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208 CANAL STREET - SIGN PERMIT Zo8 carat :S+ r3- The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AtTTHORITY. Applicant Information _ ,/ ',Ivp,, //�PPlease Print Le ibly Name (Business/Orgmization/individual): =]a DJC VA 14196,/9)//i&S� P84 i Address: 4O Gcc b L t b6 ut City/State/Zip: ),UBLI/A/ J\,,(/7 Phone#: GjOj `/ 7 Are you an employer"Check the appropriate box: Type of project(required): l�m a employer with __,f�employees(full and/or pan-lime).- 7, []New construction ? pppartnership d hlworkingf p anave no employees or me in ❑I am a sole orartn 8. E] Remodeling any capacity.[No workers'compinsurance required.] 9, ❑Demolition 3❑ m I aa homeowner doing all work myself[No workers'comp.insurance required. 40f am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[:] Building addition ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs or additions proprietors with nonemployees. 12.[]Plumbing repairs or additions $❑I am a general contractor and I have hired the sub-contractors listed on the anached sheet. I—I ✓ These sub-contractors have employees and have workers'comp.insurance.: ]3[]Roof re pairs iG tip We are a corporation and its officers have exercised their right of exemption per MGL c 14. er kTAC 152,¢I(4),and we have no employees.[No workers'comp.insurance required.] •Any applicant that checks box 4 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box must anached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they most provide their workers'comppolicy number. 1 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.Lie.#: C W C2 j'a 42 r� I �W 3 y a Expiration Date: Job Site Address: Q 0 "QC)0 J'9 G ST 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 MGL c. 152.§25A is a criminal violation punishable by 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.A copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do hereby cer[i r the pains and penaldesnof ppeerrj�urry that the information provider!above's hue a d correct. at Si nure: FIFT r� 1601 `/l Date: ` Phone#: ` �3 7-ldef 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#: 48 %. DOWNLIGHT FIXTURES n NON-ILLUMINATED LOGO w LED PRICING UNITS ... Regvlortmh 911mer lnduded 97" 16' A. _. ... ® I 0.e vlm 12'-6" e Oie,el EXISTING CONDITIONS REMOVETHISSIGN SHELL SIGN wmwrtrtozw EXISTING CONDITIONS REMOVE THIS SIGN Mi ms& EXISTING BASES SHELL BRANDED PYLON SIGN REVISION NOTES BY C]Rmaxmwmr I ,, DESIGN•MANUFACTURE-INSTALL-SERVICE CLIENT:Baddl Signs 105M17 CFC nhsigns,com• 603.437.12,00 LOCATION:Salem,MA 3 ri 66 Gold Ledge Avenue, Auburn,NH 03032 DATE:OS 10 t7 u FAX 603.131.II32 oEMRRFR:FR ®OE51NIdMIV:® ®�• RCCI.REP.In<r Maul e( pN I !tl mvaerunyrwsomrrr/nn �1 ill J` J4 Nil z • w O - a - O i E i N C co Ma'p 0 6 n Y a• i N wu f N� — i e C e v1 w Z O n I � Z co uJ I 281011 _ 371011 t _ 36^ ^ � f" 36.. y r � i y f' PROPOSED CHANGES •r EXISTING CONDITIONS REVISION NOTES_ BY oMaflwroaumx I �••,• • ,.,,, DESIGN•MANUFACTURE-INSTALL•SERVICE CLIENT;Bdddt — - uovwv •� Signs B5 ,, .f[Uf4,4F nhsigns•eom^ 603.437.7200 LOCATION:Salem,MA i ❑µo,gw., 66 Gold Ledge Avenue, Auburn,NH 03032 DATE:0510 17 3 ❑,,,,,,,,,,-- FAX 603.437.IIII DAESI"M4Nfa:,B ®cevw Da — - — - - -- � - REP:Iver Marl, fl_pUf 1 19 Commonwealth of Massachusetts 1L, i~ City of Salem IF ' .. 120 Washington SL 3rd Floor Salem.MA 01970(978)745-9595x5641 v Return card to Building Division for Certificate of Occupancy P Y Permit B-17-485 PERMIT TO BUILD FEE PAID:: $0$0.00 DATE ISSUED: 6/8/2017 This certifies that N. H. SIGNS has permission to erect, alter, or demolish a building 208 CANAL STREET Map/Lot 330001-0 as follows: Signs SIGN PERMIT AS APPROVED FOR: SHELL GAS STATION Contractor Name: DBA: Contractor License No: 6/812017 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#: "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. City of Salem Sign Permit Application Worksheet _ NAL QEF'-_". 31-May-17 Shell Gas Station 208 Canal Street loll JUN - 1 A '�- 2 b Zoning(res/non-res) I Entrance Corridor(YIN) Y Lot frontage 193 feet ' n Building or tenant frontage 48 feet U I #of businesses on site 1 Biting dist from street center <100 feet Multiplier 1 Building and Blade Signs maximum area permitted 48.00 sq it I total proposed sign area 18.00 sq ft �. Main Surface Sign 0.00 ti Sign length 0.00 inches height 0.00 inches 1 ^ Gas Shell Canopy A 9.00 Sign length 36.00 inches height 36.00 inches Gas Shell Canopy C 9.00 Sign length 36.00 inches height 36.00 inches Freestanding Signs maximum area permitted 32.50 sq ft(per side) maximum#of signs permitted 1 signs maximum height permitted 12.50 ft tall Free Standing Sign proposed sign area 32.33 sq ft length 97.00 inches width 48.00 inches proposed sign height 12.50 ft(approx) Application meets standards set forth In the Salem Sign Ordinance Yes Recommend approval Yes This permit is for two lexan shells on the canopy that are not illuminated,and a new freestanding sign with LED pricing.The upper portion of the freestanding sign will be illuminated wth exterior lights shining down on the shell logo. There are two existing freestanding signs(one does not appear to have been permitted)both of which will be removed.The two surface signs on the building will also be removed. Permit NugR APPLICATION FOR PERMIT TO ERECT A SIGN '' `` NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED AlAY 2 5 2017 'yka Location, Ownership and Detail Must Be Correct, Complete, and Legible D€PT, OF PLANNING & y COMMUNITY DEVELOPMENT Salem, Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to u Erect, u Alter, n Repair a sign on the following described buildings: Street Address Zoning District 18 1 r/ L 51 ❑ Urban Renewal Area aZAmnce Corridor C O� A ❑ Historic District n None L- N a N17-wf~PR1516s Use of Building Telephone 1' floor �gSo[1J6E /�vr�/G ' F�PAT S Ct t z floor Address J C fioli L 5 r" 3` floor Telephone �..�- 4 floor E-mail z A P R l f/C (�IJL C�nit How many businesses are in the building? If a corporate body, name of responsible officer — ' S �G 0303 a Building linear feet Construction Sup's License No 013 Jam^( lV Applicant's Space(if multi-tenant) linear feet Address fMb0D (`-pG Property linear feet Telephone ligo J2T01-I,/0;L C,cj,Q Mail Sign Permit to E-mail n Sign Owner gn Erector o Other: Si n 1 Sign 2 1 Sign 3 n Surface o Surface u Surface n Rig Angle to Building o Right Angle to Building n Right Angle to Building ee Standing n Free Standing u Free Standing n Awning ❑Awning S IP� Pf n Awning 5 r 9` C o Portable(A-Frame) n Portable(A-Frame) n Portable(A-Frame) n Other(specify) �ther(specify) V I) S C N��✓ pd5ther(specify) 0A,5C/�aIP% GrXBJN I- [OA4ivv Sign Materials Sign Materials Sign Materials r'/ Sign Dimensions G 7 ii x v� Sign Dimension b 6 I Sign Dimensions b x �6 g n Sign Area 3 a,, s s F Sign Area Sign Area sn sn en Sign Height(if free standing) /02 i3 ' Sign Height(if free standing) Sign Height(if free standing) Estimated Cost of Net Work $ ) 11 O00 Existing Signs . . Type Sign Area To B Removed? Sign Owner 2.Krface - `/x -7' �/sq ft ;es n no o Right Angle to Building sq it u yes u no p-Free Standing VO sq it 9yes o no Si n Own s Auth ed Re rpe�sentative n Awning sq ft u yes u no I / S n Other(specify) sq ft n yes ❑no ���W ff Property Owner Internal Review Planning&Cbmmunity Development Department Historical Commission Approval 414-N- Building Inspector 00r24110 rev CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT KIME6RLEY DRISCOII. 120 WASHINGION SIREET♦SALEM,MASSACI IL'S=01970 MAYOR TEL:978 619-5685♦FAX:978-740-0404 CITY OF SALEM SIGN PERMIT PROCESS All exterior signs, awnings, and interior signs that can be seen from the exterior are required to have a City of Salem Sign Permit before a sign can be fabricated and installed. Please be aware that in some areas of the city, review by a governing board must take place before a City permit can be issued. These areas include the Urban Renewal Area(governed by the Salem Redevelopment Authority) and Local Historic Districts (governed by the Salem Historic Commission). Please note that it takes roughly three weeks to receive a sign permit and in areas governed by a review board it may take longer. Before any sign application can be reviewed, the following material must be submitted with the application: ■ Scaled Drawing of Sign (including dimensions) ■ Method of Lighting ■ Color Scheme ■ Building Frontage (width of building on public ■ Letter Style (font) way) ■ Letter Size ■ Photograph of Building(current conditions) ■ Method of Attachment ■ Photograph of Building (with proposed signage) The Building Inspector may require additional pertinent information to insure compliance with the City of Salem Sign Ordinance and any other applicable laws. Sign Application Fees There is a twenty-dollar($20) minimum permit fee for each application. If the estimated cost of fabrication and installation is $2,000 or more, a fee of$10 per$1,000 plus a$5 application fee will be charged. For example, a $12,000 sign project would have a $125 fee. Electrical Permit A licensed electrician must install any sign with ancillary lighting and sign boxes must be UL listed. An Electrical Permit must be obtained from the City of Salem Electrical Department, 48 Lafayette Street, and be submitted with the sign application before a sign permit will be issued. Surety Bonds for Signs or Awnings Hung over a Public Way Any sign or awning hung over a public way or sidewalk shall require a surety bond in the sum of one thousand dollars ($1,000.00) conditioned to save harmless the City from any claims. This bond must be placed on file in the City Clerk's office. A copy of such bond must be submitted with the sign application before a sign permit will be issued. Contact your insurance provider to obtain the surety bond. Liability Insurance for Portable (A-Frame) Signs Proof of adequate liability insurance with a minimum limit of$1,000,000.00 for each occurrence must be provided to the City Clerk and remain in effect for as long as the portable sign is used. The portable sign must be indicated as being included in the liability coverage. The City, and in the Urban Renewal Areas, the Salem Redevelopment Authority, must be listed as additional insured(s). A copy of the insurance certificate must be submitted with the sign application before a sign permit will be issued. 08/14/10 rev 20th Real Estate Management, Inc 15376 Kuykendahl Rd.Houston,TX 77090 1832.375.0000 1 badatinc@aol.com ` May 16,2017 To whom it may concern: This letter authorizes Indaba Holdings, dba NH Signs of 66 Gold Ledge Ave., Auburn NH, to act as an authorized agent for Property owner of 208 Canal Street, Salem, MA With respect to the submission of applications for sign permits, Sign waiver requests, variances or other permit related documents to the Town/City of Salem, MA As an authorized agent of the owner, NH Signs is allowed to sign and submit all forms necessary for the aforementioned application. Date: Regards, Signature 208 Canal St -Google Maps 5/22/17, 9:07AM / t 201 Canal St Salem, Massachusetts Nk f, 1 � � �. u �s n Lite Mode ©2017 Google Terms Report a problem https://www.google.com/maps/place/208+Canal+St,+Salem,+MA+0197...R3Xe5rzAw!2eO!4m2!3m1!1 SOX 89e314856df7cb5d:Ozdb9d2454ae497993 Page 1 of 1