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Home My WebLink AboutBuilding Permit #859-15 - 300 CHESTNUT STREET 4/28/20156 � _ NORT1/ a t(� BUILDING PERMIT ' rTOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received�,An,»,»:, Date Issued: J I PORTANT: Applicant must complete all items on this LOCATION 0 Chestnut St (a/k/a 300 Chestnut St Print PROPERTY OWNERSBA Properties, Inc. Print MAP NQ: PARCEL"` ZONING DISTRICT: 3 Historic District yes no a`? 'rc / Machine Shod Village ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial 13 Alteration No. of units: XCommercial Cf Repair, replacement ❑ Assessory Bldg C� Others: ❑ Demolition ❑ Other Communications Tower / Guyed ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer V AT&T Mobility propose to remove (3) existing antennas and replace with (3) new antennas on the existing mount with ancillary equipment as per the attached plan specifications. OWNER: Name: Address: Identification Please Type or Print Clearly) SBA Properties, Inc. Phone: 718-333-5294 5900 Broken Sound Parkway NW Boca Raton, FL 33433 CONTRACTOR Name: Phone: 603-502-8183 Keith Barnard t SAI Communications Address: 27 Northwestern Dr Salem, NH 03079 Supervisor's Construction License: CS -104639 Exp. Date 3/5/2016 Home Improv,`rnent License: Exp. Date: ARCHITECT/Eft NEER Hudson Design Group / Daniel Hamm Phone: 978-557-5553 Address: 1600 Oso ' St. Bldg 20 N Suite 3090 North Andover, MA 01845 Reg. No. 40720 FEE SCHEDULE. \�\ PING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 60.000 FEE: $ 720.00 Check No.: Receipt No.: d NOTE: Persons co tracting with unregistered contractors do not have access to the guaranty fund Agent/Owner of Signature A �, g g �� Signature of contractor r —w- q I Permit No#: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNE h O��tteo .ae,hC Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 1 ❑ Water/Sewer DESCRIPTION OF WORK TO BE PEKi-Urtmtu: Identification - Please Type or Print Clearly OWNER: Name: Phone: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Home Improvement License: Exp. Date: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ E: $ Check No.: Receipt No.: NOTE: Persons contractine u"`' unregistered contractors do not have access to the guaranty fund h T Locatio No. Date IS -1 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # Lf '*"-Building Inspector Plans Submitted1j, Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONS2RVATION COMMENTS HEALTH COMMENTS Reviewed On Signature_ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street P REbLIAR►TiMENiT - Te mp�pumpster o,mste lyes no, Locatedidf 1-2 .4, FirelDepa t h entsignature/.date: COMMEN— Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4.. Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work .� Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application . Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract .rr Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional )Ja' for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Number: BS23XC422 Project Title: NORTH ANDOVER (Sprint NV2.5 Project) Date: May 1, 2015 Property Address: 300 Chestnut Street North Andover, MA Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: Sprint PCS site modification. Install (3) new antennas, (3) new remote radio heads, and (1) fiber cable as well as associated DC power, coaxial cable jumpers and antenna remote electrical -tilt (RET) cable on existing roof. I Derek J. Creaser, MA Registration Number: 49195 Expiration date: 6/30/16 , 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: Entire Project 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. IIave 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 inspection report does not include modifications to the tower structure. Those modification inspections are strictly the responsibility of the tower owner & general contractor performing such installation. Nothing in this document relieves the contrac Enter in the space to the right a "wet" or electronic signature and seal: Phone number: (978)557-5553 EmE Hudson Design Group, LLC 1600 Osgood Lndg, Bldg 20N, Suite 3090 North Andover, MA 01845 Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 ,rovisions of 780 CMR 107. m x n n Am _Q SET T 0 t C I o •- W 06< ^ zo=o d Oz °o° a } w w LL w W w w w w w w w LL m N N N m N fn V) N N N m N N 00 Z m Q - Y m0 m m m m m m m m m m m zOO Y Y Y Y Y Y Y Y Y Y Y Y Y w WD Q J > OOm w ]~ J O Y O m W j¢ W F- W U W O n Q Q Q v m ° Q 2(z J O O FO=O �a c „^ 0 CL U< a n t es Ifiv rn H X Uw M, Z .o�v`Vi x o W w Q�3o Bmv W p Z (n m N 0=wo , o Z Z Ld F J z=> ✓ 11 N O (� J S a z > > (O Q p O o;.w H r- O O W 0 3 ~ o 0 0 2 w m z Q d apUCW7 nJ Z W Q w LU �� °'tw- �cn(n� N d aaW¢ Ii CI a wLLI Q Q Q O Z J J Q J a - O m= s W Q Q 0 - U ¢ Q Lb U W H W p N W W W 3Szrw��oo� Q p ��wy W �. 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(Q Z 4aQ C7 � = Z • ,�: y m Cl) w0 o � I- -t� 7S Z to w t/) LU 0-0 c a m Q— 4) X p O W E c c U moo Cl) =�,3 �W MI) o = W J a. Z CL as CL �� m 0 H o c CD = Q L �; o CLCO °' N W 'a O O MD N C O • W .V V 0 cc E 0 Z � 0 N D � � � C d 0 � •E m m d O `+ ; v o 0 a CL cmQ O ccs v_ J •O- O i Z U N a CL U) B WA April 28, 2015 Town of North Andover MA Building Department 1600 Osgood St North Andover, MA 01845 RE: AT&T #MA3349 // 0 CHESTNUT ST (a/k/a 300 Chestnut St) NORTH ANDOVER, MA Building Department, Please find enclosed a Construction Permit Application for processing for the above listed location. Please notify me when the permit has been approved and is ready for pickup with the contact info listed below. If you have any questions, feel free to reach out. Enclosed: (1) Construction Permit Application (2) Set of Construction Drawings (1) Structural Analysis Report (1) CCA (1) Copy of GC License (1) GL COI (1) WC Affidavit (1) Permit Fee Thank you. Kind regards, Tarah Nolan Site Acquisition Specialist SAI Communications 27 Northwestern Dr. Salem, NH 03079 Mobile: 603-401-8990 Desk: 603-.212-5049 Email: Tarah.nolan@sai-comm.com 27 Northwestern Drive, Salem, NH 03079 (603) 421-0470 FDH FDH Engineering, Inc., 6521 Meridien Drive Raleigh, NC 27616, Ph. 919.755.1012 Structural Analysis for SBA Network Services, Inc. 152' Guyed Tower SBA Site Name: North Andover SBA Site ID: MA01085-A-13 AT&T Site ID: MA3349 FDH Project Number 15BHDP1400 Analysis Results Tower Components 102.6% Sufficient Foundation 103.7 % Sufficient Prepared By: David D. Vaughan, EI Project Engineer FDH Engineering, Inc. 6521 Meridien Drive Raleigh, NC 27616 (919) 755-1012 info@fdh-inc.com March 30, 2015 Reviewed By: /fJA v Dennis D. Abel, PE Director of Structural Engineering MA PE License No. 45976 03-3o-Zo 13' Prepared pursuant to ANSIMA-222-G Structural Standard for Antenna Supporting Structures and Antennas and the 2009 International Building Code (2009 IBC) Document No. ENG -RPT -503S Revision Date: 07/05/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 TABLE OF CONTENTS EXECUTIVESUMMARY............................................................................................................................................................3 Conclusions............................................................................................................................................................................ 3 Recommendations.................................................................................................................................................................3 APPURTENANCELISTING.......................................................................................................................................................4 RESULTS...................................................................................................................................................................................5 GENERALCOMMENTS............................................................................................................................................................8 LIMITATIONS.............................................................................................................................................................................8 APPENDIX.................................................................................................................................................................................9 Document No. ENG -RPT -503S Revision Date: 06117/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 EXECUTIVE SUMMARY At the request of SBA Network Services, Inc., FDH Engineering, Inc. performed a structural analysis of the existing guyed tower located in North Andover, MA to determine whether the tower is structurally adequate to support both the existing and proposed loads pursuant to the Structural Standard for Antenna Supporting Structures and Antennas, ANSIITIA-222-G and the 2009 IBC. Information pertaining to the existing/proposed antenna loading, current tower geometry, member sizes, geotechnical data, and foundation dimensions was obtained from: ❑ URS Greiner (Job No. 0535525.03) Existing Tower Elevation and Layout dated October 7, 1998 ❑ FDH Engineering, Inc. (Project No. 04-0333E) Dispersive Wave Propagation Testing of an Existing Tower Foundation dated April 14, 2004 ❑ Geotechnologies, Inc. (Project No. 1 -04 -0498 -EA) Report of Subsurface Investigation dated April 23, 2004 ❑ Sterling Engineering (Project No. 061-575) tower reinforcement drawings dated May 25, 2004 ❑ Sterling Engineering (Project No. 061-697) Structural Analysis Report dated February 17, 2005 ❑ FDH, Inc. (Project No. 10-04106T T3) Anchor Mapping Report dated November 24, 2010 ❑ FDH Engineering, Inc. (Project No. 11-05129E S2) Modification Drawings for a 152' Guyed Tower dated January 23, 2012 ❑ FDH Engineering, Inc. (Project No. 11-05129E S2) Post Construction Inspection Report dated April 10, 2012 ❑ FDH, Inc. (Job No.146DX81700) TIA Inspection Report dated January 16, 2015 ❑ FDH Engineering Inc. (Project No. 146D901400) Modification Drawings for a 152' Guyed Tower dated September 19, 2014 ❑ FDH, Inc. (Job No.146DX81700) Modification Inspection Report dated January 16, 2015 ❑ SBA Network Services, Inc. The basic design wind speed per the ANSUTIA-222-G standard and the 2009 /BC is 110 mph without ice and 40 mph with 1" radial ice. Ice is considered to increase in thickness with height. Furthermore, this structure was analyzed as a Class II structure, with a topographical factor of 1, and Spectral Response Accelerations of Ss = 0.324 and S, = 0.074. The structure is located in a transition zone between Exposure Categories B and C and, as such, the value of Kz has been corrected using the method as defined in ASCE 7-05 Section C6.5.6.6. Per Section 2.7.3 of the ANSIITIA-222-G standard, the seismic/earthquake loading effects can be ignored if spectral response acceleration at short periods (Ss) is less than or equal to 1.00. The tower's location mandates a design Ss of less than 1.00, thus seismic loading was not considered as part of the analysis of this structure. Conclusions With the existing and proposed antennas from New Cingular in place at 120 ft the tower meets the requirements of the ANSI T1A- 222-G standard and the 2009 IBC provided the recommendations listed below are satisfied. Furthermore, provided the foundations were modified per Sterling Engineering's modification drawings (see Sterling Project No. 061-575) and FDH Engineering, Inc. modification drawings (see FDH Project No. 11-05129E S2 and Project No. 146D901400), and utilizing the existing soil parameters (see GI Project No. 1 -04 -0498 -EA), the foundations should have the necessary capacity to support the existing and proposed loading. For a more detailed description of the analysis of the tower, see the Results section of this report. Our structural analysis has been performed assuming all information provided to FDH Engineering, Inc. is accurate (i.e., the steel data, tower layout, existing antenna loading, and proposed antenna loading) and that the tower has been properly erected and maintained per the original design drawings. Recommendations To ensure the requirements of the ANSIITIA-222-G standard and the 2009 IBC are met with the existing and proposed loading in place, we have the following recommendations: 1. Feedlines should be installed as shown in Figure 1 in the Appendix. 2. All AT&T proposed and existing apparatus to be installed on the mounts behind the panels. 3. RRU/RRH Stipulation: The equipment may be installed in any arrangement as determined by the client. Document No. ENG -RPT -503S Revision Date: 06117111 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 APPURTENANCE LISTING The proposed and existing antennas with their corresponding cables/coax lines are shown in Table 1. If the actual layout determined in the field deviates from the layout, FDH Engineering, Inc. should be contacted to perform a revised analysis. Table 1- Appurtenance Loading Existing Loading: Antenna Description Elevation (ft) -� Mount Elevation (ft) p- (1) Andrew P2F-52-NXA (1) Andrew VHLP800-11-DW1 145.5 (1) Andrew VHLP2-11-DW1 (4)1/2" (1)12" x 6" 2" ODU (3) 7/8" Clearwire2 142 (3)12'T -Frames 3 7"0 x 4.5" ODU (3)1/4" (3) Argus LLPX310R 142 3 Samsung RRH2WBO 3 2 12" X 12" X 7" Junction Boxes 2 2' Standoffs 133 (2) RFS APXVSPP18 (1) Powerwave P40-16-XLPP-RR-A 130.4 (3) RFS APXVTM14-C-120 (3) Alcatel Lucent TD-RRH8x20-25 (1) 5/8" Fiber (4)1-1/4" Hybrid Sprint 132 (3)11' VT -Frames (3) Alcatel Lucent 2500 MHz RRHs (3) Alcatel Lucent 1900 MHz RRHs 130 (3) Alcatel Lucent 800 MHz RRHs (3) Alcatel Lucent 800 MHz Filters 4 RFS 4"x2"x3.5"RETs (6) Kathrein 800-10121 (3) Kathrein 800-10766 (3) CSS DUO1417-868-00 (12)1-518" 122 (12) Powerwave LGP21401 (2) 3/4" DC New 121 (3)12'T -Frames (6) Ericsson RRUS11 (1) 7/16" Fiber Cingular (1) Raycap DC6-48-60-18-8F (1) PCTEL TMG -HR -26N 12 Kathrein 86010025 (6) Commscope LNX-6514DS (6) Commscope SBHH-1D6516DS 112 (3) Alcatel Lucent RRH2x60 (3) Alcatel Lucent 9442 RRH (12)1-5/8" Verizon 112 (3)12' Sector Frames (3) Alcatel Lucent PCS B25 RRH4x30 3 RFS DB-B1-6C-12AB-0Z 107.5 PD1187 (1)1-1/4" Arch 100 (1) Standoff 47 5' Sat Dish (1)1/4" 47 (1) 2' Standoff 1. Feedlines installed as shown in Figure 1 in the Appendix. 2. Clearwire has (3) 7/8" and (3)1/4" coax install inside (2) 2.3" conduits. Proposed Carrier Final Loading: Document No. ENG -RPT -503S Revision Date: 06/17/11 RESULTS Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 The following yield strength of steel for individual members was used for analysis: Table 2 - Material Strength Member Type Legs 50 ksi Bracing 36 ksi Table 3 displays the summary of the ratio (as a percentage) of force in the member to their capacities. Values greater than 100% indicate locations where the maximum force in the member exceeds its capacity. Note: Capacities up to 105% are considered acceptable. Table 4 displays the maximum foundation reactions. Table 5 displays the maximum antenna rotations at service wind speeds (dishes only). If the assumptions outlined in this report differ from actual field conditions, FDH Engineering, Inc. should be contacted to perform a revised analysis. Furthermore, as no information pertaining to the allowable twist and sway requirements for the existing or proposed appurtenances was provided, deflection and rotation were not taken into consideration when performing this analysis. See the Appendix for detailed modeling information. Table 3 - Summa of Working Percentage of Structural Components Section No. T1 Elevation 152-146 Component Type Leg Size P2.5x.276 GR .pa 16.5 Pass T2 146 -143.417 Leg P2x0.30 GR 22.3 Pass T3 143.417 -141 Leg P2x0.30 GR 29.1 Pass T4 141-136 Leg P2x0.30 GR 49.3 Pass T5 136-126 Leg P2x0.30 GR 73.5 Pass T6 126-116 Leg P2x0.30 GR 82.1 Pass T7 116-111 Leg P2x0.30 GR 79.6 Pass T8 111-108.5 Leg P2x0.30 GR 70.7 Pass T9 108.5-106 Leg P2x0.30 GR 61.3 Pass T10 106 -103.417 Leg P2x0.30 GR 57.8 Pass T11 103.417 -101 Leg P2x0.30 GR 45.0 Pass T12 101- 98.5833 Leg P2x0.30 GR 43.8 Pass T13 98.5833-96 Leg P2x0.30 GR 45.1 Pass T14 96-90 Leg P2.5x.276 GR 50.3 Pass T15 90-80 Leg P2x0.30 GR 64.3 Pass T16 80-70 Leg P2x0.30 GR 65.1 Pass T17 70-60 Leg P2x0.30 GR 66.8 Pass T18 60-50 Leg P2x0.30 GR 69.3 Pass T19 50-40 Leg P2x0.30 GR 77.8 Pass T20 40-30 Leg P2x0.30 GR 78.8 Pass T21 30-20 Leg P2x0.30 GR 80.3 Pass T22 20-10 Leg P2x0.30 GR 82.4 Pass T23 10-0 Leg P2x0.30 GR 84.9 Pass T1 152-146 Diagonal L2112x21/2016 2.1 Pass T2 146 -143.417 Diagonal L2x2xl/4 59.6 81.1 b Pass T3 143.417 -141 Diagonal L13/4x1 3/43/16 75.8 102.6 b Pass T4 141-136 Diagonal L1 3/413/43/16 71.1 95.0 b Pass T5 136-126 Diagonal L1 3/413/43/16 70.4 Pass Document No. ENG -RPT -503S Revision Date: 06117/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 Section No. . ElevationCapacityComponent Type Size 95.7 b T6 126-116 Diagonal L1 3/413/43/16 36.2 43.3 b Pass T7 116-111 Diagonal L1 3/413/43/16 43.4 54.7 b Pass T8 111 -108.5 Diagonal L1 3/413/43/16 74.6 95.5 b Pass T9 108.5-106 Diagonal L2x2x3/16 61.9 90.9 b Pass T10 106 -103.417 Diagonal L2x2x3/16 67.3 96.6 b Pass T11 103.417 -101 Diagonal L2x2x3/16 63.7 90.9 b Pass T12 101- 98.5833 Diagonal L2x2xl/4 53.2 69.7 b Pass T13 98.5833-96 Diagonal L2x2xl/4 57.9 77.6 b Pass T14 96-90 Diagonal L21/2x21/2x7/16 15.3 83.7 b Pass T15 90-80 Diagonal L1 3141 3/43/16 39.5 44.8 b Pass T16 80-70 Diagonal L1 3/41 3/43/16 28.2 Pass T17 70-60 Diagonal L1 3/41 3/43/16 18.2 Pass T18 60-50 Diagonal L1 3/41 3/4x3116 30.7 Pass T19 50-40 Diagonal Ll 3/41 3/43116 39.8 Pass T20 40-30 Diagonal Ll 3/41 3/4x3116 27.0 Pass T21 30-20 Diagonal Ll 314x1 3/43116 17.6 Pass T22 20-10 Diagonal L1 3141 3/43116 18.4 Pass T23 10-0 Diagonal L1 3/41 3/4x3/16 24.0 27.7 b Pass T1 152-146 Horizontal L31/2x4x7/16 0.7 Pass T4 141-136 Horizontal P2x.218 1.7 Pass T5 136-126 Horizontal P2x.218 2.5 Pass T6 126-116 Horizontal P2x.218 3.9 Pass T7 116-111 Horizontal P2x.218 2.8 Pass T8 111-108.5 Horizontal P2x.218 3.1 Pass T9 108.5-106 Horizontal P2x.218 2.4 Pass T11 103.417 -101 Horizontal P2x.218 2.0 Pass T12 101 - 98.5833 Horizontal P2x.218 1.6 Pass T13 98.5833-96 Horizontal P2x.218 1.6 Pass T14 96-90 Horizontal L31/2x4x7/16 10.7 Pass T15 90-80 Horizontal P2x.218 2.2 Pass T16 80-70 Horizontal P2x.218 2.3 Pass T17 70-60 Horizontal P2x.218 2.3 Pass T18 60-50 Horizontal P2x.218 2.4 Pass T19 50-40 Horizontal P2x.218 2.7 Pass T20 40-30 Horizontal P2x.218 2.7 Pass T21 30-20 Horizontal P2x.218 2.8 Pass T22 20-10 Horizontal P2x.218 2.9 Pass T23 10-0 Horizontal P2x.218 2.9 Pass T1 152-146 Top Girt L3112x4x7/16 4.9 Pass T2 146 -143.417 Top Girt P2x.218 9.0 Pass T3 143.417 -141 Top Girt P2x.218 2.6 Pass T5 136-126 Top Girt P2x.218 4.1 Pass T6 126-116 Top Girt P2x.218 1.9 Pass T7 116-111 Top Girt P2x.218 1.5 Pass Document No. ENG -RPT -503S Revision Date: 06/17/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 No. T10 Elevation 106 -103.417 Component Type Top Girt Size P2x.218 CapacitySection 5.1 Pass T14 96-90 Top Girt L31/2x4x7/16 5.1 Pass T15 90-80 Top Girt P2x.218 3.9 Pass T16 80-70 Top Girt P2x.218 1.8 Pass T17 70-60 Top Girt P2x.218 1.0 Pass T18 60-50 Top Girt P2x.218 1.6 Pass T19 1 50-40 Top Girt P2x.218 2.3 Pass T20 40-30 Top Girt P2x.218 3.0 Pass T21 30-20 Top Girt P2x.218 1.1 Pass T22 20-10 Top Girt P2x.218 1.1 Pass T23 10-0 Top Girt P2x.218 1.2 Pass T1 152-146 Bottom Girt L31/2x4x7/16 9.5 Pass T4 141-136 Bottom Girt P2x.218 4.1 Pass T5 136-126 Bottom Girt P2x.218 2.3 Pass T6 126-116 Bottom Girt P2x.218 1.6 Pass T9 108.5-106 Bottom Girt P2x.218 4.7 Pass T13 98.5833-96 Bottom Girt P2x.218 25.7 Pass T14 96-90 Bottom Girt L31/2x4x7/16 10.8 Pass T15 90-80 Bottom Girt P2x.218 1.6 Pass T16 80-70 Bottom Girt P2x.218 1.0 Pass T17 70-60 Bottom Girt P2x.218 1.0 Pass T18 60-50 Bottom Girt P2018 1.5 Pass T19 50-40 Bottom Girt P2x.218 7.1 Pass T20 40-30 Bottom Girt P2x.218 1.4 Pass T21 30-20 Bottom Girt P2x.218 1.1 Pass T22 20-10 Bottom Girt P2x.218 1.2 Pass T23 10-0 Bottom Girt P2x.218 6.6 Pass T1 152-146 Guy A@1 51.5 61.185 de 3/4 41.5 Pass T13 98.5833-96 Guy A@96.11667 61.718 de 3/4 50.9 Pass T19 50-40 Guy A@40.1667 1/2 35.1 Pass T1 152 -146 Guy B@151.5 61.185 de 3/4 41.5 Pass T13 98.5833-96 Guy B@96.1667 61.718 de 314 51.1 Pass T19 50-40 Guy B@40.1667 1/2 35.2 Pass T1 152-146 Guy C@151.5 61.185 de 3/4 41.7 Pass T13 98.5833-96 Guy C@96.1667 61.718 de 3/4 51.1 Pass T19 50-40 Guy C@40.11667 1/2 35.2 Pass T1 152-146 Torque Arm Top@151.5 L3x3xl/4 28.5 53.8 b Pass T13 98.5833-96 Torque Arm Top@96.1667 L3x3xl/4 43.4 81.8 b Pass T1 152-146 Torque Arm Bottom 151.5 L3x3xl/4 94.0 Pass T13 98.5833-96 Torque Arm Bottom 96.1667 L3x3xl/4 101.2 Pass Table 4 - Maximum Base Reactions ` Current analysis reactions are within an allowable factor of 1.35 when original design reactions are based on an allowable stress design per ANSI/TIA-222-G. Modification design capacities determined by Sterling Engineering and Design Group, Ltd. (Report No. 061-697) Structural Analysis Report dated February 17, 2005. "' Inner Anchor determined adequate per independent analysis. Document No. ENG -RPT -503S Revision Date: 06/17/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 GENERAL COMMENTS This engineering analysis is based upon the theoretical capacity of the structure. It is not a condition assessment of the tower and its foundation. It is the responsibility of SBA Network Services, Inc. to verify that the tower modeled and analyzed is the correct structure (with accurate antenna loading information) modeled. If there are substantial modifications to be made or the assumptions made in this analysis are not accurate, FDH Engineering, Inc. should be notified immediately to perform a revised analysis. LIMITATIONS All opinions and conclusions are considered accurate to a reasonable degree of engineering certainty based upon the evidence available at the time of this report. All opinions and conclusions are subject to revision based upon receipt of new or additional/updated information. All services are provided exercising a level of care and diligence equivalent to the standard and care of our profession. No other warranty or guarantee, expressed or implied, is offered. Our services are confidential in nature and we will not release this report to any other party without the client's consent. The use of this engineering work is limited to the express purpose for which it was commissioned and it may not be reused, copied, or distributed for any other purpose without the written consent of FDH Engineering, Inc. Document No. ENG -RPT -503S Revision Date: 06/17/11 Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 APPENDIX Document No. ENG -RPT -503S Revision Date: 06/17/11 (3)118° EXISTING FEEDLINES (3) 7/8" EXISTING FEEDLINES WITHIN (2) Z' EXISTING FLEX CONDUITS (4)1/2" EXISTING FEED LINES FOR CLEARWIRE T0142 CLIMBING LADDE SAFETY C (4) EXISTING HYBRID CABLE (1) 5/8" EXISTING FEED LINE FOR SPRINT T0132 �A LEG (32°) O - EXISTING -PROPOSED -FUTURE Figure 1. Coax Layout Structural Analysis Report SBA Network Services, Inc. SBA Site ID: MA01085-A-13 March 30 2015 (9)1-518" FUTURE FEEDLINES (3)1-5i8" EXISTING FIBER CABLES FOR VERIZON T0112' (1) EXISTING FIBER CABLE (2) EXISTING DC POWER CABLES WITHIN (1) 3" EXISTING CONDUIT f(1) PROPOSED FIBER CABLE (2) PROPOSED DC POWER CABLES WITHIN (1) 3" PROPOSED CONDUIT FOR NEW CINGULAR T0121' (12)1-5/8" EXISTING FEEDLINES FOR NEW CINGULAR T0121' Document No. ENG -RPT -503S Revision Date: 06/17/11 10 152_0 ft 143.4 ft' 141.0 ft 136.0 ft 106_0 ft 103.4 ft 101_0 It 98.6 ft 96.0 ft 90.0 ft 80.0 ft SIZE o SIZE A P2.5x.276 (GR) E P2x.218 N L2 112x2 1/2x7116 Q N.A. m i X W 0 dd z 0 z L3 12KU7116 N N - ALL REACTIONS ARE FACTORED 50.0 ft MAX. CORNER R d z DOWN: 73 K SHEAR: 5 K 40.0 n m m m d - m @ � Ci 214 K O h Ny NN a Nyy a O a 4 z d � s m z W x W i LL m () m d Z O W C) N N a ( lV e Q N N N rr m �X O a a aV O 0. J M m N m C7 42 d m 152_0 ft 143.4 ft' 141.0 ft 136.0 ft 106_0 ft 103.4 ft 101_0 It 98.6 ft 96.0 ft 90.0 ft 80.0 ft SIZE o SIZE A P2.5x.276 (GR) E P2x.218 a L2 112x2 1/2x7116 i N.A. 70.0 it i G 60.0 tt D L3 12KU7116 H 1 @ 2.33333 ALL REACTIONS ARE FACTORED 50.0 ft MAX. CORNER R DOWN: 73 K SHEAR: 5 K 40.0 n UPLIFT. 0 K SHEAR: 0 K - AXIAL -- 214 K 30.0 ft SYMBOL LIST %M08A MARK SIZE MARK SIZE A P2.5x.276 (GR) E P2x.218 a L2 112x2 1/2x7116 F N.A. C L2x2x1/4 G 1 @ 2.5 D L3 12KU7116 H 1 @ 2.33333 MATERIAL STRENGTH GRADE Fy Fu GRADE F Fu A572-50 50 ksi 65 ksi A36 36 ksi 58 ksi \with OWER DESIGN NOTES 1. Tower is locatesex County, Massachusetts. 2. Tower designeposure B to the TIA-222-G Standard. 3. Tower designe10 mph basic wind in accordance with the TIA-222-G Standard. 4. Tower is also dd r a 40 mph basic wind with 1.00 in ice. Ice is considered to increase in thicwith eight.5. Deflections are upo a 60 mph wind. 6. Tower Structurs II.7. Topographic C 1 with est Height of 0.00 ft 8. Grouted pipe fsi9. TOWER RATI2.6% 0 K . j 6 kip -ft 20.0It TORQUE 0 kip -ft 40 mph WIND - 1.0000 in ICE' AXIAL 107 K 10.0 ft SHEAMOMENT 2 K� 45 kip -ft TORQUE 0 kip -ft 0.0 It REACTIONS - 110 mph WIND AT BASE.- 0 ASE. 4K 10 9K R=85.00 It ALL REACTIONS ARE FACTORED \ 9K 1, R=145.00ft FDH Engineering, Inc. 6521 Meridien Drive, Suite 107 Raleigh, North Carolina 27616 T --r Analysis Phone: 919-755-1012 FAX: 919-755-1031 North Andover, MA01085-A-13 Pmlect:15BHDP1400 Ckent. SBA Network Services, Inc. Daae: DVaughan 'P code: TIA-222-G Date: 03/30/15 Scale: NTS Path: Dwg No. E-1 � Qf TYPE m U 103.4 it ❑ W ❑ d O d 101.oft N N HPA-65R-BUU-H8 w/ Mount Pipe C 98.6 ft 142 HPA-65R-BUU-H8 w/ Mount Pipe e 96.0 ft \ (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe z z 121 LLPX31OR w/Mount Pipe 142 (2) LGP21401 TMA 7 90.0 ft 142 (2) RRUS 11 Z RRH2WBO 142 (2) RRUS 11 121 RRH2WBO 12 (2) RRUS 11 121 m 142 RRUS-32 m 80.0 It 142 n 121 12"x 12"x r Junction Box 142 RRUS-32 � (3) 177 -Frames 142 X 121 P2F-52-NXA N DC6.48.60-18.8F 121 C7 ` X i+r 121 N / (2) 860 10025 RCU 121 60.0 ft / ` (2) 860 10025 RCU d a APXVITM4-0-120 w/Mount Pipe \i (3)1Z T -Frames 121 50.0 ft 132 80010121 wl Mount Pipe 121 APXVTM/4-C-120 w/Mount Pipe C i 800 10121 w/ Mount Pipe 121 TD-RRH8x20-25 13299442RRH (2) LNX-6514DS w/ Mount Pipe d z TD-RRH8x20-25 132(2) SBHH-1D6516DS w/ Mount Pipe 112 ;V 132(2) SBHH-1 D6516DS w/ Mount Pipe 112 1900 MHz RRH < SBHH-1 D6516DS wl Mount Pipe 112 1900 MHz RRH U x 1900 MHz RRH r 112 m 132RRH2x60 z w 800 MHz RRH 132 112 800 MHz RRH 132 9412 RRH LU 800 MHz Filter LL 9442 RRH r 800 MHz Filter 132 PCS B25 RRH4X30 112 800 MHz Filter 132 PCS B25 RRH4X30 Z m 132 a 112 ACU -A20 -N RET 132 B25 RRH4X30 112 ACU -A20 -N RET Q B25 RRH030 N (2) 4'x 2"x 3.5" RETS N @ DB-B1-6G-12AB-0Z 112 4" x 2" x 3.5' RETS 132 DB -B1 -6G -0Z 112 4"x 2"x 3.5" RETS w a 112 a 132 (3) Sector Mounts 112 N N m I 112 . APXVSPPl8 w/ Mount Pipe 132 m 112 N r 121 15' Omni 100 800 10766 wl Mount Pipe 121 � 96 800 10766 wl Mount Pipe I 7 Standoff � 800 10766 w/Mount Pipe 121 5 Sat Dish 46 � m n O N N N N O a � @ J C c C c m U C7 49 c v c � Y i -- m 0 0 m m d o o m 0 x u 3 152_0 ft 143.4 ft' 136_0 tt 106.0 tt ELEVATION TYPE ELEVATION 103.4 it / HPA-65R-BUU-H8 w/ Mount Pipe 121 101.oft ` HPA-65R-BUU-H8 w/ Mount Pipe 121 98.6 ft 142 HPA-65R-BUU-H8 w/ Mount Pipe 121 96.0 ft \ (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe 6V/17 (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe 142 (2) LGP21401 TMA 7 90.0 ft 142 (2) RRUS 11 121 RRH2WBO 142 (2) RRUS 11 121 RRH2WBO 142 (2) RRUS 11 121 RRHZWBO 142 RRUS-32 121 80.0 It 142 RRUS-32 121 12"x 12"x r Junction Box 142 RRUS-32 121 (3) 177 -Frames 142 DC648-60-18-8F 121 P2F-52-NXA j. DC6.48.60-18.8F 121 70.0 ft ` (2) 860 10025 RCU 121 VHLP2-11-DWI / (2) 860 10025 RCU 121 60.0 ft / ` (2) 860 10025 RCU 121 APXVITM4-0-120 w/Mount Pipe \i (3)1Z T -Frames 121 50.0 ft 132 80010121 wl Mount Pipe 121 APXVTM/4-C-120 w/Mount Pipe 132 800 10121 w/ Mount Pipe 121 TD-RRH8x20-25 13299442RRH (2) LNX-6514DS w/ Mount Pipe 112 TD-RRH8x20-25 132(2) SBHH-1D6516DS w/ Mount Pipe 112 40.0 It 132(2) SBHH-1 D6516DS w/ Mount Pipe 112 1900 MHz RRH 132(2) SBHH-1 D6516DS wl Mount Pipe 112 1900 MHz RRH 132RRH2x60 112 1900 MHz RRH 132RRH2x60 112 30.0 ft 132RRH2x60 112 20.0 tt ALL REACTIONS \ ARE FACTORED MAX. CORNER REAL DOWN: 73 K SHEAR: 5 K UPLIFT. 0 K SHEAR: OK AXIAL �vHr 214 K I--'14,s68dk DESIGNED APPURTENANCE LOADING TYPE ELEVATION TYPE ELEVATION Lightning Rod 154.6 HPA-65R-BUU-H8 w/ Mount Pipe 121 12" x 6' x 2" ODU 142 HPA-65R-BUU-H8 w/ Mount Pipe 121 r da x 4.5" ODU 142 HPA-65R-BUU-H8 w/ Mount Pipe 121 (2) r dia x 4.5" ODU 142 (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe 142 (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe 142 (2) LGP21401 TMA 121 LLPX31OR w/Mount Pipe 142 (2) RRUS 11 121 RRH2WBO 142 (2) RRUS 11 121 RRH2WBO 142 (2) RRUS 11 121 RRHZWBO 142 RRUS-32 121 12" x 12'x r Junction Box 142 RRUS-32 121 12"x 12"x r Junction Box 142 RRUS-32 121 (3) 177 -Frames 142 DC648-60-18-8F 121 P2F-52-NXA 142 DC6.48.60-18.8F 121 VHLP800-DW 1 142 (2) 860 10025 RCU 121 VHLP2-11-DWI 142 (2) 860 10025 RCU 121 P40-16-XLPP-RR-A w/ Mount Pipe 132 (2) 860 10025 RCU 121 APXVITM4-0-120 w/Mount Pipe 132 (3)1Z T -Frames 121 APXVFM14-C-120 w/Mount Pipe 132 80010121 wl Mount Pipe 121 APXVTM/4-C-120 w/Mount Pipe 132 800 10121 w/ Mount Pipe 121 TD-RRH8x20-25 13299442RRH (2) LNX-6514DS w/ Mount Pipe 112 TD-RRH8x20-25 132(2) SBHH-1D6516DS w/ Mount Pipe 112 TD-RRH8x20-25 132(2) SBHH-1 D6516DS w/ Mount Pipe 112 1900 MHz RRH 132(2) SBHH-1 D6516DS wl Mount Pipe 112 1900 MHz RRH 132RRH2x60 112 1900 MHz RRH 132RRH2x60 112 800 MHz RRH 132RRH2x60 112 800 MHz RRH 132 112 800 MHz RRH 132 9412 RRH 112 800 MHz Filter 132 9442 RRH 112 800 MHz Filter 132 PCS B25 RRH4X30 112 800 MHz Filter 132 PCS B25 RRH4X30 112 (2) ACU -A20 -N RET 132 PCS B25 RRH4X30 112 ACU -A20 -N RET 132 B25 RRH4X30 112 ACU -A20 -N RET 132 B25 RRH030 112 (2) 4'x 2"x 3.5" RETS 132 DB-B1-6G-12AB-0Z 112 4" x 2" x 3.5' RETS 132 DB -B1 -6G -0Z 112 4"x 2"x 3.5" RETS 132 DB-B1-6C-12AB-0Z 112 (3) T -Frames 132 (3) Sector Mounts 112 APXVSPPI8 w/ Mount Pipe 132 (2) LNX-6514DS w/ Mount Pipe 112 . APXVSPPl8 w/ Mount Pipe 132 (2) LNX-6514DS wl Mount Pipe 112 800 10121 w/ Mount Pipe 121 15' Omni 100 800 10766 wl Mount Pipe 121 Torque Ann Pladonn 96 800 10766 wl Mount Pipe 121 7 Standoff 47 800 10766 w/Mount Pipe 121 5 Sat Dish 46 0 K ►i 6 kip -ft K MOMEN 45 kip -ft MARK SIZE MARK SIZE A P2.5x.276 (GR) E P2x.218 B L21/2x21YbO/16 F N.A. C L2x2xl/4 G 1@ 2.5 D L3 1/Dc4x7/16 H i @ 2.33333 Path: Dwg No. E-1 TORQUE 0 kip -ft 40 mph WIND - 1.0000 in ICE AXIAL SYMBOL LIST 10.Oft 107 ` SHEAR 2 K K MOMEN 45 kip -ft MARK SIZE MARK SIZE A P2.5x.276 (GR) E P2x.218 B L21/2x21YbO/16 F N.A. C L2x2xl/4 G 1@ 2.5 D L3 1/Dc4x7/16 H i @ 2.33333 TORQUE 0 kip -ft MATERIAL STRENGTH 0.0 it REACTIONS - 110 mph WIN GRADE Fy Fu GRADE Fy Fu A572-50 50 ksi 65 ksi A36 36 ksi 58, ksi R=85.00 It TOWER DESIGN NOTES 1. Tower is IWi? cNd,}� gti ftE gassachusetts. 2. Tower designed for Exposure B to the TIA-222-G Standard, 3. Tower designed for a 110 mph basic wind in accordance with the TIA-222-G Standard. FDH Engineering, Inc. 6521 Meridien Drive, Suite 107 Raleigh, North Carolina 27616 Tower Analysis Phone: 919-755-1012 FAX: 919-755-1031 "':North Andover, MA01085-A-13 Proled:ISBHDPI400 client SBA Network Services, Inc. Dawn 5y: DVaughan APpd: cede: TIA-222-G Date: 03/30/15 Scale: NTS Path: Dwg No. E-1 Initial Construction Control Document To be submitted with the building permit application by a tr I Registered Design Professional for work per the 8`" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Number: MA3349 Project Title: North Andover Mill Hills Date: April 24, 2015 Property Address: 300 Chestnut Street. North Andover, MA 01845 Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: AT&T Wireless (New Cingular Wireless) Telecommunications site installation. Install new Antenna and radio heads on existing tower. I Daniel P. Hamm, MA Registration Number: 40720 Expiration date: 6/30/16 , 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: Entire Project 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 Enter in the space to the right a "wet" or electronic signature and seal: Phone number: (978)557-5553 Email: Hudson Design Group, LLC 1600 Osgood Lndg, Bldg 20N, Suite 3090 North Andover, MA 01845 a `Final Construction Control Document'. Building Official Use Only Building Official Name: Permit No.: Date: 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 06 11 2013 "". , • � r s � '� a � t * e * w *' M l i � 1 a► # • tl �� The Commonwealth of Massachusetts Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 `` www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARRficant Information Please Print Lellibly Name(susiness/Organizatiot>nndividual): Site Acquisitions, Inc. d/b/a SAI Communications Address: 27 Northwestern Drive City/State/Zin: Salem, NH 03079 Are you an employer? Check the appropriate box: 1,r❑ 2. ❑ I am a employer with 138 employees (full and/or part-time).* 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Phone #: 603.421.0470 4, ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.l ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' corn. insurance required.] Type of project (required): 6. ❑ New construction 7. [] Remodeling S. ❑ Demolition 9. [] Building addition 10.0 Electrical repairs or additions 11.❑ .Plumbing repairs or additions 12.❑ Roof repairs 13.[] other Telecom munications 'Any applicant that checks box #1 must also 611 out flee section below showing their workers' compensation policy information. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors 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 iv the policy and job site information. Insurance Company Name: AIG/Commerce & Industry Ins. Co_ Policy # or Self -ins, Lie. #: WC 62715523 Expiration Date: $/1/2015 Job Site Address: 300 Chestnut Street City/State/Zip: N. Andover, MA 01845 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 cern fy undthpains andpenalties of perjury that thein ormation provided above is true and correct. 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. Citytrown Clerk 4. Electrical Inspector S. 'Plumbing Inspector .6. Other Contact Person: Phone #: ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/28/2015 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(les) 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 USI Insurance Services LLCPHONE 3 Executive Park Drive, Suite 300 Bedford NH 03110-0406 CONTACT NAME: _ 74- 1(AIC, AIC No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:LffibeU Surplus Insurance Corporati 10725 100000327704 INSURED SITEACQU 1 INSURER B:Hanover Insurance Com n 2 INSURER C:Starr Indemnity Site Acquisitions, Inc. dba SAI Communications 27 Northwestern Drive INSURER D:COMMerCe & Industryn r n 41 INSURERE:Hiscox Insurance man Lt 02 0 Salem NH 03079 INSURER F: COVERAGES CERTIFICATE NUMBER: 1 501 961 855 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. TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY EFF MM/DD POLICY EXP LIMITS A GENERAL LIABILITY 100000327704 /1/2015 /1/2016 EACH OCCURRENCE $1,000,000 MMERCIAL GENERAL LIABILITY XCLAIMS-MADE a OCCUR VX B01/PD DAMAGE TO RENTED PREMISES Ea occurrence $300,000 MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $1,000,000 Ded:25,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRo- LOC $ B AUTOMOBILE LIABILITY AWV697898704 /1/2015 /1/2016'(1E1.1m=61NULL LIMIT 1,000000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident $ ) X NON -OWNED HIRED AUTOS Ix AUTOS PROPERTY DAMAGE $ Per accident $ C X UMBRELLA LIAB X OCCUR 1000021452 /1/2015 /1/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDE D9 N❑ N I A WC62715523 /1/2014 /1/2015 X WCSTATU-OTH- —I TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, descr be under E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below E B Professional Inland Marine MPL105991914 IHV707584304 /1/2014 /1/2015 /1/2015 /1/2016 $1 MM/$1 MM/$20,000 Ded $150,000/$2,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This Certificate covers all operations usual and customary to the insured's business. Type of Insurance - Excess Liability/ Policy # 5227949781 / Company - Crum & Forster Ins Co / Term 1/1/15 - 01/01/16 / Limit: $5,000,000 Occ/$5,000,000 Agg / Excess of Starr Indemnity Excess Liability Policy. See Attached... Town of North Andover 1600 Osgood Street No. Andover MA 01845 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACS 16..� AGENCY CUSTOMER ID: SITEACQU1 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED USI Insurance Services LLC Site Acquisitions, Inc. dba SAI Communications 27 Northwestern Drive POLICY NUMBER Salem NH 03079 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 Type of Insurance - Contractors Pollution Liability/ Policy #G2710020A002 / Company: Ace Insurance Company Term: 1/1/2015 - 1/1/2016 / Limit: $3,000,000 Each Pollution Condition/$3,000,000 General Aggregate / $5,000 Deductible RE: MA3349 - 300 Chestnut Street, No. Andover, MA ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. 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