4 River St - C of A - paint colors Dmjt Stamp
Salem Historica l C0111mission
12a WASHINGTON STREET, SALEAA, MASSACHUStj-rS0jp?0
(978) 619-5685 FA)( (1;78) 7�p�lpa For O�� UW001V
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
Pursuant to the Historic District's ,act JeCiOL-0 Chiapt�. 40C) and the SalemHis torical Iommission Ordijiumce,application is hereby made for issuance o f a Certi ficate o fAppropriateness for.
� New Construction ❑
� Demolition Moog ❑ Reconstruction 0 Alteration
painting ❑ Sign ❑ Other
District: ❑ Derby Street ❑ Lafayette Strcet
McIntire i In p jy � SqUM
Address of Propert y; ` V e.1� �-f Name ofR=rd Owner s);
Owner Mailing Address : A I
Deserl lion of Work pr
oposed
Please ope orPruliclearlio &44ttadiaddi0oiialsliteatasiie.trman:
4f6c� nyl S I�.l o d 4 Ao^ �Yl
IDO
Name of App]Ic %mex 11Conftctor ❑ Tenant O Other;
S) Blur 00GERM"
601OF Data: �- l
T �� " _ f � ( �D E-mail Address ; L
r �
C,f"ificale will be mailed to the mmer unless othqrwlse in Ga ted hera:
CCftjfi tC should be mailed to: Name A /7
low
10011
10011
10011
10011
Mailing address, City: stalte:
ATTACHED DOCUMENTATION
An application will not be considered complete unless al! work items are thorough ly ae, cribed and the application
includes all informat ion needed for the Commission to make a determination.
r"4,F, ilure EMERSEREto submit a complete application may result ion a continuation to a future meenoz.,
Recommended information includes : E4Z
Photos of existing conditions, taken from all public ways
Site plan showing location of improvements
Elevation drawings of the existing conditions and proposed uzprovements -
Dravangs of details and other; special conditions, including profiles
Description, photographs, and/or catalog cuts of proposed materials (please bring to the
0
meet ing product samples, if appropriate)
Dimensions (i .e. height of fence, si ze of pickets and posts, etc.)
Paint color samples, if applicable (no less than 2 "x2")
Location d size of all mechanical equipment, such as transformers, HVAC equipment,
electrical service, and meters,
and proposed screening