0040 REAR HIGHLAND AVENUE - BPA-5-171 �55
'IeL N61MT9E fIW94AD APPROVED 8V T44E
JMMMIDA PROR TD A PERMIT BEING GRANTED
CITY OF_SALEM
No1
Date -S- o Y
weed
ZW" Dlat M kFS
Isft Historic PWtY Dhtr Loaded
in Yam No X Location of y p I
Is Propoty Loaded to
Me Oannnation Ana? Yes No X
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Insbgl Siding, Construct Deck, Shed, Pool,
Repair/Replace, er: Teleca ,�un c�+fbns Zhs /(
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build accordNig.to the following
specifications:
Owner's Name 61d Sa lem ern i f e d ��n e
Address & Phone yo R 9�4 land Ave F��gi �Yo-d6sy
Architect's Name T ecion('c. fel A,�i e e rrr,3
Address & Phone /3yyS/g s e119wX ixkyf//� c� f$601 S63 -2 3 y 1
Mechanics Name
Address & Phone
What Is Rea purpose a WNW Te le ccmrr an;ca.4 001s - ns,cL /
r dww of buYdrp? t( I dwaft,for how many famWes?
wa b Amm conform to law? 3 e s Asbasfos? No
Eats med coat 9fYsOoo. pO Clly Lkm ma s so"LkWW s `/ G(/
seems Impro►saat
Lie. Il
SV!U O Appll t
S E NDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
nsfa//af,oi of Tlecv. �r�u,�;ca�i�ti e� u,' .�e.�f fJloced o � c�
steel dLi'ii o,i Lt roaF'o¢ t%e buil(-J,�,9, S;x a,-)fenllas plovd
on -fke roo-F 0- At hulldrtrg.
MAIL PERMIT TO: g� 9s 6nfer, Su le 3161t, 3euer1.y m14, 0(9/S
No\
APPLICATION FOR
PEFUM TO
LOCATION
PIEERMIT G D
v � \ 19
AP OVfD
INSPECTOR OF BUILDINGS
r'
' s
iffill
iffil
nEimiaroN Ilrsol i m - a MPERTI/ZZU,AtiD MMUM
.$10,000,000 BI/PD Combined LOss Limit for Towers .b lion-rower Properties
.$10,000,00o Earthquake Per Occ/Annual Aggregate
.$10,000,000 Flood. Per Occ/Aaanal Aggregate
.$ 5,000,000 California Earthquake occ/Agg
.$ 2,500,000 Contractors Equipment
.$ 2,500,000 Newly A:sanired Property (90 de0*s)
.$ 2,500,000 EDP (including media)
.$ 2,600,000 Builders Risk/IUStallations
.$ 15comp Inland Transit
.$ 250,000 Miac Unnamed Locations
DEDVCTIBLES:
1. Tower Properties:
.$150,000'Far Occurrence
.0300,000 Annual Aggregate
.$ 50,000 Each Loss - Trailer Maintenance
2. Ron-Tower Properties:
.$15,000 Per Occurrence .
NAIM INSUREDS:
. sBA Communications Corporation SBA Properties Louisiana LLC
SBA Teleoommunicatious, Inc. SSA Senior Finance, Inc.
SEA Network services, Inc. Tanga Towers, Inc.
SBA Leasing Inc, Total Toner Services, Inc.
SRL Subsidiary Holding, Inc.
SBA Communications International., Inc.
SBA Towers, Inc.
SBA Properties, Inc.
SBA Canada, Inc. .
SSA Puerto Rico, Inc.
SBA Sites, Eac.
SSA 0ermany, Ine.
SEA Towers USVI, Ina.
SSA Broadband Services, Inc.
SBA Network services, ombH
DATE(MMIDDIW)
ACORD. CERTIFICATE OF LIABILITY INSURANCE 04/01/2005 06/04/2003
PRODUCER CERTIFICATETHIS ISSUED LocktonCompanies ON YAND CON ERSNO RIGH RIGHTS ON THE ICERTIFICATE
444 W.47th Street,Suite 900 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Kansas City Mo 64112-1906 ALTER THE COVERAGE AFFORDED B iE IES BELOW.
(816)960-9000 INSURERS AFFORDING COVERAGE
INSURED SPRINT SPECTRUM LP. wsURERA: CONTINENTAL CASUALTY CO. V
14966 6160 SPRINT PARKWAY I INSURER B: AMERICAN CASUALTY CO.of Reading P
OVERLAND PAK KS 66251 INSURER c-TRANSPORTATION INSURANCE CO.(A XV
COVERAGES SPRC001 DE
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.
INSR POLICYEFFECTNE POLICYEJ(PIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDlYY) I)ATEIMMIDDfM UNITS
GENERAL LIABILITY EACH OCCURRENCE 2,000,000
A X COMMERCIAL GENERAL LIABILITY GL251929176 04/01/2002 04/01/2005 FIRE DAMAGE(Any onefire 500000
CLAIMS MADE rX1 OCCUR MED EXP ore $ )OOQ{XXX
X CONTRACTUAL PERSONAL BADV INJURY $ 2000000
GENERAL AGGREGATE $ 5,000,000
GENL AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGO $ 3000000
X POLICY MT Fl LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE IUAR S 2,000,000 'I
A X ANY AUTO BUA 251929193 04/01/2002 04/01/2005 (Ea-odeM)
ALL OWNED AUTOS
BODILY INJURY $ J(xxXf{7{x
SCHEDULED AUTOS (Per arson)
HIRED AUTOS - BODILY INJURY
$ XXXXXXX
NON-OWNED AUTOS (Par aayera)
PROPERTY DAMAGE $ X)CKXXXX
X I CONTRACTUAL (Peraecwera)
GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX
AUTOONLY: AGG $ XXXXXXX
EXCESS LWBILRY EACH OCCURRENCE $ XXXXXXX
OCCUR ❑CLAIMS MADE NOT APPLICABLE AGGREGATE $ XXXXXXX
UMBRELLA XXXXXXX
DEDUCTIBLE ❑FORM & XXXXXXX
RETENTION S $ SOL30Z xxx
B WORKERS COMPENSATION AND WC 251929159(AOS) 04/01/2002 04/01/2005 X I
WC srAN- OTH-
C EMPLOYERS LIABILITY WC 251929162(A7,OR,WI) 04/01/2002 04/01/2005 EL.EACH ACCIDENT $ 1,000,000
B WC 251907792(CA) 04/01/2003 04/01/2005 EL.DISEASE-EAEMPLOYEE $ 1000000
B N/A IN MONOPOLISTIC STATFE EL DISEASE-POLICY LIMU $ I Arlo noo
OTHER
DESCRIPTION OF OPERATIONSILOCAMONSNEHICLESIERCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS -
CERTIFICATE L ADDITIONAL INSURED•INSURER LETTER: CANCELLATION
1171830 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
TO WHOM IT MAY CONCERN: DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25S(7197) For RMeeMom mMarM+nM We s<rMBoer cwMadit numwrR+ma In s,oaecar on me mde ecW Meanan ce TPRc '. ®ACORDC PORATION1988
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 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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this for 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, extend or after the coverage afforded by the policies listed thereon.
- � � Commorunuallk of�a�achues>�e .
�LJaPsalwaala��ideirlydal�on�•
boo w.. .S�...l
+.W.a a Canna godow, M"uLA 02111
cw.aoar
Workers' Compenssdn Immum AtfMn*
D ll
i, UPS PercI�OmO SB/t /UelinX�rK SerLleceS
. . wh;rs.a prbal p1m of bvsl a au
do hereby•cersly under w)n pains and pamilde of pull. dm
0 1a er employ p+ovfdbK workers' compensation covep/e for opt employe" working an�/�rr rl P.nTa W wa
Insuran" Caagagr P Numbel
1 so a sole proprietor and haw ao one workbag fear me he any op cky.
0 1 am a sole proprieter, seneral contractor or homeowner (drde one) and how hired do
contactors listed below who-how the following workers' compensation poNden
Conaaaw Insunnu Compaq/Pelt Nvobet•
Contractor Insurance Compavirlftllcylgu�mber
Contractor Innuance Compaq/Poikr number
0 1 am a homeowner performing all the work myself.
•1 vnewum"an a eaar of 06 rota""WE toe forwareea ea elf Office it M.edraaaw of dw MA 4 towrap wAaraean air an lamer man
rosrap a rnvves cow Secian SSA 1 2 can Men wow:wsenbn d eriMwr remade arced"of a fit of A ni I,Sam abler ass
w ream'iwovnem a yr a" of a STOP WORK ORDER w s fee el s 100AC s on s bo aL
Signed chic ' day of Aa2y S 1 Zoo, (
:iccrscci'Fcrmiuee iiullatnf Department
ucensinf Eoarf
Selectmen Office
^calth Deparmer,-
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RDFLOOR
SiALcw,MA O1 S70
TEL (976)74"595 OUT.360
FAX (378) 740-964S
STANLOY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions Of MGL c 40,S34,I aclmowledge flat as a condition
Of Bmlding Permit#_ all des=resulting Rom the cmgmctxm acbvlly
govam d by this Building Permit shall be disposed of in a pmpaly licemed sOlid-waM
disposal facility,as defined by M(R,c IQ SlSQA.
ThedcbdswMbedisposedofat �L rsfe�n�Svd, Cr�aS�awbit�� C'T'q,�3
Location ofFwflky
igoatiue of Permit Applicant Dde
FULLY complew
(PLEASE PRINT CLEARLY) .
Ud P r do�o
Nano OfPamltApphcaut
SE3l /VZT(.0 rk 5rv('ce_5
Firm Name,if Buy
Addresk City Jt State
The above statute regains that debris from the demolition, movation,mbab or other
ahastion of building or structure be disposed in a pmperly-lic=uW solid-waste disposal
facility of defined by MGL cIq S 150A, and the building paWts or hOH&w
indicate the location of the facility. see to
00.35,000 d enclosed space "
(MGL C 112 S.601.)
1A-Mawnryonty -
- - - 1G-182 Family Homes
failure to possess a current edition of the
Massachusetts State Building Code is muse for revocation of this license. -
- DIG SAFE CALL CENTER: (888)344-7233, _
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CITY GRA OMAt
CITY OF SALEM
PLANNING BOARD
101 Jig N P 3: oz
Uccision For The Petition of Sprint 11CS For'1'he Property Located At 40 Rear highland
Avenue
Public hearing tin this petition was held tin June :i, 2004 and was CantiI1UCJ to June 17, 2004.
Notice of this meeting was sent to abutters and notice of the hearing was pioperly published in
the Salem Evening News.
The petitioner is requesting a Wireless Communication Facility Special Pcunit undcr Section S
3, Special Permit Uses, of the City of Salem Zoning Ordinance, to allow Ilse ,nstallation of three
antenna arrays cuusisting of three (3) antennas each, and a I YX 25' enclosed area to house
Coil)InLIMCution equipment on the roof of the existing Fairweather Apartincnts building located at
40 Rear Righimid Avenue, Salem, MA.
The Planning Board reviewed the application and plans submitted and found that th,: petitioner
addrus:e' d the fequl"O'llents of[Ills section fur the issuance of a Special Pcrmii
Un June 17, 2004, ilu- Roard closed the: Public Hearing and voted by a vote ul seven (7) in favor
(Power. (:ollina, Puleo, Moustakis, Lwnbardini, Sullivan, DiGeroninlo), ions opposed, to grant
the wireless Communication Facility Special Permit for the location stated a.)uve, tit accoidan1x:
with the applications (dated April ''l, 1004) and site phut dated April 37, 2NI and rcvisad Mav 1.
2004 and June 17, 2004, titled "Cascade No. BS60XC325A, Fairweather Ap:i talent.,, Sprint,"
sheets T-I, LS-1, A 1, A-2, A-3, and drawn by Tectonic, Engineering & Surveying Consultants
submitted and now part u('thc file.
This endorserncnt shall not take clIeCt until a Copy of the dct:isiuu bearing verification al' the
City Clerk that twenty (20) days have elapsed and no appeal has been filet ur that i1•such appeal
has been filed that it has been dismissed or denied, is, recorded in the Essex South Registry 01
Deeds and is indexed in the grantor index under the name of the owner of record or is recorded
and n„Ird on the owner's certificate of title. Thu Iec for recording ov registering shall hC paid I"
the owner ur applicant.
I Ircrehv eel Illy that a copy of this decision is oilfile with the City C'le.rk :,,,(I Ihat a Copy n( the
decision anti plans is on file with the Planning Board,
Wulter B. Po"er. III
Chairman
12U WAsu:N(',I ON SALEM, MAs�;nCnuso-:I•rs 01970 . TFL: 478.745.9595 FAX: 91i.,'i U.04 04 . N•Ww.SAI I':M.1:11M
I