44-014 (8) this Agreement represents and warrants that he or she has full authority to execute this Agreement on
behalf of,and to bind to the Agreement,the party on whose behalf he or she is signing.
14. Limitation of Liability. In no event shall any party hereto be liable to any other party hereto for
special, incidental, indirect, punitive or consequential damages, Including loss of revenue or profits, In
connection with this Agreement.
The parties hereto have caused this Agreement to be executed as of the day and year first written
above.
SBA Network Services,LLC T-Mobile USA,Inc.
By: B
Name: 1�cy`►a.Q �J/ Dave M
Named o Terhonlagy Stfat y, ance& eveiopment
Title: ���t��i"t�l�`Gic°� Title:
CONFIDENTIAL AND PROPRIETARY TO SBA
_ i
intent of any of the terms of this Agreement. This Agreement will be interpreted and enforced in
accordance with Its provisions and without the aid of any custom or rule of law requiring or suggesting
construction against the party drafting or causing the drafting of the provisions in question.
S. Notices. Except for purchase orders issued pursuant to Section 1,above,all notices,demands or
communications required or permitted under this Agreement will be in writing and delivered by hand or
mailed by certified mail,return receipt requested,postage and registration or certification charges
prepaid,or by nationally recognized overnight courier service,to the party entitled thereto at the
address first set forth above,or such other party(ies)or address(es)as either party specifies by written
notice to the other from time to time. A purchase order issued pursuant to Section 1 above shall be
deemed to meet the requirement,if any,under the applicable Tenant Lease that the TMUS Affiliate Is to
give notice regarding removal of the Equipment from said Tower Site,
6. Attorneys Fees and Costs. In the event of any litigation or arbitration arising out of this
Agreement,the prevailing party will be entitled to recover all expenses and costs incurred,including
reasonable attorneys'fees and costs,from the non-prevailing party.
7. Assignment. No party to this Agreement shall have the right to assign any of its rights or Interests
in this Agreement to any entity or person that is not a party hereto,without the prior written consent of
the other party to this Agreement,which may be withheld by such other party In its sole and absolute
discretion.
8. Governing Law. This Agreement will be governed by and construed and enforced in accordance with
the internal laws of the State of Florida without regard to principles of conflicts of laws.
9. Integration. All prior understandings and agreements between the parties with respect to the
removal of Equipment from Tower Sites,as described herein,are merged in this Agreement. Neither
party is relying upon any statement,covenant or representation made by the other party with respect to
such subject matter which is not embodied in this Agreement.
10. Amendments. No purported amendment to or waiver of any term of this Agreement will be
binding upon any party,or have any other force or effect in any respect,unless the same Is in writing
and signed by the party to be charged.
11. Further Assurances. Each party will,from time to time,execute,acknowledge and deliver such
further Instruments,and perform such additional acts,as the other party may reasonably request In
order to effectuate the intent of this Agreement.
12. Third Parties. Nothing in this Agreement,whether express or implied,is intended to confer any
rights or remedies to any persons other than the parties hereto and their respective successors and
assigns,to the extent permitted pursuant to the terms of this Agreement.
13. Authority,This Agreement constitutes a valid and legally binding obligation of each party executing
this Agreement.The execution of this Agreement,and the transactions and performance contemplated
hereby,have been duly authorized by the requisite action on the part of each party. Each person signing
CONFIDENTIAL AND PROPRIETARY TO SBA
of this Section shall in no way be interpreted to(i)create any new termination rights under any Tenant
Lease,or(il)amend,modify or repeal any environmental or other indemnity obligation under any
Tenant Lease. Ownership of the Equipment shall be transferred to SBA(or its designated other SBA
Affiliate)upon SBA's(or its designated other SBA Affiliate's)receipt of the applicable purchase order as
described above and payment of the Fee In full to SBA(or its designated other SBA Affiliate)from the
applicable TMUS Affiliate.T-Mobile and the applicable TMUS Affiliate represent to the SBA Affiliates that
T-Mobile or the applicable TMUS Affiliate is the owner of the Equipment. EXCEPT AS EXPRESSLY
PROVIDED HEREIN,ALL WARRANTIES AND REPRESENTATIONS OF ANY KIND WHATSOEVER,EXPRESS OR
IMPLIED,FROM OR ON BEHALF OF T-MOBILE AND THE APPLICABLE TMUS AFFILIATE AS TO THE
CONDITION,QUALITY,MERCHANTABILITY,AND FITNESS OR SUITABILITY OF THE EQUIPMENT FOR ANY
PARTICULAR USE OR PURPOSE ARE HEREBY EXCLUDED AND DISCLAIMED BY T-MOBILE AND THE
APPLICABLE TMUS AFFILIATE. SBA(or it designated other SBA Affiliate)and T-Mobile together with the
applicable TMUS Affiliate acknowledge and agree that it is their intent to herein convey to SBA(or Its
designated other SBA Affiliate)at the time of the payment of the Fee the entire right,title,and Interest
in and to the Equipment described herein. Additionally,SSA(or its designated SBA Affiliate)and T-
Mobile together with the applicable TMUS Affiliate agree that no individual bill of sale is needed for the
transfer of the described Equipment to be effective. Upon transfer of ownership of the Equipment to
SBA(or its designated other SBA Affiliate)pursuant to and in full compliance with the terms of this
Section 1,the applicable TMUS Affiliate will have no further duties or obligations under the related
Tenant Lease with respect to removal of the Equipment from the applicable Tower Site.
2. Default and Remedies;Acknowledgment of Separateness of Existence. If any party to this
Agreement is In breach hereof,the non-defaulting party shall be entitled to all remedies,at law or In
equity,as a result of such breach,but such cause of action shaft only be against the breaching party. Any
default under any Tenant Lease shall be governed by the default and remedies provisions contained in
such Tenant lease,and in no event shall any event of default under this Agreement give rise to any right
of any party hereto or to any Tenant Lease to terminate or seek any remedies under any Tenant Lease
other than as such breach relates to the particular Tower Site and is a breach under such Tenant Lease.
The commitments of the parties hereunder shall be the several,and not joint,commitments of the
parties hereto and no party shall be liable for any obligation of the other party under this Agreement. In
connection with the bankruptcy filing of any party to this Agreement,each party to this Agreement
agrees that it will not in any manner use the existence of this Agreement as evidence that any other
party to this Agreement should be consolidated with the bankrupt party in such bankruptcy proceeding.
3. Term. The term of this Agreement shall commence as of the effective date set forth above and shall
expire two(2)years from such effective date,unless otherwise extended in writing by the parties
hereto.
4. Interpretation. The singular includes the plural and the plural Includes the singular. The word"or"
is not exclusive and the word"including"is not limiting. References to a law Include any rule or
regulation issued under the law and any amendment to the law,rule or regulation. References to a
Section mean a Section contained in or attached to this Agreement. The caption headings in this
Agreement are for convenience and reference only and do not define,modify or describe the scope or
CONFIDENTIAL AND PROPRIETARY TO SBA
• E
E
AGREEMENT FOR REMOVAL OF EQUIPMENT
This Agreement for Removal of Equipment("Agreement')is effective the 1 day of\)i 2014,
by and between SBA Network Services,LLC,a Florida limited liability company with an ad ress at 5900
Broken Sound Parkway NW,Boca Raton,FL 33487,for itself and on behalf of its tower-owning affiliates
("SBA", and together with its tower-owning affiliates,the"SBA Affiliates",and individually,each a"S
Affiliate")and T-Mobile USA, inc.,a Delaware corporation,with an address at 12920 SE 38'h Street,
Bellevue,WA 98006,for itself and on behalf of Its affiliates(`T-Mobile",and together with its affiliates,
the"TMUS Affiliates",and individually,each a"TMUS Affiliate").
WHEREAS,TMUS Affiliates have entered into tenant leases which were formerly MetroPCS leases
pursuant to which they lease or license tower and/or ground space from SBA Affiliates(each such
former MetroPCS lease,a"Tenant Lease")with respect to the tower communications facility described
therein(in each instance,a'Tower Site"),and
WHEREAS,T Mobife has requested that upon expiration or rightful termination of any Tenant Lease,the
applicable TMUS Affiliate has the option to leave certain of its Equipment(as defined below)at the
Tower Site thereunder for removal and disposal by SBA; and
WHEREAS,SBA has agreed to perform such removal and disposal of Equipment upon the terms and
conditions set forth in this Agreement.
NOW,THEREFORE,in consideration of the foregoing premises and the mutual promises and agreements
contained herein,the parties to this Agreement agree as follows:
1. Removal of Equipment. For any Tenant Lease between any TM US Affiliate and any SBA Affiliate with
respect to a Tower Site that the applicable TMUS Affiliate terminates in accordance with its terms or
does not renew,such TMUS Affiliate shall have the option of(I)removing all of its property located at
the applicable Tower Site In accordance with the terms of the applicable Tenant Lease or(ii)paying SBA
(or its designated other SBA Affiliate)a fee of Eleven Thousand Five Hundred Dollars($11,500.00)(the
'Egg")and not removing the applicable TMUS Affiliate's coaxial lines,antennas,TMA's,empty shelters
or cabinets and any other equipment attached to the applicable tower or adjacent on the ground
(collectively,the"Equipment"),provided(a)the applicable TMUS Affiliate timely Issues to SBA(or its
designated other SBA Affiliate)a purchase order containing a provision which states that upon SBA's(or
its designated other SBA Affiliate's)receipt of such purchase order and payment in full of the Fee to SBA
in connection therewith,the Equipment will become owned by SBA(or its designated other SBA
Affiliate)and T Mobile and the applicable TMUS Affiliate relinquish all ownership rights to such
Equipment,(b)such payment of the Fee is made in full within thirty(30)days following such TMUS
Affiliate issuing to SBA(or its designated other SBA Affiliate)such purchase order,and(c)all property of
the applicable TMUS Affiliate other than the Equipment(such other property to Include but not be
F
limited to electronics,batteries,generators,fuel tanks and equipment within a shelter)must be
removed by such TMUS Affiliate in accordance with the terms of the applicable Tenant Lease. The terms
CONFIDENTIAL AND PROPRIETARY TO SBA
DocuSign Envelope ID:213D7395-7E6D-4800-BiB6-822148A341A4
N
. . . .M Il
� e SQ)
SBA Site# T-Mobile Site# Decommission Date
NH02249-S BOS0687 8/29/2014
N H47173-A BOS0665 8/29/2014
NH02307-S BOS0661 8/4/2014
MA14297-A BOS0654 7/29/2014
MA12206-A BOS0652 7/25/2014
MA11556-A BOS0639 8/8/2014
MA46692-A BOS0630 8/1/2014
MA12213-A BOS0613 8/28/2014
MA13732-A BOS0571 8/1/2014
MA46701-A BOS0540 8/26/2014
MA46689-A BOS0535 8/3/2014
MA03532-S BOS0522 8/26/2014
MA07276-A BOS0500 7/30/2014
MA41212-T BOSO462 7/24/2014
NH13785-A BOSO404 8/29/2014
NH13778-A BOS0399 8/29/2014
NH2O094-A BOS0397 8/29/2014
MA07717-S BOS0396 8/26/2014
MA13710-A BOS0378 8/6/2014
MA30044-M BOS0353 9/10/2014
MA03056-S BOS0348 8/27/2014
MA46705-A BOS0340 7/31/2014
MA07669-S BOS0304 8/6/2014
MA41206-T BOS0271 7/25/2014
MA41202-T BOS0230 8/25/2014
MA46707-A BOS0211 8/28/2014
MA13734-A BOS0152 8/5/2014
MA06496-A BOS0137 8/26/2014
MA12750-A BOS0131 8/5/2014
MA13736-A BOS0116 8/27/2014
MA41203-T BOS0045 8/25/2014
MA04712-A BOS0040 8/25/2014
MA41200-T BOS0008 8/21/2014
DocuSign Envelope ID:213D7395-7E6D-4800-B1B6-B22148A341A4
WE
r
SBA Site# T-Mobile Site# Decommission Date
CT12219-A NHC0169 7/28/2014
CT02694-8 NHC0153 7/17/2014
CT03538-5 NHC0111 7/28/2014
CT03110-S NHC0052 7/17/2014
NH47174-A MAN0025 8/1/2014
NH47171-A MAN0016 8/1/2014
NH07567-A MAN0013 8/19/2014
MA46695-A HYN0038 7/24/2014
CT46126-A HFC1516 7/21/2014
CT11558-A HFC1502 7/21/2014
CT03801-S HFC1500 7/18/2014
CT46134-A HFC1499 7/18/2014
CT01080-5 HFC1494 7/18/2014
CT01725-A HFC1457 7/17/2014
CT95919-L HFC1394 9/18/2014
CT07824-S HFC1282 7/24/2014
CT04382-S HFC0755 7/18/2014
CT08558-B HFC0754 7/18/2014
CT13062-A HFC0636 7/17/2014
CT13063-A HFC0612 7/21/2014
CT02216-5 HFC0386 7/21/2014
CT46124-A HFC0331 7/24/2014
CT01498-S HFC0025 7/18/2014
MA02260-5 BOS1142 8/6/2014
MA08178-A BOS0771 7/30/2014
MA08179-A BOS0767 7/21/2014
MA46693-A BOS0761 7/31/2014
MA06224-A BOS0749 9/4/2014
MA10710-A BOS0729 7/30/2014
MA07279-A BOS0722 7/30/2014
MA12221-A BOS0717 7/30/2014
DocuSign Envelope 1D:213D7395-7E60-4800-BiB6-B22148A341A4
■ n ■ ■M bi e ■
SBA Site# T-Mobile Site# Decommission Date
MA11629-S PVD0152 7/31/2014
MA12220-A PVD0150 8/4/2014
MA20024-A PVD0120 7/21/2014
MA11606-S PVD0117 7/21/2014
R197704-L PVD0082 7/23/2014
R140272-T PVD0068 7/24/2014
8108737-A PVD0036 7/23/2014
R196062-L PVD0028 8/1/2014
CT13076-A NLD0067 9/22/2014
CT13556-S NLD0044 8/28/2014
CT09680-S NLD0036 8/29/2014
CT13074-A NLD0023 8/29/2014
CT01493-S NLD0022 8/29/2014
CT03241-S NLD0021 8/29/2014
CT00595-S NLD0015 8/29/2014
CT11561-A NLD0003 8/29/2014
CT00235-B NLD0001 8/29/2014
CT46149-A NHCO597 7/17/2014
CT13071-A NHC0594 7/17/2014
CT00252-S NHC0488 7/17/2014
CT33762-M NHC0477 7/17/2014
CT97402-L NHCO462 7/24/2014
CT13070-A NHC0412 7/17/2014
CT02722-S NHC0375 7/18/2014
CT13616-A NHC0322 7/17/2014
CT46138-A NHCO279 7/28/2014
CT46128-A NHCO274 7/17/2014
CT01499-S NHCO170 7/28/2014
DocuSign Envelope ID:213D7395-7E6D-4600-B1B6-B22146A34iA4
■ ■ ■ ■Mobile
SBA Site# T-Mobile Site# Decommission Date
MA08741-A WOR0084 7/28/2014
MA95911-L WOR0083 8/19/2014
MA09985-S WOR0064 8/19/2014
MA12209-A WOR0062 7/24/2014
MA13740-A WOR0061 7/24/2014
MA46700-A WOR0059 7/25/2014
MA46681-A WOR0052 8/6/2014
MA08745-A WOR0049 8/5/2014
MA00713-S WOR0044 7/28/2014
MA12229-A WOR0035 8/19/2014
MA04528-B WOR0029 7/24/2014
MA08736-A WOR0028 7/28/2014
MA06223-A WOR0026 8/5/2014
MA08744-A WOR0019 7/24/2014
MA13741-A SPM0232 8/2/2014
MA12216-A SPM0144 8/4/2014
MA09875-5 SPM0103 8/2/2014
MA13720-A SPM0093 8/2/2014
MA13729-A SPM0092 8/2/2014
MA13216-A SPM0089 8/4/2014
MA08544-5 SPM0087 8/2/2014
MA13210-A SPM0085 8/19/2014
MA13208-A SPM0076 8/5/2014
MA13219-A SPM0047 8/2/2014
MA13731-A PVD0280 7/23/2014
MA13742-A PVD0268 7/23/2014
R114814-A PVD0256 7/22/2014
R113847-A PVD0248 7/21/2014
R113381-A PVD0245 7/22/2014
MA06901-5 PVD0241 7/31/2014
R147739-A PVD0233 7/22/2014
R147732-A PVD0227 8/1/2014
MA41201-T PVD0206 7/23/2014
DocuSign Envelope ID:213D7395-7E6D-4800-BiB6-B22148A341A4
M
Schedule 1
to Equipment Removal and Transfer Notice
SBA Site# T-Mobile Site# Decommission Date
NV09869-S VGS056 7/29/2014
NV21299-A VGS228 8/20/2014
NV47300-A VGS224 7/28/2014
NV20207-A VGS208 8/16/2014
NV11758-A VGS206 8/6/2014
NV12842-A VGS184 7/31/2014
N V20346-A VGS179 7/21/2014
NV09981-A VGS178 7/28/2014
NV20345-A VGS177 7/21/2014
NV33728-M VGS167 7/21/2014
NV20347-A VGS161 7/21/2014
NV20201-A VGS160 7/21/2014
NV12841-A VGS157 7/21/2014
NV47339-A VGS156 8/1/2014
NV20185-A VGS155 7/21/2014
NV47323-A VGS144 8/4/2014
NV12290-A VGS112 7/21/2014
NV20057-A VGS105 7/29/2014
NV20102-A VGS095 8/4/2014
NV20862-A VGS093 7/28/2014
NV40196-T VGS089 8/5/2014
NV20045-A VGS079 7/21/2014
NV20051-A VGS077 7/21/2014
NV10075-B VGS071 8/4/2014
NV20040-A VGS065 8/4/2014
NV20046-A VGSO47 7/30/2014
NV47288-A VGS035 8/25/2014
NV20058-A VGS023 7/30/2014
NV47325-A VGS017 7/31/2014
NV47325-A VGS017 7/31/2014
NV11466-A VGS005 7130/2014
NV98088-M VGS004 7/31/2014
MA04372-5 WOR0110 7/30/2014
i
Docuftn Envelope ID:213D7395-7E6D-4800-8186-822148A341A4
e
. . .M( l e
12920 SE 3e Street
Bellevue,WA 98006
Equipment Removal and Transfer Notice
SBA Network Services,LLC
5900 Broken Sound Parkway NW
Boca Raton,FL 33487
Re: Equipment Removal and Transfer Notice("Notice")
This Notice is being provided in connection with that certain Agreement for Removal of
Equipment dated July 1, 2014(the"Agreement")by and among SBA Network Services,
LLC, a Florida limited liability company, for itself and on behalf of its tower-owning
affiliates("SBA",and together with its tower-owning affiliates,the"SBA Affiliates",and
individually, each a "SBA Affiliate") and T-Mobile USA, Inc., a Delaware corporation,
for itself and on behalf of its affiliates ("T-Mobile", and together with its affiliates, the
"TMUS Affiliates",and individually,each a"TMUS Affiliate").
Unless otherwise clear from the context in which they are used,all capitalized terms used
herein shall have the meanings given to them in the Agreement.
Notice is being provided that:
i) At the sites listed on attached Schedule 1, T-Mobile has elected to leave the
Equipment as detailed in the Agreement;
ii) For each site listed on Schedule 1, T-Mobile shall issue a purchase order for the
agreed upon Fee of$11,500.00;
iii) Upon SBA's receipt of the purchase order and the Fee, the Equipment shall be
transferred to and will become owned by SBA("Transfer Date");and
iv) On and after the Transfer Date, the applicable TMUS Affiliate will have no further
duties or obligations under the related Tenant Lease with respect to removal of die
Equipment.
The sites listed on Schedule I were decommissioned during the months of July, August
and September of 2014.
Please contact Allan Tantilto at 425-383-2413 if you have any questions. Thank you.
Sincerely,
Fa7eayo
Senior Vice President
r The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' I Congress Street, Suite 100
t Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): SBA Network Services
Address: 117 Precourt Street
City/State/Zip:Biddeford, ME 04005 Phone #:(207)282-4200
Are you an employer? Check the appropriate box: Type of project(required):
1.0 1 am a employer with 50+ 4. ❑ I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working or me in an capacity. employees and have workers'
g Y 9. E] Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no Demolition
employees. [No workers' 13.❑■ Other
comp. insurance required.]
*Any applicant that checks box#1 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 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 is the policy and job site
information.
Insurance Company Name: Henderson Brothers, Inc.
Policy#or Self-ins. Liic.��9:TC20UB475M4437814 Expiration Date:3/15/2015
Job Site Address: Cr `75, Od LQ,J I I C4-1)w V_d City/State/Zip: &IUMOUJ o Iwo
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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: 2072824200
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
6. Other
Contact Person: Phone#:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
l
Signature of Owner Date
r
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Si ned under the s nd I' erlu rr�_
Print Name
. _e
Signature of wner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License—Number
Address Expiration bate
Signature Telephone
SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the builqipg permit.
Signed Affidavit Attached Yes No 0
Vomiooi7 Commercial Building Permit May l5,20O0
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
'I Not Applicable
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address ReRistration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable 0
Company Name:
Responsible In Charge of Construction
Address
Signature felephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
.. �.
Frontage
Setbacks Front
e _ s
Side L. .�eea� R. _�er®- L: ,lm�. � R.[ —
Rear .... __ ._.
Building Height m
Bldg. Square Footage 3 °° % `
Open Space Footage �o % �o
(Lot area minus bldg&paved
parking) ®�
#of Parking Spaces
�
Fill:
1.
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW a YES 0
IF YES: enter Book 1 Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW � YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained , Date Issued:
N
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO ef
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations [:1 Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration Eff Existing Ground Sign[:1 New Signs❑ Roofing❑ Change of Use[:1 Other
—------------
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SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly El A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify: '—'
M Mixed Use ❑ Specify: i
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
F
Existing Use Group: Proposed Use Group: L1___________1_11__
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):ip
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
St I St
2 nd
2nd
rd
3rd 3
to
th 4
4 L
Total Area(sf) Total Proposed New Construction(se
D_
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) N 7.1 Flood Zone Information: I'SW [T73 Sewage Disposal System:
Public ❑ Private ❑ Zone=j Outside Flood Zon e — M unicipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
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City of Northampton ,� rrtilt
Building Department
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212 Main Street Sewer ` Il �HMut�nwr 'a
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Room 100 tetl laE �
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. 20 15 �; Northampton, MA 01060
ph ne 413-587-1240 Fax 413-587-1272 r# Se ads
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Electrl Pu�[; ,,�Cas Inscec ions 51$�
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TRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Old Map Lot Unit
Zone Overlay District
Sim St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
Pi
Name(Print) Current Ma.ilin9 Address:.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing w Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number (✓
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0730
APPLICANT/CONTACT PERSON SBA COMMUNICATIONS LLC
ADDRESS/PHONE 117 PRECOURT ST Biddeford04005 (207)282-4200
PROPERTY LOCATION 254 OLD WILSON RD
MAP 44 PARCEL 014 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE 3 ANTENNAS&ASSOCIATED EQUIPMENT-T MOBILE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 071639
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOPMATION PRESENTED:
AOApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
emo ' ' elay
Si uild' ffici Date J
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
254 OLD WILSON RD BP-2015-0730
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-014 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0730
Project# JS-2015-001421
Est. Cost: $11500.00
Fee: $69.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SBA COMMUNICATIONS LLC 071639
Lot Size(sq. ft.): Owner: AMERICAN TOWER CORPORATION C/O OMNI POINT
Zoning: Applicant: SBA COMMUNICATIONS LLC
AT: 254 OLD WILSON RD
Applicant Address: Phone: Insurance:
117 PRECOURT ST (207) 282-4200 WC
BiddefordME04005 ISSUED ON.1116120-15 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE 3 ANTENNAS & ASSOCIATED
EQUIPMENT - T MOBILE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 1/16/2015 0:00:00 $69.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner