384 Essex St - C of NA application - rebuild damaged fence RF
P .
NOV 212017
Salem Historical Commission D=PT
120 WASHINGTON STREET SALEM,M.ASSACHUSET c S 01970 COMMUNITY
1978}619-5655 FAX E973!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: El Derby Street El Lafayette Street ❑McIntire []Washington Square
Address of Property: 3�'�1 C_SS eY- 5 V
Name of Record Owner(s): 0v:-tc- l oi�nC;
Owner Mailing Address:
Description of Work Proposed:
Qd -�e.M C e- '7�n ti.�ye b�i S
Applications must include photos of existing conditions, taken from all public
Name of Applicant: 1)) 6�,vZ, C (.4 0T_r 18A '� []Owner ❑Contractor ❑Tenant []Other:
Tel. #: 9L1'Y ".)�k3 - S 7 S b E-mail Address:`M COMP+ q 9E11
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: