0488 REAR HIGHLAND AVE - BPA-08-2043 CITY Or, SALL I
PUBLIC PROPE 'r Y
DEPARTMENT
KIMBERLEY ORWAA.L
NfAYOR Q�k
V7&745-9595 0 U.V:
APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT
ALL STRUCTURES EXCEPT I AND FAMILY D WELUNGS 8D
IMPORTANT:Applicaut&must complete all items on this page
SITE INFORMATION
Location Name (Qrnnf51M(-rt;1S Building- -row'C-4 L-a H,
Property Address Iffm " I qil 10-1�ej 4Ve
map#
Located in: Conservation Area Y&D—Historic district
Use Groups
(check one)
Residential(3 or more Units) R2
Type of improvement Residential(hotel/motel RI
(check one) Assembly(churches) Al
Now Building Assembly(nightclubs etc) A2—
Addition—7— Assembly(restaurants,recreation) A3
Alteration Business 6 T
Repair/Replacement_ Educational E
Demolition— Factory(moderate.hazard) Fi--
MovelRelocate Factory(low hazard) F2
Foundation Only High,Hazard I-[
Accessory Building Institutional(residential care) 11
Other(describe) histifutionall(incapacitated) 12—
X,,, 6, wl✓�(' Institutional(restrained) J13—
jqjj4Cp)k)4.,D e Mercantile k�
*toragi(moderate jjazai ]). Sk
Storage(ftm hazard) S2
OWNERSHIP INFORNIATiON(Please fvpeor Print(Acart3i) C-Tn PCs,
OWNER Name 0- Q Ion kpf% -V 4,'C. —
Address llrza�1' 1 LY *-VC-
Telephone
DESCRIPTIONI OF WORK*.1.'0 BE PERFORMED AJ—J 42 Wwe-'/css
in<- I A,,Ir-0 k04-6 -< ,Y L-4 17-Q
4721Ve-l- tL., d i-e IQ Lrd -r ' u-tp* Me-" I kCOME04-rVt
ESTIMATED CONSTRUCTION COST t 3 0" 0on
CONTRACTOR INFORMATION
Name �V
Address4 9 t f�oe F�� l Ii -, a n r✓i ILIA
Telephone 50 8 - q t3 q- I-1576X
Construction Supervisor's Lic # 9�1 b'7.
Home Improvement Contractor#
ARCHITECTIENGINEER INFORMATION
Name( ��
Address . A i
t 144
Telephone �1 `J
Mass. Registration # 1- 0'1 ZCG
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00 =
Commercial est. cost x $11/$1,000 +$5.00= 335• 00
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of my knowledge under the penalties of perjury
a
Signed �o—�t---
Date o
Z J
a N
°a
i CITY OF S.U.Etii, L%LA.SSACHUSETTS
• BUILDING DEPAR'1(&NT
120 WASHINGTON STREET,340 FLOOR
I) L. (978) 745-9595
FAX(978) 740-9946
KI\tBERLEY DRISCOLL
MAYOR T3ioSIAs ST.P[ERR13
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
CONSTRUCTION CONTROL DOCUMENT
Project"rifle: ATC 0 Cain Road, MetroPCS Inc. Date: 5/30/08
Project Location: 488R Highland Ave., Salem, MA
Scope of Project: Attach 6 wireless antennas to the existing 180' lattice tower and place
related equipment within the existing fenced compound.
In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State BuildingCode :
1,-IA 192 l 1n 1 M /
R t,rK Mass.Registration Number /y 72 0
being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised
the preparation of all design plans,computations and specifications concerning:
h7� Project [ ] Architectural [ ] Structural [ ] Mechanical
`(] Fire Protection [ ] Electrical [ ] Other(specify)
for the above named project and that to the best of my knowledge,such plans, computations and specifications meet
the applicable provisions of the Massachusetts State Building Code,all acceptable engineering practices and all
applicable laws for the proposed project.
Furthermore,I understand and AGREE that I shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the
documents approved by the building permit and shall be responsible for the following as specified in section
116.2.2:
1. Review of shop drawings,samples and other submittals of the contractor as required by the construction
contract documents as submitted for the building permit,and approval for the conformance to the design
concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with
the progress and quality of the work and to determine, in general, if the work is being performed in
a manner consistent with the construction documents.
I shall submit periodically, in a form acceptable to the building official,a progress report to er with pertinent
comments. Upon completion of the work, I shall submit to the building official a IIna
satisfactory completion and readiness of the project for occupancy. P ssq
A� �o DAlVIEL PHAIV
. �c
Signature and Seal of registered professional: 0 CIVIL
0.40720
9
FGtgTEF�'�EQ
�SStO,V L E9C:�'G¢'
Construction Supervisor License
License: CS 61072
Expiration: 3/16/2010 Tr# 1.9127
Restrictiom 00
i r
( PETER R MORO -
49 5TH AVE EXT -
BELLINGHAM,MA 02019 Commissioner
1 .•
i
MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
ATL-001349006-02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Marsh USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
100 North Tryon Street,Suite 3200 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
Charlotte NC 28202 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
CA NON-RESIDENT NO.OB22889 COMPANIES AFFORDING COVERAGE
COMPANY
63191-Andre-07-08 A AMERICAN HOME ASSURANCE COMPANY
INSURED COMPANY
Andrew Systems, Inc. B CONTINENTAL CASUALTY COMPANY
3 Westbrook Corporate Center
Suite 900 COMPANY
Westchester,IL 60154 C AMERICAN CASUALTY COMPANY OF READING, PA
COMPANY
D ST PAUL FIRE&MARINE INSURANCE COMPANY
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 8
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MMIDDIYY) DATE(MMIDDIYY)
A GENERAL LIABILITY GL 7218295 07/25/07 07/25/08 GENERAL AGGREGATE $ 5,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGE $ 2,000,000
CLAIMS MADE 1XI OCCUR PERSONAL B ADV INJURY $ 2,000,000
OWNER'S S CONTRACTOR'S PROT EACH OCCURRENCE $ 2,000,000
FIRE DAMAGE(Anyone fire) $ 1,000,000
MED EXP(Any one persm) $ 10,000
B AUTOMOBILE LIABILITY BUA 2057345190 07/25/07 07/25/08
COMBINED SINGLE LIMB $ 2,000,000
X ANY AUTO
ALLOWNEDAUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NOWOW NED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
D EXCESS LIABILITY QK06802536 07/25/07 07/25/08 EACH OCCURRENCE $ 25,000,000
X UMBRELLA FORM AGGREGATE $ 25,000,000
OTHER THAN UMBRELLA FORM $
D WORKERS COMPENSATION AND WC2057340586-ADS 12/27/07 07/25/08 X TORY LIMITS OTH
EMPLOYERS'LIABILITY
C WC2057340619-CA 12/27/07 07/25/08 EL EACH ACCIDENT $ 1,000,000
B THE PROPRIETOR/ X INCL WC2057340636-OR 12/27/07 07/25/08 EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSIV HICLEWSPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 3A DAYS WRITTEN NOTICE TO THE
Evidence of Insurance CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,nG AGENTS OR REPRESENTATIVES,OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: Cynthia L.Fox T(.�'cljU0.�- S4
MM1(3102) VALID AS OF: 01I09/08—�
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII MAY 1 4 2008
�v CITY OF SALEM 2006051400312 Bk021115EPg9496ON 05/1412008 Date
n 1 hereby certify that 20 d4fte expired
PLANNING BOARD from the date this instrulMrps received,
��rnre and that r,!( :;laP,- ` t_ h0bW filed in this
\ officeing APR tR A fn:U`�l I I
Wireless.. Special Permit ILE #a
_
The Petition of Metro PCS for the Pro Salem,, mass.
48$4Rear Highland Avenue
A Public Hearing on this petition wasiheld on April 17, 2008. The following Planning Board
members were present: Charles Puleq Tim Kavanaugh, Tim Ready, John Moustakis, Gene
Collins, Pam Lombardini and Christi le Sullivan. 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 six
panel antennas on the existing lattice tower located at 48SR Highland Avenue, Salem, MA (Map
3 Lot 139). The proposal also include's the addition of three equipment cabinets, one GSM
antenna, and one GPS antenna.
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 April 16, 2008, the Board closed the Public Hearing and the Planning Board voted by a vote
of seven (7) in favor (Puleo, Kavanaugh, Ready, Moustakis, Collins, Lombardini and Sullivan),
and none opposed, to grant the Wireless Communication Facility Special Permit for the location
stated above, in accordance with the.application dated April 1, 2008 and site plan last dated
February 20, 2008, titled `BOS0025A: ATC 0 Cain Road, Salem, MA", Sheets T-1, C-1, Z-1, Z-
2, drawn by Hudson Design Group LLC, submitted and now part of the file.
The Special Permit was approved with the following conditions:
„;..
1. The equipment shall be painted a color which reduces its visibility and allows it to blend
with the existing equipment;-ihe applicant, his successors or assigns shall maintain the
appearance of the equipment;;':
I 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 thePlanning Board. (�
Charles Puleo, Chairman ,
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.
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 • TEL: 978.745.9595 FAx: 978.740.0404 ♦ WWW.SALEM.COM