26 CONGRESS STREET - SIGN PERMIT _ 26 Congress Street
'The Grapevine Restaurant
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APPLICATION FOR PERMIT TO ERECT A SIGN
sP Salem, Massachusetts 19
PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
APPLICATION MUST BE SUBMITTED TO THE BUILDING INSPECTOR WITH STAMPED APPROVAL
FROM THE SALEM REDEVELOPMENT AUTHORITY.
TO THE BUILDING INSPECTOR:
The undersigned hereby applies for a permit to Erect,
Alter, Repair a sign on the following described
building.
Location O n � I Zoning/District
Name of Property Owner , )Ono L� 'J I- C_lCl)d<Q .
Name of Sign Owner 1�\,grn m/kjo, G1Qf��/ h4 l�p �` Yt1Yt1
Address {0 �Q55SI rr7, (��
If Owner is a corporation, name of responsible Officer;- J S
Name of Licensed Sign Erector_,Q,&_r�(J��
Address Salem License No.
Use of Building: 1st Floor ✓ 3rd Floor
2nd Floor 4th Floor
Type of Sign: Surface Right Angles to Building
A0 rn2
Free Standing Other ( q ) Height:
Sign Materials :
Sign Dimensions : q� q�{p(� Sign AreaYY' SF
Existing Signs : Surface: Sign Area SF
Right Angles : Sign Area SF
Free-Standing: Sign Area SF
Other: Sign Area SF
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Signs to be removed: Type ,, c� SCS Sign Area ,l',�`X IC SF
Frontage: Building FT Property FT
Signature of Owner ( i//� z2a Aaell
Name & Address of Address
Insurance Company:
Telephone 5-0� X45/b0�
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IA 1-7 Iq
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r�'R.IcL III
Estimated Cost of New Work: CO
APPROVALS :
✓* $i vr:
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.(503)233-0190/771 C�r-4 OkLA-JVjl� 7105 ric' Z)zfp HARRIS AWNING CO.•
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the
rapevzne
T'i}" 26 Congress Street
Salem, Massachusetts 01970
(508) 745-9335
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DATE INVOICE AMOUNT 53-179
SQUID INC. 113
dba THE GRAPEVINE RESTAURANT
26 CONGRESS STREET
SALEM, MASSACHUSETTS 01970 No 7 7 6 9
� pp (5088)..7_45-93355PAY
AMOUNT J'C / ,( / ( .f /) l,y1
� i7) DOLLARS
CHECK NO. TOT E ORDER OF DATE S]DESCRIPTION 11 CHECK AMOUNT
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EASTERN BANK—SALEM, MASSACHUSETTS
1'00746911' 1:0 L L30 0981: 09 L69LI 311'
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C E R T I F I C A T E O F I N S U R A N C E _ ISSUE DATE (MM/DD/YYYY): 7/25/1994
(PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO I
IConly Lyman Ins. Agency I RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, 1
1564 Loring Avenue I EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I
ISalem, MA 01970 1 I
(CODE 2028479 SUB-CODE I COMPANIES A F F 0 A D I N 6 C 0 V E R A 6 E I
I I I
IINSURED I COMPANY LETTER A: Comm Union 20-28479 D/B I
ITheMid Inc. dGa I COMPANY LETTER B: I
Grapevine I COMPANY LETTER C: 1
126 Congress St. I COMPANY LETTER D: I
ISalem, MA 01970 1 COMPANY LETTER E: I
I i I
1= COVERAGES — =--- I
I THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISM TO THE INSURED NAMED ABOVE FOR THE POLICY I
I PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT I
I TSUBJECTHTO THIS
ALLLLTHEIFICATE TERMS, EEXXCLUSIONSY BE SS,AANDRMAY CONDITIhONS 6� THE INSURANCE AFFORDED LIM17S 8SHOWNEMAY HAVEPOLICIES
BEEN DESCRIBED
REDUCEDHEREIN
PAID CLAIMS. I
I - I
ICO I TYPE OF INSURANCE I POLICY NUMBER I POLICY IPDLICY EXPIR-I ALL LIMITS IN THOUSANDS I
ILTRI I (EFFECT. DATEI ATION DATE I I
I I I I MM/DD/YYYY I MM/DD/YYYY I I
1-1— I— I I I - 1
I A IGENERAL LIABILITY I NBF950079 1 8/05/1993 1 8/05/1994 IGENERAL AGGREGATE I $ 1,000 1
I I[X]COMMERCIAL GENERAL LIABILITY I ALSO INCLUDES RENEWAL 1 I (PRODUCTS-COMP/OPS I I
I I I POLICY SAME POLICY NUMBER I I I AGGREGATE i f 1,000 1
I I [ ]claims made [Xloccurrence I SAME LIMITS EFFECTIVE I I IPERS. 8 ADVERTISING I I
I 1 1 B-4-94 TO B-4-95. 1 1 1 INJURY I f 1,000 1
I I[ ]OWNERS d CONTRACTORS PROTECTIVE( I 1 I I I
I I I I I (EACH OCCURRENCE I f 1,000 1
I IC ] I 1 IFIRE DAMAGE (ANY ONE I I
I I I I I I FIRE) 1 $ 50 1
1 I[ ] 1 1 1 IMEDICAL EXPENSE (ANY I I
I f I I I OPE PERSON) 1 f 5 1
I (AUTOMOBILE LIABILITY I I I ICWINED SINGLE LIMIT 1 $ 1
1 11 ] ANY AUTO I I ]BODILY INJURY I I
I I[ ] ALL OWNED AUTOS I I I I (PER PERSON) 1 f 1
1 I[ ] SCHEDULED AUTOS I I I IBODILY INJURY I I
1 I[ ] HIRED AUTOS I I I I (PER ACCIDENT) I f 1
1 I[ I NON-OWNED AUTOS I I I I I I
I I[ ] GARAGE LIABILITY I I I IPROPERTY DAMAGE 1 f 1
I I[ ] I I I I I I
I (EXCESS LIABILITY I I I EACH OCCURRENCE AGGREGATE I
I IL ] I I I I I
1 11 1 OTUER THAN UMBRELLA FORM 1 I 1 $ f 1
1-1 - I-- I —I- I I
I I WORKERS' COMPENSATION I I I (STATUTORY I
I I AND I I 1 1 $ (EACH ACCIDENT) I
I I EMPLOYERS' LIABILITY I I 1 1 $ (DISEASE-POLICY LIMIT)(
I I I I I I $ (DISEASE-EACH EMPLOY.)I
1-1-- I--- ----I- --I---I -1
I I OTHER I I I I I
11 I I I I I
I I I I I I I
I I I I I I I
IDESCRIPTIONS OF OPERATIONS/LDCATIONS/VEHICLES/IESTRICTIONS/SPECIAL ITEMS I
I PROVIDES LIABILITY IN CASE OF BODILY INJURY OR PROPERTY DAMAGE IF INSURED'S I
1 AWAMING CAUSES SAME. I
I I
1= CERTIFICATE HOLDER =—=________=_-_= CANCELLATION —=1
I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I
I City of Salem I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL I
I City Hall 1 21 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT I
I Salem, MA 01970 1 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIL- I
I I ITY OF ANY KIND UPON THE COMPANY, La BENTS OR REPRESENTATIVES. I
I�, dt& I RUT ORIZED REPRESENTATIVE I
11
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