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205 HIGHLAND AVE - BUILDING INSPECTION (4) Nabs—'° City of Salem ward tr r� APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT101 IMPORTANT-Applk ant to complete all Items in sections:4 11, 114 N,and AC. L AT(U)CATION) `Zd S H�a H Lq n.,'� LS - lJ V I r, G _Z LOCATION OF BETWEEN AND BUILDING ICrlb®S1NEEn CrAmamffn LOT.. SUBOMSION LOT BLOCK SUE ff. TYPE AND COST OF BUILDING-All applicants complete Parts A-D A. TYPE OF IMPROVEMENT 0. PROPOSED USE•FOR"DEMOLITION"USE MOST RECE W USE 1 Q Nwr buddk* RWArhbw Nwanwtlrwr 2 Q AddXbn rd rsaiden W.annr nurrora new 12 Q ore WNy 18 Q AMMMMM wOtlOdW era mM unea added.d any.m Part 0.131 13 l.7 ;o or maw bandy-Enter number 19 13CMra,oveg r aora 3 Q Aannwan rS 2 aboha) of unity 20 Q Inaintrea 4 Q � Specie ie w 140 Trarow Mow noel or"wilory. 21 Q Prhtrg gimps ewraanbrarmus 22 ❑ SSrrioa awwri marompm , s Q w acke p td naddwrrrr ratrdri'el rnw ramnbw - 23 (3 NoapMal,imtltlNorme IIFF or umw n unitnp a Fad A 13) 15 Q Grape 6 Q MoMnp lracoaornl 24 13uift Dank praw.orr 16 ❑ Caroan u Q Pndlrl nfft 70 Fonecatanowy 17 Q omr-Spec& 20 Q swdwok�W B.a ErP-NIP 2B Q Tm tR wwm 6 �P irisral mrparmarl rhrhgPlN 29 Q otter-SPicity 9 Q Pubic IFedraA Slaw.or coal Wmw*M C.COST tome orhwl Nowesarwi-Deevoa M dews a000ew uea of budwmja,a p.tood wprawitag owe. maernne arm wuhdry bhidi-at hoapaeL 000 O—V School Secondary school.cawpe. 10. Car of imormemew S 6 0 a oroctlml aerial DaMwh9.dodge bar awarders atop,barer dress bhidirhp,dllwe bhred'ng t al mdu@UW P"a nee a sawing baddlrnp s bang ebrnged,rnwr Proposed hie. To be ft$tUW but not nc4ged m de eeow mr a. Ewabol jjam_, 0. P N ON TU /�!P �r/�'( �oO 17t Isc Naft ae eorhdawrg `F d. OBhrpr.r,v.am) ! 11. TOTAL COST OF IM FROVEMENT B b 0 0 U IIL SELECTED CHARACTERISTM OF BUILDING -For new buildings and additions, complete Parts E-L:demolillon. complete only Parts J&M.aN others skip to IV E PRe1CUIAL TYPE OF FRAME F- PRNCPAL TYPE OF NEATM FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MEClIAWCAL 30 Q minew yleaibmrwp) 35 Q Gam 40 Q Pubic aPrimammmparny WIN real beGW"air cwWftnW 32 Q StrteSealStrlewe a Styr 3713 eabirwy 41 Q Amu IaePIC beat.atl 44 Q tea' 48 Q No 33 0 iterate mhoaam 38 ❑ caw K TYPE OF WATER SWPLY ova two by w awhaae? 34 Q Odw.Sgsc* 39 Q Otter-Spat& 42 Q Ph/ibwwwwownpow 46 Q.YOM 47 Q Nd 43 13 P&mm*Kcwwm J.OWE%Sw wer M. DEMOLITION OF STRUCTURES: 46 N.n a 49. TOM swan"of no«area Has Approval from Historical Commission been received a:noon oases an a:wcr for any structure over fitly(50)Years? Yes_ No_ c:maecne -----...------'--- So. Tow two area ea a_ Dig Safe Number IL NUMBER OF OFF-STREET PARKING SPACES Pat Control: 51 Er¢sosea.___ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 5Z Ouldm - Yes - No 51 Enae.a Fue Sewer 56. N11°"a DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED " ` Partial BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ Not Of yes,Please enclose documentation from HisL Com.) Conservation Area? Yes_ NO_ (If yes,Please enclose Order of Conditions) Has Fire Prevention approved and stamped Plans or applications? Yes_ No_ Is property located in the SRA district? Yes_ No_ Comply with Zoning? Yeses No_ (If no,enclose Board of Appeal decision) 1 Is lot grandlethered? Yes_ No_ (if yes,submit documentation/if no,submit Board of Appal decision) E If new construction,has the proper Routing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor Ucense# O(�l E 8 Salem License# Home Improvement Contractor# f 21 1493 Homeowners Exempt form(if applicable) Yes_ No— CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT ssary, submit CONSTRUCTION IS TO BE COMPLETED BY: Men extension is n Place in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants 1 Now Me&*aaarms•NomOeer,s9e I co,ertl S M1 LP Caw Tel Na t R' ,3,,L s ZLC 106 6P-A ., ,v,Kw koA,� J-ze 71I 844— Ow w O2iey ZIll L r &,,A 1,vTM-Ls M W Z A3wiItr.e o ISA XI �1G€ `AAJF l� 1Y43 7�l-`J3t�, roman« u r2 r-n Z 3 3 Z tm 9 r 3 l a & /LoAA ArGelMa or ,f S 1C G EiRino .4'N L16 v 4 I hereby certify that the Proposed work is autarizW by the owner of record and that I have been authonzed by to owner to make lhis application as his BUlhorize0 adent ano we agree to Conform to all amicable laws of this-knisdlction. I �S�\ 1 n Application date Sig re 0 appl -3- tz^ T�4- DO NOT WRITE BELOW THIS LINE VI. VALIDATION BUIUN FOR DEPARTMENT USE ONLY Permit number UseG�+o Building » Permit issued 19— Fire Gradog Building live LOe�n9 Permit Fee $ Otapeney Load i Certificate of Occupancy S Approved by. Drain Tile S Plan Review Fee $ TITLE 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 SITE OR PLOT PLAN •For Applicant Use i i r n� FROM : BRITT WHITNEY FF88 FAX NO. : 1-791-934-9731 Mar. 16 2005 05:04PM P3 �iiR-1e _©0� 13�11 H,d� CITY OF SALEM, MASSAGHU6ETT5 1 PUBLIC PROPERTY DEPARTMENT !20 WASHINGTON STREET, 3RO FLOOR • SALEM, MAC 1970 TEL. (978)745-9595 EXT. 3B0 FAX (978) 740-9945 9TANL9Y J. USOVICZ. JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I aclmowledge that as a condition of Building Permit# all debris resulting from the construction activity governed by this Building Permit shall be disposed oflna properly licensed solid-waste disposal facility,as dcfined by MGL a III,S 150A The debris will be disposed of at: Location of Facility Signature of Permi(-Applieent^ Date �. FULLY complete the following information, (PLEASE PRINT CLEARLY) 13 �/'.� p Name of Peffiir Applicant Firm Name,if any Address,City &State The above statute requires that debris from the demolition,renovatmN rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL d[L S150A,and the building permits or licenses are to indicate the location of the facility. ToL a T a .es FROM BRITT'WHITNEY FFee- FAX NO. : 1-781-934-9731 Mar. 16 2005 05:05PM PS i1Hr'•10-f ry 1'o ld The Commonwealth Of Massachusetts DepaHffwnt of lnduWal Acdldems c 600 WadringlonSveel, 1e+Flooi Woricdn'Com tb>t lsceneceOVON,Marg. 40211 B2111 reDta xbical Controctan aaarrsu f�Z/' tea. _ z Uly /✓'�i - .G �i d�3J FaneY �O }�/ j u •-f I am a homeowner Derfom:lns all wont myself. Project TYPt' New C 'am a sole ry � anAdditbii ORearnifel • _ P Praetor and have no one warkinR in any cspacrty, �Bvildine wddition �am an rrlploycr ptovlautg wwkers com oe form M00y P Y aRs worldn�oa Lh swab cpobpu*�M Ad y yy,..4���y.. � •V I ,SVT Qr'�It '---�-"Y�•n '. 1 coort�ct .Ur homsbs.oer ['I�i,pnd)enA h.u.t,r�.�a 1 �below who ha�o tFa faL'ow-ulrworkas'-' idt3.��-�•, YQMerx ..�.:"..'.��`,•Irrii:.: ,,�, .?+;R,,yq.:.�.1 IaLiA111�tfiL! - • •• . :FMI•nu xcvre eoven=ea rtqu1M.new SetAoe 21a or MCL 11 aele•d Nth•IspotlaN of crlmb.l PtsnhFee efa Rot■ox re•en'etpAremam is wetl a•dra peoeGm m the btm dre STOP WORK O D to a1dOd00.rd/ar ORDER rM a foe dTrlhRae a doY r0liort ta•. !tedetcaed thee.mpr of reh ueletamt m�he bevetdea to eh.Oa1ir•f rtnetclptbtu M dN AU br to.enye eenaattldq 1 do htreA,aniJy aAdtr thePaw dAd ptnadNts of prrjnry Ihm rb htfarn dojo pr�j d opy,e v hYt and hM. ,.�-• ji(yi•tgR _ dam - ? ?Tint vane= p. y�. a wit_7>j -Elf F ,q eo not-Ale 10 99%vm to w c,opelod br rip ar tow.racial _— -- Bollelea Deperrnwt mmtdl•lt n oacm i,regr6ed uauDR•ra Osdmt. •t oreet e: pMo•ds EkwrbOepeowal ❑Other