14 Cambridge St - C of NA application - reroof flat roof Date Stamp
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Salem Historical Coma,, ls` ion For Office Use Only
93 WASHINGTON STREET,SALEM,k1AS5ACHUSETTS 01970
{978)619-5685
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:
L New Construction E Moving C Reconstruction Alteration
E Demolition E Painting E Sign C Other
District: CDerby Street l=,Lafayette Street ❑MC,Pubire ;l Washington Square
Address of Property: [q ('ails br s'0(D14- 5t-
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
Please type or print clearly. Attach additional sheets, as necessary.
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Name of Applicant: C E Owner *ontractor 01 Tenant I Other:
Signature: Date: C,l
Tel. #: �7�r� 1 1 at a� E-mail Address: 01(-6Ce (,z) ,q -a erV1'CG�
Certificate will be mailed to the owner unless otherwise indicated here
Certificate should be mailed to: Name
Mailing address: Il r3 JVO, f-C f Sj City: �e Vr� State: �4�ip: «0
ATTACHED DOCUMENTATION