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B-17-146 UPGRADE T MOBILE ANTENNA T Mobile Northeast LLC,a subsidiary of T-Mobile USA,Inc. 15 Commerce Way,Suite B Norton,MA 02766 July 31, 2017 City of Salem Building Department 120 Washington Street 31d Floor Salem, MA 01970 RE: T-Mobile L700 Antenna upgrade project at Three Corners Realty Trust, 18 Washington Square Salem, MA. To Whom It May Concern, I hereby authorize the transfer of the building permit contractor for the site located at 18 Washington Square, Salem MA from Centerline Communications, LLC, Peter Moro CS-081072 to DJL Construction Corp, dba Penta Communications, 1421 Witherspoon Street, Rahway, NJ 07065, Michael Koper CSL# CS-108010 dated 03/12/2018. If you have any questions please do not hesitate to call. Thank you. Sincerely, Robert C. Foley Ericsson Construction Manager/Authorized T-Mobile Representative robert.x.foley(�ericsson.com (508) 542-3771 Cc: 4BS0352A of , k "tea 1 3 Y tE Sy jg 2 i 5 w Y � z 4 � 1 � 5 t � 3y � Client#:28247 DJLPENT DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 5/08/2017 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 endorsement(s). PRODUCER NAME: T Cook Maran 1856 PHONE 631-390-9700 FAX 631-390-9790 A/C No Ext: AIC,No Cook Maran n DRESS: Certificates@cookmaran.com 40 Marcus Drive,3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville,NY 11747 INSURER A:Continental Casualty Co. 20443 INSURED INSURER B:Continental Insurance Company 35289 D.J.L.Construction Corp. INSURER C:General Casualty Company of WI 24414 DBA Penta Communications INSURER D:Columbia Casualty Company 31127 1421 Witherspoon Street American Casualty Company of Re 20427 INSURER E: Y P Y Rahway,NJ 07065 INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 LTR INSR WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 5099444974 5/15/2017 05115/2018 EACH OCCURRENCE s2,000,000 CLAIMS-MADE �OCCUR PREMISES(Ea occurrence) $1,000,000 X PD Ded:1,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY FXI ECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY 5099444960 5/1512017 05/15/201 Ea acccidentINEDSINGLE LIMIT 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X NON-OWNED AUTOS Per accident B X UMBRELLA LIAB X OCCUR 5099444988 5/1512017 05/15/2018 EACH OCCURRENCE $9,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION TH- CWC1183318 511512017 05/15/201 X PER ES AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/NE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' N 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 $1,000,00 D Professional Liab C6045990562 5/15/2017 05/15/2018 $2MM Ea.Claim/$2MM Agg. D Pollution C6045990576 5/15/2017 05/15/2018 $2MM Ea.Claim/$2MM Agg Liability DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1192414/M1191785 FM2 ` ° ' Commonwealth of Massachusetts Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. B-17-146 FEE PAID: 220.00 PERMIT TBUILD DATE ISSUED: 3/16/2017 This certifies that THREE CORNERS REALTY TRUST HARRINGTON DOROTHY has permission to erect, alter, or demolish a building on: 18 WASHINGTON SQUARE WE Map/Lot: 350412-0 as follows: Other Building Permit 1 ADDING THREE(3) PANEL ANTENNAS (ONE (1) IN STEALTH FLUE); ADDING THREE (3) REMOTE RADIO HEADS TO EXISTING T-MOBILE WIRELESS FACILITY (PER DRAWINGS ON FILE) Contractor Name: PETER R. MORO DBA: CENTERLINE COMMUNICATIONS LLC Contractor License No: CS-081072 3/16/2017 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. All work authorized by this permit shall conform to thejapproved application and the approved construction)documents for which this permit has been granted. All construction,alterations and changes of use of an:building and structures shall be in compliance with the i�cal zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained o n for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire O als are provided on this permit. H IC#: "P�rsons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. CON - Commonwealth of Massachusetts R a Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 <; Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT GOND PERMIT TO BE POSTED IN THE WINDOW Excavation Footing INSPECTION RECORD Foundation Framing Mechanical Insulation INSPECTION: BY DATE Chimney/Smoke Chamber Final WOOD Plumbing/Gas Rough:Plumbing Rough:Gas Final Electrical a Service Rough I Final Fire Department Preliminary Final Health Department Preliminary Final