5 HARBOR STREET - SIGN PERMIT - VIGOCity of Salem Sign Permit Application Worksheet
Zoning (res/non-res)CD except not
Entrance Corridor (Y/N)Y
Lot frontage 68 feet
Building or tenant frontage 44 feet
# of businesses on site 1
Bldng dist from street center <100 feet
Multiplier 1
Building and Blade Signs
maximum area permitted 44.00 sq ft
total proposed sign area 24.10 sq ft
Blade Sign 4.71 sq ft
width 31.56 inches
height 21.48 inches
Existing Wall Sign 10.28 sq ft
width 148.00 inches
height 10.00 inches
Existing Canopy Sign 9.12 sq ft
width 84.00 inches
height 15.63 inches
Freestanding Signs NONE
maximum area permitted 0.00 sq ft (per side)
maximum # of signs permitted 0 signs
maximum height permitted 0.00 ft tall
sign 1
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
Application meets guidelines set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
April 224, 2023
Vigo
5 Harbor Street
Notes: The blade sign is a replacement of the previously approved
sign damaged in a storm. The previously approved sign was
internally illuminated. Otherwise, the sign conforms to the city sign
ordinance.
PRINTS ARE THE EXCLUSIVE PROPERTY OF STRATUS. THIS MATERIAL SHALL NOT BE USED, DUPLICATED, OR OTHERWISE REPRODUCED WITHOUT THE PRIOR WRITTEN CONSENT OF STRATUS.
ADDRESS:
ORDER NUMBER :
SITE NUMBER:
ELECTRONIC FILE NAME:
PROJECT NUMBER :
PROJECT MANAGER:
PAGE NO.:s tratusunli mi ted.com
8 8 8 .5 0 3 .1 5 6 9
8959 Tyler Boulevard
Mentor, Ohio 44060
Rev #Req #Date/Artist DescriptionRev #Req #Date/Artist Description
Rev 7 000000 00/00/00 xxx1188059
3 HARBAR ST
SALEM, MA 01970-5041
5979
FRANK SZEKER 41649
1
CLIENT:
G:\ACCOUNTS\W\WESTERN UNION\2023\MA\
Salem Business Center_Salem
Original 416058 02/03/23 Z-RA
1
DATE:SIGNATURE:
PAGE:
AGENT APPROVAL / SIGNATURE I S REQUIRED ON ALL PAGES
APPROVED
AS IS
APPROVED
WITH CHANGES
NOTED
NOT
APPROVED
S I G N
H E R E
BY APPROVING THIS ART, YOU ARE ALSO AGREEING TO THE
TERMS & CONDITIONS REQUIRED BY WESTERN UNION
ON THE LAST PAGE OF THIS FILE:E01 Scale: 1/4"=1'-0"
D/F ILLUMINATED BLADE SIGN REPLACEMENT PROPOSED SIGNAGE
EXISTING CONDITIONS:
EXISTING MOUNTING HARDWARE AND PLATES TO BE REMOVED; NEW
D/F ILLUM. BLADE SIGN TO BE INSTALLED IN SAME LOCATION
7'-0 "
DOO R
H EIG H T
12 '-0"
ABO V E
GRADE
SCALE BASED ON 7'-0" DOOR HEIGHT
PRINTS ARE THE EXCLUSIVE PROPERTY OF STRATUS. THIS MATERIAL SHALL NOT BE USED, DUPLICATED, OR OTHERWISE REPRODUCED WITHOUT THE PRIOR WRITTEN CONSENT OF STRATUS.
ADDRESS:
ORDER NUMBER :
SITE NUMBER:
ELECTRONIC FILE NAME:
PROJECT NUMBER :
PROJECT MANAGER:
PAGE NO.:s tratusunli mi ted.com
8 8 8 .5 0 3 .1 5 6 9
8959 Tyler Boulevard
Mentor, Ohio 44060
Rev #Req #Date/Artist DescriptionRev #Req #Date/Artist Description
Rev 7 000000 00/00/00 xxx1188059
3 HARBAR ST
SALEM, MA 01970-5041
5979
FRANK SZEKER 41649
2
CLIENT:
G:\ACCOUNTS\W\WESTERN UNION\2023\MA\
Salem Business Center_Salem
Original 416058 02/03/23 Z-RA
2
DATE:SIGNATURE:
PAGE:
AGENT APPROVAL / SIGNATURE I S REQUIRED ON ALL PAGES
APPROVED
AS IS
APPROVED
WITH CHANGES
NOTED
NOT
APPROVED
S I G N
H E R E
BY APPROVING THIS ART, YOU ARE ALSO AGREEING TO THE
TERMS & CONDITIONS REQUIRED BY WESTERN UNION
ON THE LAST PAGE OF THIS FILE:E01 Scale: 1-1/2"=1'-0"
Scale: NOT TO SCALE
4.7 square feet
D/F ILLUMINATED BLADE SIGN CABINET
2 '-7-1/2"
CABINET SIZE
1'-9-1 /2"
C ABI NET
S IZE
12"
C/L TO C/L
5-1 /4"
2"
1'-9-1/4"
Face Trim: 1'-9" x 2 '-7"
6"
8 " de ep al um inum extrusion w / 1/2 " re ta i ners
a ll p ainted Gloss Bla ck
CABI NET:
FACES :.150 S olar grad e, pan f orm ed p oly ca rbona te
GR APHIC S :
I LLU MIN ATIO N:In te rnal l y illu min at ed w/ LEDs as re quire d pe r m anufacturer ;
POW ER SU PPLI E S HOU SED W ITH IN CENT ER OF CABI NET
Disco nnect swi tch to be p rovide d
I NSTA LL:
QUANTI TY:
P LATE DE TA IL
Reverse sp rayed to m atch c olors show n
Cabinet to be secured to wall w/ 2"x2"x1/8" Aluminum Tube,
6063-T52 w/ 3/8" base plate (3003-h14); Weld tube supports from
both sides and secured to wall using masonry anchors as required;
All hardware and supports to be painted black
(1) ONE NEW D/F ILLUMINATION CABINET REQUIRED
WALL MAT.: Signband material is BRICK
8"
SID E A & SID E B SID E VIEW
COL OR PAL E TTE
Pantone 109 Yellow Black
Pantone 2728 Blue
2" X 2" X 1/8"
Al u m. Tube,
6 063-T52
w/ 1-3 " x 8"
3/8" base plat e
3 0 03-h14
This SIGN TYPE has been reviewed by the
In-House Engineering Dept.
By:Date:Adam M 2/3
Additional information may be required. Preliminary specs as shown are approved.
ActionRequired:Provided support / plate
detail
PRINTS ARE THE EXCLUSIVE PROPERTY OF STRATUS. THIS MATERIAL SHALL NOT BE USED, DUPLICATED, OR OTHERWISE REPRODUCED WITHOUT THE PRIOR WRITTEN CONSENT OF STRATUS.
ADDRESS:
ORDER NUMBER :
SITE NUMBER:
ELECTRONIC FILE NAME:
PROJECT NUMBER :
PROJECT MANAGER:
PAGE NO.:s tratusunli mi ted.com
8 8 8 .5 0 3 .1 5 6 9
8959 Tyler Boulevard
Mentor, Ohio 44060
Rev #Req #Date/Artist DescriptionRev #Req #Date/Artist Description
Rev 7 000000 00/00/00 xxx1188059
3 HARBAR ST
SALEM, MA 01970-5041
5979
FRANK SZEKER 41649
3
CLIENT:
G:\ACCOUNTS\W\WESTERN UNION\2023\MA\
Salem Business Center_Salem
Original 416058 02/03/23 Z-RA
Note
Note
WESTERN UNION EXTERIOR SIGNAGE PROGRAM
TIMELINE, TERMS & CONDITIONS
TIMELINE:•S t a n d a r d s i g n i n s t a l l a t i o n s r e q u i r i n g p e r m i t s t a k e a n a v e r a g e o f (3 4 ) b u s i n e s s d a y s t o c o m p l e t e .
•C u s t o m s i g n i n s t a l l a t i o n s t a k e a n a v e r a g e o f (6 4 ) b u s i n e s s d a y s t o c o m p l e t e .
T H E FOLLO WIN G S TE P S MAY CAUSE A DEL AY:
•P ERMITTIN G: Cer t ain c it ies may require e xt ende d permit ti n g ti me b e yond the (7) day s a lloca ted i n time line .
•AGENT AR TW OR K APPR O VAL: (3 ) day s a llowed in t imel ine f or A g e n t a r t wor k appr ov al . Tim elin e i s d e p e n dent o n Agent re sp ons ive n e ss.
TERMS &
CONDITIONS:
1. T h i s or d e r i s s ubj e c t t o pe r mi t a nd la nd l o rd a pp r o val s.
2. L a nd lo rd si g n a t u r e is m a nd a t o r y on a l l si g n a g e pe r m i t a p pl ica t io n s . If Ag en t or d er s t he s i gn a ge p r io r t o o b tai ni ng La ndl o r d
app r o va l a nd th e L an d l or d s ubs eq ue nt ly re fu se s f o r a ny re a son t o g ran t a ppr o v al s t o th e Ag en t , t he n Ag en t i s r es p o ns i bl e f o r
cos t s i nc ur r ed b y We s t e r n Un ion r e l a ti v e to t he s i gn an d t h e s ign i ns t al la t io n .
3. In st a ll ati o n of e x t e r io r s ig na g e co ve rs su r v e ys , pe r m i ts , an d a ny o t h er re qu ire m en ts d e em ed n ec ess a r y b y l o c al j u r is d ic t io n a n d i s
gov er ne d by th e Ag en cy Ag r ee m en t b e twe en We st er n U n i o n a n d A g e nt.
4. A LL exi s ti ng si g n s m a y b e i n s pe cte d f o r v al id p e r mi t s on f i l e wi t h th e loca l mu ni c ip a l o f fi c e .
5. Wes t er n Un io n w i l l p ro vi d e e le c tr i ca l h o o k-u p s i f el e c t ri c al s ou rc e i s wi t h i n (5) fe e t o f si g n loca t io n . I f t he e le ct r ic a l hoo k -u p i s no t
w it hi n (5 ) fe et o f t he s i gn l o c at i o n, A ge n t w il l b e re s pon s ib l e for a dd i ti on al e le ctr i ca l a nd / or co n s tr u cti o n c o s ts , w hi c h m a y b e
r eq ui r ed to l ig ht th e s ig n.
6 . I n t h e e v en A g en t c an c e ls o r r ef us es de li ve r y of th e si g n a f te r i t has be en o rd er ed, Ag en t u n d er sta nd s th at it is re spon si b le an d li a b le
f o r c os t s i n c u r r e d by We s te r n U ni on r el a ti ve to t h e s ign a nd si g n in s ta ll a ti on . Cos t s i n c ur r e d w il l b e a u t o mat i ca ll y d edu ct ed fr om t he
A ge nt ’s c o mm is s io n .
7 . I n t h e ev en t t he A g e nc y A g re e m e nt b e t w ee n Ag en t a nd We s t e r n U nion i s t er m in a te d a t a ny ti m e an d f o r a ny re a son w h a t soe ve r, A ge n t
s h a ll coo pe rat e f u ll y wi t h We s te r n U ni on i n r e mo vi ng an y s ig ns di s p l a yi ng We s te r n U ni on ’s n a me or logo or, in t he al te r n a ti v e , an d a t
Wes t er n Un io n ’s s o le d i sc r e t io n , co v eri ng u p We st er n U n i o n’s n am e o r l o g o o n a l l s ign s. A l l s uc h s ig ns m ust be re m ov e d (or if We st e r n
Un io n pe r m i ts , co v ere d up ), n o l a te r t ha n (1 0 ) d a ys fol low in g t h e t er m in at i o n of th e Ag en cy Ag r e em en t. A g e nt a gr ee s t h a t , i f A ge nt fa i ls
t o re m ov e o r f a il s t o co o p e r at e wi t h th e r e mo v a l of al l su ch si g n s wi t hi n t h e (1 0 ) d a y p e r io d f o ll o w i n g t h e te r m i n a t ion o f t h e A ge n c y
Agr ee m en t , We st er n U n i o n ’s r em e d ie s a t l aw w il l n ot b e ade qu a te , a nd i n ad d iti o n t o th e o t he r r e me d ie s s e t f or th h er ei n, We s t e r n Un ion
s h a l l be e n t it l e d t o s pe ci f ic pe r f o r ma nce , i nc lu d in g a ppr o p ria t e in j un cti ve r el ie ve an d a t tor n e y f ee s.
12510 E. Belford Ave. • Englewood, CO 80112 • westernunion.com
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
2 Avenue de Lafayette, Boston, MA 02111-1750
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 affidavit 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 (check 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.]
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers’ compensation for their employees.
Pursuant to this statute, an employee is defined as “...every person in the service of another under any contract of hire,
express or implied, oral or written.”
An employer is defined as “an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.”
MGL chapter 152, §25C(6) also states that “every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.”
Additionally, MGL chapter 152, §25C(7) states “Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority.”
Applicants
Please fill out the workers’ compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers’ compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers’
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under “Job Site Address” the applicant should write “all locations in ______(city or
town).” A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department’s address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Lafayette City Center, 2 Avenue de Lafayette
Boston, MA 02111-1750
Tel. (617) 727-4900 or 1-877-MASSAFE
Fax (617) 727-7749
www.mass.gov/dia Revised 7-2019