31B-193 (16) 123 ELM ST BP-2020-0528
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3 1 B- 193 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ANTENNAS BUILDING PERMIT
Permit# BP-2020-0528
Proiect# JS-2020-000833
Est.Cost: $60000.00
Fee: $420.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ERIC KUKLINSKI 97447
Lot Size(sa.ft.): 45302.40 Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: EU(100)/URC(100)/ Applicant: ERIC KUKLINSKI
AT. 123 ELM ST
Applicant Address: Phone: Insurance:
1086 MAIN ST (972) 583-0000 WC
WAREHAMMA02576 ISSUED ON.10/25/2019 0:00.00
TO PERFORM THE FOLLOWING WORK.-MODIFY EXISTING ANTENNA FACILITY IN
STEEPLE
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 Siynaturc:
FeeType: Date Paid: Amount:
Building 10/25/2019 0:00:00 $420.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
h 7
Version 1.7 Commercial Building Permit May 15,2000
Department use only
CE�VE " of Northampton Status of Permit:
=25
Bui ding Department Curb Cut/Driveway Permit
12 Main Street Sewer/Septic Availability
OCT - Room 100 Water/Well Availability
Nort ampton, MA 01060 Two Sets of Structural Plans
13- 7-1240 Fax 413-587-1272 Plot/Site Plans
DOF SUILDING INSPECTIONS Other Specify
^�THAMOTON MA n oro
APPLICATION TO CON EPAIR, 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 ELM STREET Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
SMITH COLLEGE AMERICAN TOWER(FACILITY MANAGER)
Name(Print) Current Mailing Address:
ut)k
Signature Telephone
2.2 Authorized Agent:
MARK ROBERTS PO BOX 916, STORRS, CT 06268
Name(Print) Current Mailing Address:
1(860) 670-9068
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $60,000.00 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) '" � �
5. Fire Protection
6. Total =(1 +2 + 3+4+ 5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of 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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description MODIFY EXISTING AT&T ANTENNA FACILITY IN STEEPLE: REMOVE & REPLACE
Of Proposed Work: (3) ANTENNAS; REMOVE& REPLACE (9) REMOTE RADIO UNITS (RRU)
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 113 ❑
B Business ❑ 2A ❑
E Educational ❑ 213 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:
TELECOM 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
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
15t
1 St
2nd 2nd
3rd aro
4th
Total Area (sf) �— Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: F7.73Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[:]
Version 1.7 Commercial Building Permit May 1 000
8. NORTHAMPTON ZONING (LI
Existing Propose qutred by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
.
Setbacks Front
Side L: R:0 L:t-- R: 0
Rear ! 0
Building Height
Bldg. Square Footage %
Open Space Footage % C
(Lot area minus bldg&paved
Arkin
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW Q YES
IF YES, date issued: 177
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES
IF YES: enter Book Page E and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW o YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ® , Date Issued:
C. Do any signs exist on the property? YES ® NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
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 ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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 THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
JAMES P. STROKE
Name Area of Responsibility
23 MIDSTATE DR. #210, AUBURN, MA 01501 20068
Address Registration Number
(508) 981-9590
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
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
ERICSSON INC Not Applicable ❑
Company Name:
ERIC KUKLINSKI
Responsible In Charge of Construction
6300 LEGACY DRIVE, PLANO, TX 75024
Address
Signature Telephone
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 O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
MARK ROBERTS
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.
MARK ROBERTS
Print Name K � S�
t0 ?l f 2
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ERIC KUKLINSKI CS-097447
License Number
1089 MAIN STREET, WAREHAM, MA 02576 08/19/2021
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 0 No 0
Vertical Resources Group, Inc.
July 8, 2019
Stephanie Wenderoth
Site Acquisition
SAI Communications
12 Industrial Way
Salem, NH 03079
SUBJECT: LTE4C5C Upgrade Opinion Letter
Existing +136'-0" Tall Smith College Hellen Hills Chapel
Site ID: MA4106 Northampton— Helen Hills Chapel
123 Elm Street, Northampton, MA 01660
Our File: MA4106-LTE4C5C
The following is to confirm we have reviewed aforementioned church steeple for the proposed
replacement of existing LTE700bc(3)Ericsson KRC118048/1 (97"x12"x8", 121 Lbs))ppanels for new(3)Kathrein 80010965
(78.7"x20"x6.9", 108Lbs), replace (6) RIRUS-12, (3) RRUS-11 radios, for new (3) RRT4449, (3) RRUS-4415, (3) RRUS-
8843 radios all on existing wallI mounted unistruts.
Reference Documents: -AT&T Structural Analysis Guidelines G Codes R-61 dated March 11 2015
-AT&T RF Design Data Sheet for MA4106 dated 03-05-2019
-Previous analysis by Proterra project MA4106 dated 06-27-2013
Code: Massachusetts Building Code 9`h Editions, I.B.C. 2015, ASCE7-12, EIA-222-G
Risk Cate Category: II Ex osure Cate o : 'B' Topographic Cate o 1
Wind Speed: 117 Mph MA B.C. 91h ultimate gust), 91 Mph (nominal 3 sec gust IBG 1609.3.1) 90Mph (EIA-
222-G),3 sec.Gust Speed
Ice: 1" o radial Snow:Pc=ground snow load = 40 Psf(MA B.C.9T"Ed)
Load Combination: 1.2D+1.ODc+ 1.6Wo 1.2D+1.ODc+1.OD +1.OW;
Steeple Existing & Proposed Loading (appurtenances): install height of antennas±74', RRU's ±66'
2019 LTE4C5C upgrade Loading CaAa CaAa
(e-3)Quintel QS665122 8.1 Ft2 (e-3)Ericsson RRUS-11 2.79 Ft2
(P-3)Kathrein 800-10965 13.8 Ft2 (e-3)Raycap DC6-48-60-18-8F 2.40 Ft2
(P-3)Ericsson RRUS-441500 1.85 R2 (P-3)Raycap DC6-48.60-0-8F 1.40 Ft2
(P-3)Ericsson RRUS-8843b2b66 1.66 R2 (P-3)Ericsson RRUS-4449002 1.0 R2
TOTAL 105 Ftp
To be removed(e-3)Ericsson KRC11804811 11.5 Ft2, (e-6)RRUS-12 3.15 Ft2,(e-3)RRUS-12 2.79 Ft2
Considering existing AT&T antenna supports have been installed per MA4106 VRG construction
drawings issued 'LTE4C5C' dated 07-03-2019, the existing antenna/RRU support frames are capable of
supporting the proposed and existing antenna loading in conformance with the requirements of the
Massachusetts Building Code, ASCE 7 for a nominal reference wind velocity of 91 mph (3 sec.Gust Speed,
nominal IBC 1609.3.1) and Vo radial ice.
Analysis results stemming from worst case scenarios for bare wind and iced loading for AT&T's
replacement of (3 Ericsson KRC118048/1, (3) RRUS-11, (6) RRUS-12 radios, for new (3) Kathrein 80010965, (3)
RRUS-4449,(3)RRUS-4415,(3)RRUS-8843 radios, with associated DC &fiber cables generate stresses which
remain within the allotted capacities in accordance with Connecticut Building Code, ASCE 7 Minimum
Design Loads for Buildings and other Structures.
Based on these results, we can confirm that the present ±136'-0" tall church steeple and associated
AT&T Mobility mounts can accommodate AT&T existing & proposed loads outlined above in
appurtenance loading, in apparent agreement with the Massachusetts Building Code, EIA-222-G with
respect to individual member capacities.
We trust the analysis and recommendations presented in this report will meet your requirements.
However, please do not hesitate to contact us if you have any queries, or require any further information
regarding this study. &AAA
1�
Yours very truly, '.2 S��i�
No.2ooee
Miguel Nobre,P.E.
►r
Yertical Resources Group,Inc.
489 Washington Street-Auburn,MA 015M
P 508-981-9590 F. 508-519-8939
CERTIFICATE OF LIABILITY INSURANCE DAO/23/2019D(YYrY)
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 have ADDITIONAL INSURED provisions or 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
Marsh USA,Inc. NAME:
4400 Comerica Bank Tower PHONE =All.No):
1717 Main Street EMAIL
Dallas,TX 75201-7357 ADDRESS:
Attn:dallas.certs@marsh.com 212-948-05191866-966-4664 INSURERS AFFORDING COVERAGE NAIL#
06925-GAWX-PPol-19-20 ORG INSURER A:ACE American Insurance Company 22667
INSURED Ericsson Inc. INSURERS:ACE Property&Casualty Insurance Company 20699
Attn:Jackclueline Madrid INSURER C:ACE Fire Underwriters Insurance Company 20702
6300 Legacy Drive
INSURER D
Plano,TX 75024
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: HOU-003572438-01 REVISION NUMBER: 4
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 TYPE OF INSURANCE ADDL SUBR _ POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MWDD/YYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY HDOG71238374 05/0112019 05/01/2020 EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 1,000,000
_ MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X J POLICY L__]JET F-1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $
ISA H25294877 05/01/2019 05/01/2020 COMBINED SINGLE LIMIT $ 1,000,000
A AUTOMOSILELJABILRY Ea accident
X1ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
$
X UMBRELLA LIAB X OCCUR XOO G27975422 004 05/01/2019 05/01/2020 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED I RETENTION $
A WORKERS COMPENSATION WLR 065891323(ADS) MTfMTT--05/01/2020 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
C Y/N SCF 065891360(WI) 05/01/2019 05I01I2020 1 ppp Opo
ANYPROPRIETOR/PARTNER/EXECUTIVE __1 N/A E.L.EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
ReProject Name/Contract Number.T4.0
CERTIFICATE HOLDER CANCELLATION
City of Northhampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
212 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Northampton,MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee Mau�� C`nv�u
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
'\ The Colnnio»tvealth of Massachusetts
Department of Industrial Accidents
a
1 Congress Street,Suite 100
Boston,MA 02114-2017
1v1v►v.n1ass.g0v/iia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE PILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (BosinesstOrgatnization/Ittdivialtttal).Ericsson Inc. et al.
Address:6300 Legacy Drive
City/State/Zip:Plano, TX 75024 Phonc #:972-583-0000
Are you an employer?Check the appropriate box: Type of project(required):
I. 1 am a employer with 6042 employees(full and/or part-time).'
❑ 7. E] New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in R. ❑ Remodeling
any capacity.(No workers'comp.insurance required.]
9. El Demolition
3.a t am a homeowner doing all work myself.[No workers'comp.insurance required.]f
10E] Building addition
4.❑I am a homeowner and will be;hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.Q f lambing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.:
13.F]Roof repairs
G.❑We are a corporation and its officers have exercised their right of excnyriion per MGL c. 14. Other_
152,?;1(4),and we have no employees.[No workers'ecnnp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t t lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
-Contractors that check this box must attached an additional sheet showing lite name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lain as employer flint i.c proriding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:ACE American Insurance Company
Policy#or Self-ins.Lic.#:WLR C65891323 (AOS) Expiration Date:05-01-2020
Job Site Address:All Ericsson Job Sites City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 up to$250.00 a
day against the vilator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verifica on.
I do herehp eertffyy ii(lei,HV pains enalliiee/o!f petIr at lite information provided abo► is true ud correct.
Si nature,
-r=-�V" 11G Date:
Phonc#: (214) 620-5132
Official rise only. Do nor write iii this urea,to be completed by city a-lowrt ojjic•itlt
City or-Town: Permit/License#
Issuing Authority(circle one):
1. Board of Flealth 2. Building Department 3.City/Town Cleric 4.Electrical Inspector S. Plumbing Inspector
G.Other
Contact Person: Phone#: _
Co vT%on earth of Massae uwtts
Drvis#on of Professoon l L censwe
Board of Building Regulations and Stance
Cons '
tea:
-.:)97447 =" ` U p ares S(2W
ERIC A KUKI.HVSKIlid i -
108S to Al N ST
VWAAEHAM NSA 02576
r ommissioner
File#1 MP-2020-0021
APPLICANT/CONTACT PERSON AT&T a /�
ADDRESS/PHONE (860)670-9068
PROPERTY LOCATION 123 ELM ST
MAP 31B PARCEL 193 001 ZONE E0000YURC000,�/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENC REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TypgofConstruction: ZPA-MODIFY EXISTING ANTENN ILITY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans'Plot Plan
THFN'r, . :OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ZINF n1AT10N PRESENTED:
Approved Additional permits required(see below)
I'LANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project:___ _Site Plan AND/OR _Special Permit with Site Plan
Major Project:___,__. ite 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
IO I
Sa ature of Building Oti
ficial Date.
Now: 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 the Office of
Planning&Development for more information.
AMERICAN TOWER`
C 0 i V 0 4 A T I p N
LETTER OF AUTHORIZATION
ATC SITE #/NAME: 319079/SMITH COLLEGE RT MA
SITE ADDRESS: 126 West Street, Northampton, MA 01060
LICENSEE: New Cingular Wireless PCS, LLC d/b/a AT&T Mobility
1, Margaret Robinson, Senior Counsel for American Tower*, owner of the tower facility
located at the address identified above (the "Tower Facility"), do hereby authorize New
Cingular Wireless PCS, LLC d/b/a AT&T Mobility, its successors and assigns, and/or its
agent, (collectively, the "Licensee") to act as American Tower's non-exclusive agent for
the sole purpose of filing and consummating any land-use or building permit
application(s) as may be required by the applicable permitting authorities for Licensee's
telecommunications' installation.
We understand that this application may be denied, modified or approved with
conditions. The above authorization is limited to the acceptance by Licensee only of
conditions related to Licensee's installation and any such conditions of approval or
modifications will be Licensee's sole responsibility.
Signature:
///X�
Print Name: Margaret Robinson
Senior Counsel
American Tower*
NOTARY BLOCK
Commonwealth of MASSACHUSETTS
County of Middlesex
This instrument was acknowledged before me by Margaret Robinson, Senior Counsel for American
Tower*, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person
whose name is subscribed to the within instrument and acknowledged to me that he executed the same.
WITNESS my hand and official seal.thisloZ-��day of S _ ' 2019.
NOTARY SEAL
0GERARD T.HEFFRON
NotaryPuboc Notary PubllExpiress�:
Commonwealth of Massachusetts My Commi _
W Comrnbslon Expires C
August 9,2024
*American Tower includes all affiliates and subsidiaries of American Cower Corporation.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work:
The debris will be transported by: S-i,.,� �;
The debris will be received by:
Building permit number:
Name of Permit Applicant
1 5
Date Signature of Permit Applicant