2 North Pine Street - C of NA - application - 3 tab shingles Date Stamp
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Salem Historical Commission
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 Non-Applicability as described below for:
New Construction ❑ Moving �✓ Reconstruction Alteration
Demolition ❑ Painting ❑ Sign Other
District: Derby Street Lafayette Street R McIntire Washington Square
Address of Property: 2 N Pine St
Name of Record Owner(s): Theodore Cowan;Diana Cowan
Owner Mailing Address: 2 N Pine St,Salem MA 01970
Description of Work Proposed
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Replace existing 3-tab roof shingles with 3-tab shingles of like kind of color.
Name of Applicant: Theodore Cowan OwnerE]ContractorE]Tenant Other:
Signature:. -t- Date: 12-9-2020
Tel. #: 978-327-1223 E-mail Address: t@theodore.me
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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