145 Federal Street CofNA application i
Date Stamp
Salem Historical Commission
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APPLICATION FOR A CERTIFICATE OF NON-APPLICABILITY
Pursuant to the Historic District's Act (M.G.L. Chapter 44C) 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:
Name of Record Owner(s):
Owner Mailing Address:
Description of Work Proposed
Please tjpc or prirtl clearly: Auarlt additional sheets, as ncressary.
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Name of App�icant: F [� - Ullrti Owner❑Contractor❑Tenant❑Other[]Other: t)
Signature: Date:
Tel. #: L2 E-mail Address:
Certificate will he mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Nance
Mailing address:� _� b __ _ � City Stat"ip:
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 maE result in a continuation to a future meeting,
Recommended information includes:
EZPhotos 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) A—
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 transforiner (HHVAC equipment,
electrical service and meters, and proposed screening1�
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