24 Chestnut Street - C of A application - architectural shingles FPLANNING
Stamp
r+ 11
REE
1. � M
Salem Historical Commission DEPT &
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 LO
CO M M UMENT
Use Only
(978)619-5685 FAX(978)740-0404
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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:
0 New Construction 0 Moving ❑ Reconstruction \,EC Alteration
❑ Demolition ❑ Painting 0 Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street �Vlchitire ❑Washington Square
Address of Property: µ ' /l ,
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
Please lipe or prv2t clearly:Attach addidonal sheets, as Decessaly.
�.c�� I ��-.�, --� l�P lam. � ►-�--�,
Name of Applicant. ( Owner ❑Contractor ❑Tenant 0 Other:
Signa Date:
Tel. #: 7'� — �' E-mail Address: j _ n
Certificate will be mailed to the owner unless otherwis indicated here: �� r1 r 1Y�t� QCi Ct j ,CEO''
Certificate should be mailed to: Name—
Mailing address:__z�-4 __ City: !) State zip: I