12 POPE ST - BUILDING INSPECTION (10) crry or,
PUBLIC PROPERTY
DEPARTMENT
IYOR 1101VASuW(;'i015rR1;J-1 #SAIJ:M,MAsaAl
Tij--978-745-9595 0
APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT
ALL STRUCTURES EXCEPT] AND 2 FAMILY DWELLINGS
IMPORTANT:Applicants must complete all items on this page
SITE INFORMATION
C,Location Name "54%e VY% ylk BuildingA(24 -
Property Address I I Vai:g 151
Map# IP3 1
Located in: Conservation Area Y/N�)—Ristorkc district
Use Groups
(check one)
Residential(3 or more Units) R2-A,/-
Type of improvement Residential(hotel/motel RI
(check one) Assembly(churches) Al
New Building_ Assembly(nightclubs etc) A2
Addition Assembly(restaurants,recreation) A3_
Alteration Business 6
Repair/Replacement_ Educational E
Demolition— Factory(moderate hazard) Fi
Move/Relocate Factory(low hazard) F2
Foundation Only High Hazard
Accessory Building Institutional (residential care) 11
histitutional (incapacitated) 12
Institutional(restrained) 13
Mercantile M
Storage(moderate hazard) Sl —
Storage(low hazard) S2—
OWNERSHIP INFORMATION(Please type or Print0carly)
OWNER Name tWyo yus rne
Address-tAi;i tie
Telephone 110), 9) Lq)-
DESCRIPTION OF WORK TO BE PERFORMED
A n 4 It j!3 rl 4-5 6A nd Y"e 14 icd
tkv ArOc")L Of b4e, kiii ; jdj o
ESTIMATED CONSTRUCTION COST 50
CONTRACTOR INFORMATION
Name Qin wy UJ
Address -2,iq A%ndaye , illili m in MA 2f 7
Telephone q 7S' 636- 705 ;?
Construction Supervisor's Lic # �707 !Vb
Home Improvement Contractor #
ARCHITECT/ENGINEER INFORMATION
Name CI Sat , T*)( 5i NHL
Address lw)D 0-5a xi a. k3 o- & n do utr 1AA
Telephone 0 0 0 • 5 5-7- 5553
Mass. Registration # 1+0'7 O
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00 =
Commercial est. cost x $11/$1,000 + $5.00= s _
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of my knowledge under the penalties of perjury
Signed
Date g
__.-' '��, T)IJ)JUJJt6%dlUt°�� dJJ• ✓�!.�Jd.9L1G�UuClfd
Board of Building Regulations and Standards
... Construction Supervisor License
License: CS 70740
i Birthdate:• 3130M968
Expiration: 3130/2009 Tr!! 11416
Restriction: OOi
CHARLES R WING,JR
84 ANDOVER ST
WILMINGTON, MA 01881 commissioner
LETTER OF AUTHORIZATION
This Letter of Authorization dated this 27 day of May 2008, provides written
authorization for MetroPCS Massachusetts, LLC, a Delaware limited liability company
("Lessee"), its attorney, agents or representatives, to apply for any necessary zoning
petitions, permits or any other approvals, including, but not limited to the filing of a
building permit application (after required zoning approval has been completed), which
are necessary for Lessee's placement of a wireless communications facility within a
portion of the Lessor's real property, commonly known as: Salem Heights Preservation
Associates, LP, located in the State of Massachusetts, County of Essex City of Salem,
legally described as:
12 Pope Street
This Letter of Authorization shall not constitute an agreement to enter into a
binding agreement and neither party shall be bound with regard to the leasing of the
above mentioned property until a final agreement has become fully executed between the
parties.
LESSOR:
Salem Heights Preservation Associates, LP
r v+t
By:
Lee John relgar
F.eskkmt
Preservation Housing Management,LLC
As Agent for Owner
Site No. BOS0024B
Site Name: Salem Heights
State: MA
a D-Rv CERTIFICATE OF LIABILITY INSURANCE o;iia/a o'
PRODUCER (978)223-4037 FAX (978)223-4038 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CFR Ins Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
153 Andover Street Unit 208 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Danvers, MA 01923
INSURERS AFFORDING COVERAGE NAIC•
INSIREo Infinite Solutions, Inc INSURER A-' Scottsdale Insurance Company
214 Andover Street INSURER& Safety Insurance 394S4
Unit 111 INSURER C:
Wilmington, MA 01987 INBU NsuRaTo
Re1
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY IBg10M LIMITS
GENERAL LIABILITY REM OF CLS1371696 03/18/2008 03/18/2009 EACH OCCURRENCE $ 11000,
X COMMERCIAL GENERAL LIABILITY DAMAGETORENTED S SO DD
CLAIMS MADE r OCCUR SEDEXP(Anyene Pe ') $ S 0O
A PERSONAL&ADV INJURY S 2.000.004
GENERAL AGGREGATE S 2 000
OEM AGGREGATE UNIT APPLIES PER PRODUCTS-COMPIOP AGG S 2 000
X POLICY J LOC
AUTOMOBILE LIABILITY 6200922 09/29/2007 09/29/2008 (OIr�SINGLE LIMIT
$ 1 000
ALL OWNED AUTOS BODILY INJURY
X SCHEDULEDAUTOS (Pffp�) s
B X HSREOMTOS
X NON-0WNEOAUTOs (Per ecdd9nl)
PROPERTY DAMAGE $
(Per eeCIeNX)
GARAGE LMmUTY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC I
AUTO ONLY: AGG $
EXCESSJUMBRELLA LABILITY REN OF XLS0040495 03/18/2009 03/19/2009 EACH OCCURRENCE $ 5.000.000
X OCCUR CWMSMADE AGGREGATE S S D00
A :
DEDUCTIBLE s
RETENTION $ $
WORIENS COMPEMBATION AND WCBTA- OTH-
EMPLOYERS'LIABILITY EL EACH ACCIDENT S
ANY PROPRIErO IPARTNE W EXECUTIVE
OFFICER/MEMBER EXCU OEDY EL DISEASE-EA EMPLO
XpC IDAeL MRYN S belw EL DISEASEOCYLIMIT S
S
OTHER J wWw a
DEBCmPTpN OF BPERATIONB/LOCATIONS/VE11N; .g/EXCLu810N¢L1QOP,p EY ENDOAtEp dire t,y by Liberty Mutual Insurance Company
e Workers Compensation Certificate wi be malTea
nder Policy 8 WC231S3S112S018 effective from 3/20/08 to 3/20/09.
CERTIFICATE HOLDER PI I ATMM
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE
EXPRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL
Metro PCS 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAIEO TO TE LET,
Matthew P Granese BUT PAILURE TO MAIL SUCH NOTM SHALL IMPOSE NO OBLIGATION OR LI1m UTY
28 S Billerica Road OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
Chelmsford, MA 01824 AUTHORInD REPRESENTATIVE
Nicholas Consoles GAIL
ACORD 26(2001M) GAICORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may
require an endorsement.A statement on this certificate does riot confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this forth does not constitute a contract between
the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it
affirmatively or negatively amend,e)dend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001108)
0
CITY OF SALEM
PLANNING BOARD
[8�tl s'11. 1 a 11: 51
Wireless Special Permit Decision —July 18, 2008
For The Petition of Metro PCS For The Property Located At 12Lfe Stregt;r,L'-i i. ;.SS.
A Public Hearing on this petition was held on July 17, 2008. The following Planning Board
members were present: Charles Puleo (Chair), John Moustakis, Timothy Kavanaugh, Christine
Sullivan, Gene Collins, Pam Lombardini, and Tim Ready. Notice of this meeting was sent to
abutters and notice of the hearing was properly published in the Salem Evening News.
The petitioner is requesting a Wireless Communication Facility Special Permit under Section 5-
3, Special Permit Uses, of the City of Salem Zoning Ordinance, to allow for the installation of
five panel antennas facade mounted on the existing penthouse, one faux chimney on the roof to
conceal one panel antenna located at 12 Pope Street Salem, MA. Additionally there would be
three equipment cabinets on the roof behind a screen wall painted to match the building.
The Planning Board reviewed the application and plans submitted and found that the petitioner
addressed the requirements of this section for the issuance of a Special Permit.
On July 17, 2008, the Board closed the Public Hearing and the Planning Board voted by a vote of
seven (7) in favor and none opposed, to grant the Wireless Communication Facility Special
Permit for the location stated above, in accordance with the application, dated June 26, 2008, and
site plan last dated June 18, 2008, titled `BOS0024B, Salem Heights", Sheets T-1, Z-1, Z-2, and
Z-3 and drawn by Hudson Design Group, submitted and now part of the file.
The Special Permit was approved with the following conditions:
1. The applicant paints the equipment to match the color of the building and the existing
roof structures; the applicant, his successors and assigns, shall maintain the paint on the
screen wall and all equipment which is permitted as part of this decision.
This endorsement shall not take effect until a copy of the decision bearing certification of the City Clerk that twenty
(20) days have elapsed and no appeal has been filed or that if such appeal has been filed that it has been dismissed or
denied, is recorded in the Essex South Registry of Deeds and is indexed in the grantor index under the name of the
owner of record or is recorded and noted on the owner's certificate of title. The fee for recording or registering shall
be paid by the owner or applicant.
1 hereby certify that a copy of this decision is on file with the City Clerk and that a copy of the
decision and plans is on file with the Planning Board.
C(L", (, (� L,�m
Charles Puleo, Chairman
120 WASH ItiMON STREET, SALEM, MASSACI I CSEFFS 01970 • Tr:L: 978.745.9595 FAX: 978.740.0404 WWw.SALFII.00 NI