4 Carpenter St - C of A application - paint colors Date Stamp
r
OCT 21 2019
Salem Historical Commission
For Office Use Only
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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 Appropriateness for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition W Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street �clntire ❑Washington Square
Address of Property: Ca C -t(Y' e t
r
Name of Record Owner(s): _ 0 �J(D d i ai Un Y 1 n Q
Owner Mailing Address: Delleel
Description of Work Proeosed
Please type or print clear l}: Attach additional sheets; as necessary.
(ompleft jairrnh� 0-f Mclln loody and
V i M \Y) C l A d Ing
Nud washnc , wo p,n�, allc sandin )
Name of Applicant: ❑owner[MContractor❑Tenant❑Other:
Signature: os o o® Date: ZILI
Tel. #: - _ E-mail Address: U���� (Q�'1Q�n�( tv ,
Certificate will be mailed to the owner unless otheW\11 (1ndicad he
Certificate should be mailed to: Name. L]U 0 K I )_) C) _
Mailing address: _CaQ)tnty (S-yrCt' City:_ksol em _ State:MA Zip: CZLq
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 complete application may result in a continuation to a luture 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 of proposed materials (please bring to the
meeting product samples, if appropriate)
Dimensions (i.e. height of fence, size of pickets and posts, etc.)
XPaint color samples, if applicable (no less than 2"x2")
(f��ru tilt 4
Location and size of all mechanical equipment, such as transformers, HVAC equipment,
electrical service and meters, and proposed screening
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