12 POPE STREET - AFFIDAVIT Final Construction Control Document
To be submitted at completion of construction by a
Registered Design Professional
for work per the 9 h edition of the
Massachusetts State Building Code,780 CMR, Section 107
Project Number:4BSM001A Date:January 3,2022
Project Title: Salem Heights(BOS0024B)
Property Address: 12 Pope St.Salem,MA
Project: Check(x)one or both-as applicable: New construction X Existing Construction
Project description:T-Mobile Anchor telecommunications site upgrade.Installation of(6)new antennas and(6)
new radios on the roof top.Reference Construction Drawings dated 3/30/2021 by Hudson Design Group LLC.and
Structural Analysis Report dated 4/7/2021 by Hudson Design Group LLC.
I Daniel P. Hamm,MA Registration Number:40720 Expiration date:6130/2022,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:Telecommunications Installation
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
permit 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.
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
electronic signature and seal:
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DANIE�pL��P
U CIVIL
Phone number: No.4072t)
Hudson Design(Group,L S,C553 MAIL *1
45 Beechwood Drive
North Andover,MA 01845 Email:info@hudsondesigngmupllc.com
W Building Official Use Only
Building Official Name: Permit No.: Date:
Version 01 01 2018