40 Chestnut Street - C of NA - Replace shingles on roof Date Stamp
RECEIVED..
4 � ►EP 26 2018
v j" D PT. OF PLANNING & `
Salem li istoncal Commission COM UNITY DEVELOPMENT
120 WASHINGTON STREET.SALEM.MASSAGHUSETTS 01970 For Office Use Only
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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 QMcIntire QWashington Square
Address of Property: 40 Chestnut Street
Name of Record Owner(s): Jeffrey P.Beale
Owner Mailing Address: 40 Chestnut Street
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
1. Remove existing three square asphalt shingle roof
2. Replace with same three square asphalt shingle roof. Same product that was used on the roof 20 years ago.
Name of Applicant: Jeffrey Beale ZOwnerQContractorQ Tenant[]Other:
Signature: Date:
Tel. #: 617-513-9041 E-mail Address: jeffreypbeale@gmail.com
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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