126.5 Federal St - C of NA application to reroof sections Date Stamp
®i.�
EC 06 2017
'Z{1• ] DEP OF PLl'.t� MNG &
Historical
}i Salem ,[l sto al CommissiolICOMMU LITY DEVELOPMENT
120 WASHINGTON STREET,SAL.EM.MASSACHUSETTS 01970 For Office Use Only
(9781 619-5685 FAX(97B)740-0404
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 Q Alteration
Demolition ❑ Painting Sign ❑ Other
District: Derby Street Lafayette Street Q✓McIntire Washington Square
Address of Property: 126 1/2 Federal Street
Name of Record Owner(s): Scott&Joy Marchand Davis
Owner Mailing Address: 126 1/2 Federal Street,Salem,MA 01970
Description of Work Proposed
Please lype or print clearly:Attach additional sheets, as necessary.
Replace one(1)square black rubber roofing of 2nd floor street-facing bay window(not visible from street);
Replace half(0.5) square "Charcoal"asphalt roofing of bulkhead entry in rear of house(not visible from street).
Name of Applicant. Chris zorzy []OwnerOContractorO Tenant[]Other:
Signature: Date: 12/6/2017
Tel. #:978-741-0424 E-mail Address: rfearon@a-aservices.com
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name Chris Zorzy
Mailing address: 115 North Street City: Salem State:_�bZi 01970
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