104 Federal St - C of NA application - rear kitchen door Date Stamp
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ECE � . . RECEIVED
14 2018 � � �`
SEP ` SEp 13 2018
DEPT, OF PLANNING�& D PT, OF PLANNING &
COMMUNITY DEVELOf eM is j istoricai Commission M UNITY DEVELOPMENT
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01�'70 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 Moving Reconstruction x❑ Alteration
Demolition Painting Sign Other
District: Derby Str,.eet OLafayette Street QMclntire Washington Square
Address of Property: 164 Federal St
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Name of Record Owner(s): David M. Hart, Barabara A. Cleary
Owner Mailing Address: 104 Federal St, Salem
Descri tion of Work Proposed
Please type orprint clearly.Attach additional sleets, as necessary.
Salem
Install new screen door and exterior trim at kitchen elevation, paint to match
exisitng trim color
Name of AppFqftN. David U. Hart OwneroContractorQ Tenant E]Other:
Signature: Date: 9/14/2018
Tel. #: 978 395 6381 E-mail Address: davidatsalem@comcast.net
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name David M. Hart
Mailing address:_ 104 Federal St, Salem City: Salem State: MAFip: 01970
ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly described and the application
includes all information needed for the Commission to make a determination.
Failure to submit a comr:4ete ate l� ication ma�'result in a continuation to a lirture meeting:
Recommended information includes:
E� Photos of existing conditions,taken from all public ways
E::] Site plan showing location of improvements
Elevation drawings of the existing conditions and proposed improvements
Drawings of details and other special conditions, including profiles
Description,photographs,and/or catalog cuts of proposed materials (please bring to the
meeting product samples, if appropriate)
Dimensions (i.e. height of fence, size of pickets and posts, etc.)
Paint color samples, if applicable(no less than 2"x2")
Location and size of all mechanical equipment, such as transformers,HVAC equipment,
electrical service and meters, and proposed screening
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