Application for a Certificate of Non-Applicability Date Stamp
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Salem Historical Commissiolz
120 WASHINGTON STREET. >a_EM , ntAssnCHusETTs 01370 For Office Use Only
(47e) 619S685 FAX (978) 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 ❑ Alteration
❑ Demolition ❑ Painting ❑ Sign ❑ Other
District: []Derby Street ❑✓ Lafayette Street ❑McIntire ❑Washington Square
Address of Property: 255 Lafayette Street, Salem, MA 01970
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Name of Record Owner (s) : Lafayette Court Condominium Trust
Owner Mailing Address ; 255 Lafayette Street, Salem, MA 01970
Description of Work Proposed
Please hy-)e or print c/eadr: Attach additional sheets; as necessarrz
Replace wooden gutters with alumimun gutters . Replace fascia board if needed. The exact site is on the left back
side of the building (255 Lafayette Street; facing the building from Lafayette Street),
Susan Atkins, Trustee
Beth Gillett, Trustee
Deborah Ribaya, Trustee
Name of AppIicgLalaytte urt Condominium Trust ❑Owner ❑Contractor❑Tenant ❑✓ Other: Trustee
Signature: [//`,• Date : March 13, 2017
Tel. #:
339-204-3331 E-mail Address : debbieribs@yahoo.com
Certificate will be mailed to the owner unless o /i vise i dicated here:
Certificate should be mailed to: Name f Ce�T c/o beborah Ribaya
Mailing address ; 255 Lafayette Street, Unit #7 City: Salem State :M Zip: 01970
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
Site plan showing location of improvements
Elevation drawings of the existing conditions and proposed improvements
Drawings of details and other special conditions, including profiles
Description, photographs, and/or catalog cuts of proposed materials (please bring to the
meeting product samples, if appropriate)
Dimensions (i.e. height of fence, size of pickets and posts, etc.)
Paint 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
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