205 HIGHLAND AVE - BUILDING INSPECTION (6) No. ��� '� City of Salem Ward
H.ca.00�
x
9
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT1011
IMPORTANT-Applicant to compAAle__te�� all items in sections.R /l, IIG IV, and AC
L AT(LOCATKTNI 20 8 H 9 Ci H LA N I� .. ,Y-'��S' !]U t L:,6 r N e, S
LOCATION NDJ '"�"
OF BETWEEN AND
BUILDING aalaessmffr $LOOT .
SUBDPJWN LOT_BLOCK SIZE
U- 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 Q NOW ou"M PAddenOW NaOrendenlbl
2 Q Addison fa Maadewef.wWM/nWV of 12 (3 Orr aw* is ❑ Ammwa M aarae0dw
Ao="units added d&W n PW10.13) 13 Q ""o or Mre 0w*-EnwfMf ww 19 Q OWAK atlw Mbgimw
3 Q Aftwoon rS 2 amre) Ca uMdt 20 ❑ iraduww
21 Pokbiggefam
Etaerfa
s Qar Rep rnpaa4lanefe 14 13finWtxmaheiWMob e MOM rtiwL a drmiofy• 22 ❑ Snub sNWm mm grape
5 0 Wa *-v(1f ft*A wr Meadwv*w w wmbr 23 I aepalI *wMuidw of urub m biddnp n Pan 0. 13) 150 Garage 2413 ONIM brat paabaerarl
6 0 MOw9lfelaotcnl 15 ❑ Carp" 25 Q-Plaefaumv
7 ❑ Fo111tletgn ortly 20 1-1IJ odw-saacdy 270 0 swwmwcw ScImak a�adta W
IL OWNERSHIP 28 I] Ta t Wawa
9 ❑ Pudic fFedw*L Shft r WCO Wwm0
C.COST - (Obecwm Nweenrw.Oaeoos n deW rapond uee Of euedalA a g-i0W OrOMM"PM M
ROOM rfaP.hurray doltlinq z M ce cPOL aim V Kt"eanaery erNDA Oafape.
t a Cop at.narosarrrd s 6 0 0 °'0fJ11 ee, , of lb'0 w.p.lar dow0'we soon,mnw anlee build p,on*drdaw
at ntlueaw 0"s use CO exleft " pa bsalg e0r1pe4 fAtlr pnapceed um
TO be awadey our not nckow (/_ ` �•
m roe agora Cost t—'re ✓o D iy ✓U✓-e
a Ebancal
a Oierelq,w mritlrrer9
d. ONM WrA or.eel
1I- TOTAL COST OF Mf%O%EMEW s 6(00 0
UL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, comptel a Parts E-L:demolition.
Complete only Parts J&M, all others skip to IV
L PRMCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF NEATND FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANCAL
30 0 jWb=-Vt.W- rop) 35 1] Gee 40 Q PuOeeorw wemnat say - WEsaenbefarraler
3Q37 31 a PMY bePOc Wc ee) corownrW
2 ft um wo 0 8@0kN
44 ❑ yls. 45 13 Na
33 ❑ Reaebeeesaner 3B ❑ Cog H. TYPE OF WATER RIPPLY weVi by anwrron
34 ❑ O9w.Spw& 39 0 Ofw•Sp w* 42 13 P%d fa w P- cmwmw 46 ❑ Yw 47 ❑ NO
43 13 P*-vm(well costae
J.DIMENSIONS'�' _ - M. DEMOLITION OF STRUCTURES:
+8 N.n '74crones_._.......
---_:.----._...._..__.
as my edam t"of kw area Has Approval from Historical Commission been received
a:Boors oared M ecru for any structure over fifty(50)years? Yes_ No—
w Tow and a ea ea R. Dig Safe Number
IL NUMBER OF OFF-STREET PARKIMG SPACES Pod Control:
SI Encgaed.__.
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
5z pmdm ._ — Yes No
art ErrttAultvanuss OWWlAer
S& Erlddaed .. - EleC1tIG -
GaE
Full .Sewer
se. NUMON of DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
baw O P.M* BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Now (If yes,OEM enclose documentation from Hiist.Com.)
Conservation Area? Yes_ No_ (11 yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No_
Is property located in the S.R.A.district? Yes— No_
Comply with Zoning? Yes__ No_ (If no.enclose Board of Appeal decision)
Is Icl 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_
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License# O LA 8 S Salem License-*
Home Improvement Contractor# l z.1 `{ 5 3 Homeowners Exempt form(if applicable) Yes_ No—
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an i
CONSTRUCTION IS TO BE COMPLETED BY: extension is necessary,p�submit
writing to the Inspector of Buildings.
V. IDENTIFICATION• To be completed by all applicants
N" MwkV awm•Num0e6 saeel CO.aw JIM ZIP Cade Tel Na
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coma= v a 2-3 3 '2 uBuudw tie gZby�g 7 3 f
a F� R6P2o uD I'�J TR4 fhb Zff-27o -
AMhM=°` 5 26 0
t &rz- m A 0 I c316
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as pis autorizea anent ano we agree to conform to all applicable laws of this iurisdiction.
� re apWi g Apph V` 'date
G10 ��
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN•For Appfieant Use
O N
I
i
I
i
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DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building use Gmw
Permit issued t 9— Fee Gratleq
Building Live 9
Permit Fee $
Otruprc:y Load
Certificate of Occupancy5 Approved by'.
Drain Tile $
Plan Review Fee S
TITLE
NOTES AND Data•(For department use)
j PERMIT TO BE MAILED TO:
F
DATE MAILED:
4 Construction to be started by. Completed by.
i
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I
f
�F
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FROM : BRITT WHITNEY FFes FAX NO. : 1-781-934-9731 Mar. 16 2005 05:04PM P3
rjiP-1c-200 1`c li v
/i CITY OF SALEM, MASSAr-HUSETTS
r- 1 PUBLIC PROPERTY DEPARTMENT
120 WASHINCTONTR STREET, 3RO FLOOR
SALEN,MA O 1270
+ TEL. (978)745-9595 F.XT. 360
FAX (978) 740-9045
STANL¢Y J. USOVICZ. JR.
MAYOR
DISPOSAL OF DEBRIS APFIDAVrr
In accordance with the provisions of MGL c 40, S34,I ardmowledge tha as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shalt be disposed ofin a properly licensed solid-waste
disposal facility,as defined by MGL c III,S150A
The debris will be disposed of at:
Location of Facility
Signature ofPermi Applican Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name,if any
Address,City &State 0�2 3'30;�
The above smte requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-wastc disposal
facility as defined by MGL cIIL S150A,and the building permits or licenses are to
indicate the location of the facility.
TOTAL P.03
FROM BRITT WHITNEY FFee FAX NO. : 1-7el-934-9731 Mar. 16 2005 05:05PM P5 -
i1Hl':"1b-cll� P.02
•",` -:. The•Com nonwealth of Massachusetts'
c
Department of fndusritaf Acddewfs
456YTYT 600 Wath jrtgton SPKlr 7*Floor
Boom Mass• 02111
�' WorlterD'Cow fts]Asmftn Aifdavik Build lB Nubia Bi Coutrecton
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i em a hottuowner Derlom^{ng alI worK myself. Project Type., ❑New cwutructioa❑RerrrOdef'.am a sole ptapriebrr and have n0 one wDri;inp in any capacity. BDild'ne Addition
am an ampl0ycr providininsg/ rkers'o=penatloe for my tmQloyeros workfn oa thitjob.
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