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121 Camp St #136 Building Permits
TOWN F_YARMI ino � �T,u Building AT: Location New[Y Plans Submitted AUG 2 5 2005 0 A Renovation ❑ Yes ❑ No fR APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By q Fee: PERMIT NO. Date Owner,$ / Name- A��il/sl� 5r Type of Occupancy ;FFojM / Age Replacement ❑ N ui W y Y w rA w @ O O U M m F H Ui M = N z J a Z¢ Z O w l < = z�a >W �n a o Lxu��a lu w Wm z ¢ a c: w r- w cc X U. Lu . a>wMaa°o°wP w M QQ o w o 0 M x 0 0 x iL : 0 ry U ¢ Wu G a H SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR It 3RD FLOOR Yel� (PRINT OR TYPE) Installing Company Name DucJs — V A]/,I &--A o ITEM Address t G 14AI E S r Check One: ❑ Corp. ❑0PPartnership — L�J Firm/Company SO F-7 3 7-36 i 4 Business Telephone _ Name of Licensed Plumber order 1A W Gr- INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes �No ❑ If you have checked yes, please indic^ate �t e type of coverage by checking the appropriate box. A liability insurance policy E r Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent P, hereby certify that all of the details and information I have submitted Signature o Licensed Plumber or Gasfitter (or entered) in above application are true and accurate to the best of 2 1 S my knowledge and that all plumbing work and installations performed 1 under Permit issued for this application will be In compliance with all License Number pertinent provisions of the Massachusetts State Plumbing Code and rvcc r ircucF• r- FILE COPY :J L; U Iy' i4 r; MAR 3 n 2005 LJ LOT 135 TING TION LOT A 36 I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD ARE ,r &L30 AaS DATE REGISTERED PROFESSIONAL LAND SURVEYOR Dc< FOUNDATION EXISTING LOT 137 �b I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF THE 408 SPECIAL PERMIT. /w" ap 22s- DATE REGISTERED P FESSIONAL LAND SURVEYOR GRAPHIC SCALE 01 r ( IN FEET ) 1 inch = 20 ft. AS —BUILT PLAN holmes and mcgrath, inc. VZH of Mgssa� OF LOT 136 civil engineers and land surveyors ��yt PREPARED FOR z� Ml HAeI_ MILL POND VILLAGE 362 gifford street $ IN falmouth, ma. 02540 TH YARMOUTH, MA JOB N0: 201197 DRAWN: LMC ��s�� ���STEa`�° JQ, SCALE: 1 "=20' DATE: 3-25-05 DWG. NO.: A2522A CHECKED: '*.°y4t L OF' �� TOWN OF YARMOUTH Building Department - BUILDING + (508) 398-2231 ext.261 PERMIT NO B-05-1038_ PERMIT K ISSUE DATE : _ 3/10/2005 - ; PROPOS E ------- APPLICANT Frank Capra JOB WEATHER CARD PERMIT TO ' New Construction ' AT (LOCATION) 00121CAMP ST # 136 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C136 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE O new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans dated REMARKS 02/09/05 and BOA # 3546. AREA (SO FT) EST COST ($ 1$148,896.00 PERMIT FEE (g) 1$543.Uo OWNER IVillages 0 Camp Street, LLC B ILDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville MA 02632 "J CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 Certificate Issue Date 3 CQUos� CERTIFICATE-of.00CUPANCY''% Departmental Approval for Certificate of Occupancy and Compliancey 1..0^n^fnr nnta Permit Number ADDroved BY Remarks PLUMBINGIGAS WA �011�../ / ENGINEERING To be filled in by each division Indicated hereon upon completion of its final inspection. TOWN OFYARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO B-05-1038_ PERMIT PROPOSED USE __________ ISSUE DATE ; - 3/10/2005 _ ; ' kC ---------- JOB WEATHER CARD APPLICANT 'Frank Capra _-_ - ' - - - - - - ________ PERMIT TO 'New Construction ; AT (LOCATION) 100121CAMP ST # 136 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1044.21A.C136 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 diningroom, 1 kitchen, 1 livingroom as per plans dated REMARKS 02/09/05 and BOA # 3546. AREA (SO FT) EST COST ($ j$148,896.uu mrirm i rcQ t,�j i OWNER lVillages ® Camp Street, LLC BUILDING DEPT BY ADDRESS 1600 Falmouth Road # 25 Centerville MA 02632 INSPECTION RECORD CONTRACTOR LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 FIELD COPY Date Note Progress - Corrections and Remarks Inspector O� v� Cv 17 G�dew : s� p l l� TOWN OF YARMOUTH % Building Department Town Hall MW*r"M Yama &, MA 02664 (508)398-2231ext261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-390 Applicant Name: Frank Capra Applicant Phone: 6087789669 Building Location: 00121 CAMP ST # 136 Owner's Name: Villages Q Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 — Centerville � MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 1/31/2005 Issue Date: Expiration Date Comments: 044.21.1.0 new construction: ZONING APPROVED 6 �~ REVIEWED BY: ✓1. WATER DEPARTMENT: DATE: WA: �2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: N/A: ✓ 4. HEALTH DEPARTMENT: DATE: N/A: ✓5. BUILDING DEPARTMENT: DATE: WA: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: Date Printed: 1/31/2005 r.. Of y i'tr MATTACMCCT �.v�J ONE & TWO FAMILY 6NLY - BUILDING PERMIT APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Towrl of Yarmouth Building Department '1146 Route 28 • Yarmouth, MA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508).398-0836 I UO i1G 1: t OF i`�LI$ 23 ,— i}P H`MYV'Y Jal'irn�oyg�oard�nfo�r�ahon�,.Asses�dYr�Uepa[�Y�aterrt�M�ormcaUOD��,�"�•.h � �51, � +,-,g ���€�* ;li' 4F{a^.1 .Y"F S. fny+�� iS.�3paia f �.'PI ;y jai �: �¢' t Pe 41Y�$`'=4�[r�������i� $li)hi+}� N� .YF "'j�/J'e���� �a°.�`ef�Fk`�q�•1 4%f.J. 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(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (BLO.L c. 40. S 54) '� '+ t < C ro}Si4'- s-0 •! a ter .�HS"f s .." !A','W744`..z{ k;?{> §, S lood��rne3nfomfation xH { am rentsy s Public Private �� W- s �ectton�,�2"��ro Q'.'�it�,rsl2irp`l�'i_i}tnnzQi,Y�,ger) 2.1 Owneof Rcrdeo tk f: M-- L cc(' Oc7 � ; > 1 N me Pntk Mailing Address r^Q� r v( 7 1A14 J� lc — Signature Telephone ►/1 uthourizOe4Agent:lM —C 0O✓ (print) (�p�„� P a Mailing Address I _re Telephone Il 19 L�, F j . ' III ' I es2fon arast( ac' e ieest �, I I � ' r nnG 41 /I rP . 3.1 Licensed Construction Supervisor.. lJ r f c Not APPli le 'q aR F d II a a License Number 00 clfaq3d Address % 7 -Sv Expiration Date ��-.�b—O Signature Telephone La art.rr%pr�vernet�bnra` or- 14 >2reslexe Company NameM tJ Not Applicable ❑ Address �]—T — - 1 License Number Expiration Date Signature Telephone 11P:7;01 7 9-15-99 1 of 2 OVER Seetfan°4 ..WorkerS� Coi%pensa�itu�lctsaratce �+tficiavtt (MG<Lp.'t�2�525C�t�j; Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial f the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... 5e�ctfs�'1� 5 `�i3esptfon oiFroposed���zl�,rchecrc�llYappiicah�e ; New Construction No. of Bedrooms No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. El Type Demolition Other Specify: Brief Description of Proposed Work: c ` W` fln Cn`sts, �Sectf©n, t�s�tiratedwConstructto\ Item Estimated Cost (Dollars) to be completed by permit applicant Check Below ❑ Conservation -Commission Fling (if applicable) ❑ Old Kngs Highway& Historical Commission approval (if applicable) 1. Building. o 2. Electrical 3. Plumbing / Gas S 4. Mechanical (HVAC) O 5. Fire Protection o G 6. Total = (t + 2 + 3 + 4 + 5) O S'-7 0 7. Total Square Ft. (new houses & add'Nons) Sect a a� caner A thorrraf rl wraes ent of Car3%actotAp besaf T&,be,Ctjmpfet d W e "~ BUfdtrtg F?rrrr)it e�1� r as owner of the subject property hereby authorize f -7A _ ���' J` YMA-e S lr'i 64P i'^ to act on m beh , in all matters elative to work authorized by this building permit ppl'dation..� r 1 0 Signature of owner Date 5ecttolb Ovuh'er/1ttanzedAjerltaD616faratian: I .1 , 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. F Aqf - Print name c� LJ �� r Signature of Owner/Agent Date u iA 9- 15-99 2 of 2 a TOWN.OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. - job Location: _ Owner of Property: Construction Supervisor: Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: .� s 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 any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yam, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE W R: I am aware that the licensee does not have the insurance coverage required by Chaprl,W of th Mass. a ral Laws, and that my signature on this permit application waives this requirement. :2) _ .d1./ ► Check one: Signa re of Owner or Owner's Agent Owner Agent Signature: Building Official Approval: OW- C 2� The Commonwealth of Massachusetts Department of Industrial Accidents oJJlee911nes olffoss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit cits ( ilk WI A -ohon I am a homeowner performing all work myself. Lam a sole proprietor and ha%e no one working in any capacity I am .an employer pro% iding workers' compensation for my employees working on this job. comnanv name: address: city: Ann 0: insurance co. ooliev 0 CR/l am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below ttho ha%e cSi x-. phone q: . insurance co.. policy H company name: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Qne sp.to 51,500.00 and/or one years' imprisonment as well as civil penaldei in the form of a STOP WORK ORDER sad a flue of 5100.00 a day against me. I nndersmnd'that a copy of this statement rosy be forwarded to the Otnce of Investigsiions of the DU for coverage verification. t do hereby cert' u er the p ins and pe t a perjury that the information provided above is mu and eorre k Signature f� Print name \ ` a-t^ � V Phtme 0 ,529,C3��/ oRcial use only do not +.rite in this area to be completed by city or town ofBeial city or town: ynxHooTri _ permitAlccosc 0 0Building Department pLicensing Board cheek if immediate response is required 261 C3Seleetmen's Omee E3Healtb Department contact person: phone pt _ (508) 398-2231 eat. mother. TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL. GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be / conducted at 1 ` `�'3' 0 5+• Work AAress is to be disposed of at the following location: 0 w►'�N5 `�6 l` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. / / X Date Y t BOARD OF BUILDING. REGULATIONS- Licensee CONSTRUCTION SUPERVISOR. F` Numt>er.Z�S= 01-2430 3" w Btrilidaie D66F6}940 EuLrss Wf=067 Tr. no: 25926 Restn'dt'ed� '--a= FRANK CAPRk �. 4000PPERCN CENTERUfLLE. MA 02632 Commissioner - a i f �! 00 - 35,000 cf endosed space ' (MGLCA 12 S.60L) - to . Masonry only _ 1G = 4 & ZFamily Homes s Failure to possess a current.edition of the Massachusetts State.Bulding:Code .- is cause for revocation of this license. 01 r 3 i i DIG SAFE CALL CENTER: (888) 344-7233 ti `6 •8AIA 9ASRIIRONCECO 1r IICII Iff. IDYJ+ - " A ORD. CERTIFICATE OF LIABILITY INSURANCE ;o0410 °"""' PROVUCER - Dowling & O'Neil Insurance Agency, Inc. 222 West Main St. PO Box 1990 Hyannis, MA 02601 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED - - Assurance Construction, Inc. A/0 Assurance Excavation, Inc. 550 Willow Street West Yarmouth, MA 02673 INSURER A: Travelers Insurance Company - INSURERB: INSURERC: INSURER D: INSURER E: I:UVLKAGtJ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ATE MIDD POLICY EXPIRATION MMMDfnn LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LABILITY CLAIMS MADE 5� OCCUR 16808387A9841ND04 08/01/04 08/01/05 - - O CE S1 000,000 EACH To RREN s300 O00 MED EXP (Arty are person) SS 000 PERSONAL & AOV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLES PER POLICY PRO-LOC PRODUCTS-COMP/OP AGG S2000000 - AUTOMOBILEE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - - COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO - AUTO ONLY- EA ACCIDENT S OTHER THAN EA ACC AUTOONLY: AGG S $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTVE OFFTCERIMEMBER EXCLUDED? H yyea, descnbe under SPECIAL PROVISIONS below - - EACH OCCURRENCE S AGGREGATE $ S S WC STATU- OTH- I PR S E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS T VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS - operations performed by the named insured subject to policy conditions and exclusions. Gatewood Homes, Inc. Attn: Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ACORD 25 (2001108) 1 of 2 #35866 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION IEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL III_ DAYS WRITTEN TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR AUTHORIZED REPRES ATIVE LS1 O ACORD CORPORATION 1988 S a � CERTIFICATE OF LIABILITY INSURANCE DAfE (MhVDD,YY, 0/4/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RlaB A- CYazll Tna� ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Bac 337 HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR �,,{�r (�']�_�!p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW May.- •• D Mills, bA 02648 INSURED 1YIEE� lM m. ( Inc. 43 P1zulDeyls T e cxnr:r iL1eI. NA 0202 rnVFRCf:F¢ INSURERS AFFORDING COVERAGE INSURER A:_M-je ?MOVi%tm M141p -, .TIIi.. (b. 1.INSURERS: SaVeM PECpert y & C�k$liy INSURER C: I INSURER D: - I INSURER E: THL 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. INSk LTH TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION I AT IMM/DD Y LIMITS GE!NckaL LIABILITY ; OCCURRENCE j S 1(000( 000 +� C011I1,IFiRC1AL GENlih'AL L.IAB.UTY -EACH ' _FIRE DAMAGE (Any Una tire) S _ _ _. .. �/ M (0W CLAIMS MADE { OCCUR i (. _ . I MED EXP jAny o!w perwn) S 51 wo PERSONAL & ADV INJURY I S 1�n/OW. F.4( _ ! I GENERAL AGGREGATE ; 5 21 OW( 000 A GEN'L AGGHEGATE UMI f APPLIES PER: I GO 0005933 04 - ! 10-05-M I 10-05-04 FPRODUCTS -_COMP_OP AGG 1 S 210001000 POLICY, I �t, ' _oc I CP00005933 05 1 0-5-04 i 1 0-5-05 AUTOMOSILE LIABILITY ! 1 COMBINED SINGLE LIMff 5 ANY AUTO (Ea accident) �-- ALL OWNED AUTOS I _ I SCHEDULED AU L'OS ! `. ! BODILY INJURY % I (Per person) $ HIRED AUTOS ! - ! I BODILY INJURY 3 NON -OWNED AUTOS (Per accKiew) I l PROPCRTY DAMAGE I (Per aceident) $ - GARAGE LIABILITY, . ! -. j I AUTO ONLY • EA AC ACCIDENT J 3 _. t.......-.. " ANY AUTO ! - ACC I - ' i ± I OTHER THAN _EA �.$._.. - .AUTO ONLY: AGG 1 $ EXCESS LIABILITY I I - I EACH OCCURAENCE _• 5 OCCUR I { CLAIMS MADE ; AGGREGATE § UEUUCTIULE IL - � REI'EN TIUN 3 I � - I I $ WORKERS COMPENSATION AND ! WC STATU• OTH-; TORY IMITSj__ER EMPLOYERS' LIABILITY ! I - E.L. EACH ACCIDENT ! 5 100f 000- 04-01-04 04-01-05 1 EML DISEASE • EA EPLOYEF� 5 '---- -' '- -- ' - - 100y 000 B tiM 001630 I I E.L DISEASE. POLICY UFAIT 1 $ 500,000 OTHER I I DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 11 ADDITIONAL INSURED: INSURER LETTER: CANCELLATION Gatewood Homes 1600 Falmouth Rd. Suite 25 Centerville MA 02632 508-778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25-S (7I97) 0 ACORD CORPORATION 1988 r A'CORD` CERTIFICATE OF LIABILITY INSURANCE °ATE,MMDO/YYYY) ru - 11/01/2004 PRoouc (508) 540-2400 FAX (508)289-4111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MurrayMacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1406 Jones Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC # INSURED Tracy Howerton:.. INsuRERA: Arbella Protection Insurance P0. Box,1551::;, INSURERB: Liberty Mutual Ins:Corp Mashped,'TMA' 02649 INSURER c INSURER D: .:. ... ... .. INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH - POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWDD POLICY EXPII=ON DATE MMIDD LIMITS A GENERAL LIABILITY - COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR 8500028756 08/14/2004 08/14/2005 EACH OCCURRENCE S 19000,000 PREMISES Ea occurence S 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE a Z , 000 , OO GEN'L AGGREGATE LIMIT APPLIES PER POLICY j RO. -7 PRODUCTS - COMPIOP AGG $ 2,000,000 - AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Par person) S BODILY INJURY (Per accident) $ PROPERTY. DAMAGE (Pecaccident).' ._ $ . __.. ... . _. GARAGE LL481LnY ANY AUTO :. 'EXCESSIUMBRELLA _ ...: - .. .... _ "AUTOONLY - EA ACCIDENT S-' -•- OTHER THAN - EA- AUTOONLY..__ ._.. -AGG S .. .S_.. LIABILITY OCCUR - a CLAIMS MADE DEDUCTIBLE RETENTION $ - EACH -OCCURRENCE _.. S. __ ... AGGREGATE. $ S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC531S317310033 10/05/2004 -, 10/05/2005 IAI$ TORY LIMITS ER E.L. EACH ACCIDENT $ lOO , 000 E.L. DISEASE - EA EMPLOYEE S 100,000 E.L. DISEASE- POLICY LIMIT S 500000 + OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL �_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Gatewood Homes, InC • BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Paula 1600 Falmouth Road, Suite 25 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 Dou las MacDonald ACORD 25 (2001/0) 191i/F9'j/'Ltlb4 17y:1! !!H --- JUI'RY t,Muw T rix Ulf UA � Y DATE MMI =yk-._ 0810sn004 ACC. CERTIFICATE OF L1ABILITY�sAISURAN� Al ELIED AS p MATTER OF INFORMATION g7g.394 2253 DIRECT ONLY AND CONFERS NO RIGHTn^rc uoTO AMEND, N THE EXTE�NDAOR ATLANTIC HOLDER. THIS L-r"Ilrn.r..� ANTIC INSURANCE GROUP' INC. RAGE AFFORIIE° BY THE POLICIES ALTER-THE—COVE AIP.LLC 365 BOSTON POST ROAD PUB 203 INSURERS AFFORDING COVERAGE SUDBURY, MA 01776 —' '—"' ,,,,,, '•—'- '!-- - INSURED A: NATIONAL FIRE & MARIN . __...—. --•• UnEo I INSURER B: MW A ORKERS COMP-RESEARCN_B GATEWOOD HOMES INC. — _ -- — INSURER C: _ 1600 FALOMOUTH ROAD INSURER D: ---• .....__ --- ....__._. CENTERVILLE MA 02632 THE POLICIES OF INSURANCE LISTED BELOW HAVE BE I ANY REQUIREMENT. TERM OR CONDITION OF ANY COI MAY PER LAIN, THE INSURANCE AFFORDED BY THE POL POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN GENERAL LIABILITY 72 LPE 691943 A i x I C_CMMERCIAL GENERAL LIAVIUTY CLAMS MAOE I X.I OCCUR LGENL AGGREGATE LIMIT APPLIES PER: r-" I PRO.. ( ..... I I ANY AUVO .I AL_OWNEDAUfOS SCHEDULED AUTOS HIRED AUTOS NON.OMEO AUTOS OARAG- LIABRIPr i 1 ANY AUTO GTHEINSURR DOCUMENAT WITH RESPECT TO WHICH THIS CERTIFICATE AED ABOVE FOR THE POLICY PER] MAY BE ISSUE IBED HEREIN IS.SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH Y PAID CLAIMS. ._..._.. EACH OCCURRENCE s _ 50000•, _ 4129/04 4129/05 FOffi DAMAGE (AAY o w ra.: S • MEO IADY on_e Mnwy. S 10000 _E%P A ADV IN,AURY S 1000000 __.� _PERSONAL GENERALAGGREGATE S' 20CLOW S 1000000 PRODUCTS - COMP'CPA-&-1 ' EXCESS U"ILITY ~. IOCCUR ( ICLAW MADE 1 F , 06DUCTISIA It RETENTION i B IWORK' COMPEMWSA Al10 I POLICY UPDATE NUMBER TBAj 8/4/04 I 814105 I 1 OTHER I - DESCRIPTION OF O►EAAi10Hi/LUYw„w•,•�•••••-- - PROJECT: MILL POND VILLAGE MLLAGES AT CAMP ST. LLC - DON TOWN OF YARMOUTH BUILDING DEPARTMENT PROVISIONS COMDINEO SINGLE LIMIT I S (EA 6=10M) ... . _ IIt BODILY INJURY S (Porpenoe) B^AILY DI.IURY I (Pm acci ......- -----... __.. . PROPERTY DAMAGE i.S (Per "dd*M) AUTO ONLY. EAACCIDEN- (S __-- OTHER THAN EA ACO : .•, —.. __ AUTO ONLY: AM � S EACH OCCURRENCE • -- i—•• ' --- -... AGGREGATE • ._- E.L. EACH ACCIDENT __ _ S ... E.L OISEME-EA EMPLDYE� I.- e . nIeEASE . POIICY UAS7 S SHOULD ANY OF TIEABOVE DESCRIBED POUC£E BE CANCELLEO BBFORE TI(E EXPIRATION . DATE THEREOF, THE IEEURIG NSY0.EA WILL ENDEAVOR TOMA:L 60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOL MED TO THE LEFT, BVT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR 0.1TY F ANY XIHO UPON THE INSURER, ITS AGENTS OR eAat)RD. CERTIFICATE OF LIABILITY INSURANCE. DATE(MWOONY) Q5-174A PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 193,HL>3 X Qm3fl 114mnce ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Bsc 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. :- MMr r• li.� INSURED �- I a - '• IhSI i INSURERS AFFORDING COVERAGE ..INSU_RER .A: mle F1T7J��' /�M3bml� �Fi�re _Im. OJ., INSURER B_.�.� PiL�L ty & d7l ty INSURER C: - I INSURER D_ I ,vwncn c. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCF POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ -._ .. ... ._ ._ ._.—.__.. ._. ... _.. _ ILTR; TYPE OF INSURANCE i POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION • LIMITS LTR � DATE N1M/OD/YV � ATE/MM/DD V GENERAL LIABILITY i I I EACH OCCURRENCE I S 1, 0mj LAAI XX COMMERCIAL GENERAL LIABILITYI FIFE DAMAGE (Any one fire)' $+ Im. CLAIMS MADE j�1 OCCUR I I I MED EXP (AIRY one person) S. I I 1 PERSONAL & ADV INJURY i $ 000 0� AGGREGATE 5 GENERAL � _2,OW -Q O. A GEN•L AGGREGATE LIMIT APPLIES PER: CEO0005933 04 I 1 �OS-M _ j 10-05-04 � ODUCTS_COMPIOP AG_G j S� - 2, 000f i I POUCY ; I IECo-I' j� LOC; AUTOMOBILE LIABILITY I I , COMBINED SINGLE LIMIT $ I ANY AUTO I I I (Ea accident) _ ' ALLOWNED AUTOS I el OOILY INJURY ! $ jSCHEDULED AUTOS ( I (Per person) .__-�._ • __._-. ___.. AUTOS BODILY INJURY $ OPe NON -OWNED AUTOS _YHIRED (Per accident) PROPERTY DAMAGE is accident) I GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT is - _- ANY AUTO i OTHER THAN EAACC I - j AUTO ONLY: AGG ; $ -_ j EXCESS LIABILITY I EACH OCCURRENCE _ $ OCCUR CLAIMS MADE I I AGGREGATE IS iI DEDUCTIBLE ! RETENTION $ I I I $ ! WORKERS COMPENSATION AND WC STATU- '0TH-1 TORY LIMITSI I EMPLOYERS' LIABILITY ( E.LEACH $ 1cot 000 04-01-04 04-01-05 `EL DISEASE: EA EMPLOYE $_ 1001000 SEEA B i I WM 001630 I I E.L DISEASE - POLICY LIMIT j $ 500r 000 j OTHER I - ( I I i I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I I ADDITIONAL INSURED: INSURER LETTER: CANCtLLA IIUN Gtacca Hmim, mr— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATOOI 1600 Falm>t1 1�TMad DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEI gTitP NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALI 11Pr - O2rm IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS Of ., REPRESENT ES AUTHOR R RESE A VJ; FY4C: 50$.7J8.5603 c ACORD 25-S (7197) © ACORD CORPORATION 198 V ACORD- ��UR/11`IL.Cla7 CERTIFICATE OF LIABILITY INSURANCE 1D.A:TE,(MM1D0NY R/04 i Dowling $ O'Neil Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Hyannis, MA 02601 Assurance Construction, Inc. A/O Assurance Excavation, Inc: 550 Willow Street West Yarmouth, MA 02673 THE POLICIES ()F IMCI 10A.— - -.. „........... _ ___. _ INSURERS AFFORDING COVERAGE INSURERA: Nautilus Insurance Con INSURER B: INSURER C: INSURER D: INSURER E: NAIC # ANY REQUIREMENT, TERM OR CONDITION OF�v= tJtt:N SUED TO THE INSURED NAMED ABOVE ANY CONTRACT OR OTHER DOCUMENT WITH R SPECTTRTO WHICTHEOH LICY THIS CERTIFICATE MAY BE IPERIOD IDICATED. SSUED OR THSTANDING MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER' POLICY EFFECTIVE POLICY EXPIRATION e DATE MMMD DATE MM/D LIMITS X COMMEMERCCIALAL rI GENERAL RINC289301 .Q9/08/03 09/08/04 EACH OCCURRENCE $1 Q00 000 GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE O OCCUR - PR 1 $100 000 X BI/PD Ded:1.000 MEG EXP (Any me person) $5 000 PERSONAL &ADV INJURY $1 nnn nnn LIMB APPLIES PER - AUTOMOBILE LIABILITY-T- ANY AUTO SINGLE LIMIT ALL OWNED AUTOS SCHEDULED AUTOS URY ;(Pwa=�y1diderg HIRED AUTOS NON -OWNED AUTOS - RY PROPERTY DAMAGE $ GARAGE LIABILITY (Per accident) ANY AUTO AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: qGG S EXCESSIUMBRELLA L I CIIJTY EACH OCCURRENCE S OCCUR � CLAIMS MADE - AGGREGATE S DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY -W ANY PROPP.IETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L EAR: if yes, describe under E.L. DISI SPECIAL PROVISIONS below OTHER E.L. DISI DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Operations performed by the named insured subject to Policy conditions and exclusions. Gatewood Homes, Inc. Attn : Paula 1600 Falmouth Road, Suite 25 Centerville, MA 02632 ACORD 25 (2001i08) 1 of 2 #35194 S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL 10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR AUTHORIZED JV —10 ACORD CORPORATION 1988 ---•l1_ J"ax Server AI%DUCE®I:1/. yT[1T'�[U►N 'j x p ° , _ ; ; °oa o04� PROR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION •` ONLY. AND CONFERS NO RIGHTS UPON THE-EERHF)EATE . EMPLOYERS INS GROUP INC HOLDER. THIS CERTIFICATE DOES .NOT AMEND EXTEND OR 281 MAIN ST ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. SIE 5 FITCHBURG MA 01420, COMPANIES AFFORDING COVERAGE COMPANY 76HCK - A ROYAL INSURANCE COMPANY OF AMERICA INSUR COMPANY. RESOURCE MANAGEMENT INC .B 281 MAIN STREEI SUITE 5 FITCHBURG MA 01420 COMPANY C / //A� GJCCQV Q ft OYj t1S5Ur�1ce COMPANY D COYERAGES. „ > _ �.H THIS ISTO.CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED.TO THE INSURED NAMED ABOVE FOR THE.POL%:Y PERIOD_. INDICATED, NOTWITHSTANDING ANY REOUIREMENT, 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, EXCLUSICNSANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. CO L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDMYY) POLICY EXPIRATION DATE(MMtDD1YY) LIMBS GENERAL LIABILITY - GENERAL AGGREGATE $ PRODUCTS-COMPIOP AGG. MERCIAL GENERAL UUIBIUTY CLAIMS MADE�OCCUR PERSONAL& ADV. INJURY S EACHOCCURRENCE S ER'S & CONTRACTORS PROT. tlJTOMOBiLE FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) S LUBIIJI'Y ANY AUTO COMBINED SINGLE LIMIT S ALL OWNED AUTOS- BODILY INJURY SCHEDULED AUTOS (Per Person) S HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY (Per Accident) s PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO El OTHER THAN AUTO 0NLY: EACH ACCIDENT $ - AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE s UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND EMPLOYERS LIABILITY (LIB-967X499-9-03) 11-20-03 11-20-04 - STATUTORY LIMITS EACH ACCIDENT $ 100,000 THE PROPflIETOR! PARTNERS'EXECUTIVE X INCL OFFICERS ARE: EXCL OTHER DISEASE —POLICY LIMIT s 500,000 DISEASE —EACH EMPLOYEE Is 100,000 DESCRIPTION OF OPERATIONSILOCATION&VEHICLFSRESTRICTIONS!SPECIAL S COVERS EPIPLYS LEASED TO ASSURA.HCB—EXCAVI': TORS 5501 WILLOW ST W YARMOUTH MA 02673 7 THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ERTIFICl4FE}IOLDFfi r .". GAMCE! LhTION SHOULD ANY OF THE ADOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE GATEWOOD HOMES, INC. ATT:PAULA CENT FALMOURVILLETH ROAD—SUI A 25 CENIERVILLE MA 02632 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOOD e- LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABR.RY OF ANY KIND UPON THE COMPANY, ITS AGENTSOR REPRESENTATIYM AUTHORIZED REPRESENTATIVE •. ::- z ,sU...a Y1'.3 $ 2'i_ kC .5 ^:k^L 2 �. i s........ AOEiD-255j3/81} 1;...,:mE[1i2i3rrltiilYALrA Teoi' AL-ORD. CERTIFICATE -OF LIABILITY INSURANCE =(MMIDDAYM PRODUCER (508)997-6061 FAX (508)991-3283 THIS CERTIFICATE IS ISSUED AS,A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 662 State Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 79398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC # INSURED R ] Bevilacqua Construction PO Box 628 INSURER A: Arbella Protection Insurance INSURER B: Forestdale, MA 02644 INSURER C: INSURER D: INSURER E rnvccacec - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE 1MM1DOffYI 07/15/2004 POLICY EXPIRATION 07/15/2005 UNITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR X Special Form 8500018147 EACHOCCURRENCE E 1,000,00 1 DAMAGE TO RENTED $ SO, OO MED EXP (Any one person) E 5 ' 00 PERSONAL d ADV INJURY $ 1,000,00 GENERAL AGGREGATE E 2 000 00 GEN'L AGGREGATE UMIT APPLIES PERPRO- f7 POLICY 7 JECT LOC PRODUCTS-COMP/OP AGG E 2,000,00C A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 86852400001 02/21/2004 02/21/2005 COMBINED SINGLE LIMIT (Ea accident) E Bar person)ILY (Per person) E 250 000 X X BODILY INJURY (Per accident) E 00.Qo 500.000 X PROPERTY DAMAGE (Par accident) E 500.000 GARAGE LIABILITY ANYAUTO' • AUTO ONLY - EA ACCIDENT E 0 OTHER THAN EA ACC AUTO ONLY: AGG E E EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ - EACH OCCURRENCE S AGGREGATE E E S E A WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? yyeess describe under SPECIAL PROVISIONS below OTHERE.L. OTHER 9088680402 04/27/2004 04/27/2005 .X wcsrnru- orH- MITS S 100,000 E.L. EACH ACCIDENT EE.L.DISEASE - EA EMPLOYE E 100, 00 DISEASE - POLICY LIMIT E 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS or any and all operations performed during the policy period. Gatewood Homes Inc. 1600 Falmouth Rd Ste 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Pauline Desrosiers ^. wnw co JAUU uual - ©ACORD CORPORATION 1988 I w CERTIFICATE OF LIABILITY INSURANCE 03/09/2 0 PRODUCER (508) 994-9688 FAX (508) 991- 5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RUTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 414 COUNTY STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEW BEDFORD, MA 02740 INSURERS AFFORDING COVERAGE INSURED Frank Capra INSURER A: Providence Mutual PO Box 664 MURER B. 066Beacon West.Hyannisport, MA 02672 INSURER Continental Casualty Co . INSURER D: . INSURER E COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE MM POLICY EXPIRATION ATE (MMIDDfYY1 LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR CPP0053131 01 12/13/2003 12/13/2004 EACH OCCURRENCE a 1,000,0( FIRE DAMAGE (Any one fire) $ 50,0( MED EXP (Any one person) $ 5 , 0( PERSONAL 8 ADV INJURY S 1, 000, 0( - GENERAL AGGREGATE 5 2,000,0( GEWL AGGREGATE LIMIT APPLIES PER: RD- Lor- i POLICY SECT PRODUCTS - COMP/OP AGG $ 2 , 000 , OC B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CBXE4812S 02/14/2004 " 02/14/2005 COMBINED SINGLE LIMIT (Ea acddenq $ BODILY INJURY (Per Person) S 250,00 X BODILY INJURY (Per accident) $ 500,00 PROPERTY DAMAGE (Per accident) $ 100,00 GARAGE LIABILITY ANY AUTO .. ".. _. AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S E EXCESS LIABILITY OCCUR O CLAIMS MADE DEDUCTIBLE RETENTION S - EACH OCCURRENCE S AGGREGATE S S . $ - S C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 6S59UB861X751604 03/22/2004 03/22/2005 11 rWORYLIMrrs °ER EL EACH ACCIDENT 5 500,004 EL DISEASE -EA EMPLOYE4 S 500,00( EL DISEASE - POLICY LIMIT S 500,00( OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECI L PROVISIONS CERTIFICATE HOLDER I I ADDITIONAL INSURED. INSURP LETTER: CANCELLATION Gatewood Homes Inc 1600 Falmouth Rd Ste 25 Centerville, MA 02601 25s (7/97) FAX: C508) 778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY �COMP.ANY, ITS jG^_ O�! -RAV_ ffV - .rAUTHOR®CRPES IVE. AC IRDt CERTIFICATE OF LIABILITY INSURANCE DATB(MMROD/YYY1T PRODUCER 509-398-6033 - • FAX 508-760-1667 Eastern Insurance Group LLC 1 Atlantic Ave So Yarmouth MA 02664 08/D9/2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER H COVERAGE AFFORDED BY THE POLICIES BELOW. INsuRED Cape COB Custom Floors 762 Falmouth Road Hyannis NA OZ601' INSURERS AFFORDING COVERAGE POSURERA: Arbelia Protection Ins Company NAIC # IvSURERB: Hartford INSURER INSURER D: INSURER Q COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTTHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDA TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS M I'Y 7500000373 12/13/2003 12/13/2004 EACROCCLRRENCG $ CONMERCLLL GENERAL LIABILITY DAMAGE TO RENTED $ 50,00 CLAIMS MADE X� OCCUR - MEO EXP (Any me Perm) S S A PERSONAL I ADV INJURY S 1 , 000 , 000 GENERAL AGGREGATE S 2 ,000,000 PRODUCTS -COMPIOPAGO E 7-nnn_nnn �OEN'L AGGREGATE LIMIT APPLIES PER: 1 ^ POLICY n JECT I^ ' LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NOMOWNED AUTOS GARAGE LIABILITY 7 ANY AUTO EXCESSNMBRELLA LIABILITY OCCUR CLAIMS MADE COMBINED SINGLE LIMB I S (EA ecddel ) BODILY INJURY ' (Per persdn) BODILY INJURY S (PW ecCidMt) PROPERTYDAMAGE (Per eeddew) S AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AOiI S AGGREGATE DEDUCTIBLE - RETENTION S ' WORKERS COMPENSATION AND 08WECKLI007 05/25/2004 EMPLOYEROS/2S/2005 X wcs74Tu. S' UABILITV B ANY PROPRIEMPJPARTNEWEXECUTNE EL. EACH ACCIDENT EXCLUDED? If decdMe under ELL DISEASE . EA EM SPECIAL ➢ROMSIONS baloR OTHER E.L. DISEASE • POLIC ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLU910NS ADDED BY ENDORIEMENT /SPECIAL PgOYITONS ridence of Insurance for work performed within the Insured's scope -of normal operations Gatewood Homes 1600 Falmouth Road 92S Centerville, MA OZ632 ACORD 25 (2001/08) FAX: (508) 778-5603 Soo SHOULD ANY OF THE ABOVE OESCRIEED POLICICS BE CANCELCE9`BVRMETRC-- "PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATX HOLDER NAMe0jOjHE-CErr_ BUT FAILURE TO MAIL EVCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF A KMD UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE¢...... fH D gEPRE9 ATNE GACORD CORPORATION 1988 DATE(MM/DONYM ACED- -CERTIFICATE OF LIABILITY INSURANCE 8/2/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance.Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Osterville, Ma.02655 508-420-9011 INSURED Casperson Overhead Doors Box 517 East Falmouth, MA 02536 508-563-5633 rnV=Ancc INSURERS AFFORDING COVERAGE NAIC# wsURERA: Worcester Insurance Company INsuRERB: National Grange Mutual INSURER C: INSURER D: 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. IR R LTR DL RSRD TYPE OF INSURANCEDATE POLICY NUMBER POLICYEFFECTNE MM/DD POLICY EXPIRATION DATE MMIDD LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE O OCCUR CB 2J1973 05/28/04 05/28/05 EACH OCCURRENCE 5 1 000 000 PREMISES oaureme $ 100,00 MED EXP(Anf one person) $ l0 OOO PERSONAL& ADV INJURY S 1 000,000 GENERAL AGGREGATE S Z OOO 000 GENT AGGREGATE LIMIT APPLIES PER' POLICY PRO- LOC PRODUCTS-COMP/OPAGG S 2,000,000 AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT (Ea acddent) S BODILYINJURY (Perpers ) BODILY INJURY (Peraccident) $ PROPERTY DAMAGE (Peracddent) S GARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT S OTHERTHAN EAACC AUTOONLY: AGG $ S EXCESSNMBRELLA LIABILITY OCCUR CLAIMSMADE DEDUCTIBLE RETENTION S EACH OCCURRENCE $ AGGREGATE S S S S B WORKERS COMPENSATIONAND EMPLOYERS LIABILITY ANY PROPRIETORMARf ERIEXECUTNE OFFICER/MEMBER EXCLUDED? Hyes.desaibeunder SPECIAL PROVISIONS below - CP48352 02/22/04 02/22/05 X A T RYLIMRS ER E.L. EACH ACCIDENT $ 500 000 E.L. DISEASE- EA EMPLOYE $ 5OO OOO E.L. DISEASE -POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER Gatewood Homes, Inc. 1600 Falmouth Rd., Ste. 25 Centerville, MA 02632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO! DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR ACORD25(2001/08) V CACORDCORPORATION 1988 'ACORDCERTIFICATE OF LIABILITY INSURANCE PRODUCER (508) 790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER Sandpiper Ins. ONLY AND CONFERS NO RIGHTS UPON Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AM 12 Enterprise Road ALTER THE'COVERAGE AFFORDED BY THE PC DATE (MMIDONrn n arenas P A UZbUl- I INSURERS'AFFORDING COVERAGE NAIC # INSURED INSURERA:Zurich Small Construction CENTURY PAINTING AND DRYWALL,INC CENTURY PAINTI INSURER Ft PO BOX 2903 , p� INSURER C: INSURER D: HYANNIS MA 02601-7903 INSURER Cf1VFAAGCC NFORMATION CERTIFICATE EXTEND OR THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN` REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANC CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADCYL INSRC TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY) POLICY EXPIRATION DATE (MMIDDrrO LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE S 1,000,00 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR SCP034309873 12/18 /2002 12/18/2003' DAMAGE TO RENTED PREMISES aoxvrence S 300,00 MEDEP (Any one rsan S. 10,00 PERSONAL 3 ADV INJURY IS 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER 17 POLICY JJEECT Loc PRODUCTS-COMP/OP AGG S 2,000,00 AUTOMOBILE LIABILITY ANY AUTO / / / / - COMBINED SINGLE LIMIT (Ea w6derd) S ALL ONMED AUTOS SCHEDULED AUTOS - / / / / BODILY INJLRY (Per persm) S HIRED AUTOS NON-OV%NED AUTOS / / / / BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per amident) - S GARAGE LIABILITY AUTO ONLY -EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSNMBRELLA LIABILITY / / / / EACH OCCURRENCE S AGGREGATE S OCCUR CLAIMS MADE S DEDUCTIBLES RETENTION S S WORKERS COMPENSATION AND EMPLOYER5 LIABILITY / / / / TORY LIMITS ER E.L. EACH AC=IDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE- OFFICERIMEMBER EXCLUDED? If yes, de=ibe wder - / EL DISEASE- EA EMPLOYEE S E.L OISEASE- POLICY LIMIT S SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENOORSEMENTISPECIAL PROVISIONS PAINTING S DRYWALL (508) 778-5603 GATEWOOD HOMES 1600 FALMOUTH RD SUITE 25 WA ACORD 25 (2001/08) y INS025 (olos).os SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ELECTRONIC LASER);QRMS,AC. - (800)327.0545 © IORD CORPORATION 1981 Page 1 of: AC-ORA CERTIFICATE OF- ttA►tpft5tttiv n -AT-� PRODUCER Sullivan, Garrity & no=;B12y THIS CERTIFICATE IS ISSUED AS- 508-754 -1767 ONLY AND CONFE- IS NO RIGHTS 10 inatituta TE DOE Rd PO Box 15010 ALL ERTHEHCOVEFAGE FFORDF IS CEI Worcester KA 01615-0010 Phone:5D8-754-1767 rzx:S0&-754-1885INSURERS AFFORDII IG COVERAGE INSURED _ INSURER A: Hanov 3r insurar INSURER B: Arn_h ��.�..-�....e Crowell Conatruction, Inc. BsuaEac: PO Box MA 02660 INSUKR O: COVERAGES PON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE FqXucjEsaF, NAIL..#_.. 22292 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE O POLICY PERF D INDICATED. DR:+LTEO. NOTW D-HSTA1+dIM;1 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS GEf' RFN MAEDOR I Y BE ISSU HER61N IS SUBJECT TO ALL THE TERMS, EXCL MAY PERTAIN, THE INSURANCE AFFOFIpED BY THE POLICIES DESCRIBED U:� OR; AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR MSR TYPE Of u'+SURANGE POLICY NUMBER F TIV pA E MM/DO/W UGY E: VIR4 1 DAZE NI IA[uYY LIMITS A GENERAL X UAIULITY COMMERCIALGRUERALLMAILITY CLAIMS MADE ®OCCUR ZHU7007141 05/01/04 05/ 11/OS 1— EACH OCCURREN6L S 1000000 _ PREMIs s EAe� cel f 100000 MEDEXP(AnrpNbw,Knj $ 5000 PERSONAL&A1 .,ko11rY f 1000000 GENERAL AfY31L.dPT6 $ 20a0�Q�"' ' GENT AGGREGATE LIMIT APPLIES PER; POLICY '"IT LOC PRODUCTS.F�jIw nr>AOG '— A 2000000 AUTOMOBILE LIABILITY 1'-'— A ' ANY AUTO ABN7001142 05/01/04 O5/ 1/05 COMBINEO S W131-6LI'IRr (Ed acddenB I J_. S All OWNED AUTO$ BODILY INJURY I (Par Ilenonj $SOOOOOD X SCHEDULEDAUTOS - - X HIRED AUTOS — BODILY INJURY I (Per 2C6d&nt) 2f 1000000 X NON -OWNED AUTOS GARACELVI/R.ITY MIY AUTO - PROPERTY OAMf,GB (ParPccldeM) �- AUTMONLY - EAAGICIIK]JT - $500000 S OTHER THAN , E^_ACC AUTO ONLY: I-__a,30 S S EXCESSAIMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURReICE f _ AGGREGATE S f DEDUCTIBLE - - S RETENTION f - f WORKERS COMPENSATION AND B EIAPLOYPJ36'WBILITY IRWCIDOlOO ANY PROPRIETOPJPARTNERfEXEC1ANE 03/22/04 OFFICER/MEMBER EXCLUDED? _ TORY LIMITS .L I �. 03/:'2/OS ELEACHACCIDENT — f 500000 Iryyeelod aedbeKndw E.LDISEA36-EAEMPLOY SPHERE PROVISIONS batOw OTHER E.L DISEASE - POLICY UhRT — �.._ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHKLES / EXCLUSIONS ADDED BY ENOORS6MEN7 f SPEpA1- ppOVISION3 As per policy forma, conditions and exClusions. $500000 S 500000 CERTFFICATE HnLnFR-- Gatewood Homes, Inc. 1600 Falmouth Road Suite 25 Centerville MA 02632 (2001108) GATZWOO I SHOULD ANY OF THE Asm I Of SCRIBED POLICIES BE CANCELLED BEFORE-THE£XIIpAft GATE THEREOF, THE LSSUIP S INSURER WILL ENDEAVOR TO I.UL 10 DAYS WHEN NOTICE TO THE CERTMCR S POLDER NAMED TO THE LIFT, INJT FAILURE Tn C ae IMPOSE NO OBLIGATION OF' LIA 4LnY OF ANY KIND UPON TIi._ Rj3URER, ITS AGENTS OR ACORD. CERTIFICATE OF LIABILITY INSURANCE D08/04/200YY) os/oa/zoo4 PRODUCER 508-428-0440 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MARK SYLVIA INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 969 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR OSTERVILLE MA 02655 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # ' INSURED PETER J. GOVONI INSURERA FARM FAMILY CASUALTY INSURANCE DBA P. GOVONI LAND SERVICES INSURER B: 20 OPEN TRAIL RD. INSURER C: SANDWICH, MA 02563 INSURER D: INSURER E: COVFRAY;FR - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DO' LTR POLICYNUMBER POUCYEFFECTIVE EXPIRATION MMfDOfYYl UNITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS MADE OCCUR 200IL6202 05/31/2004 05/31/2005 EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurence S VIED EXP(Any one person) $ 5000 PERSONAL a ADV INJURY S GENERALAGGREGATE $ 2,000,000 GEWLAGGREGATE UMITAPPUES PER: POLICY JE LOC PRODUCTS. COMPCP AGO $ 1 OOO OOO AUTOMOBILE LIABILITY ANY AUTO ALLOWNED AUTOS SCHEDULEDAl1TOS HIREOAUTOS NONoOWNEDAUTOS .. COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Perperscn) S BODILY INJURY . (Peraccident) . PROPERTYDAMAGE (Peraccident) S ..—..__... . ._ .. I GARAGE LIABILITY. w.,.. - III ' ANYAUTO ' .. .. AUTO- ONLY "EA ACCIDENT . OTHER THAN EA ACC AUTO ONLY:' AGO S' _S`.•::". I I IXCESSIUMBRELLA LIABILITY OCCUR a CLALMS MADE DEDUCTIBLE RETENTION E RENCE S ` $ s S PDISEASE�EA S A WORKERS COMPENSATION AND EMPLOYERS'LIABIUTY PROPRIETORIPARTNEWEXECUTIVE EXCLUDED?aea, describe under SPECIAL PROVISIONS below OTHER TO BE ISSUED 07/04/2004 07/04/2005 U> OTHr X RANY IDENT S1,000,000OFFICERAAEMBER EA EMPLOYEE S 1 000 000 POLICY LIMIT S 11000000 DESCR�TION OF OPERATIONS /LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS LOGGING AND LUMBERING, TREE PRUNING, STREET CLEANING CCRTICIf`ATCUnl GATEWOOD HOMES, INC. 1600 FALMOUTH ROAD #25 CENTERVILLE, MA 02632 25 (2001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL `30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OFANY KWDIH'O. THE iNSURER;YTS.ABE14TS. OR REPRESENTATIVES. I '^"' N AUTHORIZED REPRESENTATIVE I 1<._ D- •it.a _ I I ................:. .........:......... ..::::.:....:::..:. �r ..:........:::. ::: .. R.....1.. DATE (MM/DO/yY) ....:n.�nn,:...i....W.v........,..,:...::.::n.:......................:::..::.:::.:::.............. <..... ...... 8 03 04 PRoovcER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HAROLD H WILLIAMS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 81 BASSETT LANE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE HYANNI S MA 0 2 6 01- COMPANY . (508) 775-3366 ( ) A MERCHANTS INS CO OF MA INSURED COMPANY STEPHEN M CHILDS B 145 CAMMETT ROAD COMPANY C MARSTONS MILLS MA 02648- COMPANY (508) - D :.J4::.v.V.A.:.WM.Li.vtmmnvmw.2.x:nv:.{9YTvw:..::pUmv}n,n:+(vp.:nq.:...a..,H:u:Li:.+:.is2v'::J:i%::L:4iri.::vv:.a.�+i+:v:Wiy�:::: /liiv ryi:;.:2.)F'i.}Y": is ••:. ..: ':4':': �:•v..,..:..::2.:::: y�.Y�i:2:::i: �:: ii2 �':' 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMB LTR DATE (MM/DD/YY) DATE (MM/DDNY) A GENERAL LIABILITY GENERAL AGGREGATE $6 0 0 0 0 0 X COMMERCIAL GENERAL LIABILITY CCP8567749 04/28/04. 04/28/05 PROODCTS-COMP/OPAGG s600000 CLAIMS MADE FX occuR PERSONAL & ADv INJURY s 3 0 0 0 0 0 OWNERS & CONTRACTORS PROT EACH OCCURRENCE - s3 0 0 0 0 0 FIRE DAMAGE (Any one fire) $ MEDEXP(Any oneperson) $5000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS' NON -OWNED AUTOS ' - COMBINED SINGLE LIMIT S BODILY INJURY (Per person) - $ - BODILY INJURY (Per acddent) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO / / _ / / AUTO ONLY - EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT $ - AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM / / / / EACH OCCURRENCE - S AGGREGATE S ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPFIETCP/ INCL PARTNERSIEXECUTNE OFFICERS ARE. EXCL WC STMTU- TO-:: TORY S I.PER ........... EL EACH ACCIDENT $ EL DISEASE- POLICY LIMIT S EL DISEASE - EA EMPLOYEE $ OTHER ELECTRICAL WIRING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ti 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Gatewocd Homes Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Falmouth Road Ste 25 OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES, CentervilleMA 02632 AUTHORIZED REPRESENTATIVE ,. -A �'.-(d{ i'e y'. '9."s w � ^-. rc .sk 4^.a r x }�CER� �' ` A'. �+-�-x ^"�bs 4 �sY� �J''�•' '3 vr,i4 � m, � C TEOF INS CFr�E cy exs' �_a-h-e� _.r-..•� nas�'•..� 34"W4..+cvx'Y �ti "fug`_ '„ srocr-= ._. m�; ISSUE DATE(hUvfIDD/YY) 9/03/2 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Harold H Williams Ins Agcy Inc DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE OLICIES BELOW. P 81 Bassett Lane Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE INSURED Stephen M. Childs 145 Cammett Road COMPANY A A.I.M. Mutual Insurance Co Marston Mills, MA 02648 COVERAGES y } !^s �'�rs. '�F <P k'zY.'': a .. 5my+ ^rk/or +✓.T<. I.Yd v.vARY R�S.S .. N'� � e f. 4 � X.'-'n".-., rvrei"�lt �'ar��ld� �i'�.HF. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN ISSUED TO T IM INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH. THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DD/YY) POLICY EXPERATIO DATE(MM/DD/YY) LIMITSL GENERAL L1ABnX Y GENERAL AGGREGATE S PRODUCTS-COMP/OP AGO. - S COMMERCIAL GENERAL LIABILITY S MADEE�JCCUR PERSONAL A ADV. INJURY $ EACH OCCURRENCE S OWNER'S A CONTRACTOR'S PROT. FIRE DAMAGE (Any = fre) $ ED. EXPENSE (Any one person) S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE IT S BODILY INJURY (Perperson) S ALL OWNED AUTOS CHEDUI AUTOS BODILY INJURY =idem) S TIRED AUTOS ON -OWNED AUTOS GARAGE LIABILITY DAMAGE S tjPROPERTY CESS LLIBIITTY - EACH OCCURRENCE S AGGREGATE S BRELW FORM R THAN UMBRELLA FORM .-X " A WORKERS COMPENSATION AND EMPLOY'S CO ABIrTY THE PROTN PRIETOR/ INCL PAR OFFICERS ARE: X EXCL 7115793012011 12/13/2003 12/13/2004 WCTTATU- OIH t"'"� >."-` $ EL DISEASE—POLICYLIMIT S 500,000 EL DISEASE —EA EMPLO-EE S 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIV EffiCLES/SPECIAL ITEMS EERTIFI�ATEHOLDERy « r .r sr `.CANGE>TATION�. M. _<.,, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE GATEWOOD HOMES, INC. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATEHOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 1600 FALMOUTH ROAD, SUITE 25 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. CENTERVILLE, MA 02632 ADTHORIREPRESENTATIVE ZED . .:'.:� -.., _:� 59T! _''�3.-i�4 atz}�. F"'�'F+%..�,,", W.. fisYM�^"✓�r1.inY..T .4 � :'6y i��wY ._�.� .%.(w..��T }'. ;.L i4: ACORa CERTIFICATE OF PRODUCER McShea Insurance Agency, Inc. 749 Main Street, Suite#H Osterville, Ma. 01655 508-420-9011 INSURED Casperson Overhead Doors Box 517 East Falmouth, MA 02536 508-563-5633 rnvFRAPCC LIABILITY INSURANCE I DATE(MM/)D/YYYY) 8/2/2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON .THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES RFI nW INSURERS AFFORDING COVERAGE NAIC# INSURER A: Worcester. Insurance Company INSURER B: National Grange Mutual INSURER C: - INSURER D: 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. IN D1 RX LTR rvsao TYPE FIN URANCE POLICY NUMBER POLICY EFFECTNE DATE MWDD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE ❑X OCCUR CB 2J1973 • 05/28/04 7- EACH OCCURRENCE $ 1,00010 O X PREMISES Eao rem S 100 00 MEDEXP(Anymeperson) $ 10,00 PERSONAL&ADVINJURY s 1 000 00, GENERAL AGGREGATE s 2 000 001 GEITL AGGREGATE LIMIT APPLIES P POLICY PR9 LOC PRODUCTS-COMP/OPAGG s 2,000 001 AUTOMOSILELIABILITYN ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS COMBINED SINGLE LIMIT (Ea accident) S _ BODLYINJURY (Per Person) S BODILYINJURY (Peraccident) S PROPERTY DAMAGE (Peracddent) S GARAGE LIABILITY ANYAUTOOTHERTHAN AUTO ONLY -EA ACCIDENT FAACCJS AUTOONLY: AGG S S EXCESS/UMBRELLA LIABILITY OCCUR CLAIMSMADE DEWCTIBLE RETENTION S EACHURRENCE $ E $ $ $ $ WORKERS COMPENSATIONAND EMPLOYERSLIABILITY- ANY PROPRIEfON/PARTNERtEJ oTrvr OFFICER/MEMBER EXCLUDEDTlfyes,desaibewcIv PROVISIONS belowOTHER-POLICY CP48352 02/22/04 q H- IMITS ER CIDENT s 500,000 E-EA EMPLOYE S 500000SPECIAL LIMB S 5OO OOO DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Gatewood Homes, Inc. 1600 Falmouth Rd., Ste. 25 Centerville, MA 02632 ACORD25(2001108) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES AUTHORIZED REP S T ©ACORD CORPORATION 1988 coRfl CERTIFICATE OF LIABILITY INSURANCE DATE WM/OD1Y" 08/02/2004 PRODUCER (781)431-9800 FAX (781)431-0222 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Cochrane & Porter Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER c% Renaissance Alliance Ins. ALTER T EHCOVERAGE AFFORDED IS CERTIFICATE DOES BOY THE POLIO EXTEND OR 981 Worcester Street Wellesley, MA 02482 INSURERS AFFORDING COVERAGE =NAIC # INSURED INSURERA: OneBeacon American, Ins. Co. Cape Cod Ready Mix, Inc. INsuRERB: Commerce Insurance Company 300 Cranberry Highway INsuRERc: Zimmerman Specialty Insurance Orleans, MA 02635 INSURERD: 20621 34754 ZSI001 " INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD*L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABfLITY CLAIMS MADE a OCCUR - CBR817036 01/01/2004 01/01/2005 EACH OCCURRENCE s 1,000,00( DAMAGE RENTED PA rp.S lOO, OOl MED EXP (Any one person) is 5,001 PERSONAL & ADV INJURY s 1,000,004 GENERALAGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS-COMP/OP AGG Is 2,000,00( B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS XY9014 01/01/2004 - 01/01/200S COMBINED SINGLE LIMIT (Ea accident) _ 1,000,00( BODILY INJURY (Per person) - S ' X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG s S C EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S BE9744481 01/01/2004 01/01/2005 EACH OCCURRENCE Is 11000.000 AGGREGATE Is 1.000.000 SIR Is 10.000 S S WORKERS COMPENSATION AND LIABILITY ANY PROPMETOR/PA..4TNER'E(ECJ.IVE OFFICERIMEMBER EXCLUDED? H yes, describe under SPECIAL PROVISIONS below WC ST.4TU- OR - E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEES E.L. DISEASE- POLICY LIMIT S OTHER " DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES( EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Gatewood Homes, Inc. 1600 Falmouth Rd. Suite 2S Centerville, MA 012632 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTFCATE HOLDER N TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL WCSE NO OBLIGA OR LIABILITY OF ANY ND UPON THE INSURER, ITS AGENTS CR REPRESENT IVE KIND S. AUTHORIZED REPRESENTATIVE .. d 25 (2001/08) ORD CORPORATION 1988 ACORDn CERTIFICATE OF LIABILITY INSURANCE �118AT�^""°°�nPRODUCER /02/04 �� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Fel et (berg Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222 Milliken Blvd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 3220 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fall River, MA 02722 INSURERS AFFORDING COVERAGE INSURED Cape Cod Ready Mix Inc. INSURER A. Construction Industries Compensation PO Box -399 .. .. INSURER B: Orleans, MA 02653 INSURERC' INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED Of MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OF SUCf NSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE M/D DATE M/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE E 1COMMERCIAL LIABILITY FIRE DAMAGE(Any one fire) E CLAIMS MADE I ,� CLAIMS MADE OCCUR MED EXP (Any one person) E IL PERSONAL& ADV INJURY § AGGRECOMPIGATE GENERAL AGGREGATE § GENI.AGGREGATE LIM ITAPPLIESPER: PRODUCTS § PET POLICY LOC AUTOMOBILE LIABILITY PP ANY AUTO NED SINGLE LIMIT § (COMBIEa ) ' I ALL OWNED AUTOS IH� SCHEDULED AUTOS BODILY (Per person)§ HIRED AUTOS I L NON -OWNED AUTOS BODILY INJURY E (Per accident) PROPERTYDAMAGE (Per accident) Is GARAGE ' I AUTO ONLY - EA ACCIDENT S ANY AUTO AUTO � OTHER THAN EA ACC S AUTO ONLY: AGG IS EXCESS LIABILITY EACH OCCURRENCE § OCCUR CLAIMS MADE AGGREGATE § E§ DEDUCTIBLE RETENTION S A WORKERS COMPENSATION AND WC0009254 01/01/04 O1/O1/O5 X WC STATIC OTH- I EMPLOYERS' LIABILITY EL EACH ACCIDENT s500,000 E.L. DISEASE. EA EMPLOYEEI $500,000 I OTHER E.L. DISEASE •POLICY LIMIT §SOO,000 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Gatewood Homes Inc. 1600 Falmouth Road Suite 25 Centerville, MA 02632 JnwLD ANTOFTH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, -THE ISSUING INSURER WILL ENDEAVOR TOMAIL3,ODAYS WRITTEN NOTICE TO THE CERTIFICATE H OLD ER NAM ED TOTH E LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OB LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ACORD 25S (7/97)1 of 2 #S61300/M55627 CL3 0 ACORD CORPORATION 1988 Aur03-04 02:42pm F ram -A I G 973-316-6903 T-2j0 P-002/002 F-431 Dias Ins Agency Inc 535 Brayton Avenue Fall River, MA. 02721 EDa Carpentry Inc 100 West Main street, St io Hyannis. MA 02601 qp I N S D U ... ... . .... L 7AS C�' ONLY Aj� HOLDER. Two THE- I ICATE IS ISSUED AS A MATTEROFINFORMATION ONLY AND C ONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Tl- IS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE -;OVERAGE AFFORDED BY THE POLICIES BELOW- `%J'wrANJ=-j AFFORDING IN COMPANY A GRANITE STATE INSURANCEOM CPANY 77 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED ;1-"LUW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING ANY REAL REMENT- TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY B ; ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E ZCLUSIONS AND CONDMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. tMKOYERS' LIABILITY PfWrfuirmw C3 EXCL 0 1 C Group R 1 0085615 age Appra to w Opeal M6 ONy. CERTIFICATE HOLDER GATEWOOD HOMES 1600 GALMOUTH ROAD, SUITE 25 CENTERVILLE, MA 02632 7/24/2004 - ' 7/24/2005 ACCIDENT SE POLICY LWIT SHOULD ANY OF THE ABC /E DESCRIBED POLICIES BE CANCELLED ED BEFORE THE 04PPATION DATE THERE )F' THE ISSUING COMPANY WILL ENDEAVOR TO MAIL to DAYS WKrrrEN KVME 7 , THE CFRTIFCATE HOLDER NAMED TO THE LEFT. BUT FALURr TO MAIL SUCH )TICE SHALL IMPOSE NO OBLIGATION OR LIAOX17Y OF ANY KIND UPON THE COL 'ANY, ITS AGENTS OR REPRESENTATIVE& AUTHORIZED REPRi SENTATI IE ('� cjlo ..... i:. ... V. vu Aln 4voravv6421 UULUXILN ASSOC do CI=RTIFICA ft. �x �AABQILITY INSURANCE aR` 3Ht3CERT1iC/1C�-IS IS�iUED GOLTINAN L SERVICES INC.CcTTm�TTr Te ON6Y AND CONFERS NO RIGHTS BIiiA3AL SERVICES IHOLDER. THISCERTIFICATEDOP 933- paw...... a ALTFP-TK C =16NNIS DIM 02601 P17oas1508aTT5efi0.10 P:;:508-790-0243 I"$"—€R3AFFORDING CVrERAGE INSTIOPD 7 O X)r)wSR RENOVATIONS INC I NPO BOY 116 SM-M-MR3 nRAC•s MA 02562 THE la Ol DATE p1lAL)IDYrq� NAIQ N . THE POLICIES OF MSURANCS LISTED BELOW HAVF RMN LWUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHSTANDING ANY RMULREMENT. TVW OR COON OF ANY CONTRACT OR OTHER DOCL Ma WITH aFSP£L"f TO WHICH THIS CERTIFICATE PAY BE ISAIED OR MAY BE.L' TA,�Y, THE RL4U831CCE •EE^�"m BYTt� EOL!"'E L`�:.:�MED HE�.LY IS ^..UCM1CT TO ALL TY7: TEi.C.:3, fi7(CLU37CN5 ANDCONDITIONS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLABIS OF SUCH LTR TYPE OF NSUPANCE POLICY NUMBER DATE Iy4.YpWyyl DATE uLars GENERAL YAMLITT A Y COMMERCWLGENERALLWBILITY 3CH2718 EACHOCCUMtENCE s 1000000 CLAIMS MADG ®OCCUR 12/12/03 12/12/04 PREIUISES(Emo re ) s 50000 MED MCP (Any pp,o„) 55000 PERSONAL d ADY IwURY S 1000000 CPXRAL AGGREGATE s 20UII0'0'iT" 22M AGGREGATE LaLTT APPLIES PER PRDDL•'TS-CCdtPlO►AGG $1000000 POLs:Y I LOC AUTOMOBLEUABILITY ANYAUTO CO GLE UNIT E ALL OWN= AUTOS SCHEDULEDAUT03 RODILYWAIRYY _ HIREDAUTOS . NON13Yi mAUTOS ROOILY BWRY _ (Pr iC..CID PROPERTY DAMAGE i I LPP!leE4eM1 AUTO C,ST.T- EA ACCIvENT S �SA.T:.:S AUTOOJTY ANYAUTO. OTHMTHAN FA ACC s AUTO ONLY. AGG S K4ES4N 1_•L�A WM14Il. ' OCCUR CLAIMS MADE EACH OCCURRENCE 15 AGGREGATE i DEDUCTIBLE s RETENTION s I ! waTITtR3 COiPEILSS11TgN AND s E►PLAYELT uABLIrY - $ ANrrsaraxTCPtASTr�••^CLITlVE 4Bi�IC7016018012004 01/03/04 01/03/05 TORN LIMITS ER E.LEAcHAccivENT OFFY:cRf�Lid-eR flCCUIueD? s100000 Y vec, desulue lrrloar - C.L. DISEASE -EA EMPLOYEs 10000E P INON$°C1oiM OTHER-- EL.D" SE-POLcrUMrT I s.500000 DFsCRirnON OP OPERAr"sI LOENmii31{rti£Le'SI EACtiTaiGNSADDEDBYENDGRSENENT/SPEC AI PRBYTSa7N9 - . CERTIRCAI E rIC&DER% GA4'>i�RiO S�DAr.70FTNv An.^VE `t<�.:.^.�' � PO< BE CAtK:EILED aE>~;.» rr r .:>r,Y Dare THEREOF. Tr-- ISSUING IPguRER WILL E.tin:AYOR TD u•• 3 0 DAYS rr°.,IrrEY GATZOMM Ercros n.vc NMVCT@ TNB CCRTiVCATE HDk4ER NANEU TO THU LEF71 BUT FALUIM T044 W-&ML FAY 508-778-S403 BB•OSE NO DOUG TIO_NOR tLLBILm OF ANY WND UPON THE NLf1IREq R4 eflgWT.FR 1600 rAL-.'•"= — AD REPRESENTATNES. CENTERVILLE MA 02632 AUTNWiQE R TIESEI{rArnTs d/4/U4 -L:JL,:Jb PM 4154 ® 02/03 ACOR4 CERTIFICATE OF LIABILITY INSURANCE =(MPRODUCER (SOH)540-2400 FAX 508 760-1988 ( ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Murray & MacDonald Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE- 406 Jones Road HOLDER. THIS CERTIFICATE DOES ALTER THE OVERAGE AFFORDED BOY THE POD, EXTEND OR LICIES Falmouth, MA 02540 C ES BELOW, Falmouth, Douglas MacDonald INSURERS AFFORDING COVERAGE NAIC # INSURED TRACY HOWERTDN INSURER A: Hartford Fire Ins co PO BOX 1551 19682- INSURER e:. Liberty Mutual Ins Corp MASHP� I MA 02649 INSURER C. INSURER 0: INSURER E: CAVFRACCC _ THE POLICIES OF INSURAVCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING - ANY OF ANY CONTRACT MAY PERTAIN,REQUIREMENT, HE INSUWWOCE AFFORION DED B T E POLICIES ESCRIBED HEREIN SUBJECWITH CH THIS CERTIFICATE MAY SE PECT TO VTEIRMS, T TO ISSUED OR IS ALL THE E:XCU)SIONS AND CONDITIONS OFF SUCH POLICIES. AGGREGATE UN11TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I DO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE GENERAL LIABILITY O85BAIQi7945 lO/O2�L/� 003 POLICY EXPRATRHI lO/02�LIMITS 004 EACH OCCURRENCE COMMERCIAL COMME:ERCULL GENERAL LIABILITY § CLAIILS MADE ❑ DAMAGE TO RENTED § 300OCCUR A MED EXP (Any oIe Pxsd") $ lo- p ADVN,IURY $ SOO GEN'L AGGREGATE LMT APPLIES PER: GENERAL AGGREGATE § 1 I ODMI PF0. POLICY JEI—T LOC PRODUCTS-COMP/OPAGG § 1 OLIO AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT - (Es Nxieem) § ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Px Person) § HIRED AUTOS NON-OWNEDAUTOS BODILY INJURY § PROPERTYDAMAGE (Px nCCiOmI) § GARAGE LIASLRY ANY AUTO AUTO ONLY-EAACCIDENT§ OTHER THAN EA ACC § AUTO ONLY: ADD § EXCESSNMBRELLA L4IBLRY OCCUR C CLAIMS MADE EACH OCCURRENCE § AGGREGATE § DEDUCTIBLE § RETENTION S § WORKERS COMPENSATION AND WC131S317310021 10/05/2003 § 10/05/2004 WC STATLL EMPLOYERS' LIABILITY OT B ANY PROPRIETOR,PARTNERIO(ECUTNE OFFICEWMEMBER EXCLUDED? E.LEACH ACCIDENT § 1�, UYM dewdu entlx SPECIAL PROVISIONS Delav E.E.L.DISEASE -EA EMPLOYE § TOO OTHER E.L. DISEASE -POLICY LIMIT § Soo, DESCRIPTION OF OPERATIONS 1 L=ATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS GateAvod Homes Jeffrey Sol lows 16 Falmouth Road Suite 25 Centerville, MA 02632 ACORD 25 (2001108) FAX: (508)778-5603 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRA710N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _lO _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY AND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE />! 1515 CACORD CORPORATION 1988 ,w-w-craw rn • n K 1 I/tK K I bK bl- tC: l RL 1 STS 1 508 564 7272 P. 01 /02 .. .. k ACORD,.WIFW£RTE FRooucER UB �1� o 28/0uc;�_"M s «� x., 4 � .........'w.w ......«....,..w.y..w..us..x i.a» ... �!ae.es .,:..lye.z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RIDER RISK SPECIALISTS HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALIER-THE-CONERAGE.AFFORDED BY THE -POLICIES BELOW. INSURANCE AGENCY, INC. COMPANIES AFFORDING COVERAGE P.O.BOX 115 E CATAUMET MA 02534-0115 A SCOTTSDALE INSURANCE COMPANY INSURED .. _ .. MONUMENT INSULATION, INC. � AMERICAN HOME INSURANCE COMPANY 223 COUNTY ROAD COMPANY BOURNE, MA 02532 C COMPANY D 1•': u�o'xan.w.. Fa.au4ttfwN».w. � 0.:E.wh •-syro.4 A.irvn<., 1 ^.e.e.wv THtS IS TO CERTIFY THAT 1HE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSVED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWRH$TANDMO ANV REQUIREMENT, TERM OR CONDRtON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED-HEREM-IS-SUBJEMMA{L:THF, TFRMR EXCLUSIONS AND CONDRIONS OF SUCH POLICIES. LAARS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE Of INSLIRAIICE POLICY NUMBFA POLICY EFFECTNE_ . x GATE IMMlDDM'I DATE IMMMDIYY) LIMRS— OENEAAL LWLLTTY GENERAL AGGREGATE E 1, Q O O, O Q Q X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP OP AGG E 5 O 0, 0 0 0 CLAIMS MADE O OCCUR PERSONAL L AOV MJURY E5 00 , 0 Q O 2 OWNEWS&CONTRACTORSPROT CLS1001705 3 330/04 3/30/05 EACH OCCURRENCE :500.000 FWE DAMAGE MAY Dort MBl ICU, UUU MEO EXP IAny cM Imna"l S5.000 AVTOMOBRE WpWTY ANY AUTO ALL OWNED AUTOS SCHEOVLED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT 4--- ' BOOtLY IhUUKT IPBr BErEO^I BODILY INJURY mccdow PROPERTY DAMAGE OAMOE LIAMtITY ANY AUTO - - AUTO ONLY . SA ACCIDENT OTHER THAN AUTO ONLY: :f.",;:::'^ I•^;%;�=- µ::':'=' EACH ACCIDENT F AGGREGATE B EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM ' EACH OCCURRENCE -• •• AGGREGATE - • - B WORKERS EMPLOYERS LIABILITY NAND THE PIIOPRIETOR/ 71 Ric PARTNERSIEXECUTIVE L WC 768 29 54 3/5/0'4- 3/5/DS X W STATU- O qM• :. EL EACH ACCIDENT E 1 0 O, 000 B5eD— 090- - _ EL DISEASE- F'OLICYUwr OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE GATEWOOD HOMES EXPIRATION DATE THEREOF, THE ISSUING COMPANY . WILL. ENDEAVOR TO MAIL 1600 FALMOUTH ROAD #25 30DAYS WMTTEN NOTICE TO THE CEATIFICATE HOLDER NAMED TO THE LEFT, CENTERVILLE, MA 02632 OUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OEUGATIOM OR UASIUTT OF ANY RIND UMR THE COM?ANY, ITS AGOA* OR REPRESENTATIYEd_ Lt I •• "� GULUMAN ASSOC A colic►_ I:ERTIFICATE OF LIABILITY INSURANCE DER GOWN" & ASSO DATES nMURANCE THIS CERTIFICATE IS ISSUE D AS F13CTnr- SERV :CES 2NC, ONLY AND CONFERS NO,�g 933 FALMOtTB R >. , HOLOER THIS CERTIFICATE DOE PhuaT=s 02611 ALTER THE COVERAGEAFFORDE PI O 03 5508••775-6010 Fax:508-790-0249 f InB�R� INSURERS AFFORDING No INSURER A: COMI�RCE ROMMY TAVANO wsUREJ:B: ZIIRSCH-AMERICAN DBA M818;ANICAL SYSTEKS 11 D ROI ,DIM LANE mSURER C. EIARN .TABLa; arcs 02668 MlSURERD COVERAGES INSURER E: THE POLMMS OF ANSURM ANY REOUIREMQ R, TERM LISTED BQDW HAYS BEEN ISSUED TOO HER INS DOC(IMENT ABOVE FOR THE POLICY MAY PQS. THE WSUR" NCS N OF ANY CONTRACTOR PERIOp MIDICA7ED. POLICIES AGGREGATE LU rT5 AFFORDED 8Y THE POLICIES DESCiUB� JE RESPECT TO WHICH THIS CERTIFICATE MAYBE 65UE1) OR NOTWITHSTANDING SHOWN MAY HAVE BEEN HEREIN IS SUMJECiIOALL THE TERMS, pq,},USpNS AND oky BE SUED SUCH REDUCED By CLAIMS. R TYPE O ' MISURANCE POLINUNBQt JGAftAG!LLAIuLj RIL LM&L TY MMERCbLGEHEFALLIAB0.ITYWL8172 CIAM' MADE ®O�GGREGA E� JE�CT LOC M" LU MR AUTO OWNEC AUTOS EDULEI AUTOS OAU7T S OWNE'AUTOS Y UTO EXCMAMRS LALIABLLQY OCCUR CLANS MADE OE.7t=mL RETENTION S PANYPR ERS CCWENSA TON ANO YERS' JAsgM OPRIE fORIP'NFJLomcunvE �7278A84903 LADED?__� _ GATENOIID HOMES 3:XC FAX 50(:-778-5603 1600 F:,Z,MODTR ROAD CENTEW7LLE MA 02632 _ LIMITS 11/21/03 11/21 04 / PREYISIS (S. ew.2„aI S.. s_1 52 22 (Es aemm COMBnEO SINGLE LIMIT I S 9 (�pasen S (Per acc(earwtj� S PROPERTY DAMAGE iParscJdrit) S AUTO ONLY -EA ACCIDENT S- AOTHER THAN UTO ORLY: _ EA ACC S OS/03 Oq 05/03/05 EC EDISEASE. L LDBT S S 02 NA►C III 0 GAT=OO SHOULDANTOFTHE ABOVE DESMIED POUrJFS>TE �••wr,l DATE THEREOF, THE ISSUING INSURER BEFORE THE QTPMULflON WILL ENDEAVOR TO NAIL III DAYS WRITTEN NOTICETO THE CM FICATE LIB NAMED TO TIE LEFT. BUT FAILURETO DO SO SHALL MPoSE NO OBLIGATION OR LUIBILTrY OFANY quo UPON THE INSUREWI TS-1rGER737tw.— REPRESENTATIVM r • TOWN OF YARMOUTH Building Department Town Hd • Yarrnarth, MA 02564. (5W 398-2231 a226t BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-390 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 138 Owner's Name: Villages Q Camp Street, LLC Owner's Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: 1. WATER DEPARTMENT: 2. ENGINEERING DEPARTMENT: (OFFICE USE ONLY Recorded By: IC Permit Fee: $0.00 Deposii Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 1/312005 Comments: Map/Lot: 044.21.1.0 new construction: DATE: Wk. DATE: WA: 3. CONSERVATION: ' DATE: WA: 4. HEALTH DEPARTMENT: DATE: Z /O DSO N/A: 5. BUILDING DEPARTMENT. DATE: WA: 6. FIRE DEPARTMENT: COMMENTS: �;ii�,�i�;L•Y1� d DATE: WA: RECEIPT OF COPY: SIGNATURE OF APPLICANT: �\� / r(C QQ�r DATE: 3 l b 4 Date Printed: 1/312005 TOWN OF YARMOUTH WATER DEPARTMENT 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 Letter of Water Availability Date of Issue: February 2, 2005 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) 21.1C/136; Street: 121 Camp Street, W. Yarmouth As shown of 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 owner's expense, the installation of water mains and appurtenant items to meet water demands 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) Yarmouth Water Department A A N:\Water Availibility\121Camp#136.doc TOWN OF YARMOUTH Building Department Town Hal Yarmouth, MA 02664. (SM) 3W2231 eA251 BUILDING PERMIT Temp Permit No.: Applicant Name: Applicant Phone: Building Location: Owner's Name: Owners Addres TRANSMITTAL T 05-390 Frank Capra 5087789669 00121 CAMP ST # 136 Villages @ Camp Street, LLC 1600 Falmouth Road # 25 Centerville MA 02632 Owner's Telephone: (508) 778-9669 (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposfi Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 1/312005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: REVIEWED BY: 1. WATER DEPARTMENT: .y DATE: c3 pj^" WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: 4. HEALTH DEPARTMENT: 5. BUILDING DEPARTMENT. 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT. DATE: WA: DATE: WA: DATE: WA: DATE: WA: DATE: Date Printed: 1/312005 R r T' MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software version 2.01 Release 2 CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 Or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 4-21-2004 DATE OF PLANS: 04/21/04 TITLE: The Egret PROJECT INFORMATION: Mill Pond village 1600 Falmouth Road Unit #25 Centerville, MA. 02632 COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES Required UA = 216 Your Home = 123 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-value R-value U-value CEILINGS 832 30.0 30.0 WALLS: wood Frame, 16" O.C. 1409 15.0 15.0 GLAZING: windows or Doors 87 0.340 GLAZING: windows or Doors 40 0.340 DOORS 40 0.086 -------------------------------------------------------------------------- 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 UA 14 62 30 14 3 Massachusetts Energy Code MAScheck software version 2.01 Release 2 The Egret DATE: 4-21-2004 Bldg. Dept. Use I I I [] I I C] CEILINGS: 1. R-30 + R-30 Comments/Location WALLS: 1. wood Frame, 16" O.C., R-15 + R-15 Comments/Location WINDOWS AND GLASS DOORS: 1. u-value: 0.34 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location 2. U-value: 0.34 For windows without labeled U-values, describe features:- # Panes Frame Type Thermal Break? [ ] Yes [ ] No comments/Location DOORS: 1. U-value: 0.086 Comments/Location AIR LEAKAGE: joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. when installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type Ic rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I 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)------------------------- L oyn n)+- 0 G a — 3 GMS9/GCS9 SERIES Multi -Position, Single-Stage/Multi-Speed 46,000-115,000 nok (ink mkqnh� Standard Features • Corrosion -resistant, aluminized -steel tubular heat exchanger and stainless -steel recuperative coil for maximum efficiency • Designed for multi -position installation—GMS9: upflow, horizontal right or left; GCS9: downflow, horizontal right or left • Energy -saving, reliable Hot Surface Ignition system, featuring a Norton® Mini -Igniter with patented adaptive learning algorithm to maximize igniter life • Aluminized -steel inshot burners • Energy -saving PSC, multi -speed, direct drive blower motor • Quiet, corrosion -resistant induced draft blower assembly • Integrated furnace control with improved diagnostics • Low voltage terminal blocks • Multiple flame roll -out switches, blower door safety switch, outlet air -limit switch and pressure switch for proof of combustion air • 40VA transformer for heating and air conditioning control service • Combination redundant gas valve and regulator • Top venting is standard; alternate flue/vent located on right side • Completely assembled, factory run -tested furnace for heating or combination heating/cooling application • All models comply with California NOx Standards • Suitable for direct vent (2-pipe) or non -direct vent. (1-pipe) applications Air Conditioning & Heating The GMS9/GCS9 single -stage, 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.E Gas Low Pressure Kit (LPLPOI) • High Altitude Natural Gas/L.E Kits (HANG11, HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter Rack (EFROI) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Internal Filter Retention Kit—upflow, horizontal (RF000180) • Internal Filter Retentions i Kit—downflow � (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) S&377D www.goodmanmfg•com 6/04 r PRODUCT SPECIFICATIONS Nomenclature G IMI S 8 070 3 EA]FNI A Goodman® Brand Revision A: Initial Release Air Flow Direction NOx B: 11 Revision M: Upflow/Horizontal N: Natural Gas C.2nd Revision D: Dedicated Downflow X: Low NOx C: Downflow/Horizontal Cabinet Width H: Hi Air Flow A: 14" Description B: Mi" S: Single Stage/Multi-speed C: 21 V: Two Stage/Variable-speed. D: 241A" AFUE 8: 80% 9: 90% 045:45,000 070:70,000 090:90,000 115: 115,000 140:140,000 Maximum CFM @ 0.5" ESP 3: 1,200 4: 1,600 5: 2,000 2 (7 C: Fe PRODUCT SPECIFICATIONS Performance Ratings rt%�FiJE� .�..r*�^:,� � .;5.- Y' k..iY �- �rESP. GMS90453BXA 46,000 42,800 37,200- 93.0 3.0 35.65 GMS90703BXA 69,000 64,400 55,800 93.0 3.0 35-65 GMS90904CXA 92,000 86,OD0 74,400 93.0 4.0 35-65 GMS91155DXA 1 115,000 106,500 93,000 93.0 5.0 35-65. GC590453BXA 46,000 42,800 37,200 93.0 3.0 35.65 GC590703BXA 69,000 64,400 55,800 93.0 3.0 35-65 GC590904CXA 92,000 86,OD0 74,400 93.0 4.0 40-70 GC591155DXA 115,000 106,500 93,000 93.0 5.0 40-70 t For altitudes above 2,ODO', reduce input rating 4% for each 1,000' above sea level. z DOE AFUE based upon Isolated Combustion System (ICS). Specifications ,... a 6d i Y'e Carta'Ya�i x z a' f rt`� + . � pe �t f; ar4Pj 0No aDfi °''•` trStz� ><r1 ea.d�w s Srs osab%GMS90453BXA 41JIirnmGrti"TMM5 R traa' Grtu�k mu�� OYe �urenG mlii.. z�� 10" x 7" 1/3 4 2" 2 il 576 9.0 15 132 GM590703BXA 10" x 8" 1/3 4 2" 3 564 9.0 15 135 GMS90904CXA 10" x 10" 1/2 4 2" 4 752 8.9 15 158 GM591155DXA 11"x 10" 3/4 4 2"5 940 12.2 15 175 GCS90453BXA 10" x 7" 1/3 4 2" 2 288 576 9.0 15 132 GCS90703BXA 10" x 8" 1/3 4 2" 3 282 564 9.0 15 135 GCS90904CXA 10" x 10" 1/21 4 2" 4 376 752 8.9 ' 15 156 GCS91155DXA 11"x 10" 3/4 4 2" 5 470 940 12.2 15 175 t Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (I or 2 pipes). The optional Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC. r Minimum Circuit Ampaciry = (1.25 x Circulator Blower Amps) + ID Blower amps. a Maximum Overcurrent Protection refers to maximum recommended fuse or circuit breaker size. NOTES: • All furnaces are manufactured for use on 115 VAC, 60 Hz, single phase electrical supply. • Gas Service Connection'h".FPT • Important: It is reqused to size overcurrent protection device and wires properly and make electrical connections in accordance with the National Electrical Code and/or all existing local codes. PRODUCT SPECIFICATIONS GMS9 Dimensions l AIR l 3/4 �195R-s� 1R MITAKE PIPE (DISCHARGEAIR) 21/18 VENT/FLUE PIPE I 2• PVC ALTERNATE ALTERNATE l 7 C 211N8 .1 AIR INTAKE LOCATION GAS SUPPLY II CONDENSATE STANDARD GAE HOLE Q DRAIN TRAP SUPPLY HOLE W/ 3l4' PVC AL7ERIUTE HIGH VOLTAGE DISCHARGE ELECTRIDALV 13/4 4118 VENTIFLUE (RIGHT OR LOCATION LEF781DE 1H 40 LEFT SIDE) HIGH VOLTAGE DRAM LINE 2 SHe 1 ELECTRICAL HOLE HOLES E112 I 23 71I8 25MR RIGHT SIDE r DRAIN I DRAIN DRAIN LINE TRAP �T'I 21 U4 301 193H8 Q. HOLES 1 LOW VOLTAGE 172,6 LOW VOLTAGE 14 ELECRtICI1. HOLE 13/4� 19 18 0.I 11314 ELECTRICAL HOLE SIDE CUT-OUT 773A4 3213nE N1314 SIDE CUT-OUT L ��J �D�..� L J I �-23 WiocKvur ' BOTTOM OTOM W7GDK-0UT LEFT SIDE FRONT - RIGHT SIDE VIEW VIEW VIEW - ' 'x GMS90453BXA GMS90703BXA 171h 16" 12%" 12%" GMS90904CXA 21" 191/1" 16%" 14%" GMS91155DXA 241h" 23" 20%11 18%" NOTES: 1. Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (1 or 2 pipes). The optional Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC. 2. Line voltage wiring can enter through the right or left side of the furnace. Low voltage wiring can enter through the right or left side of furnace. 3. Conversion kits for high altitude natural gas operation are available. Contact your Goodman distributor or dealer for details. 4. Installer must supply following gas line fittings, according to which entrance is used: Left —Two 90Q elbows, one close nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials o MES- . U flow 0"1 0" 3" C Horizontal 6" 1 0" 3" C 0" 4" C = If placed on combustible (loos the floor MUST be wood ONLY. " NOTES: • For servicing or cleaning, a 36' front clearance is recommended. • Unit connections (electrical, flue and drain) may necessitate greater clearances than the minimum clearances listed below. • In all eases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. �N 4 C PRODUCT SPECIFICATIONS GCS9 Dimensions LEFT SIDE FRONT RIGHT SIDE VIEW VIEW VIEW 112 RI=�PIPE I�1By� r �J _ 1 3 LOW VOLTAGE I ELECTRICAL HOLE�7 L J 2 511e HIGH VOLTAGE ELECTRICAL HOLE DRAIN TRAP 25" LEFT SIDE 1512 DRA N LINE HOLES 11112 STANDARD GAS J SUPPLYHOLE 41/e B1I,SI 34 VENT/FLUE PIPE .(RETURNAIR) 21/18 CONDENSATE 2'PVC ' r LOW VOLTAGE DRAIN TRAP w/3/4-PVC 1 ELECTRICAL HOLE DISCHARGE (RIGHT OR HIGH VOLTAGE LEFTSIDE) ELECTRICAL HOLE L ALTERNATE J 2S S Sim 211HS VENDFLUE LOCATION + ALTERNATE 187/B AIR INTAKE LOCATION + 2 58 t T 1s 3/1 RIGHT SIDE Q Ij 14 DRAIN LINE HOLES 2 11 O S,M B 314 7 ALTERNATENATEGAS SUPPLY HOLE DISC^E UNFOLDED FLANGES ljlAIR FIXDED FLANGES DISCHARGEAIR I fS M_ GCS90453BXA 171h" 16" 12%" 141/1" 16" GCS90703BXA 1731" 16" 12%" 1411" 16" GCS90904CXA 21" 1911" 16%" 18" 19%" GCS91155DXA 241h" 23" 20%" 211h" 23" NOTES: 1. Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon fumace input, number of elbows, length of run and installation (1 or 2 pipes). The optional Combustion Air Pipe is dependent on installation/code requirements and must be 2" or 3" diameter PVC. 2. Line voltage wiring can enter through the right or left side of the furnace. Low voltage wiring can enter through the right or left side of furnace. 3. Conversion kits for high altitude natural gas operation are available. Contact your Goodman distributor or dealer for details. 4• Installer must supply following gas line fittings, according to which entrance is used: Left —Two 404 elbows, one dose nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials . 5 _' �. =�o Downflow 0" 0" 1" NC 0" 1" Horizontal 6" 0" 1" C 0" 4" C = Combustible: If placed on combustible floor, the floor MUST be wood ONLY. NC,= Non -Combustible: A combustible floor subbase must be used for installation on combustible flooring NOTES: • For servicing or cleaning, a 36" front clearance is recommended. • Unit connections (electrical, flue and drain) may necessitate greater clearances than the minimum clearances listed below. • In all cases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. 5 PRODUCT SPECIFICATIONS Blower Performance Specifications -i - x v }. �+u�g...m5 -ct ,P�n x��}• Via- u Ssitr 1 �t�14 10 MR75ECiTM1 111SE ICI M-, CFMp ;EM HIGH 3.0 1,352 -- - 1,260 ------ 1,202 --- 9 53+ G_S90453BXA MED 2.5 "" 1,214 11,318 ----- 1,172 .•.... 1,123 ------ 1,064 923 ------ 36 (LOW) MED-LO 2.0 997 ------ 994 ------ 960 35 36 LOW 1.5 757 44 753 44 734 45 704 47Dai ae HIGH 3.0 1,449 36 1,409 37 1,326 39 1,273 41 47 � 194 933�9093 1 8' `1s'N G_590703BXA MED MED-LO 2.5 2.0 1,192 981 43 53 1,172 962 44 54 1,141 943 .45 55 1,094 917 56 .. (MED-HI) 714 692 ---•-20�7b; j1(= LOW 1.5 750 ------ 730 -•--- --•--- HIGH 4.0 1,970 ------ 1,874 35 38 1,667 40;t3� �2a182-G_590904CXA MED 3.5 1,713 39 1,650 40 11:7571 1572 42 48 1,510 1,327 444 50 4b , 2�9< $56w (MED-LO) NED-LO 3.0 1,439 46 1,412 47 1,370 t03�3 �6 LOW 2.5 1 183 56 1 155 57 1,122 59 1 108 60 11GH 5.0 40 40 2,029 42 1,941 44 G_591155DXA MED 4.0 12,1341 1,678 51 12,103 1,643 . 52 1,643 52 1,577 54 "t48 s314 f2a (MED-HI) WD-LO 3.5 1,453 58 1,440 59 1,426 59 1,363 62 �1��'-Vi 9�253< ' 9 LOW 3.0 1,259 67 1239 68 1220 70 1181 ------ _ NOTES: 1. CFM in chart is without fdter(s). Filters do not ship with this furnace, but must be provided by the installer. If the furnace requires two reruns, this chart assumes both filters are installed. 2. All furnaces ship as high speed cooling. Installer must adjust blowerzooling speed as needed 3. For most jobs, about 400 CFM per ton when cooling is desirable. 4. INSTALLATION :S TO BE ADJUSTED TO OBTAIN TEMPERATURE RISE wITHIN THE RANGE SPECIFIED ON THE RATING PLATE. 5. The chart is for information only. For satisfactory operation, external static pressure must not exceed value shown on the rating plate. The shaded area indicates ranges in excess of maximum static pressure allowed when heating. 6. The dashed ( --- -) areas indicate a temperature rise not recommended for this model 7. The above chart is for U.S. furnaces installed at 0' - 2,000'. At higher attitudes, a properly de -rated unit will have approximately the same temperature rise at a particular CFM, while ESP at the CFM will be lower. (7 PRODUCT SPECIFICATIONS Accessories yY� g Foet«lP+!?NOR3B`,Ai1J3Bht904CX+1k �GS9"S�iXA' LPT-OOA L.P. Conversion Kit ✓ ✓ ✓ ✓ LPLPO7 LP. Gas Low Pressure Kit ✓ ✓ ✓ ✓ HANG11 High Altitude Natural Gas Kit 1 1 1 1 HANG12 High Altitude Natural Gas Kit 2 2 2 2 HALP10 I High Altitude LP. Gas Kit 3 3 3 3 HAPS27 High Altitude Pressure Switch Kit 3 3 3 3 EFR01 External Filter Rack ✓ ✓ ✓ ✓ DCVK-20 Horizontal/Vertical Concentric Vent Kit (2") ✓ ✓ DCVK-30 Horizontal/Vertical Concentric Vent Kit (3") ✓ ✓ ✓ Available for this model (1) 7,001'to 9,000' (2) 9,001' to 11,000' (3) 7,001' to 11,000' " Note: All installations above 7,000' require a pressure switch change. For installation in Canada, furnaces are certified only to 4,500'. Downflow Floor Base: When the GCS9 model is installed directly on a wood floor, a downflow floor base must be used. Those model numbers are: CFB17, CFB21 and CFB24. Thermostats �• Q[7 '� � s S�'_ Rt s '. Pt<#?vn����Y�"s4r +gror..�.P:,n- �'�' s�� � .,.- «3�".�'r-it�vz �-+Fr`�s•'�� x_ "> •y{ w4c. CHT18-60 Cooling/Heating, Mechanical CH70TG Cooling/Heating,Digital, Non -programmable CHSATG Cooling/Heating, Mechanical H20TWR Heating Only, Mechanical KN C� L, O \ O lbb- LOT 137 Dc 6' LOT 135 <`.� �`� ��• \, �2 \ 36 F 4 k �� Us liv C%� , �(o i NOTE• ay 2GOg � l Y R� uCHAEL y `�_ A ® SEWER LATERAL SDI SLEEVED IN ACCORDANCE Fc r�F �PHIC SCALE WITH TITLE V IF WITHIN ss, s F: 1OFT. OF WATER MAIN. �••V 20 10 10- 20 60 f::., ).. I arH! S.CveyCr ( IN FEET) (n r e• ] up 1 inch = 20 it F r rrrm,"n f Cady .f K'::nis ai �ee.,rtAA,� PLOT PLAN holmes and mcgrath, inc. OF LOT 136 M. �. civil engineers and land surveyors n�orHv^n. PREPARED FOR 362 gifford street SANTCS h� MILL POND VILLAGE J CIV;L IV;L � IN falmouth, ma. 02540 � 9o,9FcisTEF``o YARMOUTH, MA ,loB No: 201197 DRAWN: LMC FSS�°uat.E"' SCALE: 1 "=20' DATE: 12-29-041 DWG. NO.: A2522 CHECKED: 6 Commonwealth of Massachusetts Omcialuse Only Permit No. - OS' IOZO " Department of Fire Services Occupancy and Fee Che d100 BOARD OF FIRE PREVENTION REGULATIONS 11/991 ve blank ` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR �A ` u All workto be pedfonned in a000rdance withthe Massachusetts Electdal Code (b1EC), 527 CbIIt 2.00 (PLEASEPRI7VlIN12VKORT7PEALLENFVRMAT7OA9 Date: •5 05 City or Town of: YAPITrx To the Inspector of WfZpr• By this application the undersigned gives notice of his or her intention to peiform the electrical work describediiei`ow, Location (Street & ,L POND VILLAGE, 121 Camp St Bldg # Owner or Tenant Gatewcod Homes/ Jeff Sollows Telephone No. 50 8-77 8 9 6 6 9 Owner's Address 1600 Falmutn Rd., Suite 25, Centerville, Ma. 02632 Is this permit in conjunction with a building permit? Yes x❑ No ❑ (Check Appropriate Box) Purpose of Building single family residence Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) wi h hakiM battery cents lv monitored. r^smnletieit ofthe faffawinr table may be ivaived by the Irtsoeetor oflirirea No. of Recessed Fixtures No. of Cell. -Su sp. (Paddle Fans o. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool d e . ❑ d. ❑ No. of Lagliting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE. ALAR*S No. of Zones —1—' No. of Switches No. of Gas Burners No.ormetection-and 7 InitiatingDevices ' No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Totals: um er. Tons Detection/Aloer•tin Devices 7 No. of Dishwashers SpacdArea Heating KW Local 0 n icipti l ® Other No. of Dryers .. Heating Appliances KW pM a Now. of Dxte � or E go ivalent o. of Water KW o. of Ao. ol Data Wiring: Heaters . Signs Ballasts No. of Devices or uivalent Na H dromassa a Bathtubs y g No. of Motors Total HP We —communications Devi tions ulna No. of Devices or Equivale OTHER: ' Attach aamaonat aatart ry aestr", or as regwrea ey vwmspeeror of arise . INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M. BOND ❑ OTHER ❑ (Specify:) (Expiration to Estimated Value of Electrical Wodc $750.00 (When required by municipal policy.) Work to Start: $'6 Q Inspections to be requested in accordance with U EC Rule 10, and upon completion. I cerlffy, under the pains and penalties of perjury, that the information on this application is true and complete FIRMNAME: Baltic Security, Inc LIC.NO.- 1178C Licensee: Jonas R Bielkevicius Signature rr LIC.NO.: 499D (lfapplicvble, eater •'esetnpt"in the Ifeense manbe .late 02563 Bus TeL No.- 508-833-0996 Address: F0 Box .1609 Baindwac�, �• Alt. TeLNo.: 508 7 OWNER'S INSURANCE WAIVER .I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (chock one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ 40.'00, Signature. Telephone No. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) TOWN O By Al Fee: $ rr. lJUN 0 9 Z005 PERMITNo. , ) (PLEASE PRINT IN INK OR TYPE To the Inspector of Wires: By this aj Date: notice of his or her intention to perform the electrical work described below, 5-le v/7/ � 3 / Location (Street &Number) /44 l Cq�? 7 ���6��! 0 Owner or Tenant `!G — %n� Telephone No.��� Owner's Address���`-' Is this permit in conjunction with a building permit? C Yes Q No (Check Appropriate Box) c� Purpose of Building fit Utility Authorization No. I z/,el 94 71 Existing Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters New Service " Amps ,;2�O 111�6 Volts OverheadC3 Undgrd 0— No. of Metersy Number of Feeders and Ampaci 243 f Alex % Location and Nature of Proposed electrical Work: e�� /`^mnlaann nirhs fnllnwino tnhln mm ho waived by the fnuvertor OfWires o. o Total . of Recessed Fixtures f i- us d le) Fans Transformers KVA No. of Lightine Outlets No. of Hot Tubs Generators KVA ve n- ❑ � No. o Emergency Lighting No. of Lighting Fixtures SwimmingPool d. d. Baum Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No, of Zones o. of Detection an No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices' Heat p um r Tons — No. of Self -Contained No. of Waste Disposers Totals: — — — — Detection/AlertingDevices Municipal Other Local ❑ No. of Dishwashers Space/Area Heating KW Connection No. of Dryers Heating Appliances KW Secutity Systems: No. of Devices or Equipvalent No. of Water Heaters KW No. of No. o Signs Ballasts Data Wing: No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or uivalent 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 a permit issuing office. U2 �G / ��r�(� too, CHECK ONE: INSURANCE BOND[] OTHERQ (Specify:) l7 t-C (Expiration Date) Estimated Value of Electrical Work: 6.WO (When required by municipal. policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pa' sand naltie of ury, that the information on this application is true and complete. NAME LIC. NO. -7133 r ensee: 5 ,>vl< Signature LIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: Sdfr — Address- Izr, J� Cee.n-1ct�� t d � 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 ❑ owners agent.0 Owner/Agent Ci�"�h.rn T 1.—t.....e AT.. _A 99 .f 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 0 JUN 0 9 2005 (OFFICE USE ONLY) By V/LL Fee: $ t Z-A5;� PERMIT NO. ^�Os /l513 (PLEASE PRINT IN INK OR TYPE A+JXMRMATION) I Date: 6 Z�d� To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. /, / / 3 / Location (Street &Number) l� l �� _7 �� W �h f� Owner or Tenant l' 40&k �� �� /n -::� Telephone No.'dT,? Owner's Address /5&kl "` <y/ '/C e&d4 S'�i in ci f Is this permit in conjunction with a building permit? LJ/Yes Q No (Check Appropriate Box) c} Purpose of Building , Utility Authorization No. Existing Service Amps / Volts Overhead[] Undgrd No. of Meters New Service 2V Amps,:W !/_,�G Volts Overhead❑ Undgrd No. of Metersy Number of Feeders and Ampacity.2143 f /D/X Location and Nature of Proposed electrical Work: _�'_T t �g r•..,,..,ic.;.,,, .,f nc. fmm.,;no ethic mnv ho wnivcd by the InsnectorofWires No. of Total o. of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA A ove In- No. of Emergency Lighting No. of Li htin Fixtures SwimmingPool md. d. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. of Detection an No. of Switches No. of Gas Burners Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices Heat Num er ons KW No. of Self -Contained No. of Waste Disposers Totals: — — Detection/Alerting Devices Municipal Other Local Q No. of Dishwashers Space/Area Heating KW Connection Secutity Systems: No. of Dryers Heating Appliances KW No. of Devices or Equipyalent No. of Water No. of No. of Data Wiring: KW Signs Ballasts No. of Devices or Equivalent Heaters Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent !14CALn uuuutviiu& uuuu y u , - -I--- -, ..... - -� ----. , .. -- --- 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 sam��e.,�to `a permit issuing office. / l CHECK ONE: INSURANCE `3 BOND C] OTHERC] (Specify:) 4�f CJ2 /C/Y (Expiration Date) Estimated Value of Electrical Work: G/hGO (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. fy, under the pa' sand enaltie gf e 'ury, that the information on this application is true and completer. WNAME: LIC. NO. I— ensee: S92*JW Signature '! i�� % LIC. NO. (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: S'dfr — Address- 6*1' �m yrc ce d � �,�X4 t:q'g 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 0 owner's agent. 0 Owner/Agent Signature Telephone [Rev. 04/00] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, (MEC), 527 CMR 12.00 (OFFICE USE ONLY) NN-OF R i UTH By G I Fee: $ 04 - AU E; 4 20 5 lu PERMIT NO. v- 1,4 3 (PLEASE PRINT IN IN _0R TYPE ALL To the Inspector of Wire tsapp to work described below. Location (Street & ber Owner or Tenant 9- Owner's Address Date: gives notice of his or her Is this permit in conjunff- n with abuilding permit? ❑ Yes 0No Purpose of Building }1/-��, l4L�o Utility Existing Service Amps / Volts Overhead New Service Amps « / 1`,e_PV, s Overhead Number of Feeders and Ampacity u on A . Location and Nature of Proposed electrical Work: f7 to perform the electrical (Check Appropriate Box) Authorization No. Undgrd No. of Meters Undgrd �No. of Meters COmnletion of the followine table may be waived by the InsnectnrnfWires of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans No. of Total Transformers KVA IlTo. of Lighting 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 Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Dei-ection an Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: um er — — ons — — — — No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local Municipal C3 Other Connection No. of Dryers rY Heating Appliances KW g PP Security Systems: No. of Devtces or Equipvalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or uivalent Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE E17� BONDCJ OTHER (Specify:) (Expiration Date) Estimated Val u 1 ;0 Work: (When required by municipal policy.) Work to Start. b Insp tions to be requested i%accordance with MEC Rule 10, and upon completion. I certify, under e` a and NAME: see: (If applicable, a qrk em OWNER'S INSURANCE WAIVER: I am aware that the below, I hereby waive this requirement. I am the (check 'on on this application is true and complete. A . t LIC. NO. 4 LIC. NO. Bus. Tel. No.: Alt. Tel. No.: s notes have the liability insurance coverage normally required by law. By my signs re owner's agent. Owner/Agent Signature Telephone No. [Rev. 04/001 NR TOWN OF YARMOUTH IA/C7- luu APR 2 By��R(5 Building AT. Location Newg Plans Submitted Re ation El Yes No ❑ APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE USE ONLY) By Fee: $ `63 PERMIT NO. ct� Date 104 7- Name Owner 'ss Name Type of Occupancy_ Replacement ❑ Z Z to fA y O 2 Z W W W N Y J N Q U 2 Q N Z � O C7 Vl � Q. cc OJ z y W FQ.. W D: F- U 0: N ¢ LL Z Z Z 3 X U y 2 N m 0(m M N W Q F M Y Z O Q. Q W O� Q a 0 Q 0: 0 U. Z mo 0 2 V y J Z O cc 0 U. J F Q Q Q = Q= 2 00. Z Q 0 Q 0. O y _2 Z 2 W H Q O U= H y Q � O Q 0: 0: O 2 Q m F O Y J m 0 G 0 J S F- fn u, SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOORLX (PRINT OR TYPE) Installing Coml Check One: ❑ Corp. Address , /-�❑❑ ParSpership v ` � F/ir om a w''`/�y Business Telephone me of Licensed Plumber � INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ J If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner Ljq Agent 3, of Z319 / License Nu ber / Type: Master[]Journeymana-