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106 DERBY STREET - BUILDING JACKET 106 DERBY STREET D'ttOl PIT CZttu of �ttrm, �ttssur Usef#s �Iertrirnl Peparfinentr VFlltl :nR �t. 1:r;,r 1Iff1P RU 1.I r0 �t�nl',Y Wire 3noperiar 44 Tafageffe 'Salem, anza. 01970 ,Area (fn3e 617 745-5300 February 29 , 1984 Dr. Richard A. LeBel 43 Chestnut Street Salem, Massachusetts 01970 Re -106 'Derby Street_ Dear Dr. LeBel : In regards to an electrical inspection per your request, the follow- ing electrical violations exist at the above address : 1 . Counter-top receptacle (reversed polarity) . 2 . In proper wiring method of fluorescent light fixture on ceiling . 3 . Fluorescent light fixture in bathroom - secured to combustible material . 4 . Non-metallic wiring running over gas boiler ( 5 foot clearance) . An electrical permit must be taken out from this Office by a licensed electrician . Yours truly , Paul M. Tuttle Wire Inspector cc : Richard McIntosh , Building Inspector PMT/m e ,CONurr, b Salem Hist®rical Commission CITY HALL. SALEM. MASS. 01970 g '�R'oinncw*'4Y^ 745-0215 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed construction [ ] ; reconstruction [ ]; demolition [ ]; moving [ ] ; alteration [ ]; painting [X]; sign or other appurtenant fixture [ ] work as described below in the . . . Derby Street Historic District. (NAME OF HISTORIC DISTRICT) Address of Property: 106 Derby Street Name of Record Owner: Richard Lesel DESCRIPTION OF WORK PROPOSED: Painting of house: Oil base Hancock Exterior Rustic Body Color: PONGEE Trim Color: PALE MUSHROOM 1. Window Muntins & Window Sash may be painted either the trim or body color. 2. The following to be painted in trim color: door, coon pediment, corner boards, fascia, and porch. 3. The following to be painted in body color: clapboards, shingles, window trim, including pediments. will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (Federal Laws, Ch. 40C) and the Salem Historical Commission. Dated: 12/20/83 SALEM HISTORICAL COMMISSION B Chairman =: co"_oxwEALTTi of �UssacHDsz—.:: = CITY OF SALL APPLIUTION FOR C=IFICATE OF INSPECTION Date i�/i9��� Fee Required S ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code. Sect: 108. 15. 1 hereov apply for a Certificate of Inspection for the below-named premises located at the following address: Street S Number4-6 �L Name of Premises 0-" Purpose for which Premises is sed License(s) or Permits) required for the premises by other Governmental Agenciea: License or Permit A¢encv Ui n Cegtl iaate to be issued to: CH252,A/T 5F. 111M,51Mej,T F?IX - Address. _ Uj _J O�er%t Record of Buildiag:jje jj 01+14 CEJ .. m W r Address: vb 0H4,STIIJVL 67-, , 2915'M MA . OL 4D Nae of Present Holder of -Certificare:Ct{f_$yjJLy7 5T- _TAlI/i�SZMC 5 - TA)L - Name of Agent, if any. . . A I Lob ire n l Signature at Persob to wnom Lert_iicare TITLE is issued or his/her authorized aeenr a /3l I —� / Date INSTRuc2TONS: Day time phone Ll I` (-1 L1 31/ p I. Make checic payable to: The City of Salem 2. Return chin application with your checic to: Inspector of Buildines. City of Salem Buildinc Devartment. One Salev Green. Salem. MA. 01970. PLEASE No=: 1. Application form with required fee must be submitted for each building or structure of part thereof to be certified. 2. Applicarlon 6 fee must be received before the certificate will be issued. 7. The building official shall be notified within cen (10) days of any change in the above information. CERTIFICATE I I J EZPIBAIZON DATE PERIODIC INSPECTION REPORT • This form is to be completed each time a Periodic Inspection is made. At the time a new Certificate of Inspection is issued, a notation indicating that the fee has been paid will be made to Application Form prior to the new Certificate of Inspection being issued. Any changes since the last inspection are to be added to the file card of the premises. (� /'�J Street S Number ! 1/ Name of Premises p Certificate to be issued to: JP- Address � - (� Owner of Record of Building _ CQ,�(clo-y1 Address n Purpose for which premises are used �P "'Wl,r QNL Changes since last Inspection (required on file card also) 1. _ 2. 3. 4. 5. Date Order Issued: Order Issued To: Address Date Violations Corrected: REMARKS: &I If, UT Lj I have this day inspected the above premises, and the same conforms to the pertinent requirements of the Massachusetts State Building Code and the rules and regulations pursuant thereto. drw,14 L4&4�p Date Building Off icial Certificate # Date Issued: r Date Expires: Recommended Neexxtt�//���} Inspection: ,jSS ly,Cy / 04r Ti mmnnzu alb it maoignr4nol o CITY/TOWN OF In accordance with the Massachusetts State Building Code, .Section 108. 15, this CERTIFICATE OF INSPECTION is issued to . . . . . . . . . . I ( Trtif J t( e, that I have inspected the. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . known as. . . . . . . . . . . . . . . . . . . . . . . . . . . l:7. located at. . . . . . .(e. . . . .D .r-b - . .ST. . • • .. . . . . in the. . . . . . . . . . . . .of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County of. . . . . . . . . . . . . . . . . Commonwealth °of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story Capacity Story Capacity Story Capacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location . , or Structure Capacity Location R25-[ -C) -C 1-� `f Certificate Number Late Certificate Issued Late Certificate Expires Building ficial The building official shall be notified within (10) days of any changes in the above information. 779=T7 V i A 14 F iRN ■ qut JIMPAW)"' ', art jo 0-M ,Mix "i rr 1%, i�"Ylk CITYOFSALEM R fin accordance tith he Massachusetts Stare Iis ,J&�Ap [, I . ". I 1�'S P E.0 T F0 N CERTIFICATE � .QP 4 M iv i"',1, 0 1 �4 y3I,­;­! JONATHAN K, JENNIFER REARDONria 0 I S, 15s.uedto I;4 'A� npb -EYE N ,,A `P I G?�S (UrfitH that I have inspected 4 the premises known as 0 1 46 * DERBY STREET W located aI to the cityof le kv t E S e means a i�3,t u egress' County0 Essex` v wing �Ess x Commonwealth . -of Massachuse Th I t 42, �t, V V" I T e TS 0 n s "W: t RW 10, W N A 14110� BY STORY N-, 0 -2 x, ' St a Capacity Story ;tr:I, II &,A" %,a p a y C, ,C WARA�%%sssss MAys s ssssss 4 I"I t I Vi yo4 U Vi T, 4, '4 B Y L AL ' 'E-6 F.ASSEMBLY:O R�_STRUCTURE' 14 r 1116 Iv 1 iJ 11",' . K; id, If i" A 71. f, Place-,o CA s s e in b I y��II A bl �IM P.I t At;U,,RA ace*,o Assembly , s.,� 4j q i Io r Structure Capacity Location or Stl ULtureition i t, T Capacity B -4. t R, Al-P. ,-� RESTAURANT 2 illV1 "t IST FL-00 Zj- P- 01 -1:7 L )1/1 98 Jrft v V 1 "1 .,. t Cerrifica�ie Number Date Certificate Issued Date Certificate ExpiresV., Building' ,-Off I alQw 'I I I vi L The building official shall be notified within 00) days of any changes in?jhe.above,i In Ala R V y File Crmunr,mscalth ul \lassachuseus -- - - - -- S t\ 130.11d of Building RcL!uIJ(Illll\ .11ld SLuldards ! l rl! ' ,M ..... .. "Llssa,.J usms State 13wldine Code. 7S(1 ( ' R. 7'' edition i \II SIl II' \III 1 1. . �: 3 I I SI liuildin_ Pernlil ApPlicMloll To ','I]Nil Repair. Rrnu ate Or Willoli.h e j K, ,,, ,1 /.ru ..1 r OIlt' err �IrN Jllllll' 1 (- Thu S coon En Oft Clal l'sr Only ----------- - _� I HuIIJ mg Pcrnw Nun,her' n pplrc•J: --— ----- V ,I_n.nurc _ _ _ _ Hill Wing ('unm it ,I unc!/ Irl,pc, ur of I SS. SSW,- U.ur v i SECT ION 1: Sf . INHIR%1:\ f10N ' I.1 Propcirls li d 5(ss: 1.2 \ssessors )lap ce. Parcel Numbers - --- - - - ' 11.1 In ihh .M nr U)1CJ r 1', ✓ r., \Lip hUnihi ' I .u..l \uu,h -._ _. r info {Ii- ! li'ova:-e_. iriperAy•!FY. lllg j 1 1.5 Building(Setbactes Iftlr,.rJ Use — --._....._ Lot qua r,u u, Fn nu Y�rJ T Side Yards I RCaI Y'arJ Kc.--{uurJ I _pr.rvrJaJ_ Keywred PrmrJW _t KeywMeJ Pr.�„JrJ I 1.6 1Yatez Supply: i:7 G 1_c 10. §51l 1.7 Flood Zone Information: 1.8 Sewage Disposal System: -- Zone: Oulside Flood Zrnc'. P� �lic ❑ Pll,ate ❑ r \twHn al ❑ On snC Jr,Heal .yda:n ❑Check if yes❑ r P I —_ SECTION 2: PROPERTY OWNERSHIP' --- --- ' 1 Owner'of Record -- ----- --.--'-- _�/�1��G4p/V urnr 1'rr„rl Address for Service. i I lC i - ---- - g78- S-Yn9 ture Telephone SECTION 3: DESCRIPTION OF PROPOSED ORKZ(,heck all that upyly) r - - - — -'.e C' m,irue hwn ❑ Es - ing Bor!din , G i f)w r Occ up;ed -❑_ R e. urr' r ^?.\Ir r:rr r - 1 ❑ I 1JJ •r -- — — _-� f moh„o❑ G A,,c,nniy Bldg. ❑ 1 Number of Units — ) (`r _ /E<O7/4 Lam...Ylo�/'!5, ./Sul/.rr..'H al✓ r.. _K�_�'r 0 4.f_nar-!yl-�4./e Y�a�f i�/ / O4IS lP 4G e' O f✓ bP SECTION J: ESTIMATED CONSTRUCTION COSTS 1 —-- --1 Item Fst:maled Cants: -- 1 rI.ahr;r.rnd Matenalsr OfYcial Use Only 1 1 IiwlJ u,g I. Building Permit Fee' S__, InJlcate hu„ L•.: rs J�rer nunrJ' i IFlectm,11 g - ❑ Standard City(I'o,sn A;iphcaurnl Fee ❑ Total Project Cost (Item 6) s multiplier ). Plumhrng S I �. Other Fees: S 11 1 �►echamcal IH\': i tit eChd 'L"l (File t'------ - - -- 5u „re„lone ) fu(.rl :\II Fees: S - ���—� l heck .No ('heck Amount. Ca,h \m,rwn o f alit Project Oust lc --- ---- -- I 6CJ0� ❑ Paid nl Full ❑(hnstandrne 13.r l,rrne f lac I 1 Salem Historical Commission 120 WASHINGTON STREET, SALEM. MASSACHUSETTS 01970 (978) 745-9595 EXT. 311 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 ❑ 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- 106 Derby Street Name of Record Owner: Michael P. Reilly Description of Work Proposed: Replacement of two front windows as presented in drawing with 4 double hung wood windows (two on each side of door). Windows to be Andersen 400 series SDL 718" width with clear glass and bronze spacers with baked on white poly/paint finish. Sills to be as presented in the brochure. Replacement of'left.facade casement windows with double hung windows. The work has already been completed and must be altered as,follows: the owner can either 1) replace both new sash with Andersen 400 series SDL 718" width with clear glass and bronze spacers with baked on white poly/paint finish or 2) relocate the left side window closest to the street to the right side behind the chimney (replacing the existing casement) and install the Andersen 400 series SDL 718" width with clear glass and bronze spacers with baked on white poly/paint finish in the left front side. Dated: May 22, 2008 SALEM HISTORICAL CC�OMMiIISSION By: The homeowner has the option not to commence the work (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. | ho signalute WorkersCompensation Insurance altida-1 must be completed Mid suholl(ted with thi, appli-It"ol, this affidavit will result in the denial ill the issuance ill (he building permit. 0n�r `���� `oh|�op^`p/o} h�nh� ' / � x, « / i � i '-'---'__-------_----�-----'--'-- u ;cl `.on'y `/` ^|| mu/,u � � i u.�|..*/� '-----_--------------'--- --'-----�� � k authorizedhy 'm� hui|Jiogye'mir ^ypoca^`M Date ItInale true and accurate. tit the best-or ffi� kno%%!cdceJnd ' (hat t7e--st 7trements and int or7m:,�t, , the�toleeolol'�VPIII't Date ,utit registered in the Milne lmpr,)t,cment c,.n(ractor (MC) Pniggram). %t,ill n,)t ha%C access it, the kibilial"In � � � o^nhd"w o / J� ��, '' r''�h/ � vvn�n ,up`umo/ _/^ ., r""��~� r �� h h�J ��`o»�» ^� '`�^ � ` � - (including garage. m` .� � '' � | T..u| 0~o area/jq� �� / Hah//�ihk ^w000w»' -__---- ----- -'- / (;^,, |,"o, /reu .jv | r / �,m�h e, "|heJ^^`m` �- ---- -� -- � � Nuwber ., Nmnhcr,t ljJtAk//h` �� - - — - � y*obe/..tk"k"^'m` -'---' xmoh,/.., .k��`/ |^''`h�` | ' |\p« .`rhu*ov `wem -----��� �--- � /y«, -�- Cx, 13R $zG00 The Commonwealth of Massachusetts Board of Building Regulations and Standards j SPECCY&LDPVED Massachusetts State Building Code,780 CMR J`Ak 3E V10ES Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011�S APR 30 One-or Two-Family Dwelling A 38 This Section For Official U- Only M Building Permit Number. Date Ap lied: 111 Budding Official(Print Name) ._ Signature Date SECTION 1:SITE INFORMATION ^n 1.1 Property Address: D/ 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes_ no_ Map Number parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40 §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner`of Record: —in»- 1 Name(Print) ' i�,ZIP _ 0 t ti v 5�- ?; ?- ;5?2 G0 zlf 45i- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Wor Qm U SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ List: �S<� 5.Mechanical (Fire Suppression) $ Total All Fees:$ 6.Total Project Cost: $ r7 Check No. Check Amount: Cash Amount: i ❑Paid in Full 11 Outstanding Balance Due: . o Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations 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: 106 Derby Street Name of Record Owner: Tina Levse, r Layne ne Description of Work Proposed: Replacement offront entry door to replicate existing. No changes in color, material, design or outward appearance. Non-applicable due to being in kind maintenance/replacement. Dated: April 28, 2015 SALEM HISTO A MISSION By: The homeowner has the option not to commence the work(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. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS e N�umber� I i Lic t 1/1 /� Y Iq�2..7ajNU�� ens ' Expiration Date Name of CSL Tldef-� �J� //�0� List CSL Type(see below) Nam.___..__. /� Type. Description 1 )leg., C./g �� G tl Unrestricted(Buildings up to 35,000 cu.ft. CITY[Iown,Mafq ZIP R Restricted 1&2 Famil Dwellin M Maso RC Roofin Coverin WS Window andSidin SF Solid Fuel Burning Appliances / O I Insulation Tee hone _ Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Com y istran HIC Registration Number E irati Date No.and Street ( /9,-7 _ Email address City/Town,State,ZIP T /Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this appli ilure to provide this affidavit will result in the denial of the Issuance o e building permit. sit!"° Signed Affidavit Attached? Yes.......... No...........❑ N° SECTION 7a:OWNER AUTHORIZATION TO B O'O l- ED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FO UH.DING PERMIT I,as Owner of the subject property,hereby authorize LLc%da ..J/>32 Zt, "?/jJ10�i/�/fi3r d G��be to act on my behalf,in all matters relative to wo authorized y this b 'Idi rmit plication. Print Owner's Name(T a nic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the t of my knowledge and understanding. walI ,0 A Print Owner's or AuthorizedAgent's N e Mectroni um Daze NOTES: 1. An Owner who obtains a building permit to do his/her 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.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementiattics,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"may be substituted for"Total Project Cost" 61'ermit The Comniouwealth of Massachusetts �I CPrY OF Board of Building Regulations and StandardsMassachusetts State Building Code, 730 CMR SALEL&IRevised Mar 2011g Permit Application To Construct, Repair, Renovate Or Demolish aOne-or Tivo-Family avelling This Section For Official Use Onlber> DateAppli > /, 7�s/. Building Official(Print Name) Signature - Date ( SECTION I:SITE INFORtVIATION 1.1 Property Address: 1.2 Assessors tNfap& 1wreel Numbers f laE AFie& sr yc (u rl1A ev°l70 1.Is Is this an accepted street?yes z� no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Inf rmation: Ls Sewage Disposal System: Public❑ Private❑ Zone: _ OheiQe if Flood Zone? Municipal❑ On site disposal system ❑ Check if es0 SECTION2:, PROP RTY-OWNERSHIN 2. Ownert of Record: J ,AIA I SE ,9 S,�JLEiLI � O/y'p jime(Print) }� Ci /}StaterZlPn /Olv Ut'R,gy S�: 7 O ,1 o�6'���5 o,and Street Telephone Email Address SECTION 3: DESCRIPJION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) Cl I Alterstion(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. Number of Units_ Other ❑ Specify: Brief Description of Proposed 1Vorkr: CA(o e 1—E QC cf /r/ d a w d-AeY 50 6 55 SECTION 4: ESTINLATED CONSTRUCTION COSTS [rem Estimated Costs: Labor and Materials Official Use Only. . I. Building $ I. Building Permit Fee.S Indicate how fee is determined: Standard.Cityfrown Application Fee 2. Electrical s" ❑'rotal Project Cosl (Item 6),c multiplier x 3. Plumbing S 2. Other F"es: .S 1. .M.-chanical (IIV.AC) S List: i, ,,\lech:mieal (Piro Su session) S Total:All Fees:S- - Check No. Check Amount: dish Amomit n GItal Project Cost: 3 BAD• Do f ❑ 11,tid in fall Cl Out.st:mdin; H,t1a11Ca Uua: ,-go F' . ,Salem Historical Commission 120 WASI-INGTON STREET. SALEM, MASSACHUSETTS 01970 (978)619-5C85 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ❑O Alteration ❑ Demolition ❑ 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: Dcrly,Street Address of Property 106 D rr l�v Strcet Name of Record Owner: Tina Leyser Layne Description of Work Proposed: As detailed in the application subrnuted on 51712013, work will include: 1. Removing awning window on left side of house and installing a double casement window 2. Rem.oving the two awning windows closest to the street on the right, side of the house. 3. Replacing an ahuninum-frame sliding glass door with double-Ini ng sash windows. 4. Removing awning window farthest from the street on the right side of the house and installing a double- hung sash window. Considering the fact that the proposed window are ort a side elevation and barely visible from the street, the Commission approved that the replacement whulor-vs be Anderson 400 series in the same manufacturer style, material and color as approved and installed in 2008. All new siding will match the existing in color and style. Dated: Time 13, 2013 SAIAM HISTORICAL COMMISSION By. The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. TH.iS 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. . • ���OMDITq�� r- Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX (978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction i] Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Address of Property: 106 Derby ShcQt Name of Record Owner:Tina Emu Layu Description of Work Proposed: Remove alzEnainzun-frame sliding glass doors; install Anderson 400 series French doors. No work will be visible from the ptiblic way. Dated: May 23, 2013 SALEM ISTORICAL COMMISSION By: The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. T.141S 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. L SECTION 5: CONSTRUCTION SERVICES / 5.1 Comstruetimt Supervisor License(CSL) License Number E.cpiratiuu Date Name of CSL I[older List CSL Type(see beluw) type Description No. and Street U Unrestricted (Buildings up to 35,0110 cu. R. R RestrictedILU Family Dwellin City/Town,State,ZIP �I �,\dasonr RC Ruofm Coverin WS Window and Siding SF Solid Fucl Burning Appliances ( Insulation fek hung Email uJJrcs'g D Demolition 5.2 Registered Home Improvement Contractor(HIC) IIIC Registration Number Expiration Dale I IIC Company Name or FIIC Registrant Narne No. and Street Email address City/Town, State, 'LIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. t52. 1 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 AUTHORIZATIONTO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEEMIT I, as Owner of the subject property, hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION ; B entering my name below, I hereby attest under the pains and penalties of perjury that all of t information c ntained in this application is true and accurate to the best of my knowledge and understands Print Owner's or,\uthurited Ag nt's Name(Electrunic Signature) Date NOTES: I. :kn owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (nut registered in the Haute Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty Lund under M.O.L. c. I42A. Other important information on the IIIC Program can be found at www.nms:."ov:'oca ht for mat ion on the Construction Supervisor License can be found at www.ur ss.ivokliea [2. When substantial work is planned,provide the informatiun below: otal fluorarc;a(;q. R.) ____ _( ncluding garage, finished basemendattic,, decks or porch) ro;; livingarea(syhabitable room countwnber of `umber ufbedroomsathro ._--_ Nuotberofhalt'baihscpc of he.uing ;y;teni —_— I',pu "t,coolin" ;tacit Fnclo;cd - _ pcn -- ._ . ... ------------- � t f.,rd I'nq:et Oyu ua F , i.r_c in.ry hu ;nl?;nn�r.J t;,r I ,[.il I'rn'led Co,t"