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171 Federal Street - C of A application - AC
Date Stamp is, t .SalemHistorical � t o `ical Coinmission 120 WASHINGTON STREET.SALEM MASSACHUSETTS 01970 For Office Use Only (97E)919-EkP5 FAX OM 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: mLTI.-E SS AC ' ❑ New Construction ❑ Moving ❑ Reconstruction tA Alteration ❑ Demolition ❑ Painting ❑ Sign ❑ Other District: ❑Derby Street []Lafayette Street clntire ❑Washington Square Address of Property: I r7 l SQ Name of Record Owner(s): Owner Mailing Address: Description of Work Proposed Please type or print cic u-ly.Attach additional.sheets,as necessary. I©©r s © T a fio e-F- r� -co r t� C-OpW- � 5 P Ile )n 5-f`,a I I eel �►^�l� 7� kxe c� a� �y a !'bnj r00� �t c, '��-e- )--)o use . Name of Applicant: I Y l o V1 vi +2V f GL�. OwnerOContraetor❑Tenant[:]Other: Signature: Date: + ,Z Tel.#: (p ct / 3 !?',- E-mail Address: 414�f 17�V � ��1 �• e�Lp G Certificate will be mailed to the owner unless otherwise aindicate here: Certificate should be mailed to: Name �? S `100 V e j Mailing address:01 ? �e ra( City: -(�� StateodAZip: t>1 Q�7 ATTACKED DOCUMENTATION An application will not be considered complete unless all work items are thoroughly describedand the application includes all information needed for the Commission to make a determination. ,Failure to submit a complete application may result in a continuation to a future meeting. -- Recommended information includes: Photos of existing conditions,taken from all public ways -- Site plan showing location of improvements Dra VV ✓1 j L)1_ l e e e S �l c 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, electrical service and meters,and proposed screening