307 HIGHLAND AVENUE - SIGN PERMIT - PORTLAND GLASSCity of Salem Sign Permit Application Worksheet
Zoning (res/non-res)B2 non-res
Entrance Corridor (Y/N)Y
Lot frontage 130 feet
Building frontage 45 feet
# of businesses on site 1
Bldng dist from street center <100 feet feet
Multiplier 1
Building Signs
maximum area permitted 45.00 sq ft
total proposed sign area 42.90 sq ft
sign 1 42.90
length 132.00 inches
height 46.80 inches
sign 2 0.00
length 0.00 inches
height 0.00 inches
sign 3 0.00
length 0.00 inches
height 0.00 inches
Freestanding Signs
maximum area permitted 32.00 sq ft (per side)
maximum # of signs permitted signs
maximum height permitted ft tall
sign 1
proposed sign area 16.00 sq ft
length 48.00 inches
height 48.00 inches
proposed sign height 20.00 ft
Application meets guidelines set forth in
the Salem Sign Ordinance Yes
Recommend approval Yes
The wall sign meets the specifications of the City of Salem sign permit
ordinance. The freestanding sign is a refacing, with no changes to size
or structure of the sign.
13-Feb-24
Portland Glass
307 Highland Avenue
City of Salem Sign Permit Application Worksheet
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):_________________________________________________ _
Address:__________________________________________________________________________
City/State/Zip:_____________________________ Phone #:________________________________
*Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information .
† Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new a ffidavit indicating such.
‡Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees, they must provide their workers’ comp. policy number.
I am an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:____________________________________________________________________________
Policy # or Self-ins. Lic. #:__________________________________________ Expiration Date:____________________
Job Site Address: City/State/Zip:______________________
Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone #:
Official use only. Do not write in this area, to be completed by city or town official .
City or Town: ___________________________________ Permit/License #_________________________________
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other ______________________________
Contact Person:_________________________________________ Phone #:_________________________________
Type of project (required):
6. New construction
7. Remodeling
8. Demolition
9. Building addition
10. Electrical repairs or additions
11. Plumbing repairs or additions
12. Roof repairs
13. Other____________________
1. I am a employer with _________
employees (full and/or part-time).*
2. I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers’ comp. insurance
required.]
3. I am a homeowner doing all work
myself. [No workers’ comp.
insurance required.] †
Are you an employer? Check the appropriate box:
4. I am a general contractor and I
have hired the sub-contractors
listed on the attached sheet.
These sub-contractors have
employees and have workers’
comp. insurance.‡
5. We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers’
comp. insurance required.]
Richard Harvey