4 Hamilton Street C of A application Date Stamp
Salem Hist()l"lcal 1.o missioi DEPT
120 WASHINGTON STREET,SALEM MASSACHUSETTS 01970 CO M M L For Office Use Only
(978)619-5685 FAX(978)740-0404
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 F71 Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ✓❑McIntire ❑Washington Square
Address of Property: 4 Hamilton Street,Salem,MA 01970
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Name of Record Owner(s): Alexis Dwyer
Owner Mailing Address: 4 Hamilton Street,Salem,MA 01970
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessar7
The scope of work on the project shall include the following:
Proposed 1®'x19'first floor addition consisting of expanded family room,proposed mud room and relocated rear
porch. First floor kitchen area to be renovated as well, with new windows being installed on rear elevation.
Installation of 4" aluminum"ogee"profile white aluminum gutters and three 3" diameter white aluminum
conductors at areas indicated on provided elevations. Scraping,priming&painting of existing clapboard siding
trim and shutters,typ. throughout.
Name ofApplic t: an Gicrelli ❑Owner❑Contractor❑Tenant❑✓ Other:Architect
Signature: Date:
6� dress: driceiarelli@segerarchitects.com
Tel. #: 978-744-02 E-mail Address:
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name Alexis Dwyer
Mailing address:4 Hamilton Street City:Salem State:MAZip: 01970