115 Federal St - Cof NA application 5, k!b St
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PRAY 262016
:Salem Historical Commission DEPT.
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APPf t('AT10N FOR A CHRTPf iCAT OF NnN APPLICA6tI [TY
Pursuant to the Historic District's Act (M.C,.I,..Chapter 40C)and the Salem llist mW- Commission(hdin nice,
apPlication is hereby made for issuance of a Certificate of Non-Applicability as described below for:
❑ NewConstnetiun Moving Reconstruction �] Alteration Demolition Painting Sign ❑ Other
District. []Derby Street ❑Lafayette Street ❑McIntire ❑Washingtoo t qv=
Address of Property: f/T rf-b blc R L —Trt x T 28 t4 au A
Namc of Record(honer(s)_ '—'j.F Qt.tCal rti Ci 4 ,FviL7g neasr
Owner Mailing Address:----_1l15 (t>tca ��Ec y IVf7
Dewriodge of Work Pmoosed
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Name of Applicant: ea ib'11rg �Owner❑Cbtstractrn❑Tettad❑�thcr:
signanze:� � G, r P4 t" Date: .5
Tel.#: 91W 7y4-bj171 E-mail Address: Ar lee vt rha/'SL' tr°-`
CmVksar Wit he a ikd ro the owner wdesx otherwite odjew.d h�,
Certificate should be mailed to: Name-Db.a r l ee,., s•9� ['1
Mailingaddress:�le (e,�{ St. — City: 31xw Statcc;+(,(,!Zip:
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ATFACFIED RQLN4L I'A'fiM
An apfdicwHon will trot be considered complete anlesr ail rrtrk items are thoraagh(vdescribed and the appiivairon
incltulrs all informatlon needled f rr the Commusum to make a detrrmmonon.
F'ailwa to sahmit a rnlete annftca;(.1n mrav nxuh in a rontimtvli�myj a tuhrre meefine
Recommended information includes;
Photos of existing conditions,taken from all puhlic ways
Site plan showing location of improvammts
Elevation drawings of the existing conditions and proposed improvements
a Drawings of details and other special conditions,including profiles
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DescriPticn.Photographs,andtot catalog cuts of proposed materials(please bring to the
meeting product samples,if appropriate)
Dimensions(Le.height of fence.sire of pickets and posts,etc.)
Q Paint on
samples,if applicable(no loss than 2"x2")
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Location and size of all mechanical equipment,such as transformer,HVAC equipment.
electrical service and meters,and proposed sc7eening
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