44 DERBY STREET - BUILDING JACKET 4H � �Li T
FILE/C 0. COPY
rD � %m CERTIFFi OF OCCUPANCY
lb CITY OF SALEM Issued: Permit N:.L=.
SALEM, MASSACHUSETTS 01970 City of Salem Building Dept
DATE JANUARY 12 18 95 PERMIT NO. 16-1995
APPLICANT JOSEPH SKOMURSKI ADDRESS4 NORWICH RD OWNER
(NO.) (STREET) (CONTE'S LICENSE)
CITY DANVERS STATEMA ZIPCODE01923 TEL.NO. 508-777-1823
PERMITTO ALTERATION ( ) STORY ONE FAMILY NUMBEROF
DWELLING UNITS 0
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT(LOCATION)0044 DERBY STREET ZONINGDTRICTR-2
(N0.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION MAP 41 LOT 0142 BLOCK SIZE 0003450 50 FT
BUILDING IS TO BE Fr.WIDE BY FT.LONG BV FT,IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS. RENOVATIONS: REMODEL PATHS & KITCHEN J. J. J.
AREA OR PERMIT
VOLUME CUBIC/SQUARE FEET) ESTIMATED COST$ 30, 000 FEE $ 185. 00
OWNER BRILLANT RENE/BRILLIANT RENE C JR BUILDING DEPT.
ADDRESS3900 WISCONSIN AVE N W BY J. J. J
rine ocor.�m nneveve un oir_ur rn nnr�iov now eroeer n i�ev no mnnuei v no eniv Doer rueoene ertueo rcuononou v no ece...uc.r .. c...e.........c.r�
;ITE BUILDING
CITY OF SALEM
SALEM, MASSACHUSETTS 01970
PERMIT
<. o
DATE •'ANUARY 12 1995 PERMIT NO. 15-1995
APPLICANT •'r''`iaEF'I'i 3=1-;0YIIJRSKIADDRESS`INORWICH RD OWNER
(NO) (STREE7) (CONTR'S LICENSE)
CITY �'(-ihl'dEREi STATEMA ZIPCODE01923 TEL.NO. 508-777-182
PERMIT TO 1-11_ T : STORY OERALT ON NE I7AMILY NUMBEROF GUNITS 0
( )
(TYPE OF IMPROVEMENT) NO_. (PROPOSED USE)
AT(LOCATION)�70lF�t DERE+Y ^T REET DIDSTRICT R—c
INOJ (STREET)
BETYJEEN ANO
(CROSS STREET) ICROSS STREET)
SUBDIVISION 'MAP 41 LOT 0142 BLOCK SIOZE 000,31150 60. FT
BUILDING IS TO BE FT.WIDE BV FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: 2Eh.{0VA f T..OPtiS: REMODEL 9ATE'IS 4 KI ---HEN j. J. T.
AREA OR 30, 000 FERMIT� 185, OIZI
VOLUME ESTIMATED COST
(CUBICISOUARE FEET)
OWNER BRILLANT BENE/BRILLIANT RENE C SR BUILDING DEPT.
ADDRESS,900 WISCONSIN AVE N W BY S. _T. .T
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS
ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE
REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR
1.FOUNDATIONS OR FOOTINGS. CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL ELECTRICAL,PLUMBING AND
2.PRIOR TO COVERING STRUCTURAL MECHANICAL INSTALLATIONS.
MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
3.FINAL INSPECTION BEFORE OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
BOARD OF ALTH / GAS INSPECTION APPROVALS FIRE DEPT.INSPECTING APPROVALS
OTHER CITY ENGINEER 2 / - , 2
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
\� The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,790 CMR,7`�edition OF SALEM
\ Revised.farruapy
Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008
One-or Two- ily elling
This Sqdion For vial Use
Building Pemut Number: - Applied: /
Signature:
Building Commis" Inspector tf B Date
SECTION I:SITE INFORMATION
1.,Properly Address: 1.2 Assessors Map&-Parcel Numbers
1-1 LlIA a Is this an accepted street?yes_ no Map Number Parcel Number
13 Zoning Information: 1.4 Property-Dimensions:.
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(tit)
From Yard- Side Yards Rear Yard
Acquired Provided Required Provided Required Provided
1.6 Water Supply:(M G.L c.40,§54) 1.7 Hood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone:._ Outside,FloodZone? Municipal❑ On site disposal system ❑
Check if yes❑ _
SECTION 2: PROPERTY OWNERSH&
2.1 Owner'of Record:
�-o\- V-% CV-0.V3,C70t^O Lfy sec
Name(Print) _ Address for Service:
97F 97!? gOoZ$
Signahue - Telephones
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ -Etdsling Building X I Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work-2: 'Sn e
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only .
- - - or and Materials . . - -
1.Building $ _ 7' � 02,00 I" Building Permit Fee:-$- Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
- ❑Total Project Cost(Item 6)x multiplier x -
3.Plumbing $ — 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:S
OO, Q Check No.. . Check Amount: Cash Amount:
6.Total Project Cost: $ 7 a ❑Paid in Full ❑Outstanding Balance Due:
C -7O
�� I
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 066 6 03 S'C6- 13 +
J 0.W�eS ,Anted - - License Number Expiration Date -
Name of CSL-Holder H 1_ List CSL Type(see below) %V
0 ccass �J2 Sat I T -on
A-Si! - U Unrestricted l ( [0 35,000 Cu Ft)
R Restricted 1&2 Fermi Dwelling- M Only -
q78- 735-6357 .__. 77 RE..,.7Resi_demial)itoo Cow ' -, •;
Telephone WS Residential Window and Sidra
SF _Residenfial Solid Fuel Burrrin A W Ifance'Instal&6.
D Rdsidenfial Demolition
5.2 R Md Home Ira rovemeat Contractor(HIC) ' G �-7 ,
go, Registratio
n Number
HIC Compaury Name or C Registrarut Name _ _ -
H Cto55 F}Ji �ae,C��� MA 0070 j
Address 7/a�/.�Z613
,e,. 479 3S-t13.S Expiration Date
Signature � Telephone '
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT•(ALG.L e.152.§ 25C(6))-
Workers Compensation Insurance affidavit must be completed and submitted with this application Failure to provide
this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes.......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, �� �.,� C rcu,J�'o a-� as Owner of the subject property hereby
authorize o L to act on my behalf,in all matters
relative to work authorized 6y this buiildingpermit'applieation.
Signaime of Owner _ - Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION -
I, ame:s I-1-'rr.Jc7 a�- as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signaturepf Owner or Authorized Agen _ ..Date
(Signed under the pains and penalties of )
. .. -NOTES: _.
1. An Owner who obtains a building permit to do hiWher own work,or an owner who hires an unregistered contractor
(not registered in the Home improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G1._c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 1-10.116 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft) (including garage,finished basementlattics,decks or porch)
Gross living area(Sq.Ft) . Habitable room count
Number of fireplaces Number of bedrooms
-
Number of bathrooms _ Number of half/baths -
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3_ "Total Project Square Footage"maybe substituted for"Total Project Cosf'
�0
3 y;
Salem HistoricnVal Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
CERTIFICATE OF APPROPRIATENESS
it is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction Alteration
❑ Demolition O Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: Derby Street
Address of Property: 44 Derby Street
Name of Record Owner: John & Bridget Crawford
Description of Work Proposed:
Instullution of wood clapboards, 4" to weather frith 6" cornerboards and 2"x 8" water table. Existing rakes
and cornice to be retained
Application has also been continued to the meeting of October 3"d to facilitate review of any additional options
or design changes requested by the owner,
Dated: September 25 2012 SALE HISTORICAL COMMISSION
The homeowner has the option not to commence the work By.
(unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals)prior to commencing work.