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135 LAFAYETTE STREET - SIGN PERMIT 135 Lafayette Street Jimmy Johns O� N4, Commonwealth of Massachusetts �� City of Salem 120 Washington S1,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for certificate of Occupancy Permit No. 8-15-986 PERMIT TO BUILD =EE PAID: $0.00 DATE ISSUED: 9/21/2015 This certifies that WILLIAM GROGAN has permission to erect, alter, or demolish a building 135 LAFAYETTE STREET Map/Lot: 340307-801 as follows: Signs SIGN PERMIT AS APPROVED FOR: JIMMY JOHN'S (RESTAURANT) Contractor Name: DBA: Contractor License No: 9/21/2015 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 unfit 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 28-Jul-15 IhSPECT1u'AL SERVICES Jimmy John's 135 Lafayette Street 1915 SEP I b P 3t 5 3 Zoning(reslnon-res) B5 Entrance Corridor(YIN) Y Lot frontage n/a feet Building or tenant frontage 42 feet #of businesses on site 2 Or— Multiplier dist from street center <100 feet Multiplier 1 — Building:and tBlade:Si ns; maximum area permitted 42.00 sq ft total proposed sign area 29.26 sq ft I sign 1 F length 158.00 inches height 18.00 inches sign 2 length 37.00 inches height 37.00 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 Freestanding Signs 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 It Application meets standards set forth in the Salem Sign Ordinance Yes Recommend approval Yes Building sign to be halo-lit and blade sign to be non-illuminated. Permit Number �0 APPLICATION FOR PERMIT TO ERECT A SIGN NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED 1 (p Location, Ownership and Detail Must Be Correct, Complete, and Legible d Salem, Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to o Erect, o Alter, c Repair a sign on the following described buildings: AddressStreet ❑Urban Renewal Area ❑Entrance Corridor 7 2 1 3 c Historic District u None • e of Building Telephone 1 floor • 3 4c, 2 floor Address V floor Telephone 4 floor E-mail 19, How many businesses are in the building? If corporate body,name of responsible officer m • Building linear feet ConstrrKGon Sup's7Add No Applicant's Space(if multi-tenant) linear feet ess Property Ilnearfeetne Sv _ J ca >< ^ Mail Sign Permit • E-mail a n c Sign Owner a�gn Erector a Other: Proposed Signs(If more than three signs are proposed attach additional sheets) Sint 1.1 vr/myl J0,10 Sign Surface ❑Surface ❑Surface ❑Right Ang a to Buildi g Er Right Angle to Building o Right Angle to Building ❑Free Standing o Free Standing ❑Free Standing u Awning ❑Awning / ❑Awning o Other(specify) o Other(specify) D�bh(A, a Other(specify) Sn Materials Sign Mater al Sign Materials S' 4u ,c :V., v Sign Dimensionsl I` Sign DinteinsioAls Sign Dimensions l& K lSff Sign Area 26 Sign Area Sign Area ST sq ft , 2 ft i sq ft Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Estimated Cost of Net Work g 3 3 Ray Existing Signs Type Sign Area To Be Removed? Sign Owner o Surface sq It c yes u no o Right Angle to Building sq ft oyes ❑no 2 92 ❑Free Standing sq it c yes o no Sign Owner's Authorized Representative ❑Awning sq ft c yes c no o Other(specify) sq ft u yes u no Property Owner Internal Review 7_;PfaWn"8,Community Development.Department Historical Commission Approval Building or T t�Q�E tls 11N1I08 rev 0.50"(Black Vinyl Outline) 1 f; L�I LJ V L_J LJ V L_.1 L_J O L�I LJ LJ �J 13.5„ i»,ILi 19.7 Sq Ft. Wall Penetration (seal with silicone) I LED (US LED) POWER SUPPLY ADVANCE Conned secondary COLOR WHITE - 60 W POWER SUPPLY J"4 output FACE THICKNESS _1/8" '1 KICKER ANTERIAL ALUMINUM COLOR xnun unERFAC S_ HGT. TO BE DETERMINED Power Supply VINYL PER STYLE SCREWS SIZE #8 X 1/2"PHILLIPS HD. RETURN DEPTH S. __- __ COLOR TO MATCH TRIMCAP COLOR _&ACK PRE-COAT MOUNTING INTERNAL GAUGE .040"X 5.3"COIL EXTERNAL #1D SND @ SILICONE RETAINER SIZE 3/4" — �- __. UL Listed - SWITCH TYPE DISCONNECT/TOG_GLE COLOR BLACK junction box R _ �E TRIM� •2PST P CONNECTMILES PER WITCHLETTER REQUIOCATERED ED RACEWAY. \ - ----- - '2 WEEP NOTES FTiR LETTER PEOUIRfO(S/6'DIP.). BACKS MATERIAL ALUMINUM *ALL ELECTRICAL OUTS LOCATED FOR RACEWAY OR REMOTE APPI-ICATIM. Primary Signor GAUGE .063" •CAULK REQUIRED. Power \ Channel Letter � AY SIZE N/A \y COLOR N/A #IOSTUDS& MOUNTING N/A SILICONE For. T H!fovm°I"nD°IIn°aa,a.nR °„,;,,,. Jimmy John's Gourmet Sandwiches- 1 A „e„� ,ro,,, ,°,,Wion IA, BEI1d5BI1 riro FH.2,7-1177-�� Quantity: One 1 Set of halo lit channel letters. G °°""'R""°'° °"° ° "E°"` FAX:11217-1177-2347 OWIr p.Int.o b n01 A�Ygwn°,°9 rif of In Vinvl Colors: 3630-22 Black OWIr °°" Signs &Graphics, Inc. M1LIeEnA^Y lafNgn. Desgr,e„ KI. 07-29-I5 2901 N.Woodford 6c. OocoCur,IL 62526 R..M�k..w.. SkRI°N NRSALM IIX)a a i JIMMY jOnill ForT 1.4 Ogftl oro NmM W awl q wnlgomiapy Ji John's Gourmet Sandwiches - Salem.MA FX:13',7-1377-Qa4eQuantity: poletl bens p,m,ee for rw M&!rtl,en sten,xd Bendsen uantit :One I Set of halo lit channel letters.Vin I Colors: 3630-22 Black Nu ft i� l 1.ba own ,o FAXr Q97-B70.Qa47 oM1er ror ie it o De uaetl repotluttE,capie0 or o, Signs s Graphics, Inc. Quantity:One I Non-Illuminated Proiecfing sign.Vinyl Colors: 3630-22 Black and 3630-83 Regal Red 3635 M1tlII1eGlnany�a,M1bn. I nterior lwhtin rovided bN others.I °e�nef Kt" 2901 N.Woodford sc. oecocur,iL 92326sw .µ...e...wm.... sxatm Ho$ALMALM I00 BRICK WALL 52" PROJECTION 9.09'H _ T 3/B'lag Botts with anchors 1.21 TDP / W,BOTTOM 36'POWER iv ry WHIPTOCOMEOUT st OF BOTTOM BAR NON-ILLUMINATED 1/4'STEEL MOUNTING PLATE 1T35'H PAINTEDSLACK LIPH FRONTVIEW 6" SIDE VIEW _T (4)mounting 32" points PLATE DETAILS For: 1 m,.,sanfor, Ialu,rr, M m n' Gourmet Sandwiches ,wt o ,PX„« gen WINWemm w rau M Bemsarr Ggrs a.a *0iic PM:217-877-0345 uanti : One 1 Non-Illuminated ro ectin sign Gap a iM it is blbbe Mw woo nbM o F a ”a"' Vinyl Colors: 3630-22 Black and 3630-83 Regal Red SiOns 6 Graphics, Inc. mdmon air lasHron. *Bterior li=hlim rocided bN others** Kl ae- ls-Is a' en 290'1N.WoodfordSt. D•oaCur,IL 1!2620 so...w.... Bsewe HoSAI.M IOC)b YIAA ViewP®int August 6th 2015 SIGN Arlo AWNING City of Salem 35 Lyman Street TnsyectionaCServices Northboro, MA 01532 120 Washington Street, P Fi(bor Salem, Na 01970 508 393-8200 508 393.4244 Fox Re; Jimmy John's, 135 Lafayette Street signs@ViewPointSign.com www.ViewPointSign.com Hello, INTERIOR/EXTERIOR EncCosedplease findan appCicationandassociated SIGNAGE documents Electric for signs at the above location. Architectural Dimensional I have incCudeda check for the fee of s75.00. I have wayRnding provideda self addressedstampedenvelope for the permit Channel Letters once it is issued LED/Neon Electronic Message Centers Digital Graphics 7'he customer wiCCbe submitting for an eCectricatpermit andwit-Cprovide the Surety Bond. AWNINGS Commercial "We appearedbefore the BoardofAypeals for the bCade Boc Canvlas sign and were denied This sign has been re-designed to Retractable comply with the requirements set forth. SIGN SERVICE Thank you very much for your help with thisproject. I Cook forward to hearing from you. ARCHITECTURAL METAL FABRICATION Best Regards, VEHICLE GRAPHICS �Clt!,/l MEMBERS Sandy L"U.pien Massachusetts Sign Association Permit Nanager Rhode Island Sign Association I Viewpoint Sign andAwni'Tl International Sign Assoc align 35 Lyman St Northeast States Sign Association Northboro, Na. 01532 508-393-8200 Norah East Canvas Products Association SandyC@viewpointsign.COm Industrial Fo6rics Association Internacional UL LISTED FABRICATORS J .,' a Wit m! o � R ,I, SPECIFICATIONS DESCRIPTION: Dual PAR20 straight sign light with a"T' mount and 24"stem extension.Suitable for wet/damp/dry location installations. MATERIAL: Standard overall material is 6061 aluminum. HL-757-Machined Aluminum FINISH: AA-Anodized Satin Aluminum AP-Powder Coat Aluminum BK-Powder Coat Black BZ-Powder Coat Bronze WT-Powder Coat White LAMPING: Lamp Type-120V incandescent PAR20 lamp,medium base,5OW max,not included. VOLTAGE: 120-120 VAC. MOUNTING: Fixture is equipped with a 4.75"mounting plate and(2)mounting screws. OPTIONS: Glare shields GL-21 -Angled,aluminum GL-23-Straight,aluminum PAR20 FIXTURE Lenses/Louvers/Color Filters (HL-370) LA-1.20-Hexcell Louver(Black) LA-2.20-Prismatic lens LA-3.20-Linear spread lens LA-4-20-Soft focus lens(diffused) LA-5-20-Moonlight lens LA-6.20-Blue lens See fixture accessories for more Information. SAMPLE ORDER SPECIFICATION: HL-757-AA-120-GL-21-LA-2-20 24 3/4- [629] RATING: Wet/damp/dry location. cow Intertek MADE IN THE USA 0 1/4" [261] 04 3/4" (121) 02 3/4' [69) [169 69] ORDER SPECIFICATION: Fixture FInlsn Camping voltage Optlonslmcess. PROJECT: Q HEVI LITE, INC. 9714 Variel Ave,Chatsworth,CA 91311 APPROVED: Tel.,(818)341-8091 -Fax(818)998-1986 Web Site http://www.hevilite.com NOTE: CATALOG NUMBER: TYPE: HL-757 THE INFORMATION CONTAINED IN THIS DRAWING IS THE SOLE PROPERTY OF HEVI LITE.INC. ANY REPRODUCTION IN PART OR WHOLE WITHOUT THE WRITTEN PERMISSION OF HEVI LITE.INC.IS PROHIBITED. 135 Lafayette LLC 84 State Street, Suite 600 Boston, MA 02109 June 23, 2015 Re: Signage at 135 Lafayette, 135 Lafayette Street, Salem To whom it may concern: This letter serves as an approval to the attached signage provided by Bendsen Signs & Graphics and authorizes View Point Sign and Awning to secure permits to perform sign installations, removals or any sign maintenance necessary at our property located at: Jimmy John's 135 Lafayette Street Salem, MA 01970 Property Owner Name: 135 Lafayette LLC Address: c/o Planning Office for urban Affairs, Inc., 84 State St., Suite 600, Boston MA 02109 Phone: 617 350-8885 Fax: 617 350-8889 Parcel/Tax Folio Number: 34-0307-801 Sincerely, 135 Lafayette LLC By: 135 Lafayette Managing Member LLC By: Planning O�or Urban Affairs, Inc. By. William H. Grogan Chief Operating Officer 8/6,2015 Unofficial Property Record Card Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 34-0307-801 Account Number Prior Parcel ID — Property Owner PEABODY PROPERTIES Property Location 135 LAFAYETTE STREET ATTN : JUSTIN PAQUETTE Property Use Condo Mailing Address 536 GRANITE STREET Most Recent Sale Date 10/19/2012 Legal Reference 31833-154 City BRAINTREE Grantor SALEM LAFAYETTE,DEVELOPMENT LLC Mailing State MA Zip 02184 Sale Price 0 ParcelZoning Land Area 2.603 acres Current Property Assessment Card 1 Value Building Value 5,875,100 Xtra Features 0 Land Value 0 Total Value 5,875,100 Value Building Description Building Style Apt-Garden Foundation Type Concrete Flooring Type Hardwood #of Living Units 51 Frame Type Wood Basement Floor Concrete Year Built 2013 Roof Structure Flat Heating Type Forced H/Air Building Grade Average Roof Cover Membrane Heating Fuel Electric Building Condition Average Siding Brick Veneer Air Conditioning 100% Finished Area (SF)66352 Interior Walls Drywall #of Bsmt Garages 0 Number Rooms 568 #of Bedrooms 134 # of Full Baths 58 #of 3/4 Baths 0 # of 1/2 Baths 5 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 2.603 acres of land mainly classified as Condo with a(n)Apt-Garden style building, built about 2013 , having Brick Veneer exterior and Membrane roof cover, with 51 unit(s), 568 room(s), 134 bedroom(s), 58 bath(s), 5 half bath(s). Property Images IMAGE i11 4J^ Disclaimer: This information is believed to be correct but is subject to change and is not wananteed. http://salem.patriotproperties.com/RecordCard.asp try ��coNniTq„r . CITY OF SALEM MASSACHUSE 5;. BOARD OF APPEAL, 9���MtNSp 120 WASHINGTON STREET♦ SALEb[,MASSACHUSETTS 01970 KIviBERLEYDRISCOLL TELE:978-745-9595 ♦ FAx:978-740-9846 o b1AYOR rr. c July 29, 2015T - F Decision City of Salem Board of Appeals i� 3 N A Petition of JIMbIY JOHN'S, seeking a Variance from the provisions of Sec. 8.2.VEntraYlce Corridor Overlay District Signage of the Salem Zoning Ordinance to allow an internally illuminated blade sign faced with Jimmy John's logo at the property of 135 LAFAYETTE STREET (Map 34 Lot 307)(R3 Zoning District). A public hearing on the above Petition was opened on July 15, 2015 pursuant to M.G.L Ch. 40A, § 11 and closed on this date with the following Salem Board of Appeals members present: Peter A. Copelas (Vice- Chair),Jimmy Tsitsinos, Mike Duffy,Tom Watkins, and James Hacker (alternate)). The Petitioner seeks a Variance requesting relief from Sec. 8.2.6 Entrance Corridor Overlay District Signage of the Salem Zoning Ordinance to allow an internally illuminated blade sign faced with Jimmy John's logo. Statements of fact: 1. Ms. Cronin of Viewpoint Sign &Awning Northborough, MA presented the petition on behalf of the applicant Bendsen Signs &Graphics to secure permits on behalf of Jimmy John's restaurant. 2. In the petition date-stamped June 23,2015, the petitioner requested a Variance from the provisions of Sec. 8.2.6 Entrance Corridor Overlay District Signage to allow an internally illuminated blade sign faced with the Jimmy John's logo. 3. The proposed internally illuminated blade sign is approximately 52" projection, 42" diameter and 6" deep, faced with the Jimmy John's logo to be mounted to the exterior brick wall at 135 Lafayette Street. 4. The Department of Planning and Community Development submitted a letter to the Zoning Board of Appeals requesting the Board to deny the permit for the following reasons: a. The City's Commercial Design Guidelines, state, "Internally lighted signs are not recommended in the Urban Renewal Areas and Entrance Corridors." b. The City is emphatic about not approving internally illuminated signage in Salem's downtown or along entrance corridors and feels that the approval of the proposal will encourage additional similar proposals. c. The location of the proposed sign is at a newly developed building in the Point neighborhood where the City and other partners are improving the area's aesthetics. d. An externally illuminated blade sign is a more appropriate option for this location. e. Other Jimmy John's locations utilize externally illuminated signage. 5. The requested relief,if granted, would allow the Petitioner to allow an internally illuminated blade sign faced with the Jimmy John's logo. City of Salem Board of Appeals July 29, 2015 Project: 135 Lafayette Street-Jimmy John's Pale 2 of 2 ,y 6. At the public hearing no members of the public spoke in favor and one (1) person spoke opposition to, the petition. The Salem Board of Appeals, after careful consideration of the evidence presented at the public hearing, and after thorough review of the petition, including the application narrative and plans, and the Petitioner's presentation and public testimony, makes the following findings that the proposed project does not meet the provisions of the City of Salem Zoning Ordinance: Findings for Variance: 1. The Board found that there are no special conditions and circumstances that especially affect the land, building, or structure involved as it is located in an entrance corridor with other businesses in the district. Further, allowing an internally illuminated sign would set precedent for other surrounding businesses in this district to install internally illuminated signs not in accordance with Commercial Design Guidelines and Sec. 8.2.6 Entrance Corridor Overlay District Signage. 2. Literal enforcement of the provisions of the Ordinance would not create a substantial and unique hardship and allowing an internally illuminated sign as there are many examples of alternative options that are in keeping with the Commercial Design Guidelines and Sec. 8.2.6 Entrance Corridor Overlay District Signage. 3. The desired relief may not be granted without nullifying or substantially derogating from the intent of the district or purpose of the City of Salem Zoning Ordinance. On the basis of the above statements of facts and findings, the Salem Board of Appeals voted none (0) in favor and five (5) opposed (Peter A. Copelas (Vice-Chair),Jimmy Tsitsinos, Mike Duffy,Tom Watkins, and James Hacker (alternate), to grant a Variance requesting relief from Sec. 8.2.6 Entrance Comdor Overlay District Signage of the Salem Zoning Ordinance to allow an internally illuminated blade sign faced with Jimmy John's logo, subject to the following terms, conditions and safeguards: Standard Conditions: 1. The Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. A Certificate of Inspection shall be obtained. 6. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. p The Board denied the request. cc-tJ?/) Rebecca Curran,Chair Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from tbir dedrion, if any, Thal/he made pun'uant to Section 17 of the PlaJrachurettl General Lawr Chapter 40A, and shall be filed within 20 days of fIi'ng of thin derision in the office of the City Clerk. Purruant to the Massachusetts General Laws Chapter 40A; Section 11, the Variance or Special Permitgranted herein shall not take effect until a copy of the decision Gearing the certtykate of the City Clerk bar been filed Wath the Essex South Registry of Deeds. ® Massachusetts - Department of Public Safety Board of Budding Regulations and Standards Cunsrructinn Supen isnr License: CS-076718 DAVID J RANDA 8 Cider Hill Lane S Sherborn NU 01770 n " W ", Expiration Commissioner 03/15/2016 Acorr�a CERTIFICATE OF LIABILITY INSURANCE 9122/"2014 ' �-� �1zz/z01c THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANIEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsanI A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER cElizabeth Bortone NA.NED.YT4:T FM Walby Insurance Agency Inc PMONE (781)326-8383 a�C 411-(731)32S-R337 475 High Street too" .ebortone@wallayinsurance.com P. 0. Box 469 INSURERISI AFFORDING COVERAGE NAIC Y Dedham MA 02026 INSURERA:Travelers Indemnit Co of CT 25682 INSURED INSURERe:Char ter Oak Fire Ins Co 5615 Expansion Opportunities Inc wsuRsAtc:Travelers Pro Cas Co of Amer 5674 DHA ViewFoint SLgn & Awning INSURERO:Travelers Casual & Si Cc 19038 35 Lyman Street INSURER E: Northborough MA CL532 INSURER F: COVERAGES CERTIFICATE NUMBER:2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NANIED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDINO ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CY EXP CTR TYPEOFINSMNCE U POLICY NUMBER MM1DLamFF MM�DIYY'YY LIMITS M7CI-AINIS-MADE LIABILITYEACH OCCURRENCE S 1,000,000 MERCIAL GENERAL LIABILITY PRUISua tancel 5 100,000 A 7X OCCUR 6305509C939 9/14/2014 9/14/2015 MED EXP(Any one person) 55,000 PERSONAL dADV INJURY 5 1,000,000 G ENERAL AGGR EOATE Is 2,000,000 F—1GEN'L AGGREGATE UN07APPLIES PER. PRODUCTS-COMPPOP AGO S 2,000,000 X POLICY Pc' LOG S POMOSILE LIABILITY COMBINO Jn LE UM11 E.=id.nli1 00BANY AUTO BODILY INJURY(Per Person) S ALLG NED AUTOULED AO123T720 9/14/2014 9/14/2015 ( IBODILY INIJURY Px accdxl S HIRED AUTOS X NON.O'ANED PROPERTY DAMAGE S AUTOS Per accident 5 X UMBRELLA LIAS X OCCUR EACH OCCURRENCE 5 5,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE 5 5,000,000 DED X RETENTIONS 10,00 UP7673C707 9/14/2014 9/14/2015 S D WORKERS COMPENSATION X WC STATU- OM- AND EMPLOYERS'LIABILITY YIN AMY PROPRIETOWPARTNERIEXECUTIVE P EACH ACCIDENT S 1 000 000 OFFICER'MEMSER EXCLUOED7 N❑ NIA (Mandatory In NMI -4Aa-98605-14 9/14/2014 /14/2015 EL.DISEASE-EA EMPLOYE S 1 000 000 Car 0ySCReacn0e OFF E.L.DISEASE-PCUOYUMIT S 1 000 000 DESCRIPTION ur OPERATIONS hddw DESCRIPTION OF OPERATIONS r LOCATIONS!VEHICLES (Attach ACORD 101,Additional Ramarka Schedule,Irmdre space brequlred) CERTIFICATE HOLDER CANCELLATION (508)393-4244 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Expansion 0?portunitias, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. DBA Viewoc int Sign & Awning 35 Lyman Street AUTHORIZED REPRESENTATIVE Northboro, MA 01532 Frank Walley III/BETH ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. "Innne - - '— . ..-..,.,. The Commonwealth of Massachusetts Department oflndustrialAccidents Ogee of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Expansion Opportunities dba ViewPoint Sign and Awning Address:35 Lyman Street Suite 1 City/State/Zip:Northborough, MA 01532 Phone #: 508.393.8200 Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with 49 4. ❑ I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.[ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a.new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance far ny employees. Below is the policy and job site information. Insurance Company Name:Travelers Casualty& Surety Co NAIC# 19038 Policy #or Self-ins. Lie. #: UB-4A698605-14 Expiration Date:09-14-2015 Job Site Address: i1 City/State/Zip:, J<�, Attach a copy of the workers' cot nsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: �14114- Phone#: 5083938200 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#: �? MEMO t City of Salem Department of Planning & Community Check/Cash Receipt and TrackingFormp Please co 9 complete form and Date Received make two copies. tH s Amount Received Form of Payment Q Check Client Information ED Money Order CASH PAYMENTS: client initials Sign Permit Application Fee Payment received for what 0 Conservation Commission Fee ❑ Planning Board Fee/ZBA service? ❑ SRA/DRB Fee ❑ Old Town Hall Rental Fee ❑ Other: Name of staff person receiving payment Additional Notes i VIEWPOINT SIGN AND AWNING 35 LYMAN ST. SOVEREIGN BANK NA NORTHBORO, MA 01532 DATE 34570 i 60-7269/2313 AMOUNT Memo: 135 Lafayette St . JimmyJohns $ Aug 6, 2015 34570 *******$75 .00 PAY Seventy-Five and 00/100 Dollars I TO THE ORDER OF: City of Salem - AUI BRED SIGNA1 ME 11■034570r 1: -- - ----- - 2 3 13 7 2 6 91 e: ---- -- _. plllp 76743 572nr — Copy 1: Client COPY 2: Application File RIGHT OF WAY BOND Bond No. 20BSBHH1685 KNOW ALL MEN BY THESE PRESENTS: That, Champagne Mass #1, LLC hereinafter called the Principal,and Hartford Fire Insurance company hereinafter called the Surety,are held and firmly bound unto the City of Salem, MA ,hereinafter called the Obligee, in the sum of One Thousand ($1, 000) Dollars,to the payment of which sum,well and truly to be made,the said Principal and the Surety bind themselves,their successors,heirs and assigns,jointly and severally,firmly by these presents. WHEREAS, Right of Way bond is required of said Principal to guarantee the proper restoration and replacement of street rights-of-way in accordance with the plans and specifications of the Sign or awning hung over a public way or sidewalk and within the time specified for such completion, then this obligation shall be void at the expiration of the maintenance period of one(1)year;otherwise to remain in full force and effect. Signed,sealed and dated this 10th day of September 2015 Champagne Mass #1, LLC Principal D By. Hartford Eire Insurance Company Surety By: 40&&U Amy Jo Miller Attorney-in-Fact OSS10111118% °°°PO FIRE/N �h yc • � s ''•1lonne°°°°° Direct Inquines/Claims to: T POWER OF ATTORNEY One HARTFORD Hartford Plaza Hartford,Connecticut 06155 email:bond.ciaims@thehartford.com call.888-266.3488 1 fax:860-757-6836 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Code: 211-260909 X� Hartford Fire insurance Company,a corporation duly organized under the laws of the State of Connecticut Hartford Casualty Insurance Company,a corporation duly organized under the laws of the State of Indiana Hartford Accident and Indemnity Company,a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois,a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast,a corporation duly organized under the laws of the State of Florida having their home office in Hartford,Connecticut(hereinafter collectively referred to as the"Companies")do hereby make,constitute and appoint Amy.lo Miller of Lake Mary, Florida, its true and lawful Attorney-in-Fact,to sign its name as surety(ies)only as delineated above by®,and to execute,seal and acknowledge the following bond, undertaking,contract or written instrument: Bond No. 20BSEHH1685 Naming Champagne Mass #1, LLC as Principal, and City of Salem, MA as Obligee, in the amount of See Bond Form(s)on behalf of Company In its business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Company on August 1,2009,the Company has caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed,duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Company the Company hereby unambiguously affirms that it Is and will be bound by any mechanically applied signatures applied to this Power of Attorney. PI V.M 4'ttez p MPe 30 ae,.a 6 elf nM� 519 $QIP 9�i 1037 9 f§ t t9t1 M,.k. rm' Jhq-..Cz n bxo[• �-.,.. John Gray,Assistant Secretary M.Ross Fisher, Vice President STATE OF CONNECTICUT) } SS. Hartford COUNTY OF HARTFORD J On this 12th day of July,2012,before me personally came M. Ross Fisher,to me known,who being by me duly sworn,did depose and say:that he resides in the County of Hartford,State of Connecticut;that he is the Vice President of the Companies,the corporations described in and which executed the above instrument;that he knows the seals of the said corporations;that the seals affixed to the said instrument are such corporate seals;that they were so affixed by authority of the Boards of Directors of said corporations and thOx, athe signed his name thereto by like authority. Kathleen T.Maynard CERTIFICATE My Public My Cownission RVims July 31,2016 I,the undersigned,Vice President of the Companies,DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which is still in full force effective as of September 10,2015. Signed and sealed at the City of Hartford. enyh wok � ..r :R:- s rssv4} . •oar ft "vs a r19 '1:6:e•. 2 teT9 Kevin Heckman,,Assistant Vice President ePOA 2014 THE Producer Compensation Notice HARTFORD You can review and obtain information on The Hartford's producer compensation practices at www.thehartford.com or at 1-800-592-5717. HR 00 H093 00 0207 ©2007, The Hartford Page 1 of 1