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0121 OCEAN AVENUE
B -Town of Barnstable • r uildn n .�I'osttT.fiis Card SQ.Th t�'�t is-Uis�ble rom:.tfie:S#reet,,�A r+ovedPlans,Must<be;Retained on Job and thisCard-Must-ben°Ke: t , ., ---^ '' ` Posted until'Emal lns ection Has Been Made.- , 163 errlll . Where a Ce`rti�icate'of°Occu ane ;-s Re aired such`Buildm shall Notbe Occu �ed`•un#�l a Final Ins ec#�on,has.been made. Permit NO. B-17-3048 Applicant Name: KEVIN J FARRELL Approvals Date Issued: 09/19/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: m 03/19/2018 Foundation: Location: 121 OCEAN AVENUE, HYANNIS Map/Lot 305-001 Zoning District: RF-1 Sheathing: Owner on Record: BARNSTABLE,TOWN OF(BCH) ;Contractor Name: KEVIN J FARRELL framing: 1 Address: 367 MAIN STREET r Contractor License - CS-096560 2 HYANNIS, MA 02601 M rEst Project Cost: $ 12,500.00 Chimney: Description: VERIZON WIRELESS WOULD LIKE TO MOUNT WIRELESS ANTENNA AND =�s P Permlt Fee: $213.75 ANCILLARY EQUIPMENT ON THE EXISTING EVERSOURCE UTILITY POLE Insulation: LOCATED AT 121 OCEAN AVE POLE#10-13 v FeePaid $213.75 Final: Date 9/19/2017 Project Review Req: VERIZON WIRELESS WOULD LIKE TO MOUNT WIRELESS - _. ANTENNA AND ANCILLARY EQUIPMENT�ON THE'ZEXISTING, , Plumbing/Gas EVERSOURCE UTILITY POLE LOCATED AT 121 OCEAN AVE POLEx Rough Plumbing: p 'Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work a,,,,,,uthorized by this permit is commenced within six monthsafter issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl atio and the approved construction documents forwhich this permit has been granted. All construction,alterations and changes of use of any building and structures shallbe in compliance with the local zone g by law's),and codes. Final Gas: a< > This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspectiori for the entire duration of the work until the completion of the same. . ; Electrical The Certificate of Occupancy will not be issued until all applicable signatures by,,theIBuilding and'Fire Officials are provided on this'permit. - Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing ��� Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: '.'Persons contracting with unregistered contractors,do not.have access to th,e guaranty fund" (as-set fortWin.MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel F „AR STABI E Application A-1. Health Division r, - t Date Issued Conservation Division Application Fee a l3 5 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board -' I Historic - OKH _ Preservation/ Hyannis Project Street Address N Lrle �� Q_(��5 kMA 0C1Q(n Village V�40nn\5 Owner &6SDUCC-P Address Telephone Permit Request VIcV_uh 0*6-eu • Loo JA_ \s)ka -}o rmann�- ww-eVeS5 Qrftn0&. o•rnr9 Af�illrAlu tCNA 9WWA- rn, 4,� _"kSrm(4 fyefs&fc-e LatIti-ta w14_ IVL4fie� Square feet: 1 st floor: existing proposed h 2nd floor: existing vNj'R proposed•Total new n IR Zoning District Flood Plain Groundwater Overlay Project ValuatiorA 560 - 0 0 Construction Type Lot Size Grandfathered: ❑Yes J4No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)V� Age of Existing Structure n e" Historic House: ❑Yes )9 No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other n 1 Y' Basement Finished Area (sq.ft.) to 1 f1t Basement Unfinished Area (sq.ft) N Y� Number of Baths: Full: existing n %f t new Half: existing `n \A new _ Number of Bedrooms: 'A existing _new Total Room Count (not including baths): existing new First Floor Room Count YN Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric ❑Other h\0\ Central Air: ❑Yes �No Fireplaces: Existing New n I AV Existing wood/coal stove: ❑Yes 'W No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _'Barn: ❑ existing ❑ new size :,. Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: n 1 H Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes /ko' If yes, site plan review# Current Use 0+1 JQ Proposed Use ul,+(A►Ar pA-Q- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Y'n F=n61 Telephone Number all- 5R5_ W )qp Address L ca '(Y endffi) jl� License# (N-i l 6er , M Home Improvement Contractor# Email V) y1p Il't+WA— -kme= -Cvm- Worker's Compensation # U'C b (ag I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO acrs'�c�,b1ti �al�c� 1:2��t-e' �Y\�Y�4.pmnam�' SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL { p FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. " - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION IF Map Parcel .pCJ� _Fr, � 7i' ( Application A Health Division Date Issued/ 1i F, Conservation Division Application Feed Planning Dept. p _ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH_ _ Preservation/ Hyannis Project Street Address �. 1 t"� n n Ai Village l��rnn15 Owner Fv of<,r,L_(C� Address Telephone o ® Permit Request _ _ • ,4n i"7 t]'tn uw YA rsa boo,i lA 1N, f if `' (i i I-I'tri1N— ���( Leok4,( oro,( 11.1- AT), - l c _C,4VYVinc, FycfSakfe-E l.Alt''it J [1.- 10- I'3 Square.feet: 1 st floor: existing proposed Y\ 2nd floor: existing 1 O proposed v\\(\ Total new n i t\ Zoning District'" - Flood Plain Groundwater Overlay Project Valuation` Co`nstuction) ype ' Lot Size "Y Grandfathered: ❑Yes ®No If yes, attach supporting documentation. =.. , Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) �� 1 Age of Existing yStructure n 1 �'� Historic House: ❑Yes ,U No On Old King's Highway: ❑Yes No 1 3 Basement Type: ❑ Full ❑Crawl'' ❑Walkout ❑ Other n 1 Y�)" Basement Finished Area(sq.ft.) t Basement Unfinished Area (sq:ft) n \ Y ! Number of Baths: Full: existing n 'P� new \N Half: existing 1, W,\ )P� new Number of Bedrooms: C\ existing _new Total Room Count (not including baths): existing Y\VN riew it\ First Floor Room Count Y\ VN Heat Type and Fuel: 0 Gas ,,,❑.,Oil ❑ Electric ❑ Other h\f\ Central Air: ❑Yes ,®No Fireplaces: Existing New O �- Existing wood/coal sto e:' ❑Yes\] No Detached garage: ❑ existing ❑ new 'size—Pool: ❑existing ❑ new size "Barn: ❑existing ❑ new size lO,14� Attached garage:.❑existing`1❑,new size —Shed: ❑ existing ❑ new size _',Other: n t A Zoning Board of Appeals Authorization '❑ Appeal # Recorded 0 Commercial ❑Yes f®'No If yes, site plan review Current Use Propose6 Use i,t 41 A .. ... _ ._ r- '—'—___�_r.,��,�_ .::-tom. x -�;., ...,.: "`�•;;=� r =--="'- �=F f -,r,-=s`�-•�-�'-° -.• - . :;= APPLICANT INFORMATION F (BUILDER OR HOMEOWNER) Name d Y1>1 Fzlf ce\� Telephone'Number t)c)q 0 Address 0'Veacm, Jt✓ License (D333D Home Improvement Contractor# Email YL 3 �ktlL(' Q -VVMCcYr co-0, Worker'siCompensation # WC U f(01 oq ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO' , SIGNATURE r 7:. DATE a FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. APPENDIX IV Form 1 APPLICATION AND POLE ATTACHMENT LICENSE. Licensee VERIZON WIRELESS Street Address ONE VERIZON WAY,MAIL STOP 4AW100 City,State and Zip BASKING,RIDGE NEW JERSEY 07920 Date 6/17/16 In accordance with the terms and conditions of the Pole Attachment Agreement,application is hereby made for a license to make t Antenna attachment(s)to pole#10-13 located in the municipality of Hyannis in the State of MASSACHUSETTS`.- This request will be designated Pole Attachment License Application Number HyannisSC13MA-903629 Attached are my power supply specifications if applicable.The cable's strand size is 0.5 and weight per , foot of cable is 0.2. Communication Space Power t S mnlY Space Licensee's Name(Print)VERIZON WIRELESS By: Name Barbara Kassabian Signature 8arbara1lCa4>%a411 NSTAR d/b/a EVERSOURCE Power Company Title Site Acquisition - Tel.No.603-303-8001 Fax No. E-mail bkassabian@trmcom.com l ********************* ** **********a** For licensor use,do not write below this line , Pole Attachment License.Applicati n Number is hereGy`granted to make the attachments described in this application to attachments to J01 poles,_ attachments to.FO2 poles, attachments to JU'poles, Power Supplies and other attachments located., 1 in the municipality of in the State of 4•.: as i indicated on the attached "� = Forma. Licensor's Name(Print) S - Cal ° t . Signature (AGREEMENT ID#) Title Q, 03 Date --Tel.No. The Licensee shall submit an original copy of this application to Verizon New England Inc. and NSTAR Electric Company d/b/a EVERSOURCE ENERGY. x 4 Revised 02/23/2015 NSTAR d/b/a EVERSOURCE t Form 2 AUTHORIZATION FOR FIELD SURVEY WORK i Licensee: Verizon Wireless j In accordance with Article III&Appendix I of the Pole Attachment Agreement, I following is a summary of the charges which will apply to complete a field survey covering Pole Attachment License Application Number 1-IyannissC13MA-403629 in the municipality Of Hyannis in the State MaRsarb, FIELD SURVEY CHARGES Field Survev #Poles Unit Rate Total Field Survey Application Fee 1 pole $139.00 $ 139.00 (includes 1st pole) Field Survey 2-200 Poles $ 13.45 per Pole $ Additional Travel Time* ° $200.00 per Day $ TOTAL Charges $$139.00 *Based on average of 75 poles surveyed per day,add$200.00 travel time for each additional day required to complete survey. Please note,if you calculated the cost incorrectly',your check will be returned and a new check for the correct amount must be received by this office in order to schedule the survey.. If you need assistance,please call the HOTLINE on 800-340-9822. The required .field survey covering Pole Attachment License Application# xy-nissC13MA-403629_ : is authorized.I am enclosing an advance payment in the amount of$ 139.00. Licensee's Name(Print)Barbara Kassabian S Signature 13GwbvwcvXa4icd--4 v>✓. Title Site Acquisition Address 16 Chestnut St, Suite 420,Foxboro,MA 02035 4, Tel.No. 603-303-8001 Date 6117/16 Revised 03/06/2015 Eversource Energy I i i FORM 3—EVERSOURCE ITEMIZED Pole Make-Ready Work Charges PAGE OF RCE to Complete:Total Poles Surveyed Total Poles Requiring NSTAR Make-Ready Appendix IV Form 3 FIELD.SukvEy J rmAxE READt W0kK FORM SURVEYORS: DATE OF SURVEY: CWO#: Verizon _ MUNIC:Hyannis STATE: MA Exch Code: Munic Code: Licensee Barbara Kassabian LICENSEE NAME: Verizon Wireless LICENSEE APPLICATION#:HyannisSC13MA-403629 EVERSOURCE _ .. _ RLCO NAME:EVERSOURCE NSTAR APPLICATION# LOCATION POLE#'GATT 5 OWNERSHIP CHARGE _ WORK DESCRIPTION TEL RTE/STREET NAME Tel El F/C J.O. . J.U. F..O. YES NO TASK#S / *Height List one pole per line P.S. Tei El Tel El Tel El REMARKS of Att. Rise r 121 Ocean Ave 10-13 N/A TOTALS: 10 Height of Attachment=Height of Liceasee Attachment shall be 40"below ELCO MGN unless otherwise noted here by Verizon and EVERSOURCE surveyor- Revised 03/06/2015 EVERSSURCE - Work Order Application FOR KEN KENDRICK: Customer Request In-Service Date:9/17116 WO Received Date: Service Address:Street: 121 Occan Ave Suite:_Town:Hyannis Zip: 02601 Customer Of Record: Customer Responsible for Payment of Monthly Electric Bills Name to appear on Monthly Bill: Cellca Partnership DBA—C/O Name: Veriizon Wireless Billing Address:P O.Box 2375, Spokane:WA 992%-2375 Telephone:_Tax ID Number: TBD Existing Account or Meter Number(if applicable):, Property Owner Name(if different from above): _ Owner Address: Owner Phone Number: Party Responsible for Construction costs associated with work order(if different from above) Name:Verizon Wireless • Address: 118 Flanders Road:3rd Floor,Weslbarough.MA 01581 Phone Number: 508-320-2017 Please Note that Articles of Incorporation are required for new commercial EVERSOURCE Customers Type of Service Requested: (Circle Appropriate) X New Service Service Upgrade Service Relocation Temporary Service Pole Relocation Disconnect/Reconnect Service Removal Metering Only OH Service from Pole, Pole#: UG Service from; Riser-Pole# Padmount#: Customer Loading Brief Description of Work Attach (1)-antenna, (2) RRH/Cabinet and Tvoe of Load New Connected Load In KVA M meter to the }Dole. Will require 60 amp - Single Phase Three Phase single phase service. Lighting _- Electric heat Air Conditioninq' i Refrigeration,- Cooking r _ - Electric Dryer Water Heater Computer Process Equip. 14.4 Motors/Elevators ` Miscellaneous Totals 14.4 - j Number of Meters Required: r Residential: Commercial: 1 Public: Main Switch Voltage: . Amperage: Phase: Service Voltage," Amperage; Phase: Facility Type(ie:school, hospital): Telecommunications New Building Square Feet: ALL 480V SERVICES REQUIRE COLD.SEQUENCE METERING(DISCONNECT SWITCH ON THE LINE SIDE OF THE METER If more than-1 meter is required, how will meters be labeled?(ie: Unit 1,2, etc, Unit A, B,etc.) f Additional Equipment: Generator: KW: Phase: Purpose: Motor(S) : Total#: Largest HP: Phase: Locked Rotor AMP: Type of Starting Compensation(choose one): Hard Soft Capacitor VFD *See Article 802 of EVERSOURCE Information and Requirements Book for Maximum LR current and Three Phase Protection Contact Name(circle appropriate): Customer/Contractor/Consultant:Barbara Kassabian Street Address: 16 Chestnut Street Suite420, City, State, Zip: Foxboro, MA 02035 Telephone: Best Time to Call: monday-fR ay 9 am to 5 pm _ Pager: Fax: Cell: 603-303-8001 Electrician: TBD License Number: Business Name:Verizon Wireless Street Address: 118 Flande g Road,3rd Floor City, State, Zip:Westborough, MA 01521 j Telephone: 508-320-2017 Best Time to Call: Pager:: Fax:. Cell: . i Please note that by Interconnecting with the EVERSOURCE Distribution System the Customer of Record acknowledges -that they have reviewed and are in compliance with the EVERSOURCE Information & Requirements for Electric Service(Blue Book). For New Commercial Services, New Residential Developments, New 13.8 kv Two Line Station Electric Service, please provide (2) copies of City/Town approved site plans that illustrates the new facility location and the proposed location of the new utilities(electric, gas,water,sewer,telecommunications)and a One-Line Diagram., For Service Increases at existing facilities, please submit a One-Line Diagram if available. For New Residential Services where a pole must be set,please provide(2)copies of a site plan that illustrates the proposed location of the new facilities. For Temporary Service Requests, please provide(2)copies of a site plan illustrating service location. You may Fax this Form or mail any additional correspondence to: EVERSOURCE ENERGY Electric and Gas One NSTAR Way - Westwood, MA, 02090 1 Tel: (781)441 —3851 Fax,(781)441-3194 Cell:339-987-7059 H. Kendrick SW340 FOR NSTAR USE ONLY ' EVERSOURCE Revenue Allowance: EVERSOURCE Rate::. 1 KVA or KW rating of Existing Loads(if applicable): i Existing Winter Peak Demand: Month/Date/Year: Existing Summer Peak Demand: Month/Date/Year: i A , I ty i i 1 t Product Specifications COMMSCPE® i - POWERED n� - gNDR6W CommScope-Proprietary and Confidential. Preliminary specifications are for illustrative purposes = only and will be updated prior to publication. NH360QM-DG2XR >' Andrew@ Dualband Quasi Omni Metro cell Antenna,698-896 and 1695-2200 MHz, internal RETs with manual override, internal diplexer and active GPS Li band antenna ' f , ` I - Electrical Specifications _ Frequency Band,MHz 698-806 806-896 1695-1880 1850-1990 1920-2200 1( Gain,dBi 5.9 7.0 9.7 9.7 9.7 Beamwidth,Horizontal, degrees 360 360 360 360 360 Beamwidth,Vertical,degrees 28.2 25.4 11,6 10.9 10.3 Beam Tilt,degrees 0-20 0-20 0-14 0-14 0-14 USLS,dB 13 13 10 13 10 Isolation,d8 25 25 25 25 25 ' VSWR 1 Return Loss,dB 1.5 1 14.0 1.5 1 14.0 1.5 1 14.0 1.5 1 14.0 1.5 1 14.0 PIM,3rd Order, 2 x 20 W,dBc -153 -153 -153 -153 -153 Input Power per Port,maximum,watts 125 125 125 125 125 Polarization P 1450 1450 1450 1450 1450 Impedance 50 ohm 50 ohm 50 ohm 50 ohm 50 ohm Electrical Specifications, BASTA" Frequency Band,MHz 698-806 806-896 1695-1980• 1850-1990 1920-2200 Gain by all Beam Tilts,average,dBi 5.3 6.3 9,2 9.3 9.3 I Gain by all Beam Tilts Tolerance,dB 11 10.9 10.6 10.7 10.7 0° 15.1 0016.6 0 ° 19.2 0 ° 19,2 01 19.1 Gain by Beam Tilt,average, dBl 10° 1 5.4 10° 1 6,5 7° 1 9.2 7° 1 9.6 7° 19.7 t• -20° 115.3 20 ° 1 5,7 14 0 1 9.3 , 14 ° 1 9.3 14 0 19.2 Beamwidth,Vertical Tolerance,degrees 13.2 f2.3 10.7 11 t1.1 USLS,dB 14 13 12 12 12 `CommScope®supports NGMN recommendations on Base Station Antenna Standards(BASTA).To learn more about the benefits of BASTA, {� dovMload the whitepaper Time fb Raise the Bar on BSAs. i General Specifications ' jAntenna Brand Andrew@ - 1 Antenna Type Metro Cell Band Multiband t Brand DualPol@ Operating Frequency Band 1695 -2200 MHz (' 698 -896 MHz Internal GPS frequency band '1575.42 MHz Internal GPS VSWR Performance Note Outdoor usage ' ©2015 CommScope,Inc,All rights reserved.All trademarks identified by®or TM are registered trademarks,respectively,of Commscope, page I of 2 All specifications are subject to change wilhoul notice.See www,commscopc.com for the most currant information.Revised:July 20,2015 July 20,2015 1 f , Product Specifications COMMSCCPE° { NH360QMDG-2XR Mechanical Specifications l Color Light gray GPS Connector Interface 4.1-9.5 DIN Female GPS Connector Quantity 1 Lightning Protection do Ground Radiator Material Aluminum Low loss circuit board Radome Material ASA Reflector Material Aluminum RF Connector Interface 7-16 DIN Female RF Connector Location Bottom RF Connector Quantity,total 2 Wind Loading, maximum 225.0 N @ 150 km/h 50.6 Ibf @ 150 km/h Wind Speed, maximum 200.0 km/h 1 124.3 mph Dimensions Length .982.0 mm 1 38.7 in Outer Diameter 305.0 mm 1 12.0 In Net Weight 15.3 kg 1 33.7 lb. r Remote Electrical Tilt(RET) Information Input Voltage 10-30 Vdc [t Power Consumption, idle state,maximum 2.0 W r Power Consumption, normal conditions,maximum 13.0 W Protocol 3GPP/AISG 2.0(Multi-RET) RET Interface '' 8-pin DIN Male - RET Interface,quantity 1 male Regulatory Compliance/Certifications Agency Classification RoHS 2011/65/EU Compliant by Exemption China RoHS SI/T 11364-2006 Above Maximum Concentration Value(MCV) f ISO 9001:2008 Designed,manufactured and/or distributed under this quality management system UU b.. Footnotes Performance Note,' Severe environmental conditions may degrade optimum performance (c2015 CommScope,Inc.All rights reserved.All trademorks identified by n or rM ore registered Irodemarks,respectively,of CommScope. page 2 of 2 All soecificotions ore subject to change without notice,See www.commscope.com for the most current infoimotion.Revised:July 20,2015 July 20,2015 4 � , it b� w � 1� � ' � . r 4 r u ; �a � �" � � �•. '�° ''� + s 's"'�t��: Via, `# ��: . „C - .ram k. "yYf �- �a � :!P'!«"',..���S• wt, "x. �y g,S� , �"'%',�µ�.,' i { ..,,,� J.o•` �. fi � ¢ '4 yam"~ � ,'a . a' � � �� # q' w� y ca . n. _.....• ,,._._.$...,ems. AREA PLAN `ING P E- Q E76511NG POLE(h0-13 SCALE,'-60'-0' L-1 NAD 63 LATITUDE;1147'30'0E.53' NAD S.3 L0N011UDE.-M7017'37.31' I ® CHAPPELL HYANNIS MA SC13 SITE ADDRESS s m s a 1a —cuir ar cs cn AREA PLAN ENGINEERING L 0 1can ontelr: m cs ws; 0 03 6 1lr�c D1h9i 31Y cis asUTILITY POLE#10.13 -olmg ASSOCIATES,LLC a —AV= cs LEASE EXHIBIT 121OCEAN AVENUE Civil•S1!!/cluial-Land Surv eying IWE I REVSaS' I FYI APPb NOT FOR CONSTRUCTION HYANNIS,MIA Offi01 PRQEC DM NO ORAwu10 MANE OAIE LOG.CDQE f2Y NOT TO SE DmGNED Bf.CJS WVMN BY.MY 1160203 1 L-1 06/16/16 W3628 .2 A S7RUCTURFL ANALYSIS SHALL BE TFOS LEASE 15 SMA)A TIC IN NATURE AND PERFORMED ON DOSING URM IS INTENDED TO PROVIDE GEAUAA ME PRIOR TO CONSTRUCTION INFORMATION REGARDING THE LUC A-RON AND SZE OF THE PROPOSED WIRELESS CDMMUNCA"FACILITY. THE SITE LAYOUT MALL BE FiNALRm UPON COMPLETION OF - SITE SURVEY AND MLIFY DESWA A42) rrw�fz?sr uTwnafl� PROP.SEC04AA7 POM . ide PROP,LESSEE WFi1TI1ERHFAD first.4Cnn `' '� S' j r EI' r(St:Pe a 1� . PROF.LESSEE 12rO a 38.7H f CF Pfb7P-ANiFlflta-.� NTENNA +.. _ •� , A MOINRD TO SIDE OF E70SRNG UINY L POLE#10-13_. *e +A PROP.lE5$EE ffi07 _.� iq ANTENNA MOUNTED TO SIOE OF 'g i, PROP.LESSEE ANIENMA MOUKr - ff7A5T0RG UTILITY POLE,#10-F3 T EA?sr aASS 4-35• N PROP tESSRE A4TEN4C�MWNT - "r =(,A.. �; c PROP,SUER DELMRC- PROP LESSEE RGS r` CONDUIT TO METER _ r 'o PROP.GTdO1W WINE PROP.►YB£Id DE11A4C f - PROP.LESSEE(2)A'MAX R ALSG CAM WI TM Y U-GUARD TO MRDOu «Ar- • PROP.LESSEE(2)AC/DC CONVERTERS MOUNTED M"M BRACM. PROP.LESSEE AWS k PCS RRHS PROP.RER IN 2'U-GUARDMOUNTED TO OF . JID-13 Iffm O AAL RM _ ) PROP.13 NEVER WOH ,H �LEM 2)A 1, PROP.1E55P:E:SAR-O AtOU7XTED -. 60AIW 2-POLE MAIN SWANER - WDWN RRH BP/i2CET i(2)•20QWP 2-POE BRE40RS a WlfNit RRJi N44CICEl. ,a PROP.LESSEE(4))r PROP.If55FE(2)lNPU705 FftoP.OUNT ED TKO S�'OF POLE . MOUNTED TO SLOE OF POLE#10-13 COA1f TO OU'lDERS � #10 iS,LMDN bYL RRA•.RvA^CXET T �• fK1PP'.if55EE 9m WITH. PROP.-lam SAR-O::MDUMED - 0 6OW 2-POLE:MAUL BtENU)t • WOW FAR WAOO h(2)?O_2-POLf BIREW 5 r PROP.LESSEE(2)wUxERS �� - A' �, YOUNIID lO SIOE OF POLE 110-13 PROP.Lf35EE "' . GROUND ROD-•—� ELEVATION PHOTO ELEVATION ' 2 S"F.1/W_T'-0- �..L..-..,..// 'SALE N.T.S. NOEMASSOCIATES, CHAPPELLHYANNIS MA SC13 SITE ADDRESS 2 w a A REWED LW EIDW m ca us ELEVATION ENGINEERING 1 o a cTS =0 07 0 U L&W .fUV cis on UTILITY POLE#ID•17 LLC A. A -LEASE AV cb c5 LEASE 17011E1R 121 OCEAN AVENUE Civil•Structural-Land Surveying RATE ronsi 6 HPD NOT FOR CONSTRUCTION EIYANNIS,NA 02601 PRU ECT NA 'DRYAm NAPE' MTE tDG OIOf!€Y NOT To SMIE W-qG a W.OS ORATN Bh RN 14M2D3 L-2 06/%/10 1 403M j 2 • EXIST. PROP. LESSEE MEIER WITH 60AMP 2-POLE MAIN BREAKER &(2)20AMP 2-POLE BREAKERS PROP.LESSEE 12.0'0 x £X"T tl/p ,r/" 38.7 H ANTENNA MOUNTED TO rY0-15 0 EXISTING UTILrrY POLE#10-13 PROP. LESSEE(2)DELTA PROP. LESSEE(2)01PlEXETTS k < AC/DC CONVERTER MOUNTED MOUNTED TO RRH BRACKET WITHIN RRH BRACKET .®r•, PROP.ANIENYA r PROP. LESSEE 12.0'0 x PROP. LESSEE DUAL AWS/PCS 383'H ANTENNA MOUNTED tISSEE RAD10 UNIT MOUNTED TO TO EXISTING POLE#10-13 PROP.ANT --M EXISTING POLE#10-13 O I - ANTENNA PLAN UNT ANTENNA MOUNTING DETAIL(•1 L �.. STALE:1/i'- 1•-0' l-S SCALE Y/S- T-O' 7 s£caroaRr COAX CAME ITeEn PRONIIWIL x _ • &IIAUOIA0. �1 I I I 122 P I (305 YY) - . Flo OEI4ARG_ j j I ON 1 DIPLDS(M.z) d RCS k15'AA-i 56 �'. y x 4a Slft-0 I t ��� ry 1T'rn �• # Y• �-,+►,_4 DUAL RADIO UNIT ' 4 SMALL CELL CANTENNA arcs: .. METER sOCKEI WRN A7771ClIFD 6OA-2 I t^Y " ONDSIONS: 21.1.11 x 12"W x 7.2•0 POLE 05CONNECI SWRCH R15E0 WDH I OWENSIM 12.0'0 x 3&7' WEIGHT: 51 LBS (2)20A-2 POLE CIRCUIT 8REldLEltS. j WIBQR: 333 UBS 'sow AM - ._ DNENSIM& 251IN x lWill x 7.n 1 L. 9YTxJlf: 38..9.Uts- _ ,L-= - GLOUND ANTENNA DETAIL + RADIO DETAIL GENERAL- WIRING DIAGRAM SCALE_k:LS..- L-J SCALE ELTS L-3 SCALE,•-N.T.S y I Skm CHAPPELL HYANNIS MA SIC 13 SITE ADDRESS i b Coma �cisrs EQUIPMENT DETAILS ENGINEERING 1 a7 c Ls 1 LEA1£ Us I cs, . 0 C.IS:cs' UTILITY POLE M1D13 �~ ASSOCIATES,LLC A 1 - T Rv cs LEASE EXHIBIT NOT OCEAN AVENUE - Civil Structural•Land Surveying rage'R b NOT FOR CONSTRUCTION HYANNIS,MAO2NO7 PRUECI Ya °AW4 Mgt Lie COOS my NOT TO SALE OCMW W.CIS DIa1Ntt BY:i1N "m 203 - L-3 D5/18/1c WYBTt 2 vew wrreless July 2,M5 Dear Sir%Madam: Re- TRM. Lnc'., w . Please accept tti'i"s letter;as notification that TRM,:,Inc.,of Foxborough,'Massachusetts has been engaged - ? to perform research on certain pr;:opertiesiand real estate including subrriitti1.ng`for zoning approval, building permits and negotiating.real,estate agreements as well.as engage in certain engineering analysis;and conatructionfor Verizon Wireless'ongoing-:network enhance.menf . I TRM, Inc.,.is authorized:to act o.h..Ver¢on Wireless'behalf for the purpose of filing-arid consummating;;any zon ng and/or building permit applications necessary to obtain approval of the>.applicable jurisdiction for the installation and/-or modification:of Verizon Wireless':communications facilities. Should you have>any questions regarding any TRM, Ines activities on,behalf of Verizon,Wireless;,,feel free to contact Me at 508 320-2017.or via,email atscan,conway@verizonwireless:com Resp ctfully; Sean`C`onway . Verizon Wireless Project Manager=:Real"Estate 4 VerI all wirel ess May 9, 2017 Dear Sir/Madam: Re: Kevin Farrell/NEEC , Please accept this letter as notification that Keven Farrell working for NEEC, of Kingston, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits,and construction for Verizon.Wireless'ongoing network enhancement. Keven Farrell / NEEC is authorized to act on Verizon Wireless behalf for the purpose of.filing and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless' communication Facilities. Should you have.any questions regarding this please contact me at 508-942-7503 or via email at npelletier@trmcom.com. 4ectfully, Sean Conway Verizon Wireless Project Mamanger—Real Eastate y s P mla 3x ' y x l * —At - .: a'nr x "'k. .s. � -t'a_ s - 3 sa C' - t _O v VV vu'' % ,, � .«r y # et e- ¢ ; - 711 Vll Of -4 itt", m*,- *!:T A- ulaxions ., '. 'ed % r.t` e,"tig Pll ;§t."' Y `�?.7—l' ; v 'ilk ld� VL i c e-,ows CS T4, Nit c ,x p Mc � gnuu „ OWN �111 F _77j „gam, a � }} Soi �'= ` � T�- i a 40- ARs - rzei 'J- �' -'*��'£, ray.,a ;: 34 m C t - w a °'t .x > maims``. ^' * c - - Vt— Al 4 n, T�s 1 'I f! �. > V ' �: a, P a� � p � `��� � � �. ass f,r .� •'� "°es * �` +� s a " -� x " a K S to Ei Or ti The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. ' I Congress Street, Suite 100 Boston,MA 02114-2617' www.mass.gov%dia Workers' Compensation Insurance Affidavit Builders,/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(Business/Organization/Individual) New England:Electrical Contracting Corporation Address:21 Marion Drive City/State/Zip-Kingston MA Q2364 Phone#:781-585-0040' Are you an employer?Check.the appropriate box: Type of project(required): 1.21 1 am a employer with 48 4. ❑ I am a general contractor and.I employees(full and/or part-.time).* have hired the sub-contractors 6. ❑New construction listed.on the attached sheet. 7, Remodelin ❑ g 2.❑ I am a sole.proprietor or partner- - ship and have no employees These sub-contractors have. g. ❑:Demolition working forme in anypacit employees and have workers' comp. insurance* 9. ❑ Building addition [No workers comp..insurance p required.] 5. ❑ "We are a corporation and its 10.❑ Electrical repairs or additions I❑ I.am a'homeowner doing all work officers have exercised their I L Plumbing repairs or additions myself. [No workers.' comp. right of exemption per MGLI. I 12.❑ Roof repairs insurance required:]t c. 152, §1(4),and we have no employees. [No workers' 13 ❑ Other comp, insurance required.] 'Any applicant that checks box.#I 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 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 subrcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they mustprovide their workers'comp.policy number. I am an employer that is providing;workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:Zurich,American . Policy#or..Self-ins.Lic.#:WC0161691 .Expiration Date:11/13/2Q17 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation:policy declaration page(showing the policynumber and expiration date). Failure to.secure coverage as required under Section 25A of MGL a 152,can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisoriment,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 hereb certi un the pains and. "enalti o y er, uLE that-fie in ormationprovided above is true and correct.. Si _ ature: Date: - Phone 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 b.Other Contact P.erson: Phone#: Client#:23780 NEWEN16 DATE(MMIDD/YYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 11/15/2016 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 .CONTACT J Smith NAME: Sullivan Insurance Group,Inc. PHONE 508 791-2241 F 508 797-3689 1 Mercantile StreetE-MAIL� Ext: A/c,No Suite 710 ADDRESS: Jsmith@sullivangroup.com Worcester,MA 01608 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Gemini Insurance Company INSURED INSURER B:North River Insurance Company ' New England Electrical Contracting Corp INSURER CZurich American 21 Marion Drive INSURERD:Hanover Insurance Company Kingston,MA 02364 ' INSURER E 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 LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY X X VCGPO81520 11/13/2016 11/13/2017 EACHOCCCURRENCE $1,000000 PICLAIMS-MADE MMERCIAL GENERAL LIABILITY - PREMISES Ea occ'ran.) r°nce $50 000 FOCCUR MED EXP(Any one person) $10,000 BI/PD Ded:5,000 PERSONAL BADVINJURY $1,000,000 ' GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X PRO LOC POLICY $ JECT MBINED SINGLE LIMIT D AUTOMOBILE LIABILITY X x• AWNA947880 11/13/2016 11/13/201 CO Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B X UMBRELLA LIAB X OCCUR X X 5811075702 11/13/2016 11/13/2017 EACH OCCURRENCE $5000000 EXCESS LIAB CLAIMS-MADE - • AGGREGATE s5,000,000 DED I RETENTION$ $ `+ WORKERS COMPENSATION X WC0161691 11/13/2016 11113/201- X WC STATU- OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? F (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Cert Holder named as additional insured.Policies are primary and non contributory.Policies include Waiver of subrogation. 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 - n i ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #303267 KMD E ®- CHAPPELL ENGINEERING f ASSOCIATES,LLc i Civil•Structural-Land Surveyinc FAAAA SURVEY CERTIFICATION Applicant: Bell Atlantic Mobile of Massachusetts_ Corporate(dba Verizon Wireless) 118 Flanders Road. Westborough, MA 01581 Site Name: Hyannis MA SC13 Site Address: Utility Pole#10-13 121 Ocean Avenue Hyannis, MA 02601 Horizontal Datum: X GPS survey ❑Ground survey Vertical Datum: NAVD 1988 (AMSL) X GPS survey ❑Ground survey Structure Type: []New Tower ❑ Existing Steeple ❑Roof Top • ❑Water.Tank ❑Existing Silo ®Utility Pole Latitude: 41138'06;63" NAD83 Longitude: 700 17' 37:31" NAD83 Ground Elevation.: 0' (AGL) 7.5' .(AMSL)' Top of Existing Utility Pole-, 38.5' (AGL) .46.0' (AMSL) Centerline of Prop. Antennas: 30.1' (AGL) 37.6' (AMSL) Overall Height of Existing Structure, Including Appurtenances: 39.5' (AGL) 47.0' (AMSL) Certification: i certify that the latitude and longitude are accurate to within +/- 15 feet horizontally and that the ground elevation is accurate to within +/-3 feet vertically. The horizontal datum (coordinates)are expressed in terms of degrees, minutes, seconds and tenths of seconds. The vertical datum:(heights)are expressed in terms of feet.. Company: Chappell Engineering Associates Professional Engineer: Clement J.Salek, P.E. Date: , ' June 16,2016 NT d: NIL No.47362 ( �lAL R.K.Executive Centre®201 Boston Post Road Went a Suite 101 ®Miorlborough.MA 01752 t.•508.481.7400 0 www.choppellengirieering.Com f.50S.<181.7A06 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application#�� + Health Division Conservation Division Permit# Tax Collector Date Issued O f Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address __ � ('1 c�.� f-�,�l�i e•, �5 ( 't�„1n„� se. Village c, V1 < Owner 2� , v,. c e«.,r1_s+ (e Address Telephone G-0-5 _ C (3 2 Q Permit Request Re-sc lo'!!E� &CLC-L Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 (�a(] 6� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's:Highway: O Yes v4. ❑Noco Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �. Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �-i Number of Baths: Full:existing new Half:existing t new r" Number of Bedrooms: existing new �. Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name l r�✓L —2,k Telephone Number �� 3 21 6 7 Address O ,o e C cap n P/ License# dJla o n,S Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2 00 P r' FOR OFFICIAL USE ONLY PERMIT NO. � DATE ISSUED MAP/PARCEL NO. - r t S � 3 ADDRESS VILLAGE i OWNER r DATE OF INSPECTION: FOUNDATION t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r r GAS: ROUGH FINAL i FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. - v Department of Industrial Accidents Office.of Investigations: 600 Washington Street Boston,MA 02111 ',4 ,�• ' www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Legibly valrie (Business/Organization/7ndividual): Y\ ��,p Address: 3a` .City/State/Zip: qQnl K S d ` Phone#• d Tj O C'3 Zo . ►re you an employer? Check the-appropriate box:: Type of project(required): ❑ 1 am a employer with 4, ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling _ ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.0 Electrical repairs or.additions ❑ I am a homeowner doing all work right of exemption per MGL ME] Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no. 12.❑ Roof repairs insurance required.] t employees. [No workers'' 13.❑ Other comp.insurance required.] ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: `e iomeowners who submit this affidavit indicating they are doing all work and then hie outside contractors must submit a new affidavit indicating such mtractors that check this box must attached an additions]sheet showing the name of the sub-contractors and their,workers'comp.policy information. . tm an employer that is providing workers'compensation insurance for my employees'Below is the policy and job site Formation. Durance Company Name: licy#or Self-ins.Lic..#: Expiration Date: b Site Address: City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of restigations of the DIA for insurance coverage verification. 'o hereby cetWAjmder the pains and penalties of perjury that the information provided cedd above is true and correct afore:. Date:- C " 0.G one#:. 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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. ursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, Kpress or implied,oral or written." ,n employer is defined as"an?:vdividnal,PartnetshiP,:association,corporation or other legal entity,or any two or more f the foregoing.engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the Deeiver or trustee of an individual,partnership, association or other legal entity,employing.employees. However the weer of a dwelling1ouse having not more than three apartments and who resides therein,.or.the occupant of the welling house of another who employs persons to do maintenance, construction or repair woik-on such dwelling house_ ,r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." AGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance,or enewai of a license or permit to operate a business or to construct buildings in the commonwealth for any ipplicant who has not produced acceptable evidence-of compliance with the insurance coverage required." kdditionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall .uter into any contract for the performance of public work until acceptable evidence of compliance with the insurance -equirements of this chapter have been presented to the contracting authority." 4pplicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone numbers)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their. self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event The Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that mast submit multiple permitlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"*the applicant should write"all locations in __' (city or town)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that-a valid affidavit is-on file for.future permits.or licenses..A new affidavit must be filled out.each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this. affidavit The Office�of Investigations would like to thank you in advance for your cooperation and should you.have any questions, please do not hesitate to give us a call. _ The Department's address,telephone and.fainumber: The Commonwealth of Massachusetts . . ' Department of Industrial.Accidents ..Office 9f juvestigations 600 Washington Street Boston,MA 0211 L. r Tel.#617-727-4900 ext 406 or-1-877-MASSAFE Jm Fax#617-727-7749 . wised 5-26.05 www mass.gov/dia * 'S,r ..3 �'- <'.�:, ate,r' , F, ... , °„a-;e a�"5.:. ,�. 11 tr Y•. �.�,W. 3 j ^ � �: P. ., •m. E .aa 'k,. ,� rns~n �°� I h}� �� `iwyt S. a° .�h„7 r.,,� "�" '. i `.,' � it., w, r+k,J.r�`% why' �•',• €-e�.�'It� �.r '"� '� ii� � a,". ,�'.;: '�a -.r `:`'•:, " _:,, , - ,: ;,,,' °„ ��' ,,, = ;'-•:. 0,-. ,�. �t..x•, ;r, �m!; �"' `•�-' aGa� •.:'*�m� `"`: ! i �'�'":;�•c yk'" : ,�,. ',i°'°" �,'.t�` a"`,-fir ,xi + «�,",,.,,. 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I ' , t m a h , „ <�+;I •lira n`': s ., :. � {... a � � - .s+ 'xa' ,. ,„. x.. ®r WAIM rl�` g r &a " {• ' t SITE CONTROL POINT AREA PLAN- 1 q— EXISTING POLE #10-13 f' L SCALE:,1" 60'-0" L-1 NAD 83 LATITUDE: N41'38'06.53" NAD 83 LONGITUDE: W70'17'37.31', CHAPPELL HYANNIS MA SC13 SITE ADDRESS 2 06 16 16 REVISED LEASE EXHIBIT JRV CJS cis AREA PLAN ENGINEERING 1 05/19/16 REVISED LEASE EXHIBIT JRV CJS CJS 0 03 01 16 LEASE EXHIBIT 'RV CJS t CJS UTILITY POLE#10-13 ASSOCIATES,LLC A 02 23 16 DRAFT LEASE EXHIBIT JRV cis cis I I LEASE EXHIBIT ' 121 OCEAN AVENUE Civil Structural Land Surveying N0. DATE REVISIONS BY CHK APP'D NOT FOR CONSTRUCTION HYANNIS,MA 02601 PROJECT NO. DRAWING NAME DATE LOC. CO9EREVNOT TO SCALE DESIGNED BY: CJS DRAWN BY: JRV L06/16/16 403629 LEASE EXHIBIT NO A STRUCTURAL ANALYSIS SHALL BE THIS LEASE IS SCHEMATIC IN NATURE AND PERFORMED ON EXISTING UTILITY IS INTENDED TO PROVIDE GENERAL POLE PRIOR TO CONSTRUCTION INFORMATION REGARDING THE LOCATION AND SIZE OF THE PROPOSED WIRELESS COMMUNICATION FACILITY. THE SITE LAYOUT WILL BE FINALIZED UPON COMPLETION OF SITE SURVEY AND FACILITY DESIGN. EXIST. PRIMARY POWER IMRE EL. =47 0't (39.5 j— AGL) 1 TOP OF EXIST. UTILITY POLEEfO-13 f EL. =46.0't (3B.Sf AGL) 1 PROP. SECONDARY POWER • EL = 43.2 t 35.Tt AGL � ; x, . -. "•-�,- t PROP. LESSEE WEATHERHEAD EXIST. WIRE 4 EL. =39.6't (321 i AGL o 'TOP'OF PROP. ANTENNA „ - ECT= 39.2 t. 31.7 I. AGL _ EXIST. WIRE - � �• — — EC.=3d.6t731.1f AGL a" PROP..LESSEE 12.0"0 x 38.7"H OF PROP. ANTENNAS All ,• ANTENNA MOUNTED TO SIDE OF — �^ EXISTING UTILITY POLE #10-13 EL. = 37.6't (30.1't AGL) - PROP. LESSEE 12.0"0 x 38.7"H ANTENNA MOUNTED TO SIDE OF FOO EXISTING UTILITY POLE #10-13 7 PROP. LESSEE ANTENNA MOUNT t1T �O�Yp FR " Oy, EXIST CLASS 4-35' H PROP. LESSEE ANTENNA MOUNT „ µ UTILITY POLE 110-13 EXIST TELCO WIRE "' � EL. =29.3t 21.8E AGL n PROP. FIBER DEMARC PROP. LESSEE RGS _. e CONDUIT TO METER -+1 n PROP. GROUND WIRE - *_ } PROP. LESSEE (2)Xz",COAX & AISG- ^ I PROP FIBER DEMARC _ CABLE WITHIN 2" U-GUARD TO ANTENNA �' I �> • �� PROP. LESSEE (2) AC/DC • CONVERTERS MOUNTED a WITHIN RRH BRACKET. PROP. LESSEE AWS & PCS RRHS PROP. FIBER 9N 2" U-GUARD * MOUNTED TO SIDE OF POLE I #10-13 WITH DUAL RRH BRACKET II PROP. LESSEE METER WITH PROP. LESSEE (2) AC/DC E ` v PROP. LESSEE SAR-0 MOUNTED 60AMP 2-POLE MAIN BREAKER * CONVERTERS MOUNTED WITHIN RRH BRACKET & (2)2OAMP 2-POLE BREAKERS N WITHIN RRH BRACKET. PROP. LESSEE (4)J�" PROP. LESSEE (2) DIPLEXERS PROP. LESSEE AWS & PCS RRHS i' + COAX TO DIPLEXERS MOUNTED TO SIDE OF POLE #10-13 MOUNTED A SIDE OF POLE 10-13 WITH DUAL RRH BRACKET •_ .- # _ 1" PROP. LESSEE.METER WITH , PROP. LESSEE SAR=O MOUNTED ® 60AMP 2-POLE MAIN BREAKER w WITHIN RRH BRACKET ; : & (2)20AMP 2-POLE BREAKERS 0 0 PROP: LESSEE (2) DIPLEXERS` cD in MOUNTED TO SIDE OF POLE #10-13 GROUND LEVEL 7 } EL. = 7 5 t O.O t AGL)— PROP. LESSEE GROUND ROD ELEVATION PHOTO ELEVATION r2 SCALE: 1/8" = l'-0" L-2 SCALE: N.T.S. CHAPPELL HYANNIS MA SC13 SITE ADDRESS 2 06 16 16 REVISED LEASE EXHIBIT JRV CJS CJS ELEVATION ENGINEERING, 1 05/19 16 REVISED LEASE EXHIBIT JRV CJS CJS 1. o 03 Ot 1s LEASE EXHIBIT JRv cis cis UTILITY POLE#10-13 ASSOCIATES,LLC A o2 23 16 DRAFT LEASE EXHIBIT JRV Cis cis LEASE EXHIBIT 121 OCEAN AVENUE N0. DATE REVISIONS BY CHK APP'D NOT FOR CONSTRUCTION HYANNIS,MA 02601 PROJECT N0. DRAWING NAME DATE LOC. CODEF-2 - C1vil Structural-Lan d Surveying v NOT TO SCALE DESIGNED BY: CJS DRAWN BY: JRV 1460.203 L-2 O6/16/16 403629 j ( EXIST. U/P , ate+' Iy10-13 , • PROP. LESSEE METER WITH , 60AMP 2-POLE MAIN BREAKER , & (2)2OAMP 2-POLE BREAKERS I PROP. LESSEE 12.0"0 x Exrsr. u/P /� I 383"H ANTENNA MOUNTED TO • �10-13 oK ( , EXISTING UTILITY POLE #10-13 PROP.' LESSEE BRACKET '0NW I PROP. LESSEE (2)DIPLEXERS AC/DC CONVERTER MOUNTED MOUNTED TO RRH BRACKET, I WITHIN RRH BRACKET i PROP. ANTENNA PROP. LESSEE 12.0"0 x PROP. LESSEE DUAL AWS/PCS 38.7"H ANTENNA MOUNTED RADIO UNIT MOUNTED TO TO EXISTING POLE #10-13 PROP. LESSEE L 11 EXISTING POLE #10-13 ANTENNA MOUNT ANTENNA PLAN 3 ANTENNA MOUNTING DETAIL 4 , SCALE: 1/4" = 1'-0" L-3 �tt SCALE: 1/4" = 1'-0" L-3 i F --- -- J--- —� SECONDARY r COAX CABLE r —�A----11--�-- — T——--- FIBER lu� r n t. FIBER FRONTHAUL . L 1 & BACKHAUL� 12.0"0 I I L (305'MM) FIBER DEMARC ON POLE I I I I • - •' �� : DIPLEXER (TYP. 2) I '` a ! • �. I III � � , € -PCS AWS Pm ay ' ° I RRH RRH I .Cq .` ' SAR-0 , I y C-- _j;� DELTA AC/DC CONVERTER (TYP. 2)- I " DUAL RADIO UNIT SMALL CELL CANTENNA METER SO CKET WITH ATTACHED I - -, DIMENSIONS: 21.4"H x 12"W x 7.2"D . WITH ITH DIMENSIONS: 12.0"0 x 38.7" _ WEIGHT: 51 LBS POLE DISCONNECT SWITCH FUSED W W I I M WEIGHT: 33.7 LEIS (2) 20A-2 POLE CIRCUIT BREAKERS. 90W AWS: O DIMENSIONS: 25.8H x•11.8W x 7.2"0 I L WEIGHT: . 56.9 LBS I-- ——- GROUND ANTENNA DETAIL 1 RADIO DETAIL 2 GENERAL WIRING DIAGRAM 5 SCALE: N.T.S. L-3 SCALE: N.T.S. L-3 SCALE: N.T.S. L-3 CHAPPELL HYANNIS MA SC13 SITE ADDRESS 2 06 16 16 REVISED LEASE EXHIBIT' JRV CJS Cis EQUIPMENT DETAILS ENGINEERING 1 05/19/16 REVISED LEASE EXHIBIT WV CJS Cis 0 03/01 16 LEASE EXHIBIT JRV CJS CJS UTILITY POLE#10-13 ASSOCIATES,LLC A 1 02 23 16 DRAFT LEASE EXHIBIT JRv CJS Cis LEASE EXHIBIT 121 OCEAN AVENUE Civil Structural Land Surveying NO. DATE REVISIONS BY CHK APP'D NOT FOR CONSTRUCTION HYANNIS,MA 02601 PROJECT NO. DRAWING NAME DAIS LOC. CODE REV NOT TO SCALE DESIGNED BY: CJS DRAWN BY: JRV 1460.203 L-3 06/16/16 403629 2 F t 7 fV ++�� r .r �,s�. a I°g; err�5�p�] *��"'awzu ., ��2` tl>{�k ���-.� �,.a •��-,x °� - off, r?�*a �•P �'e'!'a :1( y�� ,� G. - •�, ,.#.�-M L k f:. �",w.f' `C I�t 'V' {a Af T 8 b - „ r.ti .�_ - i< � �Z,. as �� •- < u tip , a a,. x lip - ' • - ?7 h _ „ A na At Im r { , { low Al m — . x r a -. ^t'c m _ `°'T,its"'-�-.� .y_�:,,,•-r,..an..s•.�� H - �,`Ya i :� _ ' i ' • 'ice .F y d 6$� d� v, • v I lzln3 •1 h.:s ,' ,] \i' 7i' 1 '1 $ ° }' _ i 'f V�yM 1 k 'tea 41 1 :rc - . z r , y W • r` R a �m a �3 +. k, 41 a , , 1 „ } s AREA PLAN 1 SITE ON °o I�,D—,3 SCALE: 1" = 60'-0" L-1 NAD 83 LATITUDE:'N41.38'06.53' NAD 83 LONGITUDE: W70'17'37.31" CHAPPELL HYANNIS MA SC13 - SITE ADDRESS 2 06 16 16 REVISED LEASE EXHIBIT JRV CJS CJS AREA PLAN ENGINEERING 1 05/19/16 REVISED LEASE EXHIBIT JRV cis cis 0 03 01/16 LEASE EXHIBIT JRV cis cis LEASE EXHIBIT UTILITY POLE#10-13 ASSOCIATES,LLC A 02 23 16 DRAFT LEASE EXHIBIT JRV CJS CJS 121 OCEAN AVENUE CivilStl Structural Lc3fIC�Surveying NO. DATE REVISIONS BY CHK APP'D NOT FOR CONSTRUCTION HYANNIS,MA 02601 PROJECT NO. DRAWING NAME DATE LOC. CODE REV NOT TO SCALE DESIGNED BY: CJS DRAWN BY. JRV 1460.203 L=1 06/16/16 403629 2 C,l i LEASE EXHIBIT OT A STRUCTURAL ANALYSIS SHALL BE THIS LEASE IS SCHEMATIC IN NATURE AND PERFORMED ON EXISTING UTILITY i v IS INTENDED TO PROVIDE GENERAL POLE PRIOR TO CONSTRUCTION INFORMATION'REGARDING THE LOCATION AND SIZE OF THE PROPOSED WIRELESS " COMMUNICATION FACILITY. THE SITE LAYOUT WILL BE FINALIZED UPON COMPLETION OF SITE SURVEY AND FACILITY DESIGN. EXIST. PRIMARY POWER WIRE� - EL. =47.0't (J9.5'iiCL) TOP OF EXIST. UTILITY P0LE 110-1133 EL. =46.O'f (38.5f AGL) PROP. SECONDARY POWER ± EL. = 43.2 t 35.Tt AGL PROP. LESSEE WEATHERHEAD _EXIST. WIRE �EL. =3�9.6 t (3211- AGL) - +o TOP OF PROP. ANTENNA ; EL. = 39.2 t 31.T t AGL _ EXIST. WIRE la EL=3B.6 t 731.1 t AGL ' 4 " ¢A, PROP. LESSEE 12.0"0 x 38.7"H OF PROP. ANTENNAS ANTENNA MOUNTED TO SIDE OF EL. = 37.6't (30.1't�AGL) ' EXISTING UTILITY POLE #10-13 PROP. LESSEE 12.0"0 x 38.7"H ANTENNA MOUNTED TO SIDE OF FCO PROP. LESSEE ANTENNA MOUNT - EXISTING UTILITY POLE 910-13 N0aPyp0 fit. 4 EXIST CLASS 4-35' 'H PROP LESSEE ANTENNA MOUNT UTILITY POLE 110-13 M EXIST TELCO WIRE PROP. FIBER DEMARC EL =29.3f 21.8f AGL * M Ui PROP. LESSEE RGS CONDUIT TO METER H PROP. GROUND WIRE n �. PROP. LESSEE (2)Y2- COAX & AISG ^_ k PROP. FIBER DEMARC CABLE WITHIN 2" U-GUARD TO ANTENNA PROP. LESSEE'(2) AC/DC CONVERTERS MOUNTED WITHIN RRH BRACKET. 4" "FIBER IN 2 U-GUARD• PROP. LESSEE AWS & PCS RRHS PROP. 1 MOUNTED TO SIDE OF POLE #10-13 WITH DUAL RRH BRACKET (� PROP. LESSEE METER WffH PROP. LESSEE (2) AC/DC PROP. LESSEE SAR-0 MOUNTED 60AMP 2-POLE MAIN BREAKER m CONVERTERS MOUNTED "` i WITHIN RRH BRACKET & (2)20AMP 2-POLE BREAKERS - OR a WITHIN RRH BRACKET. „,- PROP. LESSEE (4)Xz" PROP. LESSEE (2) DIPLEXERS N _ PROP. LESSEE AWS & PCS RRHS COAX TO DIPLEXERS MOUNTED TO SIDE OF POLE #10-13 rK1i MOUNTED TO SIDE OF POLE #10-13 WITH DUAL RRH BRACKET I - " PROP LESSEE METER WITH PROP. LESSEE SAR-O MOUNTED ^ p 60AMP 2-POLE MAIN BREAKER -H w WITHIN RRH BRACKET & (2)20AMP 2-POLE BREAKERS " T _ r PROP. LESSEE (2) Dlf'LEXERS MOUNTED TO SIDE OF POLE #10-13 GROUND LEVEL —ice) EL. = 7.5t 0.Ot AGL I PROP. LESSEE y GROUND ROD 4T I ELEVATION PHOTO ELEVATION 2 SCALE: 1/8" = 1'-0" L-2 SCALE: N.T.S. L-2 CHAPPELL HYANNIS MA SC13 SITE ADDRESS . 2 06 16 16 REVISED LEASE EXHIBIT JRV CJS US ELEVATION ENGINEERING 1 05/19 16 REVISED LEASE EXHIBIT JRV cis cis 0 03 of 16 LEASE EXHIBIT JRV CJS CJS UTILITY POLE#1D-13 ASSOCIATES,LLC A 02 23 16 DRAFT LEASE EXHIBIT JRV CJS CJS LEASE EXHIBIT A � 121 OCEAN AVENUE civil StiUCtUfc2l Lc�/701 SUrveying N0. DATE REVISIONS BY CHK APP'D NOT FOR CONSTRUCTION PROJECT N0. DRAWING NAME DATE LOC. CODE REV NOT TO SCALE DESIGNED BY: CJS DRAWN BY: JRV HYANNIS,MA 02601 ' 1460.203 L-2 O6/16/16 403629 2 oNW EXIST. U/P /10-13 PROP. LESSEE METER WITH i 60AMP 2-POLE MAIN BREAKER i & (2)20AMP 2-POLE BREAKERS I Exrsr. u/P I PROP. LESSEE 12.0"0 x EXIST U/P .'�..., 38.7"H ANTENNA MOUNTED TO I EXISTING UTILITY POLE #10-13 PROP. LESSEE (2)DELTA` OHW 1 I PROP. LESSEE (2)DIPLEXERS AC/DC CONVERTER MOUNTED MOUNTED TO RRH BRACKET WITHIN RRH BRACKET I I PROP. ANTENNA I PROP. LESSEE 12.0"0 PROP. LESSEE DUAL AWS/PCS o 38.7"H ANTENNA MOUNTED PROP. LESSEE — I RADIO UNIT MOUNTED TO TO EXISTING POLE #10-13 EXISTING POLE #10-13 ANTENNA MOUNT I 1 iEL- ; ANTENNA PLAN 3 : ANTENNA MOUNTING DETAIL- 4 , L7 SCALE: 1/4" = 1'-0" L-3 SCALE: 1/4" 1'-0" L-3 Z ---- --J--- -- -� SECONDARY 7¢" COAX CABLE -- ------- FIBER FIBER FRONTHAUL s &.BACKHAUL 12.0"0 I ' I I (305 MM) . FIBER DEMARC ON POLE I I I I • I I I " v 'Z"m DIPLEXER (TYP. 2)—,'' 1 - E PCS AWS } RRH RRH i ' z m a -ZE _ r W 00 i • I t. • .... DELTA AC/DC CONVERTER (TYP. 2) I ,.w DUAL RADIO UNIT I I I I g SMALL CELL CANTENNA PCS: - METER SOCKET WITH ATTACHED 60A-2 I ? DIMENSIONS: 21.4'H x 12"W x 7.2"D POLE DISCONNECT SWITCH FUSED WITH I " DIMENSIONS: 12.0'0 x 38.7' WEIGHT: 51 LBS (2) 2OA-2 POLE CIRCUIT BREAKERS. 4O WEIGHT: 33.7 LBS 9OW AWS: DIMENSIONS: 25.8"H x 11.8W•x 7.2"D - WEIGHT: 56.9 LBS• L----- - GROUND ANTENNA DETAIL 1 RADIO DETAIL 2 GENERAL WIRING DIAGRAM 5 SCALE: N.T.S. L-3 SCALE: N.T.S. L-3 _ SCALE: N.T.S. L-3 CHAPPELL HYANNIS MA SC13 SITE ADDRESS 2 06 16 16 REVISED LEASE EXHIBIT JRV CJS CJS EQUIPMENT DETAILS ENGINEERING 1 05 19 16 REVISED LEASE EXHIBIT JRV CJS CJS ' 0 03 Ot 16 LEASE EXHIBIT JRV CJS CJS UTILITY POLE#10-13 ASSOCIATES,LLC A 02 23 16 DRAFT LEASE EXHIBIT JRV CJS CJS LEASE EXHIBIT 121 OCEAN AVENUE Civil Structural Land Surveying rN0. DATE REVISIONS BY AP CHK P'D NOT FOR CONSTRUCTION HYANNIS,MA 02601 PROJECT NO. DRAWING NAME DATE LOC. CODE RJEV NOT TO SCALE DESIGNED BY: CJS DRAWN BY: JRV 1460.203 L-3 06/16/16 403629