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11-002 SPM0055B Complete BP App. Package 12.05.2011erSlOn .ommercra Ul mg errm ay , Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 WaterlWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING v .17C ·IB ·ld·P ·tM 152000 SECTION 1 • SITE INFORMATION I 1.1 Property Address:This section to be completed by office Off Haydenville Road Map 11-002 Lot 001 Unit at the proposed tower at the Smith Vocational &Zone SR Overlay DistrictAgriculturalHS forest Elm St District CB District SECTION 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record: City of Northampton -Smith Vocational School 80 Locust st.Northampton, MA 01060 Name (Print)Current MailingAddress: (413) 587-1265 Signature Telephone 2.2 Authorized Agent: Michael E.Johnsen for MetroPCS Massachusetts 36 Prospect St.,Reading, MA 01867 Name (Print)CurrentMailingAddress: Signature~U/"~.-,,~()K/A.I (914) 260-5203 ./v~.....-=Telephone v ISECTION 3 • ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1.Building $20,000.00 (a) Building Permit Fee 2.Electrical $15,000.00 (b) Estimated Total Cost of Construction from (6) 3.Plumbing Building Permit Fee 4.Mechanical (HVAC) 5.Fire Protection .. S~~5InlDliQ')Check Number6. Total =(1 + 2 + 3 + 4 + 5) This Section For Official Use Onlv Building Permit Number Date Issued Signature: BuildingCommissionerllnspectorof Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE " Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other 0 '"-,~-"'-----------,',-.---."---"----" Brief Description Applicant proposes to mount MetroPCS antennas at the 176'AGL mark of the proposed tower by Of Proposed Work: others. Related equipment proposed to be mounted on a 9' X 16'concrete pad within fenced compound. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE I - USE GROUP (Check as applicable)o 5A 0 58 0 A Assembly 0 B Business 0 E Educational 0 F Factory 0 H High Hazard 0 I Institutional 0 M Mercantile 0 R Residential 0 S Storage 0 U Utility [2] M Mixed Use 0 S Special Use 0 A-1 0 A-2 0 A-4 0 A-5 0 F-1 1-1 R-1 S-1 A-3 o F-2 o CONSTRUCTION TYPE 1A 0 18 0 2A 0 2B I 0 2C 0 o 3A 0 3B 0oo1-3 4 0o -._,--,._-"._-----,,---.-,---',-,'- Existing Use Group: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE ---" Existing Hazard Index 780 CMR 34): 1-2 o o R-3R-2oS-2 o ---,------------ Specify: Place telecom antennas on JO\yerand"re1ated equip~~l!t at toW~t.bE-s~a Specify:, -.------'---------Specify: Proposed Use Group:" _ _ SECTION 6 BUILDING HEIGHT AND AREA I Proposed Hazard Index 780 CMR 34): BUILDING AREA EXISTING Floor Area per Floor (sf) 1st - 2nd "---..-3rd ,'-..""4th Total Area (sf) Total Height (ft) 7. Water Supply (M.G.L. c. 40,§54) Public 0 Private 0 PROPOSED NEW CONSTRUCTION Total Proposed New Construction (sf) Total Height ft 7.1 Flood Zone Information: Zone .Outside Flood Zone0 144 176 OFFICE USE ONLY 7.3 Sewage Disposal System: Municipal 0 On site disposal system 0 , 8.NORTHAMPTON ZONING I Existing Proposed Requiredby Zoning This column to be filled in by Building Department -Nib -.-..--Lot Size .,--.._._------.-'._-.--.--. N/A -..-Frontage - ----..---_.,.--~.-...-.-- Setbacks Front 1166 L:343 -Side L:R:R:-------- Rear 1421 Building Height N/A N/A N/A Bldg. SquareFootage N/e,.N/A %99.1 .-- OpenSpaceFootage -%... (Lot area minus bldg &paved -parking) #of Parking Spaces N/A 0 Fill:.. (volume &Location)...--..-..-..--- Version17 Commercial Building Permit May 15 2000 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'TKNOW 0 YES (!) IF YES, date issued:09/13/2011 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'TKNOW 0 YES IF YES: enter Book 10676 Page (!) 338 and/ or Document #2011 00020414 B. Does the site contain a brook, body of water or wetlands? NO 0 DON'TKNOW 0 YES @ IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained o Obtained , Date Issued:0912012011 C.Do any signs exist on the property? YES o NO ® IF YES,describe size, type and location: D.Are there any proposed changes to or additions of signs intended for the property? YES (!)NO 0 IF YES,describe size, type and location:Smallsignwit~!'1etroPCS~f~prop?_se~forfe_nc~~.. E. Will the constructionactivitydisturb(clearing,grading,excavation,or filling) over 1acre or is it partof a commonplan that will disturbover 1 acre? YES ®NO 0 IFYES,then a NorthamptonStormWater ManagementPermitfromthe DPWis required. Version1.7 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 j\pE)l~ble 0 --"---~~.<---..,~~,,~~--...--.._.---.---- <_~a~e:J!3..egi~tran2.:-------_..-.-.----.-.--<-_.--------Registrati~n Numb:r ______--.---......._-_..---~----------------------_.---------- Address -------.-~ Expiration Date-Signature Telephone 9.2 Registered Professional Engineer(s): ---------.------See Separate Page Attached with Original Signature and Date ---_.--...__.-..--_.-...----"-.---..--------...".,----._-.-----..- Name Area of Responsibility..--~-.~-.--.-~~..-~~------~~--.~,--'.----J --.~~..-~~"----.. ----..-.-.--_.-------..-.--...-- Address Registration Number'----,---.. ----- Signature Telephone Expiration Date---'-..-------.-.. --_.-----_.----------.-.-. Name Area of Responsibility--•.-----~-- ..-...-.__.-----.--------~--,.------_.-...------I Address R~gigr.~l2.n Number _._.".---__ r ____ • __• __-..~---- I .......--......~.---.-.----.•. Signature Telephone Expiration Date------._-..--..------------------- ----.-------.------- Name Area of Responsibility---,,'---- -..,-----i Address Registration Number---~----- ------ ----... Signature Telephone Expiration Date ..--...~--...._'--'->'--~--'--......-~~---~~-----,.....,~~.~~,.•..-..-.....-.•~----~--~,-...---.---......,..-.,~-~~~- .,.-----------.-~--- Name Area of Responsibility---_.-~-~-,~~-'-'-----~---~- ._------------~----------.----.---- Address Registration Number-------'--- ..-------Signature Telephone Expiration Date 9.3 General Contractor rEa~i;~Comm~~i;ati~~s,i~~:'~35 Br~di~y-Dr.,Westbro~k,ME,-04092 --J Not Applicable 0•••• y~.'.-._".-""._•••.•"'_.__._..••.•••__,•..-,..",."-..,.,,....__-",~.""~ ___.<> _ ..,•• ______ ~__·A_~'·~ .~ .~~mpa.!2Y_~ame:~--~-----_._.- -..---~Micha~lD.Hel:lth -------------._-._------- Responsible In Charge of Construction .-.-----..-------.-----72 Foreside Road,Falmouth,ME 04105 --------.------------- Address.;oaJ·~l:J..--c}n.ldv<£(207) 283-~499 Signature Telephone 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: I I Not Applicable 0I IName(Registrant):I I Registration NumberI IAddressIIExpiration Date Signature Telephone 9.2 Registered Professional Engineer(s): IJesse Moreno,PE (ProTerra Design Group, LLC)I lentire project I Name Area of Responsibility r1 Short Streetj'S;)Northampton,MA 01060 I r+~ I 147315 ! A~V~Registration Number k413) 320-4918 I 106/3012012 I ~ignature /Telephone Expiration Date,-I I I Name Area of ResponsibilityIII I Address Registration NumberIII I Signature Telephone Expiration Date I I I I Name Area of ResponsibilityIII I Address Registration NumberiII I Signature Telephone Expiration Date I I I I Name Area of Responsibility I I I I Address Registration NumberI!I I Signature Telephone Expiration Date 9.3 General Contractor !I Not Applicable D Company Name:I I Responsible In Charge of Construction I I Address I I Signature Telephone c 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 0 No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT hereby authorize Eastern Communications, Inc.to I,Smith Vocational and Agricultural High School ,as Owner of the subject property act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I,_E_a_s_t_ern__C_o_ill_ill,,-U..:;cill=_·;....c_a_ti_o_n_s_,In_c..;:..__ --'----"_---"-----:_-=--_-"-,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. Michael D.Heath PrintOin~P1 Signature of Owner/Agent ~ f~/°;?-JlI Date SECTION 12 - CONSTRUCTION SERVICES Signature Telephone Not Applicable 0 79697 10.1 Licensed Construction Supervisor: Name of License Holder :_M_i--,-ch_ae_I_D_._H_e_a_t_h_==---=--=:=-~=- ___'__'_'___" License Number--72 Foreside Road, Falmouth, ME 04105 02/20/2013 Address Expiration Date (207)283-4499 SECTION 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c.152,§25C(6)) Signed Affidavit Attached Yes (!)No 0 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. »:».iVIassachusetts - Department of Puhlic Safety Bnard of Building Regulations and Standards Construction Supervisor License License: CS 79697 MICHAEL 0 HEATH 72 FORESIDE ROAD FALMOUTH, ME 04105 ('ummissimwl' Expiration:2/20/2013 Tr#:11126 t~.;{lI .~,~:•..~,The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorslElectricianslPlumbers Applicant Information Please Print Legibly Name (Business/OrganizationiIndividual):frBa\\C.D\'\\~\0 o,-\-"C'(\":J 1\0(,". Address;.~~n(C~\e.>J \)~\\tf",~Q \I City/State/Zip:\!\!E:;S«'<X<lr',¥-Hn\f\f,OLt()Ci2..Phone#:261 --:z..'O~-'~•....\,~q A~l you an employer? Check the appropriate box: 1."f I am an employer with ?;?O 4.0 I am a general contractor and I employees (full and/or part time).*have hired the sub-contractors 2.0 I am a sole proprietor or partner-listed on the attached sheet. ship and have no employees These sub-contractors have working for me in any capacity.employees and have workers' [No workers' comp.insurance comp,insurance.t required]5.0 Weare a corporation and its 3.0 I am a homeowner doing all work officers have exercised their myself [No workers'comp,right of exemption perm MGL insurance required]t C.152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Type ofproject (required): 6.0 New construction 7.0 Remodeling 8.0 Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.~Other Q\\\')W ~\.X:.,-\'\0(\ "Any applicant that checks box #1 must also 1ill.out the section below showing their workers' compensation policy information. +Hemeowners who submit this affidavit indicating they are doing all work and tben hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the Dame of the sub-contractors and state whether or Dot those entities have employees.If the sub-contractors have employees, they must provide their workers' compo policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjoh site information. Insurance Company Name:2..\)(\c:::x-\P\N1E;(\('OO \QSI....)C ell' Policy #or Self-ins.Lie.#:WC:",--\?..'!:)'\\L'20 \Expiration Date:~,""21",,~,-,,,-\'2=-_ Job Site Address:0 .\:::\{)Vef'h.},\'R>'\2=('£)£\City/State/Zip:l.eec6 I W (\(')\OS3 Attach a copy ofthe workers' compensation policy declaration page (showing the policy number and expiration (date). Failure to secure coverage as required under Section 25a ofMGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA for coverage verification. epains and penalties of perjury that the information provided above is true and correct Date: Official use only Do not write in this area to be completed by city or town official City or Town:PermitJIicense #:_ Issuing Authority (circle one): I.Board of Heath 2. Building Department 3. City/rown Clerk 4.Electrical Inspector 5. Plumbing Inspector6.0ther _ Contact person:--'Phone #:_ ACORD®CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDNVYV) ~11/16/2011 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 ~~~~~CT Hope Cote Cross Insurance-Portland rA~gNJ'oExt. (207) 780-1677 I FAXiAlc Nol:(207)780-6377 2331 Congress Street ~~tJ~ss:hcote@crossagency.com PO Box 567 ~~g~g~~~10#~00504 7 0 Portland ME 04112 INSURER(S)AFFORDINGCOVERAGE NAIC# INSURED INSURI;RA :Peerless Insura.nce CO. INSURERB :Zurich American Ins Co Eastern Communications,Inc.INSURERC:35 Bradley Drive,Stop 1 INSURERD: INSURERE: Westbrook ME 04092 INSURERF: 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 ADDLSUBR 11':11'5%~l~g~6'6~LTR TYPEOFINSURANCE INSR WVD POLICYNUMBER LIMITS GENERALLIABILITY EACHOCCURRENCE $1,000,000~ ~~~~~~J?E~~:'E'?"nce)~COMMERCIALGENERALLIABILITY $100,000 A o CLAIMS-MADE[i]OCCUR X ~BP8568270 12/19/2010 2/19/2011 MEDEXP(Anyone person)$5,000~ PERSONAL&ADVINJURY $1,000,000~ ~GENERALAGGREGATE $3,000,000 GEN'l AGGREGATELIMITAPPLIESPER:PRODUCTS- COMP/OPAGG s 3,000,000I!xlPRO-nLOC $POLICY JECT AUTOMOBILELIABILITY COMBINEDSINGLELIMIT $1,000,000~(Eaaccident)X ANYAUTO~~A8395669 P.2/19/2010 BODILYINJURY(Perperson)$A ALL OWNEDAUTOS 12/19/2011~BODILYINJURY(Peraccident)$~SCHEDULEDAUTOS PROPERTYDAMAGE $HIREDAUTOS (Peraccident)~ NON-OWNEDAUTOS Medicalpayments $2,000XHiredAutoPhys.Dam.$50,000 Limit 250/500 ded FOmp &co11 Underinsuredmotorist $Included X UMBRELLALIAB P1 OCCUR EACHOCCURRENCE $5,000,000~ EXCESSLIAB CLAIMS-MADE AGGREGATE s 5,000,000t--x DEDUCTIBLE $ A RETENTION $10 000 CU8561771 12/19/2010 P.2/1912011 $ B WORKERSCOMPENSATION X I T";'!£$TfJg~I IOJ~-ANDEMPLOYERS'LIABILITY Y/N WC488712801 ~/5/2011 ~/5/20l2ANY PROPRIETOR/PARTNER/EXECUTIVI;D E.l. EACHACCIDENT $1 000 000OFFICER/MEMBEREXCLUDED?N/A(Mandatory in NH)E.L.DISEASE- EAEMPLOYEE$1 000 000g~s'MF~-¥r~N'b~OPERATIONSbelow E.l. DISEASE- POLICYLIMIT $1 obo 000 A Leased/Rented Equipment IM8618660 12/19/2010 P.2/19/2011 SpecialForm $350,000 Installation Floater $1,000 Deductible $300,000 DESCRIPTIONOFOPERATIONSI LOCATIONSI VEHICLES (Attach ACORD101,Additional RemarksSchedule,if more spaceis required] RE:site#MA5025, NORTHAMPTON_Refer to policy for exclusionary endorsements and special provisions.Certificate Holder, GTP 238 Littleton Road Westford, MA 01886, New Cingular Wireless PCS550 Cochituate Road Framingham, MA 01701 Smith Vocational and Agricultural High School,and 80 Locust Street Northampton, MA 01060 are Additional Insureds with respect to Commercial General Liability only. ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.MetroPCS 285 Billerica Road Chelmsford,MA 01824 AUTHORIZEDREPRESENTATIVE Hope Cote/HAC ~·G+e- COVERAGES CERTIFICATE NUMBER'CL1 012 63 9633 CERTIFICATE HOLDER REVISION NUMBER' CANCELLATION ACORD 25 (2009/09) INS025 (200909) ©1988·2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C!rity of Nort1rnmvton L~~~~ck Building Commissioner DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street. Municipal Building Northampton,MA 01060 Fax:413-587-1272 Phone:413-587-1240 Chuck Miller Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title:GTP Northampton (SPMOOSSB)Date:October 27, 2011 Project Location:Off Haydenville Road Map:-1LParcel:~Zone:~ Installation of MetroPCS equipment on a telecommunications Scope of Project:facility to be constructed by GlobaJ Tower Assets, LLC In accordance with the sixth edition Massachusetts State Building Code,780 CMR Section 116,0: I,Jesse Moreno, PE Mass. Registration #_-.:4:=....!...7"""3..=1",,,S,--_ 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: [xl 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 oicial a final report as to the satisfactory completion and readiness of the project for occupancy. Signa ur a d Seal of Registered Professional _~.,<+- __,20--U (seal) CERTIFICATE HOLDER ©1988-2009 ACORD CORPORATION.All rights reserved.ACORD 25 (2009/09) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACHOCCURRENCE $ MED EXP(Any oneperson)$ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTION DEDUCTIBLE CLAIMS-MADE OCCUR $ $ AGGREGATE $ EACHOCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident)$ $ $ $ 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. INSRADDL WVDSUBR N / A $ $ 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). The ACORD name and logo are registeredmarks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER PRODUCERCUSTOMER ID #: ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDINGCOVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025(200909) 11/16/2011 Cross Insurance-Portland 2331 Congress Street PO Box 567 Portland ME 04112 Hope Cote (207)780-1677 (207)780-6377 hcote@crossagency.com 00050470 Eastern Communications, Inc. 35 Bradley Drive, Stop 1 Westbrook ME 04092 Peerless Insurance Co. Zurich American Ins Co CL1012639633 A X X X X CBP8568270 12/19/2010 12/19/2011 1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000 A X X Hired Auto Phys. Dam. BA8395669 12/19/2010 12/19/2011 $50,000 Limit 250/500 ded comp &coll 1,000,000 Medical payments 2,000 Underinsured motorist Included A X X X 10,000 CU8561771 12/19/2010 12/19/2011 5,000,000 5,000,000 B WC488712801 4/5/2011 4/5/2012 X 1,000,000 1,000,000 1,000,000 A Leased/Rented Equipment IM8618660 12/19/2010 12/19/2011 Special Form $350,000 Installation Floater $1,000 Deductible $300,000 RE: site#MA5025, NORTHAMPTON.Refer to policy for exclusionary endorsements and special provisions. Certificate Holder, GTP 238 Littleton Road Westford, MA 01886, New Cingular Wireless PCS550 Cochituate Road Framingham, MA 01701 Smith Vocational and Agricultural High School, and 80 Locust Street Northampton, MA 01060 are Additional Insureds with respect to Commercial General Liability only. Hope Cote/HAC MetroPCS 285 Billerica Road Chelmsford, MA 01824 October13 2011 HeatherCastagaro GlobalTowerAssets LLC 238LittletonRoad Suite205B WestfordMA 01886 RE OrderofConditions DEP 246656 HaydenvilleRoadCellTower ParcelID11002 DearHeather EnclosedpleasefindtheoriginalsignedOrderofConditionsfortheabovereferencedproject ThisOrderhasbeenrecordedintheHampshireCountyRegistryofDeeds andfiledwiththeDepartment ofEnvironmentalProtectionasrequired Thetenbusinessdaylegalappealperiodfromthedateofissuancehasexpired sotheprojectmaybeginat anytimeoncepre constructionconditionsaremet Pleasereadthedocumentcarefully asitcontainsconditionsthatmustbeadheredtobefore during and afterworkontheproject Pleasefeelfreetocontactmewithanyquestionsorconcerns Thankyou SarahLaValley Conservation PreservationandLandUsePlanner Ccviaemail JesseMoreno ProterraDesignGroup JohnKelly SVAHS