143-145 DERBY STREET - SIGN PERMIT 143-145 Derby St.
Captain Dusty's Inc.
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— Permit Number
PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
APPLICATION MUST BE SUBMITTED IN DUPLICATE, ONE SET TO BE FILED WITH THE PLANNING
DEPARTMENT, AND ONE SET (BEARING THE APPROVAL OF THE PLANNING DEPARTMENT) TO BE
FILED WITH THE BUILDING INSPECTOR.
Location, Ownership and.DeLaj Must be Correct, Complete and Legible. Separate
Application Required for Every Sign.
F'r
3A g Application for Permit to Erect a Sign
Salem, Massachusetts I �U bZ
TO THE BUILDING INSPECTOR:
The undersigned hereby-applies for a permit to_Erect, Alter, _Repair
a sign on the following described building: nI
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Location and No. my lq5 �klflA Zoning/District
Name of Property Owner ygl)5 41L •
Name of Sign Owner 11wC
Address
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If Owner is a corporate body, name of responsible officer 8fZ358
Name of Licensed Sign Erector L(nI
5311
Address Salem License No.
Use of Building: Ist Floor hP.t(l l ICF IYea 0 3rd Floor t`1 A
2nvd/floor l(j,Atc,( 4th Floor N A
Type of Sign: / Surface, _ Right Angles to Building, _Free Standing
Other (specify) Height:
Sign Materials -MG
Sign Dimensions X12 X L4Z` Sign Area SF
Existing Signs: Surface: Sign Area SF
Right Angles: Sign Area SF
Free Standing: Sign Area SF
Other: Sign Area SF
Signs to be Removed: Type Sign Area SF
Frontage: Building FT Property FT
Signature of Owner
Signature of Owner's Authorized Representative
Address
Estimated CostJ / Telephone
of New Work $ 1 ' t)
Signature of Property Owner
APPROVALS:
Salern Planning Department Superintendent of Streets Historical Commission
REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING
RANr'F
i No................................. PLAN OF LOT .
APPLICATION FOR PERMIT FOR Show Location of Present Structure SHOW SIGN SIZE, COLOR AND LOCATION ON BUILDING;
E ALTERATIONS, REPAIRS AND and Signs LOCATION OF OTHER SIGNS AND BUILDING ENTRANCE
DEMOLITIONS
See attached plan.
............................:...................CLASS BUILDING
LOCATION t: :
...................................................Ward..................... -
I. q,Owner..................:
coat.. -....................... -
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CONDTPIONS � _ _ _ _ _ __ _
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..........._............ . ......-..................-........... .........
Permit Granted
.................................................................. 19.........
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CLIENT DATETHIS DRA'MNG CONTAINS PROPPJEfAR1'INFORMA710N AND pE51GN GONLEPt5 AND 15
PROPERLY OF UNNED SIGN CO,INC.R 15 SONG PRE5ENTED TO YOU FOR YOUR EKCLU5IVE
everly,
LOCATION 05E AND MAY NOT 5E COPIED OR 5HOWN TO ANYONE OUTSIDE YOUR ORGANI7AnON WITHOUT
DESIGNED 5Y OUR WRITTEN PERM15510N.CHANGING OF COLOR5,5M MATERIALS,OR ILWMINAIION DOES 33 BA BOX3106
Beverly,MA 01915
NOT ALTER THE 6.451L DRAWING.0200I UNTIED SIGN CO,INC.ALL RIGMS RESERVED. Phony 878-927-9348
Fax 978-927-9351