268 Lafayette Street - C of NA application - Front Deck ProposalSalem Historical C ommission
Reconstruction
Sign
Date Starnp
Eor0fficeUse 0nlv
Alteration
Other
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:
trtr trKnuMoving
Painting
New Construction
Demolition
Disuict:[nerhySreet
Address of Property:
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Name of Record Owner (s): .:-l
Owner Mailing Address: }:68
[WasUington Square
Description of Work Proposed
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Please type or print clearll'. Attach additional sfieets, as necessary.
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Narne of f ponaactcrf !Tenaot f lother:
Signature:
Tel. #:E-mail Address:
Certtfrcate wtll be mailed to the owner unless
Certificate should be mailed to: Name
Mailing address:
indicated here:
city' Sqa^f\ state:flkip, Q]3i9
120 WASI{IIIGISN STFEET. SALEM MASSACHUSETTS O1E7O
1978| 6'!9.$685 FAX j978,74*-C404
ATTACIMD DOCUMENTATION
An application will not be considered complete unless g!!-work items are thoroughly described and the application
includes all information neededfor the Commission to make a determination.
Failure to submit a complete applicqtien ma:t result in a continuation to afuture meeting,
Recommended information includes:
,/
Photos of existing conditions, taken from all public ways
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 ofproposed 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 that2"x2")
Location and size of all mechanical equipment, such as transformers, HVAC equipment,
electrical service and meters, and proposed screening
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