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1000 LORING AVE - BUILDING INSPECTION (2) �JOZ6-D c ►C 3O� C( The Commonwealth of Massach4settg�',,,t SERVICES ® Department of Public Safety Massachusetts State Building Code(780 CMI L � CrC t1. 1: S Building Permit Application for any Building other than a One: I Two-Family Dwel ii�g (This Section For Official Use Only) - Building Permit Number: Date Applied: Building Official: r SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) /ODo L 01144 '54%E^ (Mfg (tel lb.jzmR ) ' No.and Street City/Town Zip Code Name of Building(if applicable) 1 n SECTION 2:PROPOSED WORK U ' Edition of MA State Code used_ If New Construction check here❑ or check all that apply in the two rows below Existing Building❑ Repair❑ I Alteration ❑ 1 Addition❑ I Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other X Specify: TE(¢corl eWWHQiT 2rcPLk cwT Are building plans and/or construction documents being supplied as part of this permit application? Yes Z No ❑ Is an Independent Structural Engineer in Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: L¢ite.,4 �ANs ow 9,9-�pIA.t1 N6 GYAWked. pM6t+wAs AND ASsoUAWD t-&U% g T sai L\\ N LCiIM( AmwAj d tt t, A -SMADAU, ArIR.'vr,& -t�;- M UAtMI to Tm.,E' - FK W4r Asnim- `W-Ass.y Co&&O AO `•RACE . 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): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per FI q.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) - A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4 ❑ A-5❑ 7 B: Business ❑ E: Educational ❑ F: Factory F-1 ❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑ I: Institutional I-1❑ I-2❑ I-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ S-2❑ ease describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB 13 SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Public❑ Check if outside Flood Zone❑ Indicate municipal 11Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: Licensed Disposal Site❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY - Edition of Code: 'Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: Gerry Byrnes SITE ACQUISITION AGENT TRMi6 Chestnut Street Suite qzo Foxborough, MA ozo35 office:zoi.z73.Szgz Convergent Network email: gbyrnes@trmcom.[om CCR Registered Small Business Ce—sor�trvnod.—v�—•�o�, t �— • bia �`aa3�-z—srr+•a33—apv s�v�cc� �++u.�—.wa3�� ENDLESS MTNS WATER SERVICES•DBA ENDLESS MTNS SOLAR SERVICES 4143 CITY OF SALEM 110/30/2015 6230 Licenses and Permits 208.00 I i I' honesdale BUILDING DIOZZI 208.00 r - SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ^ I,w [QS_14 rt4 UYST6te SCS Gn.nk►c4S 7d.e-K De- #g bob \..�N614I ' `A Name(Print) No.and City/Town t Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes 4E¢a+t pigs tTRM ((, cHESn.NC 5r#�}7P �cxa� rLA, oZb3� ame Street Address City/Town State Zip to 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 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control RACA C-5-09-1 54 5 It SES ARAuieb Name(Registrant) Telephone No. e-mail address P 1 WI Registration Number 290 t.IAtE0. Sc. �I�o . Z:wa Street Address City/Town StateZip Discipline Expiration Date 10.2 General Contractor J. Le,-- Company EECompany Name li Name of Person Responsible for Construction License No. and Type if Applicable _ I}zy W,93V 62.0 4AD CeWM AL. (y1q¢yg,cwvaa VA Street Address City/Town State Zip 781 Qlo3 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 building permit. Is a signed Affidavit submitted with this application? Yes O No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item Total Construction Cost from Item 6 =$ �L�f Sca and Materials) ( ) 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to —1-0 u Or SV.1mt 6.Total Cost $ 1 S- (contact municipality)and write check number here 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. S l � Lp\ 2\3. 8292 l o lS�M1ItQl?l�[7 rc c . Please print and sign name Title Telephone,No! Date I(, c.4kE5-%&M sr.� Fto �x6auo I tl� o2p3 Street Address City/Town State Zip uAw Municipal Inspector to fill out this section upon application approval: J 7/1 _ Name Date t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor -i License:CS-097595 RICH A BURRIDCpE 290 Water Street Pembroke MA 02359 Expiration Commissioner 07/16/2017 A� CERTIFICATE OF LIABILITY INSURANCE oarE(MrovoorrvY) 4/17/2015 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 endomement(s). PRODUCER CONTACT L Blanchard, CIC,CISR NAME: Y� ancar FIAI/Cr066 III6UranCe PHONEEsU (603)669-3218 NCNo (603)645-4331 1100 Elm Street E-MAILADDRESS.Iblanchard@crossagency.com INSURERS AFFORDING COVERAGE NAIC 4 Manchester NH 03101 INSURERAGemini Ins Co INSURED INSURER B Allmerica Financial Benefit 41840 J Lee Associates, Inc. INSURERC:TOrum National Ina Co 420 Northboro Road Central INSURER D:Insurance Company of the State of INSURER E Marlborough MA 01752 1 INSURER F: COVERAGES CERTIFICATE NUMBER:) Lee all lines extnd exp 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 ADDLTYPEOFINSURANCE iNgn SUER POLICY NUMBER MMIDDY EFF POLICY Up LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11 000,000 DAMAGE TO RENTED 50,000 A CLAIMS-MADE X OCCUR PREMISES Eaocoovence $ X VCGPOS0388 4/28/2014 10/1/2015 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[X]PO- LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER'. Employee Benefits $ 11000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000,000 Ea a.dar B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AWA287120 4/28/2015 4/28/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-0VVNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Uninsured morons[BE spit writ $ 500,000 UMBRELLA LIAR Xd OCCUR EACH OCCURRENCE $ 51000,000 L, X EXCESS UAB CLAIMS-MADE AGGREGATE $ 51000,000 DED RETENTION$ I18972D1402LLI 4/28/2014 10/1/2015 $ WORKERS COMPENSATION XI PER STATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR)PARTNEWEXECUTIVE YIN NIA D WC062715644 E.L.EACH ACCIDENT $ 1,000,000 OFFICERNEMBER EXCLUDED? (Mandatory In NH) 3(a) NA, NR z effi 10/1/2014 10/1/2015 E.L.DISEASE-EA EMPLOYE $ 11000,000 U as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1, 00,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101,AddRional Remarks Schedule,may be asached if more space is required) REFERENCE OR PROJECT HERE. ******FOR INFORMATION ONLY. . . .HOLDER IS ADDITIONAL INSURED UNDER GENERAL LIABILITY (ON A PRIMARY & NON-CONTRIBUTORY BASIS) AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROBATION APPLIES UNDER GENERAL LIABILITY AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT. UMBRELLA POLICY IS FOLLOW FORM. . .FOR INFORMATIONAL PURPOSES ONLY****** Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR INFORMATION ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATION ONLY ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATION ONLY FOR INFORMATION ONLY AUTHORIZED REPRESENTATIVE Michael Guarino/LM5 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 t7n14nn Dewberry Dewberry Engineers Inc. 280 Summer Street,10th Floor _ Boston,MA 02210-1131 617.695.3400 617.695.3310 fax www.dewberry.com January 9, 2015 i Mr.Tim Baker Structure Consulting Group 49 Brattle Street Arlington, MA 02474 Re: Swampscott MA 1000 Loring Avenue Salem,MA 01970 Dear Mr. Baker, Verizon Wireless has proposed to replace (3)existing antennas(1 per sector)with(3) new antennas (1 per sector)and install (3) new antennas(1 per sector)on existing pipe mounts on the facade of the above reference building. Additionally,(3)new remote radios heads(RRHs) (1 per sector)will be installed on existing ballast mounts. The existing building is an 11-story residential structure, consisting of steel frame and brick facade structural system. The antennas are to be mounted on the facade, using existing mounting hardware as outlined in the PCS Drawings provided by Dewberry Engineers Inc. (Dewberry).The existing ballast mounts,for RRHs and surge arrestors,will be modified to reduce weight. Dewberry has performed a site visit and reviewed existing information,to assess the condition of the existing building and mounting hardware,and concludes that they have adequate reserve capacity to support the proposed equipment as shown in our PCS drawings. Our assessment is based on the assumption that the existing building structure and mounting hardware are in good condition. If during construction any damage or deterioration is noticed on the building or hardware, Dewberry is to be notified to assess any deviation from the assumed condition. If you have any questions,please do not hesitate to call me at 617-531-0742 Sincerely, Dewberry Engineers,Inc. Brenden Alexander, P. E. r, FLEL:'."rii > Senior Project Manager STRUO f.L st .a. xy R:\50002925\50070449-SWAMPSCOTT_MA\Adm\Reports\Structural\SwampscottMA_Structural Letter_01-09-15.doc> ve"zonwireless Existing Verizon VER120N WIRELESS wrreless Antenna PROPOSED YERIZON - 400 FRIBERG PARKWAY N (3/Secla�(TREEMNN) WIRM ANTENNA 1 2 W6TBOROUGH, MA 01581-3956 Existing Skylight (ON SPARE RPE MOUNT) q_J A-J - 9 (1/SECTOR) (IYP=3) Existing Ballast N.urded p Antennas (Typ.) PROPOSED VERIZON so O �w1�6BEER IXrnPo) M3 ACJ SWAMPSCO7T MA g (y (1/SECTOR) y / Existing Ballast Mounted 000 / RRH & Junction Be. 1 (t/Sector) 0 / (TO BE NOOIFlED) PCS DRAWINGS / PROPOSED RRH MOUNTED ON EXISTING 1 0s•.. / BALLA 0 ST NOU/MM �, / (+/SECTOR) \'•'�]) Existing T–Mobile Equipment Cabinets / PROPOSED HYBRID 1 On Ra.r MOU�NNTEDID CCAABLE wPOY�e 0 01/12/15 FOR SUBMITTAL Existing AT&T / A–} Equipment AreaPROPOSED HYBPoD ® / (1/SECTOR)(TYP.-3) At Gratle CABLE IN EXISTING R00F 1 0 MOUNTED CABLE TMY A_3 Dewberrye DD —— — — — — — o Existing Main Dewberry Engineers Inc. Entrance At Gratle Existing Ems[in9 _ ,., �Skyl'rght / Cable Tray C)i71T� t908TN.MAYd10 1 2 PROPOSED VERIZON ❑ CTYP) ❑ ~�L FA)tWIIT'®59eW FAY B1i.MI5.Y{IO A-J A-J WIRELESS ANTENNA e e(TO REPLACE EXISTING) ❑ ❑ Al2 (1/SECTOR) (TYP-3) ❑ ERot"' —S-4-mTyy.. ,,,,�_ Cl PROPOSED VEWON � �/ Pvntnause UBEN' e e WIRE PIPESS ANTENNA MOUNT) (ON SPARE PIPE TEA Exisling (1/SEMR) (TYP.-3) Roof Haien ® Existing t2x]G Verizon \Exisling Verizon Existing Ballast Wreless Ecv,rment Shelter Existin Wireless Antenna Mounted RRH & 1 Exisling AT&T Vent (TyR) (]/Sector) (Typ.-9) LJunction Box Aerosol. (Typ.) (TO REEWN) (1/Sector) (Typ.-] A-3 ® Existing Metro PCS (TO BE All D) Equipment Behind PROPOSED RRH o Q Screen Wan e1 MOUNTED MI MOUNT A-3 BALIASf MOUNT (1/SECTOR) (1YP.-3) PROPOSED HYBRID O o CABLE IN EXISTING ROOFe MOUNTED GABLE TRAY p-J DAWN W. MR 0 o I (1/SECTOR)(1YP.-3) Iw O REVIELYED W. GMT Existing Ballast Mounted Antennas (iYP) // CHEptm B1: BBR PROPOSED RRH / {I 0Existing Verizon PROJECT NUMBER 50002925 1 MOUNTED ON EXISTING Wireless Antenna (1�E T MOUNT (3/Sect.,) (T, -9) JOB NUMBER; 500]ON9 (TP.-J) (TO REMNN) Existing Ballast Mounted 1 RRH & Junction Box PROPOSED VERIZON SITE ADDRESS: A-3 ( ReceE)Moyp.-3) WWIRELESSSEC ANTENNA 1 2 (w/, OR)P(m-3) A_, A_3 1000 LORING AVENUE, SITE NOTES PROPOSED VERRON 4 SALEM, MA 01970 1. SOME IXSDNG AND PROPOSED INFORMATION NOT SHOWN FOR CIARIT. 1 2 MRn ccc AryTENNA 2. NORTH SHOWN AS APPROXIMATE A–J A-3 (ro REPLACE METNG) /SEC OR z. OUSTING INFORMATION SHOWN iS ARPINSPEC IO ELEVATION HAVE BASED ON ( ) J) SHEET TIRE EXISTING PIRGN ANO VSUAL PSPEDTON AND HAVE NDT BEEN VERIFlm THROUGH AN ANIETINA YAPPING 5. DRAWING PREPARED PER PMT PIAN BASED ON SPRINT SPECTRUM LP ROOF PLAN CONSTRI/CTTON DRAWINGS BY TECTONIC ENGINEERING CONSULTANT PC ROOF PLAN DATED 7/29/97 AND SITE VISIT PERFORMED BY OEWBERRY ENGINEERS SCALE:1'-40' TOR 11'x1]' 1 INCL ON 11/12/14. 1"-20' FOR 22x3$ SHEET NUMBER G. NEESE EXISTING ANTENNA MOUNTS AND CM2. IMSPECt FOR OAMAGE 0 20 M OR DECAY ANO REPLACE AS NEEDED PER STRUCTURAL LETTER DATED 01/09/15. BY DEWBERRY ENGINEERS TNG - A- 1 V11 Ven m fireless Highest AppuHembee VERIZON WIRELESS Toa Of Existing W 400 FRIBERG PARKWAY Elev. = i4�t A.bip_Antenna G.L. WESTBOROUGH, MA 01581-3956 Existing Veman Wireless Existing AT&T SWAMPSCOTT MA Equipment Shelter Mtenna (TyP-3) To, R Existin Shelter seller _ Existing ballad Mounted Elev.a= 111'-9'} ADL. RRH & Junction Be. C.L. Of Existin AMlennvs (M BE WMETEO)) nee. =Ti E't AaL PCS DRAWINGS Existing 4E Exis ing COEIe Lay Railing Top o/ Eus4ny Raaf (TYP') Elev. = 104.5'} A.C.L. IPT E.flag C.L. Q 6i2± VGL. n Wireless Means Vent x(Typ.) Elev. 107} A.G.L. J PROPOSED VERIZON Existing Vernon WIR ANTENNA Wireless Mtenna 0 01/12/15 FOR SUBMITTAL (IO REPLACE EXISTING) (3/Sector) (Typ'9) (1/SECTOR) Cr 3) PROPOSED v0tIZON0 WI Existing Vertical RELESS MTENNI,TFNNA Cable Trb, (ON SPME PIPE MOUNT) (I/SECTOR) Dewberry Engineers Inc. zm suMMER smffT 1l1IHR1]Oli BasroN,ARA IMra PRONEN].611!3N0 RM61761l tW aA8 t 9ESd.IEIN B �� REVETTE INFIL .49 r � [Ell d8 A =r. �Y.y gNVM eY: NR zrX Existng Building AEVIEWm BY' GMT Existing AT&Ttl1FO1RE0 Be. BBR Equip At lGmtle d'so Existing Building - Entrance - .. 4m PROJECT NUMBflt 50002925 JOB NUMBER: 500]0419 Ev Stine Ground Elev. 0'} A.C.L. SITE NOTES 1000 CORING AVENUE, SALEM, MA 01970 1. SOME EXISTING MD PROPOSED INFORMATION NOT SHOWN EOR CIMITY. 2 OUAYk IONS ME APPROXIMATE.MD HAVE NOT BEEN VERIFIED THROUGH MELD SURVEY. SHEET TIRE 2 E(ISTING ANTENNM SHOWN AS MP�I(IIMTE ELEVADON fllSEO ON IXISTING INFORMATON MD VLATJAL INSPECIICN AND HAVE NOT BEEN /\ w FIFO THROUGH M ANTENNA MAPPING. PARTIAL ELEVATION l PARTIAL ELEVATION 5. DRAWING PREPPER PLOT PUN BASED ON SPRINT SPECTRUM W scME 1'-200' FOR 11'x1]' CONSTRUCTION DRAWINGS BY TECTONIC ENGINEERING CONSULTMT PC 1'=10' FOR 22134' DATED ]/29/9] MO SITE NSR PERFORMED W DEWBERRY ENGINEERS 0 10 20 SHEET NUMBER INC. ON 11/12/14. B. REUSE EXISTING ANTENNA MOUNTS AND COV(. INSPECT MR DAMAGE OR DECAY MD REPUCE)kS NEEDED PER STRUCNPN. LETTER GATED - - 01/09/15. BY DEWBERRY ENGINEERS INC. A- PROPOSED SECTOR RRH PCS1 PCs/ (1/SECfOR)(TYPr3) Existing Sector PROPOSED U12 DC S(TOAN) SSO LTE LTE CDMA AWS HYBRID CABLE CROSS CROSS CROSS CROSS CROSS (1/SECIDR)(IYP:3) FOIE FOE PolE FOLE POLE \ Ex sR,g � 4V1lL'�@SS Sector RR ,1f (TD RENNN) \ Existing Gmvanieed —q W K q VERIZON WIRELESS \\\ stat Framing �a 3 400 FRIBERG PARKWAY X pp i a WESTBOROUGH, MA 01581-3956 \\ (� SINGLE MODE FIBER (1) PNR Ila MG FROM RRH �... TO SECTOR DC SURGE PROPOSED 4.4 HYBRID ,°o' SWAMPSCOTT MA CMLE FROM SECTOR LSC EiS°' I .,s TO UPPER DC SURGE w �'r• CobleT ray 1. AS MEWED STANDING BEHIND THE ANTENNAS.able T Exist:, Sol von:,rd 2. TYPICAL MR 3 SECTORS. VERIFY FlNAL ANTENNA DESIGN Strut Fmmbg SHEET PRIOR TO CONSTRUCTION. (Connecter Fo Sleepers) Exiting c„ •ate Flded pvG l+}'�� ANTENNA CONFIGURATION PCS DRAWINGS Sleeper (i%p--)) SCUM. N-TS (4 TO WITHOUT CONCRETECam I FlLLFR) GRQUND SURCE RRH NOUN Existing Rubber Roar Pod HOT PROIFLTOR GROUND PIPE (REPLACE M NEEDED) AwG 0 01/12/15 FOR SUBMITTAL f I SECTOR"NO .. Dewberry• BM .. ... j /2 AIG /z MD Dewberry Engineers Inc. �.I ]IDGUMb1ER SIHEET ' IOfH RO(N BObTON.MA 01310 LARGE TIBER PHONE:81TW59R0g TOP YGB JUNCTION BOX FNC 81).NL48t10 12 AWG iAO Existing th.".Z.o fiii REFUGE O(STING PTFE Wreless note,,, LOWER MBB S AM MOUNT (S¢NOTE 5) (TSe<lor)N'TYP 9) •• ••• REVETTE 80ff5 w 1. ALL PROPOSED EQUIPMENT TO BE GROUNDED TO SECTOR CIVIL i CRWND BM. . 2. TYPICAL FOR FOR ALL SECTORS. PRO POSm PmATE %—POE ANTENNA 3. GROUNDING Sl L COMPLY WITH NEC AIR. 250 &VERRON (ON SPME PIE MOUNT) WIRELESS SPECIFICATIONS. PROPOSED AWS F (1/SEC10R) (EYP:3) PROPOSED %—POLE ANTENNA ( 1/2' CON( JUMPER (TO REPLACE IXISTING) I FROM RRH TO SCHEMATIC GROUNDING DIAGRAM (1/SECTOR) (TP.-3) s ANTENNA (TW.-2) SCALE N.T.S. 3 DMWN BY: MR GENCRA1 u REVIEWED BY: GM 1. ALL DIMENSIONS TO, OF,AND ON aISnNG BUILDINGS. ORNNAGE STRUCTURES.AND SITE IMPROVEMENTS SMALL BE VERIFIED IN FIELD BY CNECKED BY: BBR CONTIMTOR PRIOR TO ALL FMRICARON WHIM ALL DISCREPANCIES REPORTED IMMEDMTELY TO THE ENGINEER. 2. THESE DRAWINGS DO NOT INCLUDE NECESSARY COMPONENTS FOR PROJECT NUMBER: 50002925 CONSRRUCIION SAFETY WHICH IS THE SOLE RESPONSIBILITY OF THE CONTWtTOR. JOB NUMBER: 500)0449 ElOnNG AWS JUMPERS TO 3. BRACE STRUCRIRES UNTIL ALL STRUCTURAL ELEMENTS NEEDED FOR tBE RE—CONNECTED (EYP.-2) STABBITY ME INSTALLED.THESE AR ESE ELEMENTS E AS FOLS: LOWS: LATERAL SITE ADDRES (CM&WEATHER SEAL BRACING, ANCHOR BOLTS, M. UNUSED PARTS) 4. INCOONFOR NG MAATID, DAMAGED, OR OTHERWISE E ROxOK OR Bim. NONCONFORMING WTERULS OR CONDITIONS SHALL BE REPORTED TO THE 1000 CORING AVENUE, OWNER MDR TO 1. NOT ALL N FO INFORMATION SHOWN CLARITY. ACTION SHALL REQUIRE WRITTEN OV1. OR MMOVK BY THE LH REMEDWL OW14M*S SALEM, MA 01970 REMESEMATNE MDR TO PROCEEDING. 2. INSMLL ALL EQUIPMENT PER WNUFACTURERS RECOMMENOMONS. 1 All EQUIPMENT SHALL BE GROUNDED PER wt¢ox wIRELFs 5. EACH COMPACTOR SHALL COOPERATE WITH THE OWNEYS RE'RESENTATNE, STANDARDS AND "UFACNRTS RECOMMENDATIONS AND COORDINATE MIS WORK WITH ME WORK OF OTHERS. SHEET TILE 4. ALL PROPOSED EQUIPMENT INCLUDING ANTENNAS, COM SURGE 6. REPNR ANY DAMAGE DURING CONSTRUCTION TO MATCH OUSTING MRESTORS, RRMS, ETC.SRNL BE MOUNTED IN ACCORDANCE WITH PRE—COCONSTRMSMI.J!TONAGER.�ONS TO THE SATISFACTION OF THE CONSTRUCTION SIRUCRIRAL LE TER DATED 01/08/15. BY QEWBERNI'ENDINEERS INC. 5. REUSE COSTING ANTENNA MOUNTS MID CQAY INSPECT FOR OMAGE 7. THE COMWG'fOR SHALL SUPERVISE AND DIRECT ME PROJECT DESCRIBED DETAILS OR DEGY AND REFUGE AS NEEDED. HERON. THE CONTRACTOR SHALL BE SOLELY RESPONSIBLE FOR ALL CONSTRUCTION MEANS. METHODS, TECHNIQUES, SEQUENCES AND SHEET NUMBER PROCEDURES AND FOR COORDINATING ALL PORTIONS OF THE WORK UNDER FACADE MOUNTED ANTENNA&BALLAST THE COMRACE. MOUNTED RRH MOUNTING/PLUMBING SCHEMATICSCAM. �1 B REUSE IXSTNG ANTENNA TNA MOUNT AND COOL INSEC FOR DAMAGE OR ^ SCAM. N.T.S I ECAY AND REPLACE NEEDED PER STRLUCNRAL ANALYSIS. A- 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a I Congress Street, Suite 100 Boston, MA 02114-2017 www ntassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): J Lee Associates Address:420 Northboro Road Central City/State/Zip: Marlborough, MA 01752 Phone#:781.467.9103 i Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with 35 4. ❑ I am a general contractor and I 6. F-1 New construction employees (full and/or pail-time).° have hired the.sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance? required.] 5. ❑ We are a corporation and its 10.■❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] 1 c.152,§1(4),and we have no 13.® Other R£PIACEM employees. [No workers' xNC comp.insurance required.] `Any applicant thatchecks boa#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 their hire outside contractom must submit a new affidavit indicating such. tContmetors 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 most providetheirworkers'comp.policy number. I am an employer that is providing workers'compensation insurance for mp employees. Below is the policy and job site ! information. Insurance Company Name: Insurance Company of the State of PA y WC066180955 10/1/2016 Policy#'or Self-ins. Lic. #: Expiration Date: '., 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 e aalsaX1� 4 naives of rju that the information provided above is true mid correct /�/ 12/3/2015 Signature l7t 'r n t Phone#: 7814679103 Official use only. Do not write.in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: