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CITY OF SALEM, MASSACHUSETTS Dominick Pangallo, Mayor Community Preservation Committee 98 WASHINGTON STREET ♦ SALEM, MASSACHUSETTS 01970 ♦ [PHONE REDACTED] ♦ FY26 CPA Determination of Eligibility Application (DOE) Submit 1 original and 10 copies to: Patricia Kelleher, City of Salem, Dept. of Planning & Community Development, 98 Washington St., Salem, MA 01970. To ensure consideration for Community Preservation Act (CPA) funding during this round, submit no later than Monday, January 5, 2026. Early applications are encouraged. Projects determined eligible will be invited to submit a Funding Application. Awarded funds will not be available before 7/1/26. Send questions to [EMAIL REDACTED]. PROJECT NAME: PROJECT LOCATION APPLICANT NAME / ORGANIZATION: MAILING ADDRESS: CONTACT PERSON: PHONE: EMAIL: In the chart at right, please indicate all categories that apply to this project (minimum of one). For information on CPA funding categories, please refer to the “Allowable Spending Purposes” chart on the reverse page. INDICATE THE LEGAL PROPERTY OWNER OF RECORD: HISTORIC RESOURCES PROJECTS: CPA funds are primarily for property exteriors. *At this time, the Salem CPC does not recommend awards for private residences or private, for-profit commercial properties. • Date of original construction: • Is the resource listed on the State Register of Historic Places? YES NO • If the resource is not listed on the State Register of Historic Places, has the Salem Historical Commission made a determination that the resource is significant? YES (ATTACH COPY) NO COMMUNITY HOUSING PROJECTS: • Total number of units proposed • Of the total, number that will meet the State definition of “affordable” ▶For municipal owned properties, when the applicant is NOT a city department (i.e. PTA, neighborhood group), the applicant MUST provide written consent to submit the DOE by the managing City department. Funding applications will require co-signing by the authorized representative of the City department. ▶For non-municipal properties, if the applicant is NOT the owner of the property, a written consent to apply must be included in the DOE application, which acknowledges that the funding application will be co-signed by the owner and that any required funding agreements and restrictions (i.e. preservation restriction, affordable housing restriction) will be executed by the property owner. Restrictions shall be recorded at the Registry of Deeds. PLEASE ATTACH A BRIEF NARRATIVE WHICH PROVIDES A DESCRIPTION OF THE PROJECT AND HOW IT RELATES TO THE CATEGORIES THAT ARE SELECTED IN THE CHART ABOVE – NO MORE THAN 1 PAGE & NO LESS THAN 12 PT FONT, PLEASE. REV. 11/6/25 Applicant is (check one): City board or department Other public entity (i.e. Housing Authority, MA State) Non-profit - 501(c)(3) Private group or individual* Open Space Historic Resources Recreational Land Community Housing Acquisition Creation Preservation Support Rehabilitation/ Restoration ---PAGE BREAK--- PLEASE DO NOT SUBMIT THIS CHART WITH YOUR APPLICATION