18 Chestnut St - C of A application - paint colors • Date Stamp
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Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 ® T �4 Use Only
(978)619-5605 FAX(978)740-0404 P�p�{�! lNG g
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APPLICATION FOR A CERTIFICATE OF APPROPRIANESS
Pursuant to the Historic District's Act (M.G.L. Chapter 40C) and the Salem Historical Commission Ordinance,
application is hereby made for issuance of a Certificate of Appropriateness for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition 7 Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ❑McIntire ❑Washington Square
Address of Property. I s t � -k
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
pp Please')Pe orprvit clearlf:Attach-additional slicets,as necessary
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Name of Applicant: DOS ❑Contractor ❑Tenant ❑Other:
Signature: Date:
Tel. #: S'l' cl C3 E-mail Address: L4 bxt-o'.zi
. rt ficate will be mailed to the owner unless otherwise indicated here: OM J,,L' !1 a[��(L,o CN4s ('p►�gpn L.GOB
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly described and the application
includes all information needed for the Commission to make a determination.
Failure to submit a com lete ar�r�lication may result in a continuation to a inure meetin .
Recommended information includes:
Photos of existing conditions, taken from all public ways
Site plan showing location of improvements
Elevation drawings of the existing conditions and proposed improvements
Drawings of details and other special conditions, including profiles
Description,photographs, and/or catalog cuts of proposed materials(please bring to the
meeting product samples, if appropriate)
Dimensions(i.e.height offence,size of pickets and posts,etc.)
Paint color samples, if applicable(no less than rxr)
Location and size of all mechanical equipment, such as transformers,HVAC equipment,
electrical service and meters, and proposed screening
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