360 Essex St - C of A application - paint colors Date Stamp
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Salem Historical Commission V� TYo�L ,�
120 WASHINGTON STREET SALEM MASSACHU. �+?-^ Ford. of Use Only
19781 619-5685 FAX 19781 740-040A �.41 r
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:
❑ New Construction Moving ❑ Reconstruction ❑ Alteration
❑ Demolition [a Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street ❑Mclntire ❑Washington Square
Address of Property: 3(o 0 S�55 S
Name of Record Owner(s):
Owner Mailing Address: 61) fi
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary
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Name of Applicant: U1 l `11 ❑Owner❑Contractor❑Tenant❑Other:
Signature: f Date: 7 j 1.20
Tel. #: 1`1-2 L 7_ E-mail Address: eW t v.S-�DtW-t(F c,,Wvx,,) , co w►
Certificate will he mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name Lilt-1 14.,; G*ia� 1—
Mailing address: 3(90 City: evo, State:WA-Zip:Oic):Z0
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 a lication m ;result in a continuation to a suture meeting.
Recommended information includes:
Photos of existing conditions,taken from all public ways
Site plan showing location of improvements
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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)
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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 screening
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