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148 DERBY STREET - BUILDING JACKET it X148 DERBY STREET L i Certificate Number: B-17-8 Permit Number: B-17-8 Commonwealth of Massachusetts City of Salem This is to Certify that the Resid/Commercial.Building located at Building Type ....................................................................142-148 DERBY STREET.................................................................... in the .....................................City of Salem ........................... ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Mercy Tavern This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not Applicable._..................... unless sooner suspended or revoked. Expiration Dale Issued On: Friday, March 31, 2017 Certificate Number: B-17-8 Permit Number: B-17.8 Commonwealth of Massachusetts City of Salem This is to Certify that theResid/Commercial.Building located at Building Type ....................................................................142-148 DERBY STREET.................................................................... in the ...................................._City of Salem ............... ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Mercy Tavern This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not APPAL k.... unless sooner suspended or revoked. Expiration Date Issued On: Friday, March 31, 2017 0 ��` CITY OF SALEM MASSACHUSETTS < BUILDING DEPARTMENT eGF T 120 WASHINGTON STREET, 3'D FLOOR �"'"s°'� TEL: 978-745-9595 KINMERLEY DRISCOLL FAx:978-740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER October 30,2012 Reardon Realty Trust Reardon J A&Reardon JM TRS 148 Derby Street Salem,Massachusetts 01970 RE: Ordinance Violation— 146-148 Derby Street Ms. Reardon, This letter shall serve as notification that all violations and notices stated in or Department's August 31, 2012,Notice of Violation letter are no longer outstanding with this Department. If you have any question please feel free to contact the Building Inspector's Office. Respectfully, Michael E. Lutrzykowski Assistant Building Inspector Cc: file,Jason Silva, Councilor McCarthy AIlk a CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET, 31iD FLOOR TEL: 978-745-9595 KDaERLEYDRISCOLL FAx: 978-740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER August 31, 2012 Reardon Realty Trust Reardon J A&Reardon JM TRS 148 Derby Street Salem,Massachusetts.01970 RE: Ordinance Violation— 146-148 Derby Street Ms. Reardon, Our office received a complaint regarding your property located at 146-148 Derby Street. The complaint was investigated and your property was found to be in violation of the City of Salem Zoning Ordinance, (see below and attached). The bench located upon the sidewalk on Daniels Street as previously discussed is in Violation of Salem City Ordinances 38-7 and 38-8. I have enclosed a copy of these Ordinances for you review. Non-Compliance with the City Ordinances will result in Municipal code tickets being issued. As discussed on August 30, 2012, if and until such time you go before and are granted permission for the bench from the City Council the bench must remain absent from the sidewalks on Derby and/or Daniels Street. Thank you in advance for your anticipated cooperation. If you have any question please feel free to contact this office at 978-619-5648.. Respectfully, Michael E. Lutrzykowski Assistant Building Inspector Cc: file, Jason Silva. Councilor McCarthy SAId3M11 CODI; with the ntunbers affixed thereto or merchandise or park a vehicle or 'cat It in any shall also be placed at the entrance sidewalk, street or highway For the Purpose Of to the driveway leading to the house, displaying merchandise. or place or leave an any building or Structure Sid any outdoor seating, including benches, (c) Any Person found not to be in compliance tables or chairs unless a permit issue({ by the city with this section shall be liable to pay a tine not to council, for city ways, or by the department of exceed $20.00 for each violation. A Separate of. Public works, for state highways, authorizing the fense shall be deemed committed on each day during or on which n violation occurs or urntin- use of the siis dewalk, street or highway, has been t as ues. Allbuilding, .vyforthagranted erOas nableandexipetir'tiInaybadingor tors or their designees( iln ncrldition tit'polico offic- unloading of any such article, material, merchan- ers, shall be entbreing persons for this Section. dice, cart or vehicle; provided, however, that such (Code 1973, $ 26-5) property Shall never be left so as to obstruct the: Slate law reference. c 40hority to require the number- l`ree passage of pedestrians or vehicular travel. ins of liuildints, RG.L.A. c, .411, $ 2If IIU. , Persons applying for an Outdoor seating permit See- 738-6• Encroachments generally, must obtain an application from the city clerk and No person shall erect or cause to be erected any Provide all required documents prior to receiving filnce or building on the line ofany street without first ascertaining the bounds of the Street from approval from the city council. This section shall the director of public services. If any encroach_ ant apply to any outdoor seating within the city's trent shall be made upon any street and the urban renewed districts Sn long as a cafe permit has been issued by the city redevelopment author- person making it neglects Or refuses to remove, ity' the enc roachmcnt the director of public services Shall cause the person so offetnding to be. prose- (c) Any Such fixture, structure, or property cited for such offense referred I,O t this section which has been erected, (Gude 1973, § 26-6) placed or Icft illegally in art street, highway State,lawreferonce—Rcmnvnl ofoncmnchments,hl(a.L.A. Ino g Y Y s );,hway or Sidewalk may be moved by or under the direction xe, ye 13 cr.seq. Of an Of .and at the owner'a expense. Sea 38.7. Obstructions. (d) The city council or officers iSSuin r (a) No Person Shall place, erect or cause to be for such use of sidewalks, streets or hig, pays Is Placed or erected within an are described in this Suction may in its discretion highway any within or stru tum unless atreetpermit or when occasion ,justitieS demand a suitable cash issued by the city council, for city w;tys, orb the (1e lOsit, Sure bond or insurance indemnity f Y department nFpublic works Of the commonwealth cy to save the city or the ccuumonwealth hann- fbr state highways,authorizing less from all liability of tiny nature whatsoever erection has been g•, such efaeenu`at 1, caused directly or indirect) b an,y obsf.ruction refi:rredeto n tlhis sis rubscction, erfect. 3ia fn sidewalk, streot or highwayY Y such use of rho connection with any building construction nr re- (Code 1973, �§ 26-7, 26-8; Ord. of 2-12-2 pair, the;permit Shall be issued by the inspector of 009, ll buildings, when such obstruction is on a city way. Sec• 38.8. Obstructing sidewalks with arti- Such permit shall also bear the al director' of approval OF the public Services. the (b) No poison, other than ane employed di- No person shall place or cause to be placed redly or indirect) upon any sidewalk Wily lumber, iron, coal, trunk. Y by this ri, or by the common. bale, box, crate, cask, uacka r wealth and while in the perfi�rntance Of'necessary whatsoevca•so; s dul:ieS, shall at an,y time place or Ieave in nn F {garticleoranything to ohSCruct passage for travelers sidewalk, skrej't or highway aqy.article, nmteri;tl lilt- main I,hnn 15 minute-s. (Cade 1.97.3. § 26-9) °pp_ Nu. 12 if C173$:(i of 19tt1Pm, massac4usetts Public Vropertp 13epartment +Nuilhing i3epartment (One #idem (5reen 508-745-9595 Ext. 3811 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer October 17 , 1995 Mr. & Mrs . Readon 35 Chestnut Street Salem, Mass . 01970 RE: 148 Derby Street Dear Mr. & Mrs . Readon: On Monday, October 17 , 1995 , I conducted an inspection at the above mentioned property and found there to be no hatch over the stairway in rear of the building. The hatch must be replaced, or a railing installed. This must be completed by October 30, 1995 . Please contact this office upon receipt of this letter and let us know what your course of action will be taking. Thank you in advance for your anticipated cooperation in this matter. Sincerely, hn J. e ings ocal B l 'ng In pector JJJ: scm Certified Mail # P 921 991 849 Peerless Insurance Nationale-Nederlanden North Americ Property and Casualty Group NOTICE Of CANCELLATION r City of Salem T�: City Hall May 4. . . . . . . . . . . .19.42 . . Salem MA L J Effective on or about the . 25th . . . . . . .day of. . . . . .August . . . . . . . . . ...1986. . . . E S 05 46 07in the Peerless Insurance Company, issued Bond No. . . . . . . . . . . behalf Of Chestnut St Investments DBA In A Pigs Eye running in favor of. . . . . . .c;ty of Salem, , Mk.A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I in the amount of $, 1000 . . . . . . , for_Si&n. Permit_ Bond. - _sign,located at _148 Derby Street ._Salem MASS It is our desire to terminate this bond and we hereby give notice that the lia- bility of the Peerless Insurance Company on this bond shall cease on . . . . . . . . August, 25,. 1M.. . . . . . . . . . Peerless Insurance Company 8 en S may torney-in- a CC: Elliot Whittier Hardy and Roy 62 10 464 MASS PSB-303 340 - 012 ( 7 / 88 ) (�itg of li�ttlem, Massarllusetts n � Publir t1rapertg Department illuilbing Department (One dalem *rtn 508-745-9595 Ext. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer October 17 , 1995 Mr. & Mrs . Readon 35 Chestnut Street Salem, Mass . 01970 RE : 148 Derby Street Dear Mr . & Mrs . Readon: On Monday, October 17 , 1995 , I conducted an inspection at the above mentioned property and found there to be no hatch over the stairway in rear of the building. The hatch must be replaced, or a railing installed. This must be completed by October 30 , 1995 . Please contact this office upon receipt of this letter and let us know what your course of action will be taking. Thank you in advance for your anticipated cooperation in this matter. Sincerely, hnj . e ings ocal B 1 ' ng In pector JJJ: sem Certified Mail # P 921 991 849 Yil ?7 i The Commonwealth of Massachusetts Department of Public Safety wn Massachusetts State Building Code(780 CMR) tJV Building Permit Application for any Building other than a One-or Two-Family Dwelling (rbis Section For Official Use Onl Building Permit Number. Date.Applied: Building Official: ( SECTION 1:LOCATION(Please indicate Block 0 and Lot#for locations for which a street adds is not available) n(1e aml D No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2-PROPOSED WORK. Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair 0 Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy O 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes WL No ❑ Is an Independent Structural Engineering P Review required? Y ❑ No ❑ ief Description o Proposed Work: le amu,•t�,•�._-r,� �o,�� SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing.Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)k Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as a licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E. Educational ❑ F. Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ 1: Institutional I-1❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U. Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA O ISO IIA ❑ IIB ❑ IIIA ❑ ItIB ❑ IV ❑ 1 VA ❑ VB O SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal- Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: NIA I listoric_Commission Review Vroces: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: PAAIt.re,0 -V-b G- c 11�. a SECTION 9: PROPERTY OWNER AUTHORIZATION Ve and Address of P operty Owner IQr;.c��u1 ft b�r�w�� sl �G�.l �1 02970 Name(Print) No.and Street City/Town Zip Property Owner Contact Information- --q9- <77Q - - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building rmit application. SECTION 10:CONSTRUCTION CONTROL(Pleasefill outAppendix2) f buildingis less than 35,006 cu.ft.of enclosed space and or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control 4rx - Q-_�9�o Q A e(R�gis�trant) Tel hone No. e-mail address Registration Number 7 ?.Po�,f I i� Z S;NIFA Wjq-- C91170 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Compan Name ry ;C:M0tVN CS 0"A0 Name o rion Responsible for Construction License No. and Type if Applicable reet Address City/ own State Zip Telephone No.(business) Telephone No. celle-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AI'.FIDAVIT M.G.L.c.152. 25C(Q) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No O SECTION 1&CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ OoG Building Permit Fee=Total Construction Cost x—(Insert here 2.Electrical $ 67 appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ 1 Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost 1 $ d (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. rg-ewr eou JA1r,0 Plas=tign name Title Telephone,No. Date IT r4LC- A� 029)<— Street Address Ci /Town �' State Zip Municipal Inspector to fill out this section upon application approval: i 1,1414- Name Date Da , The Commonwealth of Massachusetts Department of Public Safety �)U MaSSdehnSCUS State Building Code(780 CNIR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Budding Official: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) $ol P^ O(411) In A ?"j"r No.and Street City /Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building Repair❑ 1 Alteration ❑ r\ddifion❑ Denwlitiun ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other Specify:- Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No 3K Brief Description of Proposed Work: r. Ili Jl 4� ti ew InIC eSP SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): ,9L c yr ,C Proposed Use Group(s): Sunv.e SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed . No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) E 5 SClvlt Total Area(sq. ft.)and Total Height(ft.) SO S z SECTION 5:USE GROUP(Check as app licable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-i❑ B: Business E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-t ❑ H-2❑ H-3 ❑ H-4❑ H-S❑ 1: Institutional 1-1 ❑ 1-2❑ I-3❑ I-t❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage Sl ❑ S2❑ U: Utility❑ Special Use❑and please describe below: Special Use , SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ Ill ❑ IIA ❑ fill ❑ IHA ❑ 111B ❑ 1 IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit. Publics Check if outside Flood Zone» municipal 'A municipa A trcnc will not be Licensed Disposal Site❑ required or trench or specify:__ __ Private❑ or indentity Zone:. or on site s}'stem❑ permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: �);) i,i�.iy.�� t,�����„�,�,����,lav:r,� r�.".;,, Not Applicable e4 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ Yes❑ or No39 Yes❑ No ❑ SECTION 8:CONTENT OF CERT1171C:ATE OF OCCUPANCY Edition of Cade:__ Use Group(s). '1 vpe of Construction: Ocnipaut 1-0a11 per Flour: Dues the building contain an Sprinkler Svstem?: Special Stipulations:.__ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner E�Nb fJLM,RGwRD6til lgo beAq sT saC,&,K min pq Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 014)rap- 94$NL 414-61c 979 }y -�ab-7i ►�na a s , c Title Telephone No. (business) Telephone No. (cell) e-mat address If applicable, the property owner hereby authorizes Ai1`tK Ca-.STcuC r, \n,_ . Z C��Mc (Z� Qc1Jt/1� M1> 6I^iNA Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less Chum 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10,1 10.1 Registered Professional Responsible for Construction Control .uI CS 35911 Name(Registrant Telephone No. e-mail address - Registration Number ZC�^ t 3e +tgfb� � Ol5\ C A v Vie. n L•I Street Address C wn State Zip Discipline Expiration Date 10.2 General Contractor Company Name 'C. a 1. CS 39911 Name of Person Responsible for Construction License No. and Type if Applicable Street Address City,/ToAvn State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:IVURIaiRti'Cr?nil'ENS:\1 J0NlN9U RANQh \Frl Il,\VlF M.G.L.c.152.§ 25C6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor �r Item and Materials) Total Construction Cost(from Item 6)=S O 1. Building $ SD'' Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing. $ _ 4. Mechanical (HVAC) $ _ Note: Minimum fee=$ (contact municipality) i. Mechanical Other $ Enclose check payable to 6.Total Cost $ li 6 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the b+ t of my knowledge and understanding. Uu10e2 9LOVI '/Y3/,p Diu _ se 1,07K,t and sign n nne -rule Telephone No. L at Street Address City/Town State Zip 1 v J Municipal Inspector to fill out this section upon application approval: i ame D, to Permit IRIS "' APPLICATION FOR PERMIT TO ERECT A SIGN 0 12017 NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED (li Location, Ownership and Detail Must Be Correct, Complete, and Legibld)EPT. OF PLANNING& COMMUNITY DEVELOPMENT Salem, Massachusetts � Date 1 To the Building Inspector: The undersigned hereby applies for a permit to Arect, ❑Alter, ❑Repair a sign on the following described buildings: Street Address Zoning District I q�Q ❑ Urban Renewal Area ❑Entrance Corridor e•" i f historic District ❑None .. • LLQUse of Building Telephone 1 floor • o-,"��;c.� S'c.�.�� 2 floor �ir�t ✓ Address -) U �� ,, rr 3 floor < e/ Telephone floor E-mailFrontage��,� 1 � How many businesses are in the building? 2. If a corporate body,name �G�/� C�U� ��Y7✓ t �Z of responsible officer �✓ru[ �eZ��r, >ti Building linear feet Construction Sups License No S- Z Applicant's Space(ifmulti-tenant) linear feet Address 3 c>S ,' e�C- /1 D��1 Property O ` linear feet Telephone C 7 2 6.7 — O ` Mail Sign Permitto E-mail C ov,f�"uWYu— ign Owner ❑Sign Erector ❑Other: Proposed Signs(if more than three signs are proposed. attach additional sheets) Sign 1 Sign 2 Sign 3 ❑Surface wS-u-rface ❑Surface w fight Angle to Building ❑Right Angle to Building ❑Right Angle to Building ❑Free Standing ❑Free Standing ❑Free Standing ❑Awning ❑Awning ❑Awning ❑ Portable(A-Frame) ❑Portable(A-Frame) ❑Portable(A-Frame) ❑Other(specify) ❑Other(specify) ❑Other(specify) Si n Materials Sign MaX rials Sign Materials Si nDimensions ri Sin GDi;!�nsirons Sign Dimensions4&/ 7 Sign Area Sign Area 10 AIA Sign Area -Cl— -r7�� s ft 3 sa ft sq it Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Estimated Cost of Net Work $Existing Signs Signatures 3 OC3, DG7 Type Sign Area To Be Removed? Sign Owne� ❑ Surface sq fta � ❑no right Angle to Building c:+s�4t �4eps ❑no ❑Free Standing sq ft ❑yes ❑no Sign Owner's Au horized Representative ❑Awning sq ft ❑yes ❑no ❑Other(specify) sq ft ❑yes ❑no Prope y r Internal Review Planning&Community Development Department Historical Commission Approval Building Inspector 08/24/10 rev Permit Number APPLICATION FOR PERMIT TO ERECT A SIGN NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED Location, Ownership and Detail Must Be Correct, Complete, and Legible Salem, MassachusettslL� Date To the Building Inspector: 1 The undersigned hereby applies for a permit to arect, ❑Alter, ❑Repair a sign on the following described buildings: Street Address Zoning District ❑ Urban Renewal Area ❑Entrance Corridor I ❑ Historic District ^one TUse of Building �. Telephone 7 1 floor - Sign • 2 floor Address S F>1 SJ--," 3ra floor Telephone 4n floor E-mail y, How many businesses are in the building? If a corporate body,name Frontage of res nsible officer Building linear feet Caistnx on SLos License No Applicant's Space(if multi-tenant) linear feet Address Property linear feet Telephone Mail Sign Permit to E-mail Sign Owner ❑Sign Erector ❑Other: Proposed Signs(If more than three signs are proposed attach additional sheets) Si n1 Sign 2 Sign 3 Surface wSurface ❑Surface ❑ Right Angle to Building ❑ Right Angle to Building ❑Right Angle to Building ❑ Free Standing ❑Free Standing ❑Free Standing ❑Awning ❑Awning ❑Awning ❑Portable(A-Frame) ❑Portable(A-Frame) ❑Portable(A-Frame) ❑Other(specify) ❑Other(specify) ❑Other(specify) Sign Materials: -"D Sign Materials Sign Materials Sign Dimensions' Sign Dimensions Sign Dimensions Sign Area sq fts ft Sign Area Sign Area sq ft Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Estimated Cost of Net Work $ Existing Signs Signatures Type Sign Area To Be Removed? Sign Own i/Surface qo sq ft ❑yes ono ❑ Right Angle to Buildings sq ft ❑yes r(no ❑Free Standing sq ft ❑yes ❑no Sign Owner's Authorized Representative ❑Awning sq ft ❑yes ❑no ❑Other(specify) sq ft ❑yes ❑no Property er Internal Review Planning Community evelopment Department Historical Commission Approval Building Inspector oena/io rev