180A FEDERAL ST - BUILDING INSPECTION (2) i
-PL4M 1AUST-9Efll--E NrD APPROVED BY T44E
.Qt5P,EC3.'DB PiI1DR TD A PEFjWT BEING GRANTED
CITY OF SALEM
DateS-
NO `� � y�v� ..� �
y.t:.
Is Property Located in.. Location of
the Historic District? YesN No_ Building J gap Q d V4 C I"
Is Property Located in
the conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
e aidRe lace Other: u�) i � La " S
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone ) ,�'v A
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone II L
What is the purpose of building? S
Material of building? W o Oc4 If a dwelling,for how many families?
Will building conform to law? -eS Asbestos? N O
Estimated cost AZ SD-0 City License k N A state License N
Bome Improvement ta 1 Q'V" Lic. I ..o o A
Signature
n of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
ace LAJyct I vl IJi40 �S
MAIL PERMIT TO: 1TO
1 iT..f
' No.
1,v APPLICATION FOR
PERMIT TO D
� I
LOCATION w cr
PERMIT GRANTED
APP V�D
��f
INSPECTO OF BUILDINGS
i
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: McIntire
Address of Property: 1 R0A Federal Street
Name of Record Owner: Brenda A Connelly
Description of Work Proposed:
Replacement of windows as necessary to replicate existing (wood, true divided light, single glaze, clear glass, 6
over 1). No changes in color, material, design or outward appearance. Non-applicable due to being in kind
replacement.
Dated: Jebruary 3, 2005 SALEM HISTORIC LMMISSION
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.
M
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA 01 970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition
— - --- - - of-Building-Permit-# - - all-debris-resulting-from-the-censtmction-activity-- -- -
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S 150A. \ \ ` ^ ` /
The debris will be disposed of at: ��1 W ) V
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
R're y)ap A I vI �Le N
Name of Permit Applicant
Firm Name, if any
1~�svA i7� Aval sf� sa 0192a
Address, City & State
The above statute requires that debris from the demolition,renovation, rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SAUX
BURDING DEPAR7MM
HOUZOW NEE LICENSE DmirT10N
Plea Pdt
105-
meLOCATw
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TELEPHM
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l)nite a ko asd m.Dow aueh homeowner.to enpe an bdivSds *r hks oko does sot poaea e
ikesee,.prwitled thou ewser•ad as wpervilm
DEFVGTIONOFHObGCWI=
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farm swacsoa.A penal who anraoctt more tan au home kt s twPya puk+d*aa setke eoosidad
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other app6oDk Sao ky-kwa,tnle sad TnWwSmL
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HONMOWIMVS SIGNAnWj:�Z��l
APPROVAL OF BVIIDrNG DMTCiOR
Sa otha odt for saes Code
HOMEOWNER'S EXEMPTION
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exempt from the provftiots otthis secdoa (Settisa 709.7.1-UassiaS of Cawtruetim Supervfser�
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. as arparfrafr'
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of The pcmdl syplftadm"its homeantw caft*A hrhlte mrdas -ds the mpoossumn eta
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