205 HIGHLAND AVE - BUILDING INSPECTION (2) Ward
NO. City Of Salem
�W
1 ^ �
i
APPUCATION
i FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIOi'
IMPORTANT-Applicant to conobte all de=in secWns.,6 Il, lll, IV,and IX.
L ATfLOCnnow 2dS l l,Ql ,�cT nc� Ave.- Bv, 1A %ws I AM
-
LOCATION
OF BETWEEN - AND
CAM BUILDING smffn LOTS
SUBONISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING-All applicants complete Parts A-D
6 A. TYPE OF IMPROVEMENT 0. PROPOSED USE•FOR"DEMOLITION-USE MOST RECENT USE
E1 ❑ Nw auft" Aaaldendel NolraMelltlal
4 2 ❑ AddMn/r.aadlemmi.wW numeral new 12 ❑ O.a ww 18 ❑ Anammnelt nlaleaoolW
f
Musmp aorta adde4 d any.a part O.171 19 ❑ CMrJt Od1ar iefipiar
13 2-of u r mae gmdy•Entr/wmbr 2013 lrldlmtrr
3 ❑ Aarmloil ISee 2 aborsl W iafie ❑ PreY1p pawpe
4 IT Pepe,reowcon It 14 ❑ TWO11111 holm,nlalm.r da11'". 221 ❑ PUNT alslion iapsa paiepe
5 ❑ Wnayldlg fr na1b1m111,nesidarleal ermlr iadribar 23 ❑ NaaoalL ngihmr
a undo a au*Wv m Part D. 13) is ❑ Gawps 24 ❑ Omm boat piafewwrf
8 ❑ mwmv l eatioil) I is ❑ Carport - 23 ❑ Puhae wft
7 ❑ Fourwom only 28 ❑ SrdacL hwwv ow ecucoom
t7 ❑ 27 ❑ slaw.mailanote
0.OWNERSHP 28 ❑ Taialaioa
B 8 Pn mi-d-dWL coi=alon da voi ❑ Sir
rtaauhdn e1W
s 9 ❑ Pubic 1Fedw Sala,r 1arJ1 parwmwd .
C.COST 10maoanm Naawaaaml-Desada n dead pn]pwed use al buddinq;L e.9.food aaamn Pima,
{{FF n maaana anal6 fu lay aliitlin9 at haaWaL aMaaaary aehaat.asoorldarx aaldaL aaaapa.
R 10. Cost d:npiousn.w s 6 O O O aahooL Pmaal9 peeps for dowwwo sacra.lr 1m office build ft aftlae buda:a)
at aldlmbitl 0"91me of axwbv buaatilq a badq etwlpa4 Boar w4laeed iiae.
To be radarad but fiat owkwd
m ft seoae coat !'�Q`�� I— "�Ji -�L—M p/Q✓G 7h-{i+'�S
a. EMdadai
b. Ptumbdp +O - y i`cw( �a Vm S
a liamb as aoiltieail4p . ®
a �� lc���On✓
d. omw Masse.Wte
11. TOTAL COST OF IMPROVEMENT s
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolftn.
complete only Parts J&M.aB others Skip to IV
E PMNCWAL TYPE OF FRAME F. PRNCM TYPE OF HEATEal FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECM1WAL
30 ❑ Masaiif,Mapbearilp) 35 ❑ GY 40 O Pubic rw maccirnpow WE at
32 sb hum
mw 3377 0 EENcimiah 130, 41 ❑ Pirtle fapba Wat MG1 44 ❑ AIS 4B ❑ No
33 ❑ Nwilb, ca cim 3a ❑ Ccw H. TYPE OF WATER SUPPLY WeOboebyah OWAIMr
34 ❑ Odw•,gmch, 39 ❑ Opw-sow* 42 ❑ Puke or plamaao nlpww 4B ❑ MM 47 ❑ No
43 ❑ Pdru na.r ermrtll
J.01MENSIONs7 M. DEMOUTION OF STRUCTURES:.
la N.m of SroMS'..-.......--------------._._...___—.
49. Tc21-Mu 1ee1 a floor-area Has Approval from Historical Commission been received
&AW oaseo on enna for any structure over fifty(50)years? Yes_ No_
50. tole ma a u as A Dig Safe Number
R.NUMBER OF OFF-STREET PARIUNG SPACES Pad Control,
51 Endo w.__. 11
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdm ._ Yes No
L REESIDOMAL 0UX,0 riS OILY - _ ';.EItNe tr
51 HrAaa
Get
FW Nunor 5A. a SeMIBr:
00900 1f DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
PAMW BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Now (If yes,please enclose documentation from HisL Com.)
a
Conservation Area? Yes_ No_ (ti yes.please enclose Order of Conditions)
I
Has Fire Prevention approved and stamped plans or applications? Yes_ No_
Is property located in the S.R.A district? Yes_ No_
a
Comply with Zoning? Yeses No_ (If no,enclose Board of Appeal decision)
i
Is lot grandfathered? Yes_ No_ (If yes,submit documentation/if no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Yes— No_
i
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License x 0 (0y 8 8 8 Salem Ucense#
Home Improvement Contractor# 2 l 4 q 3 Homeowners Exempt form(if applicable) Yes_ No—
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
0 an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of BuWmgs.
V. IDENTIFICATION- To be completed by all applicants
NUM hawq aoalMe•M01W..loser.eem Nd we ZIP cede Tel Na
t. d•CS PT3 LZ(t l000RAN'�N1ta-) 9,fAh20 7 -181-"q
OWWW
x (.7�.�r2 Ill r1d 0.Va 12t � 3 &I - 93y
cmr �v�bw. 14 2 l �73/
a ( pro iva �v lT SZoa� 7cYl-Z70
Afchw or
EtpnMr
I hereby certify that the proposed work is auarorized by the owner of record and that I have been authorized by the owner to make this application
as his aunnorim agent ago we agree to conform to all aciolicable laws of this iurisdiction.
Sig re i g0dress ppplic e
/C) DOS vt, 0,. v� 3- �`l'b S
{
l
I DO NOT WRITE BELOW THIS LINE
` VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use G0°0
Permit issued 19_ Fire Graft
Building
9
Permft Fee $ Uve
Certificate of Occupancy $ Load
Approved by.
Drain Tile $ /7 ,
Plan Review Fee S Tm-E
NOTES AND Data-(For department use)
PERMIT TO BE MAILED TO:
DATE MAILED:
Constriction to be started by. Completed by.
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
i
SITE OR PLOT PLAN•For Applicant Use
1
I � �
� oN
FROM' : BRITT'WHITNEY FFee FAX NO. : 1-781-934-9731 Mar. 16 2005 05:04PM P3
fain-le-�Oe�S 1?:11 F'.V�J
CITY OF SALEMp MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
j !20 WA5HINOTON STR[ET, 3ROFLOOR
`\ SALEM, MA O 1970
TEL. (978)745-9599 Exr. 360
FAX (978) 74049945
STANLEY J. USOVICZ. JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition
of Building Permit 0 all debris resulting from the consttuctian activity
governed by this Building Permit shall be disposed ofina properly licensed solid-waste
disposal facility,as defined by MGL c M,S 150A
The debris will be disposed of at:
Location of Facility
zz
Sign=eofPemri Applicant' Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Pemtir Applicant
Firm Name,if any
Address,City &State
The above Statute requires that debris fmm the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defiaod by MGL c1II,S150A,and the building permits or licenses are to
indicate the location of the facility.
TOTAL P.03
FROM' : HRITT WHITNEY FFes FAX NO. : 1-791-934-9731 Mar. 16 2005 05:05PM P5
The Commonwealth vfMassachusetts
f Department of Industrial Aceideids
v 600 WaskiaPtonStreet, 1'+Floor
BOS[an,Mass• 02111
r
�• Woa'Iters'Com riot lAsanme Affidavit Baildia ra
bsbin I Coatrecton
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1 an a homepwnerperfom:{rag ilI wont myself. Project Typc ❑New Canstruetioa�Rmmdel
a sole proprietor and have ro oat wonting in any eamc"rty. 0 By CmuAddition
rd—ra}s•an amproya paov(yrr's A rkas'comp�rmdon for my gn�jy�,o�workjf)A on thisob
'----F�"t'dm i eootrac yr holneooDer(ei��i ate)enA F „'him.(.emr, b 1-e,,,n yeluw who havo
e.[ailwa':verwotiea3'.• _��og---`--�
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. . . . _,_ . . eL.r_.:%.Jp' atra,'An-i .w •'keCJ���Y•+.w�;r•
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mpr of}ab anlemrae mq ba fer+•arded to the Oa1er of te.a,syalleaa of dl.DIA for mexaga rartimtipy
Ida Nrrrb)anlfyjoader rhepeinr a(rdpenaMa ofyrrjnry r/edtrM lJtfarrrrdJionpavldM adv.e is hua dad rarer.
(� ,r�• nave —=�L µ�q �y Print naele�A Tw �(! /� 1, '/��/•�.
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oraAal afe 0.1) !e not+nla la*ft aaen la be ceepkred br elp'or low ankisf
e(ry or%**.,
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❑sdede.ea'a omen
eaa6m Iowa: p�ae finlrb De"'toner
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