Common - C of A application for accessible picnic table Date Stamp
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.Salem Historical Commission
A IM, For Office Use Only
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:
EJ New Construction F-1 Moving r_1 Reconstruction Ej Alteration
0 Demolition F-1 Painting r-1 Sign El Other
District: DDerby Street E]Lafayette Street EIMcIntire [Z]Washington Square
Address of Property: Salem Common
Name of Record Owner(s): City of Salem
Owner Mailing Address:.93 Washington Street,Salem,MA
Description of Work Proposed
Please type oi-piirut r1culy.Amicli a&Alioval sheets, asriec-essaly.
The Salem Commission on Disabilities (SCOD)would like to place an accessible picnic table on the Salem
Common,near the existing play area.
The SCOD has placed these tables in other locations in the City. These tables are not only durable and attractive,
but also they provide inclusive accessibility for the public.
We respectfully request approval to place this table on the Salem Common.
Thank you.
Name of Ap nt: Vsa P.Carnmarata,SCOD E:]OwnerF]Contractor[::]Tenant[Z]Other:ADA Coord.
5/24/2017
Signature: Date:
Tel. #: 978W- 9-6V E-mail Address: icammarata@salem.com
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name Lisa B Cammarata
Mailing address: 120 Washington Street,4th floor City:Salem State:MAZip: 01970
ATTACHED DOCUMENTATION
An application will not be considered complete unless all work items are thoroughly describedand 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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