87 Federal St - Cof NA application for roof and porch repairs qP
d.
Amen
Lr
a le
m i,stort- cal Comini-ssion
1. 20 NlASHfNGTON STREET. SAL42."'M - Ms A S S A%'P.'.%J,H U S S 0 ,197_
i978) 6 ? 9-5685 FAX (978) 740—p404
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 R Reconstruction ❑ Alteration
r Demolition u Painting ❑ Sign ❑ Other
r
District : ❑ Derby Street ❑ Lafayette Street YMclntire EWashington Square
Address of Pro erty ;� ' C�� � � S 1
P � w5e
Name of Record Owner s : � C �+ �' L l- t � ����� "► f / 1 � r �� � w� cj ; 1 < �:; 7
Owner Mailing Address : '��' �' •�� � t �� S �= ��'�e�'t ��" � �`� 7�' v
Description of Work Proposed :
,tit �KIP �"' � rote# 14- �
Or
4.7 POPP
� �
�e
jt4d s lna4e
Ale
Upr
el
Name of Appl icant : weer [] Contractor [] TenantL�lOther: �
Tel . # : � � � `( — -mail Address :
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to : Name �
Mailing address : City : State :_ Zip
: