17 Beckford Street Application for Certificate of Hardship Salem Historical Commission .
120 WAStilrU 70N STgEE r,SALEM,MASSACCHUSETTS 0)97,D
(978)819-568:5 FAX(978';740-0404
APPLICATION FOR A CERTIFICATE OF HARDSHIP
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 Hardship for:
11 New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
!-' Demolition ❑ Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street k-TMcIntire ❑Washington Square
Address of Property: / I 6ecK P rc1 J-1
Name of Record Owner(s): COrherts�of?e ��C��UrG71 LL C
Owner Mailing Address: �Iql I'naple S f Su L;-e, Zo3 _ 5a_nv�rs, "A D/q2 3
Description of Work Proposed:
(Please include required scale drawings,paint chips, catalog cuts and/or samples of mmaterial proposed, where applicable)
b e m o l -1 O h o e X I�5�I i�q gG ape• '1 l S�k�� t iei)C e �S l lYl I j!CLi"
-�o ex15l117Q 7Cenc&_ ai side- or garae cc fhe ,back
yarCt.ge Is remo��eol� wher� �-l��r-c 1s
C u-rrently no ��he�.
Applications must include photos of existing conditions, taken from all public ways.
Name of Applicant. .�Ie SQI�di� /n� ! CYOwner ❑Contractor []Tenant VOther•rn&1 a fi"
Tel. ##: E-mail Address: CornorGs on e Lt-C '1 @ ad
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: Stater Zip: