78 Federal St - C of NA application - inkind clapboards trim paint Date Stamp
Salem Historical Commission
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APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
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 Non-Applicability as described below for:
New Construction Moving Reconstruction /1 i/ Alteration
Demolition Painting Sign �D� t Other
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District: Derby Street QLafayette Street McIntire Washington Square
Address of Property: 1 /� Cf le�L-
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 Applic l� 1 4�L (/� /�Dy.1OwnerQContractor[]TenantQOther:
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Signature: � ��— Date: d
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Tel. #: D E-mail Address: D d C�yy
Certificate will be mailed to the owner unless other ale indicated here:
Certificate should be mailed to: Name Z/�G isf /W/=E_
Mailing address: / S-7- City:Li z`�A r State�yZip: d�
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 a complete aj)j)lication mai 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
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
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