87 Federal Street - C of A application - replace gutters t~ Date StamLVE
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REValet?, Historical Cols mission N120 WASHINGTON STREET.SALEM;MASSACHUSETfS 01970(978)619.5685 FAX(978)740-0404 DEPT
COMMUNITY DEVELOPMENT
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 �Y Reconstruction
❑ Demolition El Alteration
❑ Painting 0 Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street
k<clntire ❑Washi igton Square
Address of Property: �1 �,(r t-49 �'�; ��le" .
Name of Record Owner(s): I�ac,4 LrQ,�e �Q J�/p p � � �,7,jJ 1�fj')I
Owner Mailing Address:
Descri tion of Work Pro osed
Please tJPe orprhit clearlJ:Attach ad& oval sheets, as 11ecessarJ.
Name of Applicant: Raclrd i e/�e�rk _�� kc4�
❑Owner ❑Contractor ❑Tenant C�Other:
Signature: /--L� 4
_ �y _ Date:
# E-mail Address: R,4 G4 /1AC, jujg . CJ o
Certicate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name 1zQ teJe,4)*-1 ,4 /.I (y-d d.P W 61-7JJ
Mailing address: e.,I el �X
City: S'i¢le State•"A-Zip: 01
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 acorn lete a a lication ma result in a continuation to a uture meetin .
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.)
Paint color samples, if applicable(no less than 2"x2") ——�——
Location and size of all mechanical equipment, such as transformers,HVAC equipment,
i
electrical service and meters, and proposed screening
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