133 BOSTON STREET - SIGN PERMIT 133 Boston Street
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0133 BOSTON STREET 1124-05
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIS#: 10733 _
Map: 0016
Block: - SIGN PERMIT
'Lot: 0128-0
Permit: Sign — -
Category: SIGN
Permit# 1124-05 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2005-1523
tc Cost: $1,600.00 Contractor: License:
$20.00 ALL STAR DESIGN
#of Fixtures Owner: Peter Copelas
Applicant: WELBY PENA
AT: 0133 BOSTON STREET
ISSUED ON: 29-Jun-2005 AMENDED ON: EXPIRES ON: 29-Dec-2005
TO PERFORM THE FOLLOWING WORK:
1124-05 SIGN PERMIT TJS
THIS PERNHT MAY BE REVOKED BY THE CITY OF SALE UPON VIOLATION OV,4NY OF
ITS RULES AND REGULATIONS. ."q
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Signa
Fee Type: Receipt No: Date Paid: Cheek No: Amount:
SIGN REC-2005-001864 29-Jua-05 X $20.00
Geo I-NIS9 2005 Des L:mriers\lunicipal SOW6016,Inc.
A0+ 0\ Permit Numbe\
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APPLICATION FOR PERMIT TO ERECT A SIGN > o
PERMIT MUST BE OBTAINED BEFORE SIGN IS FABRICATED AND INLLE �
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Location,Ownership and Detail Must be Correct,Complete,and Legible U o
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City of SALEM,MASSACHUSETTS
TO THE BUILDING INSPECTOR
The undersigned hereby applies for a permit to Erect_Alter Repair a sign on the following described buildings:
Location and No. 13 3 11��'5�n .�"I I-� Zoning/District
Name of Property Owner h�C, C,,7 'k e � T21 , � �-�r/GM 4 RC•k�T� T,2 -i7
Name of Sign Owner V)t 16V T1-XI
If Owner is a corporate body,name of responsib officer
Name of Licensed Sign Erector alem License No.
Address ' - C -
Use of Building: 1"Floor G/ /07/ 71 3•a Floor
2^a Floor 41h Floor
Frontage: Building linear It Property linear h
Type of Sign Proposed: Surface ❑ Right Angles to Building rv-n Free Standing ❑ Awning
❑ Other(specify) / </ l
Proposed Sign Materials ///7U/ ��iJd / 6J/ 1e f ii7
Proposed Sign Dimension Sign Area sq h
Existing Signs: Surface: Sign Area i( sq h
Right Angles: Sign Area sq h
Free Standing: Sign Area _S X I sq h
Other. Sign Arca aq h
Signs to be Removed: Type � sq h
Signature of Owner r? �e
Estimated Cost of Net Work Signature of Owner's Authorized Representative
/ 1 Address '� C 4C- < -t' W
Telephone
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Signature of Property Owner
APPROVALS (Deparrmrnt Use Only):
*Gl&COMMUNITY DEVEWPI ZNT HISTORIGtI.COMMISSION BUILDING INSPECTOR
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City of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form
Please complete form and make two copies.
Date Received a I
Amount Received 0 ��
Form of Payment Check Cash
CHECK PAYMENTS:
write check number
CASH PAYMENTS:
write client initials
112 Sign Permit Application Fee
Conservation Commission Fee
Payment received for Planning Board Fee
what service?
a Old Town Hall Rental Fee
Other
Name of staff person
receiving payment
Additional Notes CS ) S�i k ck � � 133 � �
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Original Check and Form: DPCD Finance
Copy 1: Client
Copy 2: Application File
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CUSTOMER'S ORDER NO. /
i PARIMENT DATE
NAMES
ADDRESS Z
CITY,SAr)IP
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SOLD BY CASH V
r C.O:D. CHARGE ON ACCT. MDSE RETD PAID DUT
QUA
DESCRIPTION PRICE AMOUNT
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RECEIVED BY,
KEE THIS SLIP FOR REFERENCE
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� i DUPLICATE