Application for certificate of nonapplicability Poseidon Fountain Restoration Project Sign Date Stamp
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For Office Use Only
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 Nan-Applicability as described below for:
New Construction 7 Moving Reconstruction Alteration
Demolition 7 Painting Z✓ Sign Other
District: ❑Derby Street QLafayette Street QMclntire []W,ashington Square
Address of Property: Salem Public Library,370 Essex Street
Name of Record Owner(s): Trustees of the Salem Public Library
Owner Mailing Address: 370 Essex Street,Salem,MA 01970
Description of Work Proposed
Please type orprHit cleafly:Attach additional"sheet}, as Accessary:
The Trustees would like to place a temporary 2'x 3' sign on the fence to highlight the Poseidon Fountain
Restoration Project beginning on December 1, 2019. The sign would remain in place until fundraising efforts are
completed,estimated time frame is less than one year.
Name of Applicant: Tara Mansfield ❑Owner QContractor[—]Tenant�Other:Director
Signature: Date: 11/22/19
Tel.#:978-744-0860 E-mail Address: Mansfield@noblenet.org
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:.._Zip: