29 Washington Sq - C of NA application - 3tab shingles 4
Date Stamp
J
Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSETTS 01970 For Office Use Only
(978)619.5685 FAX(978)740-0404
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: EjDerby Street Lafayette Street OMcIntire Washington Square
Address of Property: 2A I, OSh%A c>^ _
Name of Record Owner(s): Ae o k" ov_ ?\e / .;,E
Owner Mailing Address: 2—CA WaSVVA \6 r1 0,7 0
Description of Work Pro osed
Please type or print clearly.Attach additional sheets, as ,v.
I�JC W AP0011-`S h 1 t1 /eS , v 'WerC'11
Name of plicant: (G��cvt f C Owner otontractorQ Tenant QOther:
Signature: L 1 Date: 06 6-7 Zo2�
Tel. #: 5 00 E-mail Address:
Certificate will be mailed to the owner unless otherw' a indicated her
Certificate should be mailed to: Name _ldJa 1-ct- �VI��1CZI'If��ICZ [(�Lt���'c�• (j; }
Mailing address.271 M)5 r 1-J _\N i�) city: l— rv\ Stat 1'`Zip: _�
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 mati result in a continuation to a Luture meetine 1.
Recommended information includes:
Photos of existing conditions, taken from all publics ways ke
Site plan showing location of improvements �Sa
) /
�-
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)
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 proposed screening