0027 CHARTER STREET - BPA ANTENNAS ,� The Commonwealth of Massachusetts
� Department of Public Safety
Massachusetts State BuIlding Code(7S0 CMR)
Building Permit Application for any Building other than a One-or Two-Family D llin
� (This Section For Official Use Only) � "
Building Permit Number: Date Applied: Building Official:
i�1� SECTION 1:LOCATION(Please indicate Block#and Lot#for locarions for which a street address is not available)
�'^1
���,, 27 Charter SUeet Salem,MA 01970 Salem Housing Authonry
No.and Street City/Town Zip Code Name of BuIlding(if applicable)
SECTION 2:PROPOSED WORK �
Edirion of MA State Code used if New ConshvcHon check here O or check all that apply in the hvo rows below
Existing Building❑ Repau❑ AlteraHon ❑ Addition❑ DemoliHon O (Please fill out and subuut Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other SpecifY:Wireless Communications
Are building plans and/or construcHon documents being supplied as pazt of this pemiit applicarion? Yes ❑ No ❑ �
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Blief DesCiiPtion of PxoPosetj Woil(: Replace siz existing panel antennas attached to ihe penthouse with siz Air Panel Antennas-all antennas ro be painled
to match eztenor of the building. Add an additional 3 coaxial cables all to run within ezisting cable trays.
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OA
CHANGE IN USE OR OCCUPANCY
Check here ff an ExisHng Building InvesHgallon and Evaluation is endosed(See 7S0 CMR 34) ❑
Existing Use Group(s): Proposed�Use Group(s):
SECTION 4:BUILDING HE[GHT AND AREA
Existuig Proposed
No.of Floors/Stories(indude basement leve]s)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educarional ❑
F: Facto F-1❑ F2❑ H: Hi h Hazazd H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: InsHtutional I-1❑ I-2❑ I-3❑ I-4❑ M: MercanHle❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑
S: Storage Sl ❑ S-2❑ U: Utility❑ Special Use 0 and please describe below:
Special Use:
SECTION 6:CONSTRUCTION 1'YPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone InformaHon: Sewage Disposat:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ � or indentify Zone: or on site system❑ required�or trench or specify:
- permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigafion: MA Historic Commission Review Prceess:
Not Applicable❑ Is Structure within airport approach area? Is their review complered?
or Consent to Build enclosed❑ Yes 0 or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edifion of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
� Does the buIlding contain an Spr'vilder System?: Special SHpulaHons:
���L c�'NA,� Gc,��e< ����s�
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Salem Housing Authority 27 Charter Street Salem, MA 01970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Informafion:
CarolMcGowan 978_744_4432
Title Telephone No.(business) Telephone No. (cell) e-mail address
ff applicable,the property owner hereby authorizes
Metro PCS -Sean Conway 285 Billerica Road - 3rd Floor Chelmsford MA 01824
Name StreetAddress City/Town State Zip �
to act on the ro er ownef s behalf,in all matters relaHve to work authorized b U»s buildin emut a ]ication.
SECTION 10:CONSTAUCTION CONTROL(Please fill out Appendix 2)
buildin is less than 35,000 cn.ft.of endosed s ate and or not under ConstmcHon Control then check hexe 0 and ski Section 10.1
10.1 Re istered Professional Res onsible for Construction Control
David Chappell soa 481 _7400 34706
Name(Registrant) Telephone No. e-mail address Registration Number
201 8oslon Post Rtl West-Suite 101 Marlbomugh Mn 01752 c;�;i
Street Address City/Town State Zip Discipline Expiration Date
102 General Contractor � � � �� �
Green Mountain Communications
Company Name ,
Jason Lander Construction Supervisor- CS-077763
Name of Person Responsible for Construcflon License No. and Type if Applicable
3 Hayfield Court Greenland NH 03840
Street Address City/Town State Zip
soa �i� 7117 Jason.Lander@greenmtncomm.com
Tele hone No. usiness Tele hone No. cell e-mail address
SECTION 11:WORKERS'COMI'ENSATION INSURAIVCE AFFIDAVIT M.G.L.c 152. 25C 6
A Workers'CouipensaHon Insurance Affidavit from the MA Deparhnent of Lidustrial Accidents must be completed and
submitted with this applicafion. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a si ned Affidavit submitted with this a licaHon? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMTT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)_$16,000
1.Building � Building Pemiit Fee=Total Construction Cost x ��(Insert here
2.Electrical � appropciate municipal factor)_$^°.'°°^°^:,°�
3.Plumbing 5
4.Mechanical (HVAC) $ Note:Minunum fee=$ (contact municipality)
5.Mechanical Other $ Endose check payable to City of Salem
6.Total Cos[ $ (wntact municipality)aztd write chetk number here Q�Qeosoa
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I h attest under the pains and penalties of perjury that all of the information contained in Uiis
applicafion is true and accurat tt b � o my a e and understaziding.
Sean Conway Sr. Site Acquisition Specialist 7s� 799_ 3377 6/13/13
Please pcint and sign name Title - Telephone No. Date
Meho PCS-285 Billerica Road Chelmsford MA 01824
Street Address City/Town State Zip
Municipal Inspector to fill out this secfion upon application approval:
Name Date
�ONDIT
,��..-- �\
���' � ' .°'�,
, l � � �, CIT`Y OF SALEM, MASSACHUSETTS
�
;,�� • i a� DEPARTMENT OF PLANNING AND
'�'ciMmE� COMMUNITY DEVELOPMENT
KIMBERLEY DRISWLL
MAYOR 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS O1t370
LrnrxGooN�xD�cnx,AICP ��:978-bi9-5685 ♦ Feix:q�8-74o-o4a4
Diaeecroa
May 31, 2013 �
Sean Conway
MetroPCS
285 Billerica Road, 3`d Floor
Chelmsford,MA 01824
RE: Request for Insigni£cant Changes to a Wireless Communication Facility Special Permit
for 27 ChaMer Street
Dear Mr. Conway:
The City of Salem Department of Planning&Community Development received a letter dated May 22 2013 from
MetroPCS requesting approval to replace antennas on the MetroPCS wireless communication facility project at
27 Charter Street.
Specifically, the requested changes, which are described in greater detail in said project plans, dated April 1 Q
2013, include the following:
• Replace six existing Panel Antennas(51.5' x 11.75" x 2.75")attached to penthouse with six Air
Panel Antenna (54.3"x 12.1" 7.9")The locations of these antenna upgrades will occur at locations
previously approved. �
Based upon a review of the letter and encbsures provided for the requested changes, it has been determined that
these modifications represent an insignificant change to the Salem Planning Board's decision, dated July 17,
2008, and approved plan titled `BOS0162B Salem Housing Authority,"dated June 24, 2008. This determination
shall become part of the record for this project.
In addition,a copy of this letter will be transmitted to the Salem Planning Board at the earliest date.
If you have any questions, please contact Daniel Sexton at the Department of Planning& Community
Development by phone at(978) 617-5685 or email at dsexton salem.com.
J
Sincerely,
y Duncan, AICP
Di ctor of Planning&Community Developmenf
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