151 Federal St - C of NA application - insulation and clapboards�y
Date Stamp
Salent Historical Commission OCT 31 2019
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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 V Reconstruction [] Alteration
❑ Demolition Painting [] Sign 1' Other
District: RDerby Street []Lafayette Street []McIntire []Washington Square
Address of Property: S �
Name of Record Owner(s): e r °" --U Cl L ,e 1`
Owner Mailing Address:
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
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Name of Applicant: []Owner[]Contractor Tenant[]Other:
Signature: Date: Q Zp
Tel. #: - 7 15- E-mail Address: IA c u,-
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: