10 Summer St - C of NA application - exterior repairs Date Stamp
DEPT OF PLAN[1:1W-A &
Salem Histo IS�71#,frOmMUNITY DEVELOPMENT
I!(,'WAS,iIN6TONSTREU SAAAEM MA&s'ACKu�ETrs,,31910 For Office Use Only
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:
-0- New-Construction- Moving -Reconstructiarr Q Alteration-
F-1 Demolition d Painting F-I Sign Other
District: E]Derby Street. Lafayette Street ['McIntire F]Washington Square
Address of,Property: - I D J at rtx c�ir )f KI V--
Name of Record Owner(s).- sobA--, G)Uee-� 1,00
-Owner-Mailing-Address:
Description of Work Proposed
IlePase��type orprirtt clearly.Attach adaitional sheets, as necesnecessary.necessary.j2
o-r /vpLLce T" � c&4 Cicpbv" d
Name of Applicant:..,A)b&k 1-k'4nn r—JOwner[]Contractoio TenantEjOther:
_I---
Signature: Date:
TeL o- A 3 E-mail Address: f)
Popj-rfz7ej- raw 7
Certificate will be mailed to the owner unless otherwise indicated#ere:
Certificate should be mailed to: Name- Hyqv-�D
Mailing address:- 3 P�OL5jtnf 51 Citv:Wen6m State:&j8-Zip:
A-T-TA GILD-DO CUMENT-A-T-10N_
An application will not be considered complete unless all work items are thoroughly described and the application
includes all it formation.needed for the Commission to make a determination.
Failure to submit complete a> dication may result in a continuation to a fitture meeting.
Recommended°information includes:
Photos of existing conditions, taken from all public ways
1 Site plan showing location of improvements
-�J
Elevation drawings of the existing conditions and proposed improvements
Drawings of details and other special conditions,including profiles
Description,_photagraphs,_and/oreatalog_cuts_ofp-ropos-et.materLik(please bring-to-the-
meeting product samples, if appropriate)
i Dimensions(i.e. height of fence, size of pickets and posts, etc.)
0 ,
Faint 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
:7 m
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