247 JEFFERSON AVENUE - SIGN PERMIT 247 Jefferson Ave
Family Convenience Store
Commonwealth of Massachusetts :L\
`vl �a Citv of Salem
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R 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Permit 8-15-148 PERMIT T O BUILD
FEE PAID:: $0$0.00
DATE ISSUED: 3/3/2015
This certifies that TWO FORTY SEVEN JEFFERSON TR DEORIO CRAIG M TR
has permission to erect, alter, or demolish a building 247 JEFFERSON AVENUE Map/Lot: 240164-0
as follows: Signs SIGN PERMIT AS APPROVED FOR FAMILY CONVENIENCE STORE
Contractor Name:
DBA:
Contractor License No:
313/2015
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#: 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
RECEIVED
INSPECTIONAL SERVICES
25-Feb-15
Family Convenience Store
247 Jefferson Ave. 9I5 FEB 2b P 2: 15
Zoning(res/non-res) 131
Entrance Corridor(YIN) N
p� Lot frontage 36 feet
Building frontage(total-2 Streets) 83 feet
---� #of businesses on site 1
Bldng dist from street center 29
` I Multiplier 2
U ;
maximum area permitted 166.00 sq ft
total proposed sign area 90.67 sq ft
sign 1
One side of awning length 288.00 inches
height 34.00 inches
sign 2
Second side of awning length 96.00 inches
height 34.00 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
height 0.00 inches
FreestandingSi
maximum area permitted sq ft(per side)
maximum#of signs permitted signs
maximum height permitted 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(approx)
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets standards set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
Reason for approval:Applicant originally erected this awning without
seeking or receiving a sign permit. Applicant has since submitted the
enclosed application for an internally illuminated vinyl awning system,
which meets standards set for in City's sign ordinance.
� CITY OF SALEM
DEPARTMENT OF PLANNING AND COMMUNITY DEVELAPMENT
KHvmERIEVDRiscou. 120wASHINGTONSTREET♦ SAtEm.MA.ssncHusETrs01970
MAYOR TEu 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$125 fee.
Electrical Permit
A licensed electrician must install any sign with ancillary lighting and sign boxes must be UL listed.An Electrical
Permit must be obtained from the City of Salem Electrical Department,48 Lafayette Street, and be submitted with
the sign application before a sign permit will be issued.
L
ty Bonds for Signs or Awnings Hung over a Public Way
sign or awning hung over a public way or sidewalk shall require a surety bond in the sum of one thousand
s($ 000nm conditioned to save harmless the City from any claims.This bond must be placecdon file in the
Clerk's office. A copy of such bond must be submitted with the sign application before a sign permit will bd. 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
OM4110.
Permit Number
• APPLICATION FOR PERMIT TO ERECT A SIGN
I . NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
W, Location, Ownership and Detail Must Be Correct, Complete, and Legible
a
Salem,Massachusetts
To the Building Inspector: Date
The undersigned hereby applies for a permit to Erect, ❑Alter, o Repair a sign on the following described buildings:
Street Address Zoning District
Zy } Rr rJ/ ❑ Urban Renewal Area ❑Entrance Corridor
i�Ne o Historic District a'None
' .2N9Use of Building
Telephone I CItAtG l7eOK�� 13 floor 6ojW,jeA _ S7V�
• /ylOfffJln//1EIJ j 1 2 floor
Address 12#7 -j/1 /YI 3m floor
Telephone p/ O 4m floor
E-mail /IJRI 3 Aye QV 'V'6 JGZO IT How many businesses are in the building?
If a corporate body,name Frontage
of resonsible officer
Building 3zon�afieriwv anuwE.,,linearfeet
truction
ConsSup's License No Applicant's Space(if multi-tenant) linear feet
Address Property 3to linear feet
Telephone Mail Sign Permit to
E-mail Sign Owner o Sign Erector o Other:
11"Si•n 1 Sign 2 1 Sign 3
o Surface u Surface ❑Surface
❑Right Angle to Building ❑ Right Angle to Building u Right Angle to Building
❑ Free Standing o Free Standing o Free Standing
e'Awning ❑Awning o Awning
o Portable(A-Frame) o Portable(A-Frame) u Portable(A-Frame)
❑Other(specify) ❑Other(specify) o Other(specify)
S Meter'
als ((o Z- R CS fE C Sign Materials Sign Materials
/Z k4 fric
Sign DITensions U5p, g ycic(1•-Lite Sign Dimensions Sign Dimensions
FajVY,IC850.TtAbr nj oy�e
Sign Area v-[tyl i zign Area Sign Area
sq it sq it s ft
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
S 3 7SO
Existing Signs
Type Sign Area To Be Removed? Sign Owner
o Surface sq it ❑yes u no ,,
o Right Angle to Building sq it o yes o no 4V4MO-4�2A
❑ Free Standing sq it ❑yes a no Sign Owner's Authorized Representative
❑Awning sq It o yes u no
o Other(specify) sq it ❑yes o no
X Pro�rty Owner
InternglReview
nin Community Development Department Historical Commission
App oval
v
Building Inspector
ovzaio�.
34 inchs —•—. �_
7
24_'feets '-
2'feets
9'feets
.,%METHOD OF ATTACHMENT _.-
16 Z-BRACKE & METAL EXPANTION
SCREW 1i2 X 4"INCHS
USE ERADI-LITE FABRIC & SQ. TUBING
ONE INCH GALVANIZED
FAMIL
COY11TVETIENCE ST ORE
SIGNS & AWNINGS
781-244.2039 857-249.0822
271 western mv.Iynn,ms.01904
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6 Effective Date: January 26th, 2015 s
F Western Surety Company
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LICENSE AND PERMIT BOND
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KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 62278636
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` Thatwe,Mohammed Ali dba Family Convenience Store
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of Salem _ State of Massachusetts as Principal, ;
and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of °
Massachusetts , as Surety, are held and firmly bound unto the
City of Salem , State of Massachusetts , as Obligee, in the penal
sumof One Thousand and 00/100 DOLLARS(S1,000.00 ),
lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made,
we bind ourselves and our legal representatives,firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been
licensed Over Hanging Sign City of Salem
by the Obligee.
NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply
with the laws and ordinances, including all amendments thereto, pertaining to the license or permit
applied for, then this obligation to be void, otherwise to remain in full force and effect until
January 26th 2016 , unless renewed by Continuation Certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class
U.S. Mail,to the Obligee and to the Principal at the address last known to the Surety, and at the expiration
4H
of thi I ffir ays from the mailing of said notice, this bond shall ipso facto terminate and the Surety
shal�yleup 1lieved from any liability for any acts or omissions of the Principal subsequent to said
da€ ; 9'-;,41he number of years this bond shall continue in force, the number of claims made
a; s bo ;athe number of premiums which shall be payable or paid, the Surety's total limit of
lia sha1 not
e emulative from year to year or period to period, and in no event shall the Surety's total
liellfttynb VkaAj xceed the amount set forth above. Any revision of the bond amount shall not be
cuul°a�'tiVe:
°
Date 26th 26th day of January 2015 F
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F Family Convenience Store
Principal
Aft
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WESTE SURET COMPANY
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Paul T.Bruflat,Stnior Vice President
i Form 532-12-2011
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ACKNOWLEDGMENT OF SURETY
STATE OF SOUTH DAKOTA 1 (Corporate Officer)
COUNTY OF MINNEHAHA I
On this 26th day of January 2015 ,before me,the undersigned officer,
personally appeared Paul T. Bruflat ,who acknowledged himself to be the aforesaid
officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer,being authorized so to do,executed
the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such
officer.
IN WITNESS WHEREOF,I have hereunto set my hand and official seal.
iaaaa,hy55s5Fw5wes5a5ahy5 i
J S. PETRIK
NOTARY PUBLIC a Public—South Dakota
i SEAL SOUTH DAKOTA SEAL ry
My Commission Expires August 11, 2016 ACKNOWLEDGMENT OF PRINCIPAL
o (Individual or Partners)
STATE OF ss
COUNTY OFA
On t] d `�dJ-�!^-L �'^ (�,before me personally appeared
I�LI.c�
known tome to be the individual_ described in and who executed the foregoing instrument and acknowledged to me
that—he— executed the same.
My co as n expires, rti
4a Notary Public
NIIIIIIINIpIti�
ACKNOWLEDGMENT OF PRINC
(Corporate Officer) : j+4pMM•'E#,, 'OQ'+yy
STATE OF as `(y}'a t✓!. 3
COUNTY OF 2 S 01
On this day of ,before n3k soon eredf �$
_ S
who acknowledged himself/hereelf to be the -
of ,a corporation'a '• `�:
such officer being authorized so to do, executed the foregoing instrument for the purposes therein con
the name of the corporation by himself/herselfas such officer.
My commission expires
Notary Public
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Western Surety Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey,
New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America,does hereby make,constitute and appoint
Paul T. Bruflat Of Sioux Falls
State of South Dakota , its regularly elected vice President
as Attomey-in-Fact,with full power and authortty hereby conferred upon him to sign,execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed,the following bond:
One Over Hanging Sian City of Salem
bond with bond number 62278636
for Mohammed Ali dba Family Convenience Store
as Principal in the penalty amount not to exceed: $ 1,000.00
Western Surety Company further certifies that the following is a We and exact copy of Section 7 of the by-laws of Western Surety Company
duly adopted and now in force,to-wit:
Section 7. All bonds, polices, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate
name of the Company by the President,Secretary,any Assistant Secretary,Treasurer,or any Vice President, or by such other officers as the
Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attomeys-in-Fact or agents who shall have authority to issue bonds, policies.or undertakings in the name of the Company. The corporate seal is
not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The,signature of any
such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
vice President with the corporate seal affixed this 26th day of January
2015
ATTEST WESTE N URET COMPANY
By r.-�
' L.Nelson,Assistant Secretary Paul T ruflat,Vice President
.aa::Maifdi-lar,
STATE OF SOUTH DAKOTAss
COUNTY OF MINNEHAHA .t�¢trLL..yes'�'t
On this 26th day of January 2015 ,before me,a Notary Public,personally appeared
Paul T. Bruflat and L. Nelson
who, being by me duly swom,acknowledged that they signed the above Power of Attorney as vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
}SSShSSSSSSSSNSSSSSSSSs\S}
f S. PETRIK
i SEAL NOTARY PUBLIC(SEALIX
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DAKOTA�ys
My Commission Expires August 11,2016 Notary Public
Form F1975-1-2012 a
3, t
City of Salem Department of Plannin
Check/Cash Receipt A & Community Development
pt and Tracking Form
Please complete form and make two copies.
Date Received 2 5 I�
Amount Received
Form of Payment
Check
Client Information _ ❑ Money Order
CASH PAYMENTS: MOI Ue�R�9Ce �SJzn
client initials 2 3p
Sign Permit Application Fee
❑ Conservation Commission Fee
Payment received for what
❑ Planning Board Fee/ ZBA
service?
❑ SRA/DRB Fee
❑ Old Town Hall Rental Fee
❑ Other:
Name of staff person receiving
payment sG�,6,4 --
Additional Notes
FAMILY CONVENIENCE STORE 53-179/113
247 JEFFERSON AVENUE 1011
SALEM, MA 01970
((66117)6455-57995 G DATE U _d 135-1157
Pt
ORDER OF E %J '57T J/�/��yl
I $ 2sj:v �
DOILARS 8
OEastern Banl( «�
LL FOR i ll rG
AUTHORIZED:.., AT.1,
118001011110 1:0ii30i7981: 60 102341911'
Original Check and Form: ()PCD Finance
Copy 1: Client
COPY 2: Application File