87 LAFAYETTE STREET - SIGN PERMIT 87 Lafayette Street
Game Zone
�• ti Permit Number
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.
`: . Application for Permit to Erect a Sign
D 's �PIINE
Salem, Massachusetts A9 XJ 19 Q
TO THE BUILDING INSPECTOR:
The undersigned hereby applies for a permit to Erect,_Alter, _Repair
a sign on the following described building:
Location and No. Q2 4425 e-7 L -!57 Zoning/District
Name of Property Owner 1!�' IRL V .19 TY
ame of Sign Owner
rl2v Address
lvT�v , '
If Owner is a corporate body, name of responsible officer
Name of Licensed Sign Erector Cj��
Address �Z `*" 5�� ��'c +�boc��tmE� Salem License No.
Use of Building: Ist Floor3rd Floor
2nd Floor4th Floor
Type of Sign: _Surface, d(// Right Angles to Building, _Free Standing
_Other (specify) Height:
Sign Materials NNBryr
Sign Dimensions
g 4 Sign Area 1(St SGa,�_ SF
Existing Signs: Surface: Sign Area SF
Right Angles: Sign Area SF
Free Standing: Sign Area SF
Other: Sign Area SF
R
Signs to be Removed: Type Sign Area SF
Frontage: Building a ) ta° b tyu— FT Property FT
`y Signature of Owne
Signature of Owner's Authorized Representative
i r Address
Estimated Cost TelephonepW C
of New Work $x`75
` - Signature of Property Owner
_ APPROVALS:
'i
Sa em PI ing Department Superintendent of Streets Historical Commission
ON REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILOIN G
TRANCE.
;i
o..:............I................ PLAN OF LOT
.r
APPLICATION FOR PERMIT FOR Show Location of Present Structure
ALTERATIONS, REPAIRS AND SHOW SIGN SIZE, COLOR AND LOCATION ON BUILDING;
DEMOLITIONS" and Signs LOCATION OF OTHER SIGNS AND BUILDING ENTRANCE
................................................CLASS BUILDINGSee attached plan.
LOCATION
No.................................................................................
......................................._.............Ward...................... J ;
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PL
JJ Permit Granted T
...................../��. 19 . .
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rent
buy
sell
trade
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ACORD- CERTIFICATE OF LIABILITY INSURANCECSR RE DATE(MMIDD/M
14ASTE-1 09/28/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bernard M Sullivan Ins HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
12 Market St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ipswich MA 01938 COMPANIES AFFORDING COVERAGE
COMPANY
Peine No. 978-356-5511 Fa=No. 978-356-0214 A Seaco Insurance Company
INsum
COMPANY
i
Debbie Crockett dba Game Zone j COMPANY
Debbie Roberts C
P.O. Box 702
Essex MA 01929 COMPANY
D
COVERAGES.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE.MAV ES ISSUED OP.Mid'PERTAIN,TH INSURANCE AFFORDED Bi Ti Z FC-IQE6 u.�CR13EU HERLIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TCO RI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE iPOLICY EXPIRATION LIMITS
I DATE(MMIDD") DATE(MMIOCINY)
GENERAL LIABILITY GENERAL AGGREGATE I S
A X COMMERCIAL GENERAL LIABILITY BOP1405934 04/12/98 04/12/99 PRODUCTS-COMP/OP ADD S
CLAIMS MADE ❑OCCUR PERSONAL B ADV INJURY 5
OWNER'S B CONTRACTOR'S PROT' ISI EACH OCCURRENCE $ 1000080
FIRE DAMAGE(Any we Are) S 50000
MED EXP(Any we person) $ 5000
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT S
ALLOWNEDAUTOS BODILY INJURY
SCHEOULEDAUTOS I (Per person) S
HIREDAUTOS
' BODILY INJURY 5
NON-OWNED AUTOS (Per awdenI)
PROPERTY DAMAGE S
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5
ANY AUTO OTHER THAN AUTO ONLY.
EACH ACCIDENT $
AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM ( AGGREGATE 'i3
OTHER THAN UMBRELLA FORM S
WORKERS COMPENSATION AND - "'C STA IU- OTH
EMPLOYERS'LIABILITY T RV IMIT R
EL EACH ACCIDENT 5
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT S
PARTNERSIEXECUTIVEPI
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $
OTHER
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Video Game Store
CERTIFICATE HOLDER CANCELLATION
SALEMCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
CITY OF SALEM 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
ATTN CITY CLERK'S OFFICE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
1 SALEM GREEN
SALEM MA 01970 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORRE PRESENTATIVE
ACORD 25-S.(1/95) " ACORD CORPORATION 1988