274 Lafayette St - Application of Hardship - replace slate roof with asphalt -OWA HINSTGNAME I SAL FV L 5ACItWSF If , , Jiv
APPLICATION FOR A CERTIFICATE OF HARDSHIP
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 Hardship for:
❑ New Construction I I Moving tAIIIr , Reconstruction ❑ Alteration
Demolition ❑ Painting 11 Sign , � ❑ Other
District: ❑ Derby Street [] Lafayette Street ❑ McIntire ❑ Washington Square
Address of Property JY 7 Z- '^ t . Af
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Name of Record Owner (s): . r t r l r I "
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Owner Mailing Address : l w
Description of Work Proposed :
(Please include required scale draivings, paint chips, catalog cuts and/or samples of material proposed, ivhere applicable)
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Name of Applicant i' ] Owner ❑ Contractor I ( Tenant C ] Other:
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Tel . #:� 2 t '> � `
Certiificale will be mailed to the o vner unless olhenvise indicated here.;
Certificate should be mailed to Name € -
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Mailing address : C , ' City . „ 1 % °;` ; State t zip. t ; r