97 DERBY ST - BUILDING PERMIT APP JACKET EITY-ORSALEX -
PUBLIC PROPERTY
DEPART-NMINT
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1Mal WASfAC11L3!'nS Ot970
1tL M745-95"♦FAX M740A8N
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION,
DEMOLITION. OR CHANGE OF USE OR OC ZANCY- 1 FOR ANY K2a3TING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Locadan Name: /� z J.. —c� < 9uilding; F ) h-
Prop �r `i' 7 D h -
Properly Is located in a;Cwdwvat6n Area YIN HlstotlC DkWot Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land t
Name: S 4
Address:
Telephone:
y
ROOMPLETE THIS SECTION FOR WORK IN El(LaT1Np BUILDINGS ONLY
Existing
Number of Stories Renovated
e 3 New.
Demolition Existing
Approximate year of Area per floor (sn Renovated
construction or renovation I
of existing building New
Sdef Description of Proposed Work:
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Mail Permit to:
1
What is the Current use of the Building? any unM?
Material of Budding?
.is It dwelling,how —
W o the Building Conform to Law? C�> _ Asbestos? -
Architeds Name
Address and Phone r C7
Mechanida Name
Address
HIC Regialration 0
Phone lk I s
som License d{ �� G L �° 1c v
Construction su —�--
y�'� � ermit Fee Cal,uiation
Estimated Cost of Proled 3 L •
Permit Fee S _ 7'` Estimated Cost X$741000 Residential
- - - Estimated Coat X S11I:1000 Commercial--- -
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perJury
Date �� ?
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16AM
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1
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT 311 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: Derbv Street
Address of Property: 22 Derby Street
Name of Record Owner: Alice & Dolores Jordan
Description of Work Proposed:
Repair/replace back porch to replicate existing. No changes in color, material, design or outward appearance.
Non-applicable due to being in kind maintenance/replacement.
Dated: May 22, 2007 SALE OMMISSION
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.