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134 HIGHLAND AVE - BUILDING INSPECTION (2) ' � ��6 ✓d �_ , , ., The ('omnwn�+�alth of Massachusetts , . �\ ;, 13uurd uf 13uilding Regulaiions and StandarJs I I Ult 11l'VI(�IP.\I.I�1�1� ' {.'� � Massuchuset[s Stute Buildin� Code. 78U CMR. 7ih editiun t�til: � �.,.�. I3uilding Pcrmil Applitaiion To Construct. Repair. Reno�ate Or Denwlish .� Nr�i,rJ J<uu��r�.� One- ur T�ru-Fumilr D�rrllin,q l. 'ni�S This Stctiun Fur Official Use Only 13uilding Permit Numbrr: Date Applied: __._ :-,�- � G s� sien:��ure: ------ ,�C3uiIJ�ng Cununu,iuner/ •��criur u(Bwldings Uaic — i -'�---- SECTION 1: SITF. INFORMA'1'ION ' I.1 Proprrt '�ddrr�� n� -- L2 :�ssessurs M1l�p & Parccl Vumbcrs -- �� Y� �-—I.lu 1s this :m ucrepteJ slrtC[°yCs___ nu__ Map Numbcr P:urel Number .� d.3 7_uning Inf(�rmytion: � L4 Proprrty IJimr.nsions: � ' I . _.._ _.__-__ � __. . ..---------- __...__ , ..: � Z;�oine �islri:� � Pr.,puud i�x � Ln 4 r��Sq li) f�un!age UU � `-----`-- � ---�—� -------- — - - -- -I �.5 Building Setbacks (ft) Frunt YurJ SiJe Yurds Rtar Vard ! Reyuircd Provided � Kcyuucd PruvideJ Rzyuired Pni��i��d ' 1.6 Wate�S�spply: (M.G.L c d0. §51) lJ Fiood Zone Information: 1.8 Sewage Disposal System: —� Zone: Outside Floud Zone'? Munici �I ❑ On site dis�osal s �icm ❑ I Fublic ❑ Private ❑ l'heck if yes❑ P � Y � SECTION 3: PROPERTY OWNERSHIP� ,�.1 Hner�afRec�ya• j3 ' /�/6NiA� �✓�' � �t�/!�r Lri6G/n�S `f � I N;w;e id'rint) Addmss tbrService: �Q �� .�G-��. �l9d �yv i�r9 � I Signrlure �-_ Tcicphune � SECTION 3: DESCRIPTIOY OF PROPOSED WORKZ(check all that apply) � New Cunstruction ❑ Existing Building ❑ OwnervOecupied ❑ Repuirsls) ❑ Alteration�s) ❑ r\ddiii�ro ❑ � �--- -- �Gcmu—li:�un ❑ Accessury Bidg. ❑ Number of Uni[s_ Other ❑ Spec�ly: _ I i i3rie' t�Descnp�i+:n�•'r Prepused WurAZ:__ OGC �Q�GK ----- ---._— _ -- I i i - I I ...._.._.__...-__-_-__ __ _...______..._...__ ____..-.-_-.-__.____--.____—__. --_.___.._ _.. . .__-__ ' .r.. � SECTION 4: ESTIMATED CONSTRUCTION COSTS i �iem Estimared Costs: Official Use Only ILubur and�Materialsl , I. L3uilding '� �s"p� �� [3uilding Permit Fee: $ Indir�te huw fec i�datermined: , ❑ Siandard City/Tuwn .4pplication Fee '_. �lectrical 5 � S DO p Tutal Project Cotit� (Itzm 6) x multiplier .r � . I 3. Plumbing 5 56 D 3. Other Fees: .� �j��d� I 1. Merhanical IHVAC) $ Li.r. �� 5. Mechanir�l IFire � Tutal All Fees: S I Su� restiiun) � Check Nu. Cherk :lmuunC ('a,h :\nuwne � I b 'rotal Project Cost '6 ys�D ❑ Paid in Full ❑ Oultitan�ing Balunre Due:---- I SECTION 5: CONSTRUCI'ION SERVICES � $.( Licensed Cunstruclion Supervisor �CSI.) � Lircnx tiumbar lixpiraiiun D:ua . tiuntr ul CSL- Iluldcr Li,t CSL'P�pc Iscc belu�c) _ T c Ucscri iliun . \ddrn> . - � � C l'nresinrled I u�tu ii.U00 Cu. Pi.i � R Re>trictcJ 18c'_ Famih' D��ctlinc tiiEnaturc � y1 .\1:isonrr� Onlv .-- RC Resi�rmi�IRuu�ineCmrrine I Tilcphoni• \1'S Itrsidrm:al \VinJu�� .inJ S!ihn,� _ SF ResiJtnilal $uhJ I�ucl Burnine .A >>li:mr: Insi.ill,iiu�u U Rr>i�ontiul Ucmuliuun 51 Regis[ered liome Imprurrment Contractor(HIC) HIC Company N�ntc ur HIC Rcgis�r�nl Nantc Rrgistratiun Numbcr ��-- AdJress - I - " .-- Fl�)11'UflUll �:1(C I c;,..,:mirr Triry�hcnc _. . � I _ _I SECTION 6: WORKERS' COMPENSATIOA` INSURANCE AFFIDAV[T (M.GL. c. 152. § ?SGfi)) 1Vorkers Compensation [nsurance affidavit must be completed and submitred with this appiirati�ro. F;�ilw�e tu pruvide this affidavit will result in thz denial uf lhe Issuunce of ihe builJing permit. � — — ------�� Signed Aftidavit Attached? Yes .......... ❑ No ..._...... ❑ SECTION 7a: OWNER AUTHORIZATION'CO BE COMPLETEll WHEN � , OWNER'S AGENT OR CONTRACTOR APPI.IES FOR BUfLDING PERMIT _ _ � -- I �, , as Owner of the subject prope.rty hereby � .iuthorize tu uct on my behult; in ull mu«ers � ; relative[u vn��k authorizeG b�� this buildi�g permit app'siraiion. ' � � � ---- ---- — --- � I � Sik:natureofOwnzr - --.---Dote - - ---.-.—_---'--Ji � SECTION 7b: fii".�NER� OR AUTHORI'LED Al4ENT DECL.4RATION _� �`;.. � ---- �, .✓' , as Owner ur Authorized Agent herehy declare iha[the st emen :nd information on the furegoing application are true and accurate, to tne brst uf my knowled,e:ind I� � behalf. , I f1�rGE1.�� fflGGi�✓S _ _ ' Prinl Name Sz 6�� Signature ul O er or.4 �rized Agent Dat� I (Si neJ under tBe ain� �nd enalties of er'u ) NOTES• I. An Owner �vho ubtains a building permit to do his/her uwn �surk ur an uwner whu hires .in unregistered runvactur� (nut registered in the Home Impruvement Cuntractor(HIC) Prugram), will nn! have arress m tne ;u�bitra�iun j program ur guaranty fund under Y1.G.L. c. 1�12A. Other impurC�nt inti�rmution on the HlC Program and Constructiun Supervisur Lirensing (CSL) r,in be tiwnd in 730 CMR Regulations 1 IO.RG :md I IO.RS, r�spectively. I ' When substantial work is planned, pruviJz the inti�rmatiun beluw: 1 IT��tal Fluurs �rea(Sq. Ft.) . �including garage, tinished b�semen�attics. �ecAs ur purchi j � Cirotis living �rea iSq. Ft.) Habitable ruum ruunt __ '� Number of fireplaces Number uf bedrouma � _ �,' Number ut huthruums Vumber��f h;ill7ba�h, ___ 'Cype uf heming sysmm Number uf decks/ p�xnc�s -- - --. i rYpe uf euuling sytitem LncluseG __ Upcn -----.— I 3. `Tutd Project Squore Fuuiage" may be substituted for 'Total Prujert Cuat" � � _ . y CITY OF S.�I.El�i ' PUBLIC PROPERTY DF.PAR'I'MENT K1411F��evw•ry� .. VAYot 1�WAvutiCl'OM S�7G�T�SAt�B14 VAt�A0/t.'S617S 01970 '��.. 71F1:97L71S-9S9S� F.�t:97L7a0-'N� ��. HOMEOW�IER LICENSI�: EXE.rIPTION I Ptea�t Print Date 5 0`�9 0� - , Job L,ocation Home Ownar Addres� /3 ffi6F/�An-/� Av� Home Owna Telephone ?9fs 9Yf� ��Y 9� S`�a S3z� C Pre�eat Mailin��►dd�ss 'I'he current exempdon of"Homeownen"wa� extended to include ownc-occupied dwellingr of two Units or less and W allow such homeownen W engage an individual for hire who.does not possess s Gcense,provided that the ownar acu as supeavieor. DF.FIId1TION OF HOMEOWNER peraon(�)who owns s parcel of laad on which he/ahe reaida or intends to reaide.on whic6 there ie, or is intended to be, a one or two family dwelling. attached or detached . - suuctures accessory to such use and/or farm shuctures. A person who constructs mon thaa one home in a nvo year period sl�all not be considered a homeowaer. Such "homeownd'shall submit to the Huilding O�cial,on a form acceptable to tl�e Building Official, that hdshe be responsible for all such work performed under the Huilding Prnnit- The underaigned "homeownd'assuma resporuibility for compliance with the State Building Code and otha applicable bylaws and rogulations. The undcnigned "homeowne�'cerrifies that heJshe undentand� the City of Salem Building Depaztrnent minimum inspcction procedura and requiremrnu and that hdshe will comply with said prxedura and requiremrnts. HOMEOWYERS SIGNAI'(1RE �, APPROVAL OF BUILDIlYG INSPECTO � � See other side for state code + . � . X /� � F ( r ... �. . I ..__ , ^,—_...�... . ! . � O � � � � � _. .__-i -��/// ;. ti � � � � ( �:r. .' �K / I -______ i - __�_____-- — � Q _ . ----.----. ._ .. . R/ n0 A I . ._._.___ � y, I -.__'.._' 1,�, ,. ____ . � ______ __. o r, � \ c� -- -- tq/AL7ER !` FRANCES ABRAHAM J � � � aD 5 6A9/ !. 0 432 'b C -� i \ �' DONALD �` ANN EMMERTON 455�/54� _.._-,., , � ____ cn � _ �`30�qN/y £MMERTaN � ' -1 � _ ___ _.._ �y � , �, _.. _.. . , - --- '', CHARLES J. MU ' - - ---_ � � �' ; __ _ — 6/5 � , � �, RAYMOND � � SANTO 6 G/OV,4NNA COSTA � r 13b AREA�3�� S.f. � ` � � 5/�/IRLEV LA9BE 4005/ll7 p '1 H/�/6�4��S� PARCEL 1 0 � �0 � "'� 00 S.F. � � AREA=EtP AREA = g990� S. • N , 20., h- � (`� C � �"� --P_Q►kLCEI. l TO ` "., ` --'�- � M�N'f-&\ ` � ac�- ��_ �/3B ' Y`�o- g�� CM�TY �� ,o` - ----�EAR�.A QB+�ZH+.6�. \ `� - s �3Al.�iM '�u� � R•2c) ,_- -'-��_. �PI' S GP Ui A L, ; :gy � �) D �r A, D, h �}% ia ' �_ �a ia i _..- ;, �� 1p't 10'- , �R ; _.._ -,1��0 . r__ _ , � , E ,,, _ __._ _� �N-r- ; ' --- - --- - A --- -----r p,- � '. -- l,A. E A�E M `' � �.�a-�",��.�e' ��iPER s ��ot g.�. EXiS7. S!o% HighwoY T��,�}p �qgg►;A�NT-� '� % AR�E'' a Loyou.! of Nou. io, i9,a a,REA m 394x s.P�. � �' !" > ��Od,IT�' Ita7) . �--__�..-- PERM. EAbEMEMtz' 3 '� AIlE. _f AR�A= ��bo* 8.F°. f-/lGHLANO _ _ �.__— ___._...— _-----'.--.._ �_.. . ___--___ _ _ _----_--- SCALE IN FE�T A/ferotio�7 ""- _ _.. Exlst Sfofe Hiqhway -------- "" 40� Q 4Q� $U � _ .. ____.. .. of June /B, /946 --- ' — _..._.___-- _______._ .___. _____..�L— — , "," '' i certify that thie picin hoe been prepared in n contormity wi#h the ru�es and rapulatio�s of the �L'�� Q� �'A�� 1�►:a�''�'�� Regislers of Deads of th� Commonw�alth of �:,��,,,�fyi � sss�x��4�. S,p. a�a�r. ��r'►�," , Massactwsstts. ES$i'EX CQUN'TY � .'��. � �� ,�. � `, Sh4v�ing Eas�m�ents cnd Taking .. . ,. ;�� .: ' ,<v �..: ��w� ;, e G��7a � 7�:3 f�d� +��a�7n far a Propo�d P�d�e�#�'ion Qverpas� � r. �� '77 �� pq. 2G3Y1 U �� i �,t; 4 T¢�r% Scalei I = 40 Date� 5/5/�'7 � �� '� is�afOF �i{� CE MAGUIRE INC. � ..�;'� ;7'' c�e,uu9 d'�� „ 60 FIRSTAVEHUE WALTHAM, MASS. � Date Si ature