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37-077 (12) BP-2022-0752 790 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-077-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0752 PERMISSION IS HEREBY GRANTED TO: Project# ANTENNAS Contractor: License: Est. Cost: 75000 QUALTEK WIRELESS LLC CSL098919 Const.Class: Exp.Date:05/04/2026 CONTINENTAL CABLEVISION OF WESTERN NEW Use Group: Owner: ENGLAND INC Lot Size (sq.ft.) Zoning: SR/WSP Applicant: QUALTEK WIRELESS LLC Applicant Address Phone: Insurance: 1 150 FIRST AVE (484)804-4500 WC6-63 1-5 1 0650 KING OF PRUSSIA, PA 19406 ISSUED ON:06/30/2022 TO PERFORM THE FOLLO WING WORK: SWAP OUT ANTENNAS AND ADD 3 ANTENNAS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: � 1 O . 7'. . Fees Paid: $525.00 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner !_ . .1 .t • 7--e(4 File #BP-2022-0752 APPLICANT/CONTACT PERSON:QUALTEK WIRELESS LLC 1150 FIRST AVE KING OF PRUSSIA, PA 19406(484)804-4500 PROPERTY LOCATION 790 FLORENCE RD MAP:LOT 37-077-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Penni :4 out Fee Paid 525.00 Type o onstT(' : SWAP OUT ANTENNAS AND ADD 3 ANTENNAS New Cr : •c ion • Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan • THE FOLLO •ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: proved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan MajorProject: 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 Perm its Required: Curb Cut from DPW Water Availability Sewer Availability Septic ApprovalBoard 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 I� ;v0 i it /3CV? Situ/i ture of Building Official 11/ 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. RECEN, ' The Commonwealth of Massachusetts UN 2 3 2022 t.' ).1 7 Office of Public Safety and Inspections 1 Massachusetts State Building Code(780 CMR)DFPT pF N m r" Building Permit Application for any Building other than a One-or U"Family Dwelling (This Section For Official Use Only) Building Permit Number:??- 75Z Date Applied: Building Official: SECTION 1:LOCATION 790 Florence Rd. Northampton,MA 01060 Cell Tower No.and Street City/Town Zip Code Name of Building(if applicable) 37 077 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration [i0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other l Specify: Existing Cell Tower Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work: Swap out of antennas and associated equipment and add 3 antennas to AT&T's existing array at 146' SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Wireless Communications Facility Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) N/a Total Area(sq.ft.)and Total Height(ft) N/a SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational ❑ F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use N and please describe below: Special Use Description: Wireless Communications Facility/Cell Tower SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IB ® HA JIB 0 MA IIIB ❑ IV El VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debi s Removal: Public 0 Check if outside Flood Zone DiIndicate municipal 0 A trench will not be Licensed disposal Site 0 nvate 0 or indentify Zone: or on site system 0 required g7 or trench or spec& N�a N/a permit is enclosed 0 N/a-S ,enclosed Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission R. .iew Process: Not Applicable N Is Structure within airport approach area? Is their review com Meted? or Consent to Build enclosed 0 Yes 0 or No Yes 0 No $] SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: N/a Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Continental Cable,C/O America Tower Corp Woburn,MA 01801 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: American Tower Corp - - - - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: SAI Communications 12 Industrial Way Salem NH 03079 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Daniel Hamm 978 557 5553 dhamm®hudsondesigngroupllc.cem 40720 Name(Registrant) Te11eeph0n N9 e-mail address Registration Number 45 Beechwood Drive North lover MA 01845 Civil 6/30/2024 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Qualtek Wireless Company Name Geoffrey Forse CS-098919 Construction Supervisor-Unrestricted Name of Person Responsible for Construction License No. and Type if Applicable 10 Westcroft Rd Reading MA 01867 Street Address City/Town State Zip 978_ 437_ 0443 - - NEPermitting@qualtekwireless.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildii g permit. Is a signed Affidavit submitted with this application? Yes® No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$ 75000 1.Building $ 75000.00 Building Permit Fee=Total Construction C. 7 sert here 2.Electrical $ appropriate municipal fact. =$525.00 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northmapton 6.Total Cost $ 75000.00 (contact municipality)and write check number here 81 54 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Peter Marchant,SAI Comm 603 560 8068 6/22/22 Please print and sign name Tide Telephone No. Date 12 Industrial Way Salem NH 03079 pmarchant@saigrp.com Street Address City/Town State Zip Email Address I . ---2Lty_____ Municipal Inspector to fill out this section upon application approval: • w, J_ dp_ Name Date AMERICAN TOWER® CORPORATION LETTER OF AUTHORIZATION ATC SITE#/NAME/PROJECT: 209215/NORTHAMPTON 3/OAA775586 SITE ADDRESS: 790 FLORENCE RD FLORENCE,MA 01062 APN: NHAM M:0037 B LICENSEE: NEW CINGULAR WIRELESS PCS,LLC DBA AT&T MOBILITY I, Margaret Robinson, Vice President, UST Legal for American Tower*, owner/operator of the tower facility located at the address identified above (the "Tower Facility"), do hereby authorize NEW CINGULAR WIRELESS PCS, LLC DBA AT&T MOBILITY their successors and assigns, and/or their agent, (collectively, the "Licensee") to act as American Tower's non- exclusive agent for the sole purpose of filing and consummating any land-use, building, or electrical permit application(s) as may be required by the applicable permitting authorities for Licensee's telecommunications' installation on the Tower Facility. American Tower understands 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: Print Name: Margaret Robinson Vice President, UST Legal 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,this 13th day of June,2022 NOTARY SEAL MELISSA ANN METZLER Notary Public It V I)f Notary Public My Commission Expires:March 14,2025 Commonwealth of Massachusetts tt My Commission Expires Metih 11.2025 * American Tower is defined as American Tower Corporation and any of its affiliates or subsidiaries. 10 Presidential Way•Woburn,MA 01801 • 781.926.4500 Office• 781.926.4555 Fax •www.americantower.com Initial Construction Control Document I � To be submitted with the building permit application by a 1 Registered Design Professional jy for work per the 9th edition of the --tra , 7 Massachusetts State Building Code, 780 CMR, Section 107 Project Number:MA3833 Date:June 13,2022 Project Title: LTE 5G NR Upgrade Property Address: 790 Florence Road Northhampton,MA 01060 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: AT&T Wireless Telecommunications site installation.Remove(6)existing Antenna. Install(9) new Antenna and RRU on existing Monopole. I Daniel P.Hamm, MA Registration Number: 40720 Expiration date: 6/30/22,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection Electrical X Other Describe: Telecommunication Installs for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 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 if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document' SNUf10 Enter in the space to the right a"wet"or �i� s cy O 114,-,,electronic signature and seal: z1 D I p, , U 1' 14,14 7r 4 2 Phone number: (978)557-5553 s Hudson Design Group,LLC ' 'ONni. 45 Beechwood Drive -• North Andover,MA 01845 Email: info@hudsondesigngroupllc.com Building Official Use Only Building Official Name: Permit No.: Date: I • Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 01 01 2018 —.-.. . .,.,.wsvul►,muiuh uJ JI[uaauLRllaClla cilium\ Department of Industrial Accidents 5 i l Office of Investigations is '" `= ? Lafayette City Center Si‘ ..'t S= T" 2 Avenue de Lafayette, Boston,MA 02111-1750 444. www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lei iblh Name(Business/Organization/Individual):Qualtek Wireless LLC Address:1150 First Avenue, Suite 600 City/State/Zip:King of Prussia, PA 19406 Phone#:484-804-4500 Are you an employer?Check the appropriate box: Type of project(required): 1111 I am a employer with + 100 4. 0 I am a general contractor and I employees (Foil and/or part-time).' have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. 0 Demolition workingfor me in anycapacity. employees and have workers' p �' t 9. 0 Building addition [No workers' comp. insurance comp.insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 1 Z ®OtherW'reiess Site Development employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Arthur J Gallagher Management Service, Inc. Policy#or Self-ins.Lic.#:WC6-631-510650-011 Expiration Date:i 1/30/2022 Job Site Address:_^_, `_ 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 Section 25A of MGL c. 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p9,ins a d penalties of perjury that the information provided above is true and correct. � Signature: .1 ii� j Date: 11/22/2021 Phone#: 978-505-0224 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3LJCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.D0ther Contact Person: Phone#: Ar lit ACORCP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `..."--- 11/19/2021 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 NAME: Dales Braun Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 4000 Midlantic Dr, Suite 200 (A/C No,Ext: 856-675-1334 (Nc,No):856-482-1888 Mt. Laurel NJ 08054 E-MAIL ADDRESS: CherryHiILBSD.CertM@AJG.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:First Liberty Insurance Corporation 33588 INSURED QUALUSA-01 INSURER B:Liberty Mutual Fire Insurance Company 23035 QualTek Wireless LLC 475 Sentry Parkway E INSURER C:AXIS Insurance Company - 37273 Ste 200 INSURER D: Navigators Insurance Company - 42307 Blue Bell, PA 19422 INSURER E: Liberty Insurance Underwriters Inc 19917_ INSURER F: American Guarantee and Liability Ins Co 26247 COVERAGES CERTIFICATE NUMBER:1294065223 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 INSD WVD POLICY NUMBER I(MM/DD/YYYY) (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY TB2-631-510650-041 11/30/2021 11/30/2022 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR 1 DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X PECOT- X LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ B AUTOMOBILE LIABILITY AS2-631-510650-031 11/30/2021 11/30/2022 OMBINEDtSINGLE LIMIT $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURYaccident) AUTOS ONLY AUTOS (Per $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ $ Comp/Collision Ded $$1,000/1,000 C UMBRELLA LIAB X OCCUR P-001-000073672-04 11/30/2021 11/30/2022 EACH OCCURRENCE $30,000,000 D - NY21EXCZO3HAGIV 11/30/2021 11/30/2022 E X EXCESS LIAB CLAIMS-MADE 1000324565-04 11/30/2021 11/30/2022 AGGREGATE $30,000,000 F AEC 8761755-03 11/30/2021 11/30/2022 DED 1 RETENTION$ $ A WORKERS COMPENSATION WC6-631-510650-011 11/30/2021 11/30/2022 X AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER _ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 F Installation Floater 13 UUM BK0148 11/30/2021 11/30/2022 Limit 5,000,000 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Cyber Liability(Primary) Policy#CYB-1004358-02 Policy Period: 11/30/2021 -11/30/2022 Carrier:Hudson Excess Insurance Company Limit:$5,000,000 Cyber Liability(Excess) Policy#C-4LP8-001024-CEPMM-2021 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Coverage AUTHORIZED REPRESENTATIVE cf: EZ...) r! 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: QUALUSA-01 LOC#: AORO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J.Gallagher Risk Management Services,Inc. QualTek Wireless LLC 475 Sentry Parkway E POLICY NUMBER Ste 200 Blue Bell, PA 19422 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Policy Period: 11/30/2021 -11/30/2022 Carrier:Certain Underwriter at Lloyds Limit:$10MM x$5MM Property Policy Policy#13 UUM BK0148 Policy Period: 11/30/21 -11/30/22 Carrier:Hartford Fire Insurance Company Leased/Rented Equipment: Limit:$1,500,000 Deductible:$5,000 BPP Limit/Deductible:$4,740,000/$5,000 Professional Liab/E&O/Pollution Policy#0311-0596 Policy Period: 11/30/2021 -11/30/2022 Carrier:Allied World Assurance Company,Ltd Occurrence/Aggregate:$5MM/5MM Hartford Fire Insurance Company Inland Marine Policy Eff Date: 11/30/21 -Exp Date: 11/30/22 Policy#13 UUM BK0148 Installation Operations-LIMIT:$5,000,000/DEDUCTIBLE:$5,000 In Transit-LIMIT:$1,000,000/DEDUCTIBLE:$5,000 In Temporary Storage-LIMIT:$15,000,000/DEDUCTIBLE:$5,000 Evidence of Coverage • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Q,Y HAMpj.�. Massachusetts 4�,5.• 'cQ 5 •., DEPARTMENT OF BUILDING INSPECTIONS Dj a 212 Main Street • Municipal Building O\ •�\s�`r Northampton, MA 01060 'id`y"•• '10' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. See Enclosed The debris will be disposed of in: ERRCO - Epping NH Location of Facility: The debris will be transported by: Name of Hauler: Qualtek Signature of Applicant: Peter Merchant Date: 6/22/22 Waste disposal information for work completed in Massachusetts by Qua ITek Wireless LLC The New England office for QualTek Wireless LLC (QualTek Wireless) is located at 16 Esquire Road, Billerica, MA 01862. QualTek Wireless, via its parent company, Qualtek, Inc., holds a contract with Waste Management, Inc. (WMI) for construction debris disposal, recycling, and waste disposal. QualTek Wireless crews remove construction debris and trash from their work sites and upon return to the New England office, place the materials in WMI dumpsters located at the QualTek Wireless offices in Billerica, MA. Debris is then transported by WMI to this licensed solid waste disposal facility: Environmental Resource Return Corp. (ERRCO) 270 Exeter Road; Epping, NH 03042 (603) 679-2626 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Reggulations and Standards ('1i f' Consti; con S\rrvisor CS-098919 , spires:05/04/2026 GEOFFREY FORSE /r!. 10 WESCROWT RD READING M1 51867 � . Apo Commissioner d@ f. C7&n Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl NEPermitting@qualtekwireless.com (978) 437-0443 P. Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required kas 1 Architectural 2 Foundation 3 Structural• x 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Daniel Hamm 978 557 5553 dhamm®hudsondesigngroupllc.com 40720 Name(Registrant) Telephone No. e-mail address Registration Number 45 Beechwood Drive North Andover MA 01845 Civil 6/30/2024 Street Address City/Town State Zip Discipline Expiration Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expu,ition Date Please follow this link for construction control forms to be used by Registered Design Professionals. SLIM June 22,2022 City of Northampton Kevin Ross Building Commissioner's Office 212 Main Street Northampton,MA 01060 RE: AT&T's Proposed Antenna Upgrade at 790 Florence Rd.—Building Permit. Dear Mr. Ross: Attached please find AT&T's(the Applicant)Building Permit application for its proposed Personal Wireless Facility at 790 Florence Road. Please see enclosed plans depicting the applicants proposed install. The Applicant proposes to swap antennas and associated equipment as well as add three antennas at the existing AT&T array at an elevation of 146' existing cell tower. Tower height will not be affected,and no additional ground space will be required. I am enclosing a check in the amount of$525.00 for Permit Fee. Once reviewed/approved—could you please e-mail me a copy prior to mailing Pmarchantna,saigrp.com. Pease mail BP to: Peter Marchant SAI Communications 12 Industrial Way Salem, NH 03079 Thank you in advance, please feel free to call me with any questions (603-560-8068). Sincerely, Peter Marchant Agent for AT&T Pmarchant(a),siagrp.com • 12 Industrial Way, Salem, NH 03079 (603)421-0470 AMERICAN TOWERS CORPORATION This report was prepared for American Tower Corporation by TOWER ENGINEERING PROFESSIONALS Structural Analysis Report Structure : 150 ft Guyed Tower ATC Site Name Northampton 3,MA ATC Site Number : 209215 Engineering Number : OAA775586_C3_01 Proposed Carrier : AT&T MOBILITY Carver Site Name : CTI TOWERS Carrier Site Number : MA3833 Site Location : 790 Florence Road Northampton, MA 01062 42.3039, -72.6721 County : Hampshire Date : April 12, 2022 Max Usage : 72% Result : Pass orF Prepared By: Reviewed By: ° RONALDE. GLOVER,JR. In Jack Davis STRUCTURAL a NO.52093 TEP//;;;&'' ')Z. NOsiS TEa*9foNAL 04/12/2022 Tower Engineering Professionals,Inc.--326 Tryon Road-Raleigh,NC 27603-919-661-6351 Office-919-661-6351 Fax-www.tepgroup.net ; • ♦ .0 # t • Eng. Number OAA775586_C3_01 April 12, 2022 Page. 3 Introduction The purpose of this report is to summarize results of a structural analysis performed on the 150 ft Guyed tower to reflect the change in loading by AT&T MOBILITY. Supporting Documents Tower Drawings Mapping by FDH Job#1320751500, dated October 30, 2013 Mapping by SCI Job#170793, dated July 16, 2017 Foundation Drawing Mapping by FDH Project#1320761500, dated November 1, 2013 Geotechnical Report FDH Project#1308881600, dated November 4, 2013 Modifications FDH Project#13TIS01400,dated February 24, 2014 Analysis The tower was analyzed using American Tower Corporation's tower analysis software.This program considers an elastic three-dimensional model and second-order effects per ANSI/TIA-222. Basic Wind Speed: 117 mph (3-second gust) Basic Wind Speed w/Ice: 50 mph (3-second gust) w/1.50" radial ice concurrent _ Code: ANSI/TIA-222-H/2015 IBC/Massachusetts State Building Code, 9th Ed. Exposure Category: B Risk Category: II Topographic Factor Procedure: Method 2 Feature: Hill Crest Height(H): 175 ft Crest Length (L): 1010 ft Spectral Response: Ss=0.17,S, =0.07 Site Class: D-Stiff Soil - Default Conclusion Based on the analysis results, the structure meets the requirements per the applicable codes listed above. The tower and foundation can support the equipment as described in this report. If you have any questions or require additional information, please contact American Tower via email at Engineering@americantower.com. Please include the American Tower site name, site number, and engineering number in the subject line for any questions. Tower Engineering Professionals,Inc.—326 Tryon Road-Raleigh,NC 27603-919-661-6351 Office-919-661-6351 Fax-www.tepgroup.net . LIPI.:-.4. Eng. Number OAA775586_C3_01 April 12, 2022 Page. 4 • Existing and Reserved Equipment • Elev.1(ft) Qty Equipment Mount Type Lines Carrier 6 Ericsson RRUS A2 Module 3 Ericsson RRUS 4415 B30 (2)0.51" (13mm) 3 Ericsson RRUS 4449 B5, B12 Hybrid 3 Ericsson RRUS E2 (8)0.78" (19.7mm) 146.0 Sector Frames 8 AWG 6 AT&T MOBILITY 3 Ericsson RRUS 32(50.8 Ibs) (3)3/8" (0.38" 3 Ericsson RRUS-12 800 MHz 9.5mm) RET 3 CCI DMP65R-BU8D 4 Raycap DC6-48-60-18 Control Cable 1 Commscope RDIDC-9181-PF-48 3 Fujitsu TA08025-B604 (1) 1.60" (40.6mm) 135.0 Sector Frames DISH WIRELESS L.L.C. 3 Fujitsu TA08025-B605 Hybrid 3 JMA Wireless MX08FR0665-21 Equipment to be Removed Elev.1(ft) Qty Equipment Mount Type Lines Carrier 9 CCI HPA-65R-BUU-H8 146.0 - - AT&T MOBILITY 6 Ericsson RRUS-11 Proposed Equipment Elev.1(ft) Qty Equipment Mount Type Lines Carrier 147.3 3 Ericsson AIR 6419 B77G 3 Ericsson RRUS 8843 B2,B66A 146.0 3 Ericsson RRUS 4478 B14 Sector Frames (1)0.39"(lOmm) AT&T MOBILITY Fiber Trunk 3 CCI TPA65R-BU8D 144.7 3 Ericsson Air 6449 B77D 'Contracted elevations are shown for appurtenances within contracted installation tolerances.Appurtenances outside of contract limits are shown at installed elevations. Install proposed lines alongside existing AT&T MOBILITY lines. Tower Engineering Professionals,Inc.—326 Tryon Road-Raleigh,NC 27603-919-661-6351 Office-919-661-6351 Fax-www.tepgroup.net Eng. Number OAA775586_C3_01 April 12, 2022 Page. 5 • Structure Usages Controlling Structural Component Usage Pass/Fail Legs 62% Pass Diagonals 67% Pass Horizontals 38% Pass Guys 72% Pass Leg Bolts 10% Pass Foundations Reaction Component Analysis Reactions %of Usage Base Axial (Kips) 81.7 24% Anchor 1 Uplift (Kips) 20.6 68% Anchor 1 Shear(Kips) 17.7 53% The structure base reactions resulting from this analysis were found to be acceptable through analysis based on geotechnical and foundation information,therefore no modification or reinforcement of the foundation will be required. Deflection,Twist and Sway* Antenna Deflection Twist Sway Elevation Antenna Carrier (ft) (ft) (o) (Rotation) (�) 147.3 Ericsson AIR 6419 B77G CCI TPA65R-BU8D 146.0 Ericsson RRUS 4478 B14 AT&T MOBILITY 0.152 0.104 Ericsson RRUS 8843 B2, B66A 144.7 Ericsson Air 6449 B77D 0.146 0.008 0.102 Commscope RDIDC-9181-PF-48 Fujitsu TA08025-6604 135.0 DISH WIRELESS L.L.C. 0.134 0.087 Fujitsu TA08025-6605 JMA Wireless MX08FRO665-21 *Deflection,Twist and Sway was evaluated considering a design wind speed of 60 mph(3-Second Gust)per ANSI/TIA-222-H Tower Engineering Professionals,Inc.--326 Tryon Road-Raleigh,NC 27603-919-661-6351 Office-919-661-6351 Fax-www.tepgroup.net Eng. Number OAA775586 C3 01 April 12, 2022 o w Page. 6 Standard Conditions All engineering services performed by ATC Tower Services LLC are prepared on the basis that the information used is current and correct. This information may consist of, but is not limited to the following: • Information supplied by the client regarding antenna, mounts and feed line loading • Information from drawings, design and analysis documents, and field notes in the possession of ATC Tower Services LLC It is the responsibility of the client to ensure that the information provided to ATC Tower Services LLC and used in the performance of our engineering services is correct and complete. All assets of American Tower Corporation, its affiliates, and subsidiaries (collectively "American Tower") are inspected at regular intervals. Based upon these inspections and in the absence of information to the contrary, American Tower assumes that all structures were constructed in accordance with the drawings and specifications. Unless explicitly agreed by both the client and ATC Tower Services LLC, all services will be performed in accordance with the current revision of ANSI/TIA-222. All services are performed, results obtained, and recommendations made in accordance with generally • accepted engineering principles and practices. ATC Tower Services LLC is not responsible for the conclusions, opinions and recommendations made by others based on the information supplied herein. Tower Engineering Professionals,Inc.—326 Tryon Road-Raleigh,NC 27603-919-661-6351 Office-919-661-6351 Fax-www.tepgroup.net