8Winthrop C of NA Roof repair Date Stamp
Salem Historical Commission
120 WASI-I ING FON STREE I.SALL.M. I For Office Use Only
(978)619 5685 FAX(978)740 0404
APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
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 Non-Applicability as described below for:
❑ New Construction E] Moving F-1 Reconstruction F Alteration
❑ Demolition ❑ Painting F-1 Sign Q other
District: 0Derby Street E]Lafayette Street R]McIntire []Washington Square
Address of Property: 8 Winthrop St,Salem,MA 01970
Name of Record Owner(s); Kevin Brunswick,Beth Balaban,Ann Neely
Owner Mailing Address: 8 Winthrop St,Salem,MA 01970
Description of Work Proposed
Please ope orlwihi clearly:Allicli ac1clitiotialsliects, as 11ccessV3'.
In-kind repair to storm damaged roof in storm on 3/2 and 3/3/18. Replace with like color 3-tab asphalt shingle.
Name of Applicant:Kevin Brunswick R]OwnerE]Contractoio Tenant r10ther:
Signature: Date: 3/5/18
Tel. #:
6102465039 E-mail Address: brunswick.kevinftmail.com
Certificate will be mailed to the owner wiless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:—Zip: