5 GEDNEY STREET - SIGN PERMIT 5 Gegney Street
Dekes
Permit Number
yam
♦ PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
APPLICATION MUST BE SUBMITTED IN DUPLICATE, ONE SET TO BE FILED WITH THE PLANNING
DEPARTMENT, AND ONE SET(BEARING THE APPROVAL OF THE PLANNING DEPARTMENT)TO BE
FILED WITH THE BUILDING INSPECTOR.
• location, Ownership and Detail Must be Correct, Complete and Legible. Separate
Application Required for Every Sign.
3 s e Application for Permit to Erect a Sign
Salem, Massachusetts 19
dTO THE BUILDING INSPECTOR:
The undersigned hereby applies for a permit to_Erect, _Alter, _Repair
a sign on the following described building:
ocation and No. ��r���EXT Zoning/District
Name of Property Owner_ T(�MI Q� I VA
ame of Sign Owner I'CsI iA M L+'r06 Cn-EOE&E E IE C OFF
Address r) &L�mry <�Tkr�T SAiem Ml#� c)ig76
If Owner is a corporate body, name of responsible officer 7q!'a
Name of Licensed Sign Erector Mali I>_) 0-og aj
Address `75 � /Ulw, 5+leaeT Salem License No.
Use of Building: Ist Floor X 3rd Floor
2nd Floor 4th Floor
Type of Sign: _Surface, X Right Angles to Building, _Free Standing
_Other (specify) Height:
Sign Materials W6M
q
Sign Dimensions 3 /?C 4 / A 3��f Sign Area SF
Existing Sigrys' Surface: Sign Area SF
\� Right Angles: Sign Area SF
\ O Free Standing: Sign Area SF
Other: ��}}/ Sign Area SF
Signs to be Removed:0'Type Sign Area SF
Frontage: Building FT Property FT
Signature of Owner
NSignature of Owner's Authorized Representative
.SU/eta bo"I (0,600) -_
Address
Estimated Cost Telephone
of New Work $
Signature of Property Owner ls,-,�, �
APPROVALS:
SalemtPnng Departme Superintendent of Streets Historical Commission
ON REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING
ENTRANCE.
- 1??8 5:07PrF.L S.H. Sh1ITH IN5LJRRNCE 556 4114 OCt . 7 . 98 14 :4N0.5�9 4 R.4X4 Y
_ .. . _ -' ----• ------- ------^ ------
Oaf. 1. 7959" 3:43PM S.H. SMITH INSURRNCE 556 4114 No.ee
6.H. Smith Inwrstmce Agency of Masxwhagetfi, Inc
RQI%0N M'l 01110 Pis: 61
n c
QFLuse RIND gofWIVE
Attn! �af�r Clrcls Deelrad Premium pptlantel de ew.
From: Tony No our ojWc(6jge 14 bound until oort►irmed by
Roy DET�6
We can o ftr a L14uor Llebillry Policy In United Steal L14bAit D%uratste Ca,
based ontel Orost Liquor Iteoeipt�s of $90,000 tl7 indloved below;
QT . 71.1 CA%W40Qx\Y4 i CoDul 06610
' RAT PER$100 OF GROSS LIQUOR RECEIPTS.
MMMMUM AND DEPOSIT C4\1F� (-M{ Tr,/N CWEPt'�C1e
ml-1 Club
Litnite R u 0"Frandum
SO/30 1, 4 sl,m1 /�✓jUl[�i,21��
GOYEftABE LUNDITIONS ��� !�n ey $ATIQAT
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111j0 ftVl:eof ii N ri, anr,rs
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6)it iL{�bili�ate FoaA syre x 1 �5 Peamttadte u'oA xc7¢S7pn O Ohs swity 771/1lledprR irf
L-345 Pppm! N0
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d ty]n/tiAt:d�IQelAt�tytl
HIM, endtnant❑f � r1447 Yexr 000 Com ybltttt�cc I�,4
A10puu 'on
73 vz-p-
MUST HAVE D CUMEN'TATION THAT IMS OF ALCOHOIr3ERVIAP0 EMPLOYMS
LEASE CERTIFIED
IN
NBnY MPLET9D&SIONED WARRANTY APP, (LI A, [1/971),
'"4/ri� Thlo quotation Covertalose pants and limits Indio etsd end
4y net be those requested, Plsets r4vI4w w6fully,
The 7til
Companies RetedA++ (SUPERIoPj by A.M. Rev
------------------------------------------------------
J G OE 'T. 7. 1 5 05PMTEL S.H. SMITH' INSURANCE 556 41114 Oct . 7 .99 14 :3N0.5592 P ,2i4 I -----
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Si'r'. it+. 1332- 14!'1 i 1'.,H. •177H IhP?JJRAMCC SSE 4114 N0.236 P.14 I
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S .1-3. SmWi & Company, Inc. �
is broad strecl I Telephone: (617)6664100 l
2nd doer I (600)786.7026
6otlan, MA 0211 a,' Fa%. (817►566-4114
,,np. x"ear 4, 1996 �Oi���{�� N cclq z�
To: Peter -A•J. Georgb
RAE; IJakes
I
We are plea;pd to provide you with the following premium Indication. leaso review this arefWlly ss ft I
may very from what you had requestod. Not all of the terms and wnditions of the policy are Peted.
Formal quotatlons und/or sample policies are available upon requRst,
In order (e bind covernge we must raeelve a written confirmation prior to the effective date.
Carrier(a) Northland ins, Cu. i
seCTlom 1 Perils tlaslo Co-ins; 80% Valuation: ACV Deducttibie: $500
s I
o r` v7`i $S.00Q
Gane Apgreoale„ ,,,,,,,,,,,,,,,,,,,,,, $500,000
M.
Ect10Np Umlts fAI
D Prod/Camp OPs Aggregate............ ...„ ,, $50q,000
S, tar, rl PeraanalI Advertising Injury.................. $500,000 I
,�- Eacb 0ocurrence.. $500,000 I
Fire Legal(Any Ona Fire)...................... $50,000
Mcdloal Expenses (Any One Person)..,., $5,000
Dad UC'0010: $500 �I 8 PO Per Claim- including Chim Adjustment M"nse,
Llablllty Exclusions:
Total Pollution, Asbcetos-Sill”Dust, I.nad Con'.eminatwn, Punitive/[xemplary Damages, Nuclear,
Volurltery Labor, Employment Related Praotloes,Assault&Battery,
Condlttone: G
�c ..,,r". 'i lSt,lt pf�jr�mlrauon enavrsemcnc I
�S_Lontroctue a i ,
L Daoignatnd Pre Isos Endorsement l
6uloj4ct to: l
—X_ Blpncd Appl(ratlon
X Blgnsd Aftldavit l
..XL Minimum Earned Premium 26% i
X 5ntiefactoryInap,action Mew
Pre;rnivm: 3950.00 Surplus Lines Tex: 8$9.00 Inspention Fee: $80.00
Thi: IndlcaGon is valid for 30 days. Nclthar the company nor the Insured are pound for cpvaTego,
UJc epprcclate thr, opportunity to walk on this aocount Should you have any qu"*ni or Would lkbe n i IR�2
01tenutive quote, PI ase let us know. We arc always happy to assist you,
Thank you, I I
Tony con6lanio
_ RECEIVED TIMEOCT,- 7, 3_62PM'°_ )` "�4"PRINT TIMEOCT_ 7, 3;66PM T
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