42-079-002 (7) BP-2024-0930
114 GLENDALE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
42-079-002 CITY OF NORTHAM PTON
Permit: Alts Renovations
, Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0930 PERMISSION IS HEREBY GRANTED TO:
Project# CELL TOWER MODIFICATIONS Contractor: License:
- Est. Cost: 50000 KMM TELECOMMUNICATIONS 1 1 1556
Const.Class: Exp.Date:02/23/2025
Use Group: Owner: AMERICAN TOWER CORPORATION
Lot Size (sq.ft.)
Zoning: SC Applicant: KMM TELECOMMUNICATIONS
Applicant Address Phone: insurance:
1900 LAKEWAY DRIVE STE 100 (888)566-2677 WC034275000
LEWISVILLE, TEXAS 75057
ISSUED ON: 07/29/2024
TO PERFORM THE FOLLOWING WORK:
MODIFYING EQUIPMENT AT CELL SITE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: :/
Fees Paid: $375.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
File #BP-2024-0930
APPLICANT/CONTACT PERSON:KMM TELECOMMUNICATIONS
1900 LAKEWAY DRIVE STE 100 LEWISVILLE,TEXAS 75057(888)566-2677
PROPERTY LOCATION 114 GLENDALE RD
MAP:LOT 42-079-002 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $375.00
Type of Construction: MODIFYING EQUIPMENT AT CELL SITE
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRESENTED:
1/ Approved Additionalpennits required(see below) For all projects that need additionalreviews 0+_kr
as checked below,please see the Office of Planning& Sustainability Permit page or scan here {t
PLANNING BOARD PERMIT REQUIRED UNDER:§ T,
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR SpecialPermit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
//,12 •2f• 2OZL{
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all
required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit
granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&
Development for more information.
Met 11 vn a-A-% 4`
The Commonwealth of Massachusetts
'y' � 3 �O
nFpT ,�� 49.1 Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
MSpFcri B ildin. Permit Application for any Building other than a One-or Two-Family Dwelling
q O/06 O•S (This Section For Official Use Only)
Building Permit Num• •.. "T3O Date Applied: Building Official:
SECTION 1:LOCATION
114 GLENDALE ROAD
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy ❑ Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Description of Proposed Work:
ON BEHALF OF VERIZON THE PROPOSED WORK INVOLVES MODIFYING THEIR EQUIPMENT AT THE EXISTING CELL SITE.
PLEASE REFERENCE THE ATTACHMENTS FOR FURTHER DETAILS
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IBO IIA0 IIB ❑ IIIA ❑ IIIB 0 IV 0 VA CI VBC
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
•
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
AMERICAN TOWER CORPORATION 10 PRESIDENTIAL WAY-WOBURN MA 01801
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
617 375_ 7500
-
Title Telephone No.(business) Telephone No. (cell) &mail address
If applicable,the property owner hereby authorizes:
ADAM WOLFREY-AAIJTTHORIIZED AGENT 750
COMMUNICATIONS LLC 750 W CENTER ST STE 301-W BRIDGEWATER MA 02379
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
KMM COMMUNICATIONS
Company Name
ROBERT CLARK 111556
Name of Person Responsible for Construction License No. and Type if Applicable
820 BOSTON TURNPIKE RD - SHREWSBURY MA
Street Address City/Town State Zip
(508) 579-4376 - - b.clark@kmmcorp.net
Telephone No. (business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $$50000 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $ 1
4.Mechanical (HVAC) $ Note:Minimum fee=$ 97 ntact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $50000 (contact municipality)and write check number here .4111301)
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
ADAM WOLFREY-CENTERLINE COMMUNICATIONS LLC "`e 07.16.24
AUTHORIZED AGENT a. -506 667- 3100
Please print and sign name Title Telephone No. Date
750 W CENTER ST STE 301 -W BRIDGEWATER MA 02379 awolfrey@clinellc.com
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval:
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
fi �y Massachusetts ?�' °�_�e
Ir ( C. F444
` ��} , DEPARTMENT OF BUILDING INSPECTIONS
7
.4, 212 Main Street • Municipal Building IAy Oa'
Northampton, MA 01060 sp ,.. �^o
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
KMM Telecommunications
1900 Lakeway Drive
Location of Facility: Ste Lewisville TX75057-6012
The debris will be transported by:
Name of Hauler: N/A
Signature of Applicant: uJs9.47 AGENT Date: 07.16.24