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4 Federal Ct - C of A application - vent 10-24-17 Date Stamp J�ry Salem Historical Commission ! IN WASHINGTON STFIEET.SALEM,MASSACHUSETTS 0070 � Fcr off9ee Use only (97e)619•SOBS FAX(976)740.0404 f APPLICATION FORA 9KRIffICA11 OF APPROPRIkTENESS Pursuant to the Historic District's Act (M.G.L. Chapter 40C) and the Salem Historical Comxnission Ordinance, application is hereby made for issuance of a Certificate of Appropriateness for: �K New Construction 0 Moving D Reconstruction D Alteration ❑ Demolition 0 fainting 0 Sip 0 Other District: DDerby Stre�etl ❑Lafayette Street ErMctntire DWashingtoxi Square Address of property: ~� �• r _S�t 2.+�t g _ © ��' __-- Name of Record Owner(s): Owner Mailing Address: 19 t 9 �y - Descriptiion of Work Proposed Please ljpe orprh2t clearly:Attacli additioiialslleeta, asvecessa: V1!;11'V,9— 4Ar- Aev 14 Name afAppli 7�a; -�f&ner ❑Contractor OTenant 06ther: Sep Signature: ��" -- - Date: Tel. 12— ;] jZ^3 S G fi-mail Address: C 'of @ ,ha•� ?. to Cerd,ficate will be mailed to the owner unless otherwise indicated here: Certificate should be mailed to: Name Mailing address: City: State:_Zip; 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 map result in a continuation m 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,sucb as transformers,HVAC equipment, electrical service and meters, and proposed screening r .%� � r �( r �O :a v I� ,� fO � I '� — i i � � i i i I 1 i C�` 1 ` f� � Q ` r i (� �_\ � __ c. � � 6 � � � �� ; � �- �,� � �� __ ;7 tz OIL / r -� r I ; t 1{Yj Y1r,�'�ul'Lr� 1 •f' ,t ,�Y,s+1 �M i"c � ! ,err 17 55, low ' J A'D W 'S rol- r 5 V`kil S relyfl 'IIIIIQ��It� ��,lll/ 1 '3 i'�'r°'r e 5 Y Y1 t }•Jt S � A << v I otU cr;�klr,4 �.. : r ill�ti M ,fRr C}(�f A�.7.,• �'':� if fiiio, i� now f pop