49 Washington Square - C of NA application - Date Stamp
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Salem Historical Commission
120WASHING70N STREET SALEM.uASSAC11111rsclerc For Office Use Only
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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 H Other
District: Derby Street Lafayette Street McIntire ElWashington Square
Address of Property: t in fon// // Uare
Name of Record Owner(a): O qYi� '.e$ LLC
Owner Mailing Address: I to tWiavi+ s4reed EVCrl Md 019(S
Description of Work Proposed
Please type orprial clearly.Altarli additional sheets,as necessary.
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Name of Applicant: Or Ti.a7/v trflrs LLL 20wnerE]Contracto enantE]Other.
Signature: I Date: 611 it 0"
Tel.#: 97S S7R c3G8`1 E-mail Address:
Certificate will be mailed to the owner unless otherw'a indicated here
Certificate should be mailed to: Name Y erll-u-
Mailingaddress: 16 -1::'rQr4 City: {VE rI State: V�1 Zip: -aft Ls
ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly described and the application
includes all information needed far the Commission to make a determination.
Failure to submit a complete application my result 'n a continuation to a future meeting.
Recommended information includes:
Photos of existing conditions,taken from all public ways
Site plan showing location of improvements
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
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