320 LAFAYETTE ST - BUILDING INSPECTION (4) Crty ol:
PUBLIC PROP1,7"RTY
DEPART.*NIENT
'0 W Vli HIM;I t tN S I MI I I I v, ' I it_I It"'t I
C,
APPLICATION FOR PLAN EXAMINATION AND BUILDING PERNIFr
ALL,StR UCTURES EXCEPT I AND2 FAMILYI)Wt
IMPORTANT:Applicants must complete all items on this page
SITE INFORMATION
Location Named r K- QC�
Building .24.
Property Address aL 2atea -Map 4
Located in: Conservation Area)n ---Historic district Yt�tj
Use Groups
(check one)
Residential(3 or more Units) R2
Type of improvement Residential(hotel/motel RI
(check one) Assembly(churches) AI
New Building Assembly(nightclubs etc) A2_
Addition Assembly(restaurants, recreation) A3_
Alteration Business B
Repair/Replacement Educational E
Demolition— Factory(moderate hazard) FI —
Movc/Rclocate Factory(low hazard) F2—
Foundation Only High Hazard If—
Accessory Building Institutional (residential care) 11 —
Other(describe)'. institutional (incapacitated) 12
�25 0.I/ Institutional (restrained) 13
&V Ire ss
Mercantile M
h V7 Storage(moderate hazard) SI
Storage(low hazard) S2
OWNERSIIIP INFORMA1[ON(Please type or Print Clearly)
OWNER Name Me 4-Ko 19LS / PC L I, e L-L C-
Address 2g,-,,> P2#'/&L
Telephone q -7e) -04e)-32-&*
DESCRIP FION OF W014K 10 BE PERFORMED
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lee- In-4-rd<--qtt !p axr,t e9,1-7 b-K
ESTIMATED CONSTRUCTION(:os,r
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1
CONTRACTOR INFORMATION F
Name 14,10
Address_ Lo✓ f- 1 h
Telephone >' D53 7
Construction Supervisor's Lic # 7D
Home Improvement Contractor#
ARCHITECT/ENGINEER INFORM PION
Name A—✓1 1 G �{/F Y v� lM
Address 1470
0
05aeoCl NO• t)V�tr� b185�S
Telephone g7�i'. >57,^`5553
Mass. Registration #
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00 =
Commercial est. cost x $I1/$1,000 + $5.00= ,�•oo
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 J D
WELLMAN ASSOCIATES, INC.
70 BROADWAY STREET
P.O. Box 738
WESTFORD, MA 01886
PHONE(978) 589-9870
FAx (978) 589-9421
p�MOBILE (978) 828-3264
�,\\ KRISTEN LEDUC
200805I1I4003II1IBkI,2I1I1I11 IIII9495 Date MAY 1 4 200E
CITY OF SALEM 115114/200814:08:00 OTHER P91/1
j I hereby certify that 20 days have expired
PLANNING BOARD from the date this instrument was received
and that NOj C'P� I� s berm filed in this
offiisa t BB
b� Wireless.'Special Permit Decipilme cc FILE #
C The Petition of*tro PCS for the Property,M)TEO' at CITY CL E F';C Sa
20 Lafayette Street 9
A Public Hearing on this petition was`.held on April 17, 2008. The following Planning Board
members were present: Charles Pule -.Tim Kavanaugh, Tun Ready, John Moustakis, Gene
Collins, Pam Lombardini and Christine 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 concealed within two fiberglass extensions of the penthouses on the roof of 320
Lafayette Street, Salem, MA(Map 32,,Lot 216). The proposal also includes 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 six (6) in favor (Puleo, Kavanaugh, Ready, Moustakis, Collins, Lombardini), and one (1)
opposed (Sullivan), to grant the Wireless Communication Facility Special Permit for the location
stated above, in accordance with the application dated March 31, 2008 and site plan last dated
January 22, 2008, titled `BOS0052A: 320 Lafayette Street, Salem, MA', Sheets T-1, Z-1, Z-2,
Z-3, Z-4, 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 rooftop equipment; the applicant, his successors or assigns shall
maintain the appearance of ther: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 the Planning 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 foiirecording or registering shall be paid by the owner or applicant.
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 • TEL: 978.745.9595 FAX: 978.740.0464 ♦ WWW.SALEM.COM
,
1
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the poliry(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 form 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 alter the coverage afforded by the policies listed thereon.
ACORD 25 2001( 108)
0w Trl�mbntc�isuM.RI�� ay ✓ ,na.9irc�uGC
Boar of'Building Regulations and-Standards
.. +� Construction Supervisor License
License: CS 70740
I
Blithdate: 3/30%1968
�- "Olydtion: 3/30/2009 Tr# 11416
Restriction: 00:+
CHARLES R WINGJR
84.ANDOVER ST
WILMINGTON, MA 01887 Gommissiuncr
05/19/2007 02:03
Commonwealth of Massachusetts
Department of Indushial Accidents
600 Washington Street
Boston,Mass. 02111
Workers'Compeantion Insurance Affidavit
ZN 5 R • l/✓ ,V6 J'2
(Liecnaecoraymttee)
with al�pri/rincipal place of��business at
Ir
Zi%�N�dI/G� / GN/�t97/NG7 /w
(Cityswalzip)
do hereby certi$+under the pains and penalties of pcIJuM that:
I am an employer providing workers'compensation coverage for my employees working on this job.
Insurance Company Policy Number
() I am sole proprietor and have no one working ibr me in any capacity.
() 1 am sole proprietor,general contractor for homeowner(circle one)and have hived the
contractors listed below who have the following workers'compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Poliey Number
() I am a homeowner perfb wing all the work mystiE
I unduataadearn*wofauasMft a w9l be f waded to the OScc vMvestippHoaaeflheDIA fhreovuageveificatiannod tat fnimeto Man;om=F
eequieedwdcaeeiloa 25AofMtiL lSS eaalead to dtoitapaaitton ofotmlrtal pemlCoe matiatioS ofafnmofegaSI,SOO.oD ma/ermoytara'impnwemotrs
well as eMl pautrim le the lmm one STOP W,O,R.KK OXM=da be afSI0a0tl o day c9dadd x. +
Signed /G f Z" / day of /r��/ 20 /5)�
Licansce/Permirtae BuildingDepunnalu
Lioeosing Bosrd
sdocunew'r 081oe
Hanith Depamaem
TO VERIFY COVERAGE INPORMA71ON CALL 627-7274"0 X 403,d04,4n5.409,375
i
ACORD CERTIFICATE OF LIABILITY INSURANCE o its/D2w `8
PTLODUCER (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
IS3 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 NAIL 0
INSURED Infinite Solutions, Inc NSuRERA Scottsdale Insurance Company
214 Andover Street INSURERS: Safety Insurance 39454
Unit NI INSURER
Wilmington, MA 01997 NSURERO
NSURER E
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.
INS TYPE OF INSURANCE POLICY POLICYEFFECTIM POLICYE RATION UYTB
GENERAL LIABILITY REM OF CLS1371696 03/18/2003 03/18/2009- EACH OCCURRENCE S 1000
,001
X COMMERCIALGENERALLIABILITY DAMAGE TO RENTED S 50,00(
CLAIMS LADE a OCCUR LED OP(Any one pe ) $ $ 00
A PERSONAL III AIN INJURY S 1.000.004
GENERAL AGGREGATE S 2,000,
GEML AGGREGATE UNIT APPLIES PER PRODUCTS-COMP/OPAGG S 2,000,00(
X POLICY J�L7 LOC
AUTOrOStl LAmurry 6200922 09/29/2007 09/29/2008 COMBINED SIRDLE QWrr $
mi
ANY AM (Ee ee ) 1,000,
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (pe,Pe l S
B X HIRED AUr03
EX]TNLY WART' S
X NON-OWNED AUTOS (AP 0ci7aIL)
PROPERTY DAMAGE $
(PW Beclaw 1)
GARAGE LABLTY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY. AGO $
EXCISEARIBREUA LAmUfY REM OF XLS0040495 03/18/2008 03/18/2009 EACH OCCURRENCE i 5 000
X OCCUR F-1 MADE AGGREGATE i S O00
A i
DEDUCTIBLE S
RETENTION $ $
WORIERS rn -PENSATNTNAND WCSTATIJ- OTHI-
EMPLOYERS'LIABILITY
ANY PRORBETORIPARTETLEXECUiNE EL EACH ACCIDENT $
OFFICIFUMEMBER FXCWDEDT EL DISEASE-EA EMPLOYEE $
N yBB oW undw
E NI L DISEASE-POLICY UT M
SPE CWL PROVISIONS belPx ROVIO
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS /EXCLU810 LTQO�q By E ENT/SPECALwpvm S
e Workers Compensation Certificate TFgill be ma�e` directly by L7berty Mutual Insurance Company
nder Policy 4 WC231S35112SOIS effective from 3/20/09 to 3/20/09.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
E7PmATON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAL
Metro PCS 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAEED TO THE LEFT,
Matthew P Granese BUT FAILURE TO MAIL MC14 NOTE SHALL IMPOSE NO OBLIGATION OR LAINUTY
285 Billerica Road OF ANYIDND UPON THE INSURER,US AGENTS OR REPREWNTATWEB.
Chelmsford, MA 01824 AUTxowamREPRESENTATne
Nicholas Consoles GAIL
ACORD 25(2001M) QACORD CORPORATION 1988