13 Cambridge St - C of A application - new dormer Date Stamp
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Salem Historical Commission
'20 WASHINGTON S . EE- SALEM <fASSA:; For Office Use Only
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:
YJ New Constriction ❑ Moving ❑ Reconstruction ❑ Alteration
® Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑ afayette Street ❑McIntire ❑Washington Square
Address of Property: I�J CAM 15W1 AGE ST� 1'
Name of Record Owner(s): «�
Owner Mailing Address: 13 CAM 1'P4436 E 5r-' _
Description of Work Provosed
Please type or print clearly.Attach additional sheets, as necessary.
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Name of Applicant: `7 ❑Owner❑ContractorCl'Tenant❑Other:Ati a t�f
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Signature: Date: S-1 tl 114
Tel. #: ��a— ��` Cr $ _ E-mail Address: �Je rc V e- 1Ac j e-t-t jt4,e< �-
Certificate will be mailed to the owner unless otlu,rwise indicated here:
Certificate should be mailed to: Name_
Mailing address:13 64 H t* 1&'1E; `-'$r _ City H State:_Zip:
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