122 Derby Street - C of A application - new window Date Stamp
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
El Alteration
❑ Demolition ❑ Painting ❑ Sign ❑ Other
District: ®Derby Street ❑Lafayette Street ❑McIntire ❑Washington Square
Address of Property:
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
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Name of App ' nt• f]Owner❑Contractor❑Tenant❑Other:
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Tel. #: D E-mail Address: er
Certificate will be mailed to the owner unless otherwise indicated here. S a,�
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
From: candymanl806@aol.com<candyman1806@aol.com>
To: rburkinshaw@verizon.net<rburkinshaw@verizon.net>
Subject: Pict
Date: Tue,Jul 30,2019 1:04 pm
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From: candymanl806@aol.com<candyrnan1806@aol.corn>
To: rburkinshaw@verizon.net<rburkinshaw@verizon.net>
Subject: Pict
Date: Tue,Jul 30,2019 1:05 pm
tachments: 0730191258a_HDR_resized.jpg(297K)
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