192 Federal Street - Repair and paint siding Date Stamp r
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Salem Historical JUL 24 2J19
1:20 WASNt{+.6;GTON STREET,SALEK!.IMASSAC USETTS 01070 DE IT. 0Fd?0fflbeUft8Dnlv
s970;510-5555 FAX rC78i 740-0404 COMM
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, j
application is hereby made for issuance of a Certificate of Non-Applicability as described below for:
❑ New Construction Moving Reconstruction Alteration
0 Demolition 0 Painting Sign ❑ Other
District: EIDerby Street Lafayette Street �✓McIntire OWashington Square
Address of Property: 192 Federal Street
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Name of Record Owner(s): Pamela Waldron
Owner Mailing Address: 192 Federal Street; Salem,MA 01970
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
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Removal of asphalt siding, repair of all rotted wood, and painting house similar grey/white trim/light blue front
door with black on front facade inserts, side doors (2) and back door(1).
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Name f A t: Pamela ldron Owner Contractor❑Tenant❑Other:
Signatur Date:
781-526-5470 paw02l4@hotmail.com
Tel. #: E-mail Address:
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Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
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