92 Federal St application Date Stamp
1 V ' D
` ' \ , JA 06 2016
--- EPT. OF PLANNING &
CO MU
DEVELOPMENT
Salem Historical Commission
120 WASHINGTON STREET.SALEM,MASSACHUSETTS 01970 For Office Use On1Y �
(9781518-5888 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 ✓❑Ivlclntire []Washington Square
Address of Property: 92 Federal Street
Name of Record Owner(s): Steven Sass and Ellen Golub
Owner Mailing Address: 84 Grove Street,Auburndale MA 02466
Description of Work Proposed
Please lypc or print clearly: Allach additional sheets, as necessary.
Replace the shingles on the 3rd floor dormer addition with clapboard, as the original body of the house is sided in
clapboard. The new clapboard will be painted the same color as the original clapboard.
Name of Appli t: Steven ass _ Owner❑Contractor❑Tenant❑Other:
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Signature:_t/t'��"'� Date: —��LI/bull'
Tel. #: 781.608.1951 E-mail Address: steven.sassl@gmail.com
Certificate will be mailed to the owner unless otherwise indicated here:
Certificate should be mailed to: Name
Mailing address: City: State:_Zip: