205 HIGHLAND AVE - BUILDING INSPECTION (8) City of Salem Ward
No. 1
on
4'
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��- APPLICATION
::FOR
PE MIT TO BUILD ADDITION, MAKE'ALT.ERATIONS OR NEW CONSTRUCTION
IMPORTANT .Applicant to complete all Items in sections:1, 11, Ill, 1V, and A.
I1 C)'X - _
ZoS ht'�I, I�,�,d V Get u� DISTRIC
�. sl it pL3TlON1
LOCATION "°' } W ; 15o i', 5"�✓t�
OF BETWEEN F V 11'{•C, — AND !C 0=S T)
,woss sRLEn L07 'Z4 y Z.¢j, -F
BUILDING - LOTBLOCK SIZE L``If LL_-T—
SUBDIOSION
II. TYPE AND COST OF BUILDING •All applicants complete Parts A •D
A. TYPEOF IMPROVEMENT D. PROPOSED USE•FOR"DEMOUTION"USE MOST-RECENT USE
P RaJOenOY NdryeNdlndY;
T i6 ClMwe�b'�L�e0e�1101V1
2 O AOdtlon fit nsnennal enfer number of new 12 O One ian* 19 Cl Gn,d,"ha,wom"
/wernq unm am .a any.a,Can 0. 13) t 3 lid 1w &e wn4y•En YylniW p O I14pvol
3 Ahe ,on IS4e 2 above) co u W (-�� 21 ❑ PR'kkV WaW
a ❑ Reoar'repaoemen 14 lrvonnl Mid.I„OWL v 0O nrto'y• 22 0 5r eai6On ro P-090
Enw wn, d vntl -- 23 0 H"'UL iulh,aiWal
S ❑ W, .'q to m'u iiay,as dnbat,r,w number
d unm al ou4duv n Pan 0. 131 15 I] Ga aqe 24 IF]--I � 'B'N �
26 7J7Pudlc,aiiiy.
6 O Mo+in9 vrlo li0 ) 16 ❑ Cmpon " 26-[3 S&'Od,WWY.oUw""-60 Nl
7 (J FWnoa,Dn onY 17 ❑ Olne,•SP--4---- :.27..EI:Sbra:"n"`a
26 I] laN.a vwen
B.OWNERSNIP -�I
6 PfN+1s Individual fppp tiro nonpda -.•.29 tJ p1Mr•SpedY
wln,nm rlcl
9 IJ Pudic IFedew::Swe.p Iovl WvWWnent
f0'fli,r,»nnl
yonrea:de.aial•.Dame"h,M W mOmed be d b AWir*s e.9.-bud ed,od 02M.
C.COST Irudv,e snoo Iaundry.Du7din9 e1 I,wGaal ebrrMraarY ed,00l e° 7
W.V.Penang W.qe 1v�rOmerV ate•renal office buWh9,dFv bu ng
.. a 11/ Dvl7 i1W'�'�'�tro1 ya„L n ue d exisfiq b, d Is bei,q WnQW.e"I°,.v0posed ism
Cos,d 10. C nnp neon
10 be 03ra4od M mf i,duded b 1 # 1 v 4— ► V i — i J u
in the above Coal { —
a Elecviol ✓LC 5'1"0V4
b. PAnnbin9
— � I
e Fim in9.W ev4hb,I',9 m .
d. O&W le4•v .e1G) alow
.
11. TOTAL COST OF IMPROVEMENT
III. SELECTED>CHARACTERISTICS OF BUILDING •For new buildings and additions, complete Parts E oL;demolition,
complete on Parts J 8 M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRNCPAL TYPE OF HLATM FUEL G TYPE OF SEWAGE DISPOSAL I. TYPE OF MEC WW Sk.Al
0.)g Public a Dn'��NrrWarly win Il,e,e'De cefWel�!
30 O M wa y(YM beari,e9) 75 Gaa condabr,9?
VNod name. 36 Gi Al ❑ PeMale lseWic W*-a", 44A 45 ❑ ND
32 Q SbuG, W f aW 37 ❑--7 EIectne" a TYPE OF WATER SUPPLY 1efe�W,UPPEY � � � w9 6 an e1/'awl
33 ❑ Reidorced m•,rnata 36 IJ Coal P
39 ❑ OIMr•SpeU7 ' ubOe d Pd+ap adre,Pa'1Y 46.❑ lYe' 47�N0
34 0 Ods- '1 43 ❑ P Mee I A4 dIeWN
M. DEMOUTION OF STRUCTURES:
aY e a Has.Approval horn Historical Commission been receiveo
a for-any structure over fifty(50)years? Yes_ No_
DSg"late Number
I�
Ott xest,45ontrol:
HAVE IHE,FOLLOWING U11LIIIES BEEN DISCONNECTED?
Yes No
'Water.
-EWc#x
�. . Gas.
Sewer.
g DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN.BE ISSUED.
k
04lose documentation from Hist Corr.)
enclose Order of Conditions)
4It
ations? Yes No_
Board of Appeal decision)
cedocumentationAl no,submit Board of Appeal decision)
„ iDsed? YesX— No_
No2�- (If yes, submit documentation)
Salem License a7" Z I (J(D
Homeowners Exempt form"(if:applicable) Yes_ No_
1h1PHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please subrnil
in writino to the Inspector of Buildings.
t�,harm.Wrest dp,+na=e ZIP God, let W
4111
A4 Zq j Gl 56-VO-71 ,
S-tvt r,"t Z 15
robs- 10�0
�+A and that I have been authorized by the owner to make this appticatan
Is k/nydrelgn.
- Appbcaton date
i
DO NOT WRITE BELOW THIS LINE
VI. VAUDATION _1A DEP: . .
.. FOR A5IMEM USE OtnY
Building
Permit number use(vow
Building o_ Fee Graorwj
Permil issued
Building LM
Permit Fee g Owmarcy loco
Certificate of Occupancy Approved by/�
Drain Tile $ G
Flan Review Fee g
TFFLE
NOTES AND Data (For depanment use)
-----------------
--------------
PERMIT TO BE MAILED 10:
DATE MAILED:
Construction to be started b)r.
Completed by.
M
i
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD -
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
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