346 Essex St - C of NA application - repair basement window add storm Date Stamp
R ,E I` E
.L, BAR 02 2020
Salem Historical C0H MjSSj&hk UNITY DEVELOPMENT
For Office Use Only
10M1A3HM1(iTOX STREET SALEAA 1dAtS11CHt15FTTS 07477
,-975}
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:
C New Construction C Moving E Reconstruction EE / Alteration
E Demolition E Painting E Sign tt� Other
District: E Derby Street ❑Lafayette Street rellitire ❑Washington Square
Address of Property: 3 LA & �55 t y 5 fi P-" ✓V1 N . U [ c4 7 �
Name of Record Owner(s): PCo rJ Pe ce, Z
Owner Mailing Address: I L4 6 F sS G S T SU ! e w" f A W170
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
S ,� ✓vi w See ed 41?4 C I (or J e C r�'V � G Y! D
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Name of Applicant:-��G 1�PM� Ep&ner ❑Contractor ❑ Tenant Other:
Signature Date: 2` 2�S_ ZOZ PJ
Tel. #-_S&f; - 7� E-mail Address: hU
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip:
ATTACHED DOCUMENTATION
�+ A & A SERVICES, INC.
1970
A&A SERVICES TelephORT 9 STREET 0424 faxE 978M 40-2 12
Contractor Registration No. 101609
Federal EIN: 04-3090162 Construction Supervisor No.CS057733
MISCELLANEOUS SPECIFICATION SHEET
Buyer(S)Name Date of Contract
F!5,_5" 3ez,K Fog-o cz>ojov TnusT 7 - 10 - 2-020
Buyer(s)Street Address,City,State and Zip Code
3 q sex s i s'&0' 1
Daytime Telephone Evening Telephone Mobile Telephone Number E-Mail Address
nMRa 305-978- ZSS7
The Buyer(s)listed above hereby jointly and severly agree to purchase the goods and/or services listed below, in accordance with the prices and terms de-
scribed on this specification sheet and the front and the reverse of the acoompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which
the Specification sheet is a part. &YO tN ,STWL wrry raaW � C4W)OW TA
SPECIAL INSTRUCTIONS
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