42 Broad St Unit 3 - C of A application - replace windows Date Stamp
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Sale"I Historical C01"Mission c�P I T PLANNING LOP &
124WASFiINGTONSTREET,SALEM,MASSAC►1USETTSOi870 ®MMU ITY DEVELOPMENT
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
❑ Demolition ❑ Painting ❑ Sign X Alteration
❑ Other
District: ❑Derby Street ❑Lafayei#e Street
McIntire ❑Washington Square
Address of Prope ty: Z (j Op An ST- -3
Name of Record Owner(s): JSA
Owner Mailing Address: I R,0j-6 S j
Description of Work Proposed
Please tJpe orprint clearly:Attach additional sheets,as necessarJ:
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Name of Applicant: Is ua LC E'
❑Owner contractor ❑Tenant ❑Other:
Signature:
Date: -l
m-" #: 7 � 1/2 3 - o
+ E-mail Address: 6�Y uy',? -A -5ovs iL.&TS Certificate will be mailed to the owner unless otherwise indicated here.
Certificate should be mailed to: Name
Mailing address:
City State.��I ip:
ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly described and the a
includes all information needed for the Commission to make a determination. PPlication
Failure to submit a co lete a lication ma result in a continuation to a rrture meetin .
Recommended information includes:
V Photos of existing conditions, taken from all public ways
t 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 ofproposed materials (please bring to the
meeting product samples, if appropriate)
Dimensions(i.e. height of fence, size ofpickets and posts, etc.)
Paint color samples, if applicable(no less than T'k2 -—
Location and size of all mechanical equipment, such as transformers,HVAC equipment,
electrical service and meters, and proposed screening
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