39-060 (20) Jesse G.Brown y._ one witliam way
Y" ''
Co CEO '��", Be Uingham,MA 02019
Matthew P.Mastroianni �VMS ph:508-473-1990
Co CEO c o M. m fax:508-473-1991
July 16,2015
Building Commissioner
Town of Northampton
212 Main St.
Northampton,MA 01060
Re:T-Mobile Telecommunications Installation;22 Atwood Drive Northampton,MA 01060
To Whom It May Concern,
This is authorization to allow replacement of the existing contractor:Geoffrey Forse on the
issued building permit#BP-2015-0751 for site located at 22 Atwood Drive Northampton,
MA 01060.
The new contractor taking over the construction is:Kenneth Zink
Sincerely,
Geoffrey Fors
www.heidrea.com
City of Northampton
Massachusetts -` �
_ ., ^,! D�BARTdANN3` OF 19VIbDINQ INSPECTIONS a
222 5rain street • Municipal auildizq
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Fax 413-587-1272 Chuck Miller
Building Commissioner Phone:413-587-1240 Assistant Commissioner
CONSTRUCTION CONTROL DOCUMENT
(For professional EngineerelArchitects responsible for Entire Project)
Project Title: MA Northharnpton Date: 11/21/2014
Project Location: Atwood Drive,Northhampton,MA 01063 Map: Parcel: Zone:
Scope of project: Install Shaft Reinforcement
In accordance with the Eighth edition Massachusetts State Building Code,780 CMR Section 107.6:
I Nicholas J.Schmitt Mass.Registration# 51010
Being a registered professional Engineer/Archltect hereby CERTIFIES that I have prepared or directly supervised
the preparation of all design plans,computations and specifications concerning:
[ ]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 10.7.82.2:
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,
4aS of
Sign re and Seal of Registered Professional o N18HOL S i 4
rA
Day of 20 N i'
(Seel)
INSURER'S AFFIDAVIT AS TO WORKERS'COMPENSATION INSURANCE
1,Elisabeth McLeod,of The Driscoll Agency,Inc.,93 Longwater Circle Norwell,MA 02061 ant:
❑ an authorized representative of Insurance Company
{Company Name]
(a producer"in the voluntary market)t
X an authorized agent of Liberty Mutual Fite Insurance Ca salt agent
[Company Name]
in the voluntary market,authorized to sign on belialf of a producer)}
❑ an authorized signatory of the ,the Prime Contractor
[Company Name]
(an insured of a producer in the involuntary inarket pool)t
13 an authorized signatory of ,the Sub-Contractor(an insured of
[Company Name]
a producer in the involuntary market pool,group,or otherwise insured)
and do hereby over that effective 6-20-2015 [Date], Timberline Construction Corporation ,the Prime or Sub-
Contractor, is insured for Workers'Compensation insurance with Liberty Mutual Fite Insurance Company under
Policy No[s].V rC 1 12013 1 103j_,pursuant to the attached Certificate of Insurance,and in accordance with
Massachusetts General Laws,Chapter 152 and Subsection 7.05A of the Standard Specifications for Highways and
Bridges of the Highway Division of the Massac setts-D_epartment of Transportation.
ign tu`
Commeretal Account Manager
Title
COMMONWEALTH OF MASSACHUSETTS
On this t day ofl' y 2yr� before me the undersigned notat ubGc personally a eared ,feLaU document
�. Y � 1� notary public,�P Y Pp
signer],proved tome through satisfactory evidence of identification,which was/were,yitss to be the person
who sighed the preceding or attached document in my presence,and who swore or affirmed to ate that the contents of
the document are truthful and accurate to the best of their knowledge and belief.
Notary
Expiration Date: {Printed Name)
Not=D�-Haneoy
Jana CommonweaS KY commWon
l
A producer is an insurance company that provides insurance policies directly,flat an insurance agent.
t For Prime or Sub-Contractor companies insured through the voluntary market,this Affidavit must be completed by the insurer or an authorized �
agent of the insurer.
I if the Prime or Sub-Contractor is insured through the involuntary insurance market,a pool,such as the Worker's Compensation Inspection and
Rating Bureau,or is otherwise insured they may provide a Certificate of insurance and this Affidavit Mi ich may be signed by an authorized 1
signatory(company officer)of the Prime or the Sub-Contractor,
Effective 10-May-10
Il
1
f
CROWN Crown Castle
`,, CASTLE 3530 Toringdon Way,Suite 300
Charlotte,NC 28277
Crown Castle,does hereby authorize Metro PCS and its authorized contractorsAgents to act as"Applicant"in the processing of
all applications, permits, research and other related activities associated with the processing,planning,design review,permitting,
entitlement and construction of additional equipment, antennas and site improvements for the Crown Castle existing wireless
communications facility described as follows:
Customer Site Name: NG4649 Crown Castle Site ID 800530
Number:
Site Address: Atwood Dr., Crown Castle Site MA NORTHAMPTON 11 CAC
Northampton,MA 01063 Name: 800530
This authorization is fully contingent upon Metro PCS authorized contractors/agents'compliance with the following conditions:
1. Crown Castle must review the application prior to submittal. Crown Castle must be provided all applications,narratives,
drawings and attachments at least 72 hours in advance of their submittal to the locality. Use of email and electronic
attachments is encouraged A Crown Castle Zoning Subject Matter Expert (SUE) will review and provide written
comment tip the customer within 48 hours of receipt of a complete set of application materials. If Crown Castle indicates
that changes are required,submissions shall be altered in accordance with Grown Castle comments prior to submission to
the locality.Verification of corrections should also be accomplished via emails and attachments.
2. In no event may Metro PCS encourage, suggest,participate in,or permit the imposition of any restrictions or additional
obligations whatsoever on the tower site or Crown Castle's current or future use or ability to license space at the tower site
as part of or in exchange for obtaining any approval,permit,exception or variance.
3. A copy of the final permit and/or a written summary of the zoning/entitlement decision rendered by the locality and anylall
conditions placed on that decision shall be communicated in detail to Crown Castle well within the appeal period provided
by the locality(typically 10-15 days).
4. All conditions of approval pertinent to the construction of the proposed project must be included in the construction
drawings for the project. The conditions of approval pertinent to the construction of the project shall be copied verbatim
from the zoning permit approval language, and shall be present in the drawings prior to submission for building permits
and contractor bidding. Crown Castle shall verify the inclusion of appropriate conditions of approval in the construction
drawing redline process.
5. Crown Castle will provide a Notice To Proceed(NTP) to construction to the customer upon receipt of the final approved
zoning permit and the approved Building Permit.
By Crown Castle:
Signature: _
Printed e: .Graham
Title: Real Estate Specialist
Date: January 20,2015
The Foundation for a Wireless World.
CrownCastle.com
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR,110.11) —1 1
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize___... ...... ------- Ito
act on my behalf,in all matters relative to work authorized by this building permit application.
Si Lure of Own eir' -Oate
Jerry Feathers 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.
Jerry Feathers
------ -----
Print Name
giKature of Own Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Kenneth Zink !CS-108036
Name of License Holder:
License Number
7 Johnson Rd.,Arlington, MA 02474 11/29/2017
Address Expiration Date
'(339)502-5000
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§25C(6)) T
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
Versionl.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 T14AN 35,Q90 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑_ -----------__...__—._,
Name(Registrant):
i - - ---- -- Registration Number
? ----- - - ..........
Address
Expiration Date
Signature Telephone
9.2 Registered Proisssional En inee s :
;Tectonic ciVtl
Name _ Area of Responsibility
1279 Route 300,Newburgh,NY 12550 131193
Address Registration Number
;(845) 567-6656
Signature Telephone Expiration Date
Aero Solutions I structural
__...... -.---
Name Area of Responsibility
5500 Flatiron Pky.,#100,Boulder,CO 80301 .50725
Address Registration Number
720 381-2843
Signature Telephone Expiration Date
Name I Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
___....._ . ...........
Address Registration Number
Signature Telephone I Expiration Date
9.3 General Contractor
;Timberline Construction Corporation Not Applicable
Company Name:
Kenneth Zink
Responsible In Charge of Construction
300 Pine Street,Canton,MA 02021
Address
(339)502-5000
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
B. 'NoRTHAWTop(ZONING I
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
'194756
Frontage
Setbacks Front
Side L:= R:= L:=,R:=
Rear
Building Height
..........
Bldg.Square Footage %
----------
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) -- -----
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON7 KNOW 0 YES 0
IF YES: enter Book Page and/or Document#�
B. Does the site contain a brook, body of water or wetlands? NO O DON-r KNOW 0 YES
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES (D NO 0
IF YES,describe size, type and location: emergency contact info
D. Are there any proposed changes to or additions of signs intended for the property? YES C NO e
IF YES, describe size, type and location:
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 0 NO @
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ _ _�-
Brief Description ;Remove existing antennas and replace with 6 new antennas.Add l line of fiber to the new antennas.
Of Proposed Work: Install raised platform for new cabinet.No increase to height of the tower or expansion of the compound.
SECTION 3-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A4 ❑ A-5 ❑ 18 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility Specify: !
❑ existincommunications facility _ .......___.____.A
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: U _..... __.} Proposed Use Group: 'TJ
Existing Hazard Index 780 CMR 34): _____—____—: Proposed Hazard index 780 CMR 34): _.-_....__..._..___._____
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st
1st _
2nd
2nd _.-
3rd
3fd
4t 4h th
Total Area(sf) Total Proposed New Construction(sf)
Total Height(R)
Total Height it
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zoned Municipal ❑ On site disposal system❑
Versionl.7 Commercial Bulldin Permit hda IS 2000
Department use only
City of Northampton status of Permit.
Building Department Curb Cuoriaeway Permit
JuL 2 4 212 Main Street Sewer/S®ptic AvaBability
ecl�ons Room 100 WaterWell Avallability
ois opo N rthampton, MA 01060 Two Sets of Structural Plaits
,�orir::rr one 413-587-1240 Fax 413-587-1272 PIodallePlana
Omer S*lly
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY 13UILDING
OTHER THAN A ONE OR TWO FAFMLY DWELLING
SECTION 1-SITE INF'ORMABON
1.1 Property Addnass; This section to be completed by office
22 Atwood Drive Map 39-060 Lot 001 Unit
Zone Overlay District
Elm St District co otoll t
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 owner of Record:
Oxbow Professional Park LLC 200 Silver Street,Suite 200,Agawam,MA 01001
Name(Print) durrent Mailing Address:
Signature Telephone
2.2 Authorized Anent:
Jerry Feathers 3530 Toringdon Way#300,Charlotte,NC 28277
Name(Print) Current Malang Address:
(704)405-6549
Signature Telephone
S,FrCTlON 3-E3TSIIIAT'ED CONSTRUCTION C08T8
Kern Estimated Cost(Dollars)to be Official Use Only
completed by erm3 applicant .
1. Building $15,000:00 (a)Building Permit Fee
2. Electrical $0.Q0 (b)Estimated Total Cost of
Ccnstrudlon from
& Plumbing $0.00 Building Permit Fee
4. Mechanical(IaVAC) $0.00
5.Fire Protection
8. Total=(1+2+3+4+8) 115,000 Chock Number
This Section For Official Use Only
Building Permit Number Date
Isstsad
Signature:
Building Commissionerlin etor of Brdldings Deta
22 ATWOOD DR BP-2015-0751
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39-060 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateizory: ANTENNAS BUILDING PERMIT
Permit# BP-2015-0751
Project# JS-2015-001456
Est. Cost: $15000.00
Fee: $155.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIMBERLINE CONSTRUCTION CORP 108036
Lot Size(sq. ft.): 194756.76 Owner: Oxbow Professional Park LLC
Zoning: Applicant: CROWN CASTLE
AT. 22 ATWOOD DR
Applicant Address: Phone: Insurance:
3530 TORINGDON WAY SUITE 300 (704)405-6549 WC
CHARLOTTENC28277 ISSUED ON:113012015 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE 6 ANTENNAS & EQUIPMENT - T
MOBILE
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 1/30/2015 0:00:00 $155.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner