343 Essex St - C of A application - vent pipe Date Stamp
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DEP OF f NG &
Salem
Historical
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APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
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 Appropriateness for:
❑ New Construction ❑ Moving ❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting ❑ Sign Other
District: ❑Derby Street ❑Lafayette Street *IcIntire Washington Square
Address of Property: t
Name of Record Owner(s): U vK/
Owner Mailing Address: i Ito
Description of Work Proposed
Please h pe or print clearly.Attach addillonal sheets,as necessa,3
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Name of Applicant: (Okff4 Owner MContractorE]TenantE30ther:
Signature: __ Date: t Z
Tel. #: Z► + G�.� E-mail Address: �"W ra i �►( `
Certificate 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 may result in a continuation to a�uture meeting
Recommended information includes:
Photos of existing conditions,taken from all public ways
E�] Site plan showing location of improvements
Elevation dreriMrof the existing conditions and proposed improvements
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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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