40 HIGHLAND AVENUE - AFFIDAVIT Final Construction Control Document
�';►! v I To be submitted at completion of construction by a
Registered Design Professional
for work per the 9"' edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Salem 2 MA Date: September 7,2021
Property Address: 40 Highland Avenue,Salem,MA 01970
Project: Check(x)one or both as applicable: New construction x Existing Construction
Project description:Verizon Telecommunications facility modification on an existing building. Install new
Antennas and associated radio equipment on rooftop. Reference Construction Drawings dated 04/15/2021 by
Hudson Design Group,Structural Analysis dated 04/14/2021 by Hudson Design Group,and Mount Analysis dated
03/19/2021 by Colliers Engineering.
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. I,or my designee,have performed the necessary professional services and was present at the
construction site on a regular and periodic basis.To the best of my knowledge,information, and belief the work
proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building
pen-nit and that I or my designee:
1. Have reviewed,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. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Have been 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 was performed in a manner consistent with the
construction documents and this code.
4. This report does not include inspections for the findings of the global stability analysis and modifications to the
structure. Those modification inspections,if required,are strictly the responsibility of the tower owner&general
contractor performing such design and installation.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
Enter in the space to the right a"wet"or -;yt OF
electronic signature and sea]:
DANIEL P. -
HAW
CIVIL y
No.
Phone nurnber:(978)557-5553 GtF
Hudson Design Group,LLC 0M
45 Beechwood Drive
North Andover,MA 01845 Email: info@hudsondesigngroupllc.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 01 01 2018