142 CANAL STREET - OREILLY AUTOPARTS- SIGN PERMIT (7) 142 canal Street Bldg3
O'Reilly Auto Parts
06�*5
Commonwealth of Massachusetts
Cityof Salem V120 Washington St,3rd Floor Salem.MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Permit B-15-330 PERMIT T O BUILD
FEE PAID:: $0$0.00
DATE ISSUED: 611/2015
This certifies that 142 CANAL STREET NOM TRUST SNAKEBITE REALTY, LLC
has permission to erect, alter, or demolish a building 142-bldg3 CANAL STREET Map/Lot 330006-0
as follows: Signs SIGN PERMIT AS APPROVED FOR: T TIRES
Contractor Name: RUSS BAKER
DBA: SIGNS BY"RUSS" INC.
Contractor License No: CS-062767 /���
G5/1/2015
Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: I'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Permit Numbtt
APPLICATION FOR PERMIT TO ERECT ASIGN
IOU
NOTE:BUILDING PHiMrr MAST BE OBTAINED BEFORE SIGN IS ERECTED
LOcabon,Ownership and Detail Must Be Correct,Complete,and Legible
ff)(_F Salem,Massachusetts
To the Building Inspector. Date/
l� 1 The undersigned hereby applies for a pemM to d Eneq a Alter, o Repair a sign on the following descnbed buildings:
Street Address Zoning District
l�(2 CUnu( SI is( u Urban Renewal Areatrance Corddor
_ o Hislonc District o None
e SAaKe`.�Et Qf<I L11-C -Mr Hill.
Telephone (p1'1_ q20- SnSla 1 flaw,�
7`TiK S floor
....� Atltlress Cwt � 3 floor
Telephone 7g_ _ y�dS e floor
E-meil Fldw many businesses an it the tuld"'g?
If a corporate body,name
Ogo=f officer
.5J .us B iQuu-in<- `jerr germs Building 94 linearfeet
Construction Suos license No C S OU 214 T Applicant's Space(N mutt-tenant) 3 o linear feet
Address V}apk V S.ryd 02115 P1OPenY ( o linear fast
Telephone Sod- SSo —Z21-1
E-mail �(e g;„J f..rr .aw-ruthh,e.tf- a Sign Owner vSignEractor o Other.
Si• 7 SI n2 Sion 3
n Surf
VSurtace o Sudece
❑Right Angle to Building c Right Angle to Building o Right Angle to Builtling
w7ree Standing o Free Standing c Free Standing
o Awning a Awning o Awni
c Potable(A-Frame) o Portable(A-Frame) o Pod ble(A-Frame)
o Other(spectfy) o Other(specify) o Other(specily)
Sign Malone Sign Materials Sign Materials
nHek.� L./iY1J I['x, fn r "' - .-vin
Sign Dimensions 4$n K l to S % i Sign Dimensions
Sign Area Q Sign Area Sign Area
Y t an : n
Sign Height(N free standing) Sign Haight(N free standing) Sign Height(If free standing)
Estimated cost di Net worst
$ I o0o,no
Type Sign Area To Be Removed? Sign rr G
•Surface _sgfl oyes uno
o Right Angle to Building _sq h o yes o no
o Free Standing _sq ft c yes a no a Sign Owner's AutWLedresentatve
o Awing _sq h a yes a no 4-1-W
c Other(specify) _sq h oyes ono
Property Owrrer
Planning 8 Community Development Oepertmart Historical Commission
Building Irnspegw
ave�ia«
City of Salem Sign Permit Application Worksheet
RECEIVED
23-Apr-15 NSPECTIONAL SERVICES
T Tires
142 CanalStreet i015 APR 2 4 A 5. 5 8
Zoning(res/non-res) B5
Entrance Corridor(YIN) Y
Lot frontage 160 feet
Building or tenant frontage 30 feet
#of businesses on site multiple
Bldng dist from street center 170 feet
Multiplier 1
maximum area permitted 30.00 sq ft
total proposed sign area 30.00 sq ft
sign 1
length 180.00 inches
height 24.00 inches
sign 2
length 0.00 inches
height 0.00 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
h ht 0.00 inches
maximum area permitted 32.50 sq ft(per side)
maximum#of signs permitted 1 signs
maximum height permitted 12.50 It tall
sign 1
proposed sign area 9.44 sq ft
length 85.00 inches
height 16.00 inches
proposed sign height 0.00 It
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets guidelines set
forth in the Salem Sign Ordinance yes
Recommend approval yes
SCALE 2"=1'
Replacement face for existing Pole sign.
Square footage of sign is 9 1/2 sq ft
Sign is non-illuminated Rellly
CITY PERMIT NEEDED
85"
USER NEI+rnus,wc%er
71
etTosee.Ua�neeume
TIRES USED & NEW TIRES, ALIGNMENT �s .
r<� AUTO REPAIR & DETAILING
White aluminum background with vinyl letters and logo applied to first surface
Logo is 12" x 12" letter height is 7"
Color and copy as per drawing
All .I.c[nc.l compon.M. .M m nul.c-
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DESIGN MANUFACTURE MADRENANCE ➢az C...➢s<res<
ACCEPTED DATE SHEET 1 OF 1 �/ p"` .< .� .a n
epe-eeour .w%epe� 5.➢em,M.
SCALE 2"=7'
NEW BUILDING SIGN
BUILDING FRONTAGE 26' X W
SIGN 1S NON-ILLUMINATED
CITY PERMIT NEEDED 15
SW feet
mw O FIST OVERALL LENGTH `L
24"LOGO :;yTIRES & SERVICE 12-LETTFm A' feet
BUILDING FRONT 104 SQUARE FEET
SIGN 30 SQUARE FEET
BLACK PLEXIGLAS LEPERS APPLIED TO CLEAR BACKGROUND MOUNTED TO BUILDING
LOGO is 24"x24"WHITE PLEXIGLAS WITH VINYL GRAPHICS APPLIED TO FIRST SURFACE
Color and copy as per drawing
—��_�^='�_ •zy (SIGNS BY ^HIISS^. INC.
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i w[Er as• m
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): S%9r--s--V4 R✓5 jr N G .
Address:_ 4Nk;b ,, SI
City/State/Zip:?broaJorl .n4 O ?o/ Phone.#:_
Are you an employer?Check the appropriate box:
r-,y Type of project(required):.
1.t-I I am a employer with S 4• ❑ I am a genera(contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2-❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. insurance comp.insurance.t 9• ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[J Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t C. 152, §1(4),and we have no
employees. [No workers' 13.9bther S i i✓
comp. insurance required.] I -
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box most 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.#: W C- 4y 1;?d U2c13 y' Expiration Date:
Job Site Address: / -I X C aw A,/ S+ City/State/Zip: 5 A le M, ro 4
Attach a to of the workerscompensation 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: 4 C-4 Date glg �5—
Phone#: S O� — S- 8 0 — ;L A l
FOfficial use only. Do not write7thisea,to be completed by city or town offrciaL
Town: Permit/License#
Authority(circle one):
d of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector Person: Phone#:
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-contiactor(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 bum 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
600 Washington Street
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 11-22-06
www.mass.govldia
City of Salem Department of Planning & Community
Development
CHECK RECEIPT AND TRACKING FORM
DATE 16 IS BOARD
CLIENT Timm(r
PROPERTY ADDRESS ! 2-
CONTACT
CONTACT NUMBER ( )
PURPOSE FOR APPLICATION: Sj w
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SIGNS BY "RUSS", INC. BANK OF AMERICA 12873
P.O. BOX 393 MASSACHUSETTS
SOUTH EASTON,MA 02375-0393
508-580-2221 5-13
110
PAY /7 /, LS DATE
/ 1
/ .Q(S AMOUNT
TO THE VVVV
ORDER
OF
AUTHORIZED SIGNATURE
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FEE
117
STAFF NAME
SCALE 2"=1'
Replacement face for existing Pole sign.
Square footage of sign is 9 1/2 sq ft
Sign is non-illuminated + Reilly
CITY PERMIT NEEDED
85"
�r Dsen�eEtscnus,.wcN>AET
ALTO REP.UR k DET.UIX
USED & NEW TIRES, ALIGNMENT 1699
r`P r AUTO REPAIR & DETAILING
White aluminum background with vinyl letters and logo applied to first surface
Logo is 12" x 12" letter height is 7"
Color and copy as per drawing
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ACCEPTED DATE SHEET 1 OF 1 X epos sen NoSa]eaa,Ma .aaw
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SCALE 2"=1'
NEW BUILDING SIGN
BUILDING FRONTAGE 26' X 4'
SIGN IS NON ILLUMINATED
CITY PERMIT NEEDED
26 feet
15 FEET OVERALL LENGTH
24' Loco ' TIRES & REPAIRS 12111 =ERs 14 feet
i
BUILDING FRONT 104 SQUARE FEET
SIGN 30 SQUARE FEET
BLACK PLEXIGLAS LETERS APPLIED TO CLEAR BACKGROUND MOUNTED TO BUILDING
LOGO is 24"x24" WHITE PLEXIGLAS WITH VINYL GRAPHICS APPLIED TO FIRST SURFACE
Color and copy as per drawing
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