15 Beckford St - C of NA application - vent pipe not visible (002)Salem Historical Commission
120 WASHINGTON STREET. SALEM MASS/ICHUSETTS 01970
(976) 619 5665 FAX (978) 740-0404
APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
Date Stamp
For Office Use Onlv
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:
D New Construction D Moving D Reconstruction W Alteration D Demolition D Painting D Sign Other /NTaeL O 12-/leNOV~/
District: Onerby Street Street ~clntire Square
Address of Property: _....;../...;;S-__ B_e_c_1L-_PC>_te._.,;;l> __ s_--_~_a __ 12._,;.,__ __ s _-4-L. __ ~_...;;_....,.:.,A,\A-_;;~-· __
Name of Record Owner (s): _ ___,;C--:;;....;t;..i.--tlZ--~t...;;~:;___..;.~.....;;..~-' ~.;;;;c:._;;....=:L ;;,__ ___________ _
Description of Work Proposed
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Name of Applicant: ~A,...:::.:..;I C-::;......:f::-t.;_;A-ez..~ __ 1L_£U-_ _.y'--_· Q:>wnericontracto{]Tenant[})ther: ___ _
Signanue: .,A{ JIJ { T Date: ___ _
Tel. #: 7 ( • 43 7 4 • B.2.. 'l / E-mail Address: _ ... m~f:;....{r...L....;~=-__,;;;.:U..,;;S:;...~...;;._· ....;C=D;::::;.._V\/\.;.....:. __
Certificate will be malled to the owner unless otherwise ~ated u
Certificate should be mailed to: Name & lC (~ ltc CT-l-i 10 M~IV(r til?U$C° . tZ Mailing address: ;;. -~ City: AJ~unf State Af.Zip: c'.?2l~.1
ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly described and the application
includes all information needed/or the Commission to make a determination .
Failure to submit a comp lete application may result in a continuation to a future mee ting.
Recommended infonnation includes:
D Photos of existing conditions, taken from all public ways
[ZJ Site plan showing location of improvements
D Elevation drawings of the existing conditions and proposed improvements
D Drawings of details and other special conditions, including profiles
D Description, photographs, and/or catalog cuts of proposed materials (please bring to the
meeting product samples, if appropriate)
D Dimensions (i.e. height of fence, size of pickets and posts, etc.)
D Paint color samples, if applicable (no less than 2"x2")
D Location and size of all mechanical equipment, such as transfonners, HV AC equipment,
electrical service and meters, and proposed screening
Beckford St B
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