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121 Camp St #139 Building Permits
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) OF �fRRJVIOD H By Fee: $ AUG 0 4 200_VL 1 PERMIT NO. no (PLEASE PRINT IN INK 014 E AZLINF-ORALAl IQN) Date:. To the Inspector of Wires: By this application the undersigned gives notice of his or her work described below. Location (Street & N� Owner or Tenant Owner's Address Is this permit in conj tion�lwith a building permit? Yes ONo (Check Appropriate Box) Purpose of Building 4�I Aa._t1G Utility Authorization No. Existing Service Amps / Volts Overhead New Service � '0 Amps I ZZ / ?n {- Yolts Overhead Number of Feeders and Location and Nature of Proposed electrical perform the electrical No. Undgrd C3 No. of Meters Undgrd � No. of Meters__ Comnletion of the following table may be waived by the Inspector of Wires No. of Total of Recessed Fixtures No. of Ceil.-Sus . Paddle Fans Transformers KVA o. of Lighting Outlets No. of Hot Tubs Generators KVA ove n- No. of Emergency Lighting No. of Lighting 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 Purn um er — — ons — K — — No. of Self -Contained No. of Waste Disposers Totals: — Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Local ❑ Connection Other No. of Dryers Heating Appliances KW Secutity Syystems: No. of Devtces or Equipvalent No. of Water No. of No. of Data Wiring: Heaters KW Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP 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 th ermit issuing office. CHECK ONE: INSURANCE BOND O OTHER[] (Specify:) (Expiration Date) Estimated Value o El ctric W rk: (When required by municipal policy.) J Work to Start: 6n1spections to be reque ted ' a ordance with MEC Rule 10, and upon completion. I certify, undertth _ arj of *duty, tf:g nfo f n on this application is true and complete. FakNAME: L ee: Tut A6 (If applicablp, �pAr "e0*tj in OWNER'S INSURANCE WAIVER: I am aware that below, I hereby waive this requirement. I am the (cl Owner/Agent Signature [Rev. 04/001 LIC. NO. Ve.) Signature LIC. NO. Bus. T .No.:Alt. el. No.: ,not frave the liability insurance coverage normally requi�law. By my signature c one) owner ❑ owner's agent. Telephone No. M (PLEASE Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. F -C13 ' //':� Occupancy and Fee Checked YO 11/991(lave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All workto be performed in -= dance with the Mmarhusem Electrical Code (MC), 527 i00 2O �_ 'INIEKORTYPE ALL RNFVRMA77OA9 Date: Town of: YA WUYH To the Inspector of Wires:. idle undersigned gives notice of his or her intention to perform the electrical work described below. ca, Mrr.r. pcI1D VMIAGE, 121 Camp St Bldg # i .3 Gatewood Homes/ Jeff Sollows e,,,-1$00 Falmouth Rd., Suite 25, Cent ,i conjunction with a building permit? Yes X❑ ng single family residence Telephone N0.508-7789669 Ma. 0263.2 No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number ofFeeders and Ampacity Location and Nature of Proposed Electrical Woric Fire Alarm System (low voltage control panel) with itorect- r n ._r.c_fn...__.....tt......., A. im.A..?fhu the Tt eenr arWi7rt 0: O otal No. of Recessed Fixtures No. of Ce -Susp. (Paddle) Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures LU-o. Swimming Pool d e . ❑ d. ❑ o ergency g Battery Units FIRE. AT.ARMR No. Of Zones —1—' Na of Receptacle Outlets No. of Oil Burners o. of D—etecbon.and 7 No. of Switches No. of Gas Burners Initiating Devices No. of Ranges No. of Air Cond. °t Tons No. of Alerting Devices No. of Waste Disposers t nmp um er. Tons Totals• ' o. o ontane Detection/Alerting Devices 7 No. of Dishwashers Space/AreaHeating KW Muni Local 0 ConnPion®Other No. of Dryers Heating Appliances IC�V Security stems:. No. of Devices brEquivalent No. of Water KW Heaters ° of Ballasts of signs Datao of or Equivalent No. Hydrvmassage Bathtubs No. of Motors Total Telecommunications inag: No. of Devices or E ivalent LT ._.c .JJr.r..�..i .,er.N1 ,f.7:.r.sd ns ne renuirad hV the IfimeG7al0)r{lr/l4 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. CHEM ONE: INSURANCE ® BOND ❑ OTEM ❑ (Spy) (EV=don ) Estimated Value of Electrical Work $750.00 (When required by municipal policy.) Work to Staff Inspections to be requested in accordance with NEC Rule 10, and upon completion I cen'ify, under thepains and penalties of perjury, that th a information on this application is true and complete FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C 4 " IJIC. NO.: 4 9 D Licensee: Jonas R Bielkevicius Signature. ([fapphcable,enter •esempt"indie licensemnnbe.�re� Bus. Tel.No.• 508-833-0996 Addrfiss: PO Box .1609 Sandw�c�f �• 02563 Alt. Tel. No.- 508508 7 OWNER'S INSURANCE WAIVER .I am aware that the lacensee does not have the llabrhty insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's ageut Owner/Agent PERMIT FEE: $ 40."00. Signature, Telephone No. . TOWN —OF YATRMOV .- I, u J L-3 L JL AUG 2 5 2005 6 Re, APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) Fee: PERMIT NO._ _G—Li�b— 143 Building AT. Location New IX plan-, Suhmitted Renovation ❑ Yes❑ No5g Replacement 0 Uate Namerb A%>SZ—' Type of Occupancy 2A�1�G N all 0 (� \ V y a (yU�cc O cc (� G�,°` o�,mt� �/l" WF.a O=W W M, W Z W p cc p 0-O W ' cc `fix 3 c g ¢ >Saro 0 0iLL5 SUB•BSMT. BASEMENT 1ST FLOOR 2NO FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name V��� •r�—' 1 i'`� tT�� - Address _ 11 G HAS C __�--- Check One: ❑ Corp. — ❑ Partnership P Firm/Company Business Te ep one Name of Licensed Plumber or der INSURANCE COVERAGE: COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes Er' No ❑ If you have checked yes, please indicate t e type of coverage by checking the appropriate box. A liability insurance policy r Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER. I am award that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the detalfs and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Signature o Licensed Plumber or Gastitter ZISI0% License Number Tvoo 1 treMCF• ; I i Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 'E" 05— 1 ISb BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 18S00 [Rev.11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELEC All work to be performed in accordance with the Massachusetts Electrical Code (MEC), Ct�2 91 U' (PLEASE PRINT IN INK OR TYPE ALL INFORMA TION) Date: 6/14/2005 lY np Cityor Town of: YARMOUTH, MA To the Inspector iMN 2 1 2005 19 By this application the undersigned gives notice of his or her intention to perform the electrical i tork described below. Location (Street & Number) 121 CAMP ST., UNIT 139 BUILDING DEPT. Owner or Tenant GATEWAY HOMES, INC. T Owner's Address Is this permit in conjunction with a building permit? Yes X No ❑ (Check Appropriate Boa) Purpose of Building RESIDENTIAL Utility Authorization No. 1455395 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service 100 Amps 120/240 Volts Overhead ❑ Undgrd X No. of Meters 1 Number of Feeders and Ampacity 2/100 Location and Nature of Proposed Electrical Work: WIRE HOUSE /`n.»ntotinn nftbo fnllnwi,a tahle may he waived by the Inspector of Wires. No. of Recessed Fixtures addle No. of Ceil: SusP (Paddle) ) Fans No. o Total Transformers KVA No. of Lighting Outlets 8 No. of Hot Tubs Generators KVA No. of Lighting Fixtures 8 Above n- Swimming Pool rnd. Elrnd. ❑ o. o mergency tg trig Batte Units No. of Receptacle Outlets 30 No. of Oil Burners FIRE ALARMS No. of Zones No. o Detection an No. of Switches 10 No. of Gas Burners Initiating Devices No. of Ranges 1 al No. of Air Cond. Tons No. of Alerting Devices eat Pump umber Tons No. oSelf-Contained 6 No. of Waste Disposers P Totals: ........ ....._......_____ Detection/Alerting Devices No. of Dishwashers 1 S ace/Area Heating KW P g Local ❑Municipal El Other Connection No. of Dryers 1 Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water 1 , 4.5 Heaters 0. o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent Telecommunications Wiring: dromassa a Bathtubs No. H y g No. of Motors Total HP No. of Devices or E uivalent OTHER: A/ni67n U[ MuOu{ "e[w, ,J ucm, c», v. w . cy».. — ay ..... J .... -- INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) 10/31/2005 (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. Icertify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: PATTON ELE( LIC. NO.: A 15542 Licensee: RICHARD PATTON Signature NO.: (Ifapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: 508-539-0200 Address: PO BOX 1525 MASHPEE MA 02649 Alt. Tel. No.: 774-35 t-6878 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $125.00 Signature Telephone No. FILE COPY.. 1 L=6.80' R=105.0� 1 LOT 1.25 L=10.12'� r 1� Ngp'21142~ E,� ' r �1� 66.31 /i s�• EXISTING 'S� s?•ry'h FOUNDATION o �< A e, a,0/�i/ ./vf EXISTING R�4� FOUNDATION F LOT 138 I CERTIFY THAT THE FOUNDATION IS LOCATED IN FLOOD PLAIN ZONE C AS SHOWN ON FLOOD. INSURANCE RATE MAP COMMUNITY PANEL NO. 250015 0005D AND THAT FLOOD PLAIN ZONE C IS NOT A SPECIAL FLOOD HAZARD AREAfL �ZIiZ DATE REGISTERED OROrESSIONAL LAND SURVEYOR NOTICE Unless and until such limes as the original (red) stamp of the responsible Professional Engineer. or Professional Land Surveyor appears on this plan: (A) no person or persons, including any municipal or other public officials, may rely upon the information contained herein. and (B) this plan remains the property of Holmes h McGrath. Inc. AS —BUILT PLAN OF LOT 139 PREPARED FOR MILL POND VILLAGE IN YARMOUTH, MA SCALE: 1"=20' DATE:4-26-05 I CERTIFY THAT THE FOUNDATION IS LOCATED ON THE LOT AS SHOWN, AND THAT ITS LOCATION CONFORMS TO THE MINIMUM SETBACK REQUIREMENTS OF ,4k4O8SP CIAL PERMIT. DATE REGISTERED PROFESSMNAL LAND SURVEYOR GRAPHIC SCALE ( IN FEET ) 1 inch = 20 ft holmes and mcgrath, inc. civil engineers and land surveyors 362 gifford street Falmouth, ma. 02540 JOB NO: 201197 DRAWN: DWG. NO.: A2525A CHECKE OF MICHAEL—\�� B. \`�, McGRATH H No. 28M / x %� OF -� TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 PERMIT NO � _ B-05-1041 _ eu ISSUE DATE ; _ 3/10/2005 _ ; PROPOSED USE [ :::::::: PERMIT ---------------------------, JOB WEATHER CARD APPLICANT Frank Capra _ _ _ _ _ _ ------------ PERMIT TO :New Construction ; AT (LOCATION) 100121CAMP ST # 139 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 1044.21A.C1139 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE new construction: 2 baths, 3 bedrooms, 1 kitchen/dining area, 1 livingroom as per plans dated REMARKS 02/09/05 and BOA # 3546.. AREA (SO FT) EST COST ($ 1$146,400.00 PERMI I rtt 01 jroo 4.uu 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 vs 4� Wig= O,S7 aS �' rneF„c^-.a Temp Permit No.: Applicant Name: Applicant Phone: TOWN OF YARMOUTH Building Department Tam Hall Yarmouth, MA 02664 (508) 3W2231 ext261 BUILDING PERMIT TRANSMITTAL T-05-392 Frank Capra 5087789669 Building Location: 00121 CAMP ST # 139 Owners Name: Villages C Camp Street, LLC Owners Addres 1600 Falmouth Road # 25 Centerville MA 02632 Owners Telephone: (508) 778-9669 -- REVIIEWED BY: 1. ,WATER DEPARTMENT: 2 ENGINEERING DEPARTMENT: /3. 0N5 ERVATION: V HEALTH DEPARTMENT- _ 5. BUILDING DEPARTMENT: 6. FIRE DEPARTMENT: COMMENTS: RECEIPT OF COPY: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $0.00 Deposit Rec.' $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 1/312005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: ZONING APPROVED DATE: DATE: DATE: DATE: DATE: DATE: PLEASE NOTE SIGNATURE OF APPLICANT: N/A: WA: NIA: WA: N/A: WA: DATE: Date Printed: 1/312005 7 of ,� ONE & TWO FAMILY ONLY - BUILDING PERMIT It APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Town of Yarmouth Building Department N MATTKMSCS 1146 Route 28 • Yarmouth, MA 02664 4492 Tel: (508) 398-2231 x261 • Fax (508) 398-0836 .,.. '-"�OffiCe:Ii 1 x �, q �}�`��a�f tanmr�Boaxd�n�oc�at♦on� As$e$sorstUepafimerttfnio�na�ot) 3M1 }^It ..+a YYYy 4 aC k-i7 �y. _ Y! X¢ 'i'�t�Ifk Vf k.xi x�il �3F ej`.`fin +4 .rL TJ _ 4p�}'�tl�a`I///T���s Mi"T{y t it T�M�T�'�Ct� s#''.:�1R .,�'i.�.?N�n fUr2p+3 Ft �>4 �SD•Y. "'�+�•f- �'G�af �1�3w�.i+. � 'Oi y" Pl✓r�t�'�+i \ V t f lliGi t 2.i ii A[ i�/`.Y.yb� f £ +✓y6�Kyd!s N J Epy�C'y�l Y'i +T �iy�'�fv"�f. S_ R kh i�•N~s�S'tTYL k"a 1•P {� A'I tF'\VVrYt1a4ua4. i1 '�a-1 TI'\l `3 iW+-4, pf}+9U'+ fr gy:� I A. $Yp 4 ke dj4 c �i(�'�ty /�2W ,N Perrrtft'' e 4 ram ,yF r= N4 s 5`i fs{ Atx;{ "G+ '' 'c"', C Olul4tg,"�' dlC7`."� .aws3xmk :c .+v-�,".%`'`s ?�a : £# �.,«+�s^nJ;?iY�> �r kma may. rst�IProRed�y�+mensionsCxt , x • �a ,^ivCa'h: ✓� -V ��'SSx-{r �� Ci f`^2`+c -cu S �t�oyr� �'}J`- ��p�..�il}+1�1.G 'a ���� �wzC��d. 3d ��•PH yr i rn� "�" PIS' 3 Fppi tl L�i�Np. % � J�S�s%9�j� 'ia+�.uyFNj, �%� �i4(.�M Nsy�, li?'YY 4 Yt'S �(�M �£� u�{; i { ) x .0 � !,F 5 vN(m xuy� ' � • y.� y. Y' e'er . ��4t Dt!Y r5�2 ��.Qj'F �. %: '' b �" i � � �}Vl "�'' ty„,`F '3 5 � }5• N�nST .Y � tK' �1 (SY"'$i` ,+r`. f" - .. t� • d J y'Ys girt' f i za t�ltdir� U IJ ^`+wf r j a cs �r tH �yl �tiGU rMC$ e Ad 5 SAio t n� egr n. Ci yr , r yg ./+ :3 kf .3'iY 5Sn �trt H � l3f%tL '` y;?+ ✓ ]AN.i i> � 4-t4 na^'-.JZu �,.ii�' F �'--{" •`F2.'T• - X 4� xhaz, �J, ���.} sry5 "f .R'yi.�� tm*w "�w�"��'J�.T "-Y r�.-'ri J 1 niez a n x a x #� y •» -� � �r ' s,.� � > 5 rrs � �42�,t is �:�''✓�11�yI-g�t1�Ya�l' y rt +Cr`"' Da� +-rc �r.. S�ction�] Slte rrtiprra3o Use Group: R-4 Type: 5-B 1.2 Zoning information: 1.1 Property Address: �� a - Zoning District Proposed Use 1.3 Building Setbacks. (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L.. c. 40. S 54) r f k 3 Public Private1'.1-11.11®r IFZT. y f t yi sI ect'o,2��Prop� ;��r)iers-, FAvifioi�zed"A�e�t 2.1 Owne( off Record: �L, j oc7 ; v N mePintkk Mailing Address Cu, V£ 1*0 J� lc — — Signature c Telephone 2.2 uth gent: °,-�— 1M S Goo ►, "' Name (print) (`• a Mailing Address o g, _ a �"'Telephone Stgri-atuwa ersrri~es- 3.1 Licensed Construction Supervisor . QR - Not Applicable ❑ �.� I p z t a- License Number O u ✓�� ddre Expiration Date _�- ---�? Sigr9ture lephone + LS I �I `� 717 j? 1T i� �3,2��{egfste, ,dsl3omq�l�tpfopern *C ,'nfr Company Name ) tip 1 nl 2005 JAi, 3 - otApplicable ❑ — - Address U ense Number Expiration Date Signature Telephone 9- 15-99 1 of 2 overt /3� le,Ml. Y if 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 .......... New Construction Lff I No. of Bedrooms I No. of Bathrooms Ddsting Bldg. ❑ Repair(s) ❑ I Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Zvtt f In V l Q Check Below ❑ Conservation -Commission Filing (if applicable) Q Old Kings Highway& Historical Commission approval (if applicable) asowner of the subject property hereby authorize bA-2120 -C LOL m beeh?', in all matters elative to work authorized by this building permit ppl'cation.- {{-o Signature of Owner Date to act on 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. I �Ikry IryFeA Printn Signature f Owner/Agent Date 11 9- 15-99 2 of 2 PLEASE PRINT: Job Location: _ TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION a Owner of Property: V Construction Supervisor: Name Address: - I (10 ® o SUPERVISOR FORM Village LL c OaIga Sob 9669 LCicenseNo. Phone No. 1� 963 k Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each license holder: 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures onlypursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.1-5.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes 2( No If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 47 Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of thhp, Mass. Ge eral La and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent 4V Owner ❑ Agent Signature: Building Official Approval: x a, loc The Commonwealth of Massachusetts Department of Industrial Accidents Of11ce offtestlffsBiis 600 Washington Street Boston. Mass. 02111 Workers' Compensation Insurance Affidavit cits �\.k MA 01�3—;L— ehone ❑ I am a homeowner performing all work myself. I. am a sole proprietor ZnJ ha%e no one working in any capacity I am .an employer pro%iding workers' compensation for my employees working on this job. company name: address: city: phone 0: insurance co. ooliev so 2/1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below aho ha,.e city nhone N, insurance co.. Qelicy H company name: Failure to secure coverage as required underSection 25A of MGL 152 can lead to the imposition of criminal peaddes of a fine ap.to $1400.00 and/or. one veers' imprisonment as well as eivil penaltlee is the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I eaderstand'that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do hereby certif • under the paint and !ties of petyury that the information provided above is true and lorrem ' k' Signature (� ate Print name �a—� t� one M 60L?�7�� enicial use only do not Trite in this area to be completed by city or town o, Mcial city or town: YARMOUT$ _ permit/license tt nBuildiag Department E3Uccosiog Board cheek if immediate response is required 261 Oseleetmen's Office _— contact person: i C3Health Department phone N; _ (508) 398-2231 eat. nOther r T BUILDING TOWN OF Y A R M O U T H ELECrRICAL GAS 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664-4451 PLUMBING Telephone (508) 398-2231, Ext. 261 — Fax (508) 398.2365 SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be / conducted at l ` `-��Aqp 3+• Work Ad ess C� c is to be disposed of at the following location: I oC�✓►'� DT1n56 �� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. / Signature of Applicant Permit No. Date t g.. 077-- i r�eall�i o J ariurae�.a BOARD OF BUILDING. REGULATIONS 3 License CONSTRUCTION SUPERVISOR. Nutnbe 012430 CACY E t p63E572 6 Tr. no: 25926 Restncterl FRANKG CAPRIC 40FCQPPERCN e �` CENTERVI LE, MA 0�1632� commissioner 00 - 35,000 cf enclosed space J (MGL CA 12 S.601.) 1A-Masonry only 1G=44ZFamilyHomes Failure to possess a c inent.edidon of the Massachusetts State. Building. Cade is cause for revocation of this license. 1 i �i T DIG SAFE CALL CENTER: (888) 344-7233 i tlti/by/lbba n7:1! er!!-elti-o!!v 1 -- JUrYY L..ICVwI_Gr DATE (MMm=)fI-._ C► OR. CERTIFICATE OF LIABILITY INSURANCE 0610an004 �978-394 2253 DIRECT THIS CERTIFICATE IS ISSUED pSA MATTER OF INFORMATION PRoOUCEa ONLY AND CONFERS NO RIGHT3 UPON THE CERTWICATE" ATLAMTIG INSURANCE GROUP, INC. HOLDER. THIS CERTIFICATEAEXTEND OR SODFOEEg BYY THE POLICtEES BELOW. AIP.LLC ALTER-THECOVERA6 385 BOSTON POST ROAD PMB 203 INSURERS AFFORDING COVERAGE SUDBURY, MA 01776 - — •--- •-- ..—_ INsuREaw NATIONAL FIRE&M!±��NE._-.- _-.- INSURER B: MA WORKERS_COMP_ RESEARCH.BRD GATEWOOD HOMES INC. 1600 FALOMOUTH ROAD I w$URER D CENTERVILLE MA 02632 OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TXE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITTtSTA 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 CPW � EFY�cTwE PQiICY Cy AL .5�,__ — _TYPE OF INSURANCE —• POLICY NUMBER too= xx ll I IEACN OCCVRRENCE _ S OENE%IL UAIILTY 72 LPE 691943 - 4/29/04 4/29/05 FIRE DAMAGE IAPY o!!e !as: s.__ _ .-50000_ A i X C_C NNERCUA GENEPAL LIABILITY I MEO EXPfAay aniP!nwN, S _—. 100.00 I C"INS MADE X I OCCUR PERSONAL 8 AOV INJ(JRY t 1000Q00 �CENERALAGGREGATE t' 2000000. . ___-__ _- __. PRO1000000 _ .— I OUC75•COMPAP AG3 t .._.. i GENT AGGREGATE_,LIMIT APPLrES PER: I —' 1 I AYTOMJBILE UARILITY —I ANY AUVO ALL OWN ED AUTOS $CNEOULED AUTO$ —! HIHEDAUTOS I NCN-OWNED AUTOS OARAG- LIABILITY . ANY AUTO EICESIt LIABILITY __ OCCUR I I CLAIMs MADE 1 DEDUCTIBLE WORKERS COMPENSATION AND B I EMPLOYERS' LIABILITY OTHER POLICY UPDATE NUMBER DESCRIPTION OF O►ENAnansnwn..w������+•�-------------- PROJECT: MILL POND VILLAGE (VILLAGES AT CAMP ST. LLC - DBA) COMBINED SINGLE LIMT It (EA ACCMoa) BODILY INJURY f (Parpan0a) -- _ BODILY U+x7RY .......... __--- ... _..... PROPERTY DAMAGE (Per acdo.M) IS ALTO ONLY. EAACCIOEN- �S __-- OTHER THAN AUTO ONLY. AGG S EACHOGCURRENCL_ _ — Ap R sEGATE S 8/4/04 I 8/d/05 IEL EACH ACCIDENT s_ 5000OQ rE.L OISEA$E-EA EMPLOYEE't --. 500006 C TUI.VGr� .. n.............-...__..__ - SHOULD ANY OF TIEAROVE pESCRBSED POLICES 6E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING BLSVRER WR- ENDEAVOR TO MAIL 60 DAYS WRITTEN NOTICE TO THE C:FATIFICATE NOL MED TO THE LEFT, BUT FAILURE TC• DO 90 SHALL TOWN OF YARMOUTH IMPOSE NO OBUGATON OR IL IF ANY HIND UPON THE INSURER. 119 AGENTS OR BUILDING DEPARTMENT REPRESEMTA AumDRk=D R t M ® D CORPORATION 1981 t Aa(RRV. CER 'IFICATE OF LIABILITY INSURANCE DATE(MM/DO/YY) 05-174M 'ADDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EdaLd A. Q--Y911 TnsImm o ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 �Y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 0%aem-fier-+�u;"m 1 1..!.. INSURED 1ilL' d= 1i'XY)1�1(y'1 QD. , IAC. 43 Ehirrn-y's Tam Q3rttFmrillar, M COVERGGFR INSURERS AFFORDING COVERAGE INSURER A_%he. Pimidame1 Thnl _FJ.m-Im Cb_ INSURER B_'%ver$ P=pr-LY & qjaHlt _ r ' i INSURER C: I 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 OF 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_ ___. .. _ _. ._..._._. _ __ I ) POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER i DATE NIM/DD/VY DATE MM/DO/YY LIMITS GENERAL LIABILITY j I ! "• I I EACH OCCURRENCE is tt iI', COMMERCIAL GENERAL LIABILITY I + FIFE DAMAGE (Any one fire) is F CLAIMS MADE OCCUR MED EXP (Any one peron) I $ ((y�(y�/�� PERSONAL S ADV INJURY j S ' I I 'I GENERALAGGREGATE A j GEN'L AGGREGATE LIMIT APPLIES PER: aO 0005933 Oi 11 O-Qr} Q3 I 10-05-04 ; PRODUCTS - COMP/OP AGG i S- 2, 000J 000 i ! POUCY i IOl' .' LOC I i i - ...___.. ... -' .I I AUTOMOBILE LIABILITY I I I COMBINED SINGLE LIMIT ANY AUTO I (Ea accident) $ ' ALL OWNED AUTOS i j SCHEDULED AUTOS I ( I i I BODILY INJURY i $ IF" Person) --_ ___-_.•_.. . __._.. .__.. HIRED AUTOS I I Boo 1LY INUURY $ j NON-0WNED AUTOS ((Per_ accident) -- - - - . i-- ! I .. .. .. .._ ..... _ PROPERTY DAMAGE I (Per accdent) $ ' GARAGE LIABILITY I AUTO ONLY • EA ACCIDENT is ( ANY AUTO ' I OTHER THAN EAACC I $ --• _ - -_- i I AUTO ONLY: AGG ! S— j EXCESS LIABILITY ' I EACH OCCURRENCE S I i OCCUR I CLAIMS MADE I L....J i --. — — _•- _� ------ _ _- AGGREGATE I $ ( DEDUCTIBLE ! S RETENTION $ I ! $ WORKERS COMPENSATION AND I WO STATU- OTH-! I II EMPLOYERS' UABILRY �. TORY LIMITS 04-01-04 04-01-05 E L EACH ACCIDENT ! $ — -T 100 wo — ' ' I LEL DISEASE - EA EMPLOYEE $_ 100, 000 B i 001630 . --I ' E.L DISEASE •POLICY LIMIT i $ JC00/ O�0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLMEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I ADDITIONAL INSURED: INSURER LETTER: CANCELLATION GAEkmd`,—a. Y �� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI 1600 Fd11Q1}1$Rmd DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRRTEP SA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALI lia�F-eat.i lle IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OF "•"'-����-'�/ •• REPRESENT ES. �,�p AUTHOR R RESE AT V9 �: 50$.-M.56M ` CORD 25-S (7/97) 0 ACORO CORPORATION 198 r vvv,�I"r�y GliV ACORD- CERTIFICATE OF LIABILITY INSURANCE °ATE(mw MYY 2/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling $ O'Neil Insurance 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 INSURERS AFFORDING COVERAGE INSURED NAIC # Assurance Construction, Inc. INSURERA: Nautilus Insurance Company A/O Assurance Excavation, Inc. INSURERB: 550 Willow Street INSURERC: West Yarmouth, MA 02673 INSURER D: COVFRAr.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. LTR NSR TYPE OF INSURANCE . . POLICY NUMBER POLICY EFFECTIVE DATE MM/D POLICY EXPIRATION A GENERAL LIABILITY NC289301 .09/08103 DATE MM/DMYY LIMITS 09/08/04 EACH X COMMERCIAL GENERAL LIABILITY OCCURRENCE $1 000 000 ' CLAIMS MADE 7 OCCUR - DDAMAGE TO RENTED R^ 3100000 X BI/PD Ded:1.000 11 MEO E (Am one Person) $5 000 . PERSONAL & AOV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: TE GENERALAGGREGAE2 000 000 POLICY O- PRODUCTS-COMP/OP AGG $2 000 000 JE LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea aotldent) $ "ALL OWNED AUTOS " " SCHEDULED AUTOS .BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per axiderk) $ PROPERTY DAMAGE " (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC $ ' AUTO ONLY. AGG S EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S DEDUCTIBLE $ RETENTION $ S _ WORKERS COMPENSATION AND S V/C STATU- OTH- EMPLOYERS' LIABILTf1' T M ANY PROPP.IETOR(PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? -E.L. EACH ACCIDENT $ If ym describe under E.L. DISEASE- EA EMPLOYE S SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS 1 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 #35194 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 © ACORD CORPORATION 19RR e max server OA U s TE(MMD0�Y1 aceo.i�.RC �i'[1�3Fill tl e oa-o - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY. AND CONFERS NO RIGHTS UPON THE C +FFIF4GATS EMPLOYERS INS GROUP "INC - HOLDER. THIS CERTIFICATE DOES .NOT AMEND EXTEND OR 261 MAIN ST ALTER THE COVERAGE AFFORDED BYTHE POLICIESI BELOW. STE 5 FITCHBURG MA 01420' COMPANIES AFFORDING COVERAGE COMPANY 76HCK - A ROYAL INSURANCE COMPANY OF AMERICA INSUfl COMPANY , RESOURCE MANAGEMENT INC .B 2a1 MAIN STREET SUITE 5 FITCHBURG MA 01420 COMPANY C r ' /• t�SSU('av1c� EXCAV2.�1oYl COMPANY D THIS M.TO.CE:RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW IIAVE BEEN ISSUED.TO.THE INSURED NAMED ABOVE FOR TFIEPOLIOY.PERICIT_ 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MWOMYY) POLICY EXPIRATION DATE(M%DD%YY) LIMITS GENERAL LIABILITY - GENERAL AGGREGATE g PRODUCTS-COMP/OP AGG. COMMERCIAL GENERAL LIABILITY- CLAIMS MADE F-1 OCCUR - PERSONAL B ADV. INJURY g EACH OCCURRENCE g OWNERS & CONTRACTORS PROT. FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any one person) g AUTOMOBILE LWBBJTY ANY AUTO COMBINED SINGLE LIMIT $ BODILY INJURY ALL OWNED AUTOS - SCHEDULED AUTOS (Per person) S BODILY INJURY (Per Accident) S HIREOAUTOS NON -OWNED AUTOS PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY• EA ACCIDENT S OTHER THAN AUTO ONLY: _ ANY AUTO EACH ACCIDENT g" AGGREGATE g EXCESS LIABILITY EACH OCCURRENCE g UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM A WORKERS RSLIACOMPENSATIONILITYAND EMPLOYER'S LIABILITY (UB-967X499-9-03) 11-20-03 11-20-04 STATUTORY LMTTS ' CID EACHACENT s100:.j000 THE PgOPRIETOfl/ INCL PARTNERS'EXECLITIVE X OFFICERS ARE: EXCL OTHER _ DISEASE —POLICY LIMIT $ 500,000 DISEASE —EACH EMPLOYEE S 100, 000 DESCRIPTION OF OPEMTIONSLOCATIONSVEHICLESRESTRICTIONSSPECIAL S COVERS EMPLYS LEASED TO ASSURADCBF-EXCAV? T TORS 550 WILLOW ST W YARMOUTH MA 02673 THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. �ER.TIFICA'1•EHOLDE v: N_.u.rc tl, �. GANCELLhTiON _ _ ..,: , >. ay.., "v ..E.w,wi.. >,. v"w. .4,, .v,.— .,3 ... • .n.>xr,iu: >. ryBExCANCELLED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEFORE THE GATEWOOD HOMES, INC. ATT:PAULA CENT FALMOURVILLETH ROAD-SUI A 25 CENTERVILLE MA 02632 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HGLDIMWRBIEDjV-rHC— LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVE& AUTHORIZED REPRESENTATIVE •.:., ' . A DRAM CERTIFICATE OF LIABILITY INSURANCE DATE/D 08/02/200404 PROQUCER (508)997-6061 FAX (SO8)991-3283 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 662 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC # INSURED R J Bevilacqua Construction INSURERA: Arbella Protection Insurance PO BOX 628 INSURER B: Forestdale, MA 02644 INSURER Of INSURER D: INSURER E: COVERAGES 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. INSRADD- TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE (MMIDDfYYI POLICY EXPIRATIONDATE DATE (MMIDDIM LIMA A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR X Special Form 9500018147 07/15/2004 07/15/2005 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED $ 50,000 MED EXP (Any one person) $ $ 00 PERSONAL aAOVINJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY 7 JPER0. LOC PRODUCTS - COMP/OP AGG $ 2,000,000 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) S BODILY INJURY (Per person) $ 250,000 X X BODILY INJURY (Per accident) i 500,00 X PROPERTY DAMAGE (Per ac ident) $ 500,000 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER -THAN. EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE $ AGGREGATE $ S - $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N yes, describe under SPECIAL PROVISIONS below 9088680402 04/27/2004 04/27/2005 X I wcgysTATU- OR E.L. EACH ACCIDENT $ 100,000 E.L DISEASE- EA EMPLOYEE $ 100,000 E-L DISEASE - POLICY LIMIT $ 500.000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS For any and all operations performed during the policy period. CFRTIFICATF HTH nFR - CANCELLATION 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, Gatewood Homes Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Falmouth Rd Ste 25 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Centerville, MA 02632 Pauline Desrosiers ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ACORDCERTIFICATE OF LIABILITY INSURANCE. o3io9i2o 4 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 Providence Mutual PO Box 664 INSURERS: OneBeacon West.Hyannisport, MA 02672 INSURERC: Continental Casualty Co . INSURER D. . .. - INSURER E _ .... . COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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 LTRDATE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE MM D POLICY EXPIRATION A MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL UABILITY CLAIMS MADE M OCCUR CPPOO53131 01 12/13/2003 12/13/2004 . _ EACH OCCURRENCE $ 1,000,0( FIRE DAMAGE (Any one fire) $ SO , 0( MED EXP (Any one person) S 5,0( PERSONAL & ADV INJURY S 1, 000 , 0( GENERAL AGGREGATE $ 2,000,0( GEML AGGREGATE UNIT APPLIES PER rD PRO. POLICY JECT LOC PRODUCTS - COMPIOP AGG S 2 , 000 , OC B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CBXE49125 .... _.... .. ___.. _. 02/14/2004 02/14/2005 COMBINED SINGLE LIMIT (Ea accldent) $ BODILY INJURY (Per pen) rso S 250 , 00 X BODILY INJURY (Per acciderM S 500,00 PROPERTY DAMAGE (Per accident) S 100,00 .. .. - __ GARAGE LIABILITY ANY AUTO . . .. ".. - AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGO S $ EXCESS LIABILITY OCCUR O CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ i S $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 6S59UB861X751604 03/22/2004 03/22/2005 TORY LIMITS ER EL EACH ACCIDENT S 500,004 . EL DISEASE - EA EMPLOYE4 S SOO , 001 EL DISEASE - POLICY LIMIT S 500,00( OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS L;LKTIFIGATE HOLDER I I ADDITIONAL INSURED; INSURQ2 LETTER: - CANCELLATION Gatewood Homes Inc 1600 Falmouth Rd Ste 25 Centerville, MA 02601 26s(7/97) FAX: (SO8)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 KINC'MRX7 6.COMPANY. ITS AGEUTS OR-8@PRESENTA-WES. ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER 509-398-6033 FAX 508-760-1667 Eastern Insurance Group LLC 1 Atlantic Ave So Yarmouth MA 02664 08/0 /2004' os/a9/zooa 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 THIg COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED Cape Cod Custom Dots 762 Falmouth Road Hyannis MA 02601 ' INSURERS AFFORDING COVERAGE INSURERA: Arbella Protection Ins Company _ NAIC * INSURERS: Hartford INSURER c P19URER D: COVERAGES INBVRER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDtN 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 CONDITIONSOfSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTWEI POley EXPIRATON LIMITSGENERAL LIAB,I.ITY 7500000373 12/13/2003 12/13/2004 EACHOCCLRRENCE s I;QOO; 4!i MERCIALGENERALLIABILITY DAMAG TO RENTED f 50.00o CLAIMS MADE 4 1 OCCUR A MEO EXP (Any Wit PamIm) i S �QII AGGREGATE LIMB APPLIES PER: X I POLICY n JEC7 n LOC AUTOMOBILE LIABILITY - ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS IJON-OWNED AUTOS GGARAOE LIABILITY T I ANY AUTO EXCESSAIMBRELLA LIABILITY OCCVIt ❑ CLAIMS MADE DEDUCTIBLE RETENTION f WORKERS COMPENSATION AND - EMFLOYERS L[ IUIY 8 ANY PROFRIETOWPARTNERIEXECUI OFFICEMMEMBER EXCLUDED? ADDED PERSONAL B ADV INJURY 1 11 000, OOO GENERAL AGGREGATE S 2 , O00 , OOO PROOUCTS-COMPIOPAGG S 7. nnn_nnn COMBINED SINGLE LIMITT i (Ea VI BODILY INJURY (Per P�) S BODILY INJURY s (Pr s¢ie.nt) PROPERTY DAMAGE (Pa ealde ) S AUTO ONLY. EA ACCIDENT S OTHER THAN FA ACC 4 AUTO ONLY: ADO S EACH OCCURRENCE i AGGREGATE f i S LL EACH ACCIDENT Is Inn n(IN At dence of Insurance for work performed within the Insured's scope -of normal operations Gatewood Homes 1600 Falmouth Road *25 Centerville, MA Oz632 ACORD 25 (2001108) FAX: 000778- LIMIT SHOVLD ANY OF THE ABOVE DEBORIBED POUCIES Be CANCEL-. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 OATS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEpi@THCtEPT BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBUGATION OR LUIBIUTY OF A IOND UPON THE INSURER, ITS AGENTS OR REPRESENTATNXS._...... TI D AEPRE911ATNE 10 ®ACORD CORPORATION 1988 CERTIFICATE OF LIABILITY INSURANCE DATE(MWOWYYYY) PRODUCER 8/2/2004 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 POucIFS RFI nW Osterville,. Ma. 02655 508-420-9011 JSURED Casperson Overhead Doors Box 517 East Falmouth, MA 02536 508-563-5633 CnVFRAnFC INSURERS AFFORDING COVERAGE NAIC# INSURERA: Worcester Insurance Company INSURERB: National Grange Mutual - INSURER C: INSURER D: INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTTHE 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. MR DL LT lTR NERD TYPEFINSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DO POLICY EXPIRATION DATE MM/DD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR CB 2J1973 05/28/04 05/28/05 _ CH OCCURRENCE S 1,000,006 X EMISESEao rem S 100.000 DEXP(An�oneperson) rPERSONAL S 10,000 9ADVINJURY Is 1,000 000 GENERAL AGGREGATE S 2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES P POLICY PR LOC PRODUCTS -COMP/OP-AGG S 2 OOO , 000 AUTOMOBILELIABILTTY ANYAUTO ALLOWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNEDAUTOS - COMBINED SINGLE UMIT (Ea accident) m. S URY ILYIN) (Pereerson) (Per p $ BODILYINJUwt) S PROPERTY DAMAGE (Peracadent) S GARAGE LIABILITY ANYAUTO _ AUTO ONLY-EAACCIDENi S OTHERTHAN EAACC AUTOONLY: AGG $ S EXCESS/UMBRELLA LIABILITY OCCUR CLAIMSMADE DEDUCTIBLE RETENTION E $ $ S S gEACIIC,URRENCE S WORKERS COMPENSATIONAND EMPLOYERS* LIABILITYCP48352ANY PROPRIETORMARTNER/EXECUME OFFICER/MEMBER E(CLUDED7Myes,describeunder PROVISIONS below OTHER 02/22/04 02/22/05 ITS ER CIDENi s 500 000B -EA EMPLOYE S 500 000SPECIAL -POLICY LIMIT S 500 O00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUMONSADDED BY ENDORSEMENT/ SPECIAL PROVISIONS 1� Gatewood Homes, Inc. 1600 Falmouth Rd., Ste. 25 Centerville, MA 02632 ACORD25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO! DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY.OF ANY KIND UPON THE INSURER ITS AGENTS OR C ACORD CORPORATION 1988 ' " r ACORDCERTIFICATE OF LIABILITY INSURANCE PRODUCER (508) 790-1919 THIS CERTIFICATE IS ISSUED AS_A Sandpiper Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS HOLDER: THIS CERTIFICATE DOES 12 Enterprise Road ALTER THE COVERAGE AFFORDED B n cuua�a LUA UZout- INSURERS AFFORDING COI INSURED INSURERAZurich small CENTURY PAINTING AND DRYWALL, INC CENTURY PAINTI INSURERS PO BOX 2903 ,. @I INSURER0. 1HYANNIS MA 02601-7903 IINSURERE Cf]VFRA(.FS DATE(MMIDDIYYYT V THE CERTIFICATE AMEND, EXTEND OR POLICIES BELOW. NAIC # THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AW REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTI FlCATE MAY BE 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 DO'L INSRD TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE(MMIDONY) POLICY EXPIRATION DATE(MMIDDIYY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE CCCUR SCP034309873 - / / 12/18/2002 / / 12/18/2003' EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES a cocurrence 30O 00 S r Mon EXP Anyone rson S. 10,00 PERSONAL 3 ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GENL AGGREGATE POLICY UMITAPPUES PER JJEEC I I LOC PRODUCTS- COMP10P AGG f 2,000,00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS - HIRED AUTOS NON -OWNED AUTOS / / I I / / / / I I / / COMBINED SINGLE LIMB (Ea accident) S BODILY INJURY (Per Person) S BODILY INJURY (Per accidenp f PROPERTY DAMAGE _ (Per accident) S GARAGELIABILITY ANY AUTO / I I I AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG S S EXCESSfUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE" RETENTION S / / / / / / / / EACH OCCURRENCE $ AGGREGATE S $ $ s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERNtEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below - TORY LIMITS OTH ER E.L. EACH ACCDENT f E.L. DISEASE- EA EMPLOYE f E.L. DISEASE- POLICY LIMIT Is OTHER / / / •/ DESCRIPTION OF OPERATIONSILOCATIONWEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS PAINTING 6 DRYWALL (508) 778-5603 GATEWOOD HOMES _ 1600 FALMOUTH RD SUITE 25 ACORD 25 (2001108) TM INS025 (Ofos)m MA 02632— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ELECTRONIC LASER XPRMS,-AC. - (800)327.0545 © JORD CORPORATION 1981 Page 1 of: ACOR1 CERTIFlC ;TE.�r tiABitl i �PISC►Rq`f�E * ! ODUCER C."ROS Sullivan, Garrity & Donnelly THIS CERTIFICATE IS ISSUED AS -A MATTI 5 0 8 - 7 54 -17 6 7 ONLY AND CONFE, IS NO RIGHTS UPON T 10 Institute Rd --PO Sox 15010 HOLDER. THISCEI-TWIF AGE AFFORDED YNOTA Worcester ICA 01615-0010 ALTER THE _ Phone:5D8-754-1767 Fax:508-754-1885 INSURED INSURERS_AFFORDII IG COVERAGE NaurtcRn: Hanovfr Insurance Co INSURERS: Arch Cnsurance Coronas Crowell Conatruction, Inc. nvsuRERC: SO. PO BDennis MA 02660 INSURER D: THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERT D INDICATED. NOTW RNSTAI, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEP DFI:ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUp Opt; AND CONDITIONS OF y', POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, - - �- A CH OCCURREf 7141OS/Ol/04 OS/ 11/D5 RCM.L GEN'PAL LIAOLPEP pgEMIS S ry xAIMS MADE a O LOFNEIALABILDY MEO EXP I""I [+PERSONAIiAO, GENERAL ApORl9GATE LMUT APPLIES PR000CTS-CDIN JECi AUTOMOBILE LIABIL" A ANV 4UT0 - COMBINED SIN(ya ASN7001142 05/01/04 OS/ 1/OS IE'xdd""D All OWNED AUTOS X SCHCOUL60 AUTOS BODILY INJURY (Pq DMM] • ]( HIRED AUTOS! ][ NON -OWNED AUTOS BODILY P'IJURY (Per Aeeld ,)i GARAGE LIABILITY ANY AUTO EXCE53IUMHRELLA WBIUTY OCCUR O CLAUAS MADE DEDUCTIBLE RETENTION f WORKERS COMPENSATION AND 8 EMPLOYPAE' LIABILITY ANY PROPRIErORIPARTNERIEXECUTNE IRWCI003.0 OFFICEWMEMBEn EXCLUOEDT UE9CNIFTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSE,1 An per policy forms, conditions and exclusions OTHER THAN AUTO ONLY: EACH OCCUR LIMITS OR NAIcu.-. 00000 S10 $20 $20 119f f ^_ S100000D s1000000 s 500000 :IIRDIT S EA ACO S --A30 S f S _ f S 03/22/04 03/7-2/05 E.LEACHACCIO[Nr _ s 50 E.LDISEASE-EA EMPL(T/� s 5D E.LOISEASE-POLIC'l U6BT f 50 CERTIFICATE HOLDER CANCELLATION CATZWOO SHOULD ANY OF THE ABOV i DESCRIBED POLICIES BE CANCELLED BEFORE GATE THEREOF. THE LSSUIHSINAURER VYILL ENDEAVOR TO LU.V_ SO DAY9 WPoTTEN Gatewood Homes, Inc. 2600 Falmouth Road NOTICE TO THE CERTMCA' ! 141%DER NAMED TO THE LEFT, 1lIIr FAILURE T Suite 25 IMPOSE NO OBLIGATION Of: LIABILITY OF ANY KIND UPON TH,? IISURER, ITS AGENTS OR Centerville MA 02632 REPRESENTAxvEs_ ACORD 25 A&;-U - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) PRODUCER 08/04/2004 MARK SYLVIA INSURANCE AGENCY 508-d28-0440 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 NAIL # INSURED INSURERE FAMILY CASUALTY INSURANCE PETER J. GOVONI DBA P. GOVONI LAND SERVICES INSURER20 OPEN TRAIL RD. INSURERSANDWICH, MA 02563 INSURER INSURER OVERAGES 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. ISIi Iln•i X COMMERCIAL GENERAL LIABILITY 2OO1L62O2 EACH OCCURRENCE S j A 05/31/2004 05/31/2005 CLAIMS MADE PREMISES Eaodcursnce S OCCUR I MED EXP (Anyone person) S PER: ANY AUTO ALL O WNEO AUTOS SCHEDULED AUTOS HIREDAUTOS ' NONrOWNEDAUTOS AGE LIABILITY ANYAUTO L CLAIMS MADE LE N E WORKERS COMPENSATION AND A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Ryes, describe under SPECIAL PROVISIONS below OTHER TO BE ISSUED DESCRIPTION OF OPERATIONS / LOCATIONS'VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT LOGGING AND LUMBERING, TREE PRUNING, STREET CLEANING GATEWOOD HOMES, INC. 1600 FALMOUTH ROAD #25 CENTERVILLE, MA 02632 ACORD S COMBINED SINGLE LIMIT Me accident) $ BODILY INJURY (Perperson) S . BODILYINJURY ' (PeracCldent) -S.-.. . PROPERTY DAMAGE . .. (Per accident) S—`__... . . ' .. AUTO ONLY, EA ACCIDENT S." ._ -:�•. . .• .. .. OTHERTHAN EAACC ' '• AUTO ONLY. _ AGG I S EACH OCCURRENCE - S AGGREGATE S S S S WCSTAMT, X OTW 07/04/2004 07/04/2005 . E.L EACH ACCIDENT S 1,000,000 E.LDISEASE>EAEMPLOYEE S 1000000 ELDISEASEr'POLICYLIMIT S 1,000,000 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 OF-ANY'/twp- N,ON-THE-iNSH1rRyTg.AeENTS OR REPRESENTATIVES. UTHOR2ED REPRESENTATIVE AF o• r TOWN OF YARMOUTH Building Department Tam Hag v YaMnM, MA OMM (5W) 3W=31 eA261 BBUILDING PERMIT TRANSMITTAL Temp Permit No.: T-05-392 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 139 Owner's Name: Villages Q Camp Street, LLC Owner's Addres 16M Falmouth Road # 25 Centerville I MA 02632 Owner's Telephone: (508) 778-9669 REVIEWED BY: (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: 1/3V2005 Comments: Map/Lot: 044.21.1.0 new construction: 1. WATER DEPARTMENT: DATE: WA: 2. ENGINEERING DEPARTMENT: DATE: WA: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: (',lC DATE: �f WA: 5. BUILDING DEPARTMENT'4Y DATE: NIA: 6. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: H RECEIPT OF COPY: SIGNATURE OF APPLICANT:��o� - / �1�Xll.A�l DATE: S /0 0� Date Printed: 1/31/2005 I. 6 -� LET 12 LcA � 23• �� � vi =.00-�, Na092192 I J 66.31 0 LOT 139 n LO rI'— �� �h h� s�• oQoJ��QO, o � 11 0 , pJ k� 'tij�' sv'• I I � Q�`Z� vV wj��j G 3l. 47 I Qoc�k.1 aek � r i 'N `, \ Vol Ibb 'S By r e° MJd' L `y� SEWER rATERAL SHALL BE SLEEVED IN ACCORDANCE 83/8 1APHIC SCALE WITH TITLE V IF WITHIN p'r nsr� STEREO ate ; 10FT. OF WATER MAIN. 20 «��_ 20 so ( IN FEET) r. 1 inch = 20 it. I PLOT PLAN holmes �H a, OF LOT 139 and mcgrath, inc. y, civil engineers and l PREPARED FOR and surveyors TIMOT'H.Y n 362 ifford street o S�Nres MILL POND VILLAGE g No.450-8 IN falmouth, ma. 02540 9 c±viL o y YARMOUTH MA �o�S�STE�h'a�/ JOB NO: 201197 DRAWN: LMC °'JADE SCALE: 1 "=20' DATE: 12-29-041 DWG. NO.: A2525 CHECKED: -T.r.. 0 PROPERTY ADDRESS: /�/ ALCULATION FOR PERM11 CO, (S�• 8sg moo, Eib�% L33.YS ,TIONS FION ONLY NO.OF BAYS RERC SITED STOR _ SUN F 1i) TOWN OF YARMOUTH Building Department Town Hap uM Yamq, W 02W4 . (R*) ns-ml eAM1 BUILDING PERMIT B TRANSMITTAL Temp Permit No.: T-05-392 Applicant Name: Frank Capra Applicant Phone: 5087789669 Building Location: 00121 CAMP ST # 139 Owners 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 Deposk Rec: $0.00 Payment Type: Check ChkNo.: 0 Net Owed: $0.00 Application Date: 1/31/2005 Issue Date: Expiration Date Comments: Map/Lot: 044.21.1.0 new construction: DATE: NIA: DATE: WA: 3. CONSERVATION: DATE: 4. HEALTH DEPARTMENT: DATE: 5. BUILDING DEPARTMENT: DATE: 6. FIRE DEPARTMENT: DATE: PLEASE NOTE COMMENTS: RECEIPT OF COPY: . - SIGNATURE OF APPLICANT: WA: WA: WA: WA: DATE: 099 Printed: 1/31/2005 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 I. 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/139; 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. r, Owner (si Y Department A toN:\Water Availibility\121Camp#139.doc Vj 55-013, '4E t480-21 a '; :Si2 FI - - :� t LOT 139 51 '? 01 ki It '4� 11ju o hi i C' 5y NOTE: ze• SAN SEWER LA At= ALL fBE 3978 d % SLEEVED IN ACCORDANCE �fcIST HIC SCALE WITH TITLE V IF WITHIN 10FT. OF WATER MAIN. 20 10 20 60 IN FEET I inch = 20 ft- PLOT PLAN holmes and mcgrath, Inc. OF PRLOT 139 EPARED FOR civil engineers and land surveyors 362 gifford street 'o�w MILL POND VILLAGE TiW)THV �,4 � IN falmouth, ma. 02540 No CI45VIL C7 YARMOUTH, MA JOB NO: 201197 DRAWN: LMC SCALE: 1"=20' DATE: 12-29-041 DWG. NO.: A2525 CHECKED: -%&f. (:!`)-r OGO-3 PRODUCT SPECIFICATIONS GMS9/GCS9 SERIES. 93%AFUE Multi -Position, Single-Stage/Multi-Speed Gas Furnace Heating Cap-C 469000-115,000 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 •10101111• Air Conditioning & Heating The GMS9/GCS9 single -stage, multi -speed gas furnaces offer installation versatility. Cabinet Construction • Heavy -gauge, reinforced, fully insulated steel cabinet with durable baked -enamel finish • Attractive architectural gray paint finish • Foil -face insulation -lined heat exchanger compartment • Coil and furnace fit flush for easy installation • Convenient left or right connection for gas and electric service • Bottom or side air inlet (GMS9) • Removable, solid -bottom block -off (GMS9) Accessories • L.P. Conversion Kit (LPT OOA) • L.P. Gas Low Pressure Kit (LPLP01) • High Altitude Natural Gas/L.P Kits (HANG11, HANG12, HALP10) • High Altitude Pressure Switch Kit (HAPS27) • External Filter Rack (EFROI) • Horizontal Concentric Vent Kit (HCVK) • Vertical Concentric Vent Kit (VCVK) • Internal Filter Retention Kit—upflow, (RF000180) • Internal Filter Retent ion Kit—downflow (RF000181) • Thermostats Blower Motors (CHT18-60, CH70TG, CHSATG, H20TWR) SS-377D wwwgoodmanmfg.com 6/04 Nomenclature G M Goodman® Brand Air Flow Direction M: Upflow/Horizontal D: Dedicated Downflow C: Downflow/Horizontal H: Hi Air Flow S: Single V: Two S ®1"1m AFUE 8: 80% 9: 90% a 045: 45,000 070: 70,000 090:90,000 115: 115,000 140: 140.000 3 A N A Revision itial Release NOx n Revision N: Natural GasTE�nd Revision X: Low NOx Cabinet Width A: 14" B: 17111" C: 21 " D: 2411" Maximum CFM Cil 0,5" ESP 3: 1,200 4: 1,600 5: 2,000 2 (7 C. PRODUCT SPECIFICATIONS Performance Ratings GMS90453BXA 46,000 42,800 -P I 37,200- 93.0 3.0 35-65 GMS90703BXA 69,000 64,400 55,800 93.0 3.0 35.65 GMS90904CXA 92,000 86,000 74,400 93.0 4.0 35-65 GMS91155DXA 115,000 106,500 —'72,800. 93,000 93.0 5.0 35.65 GCS90453BXA 46,000 37,200 93.0 3.0 35-65 GCS90703BXA 69,0D0 64,400 55,800 93.0 3.0 35-65 GCS90904CXA 92,000 86,000 1 74,400 93.0 4.0 40-70 GCS91155DXA 115,000 106,500 1 93,0D0 93.0 5.0 40--70 For altitudes above 2,000', reduce input rating 4% for each 1,000' above sea level. DOE AFUE based upon Isolated Combustion System (ICS). Specifications 1 p-AIm3 aftnt " �JWt W& ! M , , &, Misosat,p s. r m nrIT jjt0 A GMS90453BXA 10" x 7" 1 1/3 1 4 2- 2— 288 576 9.0 15 132 GMS90703BXA 10" x 8" 1 1/3 1 4 2- 3 282 564 9.0 15 135 GMS90904CXA 10" x 10" 1/21 4 2- 4 376 752 8.9 15 158 GMS91155DXA 11" x 10" 3141 4 2" 5 �2 470 940 12.2 15 175 GCS90453BXA, x 7" 10"1 1/3 4 V �288 576 9.0 15 132 GCS90703BXA 10"xB" 1/3 4 2- 3 282 564 9.0 15 135 GCS90904CXA 10"x10" 1/2 4 2- 4 '476 752 8.9 15 156 GCS91155DXA 11" x 10" 3/4 1 — - 470 940 12.2 15 175 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 diamete; 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. Minimum Circuit Ampacity = (1.25 x Circulator Blower Amps) + ID Blower amps. Maximum Overcurrent Protection refers to maximum recommended fuse or circuit breaker size. NOTES: • All furnaces are manufactured for use on 115 VAC, 60 H2, single phase electrical supply. • Gas Service Connection Ih".FPT • Important: It ` is required to size overcurrent protection device and wires properly and make electrical connections in accordance with the National Electrical Code and/or all existing local codes. GMS9 Dimensions 1571A t uR u 9 3/4 INTAKE PIPE 2• PVC ALTERNATE T GAS SUPPLY HOLE I HIGH VOLTAGE 1 3/4 ELECTRICAL HOLE LEFT SIDE 1 12 DRAW L NE MOLES r T� �.DRAIN 2 SM 21 LOWVOLTAGE 14 ELECTRIGL HOLE I 19 1f SIDE CUT-OUT 1314 a•1 11 a4 +� -Borr 19Yft�T _ 6oTT0M IaacK-0Ur LEFT SIDE MEW V4 FRONT MEW VENT/FLUE PIPE 2'PVC I AIR 2111166AALTERNATE AIR INTAKE LOCATION STANDARD GAS ' SUPPLY HOLE 4118 ALTERNATE VENTIFLUE LOCATION 1 HIGH VOLTAGE 2 911 ELECTRICAL HOLE 71� 2518 RIGHT SIDE DRAIN DRAIN LINE 301 I1 sm8 TRAP HOLES , 32131A—[3.ECIRICAL HOLE ! i I 1y4 SIDE CUT-OUT 1 L .J RIGHT SIDE MEW GMS90453BXA GMS90703BXA t7�i" . :«,=t �.; , `� " t s " 12 /e 16" 12%11 GMS90904CXA 21" 191/1" 163/9" s , GMS91155DXA 241" 23" 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 f nnace 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 909 elbows, one, close nipple, straight pipe Right —Straight pipe to reach gas valve Minimum Clearances to Combustible Materials IS ., a an 0„ , . 411 i I IY 3„ rBo ' }N` C C. 3p t2� � N. rx 3 x " o E, E U flow 0" Horizontal 6" 0" 3" C 0" 1.. 01 4" L; = It placed on combustible floor, the floor MUST be wood ONLY. - NOTES: • For servicing or cleaning, a 36" front clearance is recommended. • Unit connections (electrical, flue and drain) may necessitate greater clearances than the minimum clearances listed below. • In all cases, accessibility clearance must take precedence over clearances from the enclosure where accessibility clearances are greater. 4 D GCS9 Dimensions LEFT SIDE NEW FRONT RIGHT &314 VIEW SIDE VIEW 3/44j::=8 —� 112 RgfrPVC VENT PIPE 21 (RETURNAIR) 31 8 PE - r , CONDENSATE DRAIN TRAP r LOW VOLTAGE ,J LOW VOLTAGE - I 1 "' sc HARG 1 ELECTRICAL HOLE ELECTRICAL HOLE�� 40 (RIGHT R HIGH VOLTAGE . LEFT SIDE) 7----�— ELECTRICAL HOLE L J 2 S'78 295/18 {I 87/g L VENT/FLUE -� HIGH VOLTAGE ELECTRICAL HOLE LOCATION 211/16 T ALTERNATE DRAIN 18 7/8 AIR INTAKE LOCATION TRAP 25 + . 2� LEFT SIDE 151M DRAW LIN 1813N T�v �� RIGHTSIDE HOLES /J 11112 Q 1C DRAM S HOLES STANDARD GAS J SUPPLY HOLE 4 Va OIL 8 O S 1/1 17 __ I 7 3ro-.I ALTERNATE GAS S aN I SUPPLY HOLE 8 SB—� - UH—FOLDE.,VD FLANGE$ { UNFOLDED FLANGE$ I ISj�E u OAIHRARG. FIXJDE�O FLANGE$ ' 10SCHARGE AIR FOLDED FLANGES DISCHARGEAIR r GCS90453BXA 1*1'„ 16n 17111"M23" 1N/e" GC590703BXA 17'i"12s/s" 14 4" 16" GC590904CXA 21" 16%" 18" 191h" GCS9 1155DXA 24Y2" 20s/s" 21 i" 23" Tame. I. Installer must supply one or two PVC pipes: one for combustion air (optional) and one for the flue outlet (required). Vent pipe must be either 2" or 3" in diameter, depending upon furnace input, number of elbows, length of run and installation (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 Downflow Horizontal U" 6" ..x .vmr.�.. W... MPBD'tk�O,ITI -'�" �- l7 3- -. p" 0 > u,°P,-u 0„ 'T! 0" 1" 1,. NC.,., C 1" 4" L = 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 btfefi"J��05`,a.���°"[e%1#a`Itai�GP etif�{fractles;a%r Pea ee 1,352 ------ M' p 1,318 MS ------ iLF Rf5E1M"GFNI (fISE 1,260 --•--- 1,2024aq '>+FM ; tISE^,: FJrC# ,.°CF#i FM 8 HIGH 3.0 G_S90453BXA MED 2.5 1,214 -----• 1,172 ------ 1,123 ------ 1,064 •••---3$" ;1)59:, (LOW) MED-LO "' 2.0 997 -•---- 994 -----• 960 35 923 36 LOW 1.5 757 44 753 44 734 45 704 47 _ "Iz1gg,36 G_S90703BXA HIGH 3.0 1,449 36 1,409 37 1,326 39 1,273 41 �i01 (MED-HI) MED MED-LO 2.5 2.0 1,192 981 43 1,172 44 1,141 . 45 1,094 47973 `904 k793 53 962 54 943 55 917 LOW 1.5 750 ------ 730 ------ 714 -----• 692 ------62d,rs7b4 fFOri-- HIGH 4.0 1,970 ------ 1,874 35 1,757 38 1,667 40 r33 334 +y�1$2. G_590904CXA MED 3.5 1,713 39 1,650 40 1,572 42 1,510 44�' i1:3 3 9= (MED-LO) NED-LO 3.0 1,439 46 11.155 1,412 47 1,370 48 1,327 50�956i' NO- LOW 2.5 1 183 56 57 1,122 59 1,108 60 013trri`•' -IIGH 5.0 2,134 40 2,103 40 . 2,029 42 1941, 44BYB 17,33b25' G_591155DXA MED 4.0 1,678 51 1,643 52 1,643 52 1,577 54$� f3` (MED-HI) NED-LO 3.5 1,453 58 1,440 59 1,426 59 1,363 62 ;q ,fie 1"3 � �pK. LOW 3.0 1 259 67 1.239 68 1,220 70 1 181 ., 751 O8-° 1 a - re NOTES: I. CFM in chart is without filter(s). Filters do not ship with this furnace, but must be provided by the installer. If the furnace requires two returns, this chart assumes both fdters are installed. 2. All furnaces ship aE high speed cooling. Installer must adjust blowerzoohng 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 indicaues ranges in excess of maximum static pressure allowed when heating. 6. The dashed ( ---- ) areas indicate a temperature rise not recommended for this model 7. The above chart is for U.S. furnaces installed at 0' - 2,000'. At higher altitudes, a properly de -rated unit will have approximately the same temperature rise at a particular CFM, while ESP at the CFM will be lower. 6 Accessories _, ° LPT-OOA ,:,�_ ,x„�esc�rlPla'� �� �,d'"rt"���-• L.P. Conversion Kit � h�G�� ✓ � � ✓ ✓ � LPLPOt L.P. Gas Low Pressure Kit ✓ ✓ ✓ ✓ HANGt 1 HANG12 HALP10 HAPS27 EFRO1 High Altitude Natural Gas Kit High Altitude Natural Gas Kit High Altitude L.P. Gas Kit High Altitude Pressure Switch Kit External Filter Rack 1 2 3 3 ✓ 1 2 3 3 ✓ 1 2 3 3 ✓ 1 2 3 3 ✓ DCVK-20 Horizontal/Vertical Concentric Vent Kit (2") ✓ ✓ DCVK-30 I ✓.e-_a_U_ r___L._ Horizontal/Vertical Concentric Vent Kit (3") ✓ ✓ YJ I.." (1) 7,00l'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 x '. cG 4 iX r .+ •+1' Y A' ii�� ,s �.;nrP ,.• �taty� DeS�ptJa�r ����,��r'�'�.t ,g'�.��`' ,���•'�;f CHT18-60 Cooling/Heating, Mechanical CH70TG Cooling/Heating, Digital, Non -programmable CHSATG Cooling/Heating, Mechanical H20TWR Heating Only, Mechanical 7 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: 4-16-2004 DATE OF PLANS: 04/16/04 PROJECT INFORMATION: Mill Pond Village 1600 Falmouth Road Unit 25 Centerville, MA. COMPANY INFORMATION: Northside Design Assoc. 141 Main Street Yarmouth Port, MA. 02675 COMPLIANCE: PASSES HOUSE MODEL: MALLARD Required UA = 245 Your Home = 140 Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value IUA ------------------------------------------------------------------------------- CEILINGS 865 30.0 30.0 15 WALLS: Wood Frame, 16" O.C. 1631 15.0 15.0 72 GLAZING: Windows or Doors 109 0.340 37 GLAZING: Windows or Doors 40 0.340 14 DOORS 20 0.086 2 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 12596 of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 DATE: 4-16-2004 Bldg.l Dept.l Use I I I l I I CEILINGS: 1. R-30 + R-30 Comments/Location WALLS: 1. Wood Frame, 16B 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. I VAPOR RETARDER: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ) I Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. OF r� TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 � .� PERMIT NO �_ B-05-1041 _ ISSUE DATE ; 3/10/2005 ; PROP USE ' PERMIT _ _ ----ff-------__-' _ _ _ _ _ _ _ _ _ _ JOB WEATHER CARD APPLICANT Frank Capra _ _ _ PERMIT TO New Construction ' AT (LOCATION) 00121CAMP ST # 139 ZONING DISTRIC R-25 Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1.C139 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-4 LOT SIZE I CONTRACTOR new construction: 2 baths, 3 bedrooms, 1 kitchen/dining area, 1 livingroom as per plans dated REMARKS 02/09/05 and BOA # 3546.. AREA (SO FT) EST COST ($ $146,400.00 PERMIT FEE ($) 1$534.00 OWNER lVillages @ Camp Street, LLC B LDING DEPT BY ADDRESS 11600 Falmouth Road # 25 Centerville I MA IF2632 LICENSE 012430 Capra, Frank 1600 Falmouth Road #25 Centerville MA 02632 5087789669 Certificate Issue Date /" �e,r�-*�.G„ /L (/_�j ;77CERT11=1CATE of OCCUPANCY'` Departmental Approval for Certificate of Occupancy and Compliance InanaMnr nntra Pprmit Numher Annroved By Remarks To be filled in by each division indicated hereon upon completion of its final inspection.