370 HIGHLAND AVE - BUILDING INSPECTION No 2fl'0� City of Salem Ward
APPLICATION
FW
PERMIT TO BUILD ADDITION, MAKE AETERATIONS OR NEW CONSTRUCTIC'
MWORTAMT"•AppBunt to=WA&WO New in swffm -6 4 AK N,and X.
L . . .-ATILOCATIOM AV�—.vUE
LOCATION
OF SETWEEII AM
BUILDING nnrtn lAyr
SUBDM9pN LOT BLOCI( SIZE
L TYPE AND COST OF BUILDING•AN applicants complete Pars A-D
A. TYPE OF IMPROVEMENT O. PROPOSED 118E•FOR"DEMOLITION"USE MOST RECENT USE
I ® Now buMM BaalAantlol ebr000ldonWl
2 ❑ AtlWBon(it mbwa*wwnumbw anew 12 ❑.Ow W* - 18.❑.Ammumil.wosslMW
Awdnp un fa added,i wm in port A 13) 19 ❑ OW ak COW MHOW a
73 ❑ Two omoa bmW•fmr wmbar
3 ❑ Allvallon(See 2 Wion) - of uab 20 ❑ bldtatrbl
4 ❑ Repair MPW=rum 14 ❑ TWO W hobL moW,or dwMM- 21 ❑ Pw"gwap
Haarnumbarduab_—____.—. 22 ❑ SaMwsoilorr,rapeir Ma9o.
S ❑ wraektp( In Anuidmdal emr wnrew 23 ❑ IkapaK W Wludmul
ofunlla inbuddkV dkp M rt Q 13) is ❑ f ar!7� 24 ® Ooloa Dori,pioMaaiwol
o ❑ Ma ft(Mlocalion) to ❑ cwpwt. 29 ❑ Public utFAy
7 ❑ Fou clason oa, 17 ❑ OBW SpacYF 20 ❑.School.iarotY.oBnr aduraabf W
27 ❑ Slam%nwrcwMo
LOWNERSHIP 20 ❑ Tariatosso
8 Private(NdNiduaL 0orporellor4 wnprdM ❑ OUW SPadti -
InaWullaM1 etc.) 29
9 ❑ Public(Fade*Slab,w local 9owx wwo
C.C08T (Omit cmw NwvoWdw W-Demob@ it daW propowd uao a bradnpa w tbod pre oaakr9 pbr+
.�? macho chap.Wmiy I I I -at lospihL eM W*wy aao 1 secardrV school coaa9a.
Y'/iAS�'= oo I . .a .o prhb9 9m90 for dap l WN alga renN offm buYatip,o9foa Euigin9
- iR Coal a tmprouenrea__—��_ 9 330,000— at iMusbW pml It Lin d exisbr*buiWrq is baY4 abn0a4 MYr prc000ad uao.
To fio hsbBad bur not lr)cerded "
in drs&bow cost �I Z oo SF' -7RAn/f AV=7- I
L EMCbieal---------------------
b. �z-sV TES
c. "aatirp,air cwxh wtiwo.—.—__.__—_--
11. TOTAL COST OF IMPROVEMENT $330,000,10 `
IL SELECTED CHARACTERISTICS OF BUILDING •For new buildings and additions,complete Parts E-L;demolition,
complete only Parts J&M aN others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRWAft TYPE OF HEATWO Ral G. TYPE OF SEWAGE DISPOSAL L TYVE OF MECHANICAL
30 ❑ Masoay(w4Y bearM) 35 ® Gsa 40 ® Prbk o Wivab wmpwW Will dmo be central
31 ❑ Wood frame 30 ❑ oil r 41 ❑ Pftft(sepW tang sic.) condinLwMe
32 ❑ SbuauW stsW 37 ❑ Electricity 44 ® Yes 40 ❑ No
33 ❑ Rob to corrreb 38 ❑ Cod K TYPE OF WATER SUPPLY will thsi b,an elw aWl
❑ onW-spacdr ae p.YW 47 N o
3,, ® �.spac�r 38 a2 Pubic o<pfNd.mrgmY
'i�te_�t/�tYvE�/t2 a 43 Q PrWft(wWLcisMn)
wao.a s-Picuu'r �€
I Dh�orrs f M. DEMOLITION OF STRUCTURES:
dgW OM Ot y«iq.._.____..._._.._._...__.__..___
as Tow sQ,de red a M«aiee. Ha6 Approval tram Historical Commission been received
al aoo,a uaeea an estan"r 7r Z00 S-F for any structure over frfly(50)yeaB? Yes_ NO—
,----- -----
5n riot me e,ee as R----...---- 37r4 Z3 SF Dig$ate Number
hr.rrueeer oP oR-sTM�T°uo"'w SPACES Pest Control:
sr. FxaoeeA-------------
sz Cumou._.------- --
4¢ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTE yes D
u e UMM ohr hr WaW.
sa Faraoeed
Electric
Gas:
FtA .Sewer:
sk Pabst. DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
bl&M" BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes— Now (ti Yes,please and0se doCumentaton from Hint.Can)
non
a? .Yas— . NO-A (ff yes;plasse endow Order of Oond d=t
IL—
Hasi approved and stamped Plans a applications? Yes__ No
ed in the S.RA district? Yes_ No--
Comply with Zoning? YesAk No— (lf no,enclose Board of Appeal decision)
Is lot grandfat hared? Yea'_ No X (If yes,submit documentatIonM 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 X (If yes,submit documentation)
Massachusetts State Contractor License# a40379 Salem License*
Home Improvement Contractor* Haneowners Exempt form('d applicable) Yes— No—
CONSTRUCTION TO BE COMMENCED WITHIN SIX(B)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,plem submit
CONSTRUCTION IS TO BE COMPLETED BY: ar/coor» in writing to the Inspector of Buildings.
V. IDENTIFICATION• To be completed by all applicants t
Ni111e Maria ad&M-Munbc wed.car,aro snoe ZIP coo Ter NM
h. CNO�LEs 1�`✓zG6o 37� f/=GR/LAN� . ,avENVE 0/97o 978-1744•64
Cv &
Lessee
2 Gt m G'aN�7'1Cd 9G $'LdAr»P�G6rr �OAD 019,70 9?1-b-9Z-31
can a<mr sp��m , ✓1A c;u�im ft 04 03�9
s eANTtCb. ZZ! l.✓�sfrzvG,�a.� �rizi= �=T- a1996 1Y78.744 5�
arnaea« Srsv� Ls'vE�tMo �i¢]G�'r�e , rLiA
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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 applicabon ,
as his authorized and a ree to conf to all hcable laws of this jurisdiction.
Signature of applicant Address <SM' M r Sal /�lsT�a Application date
'�'aav�� - ,v,�a 9G 5e✓m.aaPseorr ;E ' Mod c vM? /1?d f113 7
rDO NOT WRITE BELOW THIS LINE
w
IDATION
FOR OEPMRTMEPIT USE ONLY
umber use GmW
19_ Fra Gra9iq
ssued
g �^+�
Fee s �a
ate of Occupancy s Approvedile.
Plan Review Fee
NOTES AND Data•(For department use)
i ,
0 pp
Aj
S U
N
C S
PERMIT TO BE MAILED TO:
DATE MAILED:
Constnxtion to be started by. Completed by.
A ZONNG PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN•For Appficanf Use
O N
CITY OF SALEM
ROUTING SLIP
NEW CONSTRUCTION
CERTIFICATE OF OCCUPANCY
LOCATION: :370 11s6 NGAij.D AVM'•DATE 4117,JO9
APPLICANT• �x�'�m �"N�zuG7zo�
ASSESSORS
FRANK KULIK� go✓` i�eL K 1 14 . Ira- DATE: �2 ��
n
(93 Washington Street)
CITY CLERK
CHERYL LAPOiNTE DATE:
(93 Washington Street)
PUBLICE SERVICES %'
DATE:
BRUCE THIBODEA 7(L`/
(120 Washington Street 4°
WATER v2 Q7 �✓v �fC�
DOTTIE THIBODEAU DATE:(120 Washington Street)4d'
CROSS CONNECT SUP
BRIAN THIBODEAU
(5 Jefferson Avenue) 7 7 V y 330 2
PLANNING Fe"K.T?Orm;.td �Z
!/`-1 DATE:
(120 Washington Street)3nd Floor
CONSERVATION COMMISSION
FRANK . .......P DATE:
(120 Washington Street)3nd Floor
ELECTRICAL DATE:
JOHN GIARDI
(48 Lafayette Street)
FIRE PREVENTION
ERIN GRIFFIN DATE:
(29 Fort Avenue)
HEALTH
JOANNE SCOTT DATE:
(120 Washington Strut)4d'Floor
BUILDING
THOMAS ST.PIERRE u DATE:
(120 Washington Street) Yd Floor
CITY OF SALEM9, MASSACHUSETTS
® e
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3Ro FLOOR
SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595 EXT. 380
FAX: 978-740-9846 -
CONSTRUCTION CONTROL AFFIDAVIT
Project Number. Date: `►'��O/b7�
Project Title:
Project Location: �3-72b t1 i
Name of-Building: .,e-2
Scope of Project: 9,t70eiC�
INC RDAN E 21�116.0 ODE, I
SS. REGISTRATION NO.OF THE S3Z BEINIG ACREGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND n
SPECIFICATIONS CONCERNING:
Civil Architectural Structural_ Mechanical V
Electrical Fire Protection Other(specify) �yES N� � �
•�AdF.
FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS,AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO
DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2.2.
1. Review of shop drawings,samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit,and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required control materials.
3. Special architectural or engineering professional Inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix I.
PURSUANT TO TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
COMMENTS TO THE BUILDING INSPECTOR. UPON COMP
THE WORKP&SHALL BMIT A FINAL REPORT AS TO ATI FA M I
OJECT FOR OCCUPANCY.
FdAWV 22.2013
Signffiure
AND S BEFORE ME THIS ��- DAY OF fj 2t)Or�
4PR'IcBED
My commission Expires: 212-2116
e
CITY OF SAD_EM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595 EXT. 380
FAX; 978-740-9846
/� CONSTRUCTION CONTROL AFFIDAVIT
Project Number. (M'/102` Date:4/t . 1
Project Title: 1 C
Project Location: UVA In"
Name of-Building: �^
Scope of Project: __,
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I
MASS. REGISTRATION NO. BEING A REGISTERED
PROFESSIONAL HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREP TIC
OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING: Aw*#6 I
Civil Architectural Structural Mechanical
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS,AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO
DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2.2.
1. Review of shop drawings,samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit,and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required control materials.
1 Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix I.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UPON COMPLETION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE AT SF TOR PLETION
AND READINESS OF THE PROJECT FOR OCCUPANCY.
Michelle e n
SUBSCRIBED AND SWORN TO BEFORE ME THIS Not Publi
os thuselVAY 0
MY Commission XPires
MOMh 24 2All
rmgslon Expires:
Notary Public