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205 HIGHLAND AVE - BUILDING INSPECTION (3) City of Salem Ward APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT101' IMPORTANT-Applicant to comptete aY items in sections:b 11, 114 N, and IX. L ATILOCATIONI Z65 W1GNVAr N AILA I.�U 1 i-D ,h1 C �.. LOCATION N0J '"�" OF BETWEEN AND BUILDING rnoaall LOT' SUBDIVLSION LOT BLOCK Siff II. TYPE AND COST OF BUILDING-All applicants complete Parts A-D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 p NM b dWnp 11eekMrba Nerreaden" 2 p AaaKwn,a,sadenea.enlwnumbwdnaw 12 p ore W* to ❑ Anuminiie,nedasedW ,auaul9 unmo added,if arry.a Pen 0.73) 13 0�Tuo ar moo Jw*-Ensrm mba 19 p Qvick cola mhgmm 3 p Afte w fsee 2 abovep - of ued 20 p wwwaa 4 0 y 21 p P&M gwage Rq=Mpocemed 14 p Twasom IateL moeel or oo, wkxv• 22 p Sadca colom weer 9= W EMvnl,merduna 5 p WMcluv o m aimow,ee4rbel a number 2313 I•w.pei.wootubom ` of units m buudiw 0 Part 0. 73) 15 p GM0 2413 oleok bank olof.ogr F 6 p NwMrw l,.woeml 18 0 ca,pp„ 25 p PWIoleiy 7 p Fp,a,0 ai,d,w, 25 p so"mmy.one offuca a 17 [J dowse•sP.w. 27 p S1det m =00 S.OWNERSHIP 260 T=eltwe=re 8 �,Mb udiviNa4 mrporauon.rw,wwla 29 p oew sm* E uldragr6 e1G1 I 9 p Pubic lFedera4 SteW or cold gnw,nl M C.COST - IOme Cww Noreeewawa•Osedbe 0 owe Wgmw use of buidalga,e.g..tow aao•n9 Prot Rmctw a coop.Aundiv bolding at hospYL aim we—j adwol.seoow=X rJmL ooespe, 10. Cod d mo,wamad t C)CJ O �adwa pareeg gaage for daoararr soda,unW office buadsy,d5on buidwg a awu11rs1 plat a use of essdp buidY g w beep ebrlge4 are Proposed clan. To a dwe4d but not Mkded /� of tlll Yl m aeda J('`'f 414P a B /-�� �/L.✓D��✓P/N+G// -'/ J FJaL4ol - b. Pfumbay j�d rI P Lila , Yit/ XO0Pn lj i GNob ae Odwldlelg �/� i ZlA j d. oewwrine e.etl 1/. TOTAL COST OF eAPROVEMENT - 11 O 0 IIL SELECTED CHARACTERISTICS OF BUILDING -for new buildings and additions, complete Parts E-L:demolitbn, c onty Parts J&M, aB others skip to IV E. PRNIcwAL TYPE OF FRAME F. PRNCiAL TYPE OF HEAT=FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANWAL 3o p mum v llne flaregl 35 p Gas 40 p PuOeb or wwww ooinmw WE ewle be Baler '4t 31 © bbff two 38 p Of 41 p RMW Iaapao Wft etcl calaiowww? 32 p Slrumaal sow 37 p Eleciffoe r 44 0 Vies 45.p No yffi 33 p Re/rdm odder 3613 cow 1L TYPE OF WATER SUPPLY VA 9we by In SISM00 c 3413 oew-some 3e p Od,a .*@C* 42 p PuOie or, ewwary 48 p ye. 47 p No 43 p PMaeiwa4amm i{ I J.DDAENswNs- M. DEMOLITION OF STRUCTURES: 48 N., -we t........_.._...._.._.__.__...____. 49. Tam sOuarAa%I:OPW area Has Appirma1 from Historical Commission been reCeNed a.:Mors Wsea m erfmrW for any structure over filly(50)years? Yes_ NO— so. Tom usa sax sa IL_ Dig Safe Number IL NUMBER OF OFF-STREET PAMWG SPACES Past Caftrot: 51 Eecwve.__. - HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? l • 52. Oaaam,s.- Yes No !) L RESIODMAL BUaDNGs ONLY 5a rIa I Gn: Fug Sewer: t a, e, DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED BEFORE A PERMIT CAN BE ISSUED. N. comPLETE THE FOLLOWING: Historic District? Yes_ Now (If yes,pie:enclose documentation from Hest.Cant.) Conservation Area? Yea_ No_ (If yes,please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No_ Is property located in the S.RA district? Yes_ No_ Comply with Zoning? Yeses No_ (If no,enclose Board of Appeal decision) ( Is lot grandfathered? Yes_ No_ (If yes,submit documentation/d no,submit Board of Appeal decision) If new won,has the proper Routing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor license# 0 6 4 8 8 8 Salem Ucense# Home Improvement Contractor# 1 a 1 y 4 3 Homeowners Exempt torn(if applicable) Yes_ No— CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary,please submit in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants rlrrle mmkv aamev•;Afto.,&"K co sna sm ZIP C'0 TeL Nor. ,. R L o ,L� Ab a zd zPl OWW LAaaee rYt O'Ll8 7Ill a '63 ! am ZI YU 781 -1341 UDrf$U A Q2. a Liralr•No. 47Y} AR,IIINq car IbU I.4 v(Z IT 7oZ 1�1-270- F'yr° N�9YCf< 1/* 6/ &l 7) 5200 I hereby certify that the proposed work is authorized by the owner of record and that I have been auftmed by the owner to make this application as his authorized scent ano we agree to conform to all awicable laws of this junsdliction. ISIgn7r oo phi plipadn datiL- A DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Use se Gmup Permit issued 19— Fie Gradmg Building Uwe Permit Fee $ Load Approved by'.Certificate of Occupancy S Drain Tile It Plan Review Fee $ l�OAWLE NOTES AND Data.(For department use) PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by. Completed by. VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD + NOTES i i f i SITE OR PLOT PLAN •For Ap bmt USe !t 1 1 ON ' f i i d i i FROM : BRITT WHITNEY FF88 FAX NO. : 1-781-934-9731 Mar. 16 2025 05:04PM P3 fiiR-le-2k305 1? 11 H.O1 CITY- OF'SALEMj MAS5ACMU6ETTS \� PUBLIC PROPERTY DEPARTMENT j !20 INUHINGTON STREET; 3RO FLOOR \ SALEA,MA O 1970 TEL. (978)745-SSSS EXT. 380 FAX (979) 740.9945 STANLCY J. LISOVICZ. JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I admowledge that as a condition of Building Permit 4 all debris resulting from the constrvotion activity governed by this Building Permit shalt be disposed of in a properly licensed solid-waste disposal facility,as defined by MGL c III,SI50A. The debris will be disposed of at: Location of Facility Signature of Permt A�pplic9n�^ Date FULLY complete the following information;; (PLEASE PRINT CLEARLY) Name of Permit Applicant Finn Name,if any Address,City d State ' The above statute requires that debris from the demolition,renovation,rehab or other alteration of building or structum be disposed it a properly-licensed solid-waste disposal facility as defined by MGL c1IL S15OA,and the building permits or licenses are to indicate the location of the facility. TOTAL P.03 FROM' : HRITT WHITNEY FFes FAX NO. : 1-7el-934-9731 Mar. 16 2205 05:05PM P5 1'elvvi P.Oi The Commonwealth Of blassacltusetts 1' Department of lndusYrlal Accidents c 600 WarhiaPfon Sneer, 70 Floor Briton,Mass. 02111 ` Wovkrr9'Com tioa!loans«AildavitBoildlp rs imbia ai Covtrarton N / 1 em a hottuowrler Peefotming ali worx myselL Project TYPt•• ❑New Coro .'am a sole ra elor and have no one woZn In an cin'. hn'ct1O° m1Odel Buildin Addition an em to tr P Y Praisin�gcworkers'compsnaxlon far my a°gloyeas worlcin�oa f�l/ 'tin%/ ♦ G �: :,�, .:fob. ,. +Y•d v 2 -�"Ydn 1 coatrac or homtow°er�ciKJ,�p )" h„„"br,�.l.tip,.,,. 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