2 North Pine St - C of NA application - rebuild chimney RE
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Salem Historical Commission APR 3 0 2018
120 WASHNGTON STREET SALENI,MASSACHUSETTS O?9,0 D EPT. OF PLANNING &
=978j 619-5685 FAX(97et 740-0A04 COMMUNITY DEVELOPMENT
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: ❑Derby Street ❑Lafayette Street ',A McIntire ❑Washington Square
Address of Property: 9__ K1 E nle— C.41� _
Name of Record Owner(s): wc�&ce. 9-
Owner Mailing Address:
Descri tion of Work Proposed:
�[,c.OhS-Irve�' ICGnir► �OSIC�L GhiMh�/ �►►1q-� i5 �' C�SIC o1 y13
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�roM t1�C'. coo 11r)e- UP.
Ck, „e,�. (,>A( COn54rL,c4ec I n $CV►1¢ G WItnS ia15 USi
U',5VeA17 i�_e►r+,W br;/-k aNd rA6144ir,
Applications •tos of existing condifions, taken from
Name of Applicant: —Vh2o�Qlr e, Cowo►�,_ C)wner ❑Contractor ❑Tenant ❑Other:
Tel. #: 01 -112-- 4 9 8 4 E-mail Address: 'W 4 a Jore..me.
Certificate will he mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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