205 HIGHLAND AVE - BUILDING INSPECTION (5) ' -)S City of Salem Ward
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APPUEATION
Foe
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT10F
itwPORTANT-Applicant to complete au items in sections.4 lt, ig N,and IX.
I L ATlLOCATIONI 2 OS l\\i` PSU I t-:-,�1,J C Ll OISIRwf
LOCATION 1Mw
anoun
OF BETWEEN AND
I BUILDINGg LED
€ SUBDMSION LOT BLOCK SIZE
f 11. TYPE AND COST OF BUILDING•All applicants complete Parts A-D
A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"OEMOUTION•USE MOST RECENT USE
1 ❑ Now bur" Re�ltlr�tlal Nenrwad.rsYl
1 2 ❑ AOWtlOn lit nisMenBY.MNI numbers nw 12 ❑ Ga lady Ii ❑ Anstowart reCrallo11s1
` housM units edited it any.n pen 0.13) 13 19 ❑ Clnea Cum 1Ngw
a'%a a mars ernM•EnMnlnbet
3 ❑ Asewlcn Me s 2 atims) of urea 20 ❑ Inctuxtird
21 ❑ Perseq 9wa9e
Enr
4 �Rapar rspeamwe 14 ❑ Tra rnw nara4 nefleL Or dorrrlaorY• 22 13Senla staeorG raper 9ssew
rsnwraurue
5 ❑ WraGngltl nyaYandy rssdereal Mlkktlerrrrbet 23 ❑ hlbeala awnbmr
of una in t yliclo p in Fan D. 13) 1 S ❑ G=w 24 ❑ Osa.band.ptaleowrrd
8 ❑ Mouep 9abovics) 18 ❑ 0111M 25 ❑ P1ePo tow
7 ❑ Fo neWan wM 24 ❑ SalmL library odw eduaeald
p 17 ❑ Oflw'Spear. 27 ❑ mom rrwrveYe
d S.OWNERSHIP 28 ❑ Tama owers
9 �MIRIArndal) wrparalrarG nanprea
i naMrearG acal 29 ❑ OUwr-spwity
9 ❑ PUbW IFedsm Slake W bvl Wwo u its
f)
{ C.COST lonlanw) Npewscer"-Dsaersts el decal Pwposed use a buildirwe,a.w.botl akoeeaseq Pi"
I nrr is OM kLXKNV 4ddn9 at nospes to en ey sich"sawMrY rJmL eaeYa
10. CoY a enprpYaners s//p� ' boo - aCMIA I '' 9 9ee9a sot de 11111- ra skate.rerlW dke buaaq,apes buldiq
at rau•b.l Piers.9 use of wKiliffint,bd*q w Item ebel9ed,tiler wWoaad pea
To bet-u but norneadad
n Pine aww mu �%'� ��D Gv� � L44,�
f a. EMWOI r
nPM.ro.q "IC�.�Gr.vr` �190M<
a AMom ar mcrStlawg ll�l, ��il� � .
d. Oerr wevow.W-1
11. TOTAL COST OF IAWROVEMENT sL . 0 0 O
IIL SELECTED CHARACTERISTICS OF BUILDING •For new buildings and additions, complete Parts E-L:detnoRion,
complete only Parts J&M,all others skip to N
E PRINCIPAL TYPE OF FRAME F. PNM=U TYPE OF NEARING RIEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHAMCAL
3o ❑ mom vtwel Erip) 35 ❑ Gr - 40 ❑ Pubee or wewks wmmw Wi two be der"Gir
32 a end ing 38001
0 41 ❑ PrMle lapel lersG Pict l 44 Q 45 ❑ No
33 ❑ Re:brna bwvake 38 ❑ Cal N. TYPE OF WATER SUPPLY we were by w stave ?
34 ❑ OVW-Sppo* 39 0 OVW-Sp=* e Q PIa 46 ❑ Ya 47 ❑ No
J.01MEMS*Ns- - M. DEMOLITION OF STRUCTURES:
_Ja Nua a,.S ._..._...
_.._..-..._..._..._.._.__.—.
49. Toni wane"a flow area. Has Approval from Historical Commission been received
a.:hags o w a:ereor Yes— NO_
a,,,,,,, s _ —_'----__—'-- for any structure over fifty(50)years.
So. TOW Wa a sa ,t_ Dig Safe Number
IL NUMBER OF OFF-STREET PARRB/G SPACES Pod C;Onha-
51 E+pmsa.-- _---- - -
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52 owdo - Yes No
L RESIOBn4LL BIADUOWGS O - _. Witiir -
53. EnaJaa E @cbrim
Gas:
FW Sewer:
sa zav w DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Paft BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Nos (If yes,please enclose documentation from H•Ist.Com.)
Conservation Area? Yes_ No_ (If yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yea_ No_
Is property located in the S.RA district? Yes— No_
Comply with Zoning? Yes x No_ (If no,enclose Board of Appeal decision)
Is lot grandfaMered? Yes_ No_ (If yes,submit documentationfrt no,submit Board of Appeal decision)
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 License* G�O k$0 S Salem License*
Home Improvement Contractor* 121 419 3 Homeowners Exempt form(if applicable) Yes_ No_
CONSTRUCTION TO BE COMMENCED WITHIN SIX(B)MONTHS OF ISSUANCE OF BUILDING PERMIT
If CONSTRUCTION IS TO BE COMPLETED BY: an extensionth is necessary,please submit
in writinggtot0 the Inspector 0<Buildings.
V. IDENTIFICATION- To be completed by all applicants
Nees Me"aomn•M~snK eat:see seer ZIP Cafe TeL All
8Z .cr,4 4 +s L 100 G sw X0A17�! 8YY
OWW or
L11 (3RaIN mA xl6 710
z (3 UJLIJ Q U3 6Ayk-1Zl6E LAlV6
cawAerar l v)4)3 v (3 2-3 3 Z
LXWM Ma
Ayi,rirea or too )S U TT— k4 K k-)
Enpmw AM)e ✓Fret- /i'1>4 at F-i b
I hereby certify that the proposed work is auawraed by the owner of record and that 1 have been auftnzed by the owner to make this application
as his authorized aaem and we acres to conform to all aool cable laws of this jurisdiction.
Sig f ap icant- ) Application date.
i
I
P
r DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building
FOR DEPARTMENT USE ONLY
Permit number use Group
u Building
Permit issued t 9— FBe GMm
Building Lire
Permit Fee $
Occupancy Load
Certificate of Occupancy $ Approved by:
E
Drain Tile
I Plan Review Fee
MTfrLE
NOTES AND Data•(For department use)
f PERMIT TO BE MAILED TO:
DATE MAILED:
Completed by.
Constriction to be started by.
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONTYARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
i
i
SITE OR PLOT PLAN •For Applicant Use
1
ON
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FROt1`: BRITT WHITNEY FFee, FAX NO. : 1-781-934-9731 Mar. 16 2005 05:04PM P3
�IiP-SC-GF.�Y�J 1_• l. - K U.J
CITY-OF SALEM, MA'SSACMUSETTS
/ = PUBLIC PROPERTY DEPARTMENT
i !20 WASHINGTON STREET, 3R0-FLOOR
SALEM, MA 0 t 970
TEL. (978)745-9595 EXT. 300
FAX (976) 740-9a4e
STANLEY J. USOVIC2. JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accord2nce with the provisions of MGL a 40, S34,i aclmowledge that as a condition
of Building Permit; all debris resulting from the consttuotion activity
governed by this Building Permit shall be disposed ofina properly licensed solid-waste
disposal facility,as defined by MGL c III,S 150A.
The debris will be disposed of at:
Location of Facility
Sigoantre of Pear A�ppfiean Date
FULLY complete the following information,
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address,City &State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration ofbuilding or$tr I=be disposed in aproperly-licensed solid-waste disposal
facility as defined by MGL c2l,S150A,and the building permits or licenses are to
indicate the location of the facility.
TOTAL P.03
FROM> : BRITT'WHITNEY FF88; FAX NO. : 1-781-934-9731 Mar. 15 2005 05:05PM P5
iiH!'".b-sGaJJ U: 1�J P.Ot
The-Commonwealth ofMassadhusetfs
DepartnrentoflndurodalAccldewts
600 Washi igton Sweet, 70*Floor
Bacon,Masi 01I f I
Wooten'Com Mee lafanttm Affidavit. 8oildhl membefavrimbical Cowrocton
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fdarext:,/f'� tea.
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I eft+a homeowner perfom:ing�ll worts myseK Project TYaC ❑'Jew Construction
.'am f axle ro ewr and have tw one wot*in in a C=Civ
���• ��Building Addition
we mp,oyer Providing erkm'o=p1etnagon for my�yloyeos worMn on cis ob
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ram... ■
oil
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