109 DERBY ST - BUILDING PERMIT APP JACKET 0
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 A Alteration
❑ Demolition 3k 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- 109 Derby Street
Name of Record Owner: Heidi Milman
Description of Work Proposed:
Paint colors
Coventry Gray-Body
Montgomery White- trim
Doors-New London Burgundy
Installation ofplumbing lent.stack(black iron pipe) on roof, 3"-4"diameter.
Replacement of windows with J B. Sush cusTom, wood, trite divided light, 5/8"muntins, in B301 frame, double glaze, clear
glass. Preference is for all windows to he 6 over 6. However, if cost prohibitive, all windows lobe 2 over 2. Combination
of 6/6 and 2/2 not permitted Staples in windows to he nun-corroding and puttied over so its to he invisible.
Window application continued to meeting of3/7/07, should applicant wish to provide information on Pella:Irchitecntral
Series.
Dated: February 26. 2007 SALEM HISTORICAL COMMISSION
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.
TI-IIS 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.
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:
0 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: 109 Derby Street
Name of Record Owner: Heidi Milman
Description of Work Proposed:
Repair/replace existing wood shingles and trim to replicate existing. Replace chimney flushing to replicate
existing.
No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind
maintenance/replacement.
Dated: February 7, 2007 SALEM HISTO L 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.
--
PUBLIC PROPERTY
DEPARTMEINT
KIMAFALFY OWCOLL
MAYOR i'.A wm mtvarm S'rzFzr•C"LxK MAAACHM-1-a 01970
TWI. ti-74S-9595•FAr 978-740.98"
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION.
DEMOLITION. OR CAANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
fjogIJJJ\
Property is located in a;Conservation Area VIN Historic Ohd t YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land [n.
Name:
Address:
Telephone: i -7 `
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
--- _- - Mail Permit to: lea
What is the current use of the Building?
_ I
Material of Building? � )��C�� If dwelling, how many units?
Win the Building Conform to Law? ",5 Asbestos?
Architect's Name
Address and Phone ( 1
Mechanic's Name
Address and Phone
Construction Supervisors License# r � 3 7 2 S HIC Registration# 109 a
Estimated Cost of Project S b Permit Fee Calculation
Permit Fee$ �s' Estimated Cost X$7/311000 Residential
Estimated Cost X$11/$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 f
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