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1800.421-1030 COPIES AND ACCESSORIES CALL 800-421-1030 COPIES AI
AND ACCESSORIES CALL 800-421-1030 COPIES AND ACCESSORIES CALL E
SALEM REDEVELOPMENT AUTHORITY
DESIGN REVIEW BOARD
Application for Design Approval - OTHER THAN SIGNS
1. Date of Application
2. Location of Building C k ( 1VC�l
Number and Street
Proposed work impacts upon _Derby Square Historic area, Museum area,
_Essex Mall, North residential area, _Peripheral area,
_Significant historic bldg. (Itemize)
3. Owner .
Name Telephone Number _
Address
4. Architect*/Engineer*/ Other, .
Name
Address Telephone Number
5. Type of Improvement New construction Alteration _Demolition
site work_ // Addition
6. Reason for Request' Security Change of use _Energy conserves
C ange of image _Safety Change of busin
** ,Other V✓ SEs e.� �.
7. Level of Approval Requested Concept _Schematic, des1
M.
Final design Field decision .
Applicant must attach 3 copies of all schematic submissions (or is the case of
originals, models, or mock ups, the original and two photos of the submission)
24 hours prior to the regularly scheduled DRB meeting to SILK staff.
(Do not.write below this line)
Number of DRB members in ttendance The vote was unanimous_ _Yes No
DRB recommended action: V Approval as submitted No action, advisory only
Resubmit to DRB =�o action, inadequate
submission
Approval subject to the following_ i0�3i
DRB comments are attached. J I `
* A licensed professional architect or engineer is required for all construction
other than ordinary repairs (p. 71 S.B.C_) or perfor—med on a building less tha
35,000 cu. ft. enclosed space.
t.*If, in the applicant's view, the change is of significant economic importance,
information including financial figures where applicable should be supplied on
a separate attached sheet which will allow the Board to evaluate the proposal
intelligently.
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