49-51 Warren Street - C of NA APPLICATION - Chimney repair Date Stamp
Salem Historical Commission
12e WA SHtNGTON STREET.SA!Ent.MASSACHUSETTS 0137�a For Office Use Only
83 FAX(878):-4'J-€A
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 ❑ Moving Reconstruction Alteration
❑ Demolition ❑ Painting Sign Other
District: DDerby Street Lafayette Street QMclntire DWashington Square
Address of Property: 49-51 Warren St
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Name of Record Owner(s): Yuri Cataldo
Owner Mailing Address: 49A Warren St
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
In-kind chimney repair (using like materials) to address leaks and damage.
Name of Applica t:Yuri Cataldo Owner❑Contractor❑Tenant❑Other:
Signature: ' Date: 10/10/18
Tel. #:917-p�78230 E-mail Address: yuricataldo@gmail.com
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: