application NA Date Stamp
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Salem Historical Commission
120 WASHINGTON STREET,SALEM,MASSACHUSE7S 01970 For Office Use Only
(978)619-5685 FAX(978)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: ❑Derby Street []Lafayette Street ❑McIntire ❑Washington Square
Address of Property: 396 Essex Street
Name of Record Owner(s): Weisman,Leavitt,Boone,Wicks
Owner Mailing Address:
Description of Work Proposed
Please type or print clearly.Attach additional sheets, as necessary.
Repair/replace and refinish bulkhead doors and door to carriage house.
Reinforce spiral staircase ba,4 gf main house gQi upto third-floor deck.
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Work will be done in-kind; bulkhead doors not visible from public way.(
Name of Applicant: �wner❑Contractor❑TenamE]Other:
Signature: Date: � C
Tel. #: 927 ,-62 7, E-mail Address:
Certificate will be mailed to the owner unless otherwise indicated here; 1
Certificate should be mailed to: Name (S
Mailing address: (3 c5� S` 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 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,I VAC equipment,
electrical service and meters, and proposed screening