IONOWON'THEINSURER. nSAGENTSOWREPRESENTATWE3' Centerville, -QZ632 ADTNORI eNEEEMATYE ACORD 25 (2001108) FAX: .(5091778-SG03-- Q)ACORD CORPORATION 1988 A!}• PnI...." 40AIA 9ARRIIRANCFCr1 9 i A ORD. CERTIFICATE OF LIABILITY INSURANCE 10104/ ate' PR UCER Dowling & O'Neil Insurance Agency, IDC. 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 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 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 AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POUCYNUMBER POLICYEFFECTIVE DATE D POLICY EXPIRATION MM/DD LIMITS A GENERAL LIABILITY 16808387A984IND04 08/01/04 08/01/05 EACH OCCURRENCE $1 000 000 DAMAGE TO NTE�Dca, E300 Q00 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one Penton) $5 000 CLAIMS MADE a OCCUR PERSONAL B ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG s2000000 POLICY PRO- LOG AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) s BODILY INJURY (Perperson) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Peraccident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY - AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S AGGREGATE $ OCCUR r ❑ CLAIMS MADE ` S $ DEDUCTIBLE $ RETENTION $ WC S7ATU- OTH• WORKERS COMPENSATION AND ER E.L. EACH ACCIDENT $ EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERSXECUT VE E.L. DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? Nyes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMB I S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. rAurcn I Al ^U SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Gatewood Homes, Inc. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ID_ DAYS WRITTEN 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 KIND UPON THE INSURER, ITS AGENTS OR Centerville, MA 02632 REPRESENTATIVES. AUTHORIZED REPRESEkTATIVE ACORD 25 (2001/08)1 of 2 #35866 LS1 0 AGUKU GUKrUKAI IUN TBaa . 01 19 O5 '^ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING & o NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 WEST MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 1990 HYANNIS MA 02GOI COMPANIES AFFORDING COVERAGE COMPANY 22LGR A ST. PAUL FIRE AND MARINE INSURANCE COMPANY INSURED - - / COMPANY HP BUISNESS SERVIC9S INC Ass ur a-nc¢ 6,islrue.filvi B 118 WATERHOUSE RD COMPANY SUITE E 1jQ,' BOURNE MA 02532 ✓ LL'�'1-�¢Jl.a- C �. COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L"J TYPE OF INSURANCE I POLICY NUMBER DATE (MPOLICY EMWD�YY) FFECTIVE I DATE POLICY EXPIRATIOMWDWY) "I LIMITS GENERAL LIABILITY COMMERCIAL GENERAL UABILTY CLAIMS MADE F OCCUR. OWNER'S & CONTRACTOR'S PROT. AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY —1 UMBRELLA FORM GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Anyone person) $ COMBINED SINGLE $ LIMIT BODILY INJURY (Per Person) $ BODILY INJURY $ (Per Accident) PROPERTY DAMAGE $ ALTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ ................. _.......... _.. _. A WORKER'S COMPENSATION AND STATUTORY LIMITS EMPLOYER'S LLABIUTY (LIB-4042837-2-04) 12-24-04 12-24-05 S....................0 __............ ' EACH ACCIDENT $ 100 000 THE PROPRIETOR/ X INCL DISEASE —POLICY LIMIT $ '500,000 FARTT lERS1EXECUTIVE OFFICERS ARE: EXCL DISEASE -EACH EMPLOYEE $ 100.000 COVERAGE RESTRICTED TO LEASED EMPLOYEES OF ASSURANCE EXCAVATION INC THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. AUTHORIZED REPRESENTATIVE Dates 5/5/2005 T1MG: 3s02 PM TO; Ii 15087785603 CI(enflh- 24359 - Paget 002.003 CAPECODREADV' ACCRD- CERTIFICATE OF UABUTY INSURANCE °"YYY' 0F PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Feitelberg Company 222 Milliken Blvd. ONLY AND CONFERS NO RIGHTS UPON THE -CERTIFICATE - HOLDER THIS CERTIRC=E DOES NOTAMENDr E)(TEND OR- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O: Box3220 Fall River, MA 02722 INSURERS AFFORDING COVERAGE NAIC k INSURED WSURER A: Acadia Insurance Companies Cape Cod Ready Mix Inc. PO Box 389 ' Orleans, MA 02653 INSURER B: Construction Industries Compensation 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 REOUIREMBHT, TERM OR CONDITION OF ANY CONTRACTOR`OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE-ISSUEDOR- MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EKCWSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEFI RE DJCM13Y PAID CLAIMS- LTRTYPEOFINSURANCE SM POUCYNUMBER LI FEGTIVE POLICY EXPIRA ON LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CW MS MADE iJ OCCUR CPA0132461110' _ _.. 0t/0't/>j5'. 01xt/w EACH OCCURRENCE E1000000 DAMAGETORENTED 5100000 MEO EXP (Arty one person) S5 000 PERSONAL 8 ADV INJURY $1 000 000 GENERAL AGGREGATE $2000000 GENt AGGREGATE LIMIT APPLIES PER POLICY PRO-LOC PRODUCTS • COMP/OP AGG s2 000 000 A _ AUTOMOBILE LABILITY ANYAUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NOWOMINEDAUTO6 MAA013246910 41101105, 01101106. OOMIINED SINGLE UMIT BODILY INJURY IF- Pa l E X X BODILY INJURY - lPaaC°oerM1) E X 'PROPERTYDAMAGE Pa aQ;faan) GARAGE LIABILITY ANY AUTO _ . _ AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC AUTO ONLY: AGO S S A EXCESSAMBRELLA LIABILITY _ :X1 OCCUR CLAIMS MADE DEDUCTIBLE X RETENTION so CUA013247010 61/01/06 _ 01/01/w EACH OCCURRENCE S1000000 AGGREGATE $ - S E - B WORKERS COMPENSATION AND EMPLQfERw-LIABILI V- .. .. ANY PRCPRIETORJPARTNER/EI(ECUTNE OFECERA(EMBER EXCLUDED? Ifye�OpsAbi W SPECIAL PROV!SIAOITNS below WC0009255 - W/01/US 01/01/00 .. . . X wCSTATU• OTH• E.L. EACH ACCIDENT . 5500000 - EL.gSEASE-EAEMPLOYE ESOO 000 El.gSEASE- POLICY LIMIT 5500003 OTHER DESCRIPTION OF OPERATIONS LOCATIONS fVEMCLESTEXCLUSONS ADDED-Bl'ENDOASEIEWj SPECOIt PROVISIONS- .. Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, MA 02632 I ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION HERE,OFTHSISSUINGINSURER-WILLENDEAVORTOMM), WDAYSWRRTEµ TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL NOOBUGATION OR LIABILITY OFANY KIM UPON THE INSURER TTSAGENTS OR '- �as.vnvvtcwaMa# 1 -oTZ #T55899WM66525 AH1' 0- ACORD CORPORATION 1988 05/06/2005 09:38 5084204474 EDWARD A GRAZLL PAGE 02 DATlIMMfOOfY1 ACORDTM' CERTiRCATE OF UABLUTY.INSURANCE. THIS CERTIFICATE IS ISSUED AS A MATTER OF WFORMAT PNDoucEN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC MEND- FJAmd A. Gm, 11.Dmra= AgeMYT ztc• HOLDER. THE GOVERILG AADEDY THE OC1BELI LE�DBP' P.O. FIC 337' MarSt[I15 Mi11S+ MA 1NWRERSAF.FOROINGCCVERAGE NAIC#' INSURER O' , .. e /�,. 4LL yt�� - INSURERC.. -- , 145 Cmmtt Pced - Gate wow I' m eST..Im- G/Q EdL Ta 'elt tbu . . Rte -28- Catteville, MA 02632 FAX:. 1-5w-778-5603 6HOULD ARV OF THE AOOV1nK=fflS OEDlOUcW3 OQ DAHCELLED OUM6,14E EXMMATION OATS THEREOF THE WALL ENOEAVOR TO MAR DAYS WwrrEH ROflCE TO,THE CERTIFICATE HOLDEN NAMED TO THE LEFT. NUT FAILURE TO DO SQ SMALL WPM 4J*0NLIGAZ0R-0N MAWLITY. OF ANY. KIND UPON THE INSDRM RS-A6ENTS-0F CERTIFICATE OF INSURANCE ISSUE DATE(MM/DD/YY) 05/06/2005 -PRODUCER Harold H Williams Ins Agcy Inc 81 Bassett Lane 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 COMPANIES AFFORDING COVERAGE INSURED Stephen M Childs 145 Cammett Road COMPANY A.I.M. Mutual Insurance Co LETTER A Marstons Mills, MA 02648 COVERAGES THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EJOD TIO DATE(MM/DDNY) LIMITS GENERAL LIABILITY IGENERAL AGGREGATE S PRODUCTS-COMP/OP AGG. S COMMERCIAL GENERAL LIABILITY LAIMS MADEL�CCUR PERSONAL&ADV. INJURY $ EACH OCCURRENCE S OWNER'S& CONTRACTOR'S PROT. - FIRE DAMAGE (Any one fine) $ MED. EXPENSE (Arty one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY (Per Pers'On) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per=ident) $ HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ (EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE S MBRELLA FORM THER THAN UMBRELLA FORM 'OREEIL'S COMPENSATION AND A XLIMITS A :Ml'LOl'ERS' LIABILITY 7015793012004 12/13/2004 12/13/2005 EL EACH ACCIDENT S 100,000 EL DISEASE —POLICY LIMIT $ 500,000 rHE PROPRIETOR/ INCL ARTNERVEXECUTIVE FFICERS ARE: X EXCL EL DISEASE —EACH EMPLOYEE S 100,000 OTHER DPSCRI17ION OF OI'ItRATTONS/LOCATIONSNEIDCLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gate1V00(1 Homes . - EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Bell Tower Mall Rte 8 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 , A,C RD. CERTIFICATE OF LIABILITY INSURANCE DA rz8`"" 004 PROPUGFR Serial # A1530 ROBERT P. BIXBY, CPCU P.O. BOX 830 - 651 PUTNAM PIKE GREENVILLE. RI 02828 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 HOLMES AND MCGRATH, INC. 362 GIFFORD STREET FALMOUTH, MA Q2540 • NsuRER A: NATL FIRE INSURANCE CO. OF HARTFORD INSURER B: VALLEY FORGE INSURANCE CO. INSURER C: CONTINENTAL CASUALTY CO. 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. rasrt �°°L TYPE OF INSURANCE POLICY NUMBER - - POLICY EFFECTIVE EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY- CLAIMS MADE M OCCUR 1074082434 10/06/04 10/06/05 EpA�,CH OCCURRENCE - f 1 000 000 PR AG O E� D �E f FIRE 250,000 MED OW Vknyone E 10,000 PERSONAL 6 ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000 000 GENL AGGREGATE LIMIT APPLIES PER' POLICY PRa LOC PRODUCTS-COMPIOP AGO $ 2000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS - COMBINED SINGLE LIMIT (6 a=KferM E BODILY INJURY IPa Pam^) f BODILY INJURY Fa acmdmM E ( GE s GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT f OTHER THAN EA ACC AUTO ONLY., AGG E E EXCF_SSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION �f EACH OCCURRENCE f AGGREGATE f f E f B WORKER'S COMPENSATION AND EMPLOYERS LIABILITY ANY OFFeFIICER/MEMBER EXCLUDED? E SPECIAL PROVISIONS below 2057445273 09/01/04 09/01/05 X TORY WC STAB OTH- EL EACH ACCIDENT s 1,000,000 EL DISEASE- EA EMPLOYEE E 1,000,000 EL DISEASE -POLICY LIMrr s 1000,000 C OTHER PROFESSIONAL LIABILITY AEA 00 43133 38 07/13/04 07/13/05 $1,000,000 PER CLAIM/ AGGREGATE DESCRIPTION OF OPERATK)NSILOCATIONSNEH=-ESIEXCLUSWMS ADDED BY ENDORSEMENTTSPECIAL PROVISIONS AGGREGATE LIMITS ARE PER THE TERMS AND CONDITIONS OF THE POLICIES. / CERTIFICATE HOLDER CANCELLATION GATEWOOD HOMES, INC. - 1600 FALMOUTH RD., STE. 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 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUT REPRE 1 ACORD 25 (2001108) l ' V ACORD CORPORATION 1988 C AFMIPROCE RTPROS Y P5 ACOiFICAT.E OF LIABILfTY INSURANCE 5/d/05rm THIS cMnFICATE IS ISSUEDASA MATTEROF INFORMATION nce Agency, Inc. ONLYAPDCOMWSNORIGHfSUPONTHECERTFlCA-TE eet ► mDmrmsC�IRCATED06N0r AMBAEXFB�OR- ALT9i THE COVERAGE AFFORDED BYTHEPOLICI6 B5-OW. 3, MA 02532 INSURERS AFFOFDINGCOVERAGE NAICA INSURED a Patton Electric, Inc. 128 Scituate Road';Mashpoe, MA 02649 COVF3tAGES 'ENE NAMED ABOVE THE POLICY ANDING PERIOD INDICATED_ NOTWITHSTOR INSURED -FOR TNE.POLICLES OF INSURANCE LISTED BELOW HAVE BEEN tSSVED TOISSUED WITH RESPECT WL�IClI.THt3 CERION A ANY REQUIREMENT, TERN ORCONDtTION OF ANY CONTRACT OR OTHER DOCUMENT IS SUBJECT TO ALL THE TERMS, C ND13E AND F E)aCLUSIONS ANO CONDITIONS OF SUCH =V-PERTAIN_THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS: - - --rouOY-EF we"'U"- JDUCY DR .. LSRITS-. o• POLICYNUMSER - - l� EACH OCCURRENCE S J OOO , OOy GENERAI.xDISLIrx SCP42415399 7/30/04 • • 7i30JQ5 .Ar m E s s 300,OD0 p, oaMu xxcIALDENERALUAeam MED �enm f l0 pan CLAMSMADE o OCCUR _ JIERSONAL&ADY RIJURY S ], y.QIIOyQiLD..' . ONALA D GENERALAOGREGATE s 2,000,000 PRODUCTS• CDMPIDP AGG CER7. AGGREGATE LIMIT APPLIES PER: PICY PRAT . ... LOC OL- COMBINED SINMUMIT t. AUTOMOBILE LIABILITY (6.otl0en0 ANY AUTO ALL OIMTEOAUTOB ... - DOOLYINAIRY {PQ Pxwnl ! SCHEDULED AUTO£... NIREDAUTOS .. 0 Oy YZARY !.. . NOH.OwNEDAUTOS. PROPERTYDAMAOE s AUTOONLY. EA AC CI DENT S GARAGELIABLIT' --- . EAACC S . ANY AUTO OTHERTHAN AUTOOHty: AGO ! EACH OCCURRENCE s AGGREGATE s EXCEMM ORELLA LIABILITY OCCVR LUPAD MADE .. t i DEDUCTIBLE RETENTION t Tt4 WORK HIS COMPENSWI(M AND EMILOYERS'LIAMLITY WC23i3353OQ901d ... 12/1D/.D4 .. 12/1Q105 E.LEACHACCIDENT.... ! .. 1OjCLAO - EL.OISE&U. EA EMPLOYEE f 500,000 B ANYPPROPRIF ARTNDRO/ECUTAC ER OFFCCRAMEMjM,. Peu b&UIIW .3eedw X ELDtSFASE. POUCYLIMR f IQ()QOii oT�R DBICRIPTIONofoFERATC"ILOCATIONS/MrJCtrXCLtlll"ADDFDBYERDDRBMLVTISPFCMLPRDMBtORS Electrical i CT/�.V YID Gateway Homes, Inc. &MOULD ANY OF THE ABOVEDESCRIDED POLKESBECANCELLED BEPORETH9111"ATION 1600 raluotsth Rd., unit 75 PATETMEREDF.TREI"UMGINSURERWLLEMDBA40RTCMAIL _OAYSW RRTEN fax 509-778-5603 MGTICETOTMECERTWICATEROLOCRNAMEDTOTHELSFT,BUTFALIRIETDDDBD9NA r Centerville, Ma 02632 IMPOSENOODLMATmo9 Uo LIIYOFWYKWQUPDNTHEMWRER,RS ADERTB OR lose.._ . _-_.:.�.._ .......... ... . ACORD OF '"CERTIFICATE _. ., :. DATE (MMA)DNY) `,. LIABILITY INSURANCE : 9 15 04 , . . .. PRODUCER Chatfield, Whitman Young 549 Washington Street THIS CERTIFICATEISISSUED 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. P.O. Box 850963 COMPANIES AFFORDING COVERAGE Braintree, MA 02185-096 COMPANY _A Harleysville Worcester ins Co INSURED COMPANY Lawrence Robinson Masonry B 5 Fresh Hole Road Hyannis, MA 02601 COMPANY C - COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE - POLICY NUMBER - POLICY EFFECTIVE DATE(MM/DD" POLICY EXPIRATION DATE(MM/DDI'M LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY - 7 CLAIMS MADE OCCUR CB 7E 32 32 9/07/04 - 9/07/05 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 PERSONAL& ADV INJURY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 OWNER'SBCONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $ 100,000 ME D EXP (Any one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULEDAUTOS HIRED AUTOS - BODILY INJURY (Per accident) $ NON -OWNED AUTOS - PROPERTY DAMAGE $ GARAGELUABILITY AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO - EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY- EACH OCCURRENCE $ AGGREGATE $ UMBRELLAFORM VJC STATU- OTH- TORY LIMBS I I ER $ . OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EL EACH ACCIDENT $ EMPLOYERS' LIABILITY EL DISEASE - POLICY LIMIT $ THE PROPRIETOR/ INCL PAFt NERS/EXECUTNE OFFICERS ARE: EXCL - EL DISEASE -EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONSA.00ATIONS/VEHICLEStSPECIAL ITEMS CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gatewood Homes EXPIRATION DATE THEREOF, THE ISSUING COMPANY WALL ENDEAVOR TO MAIL 1600 Falmouth Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Suite 25 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILI Centerville, MA 02632 OF ANY KIND UPON THE COMPANY ENT$ OK'JE14SENTATPAS. AUTHORIZED REPRESENTATIVE Robert E. Chatfield ol1CORDCOf2PORATION'1988' JMI DATE ACORD. CERTIFICATE OF LIABILITY INSURANCE Ro 6 09-27-2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 210706 P: (877)287-1312 F: (877)287-1315 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 308 FARMINGTON AVE INSURERS AFFORDING COVERAGE FARMINGTON CT 06032 INSURED INSURERA:TWln City Fire Ins Co I INSURER B: LAWRENCE ROBINSON MASONRY INC INSURERC: 5 FRESH HOLE ROAD INSURER D: HYANNIS MA 02601 INSURER E: GUVtHAUt, 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. /NSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM D POLICY EXPIRATION DAT(MMMDIYV L/M/TS GENERAL LUBMITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE O OCCUR - EACH OCCURRENCE ! FIRE DAMAGE (Any one fire) ! MED EXP (Any One Person) ! PERSONAL& ADV INJURY ! GENERAL AGGREGATE ! GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY El PRODUCTS. COMP/OP AGG ! AUTOMOBILELIARIL/lY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS - - HIRED AUTOS - NON -OWNED AUTOS - - - - - - --(Per - °-'(Per COMBINED SINGLE LIMIT Me accident) ! ' BODILY INJURY Person) ! . BODILY INJURY - accident ! PROPERTY DAMAGE' (Per accident) .. ! GARAGEUABILITY ANY AUTO . AUTO ONLY . EA ACCIDENT ! OTHER THAN EA ACC AUTO ONLY: AGG ! ! A EXCESS UABB?Y OCCUR 0 CLAIMS MADE DEDUCTIBLE RETENTION _ ! - WORKERS COMPENSATIONAND EMPLOYERS'LLABBITY - 76 WEG NQ5620 09/06/04 09/06/05 EACH OCCURRENCE ! AGGREGATE - E ! ! X WC STATU- OTH- E.LEACH ACCIDENT $100 000 E.L. DISEASE - EA EMPLOYEE !10 0 , O 0 0 E.L DISEASE - POLICY LIMIT l500 000 OTHER DESCRIPTION OF OPERA7'/ONS20CA710NSIVEMCLES/EXCLUSIONS ADDED BY ENDORSEMENTI&PECLAL PROVISIONS Those usual to the Insured's Operations. GATEWOOD HOMES 1600 FALMOUTH ROAD, SUITE 25 CENTREVILLE MA 02632 DULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE LDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25-S (7197) ACORD CURPURAI IUN 1aua 12/02/04 13:36 FAX 5087900249 GOLDMAN ASSOC "ac Rv_ CERTIFICATE OF LIABUTl�-tl UMAIV-E CSR AS DAT.(LMTnD000tp_.. _ . _ TAVAN50 1 12 02 04 vRODuceR' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOLD)IIAN A ASSOCIATES INSSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FINANCIAL SERVICES INC. HOLDER. THIS CERTIFX:ATE DOES NOT AMEND, EXTEND OR 933 FALKO7= RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NYANNIS MA 0:1601 Plionse 508-775-6610 FaxiS08-790-0249 INSURERS AFFORDING COVERAGE NAICSF INSURED - INSURERA: MARYLAND CASUALTY COMPANY INSURER B: RODM.T TAVANO DBA MECHANICAL SYSTEMS INSURERC: INSIIReIaa W18AENSTAASLE�MA 02668 INSURER e Ce7d74:7T13*-3 THE POLICIES OF INSULANCE LISTED BELOW HAVE BEEN ISSUED TO THE INe"ED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RGOURLLiNT. TERM OR CONDITION OF ANY CONTRACT OR OT34M DOCUUrNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INS:JRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SVWECTTO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMOS SHOWN MAY HAVE BEEN REDucED BY PAID CLAIMS.- LTRINSRE TYPEOFIMURANCE POLICY NUMBER DATE HAND DA E MMID - LIMITS A GENERAL LMaILITY Y COMMERCIALGENERALLMBtLITY CIfAAs MADE ❑ OCCUR 000372088 11/21/04 11/21/05 EACH OCCURRENCE S 1000000 PREMISES (Eaoml ) s 300000 MED EIIP (Any are pa ) $10 000 PERSONAL A ADV INJURY $ 1000000 GENERAL AGGREGATE s 2000000 GENT AGGFS:GATE LpGIT APPLIES PER POLICY I ,� Lac PRODUCTS-COMROPAGG s 2000000 AUTOMOBILk LIABILITY ANY AUTO ALL OWHEB AUTW ECHEDULEDAUTos HIRED AUTOS NON-O%'N€0 AUTO& .. COMBINED SINGLE LIMIT BODILY INJURY (Papa ) s BODILY INJURY IPer aslaenq s PROPERTY DAMAGE cPa.amaeAn s am 1)ARAOELW)ILOY AUTDDNLr-EAACEfOEHT Is - OTHER THAN EJAAC.C-' AUTO ONLY: AGG S S - EXCESSIULNR].LALMJIILTTY MS OCCUR CLAMADE DEDUCTIBLE -RETENTION • S EACH OCCURRENCE S AGGREGATE 3 S S - - WORIUM COMPEFISATION AND EMPLOYERS' W&JTY ANY PROPRIETORM-ARTNER/EXEGUTNE OFFICERIMEMBERI>(CLUDEM Mv� , 00 inQe' S roccit 04*00 01 hel. i TORY LIMBS ER E.L EACH ACCIDENT S E.L. DISEASE -EA EMPLOYEE s EL DISEASE -POLICY LIMIT s OTHER pESC1.YMION CF OPE7tA'TICNS/LOIJITKONSILTcN.'CLiBIfE.-.CL - PROYpgNQ-'... CFQTKN_ATF MAt AFQ CANCELLATION - 1 - GLTTPBTtTn _SHOULD AMY OF THE ABOVE DEWRIBED POLICIES BE CAMCELLEO BEFORE THE EXPIRATION DATETHEREaF.TNEmsuNaLmsuRERMIILLENDEAVORTOMAIL 30 WAYS MRID'TEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FALURE TO DO SO SHALL �wTA—MOD-ROSSES INC— IMPOSE NO OBLIGATION ORLIABBRYOFANY IGNOUPON THE NSURERITS AGENTS OR FA% 508-778-5603 1600 FALMOOTS ROAD SUITE 25 REPRESENTATIIR3. ALITH0011= REPrmEXTATnE CENTERVILLE MA 02632 U ACORD 2S (2001108) 0 AGONO COIPoNATION TVW ,. nzksnt,ran n4ZLzvta J)fufzvvu LV:J.7 eAVL, vv4/vvY rax DCz"VCr -.IQ"AT DATELMMWDtTY('_ L v. .. 05-06-OS THIS CERTIFICATE IS ISSUED AS A MATTER OF-INFORMA2tow PRODUCER -ONLY-AND- CONFERS-NP-RIGHTS •UPO*-THE--"CERTIFICATE-- GOs AssoC Iris FIN .HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 933 FALMOUTH RD ALTER-THECOVr:RAGEAFFORDMBYTHEPOLICIESBELQW--.. RTE 28 - HYANNIS MA 026012319 COMPANIES AFFORDING COVERAGE - COMPANY - 28HPP 'IA "AMERICAN "ZLTRICH-rNSORANCE'COMPANY-- INSURED COMPANY--' TAVANO, RODNEY DBA a -- MECHANICAL SYSTEMS COMPANY 201 CAPES TRAIL " ' WEST -BARNSTABLE 'MA 02668 C- - COMPANY D. a ,, a.a �� .>✓ '; > , ... THIS JS i0'`CERIIFY THAT THE POLICIES OF INSURANCE LISTED BEJ.oW-HAVEtBEEN ISSUED TO THE INSURED NAMED„ ABOVE -FOR THE POLICY -PERIOD ` INDICATED, NOTWITHSTANDING ANY REOUIREMEM, TERM OR CONDI110N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ' CERTIFICATE -"MAY B.E ISSUED. OR.MAY PFRIAtN,THE_IPLSllRANCE AFEORDEIL B1LiHE_POLICtES•QESCRI6EQ HEREINAS SUB.lEC7 ID-ALLTHE TEfMS�, EXCLtJGKWS--AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - CO L TYPEOFINSURANCE POUCYNUNBER .-.. POLICY EFFECTIVE POLICY EXPIRATION - -LIMITS - ITATEIAMADBIYY)" OATEjMMDBtW1y-"- GENERAL UABIUTY GENERAL AGGREGA-E $ PRODUCTSCOMPIOP AGG. : CCMMERCIAL GENERAL LIABILITY _ CLAIMS MAOE = OCCUR _ -- - PERSONAL & ADV. INJURY g CH OCCURRENCE OWNER'S A CONTRACTORS PROT. FIRE DAMAGE (Any oie fire) g ED. EXPE-NSE(lt"ny one person) g AUTOMOBILE LIABILITY - - COMBINED SINGLE i ANY'AUTO '-_ - LIMB..... . ALLOWNEDAUTOS BODILY INJURY SCHEOULEDAUTCS-" - - (Per Person). g HIRED AUTOS BODILY INJURY NON-OWNEOAUIOS_ - - - (Per Accidart) PROPERTY DAMAGE g _ GARAG"ABILITY ... - _ AUTO ONLY - EAACCI LENT 1. OTHER THAN AUTO ONLY. ANY AUTO EACH ACCIDENT g " - - AGGREGATE g EXCESS LIABILITY - - EACH OCCURRENCE -g UMBRELLA FORM _ AGGREGATE g OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND EMPLOLYER'SUADWY (UB-727BA84-9-05 ).. _ 05-03-05 05-03-06 STATUTORY LMiTS _ ~10D EACH ACCIDENT S 000 THE P,flOPgIETOR! - DISEASE-POLICYLurr g 500 000 . PARTNERS/EXECUTIVE INCL - _ OFFICERS ARE " X- EXCL . - DISEASE-EACFFEMPLOYEE - - 100, OAO D CRIPTION OF OPERATION&LOOM ION&VEFLCLES'RE$TRICTIONS;SPECLALITEMS - THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. C E T{FtCATE HOLDER ' CANCELLATfON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE"•" EXPIRATION DATE THEREOF, THE ISSUING' COMPANY WILL ENDEAVOR TO MAIL -I0 DAYS'' WRITTEN NOTLCETO?HECERTtFICATE-HOLDERNAAtEDTOTNC- GATEWOOD HOMES INC FALMORVILLE TH AD SUITE 25 -LEFT,_SUT. FAILURE _TQ MAIL SUCH..NOTICE. SHALL IMPOSE NO. D.BLLGATION OR _ CENT CENTERVILLE' MA 02632 LIABILITY OF ANY KIND UPON THECOMPANY, ITS AGENTSOR REPRESENTATfYES "` AUrWRIZED REPRESENTATIVE EPRESENJ�I.Lc - . (✓ m a+ o GO-3 J 1 PRODUCT IFICATIONS GMS9/GCS9 SERIES 93% AFUE Multi -Position, Single, S tage/Multi, Speed Gas Furnace Heating Capacity: 46,000-115,000 BTUH u s-vEae wwuuTED- PARTS IIM ITfO WARRANTY_\ ` m A � 10E�Mwr E1� E1� i•� nnn•s �a�o am .,.. ® C (5 MUM 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 (I-pipe)applications 0I01011110 Air Conditioning & Heating The GMS9/GCS9 single -stage, multi -speed gas furnaces offer installation versatility. Cabinet Construction • Heavy -gauge, reinforced, fully insulated -steel cabinet with durable baked -enamel finish • Attractive architectural gray paint finish • Foil -face insulation -lined heat exchanger compartment • Coil and furnace fit flush for easy installation • Convenient left or right connection for gas and electric service • Bottom or side air inlet (GMS9) • Removable, solid -bottom block -off (GMS9) Accessories • L.P. Conversion Kit (LPT OOA) • L.P. Gas Low Pressure Kit (LPLPOI) • High Altitude Natural Gas/L.E Kits (HANG11, HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter Rack (EFR01) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Intemal Filter Retention Kit—upflow, (RF000180) • Intemal Filter Retention Kit�ownflow (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) SS-377D www.goodmanmfg.com 6/04 2 LOT 133 3Ss�F 9• pR ro' oy �26„ Ho°oos i4; / 4� g G`� T • ; r9 LOT 135 32 ; e y 1 .hry i ARQo 8' FF RN , 3 RpP V56 _ 1-1w / ?3 Is*O. 3 SPNp 290 Az� Co CID nZ ' R� �� , � � •3 �• 134 • � cF \�R NSFF M,q/Nl s `i _ z'7 �� BF40�c`/� S� OpoS O R=105.00 L 12 IkAA(,q4 a< 9 y S &T-C RATil 8' SnR-- � NO. 28078 GRAPHIC SCALE 1 inch = 20 ft NOTE: ® SEWER LATERAL SHALL BE r,S v SLEEVED IN ACCORDANCE �� WITH TITLE V IF WITHIN LOFT. OF WATER MAIN. NOTICIs Unless and until such time as the original (red) stamp cf tha 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 Infomiotlon contained heroin; and (U) this plan remains the prcperty of Holmes A, McGrath, inc. PLOT PLAN holmes and mcgrath, inc. OF LOT 134 L " civil engineers and land surveyors PREPARED FOR 362 gifford street MILL POND VILLAGE falmouth, ma. 02540 IN YARMOUTH, MA- JOB NO: 201197 DRAWN: LMC SCALE: 1 "=20' DATE: 1-5-05 DWG. NO.: A2520 CHECKED: MPD3328 MPD3530 MPD4035 33' fireplace w/opt. flush face 3S' fireplace w/brusbed stainless 40' fireplace w/polished brass 4 louver and door trim trim arch door kit Beauty, efficiency, convenience and reliability. Just some of what you'll find in our Lennox Merit® Plus Series direct -vent gas fireplaces. Our combo DV configuration, with both top and rear outlets, allows for top or rear venting (except. our 33" units which have either a top or rear outlet). Standard features include a deluxe pan burner that produces big yellow flames and glowing embers, brickaded interiors and Hi/Lo flame opera- tion. And, these models are even easier to warm to when you select one of our optional remote controls, or MPD4540 MPD4M5 Standard • Louvered face design • Charred split oak gas log set • Deluxe pan burner for big yellow flames and glowing embers • Charcoal black exterior powder coat finish • Realistic brickaded interior panels • Combo top/rear direct -vent outlets (except 3328 models, which have either a top or rear outlet) • Hi/Lo flame operation • Pre -wired for wall switch Op • Choice of standing pilot (works in a power failure) or pilotless electronic intermittent) lgniuon • Decorative polished brass or brushed stainless accessories (arch door kit, door trim, louvers, hood) • Wireless remote controls • Blower kits (including a temperature control version) • Screen panel kit (heat guard) • Radiant panel kits (for a clean face look) All Merit' Plus Series direct -vent gas fireplaces utilize either a Secure Vent (rigid) or Secure Flex Iflextble) 4.5' inner/7.5' outer coaxial venting system, and include a e to Lennox' ongoing commitment to quality, ons, ratings and dimensions are subject to or nonce. editions, such as elevation, wind vent configu- oice of fuel will affect the overall appearance Hersey Q20006711) Warnock Hersey V/ C Fez US The first two model number digits indicate frame width, the last two digits indicate glass width. All are A.F.U.L-rated high efficiency vented gas fireplace heaters, certified under ANSI Z21.88 and CSA 2.33-M99. MPD3530 . MPD3328 DIMENSIONS (Rear vent model shown) 3328 MODELS (This model comes as a top or rear vent only) _1 D 1 611HB" 7-UY 4-11Z Front Face 35.40 & 45 MODELS Right Side Top (These models come with a top and Front Face Top Right Side FIREPLACE & FRAMING DIMENSIONS 3530 . 351/8 321/8 19 293t 351/s 2111h6 2478 12%6 35t/4 35Y4 16 4035 401/s 37t/8 24 34% 40% 2611A6 297i 14% 403'4 40Y4 16 45C 401/8 373/8 24 39% 451/8 2611h6 34%8 17%16 45/4 404 16 3328T NG_ 17,500 45 64 62 3328T LP 17,500 49 66 64 3328R NG 17,500 53 63 61 3328R LP _ 17,500 55 66 64 3530 NG 20,000 53 64 62 3530 LP 20,000 55 62 60 4035. NG 27,000 59 69 67 4035 LP 27,000 60 69 - 67 4540 NG 29,000 59 69 67 4540 LP 29,000 59 69 67 *Intermittent ignition systems Look for the EnerGuide TYPICAL ROOM APPLICATIONS MAscheck COMPLIANCE REPORT Massachusetts Energy Code MAscheck software version 2.01 Release 2 CITY: Yarmouth STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 HEATING SYSTEM TYPE: Other DATE: 5-7-2004 DATE OF PLANS: 05/07/04 TITLE: The Tern Family, Detached (Non -Electric Resistance) PROJECT INFORMATION: Mill Pond village Camp Street Yarmouth, MA. COMPANY INFORMATION: Northside Design ASSOC. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES i I I I Permit # I I I I Checked by/Date I I Required UA = 354 Your Home = 190 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1030 30.0 30.0 18 WALLS: wood Frame, 16" O.C. 2043 15.0 15.0 90 GLAZING: windows or Doors 115 0.340 39 GLAZING: windows or Doors 40 0.340 14 DOORS 40 0.086 3 FLOORS: over unconditioned Space 1030 19.0 19.0 26 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable standard Design conditions found in the code. The HvAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date Massachusetts Energy Code MAscheck Software version 2.01 Release 2 The Tern DATE: 5-7-2004 Bldg.l Dept.l Use I CEILINGS: [ ] I 1. R-30 + R-30 Comments/Location I WALLS: [ ] ( 1. wood Frame, 16" O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: C ] I 1. U-value: 0.34 For windows without labeled u-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location [ ] I 2. u-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] I 1. U-value: 0.086 comments/Location FLOORS: [ ] I 1. over Unconditioned Space, R-19 I comments/Location AIR LEAKAGE: [ ] I 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 I inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the i conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating [] I I [] I I I and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: Ducts shall be insulated per Table 34.4.7.1. DUCT CONSTRUCTION: All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and 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) PROPERTY ADDRESS: CALCULATION FOR PERMIT COST TYPE OF ROOM ETC ' xsyts�y y �"O� or, 90 ADDITION ALTERATIONS 6"2 3zI, - BATH 5$' BED ROOM b/ 6 • CERTIFICATE OF OCCUPANCY COMPUTER ROOM DECK OPEN DECK WITH ROOF 9:11111.2*1*. FAMILY R m FIREPLACE FOUNDATION ONLY GARAGE NO.OF BAYS / GREAT ROOM KITCHEN LAUNDRY ROOM MING ROOM MUD ROOM OFFICE PORCH CLOSED PORCH OPEN Ema-•• ' —'� TOWN OF YARMOUTH Building Department _ Town Hall e Yarmouth, MA 02664 (508) 398-2231 ext.261 R BUILDING PERMIT 1J TRANSMITTAL Temp Permit No.: T-05-616 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST Unit 134 Owner's Name: Villages @ Camp St., LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: [2IE9IEaWFLD 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: iL DATE: N/A: 5. BUILDING DEPARTMENTV DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: zzen?- RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/24/2005 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Date of Issue : May 31, 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) 21.1 Street 121 Camp St., #134 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 @ Camp St., LLC : 1600 Falmouth Rd., #25 : Centerville, MA 02632 Y ' R TOWN OF YARMOUTH Building Department _ Town Hall e.. a Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-616 Applicant Name: Frank Capra Applicant Phone: 5087789669 ' Building Location: 00121 CAMP ST Unit 134 Owner's Name: Villages @ Camp St., LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 ' Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 943 Net Owed: ($50.00) Application Date: 5/12/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: REVIEWED BY: 1. WATER DEPARTMENT: DATE: / -�N/A: i osz 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 5/24/2005 112 TOWN OF Building AT: Location _ New(X Plans Submitted NOV 2 12005 Renovation ❑ Yes 0 No Ik APPLICATION FOR PERMIT TO 00 GASFITTING —_—(OFFICE USE ONLY) Fee: -.--- PERMIT NO., 0- Oi7- 6,7 _ Owner Nam - 5 ` e � Type of Occupancy —. Replacement ❑ 1 (PRINT OR TYPE) �� Installing Company Name -✓UG.7-S-_-D-A tT _ Address Business Telephone—? Check One: O Corp. 0 Partnership rt Firm/Company _._. Name of Licensed Plumber oar _t4L!Zy L- In INSURANCE COVERAGE: Check One I have a current iiabtfity insurance policy or its substantial equivalent. Yes Li No (� If you have checked yes, please indicaatepe type of coverage by chacking the appropriate box. A liability insurance policy FS Other type of Indemnity C3 Bond O OWNER'S INSURANCE WAIVER' I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Signature of Owner or Owner's Agent t hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurste to the beat 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 Check One: Owner ❑ Agent ❑ e — V signature of Licensed Plumber or Gesfitter z ! SS 10,4 License Number Tvoe r rrawcc. r1, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 OF y ? 49,yo (OFFICE USE ONLY) FNAR I UTH By WrrACMEESE � 2005 Fee: $ � S• � d SEP /oZ5 PERMIT NO. __ �06 " (PLEASE PRINT IN INK ( ION) Date: �/ a� 0 To the Inspector of Wires: y this application the undersigned gives notice of his or her intention to erform the electrical work described below. Location (Street & Number) Owner or Tenant Gfe�. �lz��'t''j I h �' Telephone No. 271 966 9 Owner's Address Yew + k S _ � «1l6e�yelc,�, C`/cn Is this permit in conjunction with a building permit? 1'Yes [] No (Check Appropriate Box) Purpose of BuildingL��Giar�'"� �' 7 rp Utility Authorization No. A ,SSG. 7 A Existing Service Amps / Volts Overhead[] Undgrd No. of Meters vice 'M Amps -1�D /,*' Volts Overhead[] Undgrd [] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed electrical Completion of the followine table may be waived by the InsnectnrofWimv No. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA No. of Lightiniz Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- SwimmingPool md. [] rnd. ❑ No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Bumers FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners ers D n ic o. o InitiatingDevices No. of Ranges t Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: um er — — Tons _I — K K _ No. of Self -Contained Detection/Alerdng Devices No. of Dishwashers Space/Area Heating KW Municipal Local [] Connection [] Other No. of Dryers Heating Appliances KW Secutity Systems: No. of Devtces or E ui valent No. of Water Heaters f KW No, of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. H dromassa a Bathtubs Y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. 7 ,/ CHECK ONE: INSURANCE � BOND[] OTHER[] Z_ (Specify:) 4l (Expiration Date) Estimated Value of Electrical Work: � Gl/ (When required by municipal policy. Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under then s and penalties of perjury, that the information on this application is true and complete,�- j AJVM NAME: ✓ �IZ7f4 Ciiithf LIC. NO.�f- ensee: 1� �a -Signature:- �� h'J LIC. NO. (If applicable` enter "exempt" in the license number line.) �—' Bus. Tel. No.: S tl� 4/n 6 g 76 S'' Address: �� C4ln 1n G� /i � ;M4 0 Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) owner ❑ owner's agent. Owner/Agent Signature Telephone [Rev. 04/00] • .. R : Commonwealth of Massachusetts ° Use only G Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked •. •, � .� \ 1 ve bhmk LN APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Allbe pedomud in ==da= with the Massuhusetts Mee4ical Code (MEG), 527 CMR 12.00 P$IIfTIYVK0RYTPEALLXMRW770N9 Date: 0�\\ ci 1 Town of: YARN>plT1'x To the Inspector of Wires: . ✓Bythis ration the undersigned gives notice of his or her intention to perform the electrical work descnbed below. -I ation (Street & Number) max POND vmLAGE, 121 C=P St Bldg #- Owner or Tenant Gatewood Hennes/ Jeff Sollows TelephoneNo.508-7789669 Owner's Address 1600 Fallmuttl Rd., Suite 25, Centerville, Ma. 0263.2 Is this permit in conjunction with a building permit? Yes El No ❑ (Check Appropriate Box) Purpose of Building single family residence Utility Authorization No. VT!Wwg Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgcd ❑ No. of Meters NumberofFeeders and Ampacity Location and Nature ofPruposed Electrical Work Fire Alarm System (law voltage control panel) idt-h harlaM 'batterv, centrally monitored. ComoletY of the following table may be isnived*v the 1mvector ofWiret No. of Recessed Fixtures No. of Cell-Susp. (Paddle) Fans f T Transformers KVA No. of Lighting Outlets No. of Hot Tubs Genamors KVA No. of Lighting Fixtures Swimming Pool d C. 0 d. Battery Unitsg No. of Receptacle Outlets No. of OR Burners FME.ALARMS No. of Zones —1— No. of Switches No. of Gas Burners o. o etectloa.an 7 Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers t p Totals: ' umher. ors o. o ontam Detection/Alertine Devices 7 No. of Dishwashers SpacelArea Heating KW Local Mnneetion ® Other No. of Dryers .. Heating Appliances KW Security ystems: No. of Devices brEcruivalent o. of Water KW Heaters o. o o. o Si Ballasts Data Wiring: No. ofDevices orEauivaleut Na Hydromassage Bathtubs No. of Motors Total HP Telecommunications wiring, No. of Devices or Etruivilent OTHER: Assam aaataonot await a desir" oral required by StslnrpeetorCfWires M COVERAGE: Unless waived by the owner; no -permit for the performance of electrical work may issue unless provides proof of liability insurance including "completed operation" .coverage or its substantial equivalent The certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHEM ONE: INSURANCE M BOND ❑ OTFIER ❑ (Specify:) Value of Electrical Work $ 750.00 (When required by municipal policy) Work to Start: Inspections to be requested in accordance with 1v1EC Rule 10, and upon completion. rcerdfy, under the pains turd penalties of perimy, that the information on this application is true and complete 1 MMNAME: Baltic Securityr Inc LIC.NO.- 1178C (Licensee: Jonas R Bielkevicius Signature LIC. NO.: 499D (IfaRlimble, enter "exempt"in the licauemtmbe Bus. Tel. No.- 508-833-0996 Addrtss:._'P0 'Box .1609 :S dwicfM, 02563 Alt Tel No.: 508-7 —3 47 OWNER'S INSURANCE WAWER:.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. OwnedAgeat Signature. PERMIT FEE. $' 40 .'00. TelephoneNa. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 TOWN OF PLEASE PRINT IN INK OR PE ALL (OFFICE USE ONLY) �/,P Fee: $`*6`' PERMIT NO. C, To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to �erform the electrical work described below. Location (Street & ;Itpitber)'� ( Lei----jj3 `I Owner or Tenant �ne No. Owner's Address [� �J Is this permit in conju Coln with a building permit? O Yes ❑ No (Check Appropriate Box) Purpose of Building 'Ito v Utility Authorization No. Existing Service Amps / Volts . Overhead❑ Undgrd 0 No. of Meters New Service ly0 Number of Feeders and Location and Nature of Proposed electrical Undgrd 9� No. of Meters Completion of the following table maybe waived by the Inspector of Wires FixturesAmWo, of Recessed . of Ceil.-Susp.(Paddle)Transformers o. of Total KVA o. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Abo ve n- Switraiiing Pool gmd. ❑ gnid. ❑ No. o Emergency tg trng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS77 No. of Zones No. of Switches No. of Gas Burners o. ot Detection an Initiating Devices No. of Ranges No. of Air Cond. T ns No. of Alerting Devices No. of Waste Disposers eat Totalsp : um r — — ons — — — No. of Self -Contained Detection/Alertin Devices No. of Dishwashers S ace/Area Heating KW P g Local Q Municipal Connection ❑ Other No. of�Dryers Heating Appliances KW SecuNtoityoSfysms or Equipyalent No. of Water Heaters KW No. of No. of Signs Ballasts ata inng: No. of Devices or uivalent No. H dromassa a Bathtubs Y 8 No. of Motors Total HP Telecommunications [ring: No. of Devices or ivalent Attach additional detail if desired, or as required by the Inspector of Wires. 1—" INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BONDC] OTHERQ (Specify:) (Expiration Date) VEstimated Value of $lectrical Work: (When required by municipal policy.) Work to Start: 4(II certify, unde th NAME L ee: t f applicable, pP, OWNER'S INSURANCE WAIVER: I am aware that below, I hereby waive this requirement. I am the (ct Signature beLe ed in cordance with MEC Rule 10, and upon completion. thform on on this application is true and complete. LIC. NO. _ _Signature LIC. NO. ier li .) Bus. Tel. No.: • - _ TV - Alt. Tel. No.: LiceXeek does not have the liability insurance coverage normally required by law. By my signature t one) ovMer Q owner's agent. O - Telephone No. Hi Raul, Thanks for the update, I'm sorry I didn't respond earlier but I've been out the pas few days on personal business.uth Something that be cleared up is mandating the nst llat onhe Twn fand/orouse (o n o' nc ete on Building or anybodyody else) no this pipe. That conversation came out of a discussion between the developer and I when we mentioned that we would need some sort of assurance that this drain pipe would not cause damage to the basement of the abutting dwelling• construction anYou may d that the drain pipe has been disturbed horizontally and vertically hN that I have seen small holes in a few locations which have fueled our concerns. What we need is some assurance by Holmes and McGrath, Inc. that what ever is done will ement will not be egatively system works erly and the insure that the pipe. drai Once dec s o sr are made and work completed, Jim B andol ni affected by wants an Engineer's certification to that effect. Richard Anctil Yarmouth Engineering Division 1146 Route 28 So. Yarmouth, MA ranctil@yarmouth.ma.us From: Raul LizardiRi er [mailto:driverag Mra@holmesandmcgrath.comj Sent: Tuesday, April To: Anctil, Richie cc- comics@aol.com; Michael McGrath Subject: Villages at Camp Street Hi Richie, Update on the drain pipe next to unit 134 at Mill Pond Villages at Camp Street According to the contractor the drain pipe has been replaced with nnew pipe. The at noon, to pipe has thisn relocated to within the drain easement. I will visit the site today, April statements by the contractor. Next step for the contractor is to encase the pipe in concrete after 1 confine it's location within the easement. I will get back to you with additional info and my finding of today's site visit. Raul Lizardi-Rivera holmes and mcgrath, inc. civil engineers and land surveyors 362 gifford street falmouth, ma 02540 tel.: (508)548-3564 fax:(508)548-9672 e-mail: rlrivera@homesandmcgrath.com APPLICATION FOR PERMIT TO DO PLUMBING OF YqA TOWN OF YARMOUTH (OFFICE USE ONLY) MAWACHEESE /(� IIV r ^ By� 4'fivem @ VVV �`�J� a V a 'r Fee: / 42'2 D PERMIT NO. QIg 2005 L� By Date 2g� Building �;`"l/" �? Owners AT: Location Name Type of Occupancy New R at�ion ❑ Replacement ❑ J7 SDI b��, �... _:.. a Vnetvr,/ n n 0 �P"�F1yL r-j ula JUVuuuo� Z Z W W ,�`ti�(.5 h y r y J } O U Z Cn z tt Q. a 2 v y O z W Q (n= OyC W r S a r W rA y Y Q O: y O. Z Q z Q. Z Q F=- X �P U Z cc ca m cc Cl) W ¢ a W Z O J Z W n• W O LL 1 W= _ 3 0 z= a o r z z Q W u. Y W r O Q > r o Cl) y 5 a r z O O W oc ac ao a q 11 Y J m y p t] J 2 FQ- rJr) LL C7 O G Q tr m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Check One: ❑ Corp. _ Address BUJ ❑ Partnershi Vv Firm/Compan Business Telephone ( Name of Licensed Plumber OU INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check on Owner ❑AAgent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and Information 1 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. Plumber" License Number �-- Type: Master❑ JourneymanLJ