2 Oliver Street application Date Stamp
R ECEIVED
APR 01 2016
Salem Historical Commission D PT. OF PLANNING 8
COM UNITY DEVELOPMENT
120 WASHINGTON STREET SALEM,MASSACHUSETTS 01970 For Office Use Only
(978)619-5685 FAX(978)740-0404
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 [3\4ctntire faWashington Square
Address of Property: I 0 J 5' 2 `)-L AkA 22 (2G
Name of Record Owner(s): Q nyk o-S
Owner Mailing Address: _911 LA5N IA)tit, 522 . ,SAL Mi PAA OI Q7 b
Description of Work Proposed
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Name of Applicant: Owner❑Contractor❑Tenant❑Other:
Signature: Date: p
Tel. # E-mail Address: C.
Certificate will be mailed to the own less otherwise indicated her�
Certificate should be mailed to: ame T)A iD C. tm Qs
Mailing address:11 N1n1ETD�) 5 ;Q0jj12-z, City: S.44( Q4_Statej%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 maresult 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
rfj 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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