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142 CANAL STREET LITTLE CESARS- SIGN PERMIT (10) 142 Canal Street IMMMM" Little Caesar's Q Ali 142 CANAL STREET - -- 748-10 COMMONWEALTH OF MASSACHUSETTS 'GIS #: qp;-- _— — ----- CITY OF SALEM IMap: ;Block: - - - ------I Lot-. -- 0006 1 COPY SIGN PERMIT -- iPermit: Stg6 1 `Category; _ SIGN Permit# 748-10 Project# i7s-2010-001096 PERMISSION IS HEREBY GRANTED TO: IEst. Cost: $0.00 Contractor: License: - e C ar - - - Expires 'Fee Charged:j$0.00 ib1GiR0 SIGN&AWNINGS Balance Due:$.00 Owner: 142 CANAL STREET REALTY, LLC,C/O ROSANO ASSOCIATES INC. if Fixtures - Applicant: METRO SIGN&AWNINGS Dig # -- - -- —J— A T. 142 CANAL STREET U-I oup �ConstClass 1 ISSUED ON 07-May-2010 AMENDED ON: EXPIRES ON. 07-Oct-2010 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR(LITTLE CESARS)jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALENL ITS RULES AND REGULATIONS. //�UPON VIOLATION OF ANY OF Signature: Fee Type. Receipt No: Date Paid: Check No: �- SIGN Amount: REC-2010-001292 07-May-10 GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. City of Salem Sign Permit Application Worksheet 22-Apr-10 Little Ceasars 138 Canal Street Zoning (res/non-res) I Entrance Corridor(YIN) Y Lot frontage 195 feet Building or tenant frontage 30 feet #of businesses on site 3 Bldng dist from street center 100 feet Multiplier 1.25 Building and Blade Signs — maximum area permitted 37.50 sq ft total proposed sign area 35.69 sq ft sign 1 length 160.00 inches height 27.00 inches sign 2 length 84.00 inches height 9.75 inches sign 3 length 0.00 inches height 0.00 inches sign 4 length 0.00 inches height 0.00 inches sign 5 length 0.00 inches height 0.00 inches Freestanding Signs 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 proposed sign height 0.00 ft sign 2 proposed sign area 0.00 sq ft length 0.00 inches height 0.00 inches proposed si n height ft Application meets guidelines set forth in the Salem Sign Ordinance yes Recommend approval yes i i E-Mail: kevind@metrosign.net Office: 978.851.2424 Fax: 978.851.2022 170 Lorum Street Tewksbury,MA 01876 � y wrmoMvaftoil lri�M.S Kevin Duggan Permit Facilitator Permit Number APPLICATION FOR PERMIT TO ERECT A SIGN NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED Location, Ownership and Detail Must Be Correct, Complete, and Legible r Salem, Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to o Erect, Lm Iter, ❑ Repair a sign on the following described buildings: Street Address Zoning District 3 �yo Urban Renewal Area n Entrance Corridor C I}L c7- r,Histo c District o None yor1� 9?IiN�RUse of 7Telephone _ 1 c37.- _ Floor eE ors ' 2" floor dress .7� ( U M .C/- 3 floor phone g,3 _ _ 9,74, 4 floor E-mail How many businesses are in the building? If a corporate bogdYV_.Liaau;,- Frontage srble officer 6 7' ' /V6 Building linear feet Construction Sup's License No p S (I ZC6 RL r Applicant's Space(ifmulti-tenant) linear feet Address �lr cS G 6 Property linear feet Telephone Mail Sign Permit to E-mail ❑Sign Owner ig Erect ther: Si n 1 Sign 2 Sign 3 urface , Surface o Surface o Right Angle to Building �Right Angle to Building n Right Angle to Building n Free Standing = Free Standing d+Free Standing o Awning 3AvVhing o Awning o Other(specify) Other(specify) o Other(specify)D Af04o"?y/SohR.,� Sign AQ��als u�`{ 4 Sign aterials Sign Materi Is G / s�� fr}-A � n Dimensions - Sign Dimensions Sign,Dimensions I d iN /'7r X % i A! X `3 ;A.1 Sig ea Sign Area Sl* Sign Area cS s ft '7/ s ft O. _3 sq ft Sign Height(if free standing) Sign Height(if free standing) Sign H2ht(if f standing) Estimated Cost of Net Work $ Existing Signs Type Sign Area To Be Removed? Sign Owner o Surface sq it ❑yes o no o Right Angle to Building sq it n yes n no o Free Standing sq ft o yes ❑no Sign Owners Authorized Representative in Awning sq ft o yes ❑no o Other(specify) _sq It o yes o no Property Owner Internal Review mw� nning&Community Development Department Historical Commission Building Inspector �iro�roe re. Permit Number 0 APPLICATION FOR PERMIT TO ERECT A SIGN 1trlr k NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED �r Location, Ownership and Detail Must Be Correct, Complete, and Legible Salem, Massachusetts To the Building Inspector: Date The undersigned hereby applies for a permit to n Erect, ❑Alter, n Repair a sign on the following described buildings: Street Address Zoning District 3 iD ❑ Urban Renewal Area ❑Entrance Corridor C� ❑Historic District ❑None 7Telephone /II%hone _ dvoo .zee i6 S 2Floor ress 3 floor 4 floor -mail How many businesses are in the building? If a corporate body, nameo ,, of res onsible officer O v& Ait6'T,QE �'( f y- �� Building linear feet Construction Sup's License No CSdc zy,S Rig f- Applicant's Space(if multi-tenant) linear feet Address v G Iy Property linear feet Telephone _a aMail Sign Permit to E-mail u Sign Owner o Sign Erector o Other: . r. . . -- . .. -. ... Sign 1 Sign 2 Si n3 n Surface a Surface o Surface n Right Angle to Building ❑ Right Angle to Building ❑Right Angle to Building >(Free Standing J14ree Standing o Free Standing n Awning ❑Awning n Awning n Other(specify)QW1;r1o4V#11 ❑Other(specifyR L— %p///�L ❑Other(specify) Sign Materials Sign Materials Sign Materials Sigh Dimensions V Sign Dimensions << Sign Dimensions Sign Arrea3� s�7 Sign Area �(3 Sign Area i s ft s ft sq ft Sign Height(if ireg standing) Sign Height(if free standing) Sign Height(if free standing) r � Estimated Cost of Net Work Existing Signs Type Sign Area To Be Removed? Sign Owner ❑Surface sq ft ❑yes o no n Right Angle to Building sq It o yes n no ❑ Free Standing sq ft oyes ❑no Slyr3ar's&uth h e Representative n Awning sq ft ❑yes o no u Other(specify) sq ft ❑yes u no Property Owner Internal Review Planning& Community Development Department Historical Commission Approval Building Inspector 11N1NBmv 411 2411 DRIVE-THRU WINDOW � ] N CD D/F Ground Sign 3" x 3" Approved HS93N.NCO.gNGG BN NOI LMIIED f0 PLL PV SBC CR SMM COAEONENTS HEREOF.W S BEEN DESIGN�N C0MPU MCE WITH PE 2007 EOIPCN FPC NMT1H 2009 AhEND NTSL MCL'JLMG SK,1609 OR FRC SEC.301.2.I.V LOADS "HS DESGNPIXF E%L16rE FPDPfArv6lFF OESDNS LLC MDR NDI DN LLSFD N W�DIE DR MRI Pv Mry OPEP PMIFSWPHWI WAI1EN 19VM1b➢ON Pl LL4OF9fiPb LLC ONffNSDNS MIO CIXLv+i vnv vMv SJG'�Rv OLE L WAIFIDNS VAM FABIdCAPCN P141E(bVS C CLIENT DATE SALESPERSON DESIGNER Lille Caesars 3/17/10 Doug Postre Doug Postre LOCATION SCALE SQUARE FT.. DOCUMENT LOCAPON FILE NAME Salem Mass 3/4"=1' L1Lttfle Caesars\Salem Small Signs.cdr Non-Illuminated Channels / w /LED o TAPCONS 114' X 21/4' Minimum of 4 per letter PLEXI 0 CB5 Wall Sales Rep: D.P. 7.�.�/ (941)278-4 245 Fun: 278-3912 Design: D.P. � J L�G�L-I:LiCJ 3300Pa1m Avenue Ft. Myers, FI. 33901 This design is property of Lee Designs LLC and is not to be used in whole or part by any other parties without written permission by Lee Designs LLC. 301-011 160 " A Wall 30 Linear Ft Sign 27" x 160" = 30 sq/ft Approved IHSBIGN,NCLDDNG BUT NAB BEEN DESC*DNCCWIA14EV 1 2001EDITIONFBCC'MM2009AMNDK4M NCUrDNGSK,1609 OR FRC SEC.301.2.1.WINDLOADS 116 DEBIGN6 ttE SCOISNE PROPBRYOF IEE DESIGNS LLC AND R NOT 11)BE USED NWMOIF OTT PPR1 BYANYT)WPMIESVAMOUT WBGIIEN PFN.ESpN BY IEE DESIGP6 LLC DBIFNSIONSMdlCIXQtB MAY W StXEkRy M TO IMU SWBRI FABRICATION MNER I CLIENT DATE SALESPERSON DESIGNER Little Caesars 3/11/10 Doug Pastre Doug Pastre LOCATION SCALE SQUARE FT, DOCUMENT LOCATION FILE NAME - Salem Mass 1/4"=P 1L\LlttleCoesors\Salem Bevarhomcdr D- � ' 9 1 ' I I ra P 1 P 1 i 1 71-011 � 8 rr co CD a� r DRIVE-THRU WINDOW Approved THIS NGN,INCLUMG 819 NOT LIMBFD TOA.,PIASRC OR W"COMPONENISMEREOF.HAS BEEN DESIGNEDIN COMPLIANCE VlBH ME 2001 ED010N FBC NVTH 2009 AMENDMEMSI.WLJDMG SEC.T6 OR FRC SEC.301.2.1.W1ND LOADS +IS OE35:16"+E�r;;+rtpcnxnf+"F tEE OESIGNBLLC AND6NOi 10 BE pSEDN WeKKE On PMIBV ANY OIHFR PPRTESWIR1dd WHITEN PBIM65KKJ BY lH DESIGNS LLC gMHJSgN5u1D COt0�5 MAVVMVSLGNR'�gIE ID udIG110t5 VAIH FAARIMCA1pN MAlEINI$. CLAM DATE SALESPERSON DESIGNER Lille Caesars 3/17!10 Doug Pasfre Doug Pasfre LOCAPON SCALE SQUARE ft DOCUMEM LOCATON FILE NAME G.. Salem Mass 3/4' LUiMe Caesars\Salem Awnlng.cdr FULL COPY PANELS CENTER PANEL FULL TRANS FULLTRANSPANELS Extra copy strips and translates ' Pick Up Frame:2513116"x183116" Pick Up Frame:2513116"x339116" Pick Up Frame:2513116'x 183116' included with menu: extrusion die 7169 extrusion die 7169 extrusion the 7159 painted white painted white painted white Fa- routed fortrans insertion �PmnwcE Face:24 318"x 1611116" Face:24318"x 32 1/8" ., .080 non-glare acrylic .125 non-glare acrylic Face:24318"x 1611116" screened 2nd surface opaque white screened 2nd surface opaque white, .080 non-glare acrylic tracked for 9 lines of copy tracked sides and bottom. screened 2nd surface opaque white, 1 E tracked bottom edge only Copy v.o.:115116"x14518" Transparency backer:23114"x31118" .060 polycarbonate Transparency backer:22718"x1611116" Y ,• Typical copy strip trims: .060 polycarbonate No Price=2 5116"x 30 112' Trans trim:23 318"x31118" Trans Trim:23"z 16" w13-digit price=25116"x15" Trans v.o.:22118"x297118" Individual digit=25116"x 1114" Trans v.o.=22118'x 15" All screen printed second surface on — 79' Also included(but not shown) Price Point stickersheets clear .030 polycarbonate. _ fortranslites' backed with translucent white arorange — .010 polycarbonate, '-in Transaite Kit Bluellne Item#93433 included with menu. 55 3/4" 67 3/4" cxEEseoNLr cRnn' ii B PEPPEflONI CRAZY9REM III 1 1 '"'xUSROE�1�1i UI CRAZYSAUCE PLxCE YLTWFlESYxIP1E NWLNEf&EN OflBEN Z} ® ca'swrnrs 1. 46" HERE Boll 12" 1 HOT-N-READY PICK UP MENU SYSTEM Complete Menu-Internally Illuminated Cabinet, Frames, Faces, Copy and Price Kit. 4200 Lyman Court, Hilliard,OH 43026 THIS IS AN ORIGINAL UNPUBOSHED DRAWING SUBMITTED y / FOR YOUR PERSONAL USE IN CONNECTION WITH A PRO.iP'T Phone (614)950-2540 (900)544-6]26 `\ BEING PI NEO FOR YOU BY NATIONAL SIGN SYSTE1AE.n- RISNOTTO BEREPRODUCEO.EXHISITED.ORFABRICATED Fax (900)726-481] National Sign Systems ANY FASHION WITHOUT PERMISSION FROM AN AUTHOR12E0 OFFICER OF THE COMPANY. NSS PN 90009450 1 BLUELINE PNI 458101ra PDaa• 79' ai CORS HINGE LEFT EFT O O HINGE 0 � �r t GRADE t POLE COVER L yq6% •°. 0 o sin 2 ss DESIGN ASSUMPTIONS ![[[1 I. 90 MPH BASIC WINO SPEED, Exp C PER 2002 OBC NOTES. F t r 18'0 X 36' DEEP CONCRETE 2. SOIL-UNDISTURBED (NEAT EXCAVATION .i d 1�' o THS MENUBOARD UTILIZES THE SAME FACES "'. COPY AND IN SOIL), LATERAL SOIL BEARING 'A F EHi� m PRICING AS THE 12' NSS INTERIOR MENU SYSTEM. PRESSURE = 150 PST PER FOOT OF p 8 ;oay 3 SIDE HINGED COVER DOORS OFFER EASY ACCESS TO PANELS FOR DEPTH CHANGING GRAPHICS, COPY AND PRICING. 3. STEEL-TUBE - ASTM A500 GRADE B -PIPE - ASTM A53 GRADE B � - EXCEPT THE LARGE TRANSPARENCY - SPECIFIC TO THIS -PLATE -ASTM A36 g ®! APPLICATION. TRANS TRIM = 24-1/4' X 32', VISIBLE OPENING= 4. CONCRETE-30DOPS O 28 DAYS 23-3/4'X 31-1/2'. 5. REBAR-ASTM A615 GRADE 60 -P 6. BOLTS-ASTM A325 OR A490 7. ANCHOR BOLTS-ASTM AM OR A307 79' � e09e EXTRUSION 36 DETAIL B DETAIL B DETAIL B DETAIL 8 a A A DETAIL B DETAIL 8-\ ,� 8008 EXTRUSION 7963 HAT CHANNEL s e DADER DETAIL • F F DETAIL B DETAIL 8 DETAIL B DETAIL B BACK TO BACK 9008 EXTRUSION NSS! 220000D9 9011-\ 9011 1i- 381' {-19�' HAT HAT ^nw CHANNEL CHANNEL � tl (2 REWIRED AT THIS LENGTH) (4 REQUIRED AT THIS LENGTH) �• .063 ALUMINUM 9 RIVETED TO HAT CHANNEL AND CABINET EXTRUSION DETAIL A FOR CAPTURING THE TOPS OF THE INNER FRAMES ggqy �1 p CABINET DETAIL 6694 EXTRUSION NSS' 22000005 €e 4 95[[� i MATH 7963 HAT CHANNEL N55SS// 22000026 g9 AND 9011 HAT CHANNEL NSse 22000027 I IaC'py� III �, l@6 " i�"; EXTRUSION PLACED SNL BACK TO BACK .090 ALUMINUM UGHT BLOCK 1 a RIVETED TO HAT CHANNEL Zi fE�E SECTION A-A AND CABINET EXTRUSION i.Y� LL O mam:sm�mnr a.e.znsnm>w»nw.m«. a 7011. It 6e O D 4q' 0 s � € A a c 1O� 3'T6 SECTION A-A k a e Bx s-1/2 z I p O O 1Y ' O O O 3/16' STEEL PLATE N i O O O SECTION B-B 9' X 9' X 1/T' STEEL PLATE 6" X 2" X 1/4' WALL L@„ STEEL TUBE $7„ $� 6` CHANNEL ® 8.2y BACK PANFI G G 24 GA PAINT GRIP sEcnoN c-c —tJ'—F 37b"� �1`j — Fj 2-3/4' % 2' CUTOUT FOR 9 ELECTRIC ACCESS L ' �01 5 0 16 IIIIY Bo' o CQVERDDORS HIND LEFT 1/ ie�1 FOR f,WER00OR ERYUES COYEROOOR FRAMES 7169 ALUMINUM EIORUSION NSSJ 22000007 6691 ALUMINUM EXTRUSION NSS# 22000002 pgg ; (6 REQUIRED 0 18-3/16, 1 REQUIRED 0 33-9/I6) (2 REQUIRED 0 19-5/8, 1 REWIRED 0 37-7/8) 1 U LL 11�m159�IW159ery s/19/IOJ>NA wul urws a 79" 0 Sj' =36d*- r k � R spa a 42 X MP—wT FLusmk TO CKETS g WAP W FLUSH&TOYB.JSDCKETSQ r—,2—H—oIm—p—wTgLASH h TOMB. FTS 42 HO U P W FLUSH h TOMB. SOCKETS �0 9 41 NO IAMP W1 FLUSH R TOMB. SOCNEIS og N n 42 HO IAMP UH T G F <3HO W1P W RUSH Y TONG.SOC 42UYPW SH h TOu SOCKETS YY tt I def o 9011 ALUMINUM HAT TRACK 8 NSS# 22000027 ELECTRICAL SPECIFICATIONS: o ENCLOSURE - SIGN CABINET IS CONSTRUCTED FROM EXTRUDED ALUMINUM. ALL MATERIALS USED ARE THICKER THAN DOW. THE ENCLOSURE IS WEATHER PROOF AND HAS A MINIMUM Of 2 DRAIN HOLES (1/4" TO 1/2' OLA) CONSTRUCTION NOTES: > DISCONNECT SWITCH - THERE IS A CARLING 9407 OR EQUIVALENT DISCONNECT SWITCH (RATED AT 20A O 125VAC.) SWITCH IS MOUNTED TO THE CABINET AND PROTECTED PROTECTED FROM WEATHER BY A SILICONE BOOT. !� WIPING - THERE ARE (B) 42T12CW/HO EACH BANK OF 4 LAMPS ARE POWERED BY A MAGNETECH 256-448-IDO PLASTIC SIGN BALLAST OR UNE AND LAMP WIRING MUST BE KEPT IN THE RACEWAYS AT All TIMES, AiYY EQUIVALENT WITH A MAXIMUM LINE CURRENT OF 1.9 AMPS O 120VAC 6012 AND OUTPUT OF BODMA O 720 V (OPEN CIRCUIT VOLTAGE), ANY WIRING LOCATED OUT OF THE RACEWAY MUST BE ENCLOSED IN META 90' o BALLASTS (2) 256-448-100 CONDUIT l0 TOTAL LOAD OF 28 AMPS QI2OV/6DHZ. ildx ELECTRICAL PARTS SPECIFIED ARE FOR 120V/60 Hz POWER REQUIREMENTS. SECONDARY WIRING - UL RECOGNIZED 14 AWG WIRE WITH 1000 V RATING AT 90 C. ELECTRICAL PARTS MAY VARY FOR DIFFERENT POWER REQUIREMENT-. 2+ �g89� c MARKINGS - SIGN IS MARKED WITH: UL LISTED PER UL48, MANUFACTURERS NAME, FULL LOAD CURRENT k INPUT VOLTAGE, REFER TO BALLAST MANUFACTURES RECOMMENDATIONS FOR W1P WIRING DIAGRAM. I`�ggg� m SUPPLY CONNECTIONS - THE SIGN IS CONNECTED BY EXTENDING TWO 12 GA. THWN WIRES @ ONE 12 GA THWN GROUND WIRE THROUGH TO A 20/1 LAMP SOCKETS ARE FLUSH MOUNT AND CENTERED IN THE RACEWAY UNLESS CIRCUIT BREAKER THROUGH A (NEW OR EXISTING) TIME CLACK. OTHERWISE SPECIFIED. LM � LL O 1\Ioli59101II9.Mq.9/19/JWI tlA:Y YA"r9°s d �G ppp L a BACK-UP TRIM BACK-UP TRIM 31 1/8" X 23 3/8" .060 CLEAR POLYCARBONATE 22 7/8' X 16 3/4' .060 POLYCARBONATE CUT FROM NSSJ 130DO030 (1EA) NSSJ 1300051 (4 PER MENU) ySy F G Ij' (TYP ALL AROUND) KI O E 40 JIIIIIII_ O ��g J �� .118 NDN-GLARE ACRYLIC I Ili ... 1,5. (Tv) SCREENED OPAOUE WHRE 2ND SURFACE H/J TRACK-15 3/4' NSS# 12800036 (BOTTOM ONLY) .060 CLEAR POLYCARBONATE B CUT FROM NSSJ 13000030 A; U (1 EA) OBD NON-CLARE ACRYLIC SCREENED OPAQUE WHDF 2ND SURFACE Qt a NSSJ 12200082 a •' COPY V.O. NOT CENTERED - ALLOWS USE OF 'H'TRACK AS STRIP STOP LL 1\IPo35911Po]59Awp.9/t9(]W90A.9>Mt agars a 8 9 222 a p ys Flo d � A 1�. 6 9 E s . 7R3 3 ------------- --------------- --------------- N ---------------- m W --------------- L -------------- mm A -------------dnu'�cai W/"ft w ucsMR antsan aa.l um was ��_�n•_�• vwL orsaer�nx am w Nadonm9 Sign Systum UO c canwa rcxsM zFp°w+mi°�0fs-a� o-rk oxum cram e. 12W INA LLJFI I➢p625 CfIY nm ZP M1f FU CXfAIm .M1�xz WIiN P14 RE r _ m IIIIIL G[Su(Y 1[ 2 �i rrmsxm��yv r_v AOpi6 mY VAn ## ziv rypf 9Rm PDF created with pdfFactory trial version www.pdffactorv.com ' Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston, MA 01111 www.mass.gov/dio Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y� Please Print Leoibh Name (Business/Organization/Individual): �r/j-/R,/� S / 1]iIJ�I)�� Address: / 7/j LC/1 > --5 City/State/Zip: _ D/��b phone ;x Are you an employer? Check the appro riate box: ' I �, 1 am a employer with a7 p 4 ❑ 1 am a general contractor and I Type of project (required) employees (full and/or pan-time).' have hired the sub-contractors 6. ❑ New construction ❑ I am a sole proprietor or partner- listed on the attached sheet. 7 ❑ Remodeling ship and have no employees These sub-contractors bave g. ❑ Demolition working for me in any capacity. employees and have workers [No workers' comp insurance comp. insuranee.t 9. ❑ Building addition required.] 5 ❑ We are a corporation and its 10.❑ Electrical repairs of additions 3 ❑ 1 am a homeowner doing all work officers have exercised their 11.❑ ?lumbing repairs or additions myself [No workers' comp. right of exemption per MGL insurance required.) ' C. 152; 61(4), and we have no 12.[1 Roof repair= employees. [No workers' 13,9 Other comp. insurance required.] '.hny appI ManI that checks box 41 must also fill out the smnon below showng the,workers'compensation policy mfonmanon Homeowners who submit this;&Mdavu mdioung they are doing all work and then hue outside eontranors must submit a Dew affidavit indicating such :Connacrors that check this box must anachee an additional sheet showing the name of the subcontnctou and state whether or Dot those conbes have emplevees. If the subcontractors have employees,they must provide ihev workers'comp.policy number I am an employer that is providing workers'compensation insurance for trey employees. Below is the police and job site information. n Insurance Company Name: TT � Policy g orSelf-insLie #G��p e, r Expiration Date- v U Job Site Address: o C /aA/19� sT Ci /State/Zi pf 0/ ry p:Z E y?v 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 DLA for insurance coverage verification. I do hereby cerrifjt under rhe . s and penalties ofperjury that the information provided above is true and correct Sienatura �y _ Date: Phone H: OJfrcial use only. Do not write in this area, to be completed by tilt or town official City or Town: PermiULiceuse k Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plu7Jnspeclor 6. Other I Contact Person: Pbooe#: L.O CERTIFICATE OF LIABILITY INSURANCE7/7/2009 DATE IMMIDDIYYYY vsooucER (781) 898-9192 FAX: (781) 848-9116 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIC J. Williams Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICAT 14 Wood Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND C Suite 9 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO% Braintree MA 02184 _ _ INSURERS AFFORDING COVERAGE ______ NAIC4 INSURED INSURERA Hartford Fire Insurance —19682— C & D SIGNS, INC. DBA METRO SIGN & AWNING INSURER B National Union Fire Insurance 170 LORUM STREET -- ----- - -- .-- INSURER C INSURER O. _- - TEWKSB Y MA 01876 -- -- ------ - - - --- - - - INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OPSUC POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IHSR Do- SRO' POUCYEFFECTIVE POLICYE%PIRATION N Rp' PE F N POLICY NUMBER - M A M LIMBS A �GENERAL LIABILITY EACH OCCURRENCE X COMMERCIAL GENERrA--L��LIA&I.11Y PREMISES Ea Oc[urD nCe S IDD,( �CLAIMS MAGE LI XOCCUR OBSHAIJ4502 12/26/2008 112/28/2009 MED EXP(My one Person) S 10,C --'------ PERSONAL B ADV INJURY 1 1,000,( -- -- GENERAL AGGREGATE S 2,000,C GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS LOMPIOP AGG 3 2 000, X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea acneenp ALL OWNED AUTOS — I BODILY INJURY SCHEDULED AUTOS S IPer Parson) HIRED AUTOS — I NON-OWNED AUTOS (PBODILY INJURY 3 el iC[iPenl) PROPERTY DAMAGE 3 (per.'cineol) 1 GARAGE LIABILITY ,AUTO ONLY-EA ACCIDENT S ' ANY AUTO � - -- - - _ OTHER THAN EAACC S AUTO ONLY PGG $ -_- - -" E%CESS I UMBRELLALIABILITY EACH OCCURRENCE $ OCCUR 7 CLAIMS MADE -' -'- AGGREGATE y S I DEDUCTIBLE '-- 3 RETENTION 3 B WORKERS COMPENSATION 3 AND EMPLOYERS'LIABILITY YIN 1( WC STATU- DTH• ANY PROPRIETOWPARTEIEWEXECUTIVE S SDD,D OFFICE WMEMBER EXCLUDEOT E.L EACH ACCIDEM (MalWatcr,In NH) 4C6969020 It yyees,aescuoe unae� 7/7/2009 7/7/2010 El DISEASE-EA EMPLOYE S 500,0 SPECIAL PROwnderNS Pelow 7-1- EL DISEASE POLICY LIMIT S-500,D OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER INCL AS ADDITIONAL INSURED WITH RESPECT TO WORK PERFORMED BY THE NAMED INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO FOR INFORMATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITFE PURPOSES ONLY NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT,BUT FAILURE TODOSO SHAL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS C REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jonathan Willlalns/MEM ACORD 25(2009101) ©1988.2009 ACORD CORPORATION. All rights reserve) INS025(20090+) The ACORD name and logo are registered marks of ACORD Brian A. Chipman 151 Hosley Road Gardner, MA 01440 To Whom It May Concern: I hereby grant Kevin P. Duggan permission and authority to use my Massachusetts Construction Supervisors license to obtain permits for Metro Sign &Awning. This permission is restricted to activity solely related to Metro Sign & Awning. Feel free to call me at the phone numbers below should you have any questions. Regards, Brian Chipman II nJ"I III Office 978.851.2424 ext. 12 Cell 978.866.8036 Brian A. Chipman Office: 978-851-2424 + . ss Mobile: 978-866-8036 G G1 � SIGNBSEfiWNING CS# 89645 Exp 11/8/2011 Email: briancC-)metrosignandawning.com Fax:(978)851-2022 170 Lorum street - Tewksbury, MA 01876 Niassachusetis- Department of Public Safets Board of Building Regulations•and Standards Construction Supervisor License License: CS 89645 Restricted to: 00 BRIAN A CHIPMAN .'.;lam ' 151 HOSLEV ROAD N# GARDNER, MA 01440 Eaptratian: 11/8/2011 _ y�r�+��pp A./ [ �s (Lmmissinner Trp: 8973 ii BHtYSJICENSf - iLWSSAC 0036757 CAP -" IICERISE �p 77639471 + 01-17.2014 01.17 1950A' r '' L '"D'"4= fN LASS REST X61 SEX 9° M✓ %' 7 em Doe a° d""s� DUGGAN 6.03 M 11.08.2012 11.08-1 #, f tU55 RE61 5.1 M ' r i ? 1 KEVIN P E w B 110 M 25AGNESRD m ? : ' LOWELL,MA '�, <� CNIPMAN i 01852-3203 °sa"' p!!� BRIAN A wn-ox N. - 151 HOSLEY RD (- i DARDNER,MA 014404757 na.,eu ,« Quote >> Page 1 1! Quote Dale 4/15/2010 Order Id SalesRep 1HS Terms Code O DEP/SAL COD 004653 Cust Id I LITTLEC002 Phone 781 392-4608 Metro Sign 8 Awning 170 Lorum Street FaX I Tewksbury,MA,01878-USA Phone:(978)-851-2424 Fax;(978}851-2022 E-mail www.metrosign.net Phone 781 392- ]Fax S Little Caesars s Little Caesars 0 138 Canal Street H 138 Canal Street D Salem, MA 01970- USA p Salem, MA 01970- USA T T 0 O Item ID © Unit of Measure Unit Pricej Extended Price Installation 0 EA S2115.00 2115.00 Installation of Little Caesars Sign Package: (1) non-illuminated channel letter set @ 27"H x 160"W overall - three sections mounted to exterior wall fascia witn fasteners appropriate to wall type. (1) non-illuminated awning @ 36"H x 84"W - mounted to exterior fascia with 1" z-clips spaced at 48" on center with fasteners appropriate to wall type. (1) freestanding illuminated menu cabinet- includes footing excavation, poured concrete, receive/inspect/assembly of menu cabinet. (2) freestanding non-illuminated post and panels (exit and enter sign) - direct bury in concrete "--'NOTES'""" 1) primary electrical by others 2) anchor bolts and template by others Permit 0 EA 585.00 255.00 Permit acquisition fee. $255 for procurement @ $85.00 per hour. "'"estimated cost- billed at actual time""' Permit-face value $0.001 Permit face value -TBD by the City of Salem Taxabl00 No 370 00 Sales0. x Frei$000 MiS 0.00 Ord2r37ta .2. � . e... �\ Ott t��a • �{.rAL L-gg�=- ' „.y-y ,fitrEKC'fiDRIVE•THRU i / N WINDOW CEMEN I'GONCREfE VnGt'__ — —htw pf MEMO- 1 �Iw, 1Hal=I®I D!FGwtlST / �' flfJ to T-0" FAMILY DOLLAR R 1 ✓... 9.180 SF t. '� � Orow BeNe � ; P 30' 102' 1,800 SF R.10/ DEME PIT .NO NC 30'-0' tu smv .«m .14 Gto ISO, 9�S opt ®� PROM � Ilk TP'YMlDP4 _.._ KC City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please complete form and make two copies. Date Received v Amount Received d Form of Payment Check ❑ Cash Client Information C fit CASH PAYMENTS: client initials zo-Sign Permit Application Fee ❑ Conservation Commission Fee Payment received for what Planning Board Fee/ ZBA service? F-1 SRA/DRB Fee Old Town Hall Rental Fee Other: Copies Name of staff person receiving payment I Additional Notes ISZL�_ co— __- 1038 C & D SIGNS INC. 53-274-113 170 LORUM ST TEWKSBURY,MA 01676-1700 L fl DATE a �' PAY TO TH ORDER OFE L7 T ` DOLLARS �Nc/ Ba n Enterprise 12 FOR � ' ■ ., u� i:0 � L302742r: 5aU 77011 u 00 LD 38 - Original Check and Form: DPCD Finance Copy 1: Client Copy 2: Application File