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CITY OF SALEM PLANNING BOARD APPLICATION WIRELESS COMMUNICATIONS FACILITY SPECIAL PERMIT Salem Zoning Ordinance Article V, § 5-3 Applicant: Date of Submittal: Address: Proposed Date of Hearing: Date of Approval: Telephone: Date of Completion of Appeal Period: Location of Property: I. PROJECT DESCRIPTION Proposal a. Number & Location of Antennas: b. Description & Location of Additional Equipment: Site c. Description of Site: d. Square Footage of Parcel: e. Zoning district: f. Is there existing wireless communication equipment on this site? If so, describe what exists: Information required includes this application and the following additional information. File one copy of all information with City Clerk and fifteen (15) copies with the Planning Board (all copies must be stamped by City Clerk). II. ADDITIONAL INFORMATION: To be submitted by a professional engineer and/or radio frequency engineer, or other person deemed qualified by the Planning Board. Narrative: Please attach a brief narrative which describes the services and mission of your company, and explains your application by addressing the following: i. A description of the facility and how it operates ---PAGE BREAK--- ii. Technical, economic, and other reasons why the proposed location, height, and design fulfills the purposes of § 5-3 iii. Regulatory compliance, interference, and safety Drawings: Drawings to accompany this application must include the following: a. A vicinity/locus map which provides site context (display buildings and streets within 700 ft of the property, at a scale no greater that 1 inch = 200 ft) b. A site plan showing 1. Location and dimensions of all buildings 2. Location and dimensions of all parking areas, loading areas, walkways, and driveways. 3. Location and dimensions of all internal roadways and access ways to adjacent public roadways. 4. Location of all existing natural features including ponds, brooks, streams, wetlands, and marshes. 5. Location and type of any relevant external lighting. 6. Location, type, dimensions and qualities of any relevant existing or proposed landscaping and screening. 7. Location and dimensions of utilities, gas, telephone, electrical communication, water, drainage, sewer and other waste disposal (if applicable) c. A detailed plan of the roof or other proposed area for installation d. Elevations illustrating the addition of the antennas or equipment to building(s) or the site e. Photographs of the building(s) and site (photographs which superimpose equipment, or point out the location of equipment is preferred) f. Details of antennas and equipment (Sample Antenna Specifications) III. PROCEDURE: The Planning Board shall, within 7 days after the filing of this application, transmit one copy of said application, plans and all other submitted information to the Inspector of Buildings, City Engineer, Board of Health, Fire Prevention Officer and Conservation Commission who may, at their discretion, investigate the application and report in writing their recommendation to the Planning Board. The Planning Board shall not take final action on such application until it has received a report thereon from the above agencies or until thirty-five (35) days have elapsed after distribution of such application without a submission of a report. The Planning Board shall hold a Public Hearing on said application as soon as possible after receiving the above reports, in accordance with Chapter 40A of the Massachusetts General Laws. The Planning Board shall notify the applicant in writing of its decision on the special permit. The decision shall document the proposed development or use and the grounds for granting or refusing the special permit. The Planning Board may, as a condition of approval, require that the applicant give effective notice to prospective purchasers, by signs or by recording the special permit at the Registry of Deeds, of the conditions associated with said premises and the steps undertaken by the petitioner or his successor in title to alleviate the effects of same. Signature of Applicant Signature of Owner (attached consent letter is also acceptable) Date Date FEE PAID: