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329 Essex St Application Completed Date Stamp Salem Histotical Commission 120 WASHIN TON STREET,SAS€tit MASSACHUSETTS 9187=0 For Office Use Only (978)619-6683 FAX(978 ;G)- 30a 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 W Painting ❑ Sign ❑ Other District: ❑Derby Street ❑Lafayette Street dmclntire ❑Washington Square Address of Property: :3 2.9 E_ss e� 7R C C--T Name of Record Owner(s): .1. A1� PO PIC CA/ Owner Mailing Address: S AYr1�, Description of Work Proposed Please type or print clearly.Attach additional sheets, as necessary Rep nw t/A/ � 0 ('- 1 SI11E- 4 2(1-iR DF i3v/LDIAIG IN S 0 M G_ wL®K Name of Applicant: ❑Owner❑Contractor❑Tenant❑Other: Signature: Date: Tel. #: E-mail Address: Certificate will be mailed to the owner unless otherwise indicated here: Certificate should be mailed to: Name Mailing address: City: State:_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 application may result in a continuation to a future meeting. Recommended information includes: Photos of existing conditions,taken from all public ways fa iZACwc-Q lAI GMAIt_ Site plan showing location of improvements Elevation drawings of the existing conditions and proposed improvements Drawings p of details and other special conditions, including profiles fA//p Description,photographs, and/or catalog cuts of proposed materials (please bring to the SAmC- C©LO( /PPDV(.i = cALI FORM I'1 meeting product samples, if appropriate) P9iAj— aN%A) S TOWE WnTeRS Dimensions (i.e. height of fence, size of pickets an posts, etc.) N/14 Paint color samples, if applicable(no less than 2"x2") SAn1C /I nENT ICP L 1 Location and size of all mechanical equipment, such as transformers,HVAC equipment, electrical service and meters, and proposed screening