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Salem Historical Commission
120 WASHINGTON STREET.SALEM,MASSACHUSETTS 0197C
(976)619-5685 FAX(978i 74&040,
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 j Alteration
❑ Demolition X Painting ❑ Sign ❑ Other
District: ❑Derby Street ❑Lafayette Street NpVcIntire ❑Washington Square
Address of Property: I G[-;•t: TNG! T h
Name of Record Owner(s): {�la-('l�i?� ; yV11pt2T t_1 (q 'PIT
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Owner Mailing Address: 1 2 4 P l]ES'T U,l 4tT t,T� S A U=[f/! M A O
Description of Work Proposed !
Scope of Work:
I. Relocate left side yard fence approx. 10' forward(see plot plan& photo). The
new fence shall match existing, reuse existing strap hardware and restore the cap
rail. Original fence had a cap and has long since been removed or roughed away.
The relocated fence is necessary to screen two new AC units. These will not be
visible from the street.
2. Patch and paint front entry area, windows, lintels to match existing color and
finish.
3. New front light fixture consistent with street and period.
4. Replace existing 2"painted down spouts with 3" copper downspouts at front
entry.
5. New hose bib next to existing direct vents on left side (this may not even be
visible from the street). Note, no hose will be kept there, this is just to fill
watering cans only.
6. Minor roof repairs to match existing as, best available.
7. Paint and patch fences to match existing.
S. Add crushed seashells to existing seashell bed between house and driveway.
4. Paint front door with matching color and finish.
Name ofApplican r 1'Z ktl Jo►�XOwner ❑Contractor ❑Tenant ❑Other:
Signature: _ /Date:
Tel. #: y g - Q f Jr 5�/r`7 E-mail Address: Y 21 'j' yy a q/ ���py�
Cenicate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name 1/1/ AR: -W t4
Mailing address: �� Gf44—2tiiL-r 4T Ci l�Cl /� 44p: 0�ty: L Lt'it State:
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 meetin .
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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REFERENCE: pp i N T 3 ��A' r _q f e tMl�tGJ4 I�X! 4T1 N
DEED:REC.SK,SS'13 P0. 4 41
' — THIS PLOT FLAN WAS NOT MADE FROM
TD' 805-rov ¢LatRAL BAYING% QANri ANMSTRWrENTSURyEr AND 18FOR
I CERTIFY THAT THE SUILDING(S)SHOWN HEREON THE PUfV'OWS OF THE SANK DAILY. INODER
NO CSTCUINSTANC'fS ARE OFPWTS TO W
ARE LOCATED ON THE GROUND AS SHOWN AND THAT THEY USED FORESTAMJSj6WENT OF FENCNS,
CONFORM TO THE HORMMTAL DIMENSIONAL REGULATIONS WALLS,HEDGES,ETC.
OF THE ZONING SYLAWS OF THE C 11,4 0 F 6A"M
AT THE TIME OF CONSTRUCTION OR ARE PROTECTED UNOEA MORTGAGE INSPECTION PLAN
GENERAL LAWS CHAPTER 40A SECTION 7. LOCATED AT
I ALSO CERTIFY THAT THE DWELLING SHOWN M NOT T!CNESTNU/TSTREET
LOCATED WITHIN A FLOOD HAZARD ZONE AS
DELINEATED ON THE OF COMMUNITY 0 Z SDIbZ PREPARED FOR
MA EFFECTIVE R ICIIAED wyKf S KuLY
THE FEDERAL EME NCY MANAGEMENT AGENCY
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