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11-002 (5) 1 - Department of Public Sat'et■ Ewa/ d cif Bui Construction Supervsor License License: CS 98744 P. • SUE SEAMANS PO BOX 959 LEE, MA 01238 Expiratson: 6/2/2013 Tr: 19433 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) TM 0 8/18/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Applied Risk Services, Inc. PHONE FAX 10825 Old Mill Rd (A/C, No, Ext): (877) 234 -4420 (A/C N ( 877) 234 -4421 Omaha, NE 68154 A ADD DREDRE SS: PRODUCER (877)234 -4420 CUSTOMER ID# INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Continental Indemnity Co. 28258 CVS Foundations, LLC INSURER B: dba CVS Foundations, LLC 2 Fiero Dr INSURER C: Old Orchard Beach, ME 04064 -4132 INSURER D: INSURER E: CTL 1273 580156 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRFMISFS (Fa occurrence) $ CLAIMS MADE OCCUR MED EXP (any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS - COMP /OP AGG $ POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS' LIABILITY Y / N X TORY I IMITS FR ANY PROPRIETOR PARTNER /EXECUTIVEI N/A 46- 842403 -01 -01 08/08/2011 08/08/2012 E.L. EACH ACCIDENT $ 100,000 A OFFICER /MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CVS Foundations, LLC BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 2 Fiero Dr IN ACCORDANCE WITH THE POLICY PROVISIONS. Old Orchard Beach, ME 04064 -4132 Attn: Project Manager AUTHORIZED REPRESENTATIVE AGN74287 ACORD 25 (2009/09) ©1988 -2009 A ORD CORPORATION. All rights reserved the final NOI and Stormwater Pollution Prevention Plan (SWPPP) shall be submitted to the Northampton DPW for approval prior to the start of construction and prior to issuance of a building permit. 3. The proposed stormwater drainage system in the area of the proposed cell tower compound shall be completed in accordance with sheet Z -1 which specifies a 3'6" Wide by 2' Deep Infiltration Trench outside of the southwestern and a portion of the southeastern fence line. 4. Prior to the start of construction test pits shall be conducted by a Certified Soil Evaluator or Certified Professional Soil Scientist in the area of the proposed infiltration trenches A and B to confirm at least a two foot separation between the seasonal high ground water and the bottom of the proposed trenches. Test Pit logs shall be submitted to the DPW for approval. 5. The proposed stormwater management system is designed to mitigate peak stormwater flows. If, after construction of the proposed system, the system is found to increase stormwater flows to Haydenville Road or to adjacent properties, or cause increased erosion, the owner shall redesign and reconstruct the drainage system to prevent any increased and /or erosive stormwater flows. 6. Prior to construction, the applicant must secure all necessary permits and approvals from the Massachusetts Highway Department for construction work in the State Highway System layout and proposed stormwater discharges to the stormwater system owned and operated by the Commonwealth of Massachusetts. 7. All stormwater systems shall be installed as proposed and stabilized prior to receiving drainage flows. i A LA— �, i; 0 of City Engineer ate cc. PIanning Board c/o Office of Planning and Development Building Department Conservation Commission c/o Office of Planning and Development M:\Stormwater Program\Stormwater Permits Internal \'ermits_new applications\Haydenville Rd Cell Tower.doc Page 3of3 b. Limited Stormwater Hydrology Report for Upgrade of a Gravel Access Road & Installation of a Telecommunications Facility MA -5025 Northampton, Dated July 21, 2011, Stamped by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. c. Northampton MA -5025, Leeds, MA, Details Sketches SK -1 and SK -2, dated August 3, 2011, and submitted by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. 2. The Northampton Department of Public Works (DPW) or its authorized representative shall be provided access to the property to conduct inspections before, during, and after construction activities as necessary. The applicant shall arrange with the DPW to schedule the following inspections: Initial Inspection, Erosion Control Inspection, Bury Inspection, and Final Inspection. The DPW may also conduct random inspections to ensure effective control of erosion and sedimentation during all phases of construction. 3. At the completion of the work, including construction of stormwater management facilities and landscaping, the applicant shall submit a statement to the DPW from a professional engineer of record in the Commonwealth of Massachusetts certifying that the materials and construction of the stormwater management system was constructed in accordance with the approved plans and will function as designed. All changes to the approved stormwater facilities shall be documented by a professional engineer of record in the Commonwealth of Massachusetts and approved by the DPW prior to submission of the certification statement described above. 4. Annual Reports that are stamped by a Registered Professional Engineer documenting the actions completed as required by the Operation, Maintenance and Inspection Agreement shall be submitted to the Northampton Department of Public Works by October 1 of each year (see Specific Condition 1 below). 5. If construction of the proposed stormwater system has not started within five years of the issue date of this permit, then the permit will expire and a new permit will be required. Construction is defined as clearing, grading, excavation, filling, and installation of drainage structures on the lots specified in this permit. Specific Permit Conditions: 1. Prior to issuance of a Building Permit or start of construction, the applicant or property owner(s) shall record an executed Stormwater Operation, Maintenance, and Inspection Agreement that is binding on all subsequent owners of land served by the private stormwater management facility by recording it in the land records of the Registry of Deeds. The maintenance schedule and responsibility for maintenance of the proposed stormwater management system must be adequately specified in Attachment A to this Agreement. This agreement shall be approved by the Northampton DPW and signed by the owner and the Mayor of Northampton. Section 22 -85 of the Northampton Stormwater Management Ordinance provides additional guidance for the requirements of this agreement. 2. This project may be required to submit one or more Notice of Intent (NOI) to the U.S. EPA for coverage under the NPDES Stormwater Construction General Permit. A copy of M: \Stormwater Program \Stormwater Permits Internal\Permits_new applications \Haydenville Rd Cell Tower.doc Page 2 of 3 a STORMWATER MANAGEMENT PERMIT APPLICATION DECISION City of Northampton Department of Public Works Project / Site Name: Northampton MA -5025 — Raw Land Cell Tower Project Street or Location / Assessor ID: 0 Haydenville Road, Leeds, MA / 11- 002 -001 Applicant Name: Global Tower Assets, LLC (H. Castagnaro) Applicant Address/Phone: 238 Littleton Road, Suite 205B, Westford, MA 01886 / 561- 982 -1955 Owner Name: Smith Vocational & Agricultural High School c/o City of Northampton Owner Address/Phone: 80 Locust Street, Northampton, MA 01060 Application Submission Date: 7/26/2011 THE FOLLOWING ACTION BY THE NORTHAMPTON DEPARTMENT OF PUBLIC WORKS HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Disapproval of the Stormwater Management Permit Application based on a determination within seven days of the receipt of the application that the application is administratively incomplete (see attached documentation). Approval of the Stormwater Management Permit Application. X Approval of the Stormwater Management Permit Application subject to any conditions, modifications or restrictions required by the Department of Public Works (see below) Disapproval of the Stormwater Management Permit Application based upon a determination that the proposed plan, as submitted, does not meet the purposes set forth in the Northampton Stormwater Management. Standard Permit Conditions: 1. All clearing, grading, drainage, construction, and development shall be conducted in strict accordance with the following plans and information submitted with the application and as amended by any conditions attached to this permit: a. GTP (Global Tower Partners) Northampton MA -5025, 0 Haydenville Rd., Leeds, MA, Site Plans, Sheets T -1, C -1(1), C -1(2), C -01, C -02A, C -02B, C -02C, C -03A, C -03B, Z -1, Z -2, Z -3, Z -4, Z -5, Dated 7/7/2011, Stamped by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. M: \Stormwater Program \Stormwater Permits Internal\Permits_new applications \Haydenville Rd Cell Tower.doc Page 1 of 3 35. Erosion control shall be removed as soon as the site is stabilized. The applicant shall contact the Commission when removal is planned. Conditions Specific to the Northampton Wetlands Ordinance: 36. A permanent vegetated buffer, consisting of appropriate transitional wetland plants, shall be created between the road edge and edge of the treeline within protected zones. 37. A planting plan which demonstrates compliance with the requirement for 2:1 mitigation for work within protected zones exceeding the amount of current disturbance (337 - 10E(2)h 6) must be submitted to and approved by the Commission prior to work on the project. ATTEST: H MPSHIBE, .� u . 7► REGIST*. R PATRICIA A. P A 28. Soils exposed for periods greater than two months shall be stabilized with erosion control blankets and netting, a covering of straw mulch, or a temporary cover of rye or other grass to prevent erosion and sedimentation. Drainage ditches shall be stabilized and seeded with a native perennial grass mixture. Any stabilization materials such as jute netting shall be firmly anchored to prevent them from being washed from slopes by rain or flooding. Preference should be given to biodegradable materials. 29. All disturbed areas shall be graded, loamed and seeded, or stabilized with erosion control blankets or netting, and a covering of straw mulch prior to November 30, of each year. No disturbed areas or stockpiled materials will be left unprotected or without erosion control after this date. 30. No disposal of soils or other materials shall be allowed within: a 100 -year floodplain; 40 feet of the 100 -year floodplain elevation; any wetland; or any area within 100 -feet of a wetland, unless such areas are specifically approved by the Commission, in accordance with 310 CMR 10.00, and City of Northampton Ordinances - Chapter 337 31. Ongoing conditions that shall not expire with the issuance of a Certificate of Compliance are as follows: 36 32. Upon completion of the work covered by this Order, the applicant shall submit an as -built plan, signed and stamped by a registered professional engineer or land surveyor, together with a written request for a Certificate of Compliance. The plan and written request shall specify any ways that the completed project differs from the plans referenced in the Order. The as -built plan shall include, at a minimum, and as applicable to the project: elevations of all pipe inverts and outlets, pipe sizes, materials, and slopes; all other drainage structures; limits of clearing, grading, and fill; all structures, pavement, and contours within 100 feet of wetland boundaries; all alterations within the wetland resource areas; and all dates of fieldwork. 33. The owner of the property described in this Order must advise any potential buyer of the property that any construction or alteration to said property, including brush cutting or clearance, may require approval by the Northampton Conservation Commission. Any instrument conveying any or all of the owners' interest in said property or any portion thereof, shall contain language similar to the following: "This property is subject to the Northampton Wetlands Protection Ordinance and /or Wetlands Protection Act. Any construction or maintenance work performed on this property requires an Order of Conditions, and /or a Determination of Applicability from the Northampton Conservation Commission. 34. Winter maintenance is limited to plowing; salt, sand, or chemicals shall not be used. "ATTACHMENT A" 20. Prior to the initiation of any work, the applicant/owner shall submit a letter of understanding to the Commission stating that he /she has received, read, understands and shall comply with these Orders. The applicant, and, his or her contractor, foreman and/or construction manager shall sign the letter of understanding. 21. Prior to the initiation of any work, the applicant shall submit to the Commission a sequencing plan for construction, and erosion and sedimentation control installation. 22. Prior to the start of any site work, excavation or construction, a pre - construction conference shall be held on the site, between the contractor conducting the work, the site /project engineer, the applicant, and a member or agent of the Conservation Commission, in order to ensure that the requirements of this Order are understood by all parties. Prior to the pre - construction meeting, all erosion control devices must be installed. 23. All required permits must be obtained from federal, state and municipal agencies and departments prior to the start of any project. 24. A copy of this Order and associated plans shall remain on site during all construction and /or building activities. The project manager and all equipment operators shall be familiar with the approved plans, and shall be informed of their location on the site. This location shall be accessible to all contractors whenever work is occurring on site. 25. All revised plans, referenced within this Order of Conditions, shall be approved by the Conservation Commission and incorporated into the permit by reference and shall be followed during the course of construction. 26. The areas of construction shall remain in a stable condition at the close of each construction day. Erosion control measures shall be inspected at this time, and maintained or reinforced as necessary. All such devices shall be inspected, cleaned or replaced during construction and shall remain in place until such time as stabilization of all areas that may impact resource areas is permanent. These devices shall also be inspected to assure that the maximum control has been provided. Any entrapped silt shall be removed to an area outside the buffer zone and resource areas, and maintained or reinforced as necessary. Erosion controls shall be inspected after every rainfall to assure that maximum control has been provided. 27. An adequate stockpile of erosion control materials shall be on site at all times for emergency or routine replacement and shall include materials to repair or replace silt fences, straw bales, erosion control blankets, riprap, filter berms or other devices planned for use during construction. Massachusetts Department of Environmental Protection Provided b MassDEP: Bureau of Resource Protection - Wetlands ail, — �� - will WPA Form 5 — Order of Conditions MassDEP ssDEP Q File # Massachusetts Wetlands Protection Act M.G.L. c. 131, eDEP Tr- saction # , )C AA/CO City/Town E. Signatures Important: When This Order is valid for three years, unless otherwise specified as a special • °fib / ,9 01 filling out forms condition pursuant to General Conditions #4, from the date of issuance. 1. Date of Issuance on the computer, use only the tab Please indicate the number of members who will sign this form. key to move your This Order must be signed by a majority of the Conservation Commission. 2. Number of Signers cursor - do not use the return The Order must be mailed by certified mail (return receipt requested) or hand delivered to key. the applicant. A copy must be mailed, hand delivered o ed electronically at the same time 4 . with the appropriate MassDEP Regional Office. am Signatur t . e:2=X; , rim 1'M ■ f./ . . `2—ti--- cam_ :. V / ❑ by hand delivery on by certified mail, return receipt requested, on OS:thbe_ l acl Date Date F. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of and abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate MassDEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he /she is not the appellant. Any appellants seeking to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior participation in the review of this project. Previous participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing, requesting a Superseding Order, or providing written information to the Department prior to issuance of a Superseding Order. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act (M.G.L. c. 131, § 40), and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. wpa5sigs.doc • rev. 02/25/2010 Page of _ Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0656 LIIILL WPA Form 5 - Order of Conditions eDEP Transaction #:419199 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPTON j) The stormwater management system approved in the Order of Conditions shall not be changed without the prior written approval of the issuing authority. k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site Design Credit (as defined in the MassDEP Stormwater Handbook, Volume 3, Chapter 1, Low Impact Development Site Design Credits) shall not be altered without the prior written approval of the issuing authority. I) Access for maintenance, repair, and/or replacement of BMPs shall not be withheld. Any fencing constructed around stormwater BMPs shall include access gates and shall be at least six inches above grade to allow for wildlife passage. Special Conditions: D. Findings Under Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable? P Yes I- No 2. The Conservation Commission hereby(check one that applies): a. 1- DENIES the proposed work which cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: 1. Municipal Ordinance or Bylaw 2. Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order or Conditions is issued. Which are necessary to comply with a municipal ordinance or bylaw: b. F APPROVES the proposed work, subject to the following additional conditions. NORTHAMPTON CHAPTER 337 OF THE 1. Municipal Ordinance or Bylaw WETLANDS 2. Citation GENERAL CODE ORDINANCE 3. The Commission orders that all work shall be performed in accordance with the following conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. The special conditions relating to municipal ordinance or bylaw are as follows: IN ADDITION TO RESOURCES DEFINED IN THE WETLANDS PROTECTION ACT (MGL C.131, ? 40) AND REGULATIONS THEREUNDER (310 CMR 10.00), THE SITE INCLUDES ISOLATED WETLANDS, CLASSIFIED AS RESOURCE AREAS UNDER THE NORTHAMPTON WETLANDS ORDINANCE. PLEASE SEE ATTACHMENT A, Page 7 of 9 * ELECTRONIC COPY • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 -0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419199 Massachusetts Wetlands Protection Act M.G.L. c. 131, §4 City/Town:NORTHAMPTON Permit as required by Stormwater Standard 8. Construction period erosion, sedimentation and pollution control measures and best management practices (BMPs) shall remain in place until the site is fully stabilized. b) No stormwater runoff may be discharged to the post - construction stormwater BMPs unless and until a Registered Professional Engineer provides a Certification that: i. all construction period BMPs have been removed or will be removed by a date certain specified in the Certification. For any construction period BMPs intended to be converted to post construction operation for stormwater attenuation, recharge, and/or treatment, the conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that the BMP has been properly cleaned or prepared for post construction operation, including removal of all construction period sediment trapped in inlet and outlet control structures; ii.. as -built final construction BMP plans are included, signed and stamped by a Registered Professional Engineer, certifying the site is fully stabilized; iii. any illicit discharges to the stormwater management system have been removed, as per the requirements of Stormwater Standard 10; iv. all post - construction stormwater BMPs are installed in accordance with the plans (including all planting plans) approved by the issuing authority, and have been inspected to ensure that they are not damaged and that they are in proper working condition; v. any vegetation associated with post - construction BMPs is suitably established to withstand erosion. c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another party has legally assumed responsibility for BMP maintenance. Prior to requesting a Certificate of Compliance, or Partial Certificate of Compliance, the responsible party (defined in General Condition 19(e)) shall execute and submit to the issuing authority an Operation and Maintenance Compliance Statement ( "O &M Statement ") for the Stormwater BMPs identifying the party responsible for implementing the stormwater BMP Operation and Maintenance Plan ( "O &M Plan") and certifying the following: i.) the O &M Plan is complete and will be implemented upon receipt of the Certificate of Compliance, and ii.) the future responsible parties shall be notified in writing of their ongoing legal responsibility to operate and maintain the stormwater management BMPs and implement the Stonmwater Pollution Prevention Plan. d) Post - construction pollution prevention and source control shall be implemented in accordance with the long -term pollution prevention plan section of the approved Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Multi-Sector General Permit. e) Unless and until another party accepts responsibility, the landowner, or owner of any drainage easement, assumes responsibility for maintaining each BMP. To overcome this presumption, the landowner of the property must submit to the issuing authority a legally binding agreement of record, acceptable to the issuing authority, evidencing that another entity has accepted responsibility for maintaining the BMP, and that the proposed responsible party shall be treated as a permittee for purposes of implementing the requirements of Conditions 19(f) through 19(k) with respect to that BMP. Any failure of the proposed responsible party to implement the requirements of Conditions 19(f) through 19(k) with respect to that BMP shall be a violation of the Order of Conditions or Certificate of Compliance. In the case of stormwater BMPs that are serving more than one lot, the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs. A plan and easement deed that grants the responsible party access to perform the required operation and maintenance must be submitted along with the legally binding agreement. 1) The responsible party shall operate and maintain all stormwater BMPs in accordance with the design plans, the O &M Plan, and the requirements of the Massachusetts Stormwater Handbook. g) The responsible party shall: 1. Maintain an operation and maintenance log for the last three (3) consecutive calendar years of inspections, repairs, maintenance and/or replacement of the stormwater management system or any part thereof, and disposal (for disposal the log shall indicate the type of material and the disposal location); 2. Make the maintenance log available to MassDEP and the Conservation Commission ( "Commission ") upon request; and 3. Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure that the responsible party is in compliance with the requirements for each BMP established in the O &M Plan approved by the issuing authority. h) All sediment or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal, state, and local laws and regulations. i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04 are prohibited. Page 6 of 9 * ELECTRONIC COPY • 1 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 -0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419199 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPTON 6. If this Order constitutes an Amended Order of Conditions, this Amended Order of Conditions does not exceed the issuance date of the original Final Order of Conditions. 7. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 8. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 9. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to the Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work.. 10. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, " Massachusetts Department of Environmental Protection" [or 'MassDEP"] File Number : "246- 0656" 11. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before Mass DEP. 12. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 13. The work shall conform to the plans and special conditions referenced in this order. 14. Any change to the plans identified in Condition #13 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 15. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Depai lment for that evaluation. 16. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 17. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 18. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS 19. The work associated with this Order(the "Project ") is (1) F is not (2) F subject to the Massachusetts Stormwater Standards. If the work is subject to Stormwater Standards, then the project is subject to the following conditions; a) All work, including site preparation, land disturbance, construction and redevelopment, shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan and, if applicable, the Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Construction General Page 5 of 9 * ELECTRONIC COPY L Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 - 0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419195 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPT( 17. r Salt Marshes a. square feet b. square feet c. square feet d. square fee 18. r Land Under Salt Ponds a. square feet b. square feet c. c/y dredged d. c/y dredged 19. r Land Containing Shellfish a. square feet b. square feet c. square feet d. square fe( Indicate size under Coastal Banks, inland Bank, Land Under 1 20, E Fish Runs Ocean, and/or inland Land Under Waterbodies and Waterwa above c. c/y dredged d. c/y dredged 21. E Land Subject to Coastal Storm Flowage a. square feet b. square feet 22. E Restoration/Enhancement (For Approvals Only) If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.5.c & d or B.17.c & d above, please entered the additional amount here. a. square feet of BVW b. square feet of Salt Marsh 23. E Streams Crossing(s) If the project involves Stream Crossings, please enter the number of new stream crossings /number of replacement stream crossin a. number of new stream crossings b. number of replacement stream crossings C. General Conditions Under Massachusetts Wetlands Protection Act The following conditions are only applicable to Approved projects 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deer cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private prope rt! invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the followi apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to issuing authority at least 30 days prior to the expiration date of the Order. Page 4 of 9 * ELECTRONIC ( Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246-0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419199 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPTON a. linear feet b. linear feet c. linear feet d. linear feet 5. F Bordering Vegetated Wetland a. square feet b. square feet c. square feet d. square feet 6. IW Land under Waterbodies and Waterways a. square feet ' b. square feet c. square feet d. square feet e. c/y dredged f. c/y dredged 7. r Land Subject to Flooding a. square feet b. square feet c. square feet d. square feet Cubic Feet Flood Storage e. cubic feet f. cubic feet g. cubic feet h. cubic feet 8. C Isolated Land Subject to Flooding a. square feet b. square feet Cubic Feet Flood Storage c. cubic feet d. cubic feet e. cubic feet £ cubic feet 9. r River front Area a. total sq. feet b. total sq. feet Sq ft within 100 ft c. square feet d. square feet e. square feet f. square feet Sq ft between 100 -200 ft g. square feet h. square feet i. square feet j. square feet Coastal Resource Area Impacts: Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 10: r Designated Port Areas Indicate size under Land Under the Ocean, below 11.E Land Under the Ocean a. square feet b. square feet c. c/y dredged d. c/y dredged 12.1 Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 13. r Coastal Beaches a. square feet b. square feet c. c/y nourishment d. c/y nourishment 14. r Coastal Dunes a.' square feet b. square feet c. c/y nourishment d. c/y nourishment 15. r Coastal Banks a. linear feet b. linear feet 16. r Rocky Intertidal Shores a. square feet b. square feet Page 3 of 9 * ELECTRONIC COPY • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246-0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419199 City/Town:NORTHAMPTON Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 NOTICE OF INTENT PACKET: UPGRADE OF A GRAVEL ACCESS ROAD PROTERRA DESIGN July 28, 2011 & INSTALLATION OF A GROUP TELECOMMUNICATIONS FACILTY MA 5025 B. Findings 1.Findings pursuant to the Massachusetts Wetlands Protection Act Following the review of the the above - referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: a. F Public Water Supply b. r Land Containing Shellfish c. F Prevention of Pollution d. F Private Water Supply e. l- Fisheries f F Protection of Wildlife Habitat g. P Ground Water Supply h. 1 Storm Damage Prevention i. Flood Control 2. Commission hereby finds the project, as proposed, is Approved subject to: a. F The following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: b. E The proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect interests of the Act, and a final Order of Conditions is issued. A description of the performance standards which the proposed work cannot meet is attached to this Order. c. r The information submitted by the applicant is not sufficient to describe the site, the work or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the interests of the Act , and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). 3 Buffer Zone Impacts: Shortest distance between limit of project disturbance and the wetland resource 34 area specified in 310CMR10.02(1)(a). a. linear feet Inland Resource Area Impacts:(For Approvals Only): Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 4. r Bank Page 2 of 9 * ELECTRONIC COPY llIflIllIflIL 1ii011 00020922 Bk: 10683Pg: 47 Page: 1 of 11 Recorded: 10/12/2011 12:52 PM Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File #:246 -0656 WPA Form 5 - Order of Conditions eDEP Transaction #:419199 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:NORTHAMPTON A. General Information 1. Conservation Commission NORTHAMPTON 2. Issuance a. F OOC b. C Amended OOC 3. Applicant Details a. Fast Name HEATHER b. Last Name CASTAGARO c. Organization GLOBAL TOWER ASSETS, LLC d. Mailing Address 238 LITTLETON ROAD, SUITE 205B e. City/Town WESTFORD f. State MA g. Zip Code 01886 4. Property Owner a. First Name b. Last Name c. Organization SMITH VOCATIONAL BOARD OF TRUSTEES d Mailing Address 80 LOCUST STREET e. City/Town NORTHAMPTON f. State MA g. Zip Code 01060 5. Project Location a.Street Address HAYDENVILLE ROAD b.City/Town NORTHAMPTON c. Zip Code 01060 d. Assessors Map/Plat# 11 e. Parcel/Lot# 002 f Latitude 42.35699N g. Longitude 72.68622W 6. Property recorded at the Registry of Deed for a. County b. Certificate c. Book d. Page HAMPSHIRE 1267 217 7 .Dates a. Date NOI Filed : 7/29/2011 b. Date Public Hearing Closed: 9/8/2011 c. Date Of Issuance: 9/20/2011 8 .Final Approved Plans and Other Documents a. Plan Title: b. Plan Prepared by: c. Plan Signed/Stamped by: d. Revised Final e. Scale: Date: SITE PLAN SKETCH, PROTERRA DESIGN JESSE MORENO August 26, 2011 VARIED SHEETS SK3 -SK -7 GROUP GTP NORTHAMPTON, PROTERRA DESIGN SHEETS T -1, C- 1 -C -3B, GROUP JESSE MORENO June 23, 2011 VARIED Zl -ZG Page 1 of 9 * ELECTRONIC COPY YHAMP (.Y `t of No-rill-amp-tan . 1 Attssttrltusetts '477 {{ j * °` 7. DEPAR9MEN7' OF BUILDING INSPECTIONS „_)% 212 Main Street, • Municipal Building Northampton, MA 01060 Lplgig4s,uck Fax: 413 - 587 -1272 Chuck Miller Building Commissioner Phone: 413 - 587 -1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers /Architects responsible for Entire Project) Project Title: GTP Northampton (MA -5025) Date: October 12 , 2011 Project Location: Off Haydenvi l le Road Map: 11 Parcel: 2 /1 Zone: SR Scope of Project: Construction of te] Pcommunicat facility & driveway In accordance with the sixth edition Massachusetts State Building Code, 780 CMR Section 116.0: I, Jesse Moreno, PE Mass. Registration # 4 Being a registered professional Engineer /Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [x] ENTIRE PROJECT For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code - required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. 0 4 ..JESSE M. ti G Sign' • d Seal of Registered Professional g MORENO � o CIVIL y �� No. 47315 il frarali■111 LDay of .0670/3.62-. 20IL l'As 4- G /STE'1 /40) c 6q- 6 19/ r a r Versionl .7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No Q SECTION 11 -OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Smith Vocational and Agricultural High School as Owner of the subject property hereby authorize , CVS Foundations, LLC (general contractor for Global Tower Assets LLC) to act on my behalf, in all matters relative to work authorized by this building permit application. 072..k/ Signature of Owner Date I CVS Foundations, LLC as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Cary Seamans Print Name 1 J Signature of Owner gent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. Not Applicable 0 Name of L icense Holder : Sue Seamans CS 98744 License Number PO Box 959, Lee, MA 01238 06/02/2013 Address Expiration Date Signature Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached Yes Q No 0 Version i .7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable tg Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Proterra Design Group, LLC All Name Area of Responsibility 1 Short S 3, Northampton, MA 01060 47315 Address mr , Registration Number (413) 320 -4918 06/30/2012 —woos ammo Telephone Expiration Date Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor CVS Foundations, LLC Not Applicable ❑ Company Name: Cary Seamans Responsible In Charge of Construction 2 Fiero Drive, Old Orchard, ME 04064 Address (207) 281 -3166 Signature Telephone Versionl .7 Conunercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size N/A Frontage N/A Setbacks Front 1166 Side L: R: L:343 R: 1421 Building Height N/A N/A Bldg. Square Footage N/A N/A °'° N/A N/A Open Space Footage % (Lot area minus bldg & paved N/A N/A 99.1 ping) # of Parking Spaces N/A 0 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW O YES O IF YES, date issued: 09/13/2011 W YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES t IF YES: enter Book 10676 Page 338 and /or Document # 201100020414 B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: 09/13/2011 C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO O IF YES, describe size, type and location: Sign will be placed on fence to indicate tower E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE ( 1 Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other GI Brief Description Construction of a 190 -foot telecommunications tower with a 100' x 100' fenced lease area. Of Proposed Work: 1 -tn \1 Afii <,- A ; 1 ',,,r\4 M zr ,1 \ i�� e\c A-V- 1w SECTION 5 - USE GROUP AND CONSTRUCTION TYPE I USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A-3 ❑ 1A 1 ❑ A-4 ❑ A -5 ❑ 113 I ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 0 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ` 1 ❑ U Utility © Specify: Telecommunications Tower. /A s-- . f4- p M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): _ Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA 1 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1st 2nd 2 nd 3 r d 3 4t 4 Total Area (sf) Total Proposed New Construction (sf) 10,000 Total Height (ft) Total Height ft 190 • 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ig Municipal ❑ On site disposal system❑ r 1 Versionl .7 Commercial Build Permit May 15, 2000 Department use only RECEIVED City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit - 9 2011 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans DEPT. BUILDING 17 E 13- 587 -1240 Fax 413 -587 -1272 Plot/Site Plans NORfl THAMPTON, MA 01060 Other Specify _ I APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 123 Haydenville Road, Northampton, MA 01060 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Smith Vocational and Agricultural High School 80 Locust Street, Northampton, MA 01060 Name (Print) /13 Al J ` t 4 Current Mailing Address: // ,/r�,- ,` (413) 587 -1414 Signature `/ � � (i'� c ` // Telephone 2.2 Authorized Anent. ? h ca. 3-/-q 5 A► 4 s i tr $, ^� m Global Tower Assets, LLC g ,, qa �� � 0 750 Park of Commerce Boulevard, Suite 300, 0 Name (Print) � 0 G urrent Mailing Address: I S6 l.. 3 7 (561) 302 -3487 Signature ` �' Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $150,000.00 (a) Building Permit Fee 2. Electrical $0.00 (b) Estimated Cost Construction Totaf fro Co (6) of 3. Plumbing $000 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total = (1 + 2 + 3 + 4 + 5) Check Number e,/4 i 95e) This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 2 File # BP- 2012 -0472 CU APPLICANT /CONTACT PERSON CVS FOUNDATIONS LLC 2' ¢, w ADDRESS/PHONE 2 FIERO DR OLD ORCHARD BEACH (207) 281 -3166 —i 01. PROPERTY LOCATION HAYDENVILLE RD MAP 11 PARCEL 002 001 ZONE RR/SR(100)/URAIIRI /WP/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �e i R� � � Fee Paid I/ e 7 Tvpeof Construction:_CONSTRUCT 190 FT TELECOMMUNICATIONS TOWER & ATT RELATED EQUIPMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 98744 3 sets of Plans / Plot Plan THHELLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: A pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit 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 ti 11 ll Signatur 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. HAYDENVILLE RD BP- 2012 -0472 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11 - 002 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: COMMUNICATION TOWER BUILDING PERMIT Permit # BP- 2012 -0472 Project # JS- 2012- 000057 Est. Cost: $150000.00 Fee: $900.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CVS FOUNDATIONS LLC 98744 Lot Size(sq. ft.): 7932711.60 Owner: NORTHAMPTON CITY OF SMITH SCHOOL Zoning: RR/ SR (100)/URA / /RI/WP/WSPApplicant: CVS FOUNDATIONS LLC AT: HAYDENVILLE RD Applicant Address: Phone: Insurance: 2 FIERO DR (207) 281 -3166 WC OLD ORCHARD BEACHME04064 ISSUED ON:11 /15/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 190 FT TELECOMMUNICATIONS TOWER & ATT RELATED EQUIPMENT 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/15/2011 0:00:00 $900.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner �i'E;