97 Derby St - C of NA application - rear porch decking RECEIVED
Salem Historical CommissionOCT Ol 2818
120 WASHINGTON STREET.SALEM.MASSAGHUSETTS 01970
f978J 619-ss8s EAx s975,740-04ca DEPT. OF PLANNING &
APPLICATION FOR A CERTIFICATE OF NON-APPLIC5ffifffI DI=VELOPMENT
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 Q�--
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District: 16erby Street ❑Lafayette Street ❑McIntire ❑Washington Square
Address of Property:
Name of Record Owner s : e,40 res Z/
Owner Mailing Address: ICA&
Description of Work Proposed:
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Applications must include photos of existing conditions, taken from-all public-ways.
Name of Applicant:lpGc.T/i 4r 9X9.0 r_d ❑Owner ,Contractor ❑Tenant ❑Other:
LG / ►L-z z. v E-mail Address: IFA r-"ric-k e
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name AXT-regm O C a
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Mailing ad ess: o v t Ci e-4c State:—Zip: