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72 LORING AVENUE - SIGN PERMIT (2) 72 Loring Avenue Tedeschi Food Shops ej 0072 LORING AVENUE 113-08 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS#: 379 Map: 32 Bock: Lot: 0027 SIGN PERMIT Permit: Sign Category: SIGN Permit# 113-08 Project# 75S-200-2008-000122 PERMISSION IS HEREBY GRANTED TO: I $960.00 Contractor: License: Expires ed:$0.00 Sign Design Inc. ue:$.00 Owner: Tedechi Food Shops res Applicant: Sign Design Inc. AT: 0072 LORING AVENUE s ISSUED ON: 01-Aug-2007 AMENDED ON: EXPIRES ON: 01-Dec-2007 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS PER APPROVAL THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. "S. , L Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN REC-2008-000146 01-Aug-07 z 5n uu GeoTMS®2007 Des Lauriers Municipal Solutions,Inc. CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT MEMORANDUM TO: Lynn Duncan,Director FROM: Kirsten Kinzer, CDBG Planner SUBJECT: Sign Application—Tedeschi Food Shops DATE: July 13, 2007 LOCATION: Entrance Corridor ADDRESS: 72 Loring Avenue DATE RECEIVED: 6/4/07 BUILDING FRONTAGE: 89 feet I\L-\XIMUMALLOWED: Building signs: 89 square feet One freestanding sign: 32.5 square feet PROPOSED SIGNAGE: Two 46 '/z inch tall by 66 '/z inch wide signs. One free standing sign mounted on a 120 inch pylon and one mounted on the strorefront. The proposed signs include black lettering and a red logo on a white background. TOTAL AREA OF SIGNS: Building sign: 21.5 square feet Freestanding sign: 21.5 square feet NOTES: The proposed signs replace existing building and freestanding signs and will be mounted in existing hardware. There were several illegal signs located on the property at the time of that the application was submitted, including a temporary sign attached to the freestanding sign and a permanent building sign.The illegal signage was removed by the applicant. RECOMMENDATION: I recommend approval as submitted. Pylon Signage - Face replacements for existing pylon sign Duarift 2 single-sided laces She: Sign Cabinet(existing).46.5'h x 66.5"w(wlih 3/4"molding) Visual Area451h x 65"w�I',,.' 11,alcna wn. xi, !t w.lani eine Material: 3/16"white lexan polycarbonate Graphics: pressure-sensitive vinyl PROPOSED SIGNAGE Tedeschi FOOD SHOPS Tedeschi - FOOD SHOPS s seat.' Neu Chill out i1 120"above grade FePsi 50Cans sign bottom of EXISTING SIGNAGE sign ``. N"w Fi 8 NE ,nom nruxwa¢nx .._g, M' Approval: Client: Sheet 1 of 2 Color Guide Date: 05-14-07 �y TCdeSGhl Few Shops Title: i MS COLORS VINYL MATCH Project Number: 38156 7 ,IT edeschi Location:STORE 452 Corporate identity signage changeover 19ack A6090-0/A80900 Project Developer: E Stevens ��D.wl Description: PMS 185 fled A9340-1 Red Designee CW nanemerxon¢ralutlwa RL FOOD SHOPS 72 UnIng Avenue Face changes on pylon 781.878-6210 170 LBwty street-eiacdon,MA 02301 Building Signage Face repla encs for existing building signs WarNity Ilsingle-sided laces Size: Sign Cabinet(existing):46.51 x 665'w(with 3/4'moltlirg) Visual Ama:451T x 654 uf8I wgt: ;a I nr, nmcales vswl mons Material: 3/16"white leen polycarbonate Graphics: pressure-sensitive vinyl EXISTING STOREFRONT EXISTING SIGNAGE tunrI swr^ EXISTING SIGNAGE i Tedeschi FOOD SHOPS Approvot. Client: Sheet 2 0l 2 1 Color Guide Date: 08-14-06 �Y tetlescni Food Shops PMS COLORS VWYL MATCH Project Number 38156 7 JITedeschi Location:STORE 452 Title: `MS identify sigroge changeover Black A6090 01 A8090 0 Project Developer. E Steven SIGNDE.SN.D4 Salem PMS 185 Ree A934G i Rxe Designer CW FOOD SHOPS 72 Loring Avenue Descrlpdon' Face changes on building signage sign ew pophiOaahNmr 781-8786210 VI 170 Laney Street-BMM*tan.MA 02301 Tedeschi FOOD SHOPS' - Tedeschi Food Shops,Inc. 14 Howard Street, Rockland, Massachusetts 02370 Tel: 781-878-8210 • Fax 781-878-0476 www.tedeschifoodshops.com To Whom It May Concern: I authorize Sign Design, Inc. to act as our agent for the enclosed sign permit application. Business Name: T�-Dj_5Cltl #�oob (5iippS Property Location: -12 Building Owner: Phone: 7 Sincerely, Peter J. Shinney &am 24 5 a servo mark and Teoeson Fnod Snom and Lrl Pea On are reg,stemd SL:;,ce marks nr TeaesrAn Food snom c Permit Number—L/./--61R R y�� 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.D.eW Must be Correct, Complete and Legible. Separate Application Required for Every Sign. RECEIVED E 8 H s Application for Permit to Erecta Sign JUN 0 4 2001 DEPT.OF PLANNING & Salem, Massachusetts COMMUNITY DEVELOPMENT TO THE BUILDING INSPECTOR: The undersigned hereby-applies for a permit to_Erect, V Alter,_Repair a sign on the following described building: Location and No. -i z c K I C f 1 1'-1 t Zoning/District 612 Name of Property OwnerIy% `> ' I I , i.c IJ_ S I 1 i 1)S Name of Sign Owner j DE sCi i 7 cc 1) S ti s 4 Address y i i r i) S TR z T o C✓–L,a p/O� fu fl- If Owner is a corporate body, name of responsible officer ('i:`i < < }1 I ;\i �v4 Name of Licensed Sign Erector E Address I ely t2 L Salem License No. ' Use of Building: Ist Floor " 7 3rd Floor 2nd Floor 4th Floor Type of Sign: —Surface, _ Right Angles to Building., ✓ Free Standing Other (specify) Height: Sign Materials Sign Dimensions LJ Ir � A Sign Area 1 I , SF Existing Signs: Surface: Sign Area Z I SF Right Angles: Sign Area SF Free Standing: Sign Area 2 ' SF Other: Sign Area SF Signs to be Removed: Type > a l i 6 O ' Sign Area SF X ( Frontage: Building 1 FT Property /�-&Z <1, FT Signature of Owner 5 f f A-"(4V- 19 TTF-1- Signature of Owner's Authorized Representative I I ✓I r r ' ) ,i p a 1-r Address ( t U 6rC1�1–V '�T fg'1P 0(;4.717f� Estimated Cost Telephone S D t y 6 0q l of New Work S (� i Signature of Property Owner lVTTA?�IIV 1,s-1l-�. AP ROVALS: S lem Planning epartment Superintendent of Streets Historical Commission ON REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING FNTRANr'F No................................ PLAN OF LOT -APPLICATION FOR PERMIT FOR Show Location of Present Structure SHOW SIGN SIZE, COLOR AND LOCATION ON BUILDING; i ALTERATIONS, REPAIRS AND and Signs LOCATION OF OTHER SIGNS AND BUILDING ENTRANCE DEMOLITIONS- See attached plan. CLASS BUILDING ..........................._ .LOCATION _ • _. No................_.._......_.._..................._.............._. ............_.._.....................».._.._.Ward......_.._.._..._ _. ... go eOwner......... ......_......................_................_. Cwt..........»._.........._.._.._.._.._.. ._._.._......__. !� ._.:1 .... . i •`� CONDMONS ' C. _.__. ... . - - « ..................................-........ _._.._.. - 0 a................................................_....._.._....._.......... ................ .._ ...... »....» .._.-.----- --_L - .. ______ .•-_._. _.� -.. . - ... . _ .. . . _._ _ ..-. Permit Granted »............................ . .................__. 19......... !__! � ............ ' City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please complete thrm and make two copies, Date Received G D, Amount Received Form of Payment ® Check Cash CHECK PAYMENTS: write chedc number �1 �} CASH PAYMENTS: write dient initials Sign Permit Wkatlon Fee Q Conservation Commisabn Fee Payment received for what service? 0 Planning Board Fa 0 Old Town Han Rental Fee 0 Other Name of staff person V receiving payment K1Y3�r,VI 4�1 ZQI� Additional Notes �/��7 Trust 17 7 41 170 LIBERTY ST.,BROCKTON,NIA 02301 ® � ockl �` d i+ ust SIGNDESI9N� PH.508-580-0094 FAX 508-58G-0096 53447/113 •.�,,n and graphic solutions 5/29/2007 B PAY TO THE S ORDER OF Town of Salem ra40.00 Forty and 00/IOOrrrar++rarr+•+rrrarraraarrrrr*wrr+r+rara++aaraarr*aaaarrraarrra+rrrr+r+rrr+rarrrrarrrrrrraraar+rr• DOLLARS r Town of Salem 8 MEMO: Tedeschi Food Shops 1110074Lli' 1:0 1 1 3044 781: 4 640 639114 Original Check and Form: OPCO Finance Copy 1: Glent Copy 2: Application File 72 LORING AVENUE 554-10 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS#: 379 Map: 32 Lot: _ 0027 -- SIGN PERMIT Permit: Sign Category: SIGN Permit# 554-10 PERMISSION IS HEREBY GRANTED TO: Project# JS-2010-000889 Est. Cost. $6,124.00 'Contractor. License: Expires Fee Charged:$0.00 Sign Design Inc. Balance Due:$.00 Owner: JEFFERSON TRUST THE,BERTINI JOHN A,BERTINI FRANK C TRS #of FixturesApplicant: Sign Design Inc. DigSafe# AT. 72 LORING AVENUE !UseGroup ConstClass ISSUED ON: 23-Feb-2010 AMENDED ON: EXPIRES ON. 23-Jul-2010 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR TEDESCHI FOOD SHOPS jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN REC-2010-001034 23-Feb-10 x $0.00 GeoTMS@ 2010 Des Lauriers Municipal Solutions,Inc. City of Salem Sign Permit Application Worksheet 12-Feb-10 Tedeschi Food Shops 72 Loring Avenue Zoning(reslnon-res) B2 Entrance Corridor(Y/N) Y Lot frontage 368 feel Building or tenant frontage 72 feet #of businesses on site 2 Bldng dist from street center 70 feet Multiplier 1 Building and Blade Signs maximum area permitted 72.00 sq It total proposed sign area 52.50 sq ft sign 1 length 180.00 inches height 42.00 inches sign 2 length 0.00 inches height 0.00 inches sign 3 length 0.00 inches height 10.00 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 32.50 sq ft(per side) maximum#of signs permitted 1 signs maximum height permitted 12.50 ft tall sign 1 proposed sign area 21.47 sq ft length 66.50 inches height 46.50 inches proposed sign height 14.00 ft sign 2 proposed sign area 0.00 sq ft length 0.00 inches height 0.00 inches proposed sign height It Application meets guidelines set forth in the Salem Sign Ordinance yes(except height) Recommend approval yes The freestanding sign portion of the proposal is to replace an existing face.The existing freestanding sign exceeds the height recommended for entrance corridors;however, it conforms to the underlying zoning. Permft Number APPLICATION FOR PERMIT TO ERECT A SIGN NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED ONO Location, Ownership and Detail Must Be Correct, Complete, and Legible p� Salem, Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to kErect, o Alter, o Repair a sign on the following described buildings: AddressStreet District ^ -YID �.� ❑ Urban Renewal Area ntrance Corridor pl ❑ Historic District KNone • of Building 1 Teleplpz r7 . f 1 floor • QS , 2" floor AddL S L U/ m 3 floor Telepr7 _ c� /0 4 floor E }7I S How many businesses are in the building? If a corporate body, name 'AFrontage of responsible officer e S h i n n C44k 3 8 a • - - - RL Building Iinear feel Construction Sup's License No Applicant's Space(if multi-tenant) linear feet Address 1 `li�ir Property linear feet Telephone g, 5Mail Sign Permit to E-mail n Sign Owner XSign Erector o Other: Proposed Signs (if more than three signs are proposed, attach additional sheets) Si n 1 Sign 2 Sign 3 o Surface '(Surface u Surface o Right Angle to Building o Right Angle to Building u Right Angle to Building sy.Free Standing — TLIce i'Q.(t�[+CE4n o Free Standing o Free Standing o Awning o Awning ❑Awning o Other(specify) ❑Other(specify) o Other(specify) Sign Materials Sign Materials Sign Materials �I C b [J Sign Dimensions U „ Sign Dimensions „ Sign Dimensions A s ” - KC) Sign Area \a s ft Sign Area 5 15i Sign Area J . s ft sq ft Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Estimated ost of Net Work $ co, to t--1 Existing Signs Type Sign Area To Be Removed? Sign Owner o Surface .3 sq ft o yes kno o Right Angle to Building sq ft o yes o no VLFree Standing sq ft u yes u no Sign O er's Authoriz d Repr nI tive a Awning sq ft o yes n no '1` (1, �� (` (r 1( n _PI C.Y n Other(specify) sq It u yes u no - Property Owner '� reG`GLtn6J exts•t-I�n Internal Review nig &Comhiunity Developr?i-enf Department Historical Commission �/Approval 7Ft4-:; Building Inspector 11rot/OB rev JGN-09-2019 )1 :31 om BERTrHI 97B744193111' � 5051 _ B1 Tedeschi Food snow• Jmlur :,2010 Tavr, • Salem PIeMn .Uopartoleiu l20 NV r.:tinstoa Sneer Salem, A 0147) To W6 t 1t May Coram; I auto s Sign rmokm Iac• to act es 0=egg for she encloxd sign Permit appiitallOn, scab!:. Name: Tedcachi Food Shope 'raper:; 'AMO m: 72 LOft Ave 'Un*ili Ower IOA5,J 6ECfln!/ ledld6 I. Owner Addrm: .2 8p C•+..�•a[ $rgrer, S.u£rr, 'bona: (778 7}� -/q3G i f Mall f T Ak v 11 HOaa j 1te' •::ock'aM MA 07370.TNephane 781.878.8210 -Fix 78:,878,0476 . ... _ wwrr,bdeschi°0odthops.Crx,t )S a fT A,c wprl ri(1Y.':r`I)ppb 91ma+p 11�la.A YV 'NK7necl:mke m)M�M TfhDdi DmA 6+,�.,Fe. Tedeschi Food Slops:#452 Salem-72 Loring Ave Sipe Cabinet Quantity: 1 sugiesided H.A.G.to the top of siert 1'' p Size: 42"x 180" KA.G.to IM bottom of siert 10 6- Material: 1.75"ceder „n G nina mind and g painose filled logo and outlinexte 1 r 16ardrslMrt s�ndard gooseneck lamps(Arm Extension E7 8 Emblem Slade h1710-ManWxWrer.Esselte Corp.) Istaktlorc TBO e, 1, 180" — -- 42 ! Foo ? 1 � Tedesehi en`oodoPe _ -- Tedeschl sh.P. 0 LM L—� Approval: Scale®50% CSerd: Sbe 1 alt COW Guise Date: 01-07-10 �� Tedesch Food Shops . PMS COLORS VNYLMATCH Project Number. 50584 Mp Tedeseh i LoulBrc Lean Face&Sign Box ad CaRbkk Project Developer: E StekarS SIGNpES19NY Salem,AM #452-17 Lodrg Ave. PMS 185 Red Rrlon trans red Oa"r. OL geeerl fore FOO Shops. LVL listed extruded alwTdnum sign cabinet 781$78-8210 �ua.,:.mr:,"..,r.:c.;.am.ainmmosys+aee 170 L1beny Seen-Bmckbn MA O?301 �a axa owov mam ownamn rezaw. Tedeschi Food Shops:#452 Salem-72 Loring Ave Sian Cabinet Size: 42'x 180' lace she: 41.5'x 179.5' �C cut Material: 3/18'lexan face/Ulu extruded aluminum sign cabinet Q, Graphics: Tedeschi logo contour cut virryi-arion Trans red,6Wck Installation: thru bolted with 3/8'threaded rads 318 nuts arid washers-to building fascia 1 1801 _ 1795' F od 42 , 5 ede hops ° Attachment detail -Thm boiled to building Fascla Q Tedeschi Food,. — _--_— Appmrac Scale @ 25% Client Sheet 1 of 2 Color Guide Date: 01-07-10 �M Tedeschi Food Shops Tma: PMS COLORS VMTL MATCH Project Number 50584 �7A` Nu��.,, Tedeseh i taatlon: Lexan Fiedace&Sign Box Black Cal+black Boleti Developer: E S evens SIGNDES�9N� #452-17 Loring Ave. PMS 185 Red Arlon bars red Designer. DL Food Shops. Salem,MA 0&Sc listed n.rmms pm, on m. =e nndry mmmm U/L listed extruded aluminum sign cabinet „a snide m,k ,mo„mmasm,n,M.n,.b, sign are pannicwluBom 781$78$210 usmnoo,.esnm.fmmsmp�ei.admmednr xpe<dX.., 170 Liberty Street-Brockton,MA 02301 m.semer,u,we me,m sm sys,m�semnan. - 1 Tedeschi Food Shops:#452 Salem-72 Loring Ave Face replacement Quantity: 2 single-sided Sim: Existing Sign Cabinet: 465'x 66.5"(with 3/4'molding) tam sin: 46'x 56' Malarial: 3/16'Iman face Graphics: Tedeschl logo contour cut vinyl-adon Trans red Mack PROPOSED SIGNAGE 66.5' 3/4"moulding - Tedeschi Food Shops 11 - Tedeschl v Food Shops', ,/ Out'°' 120"above grade Pepsi 12-Peck pCen> to bottom of Face Size J,OSI BIg0 J'' Grtf- Approval: 5 scale Q 100% Client: Sheet 2 012 Calor Guide Date: 01-07.10 Tedeschl Food Shops Titin: PMS COLORS VINYL MATCH Project Number: 50584 Tedeschi Location: LexanFace Black Ca+back Project Developer: EStevens SIGNDESIgNq Food Shops, Salem,MA Loring Ave. PMS 185 Red Arkin Bans red Designer: DL 0escrlpliDo: won n..+r•a on rnn e�.p x.rrxrh......w w x,Ai,ann AraAll¢SeWIIAIR 3/16'Lexan face '"e iu'Atl nd e. ana a�x io �•ei•.nw 170 Liberty Smin-Brockton,MA 02301 781-676-6210 i>"n,�•°N'„•i'w�,� „a rv9rn++•man Pylon Signage Face replacemetos for easing pylon sign .. Quantity: 2 single sided faces _ She: Sign Cabinet(exkslini 46.5"h x 66.5'w(with 714-molding) I Face Cut Size.TBO Visual Area 45'h x 65"w Id:hee—a.j-: vl ual e'ea) Material: 3716 while Isatin polyrarharate Graphics: pressure-sensilrve vinyl [� l I SIGNAGE Tedeschi - FOOD SHOPS Tedeschi a FOOD SHOPS - . KK�� Out -. t 120"above grade P..". 12-PackC,, to bottom of C ` TING SIGNAGE ` � sign Y a En INE IMYReuIFxnLn lb" 5.. NIFlI elEµa: ::. APwowl. - Client: Street 1 of 2 Color Guide Dale: 05-14-07 jjT Tedeschi Food Shops TNN: P69 5710:85 Vl%y' VA-SH Project Number 38156 a edesehi Locabon:STORE452 Corporate identity Bitx A6gg,-CAy}a0,_0 Project DeveloperESleven SIGNDESI9(� Salem PWr Q Rep ?.93451 Bei Designer: CW FOOD SHOPS 721111Avenue OncripNen: Face changes on pylon „ 781-878-8270 Imt rn,socel arocxmn kN 02301 P1 �1 Official Use Only C��w�'r■�J„-�'S��Ct� Permit No. 165 m oeprtmmt 0 97ft Selpi M Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12,00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 9/23/2009 City or Town of: SALEM To the Inspector of Wires By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Sheet& No) 72 LORING AVENUE Owner or Tenant: TEDESCRI FOOD SHOPS Telephone Owner's Address 16 HOWARD STREET ROC KLAND MA Is this permit in conjunction with a building permit? Yes ❑X No ❑ (Check Appropriate Box) Purpose of Building CONVENIENCE Utillty Authorization No. Existing Service Amps / Volts Overheand ❑ Undgrd ❑ No.of Meters New Service Amps _/- Volts Overheand ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity .. Location and Nature of Proposed Electrical Work: RELOCATE EXISTING 300 AMP PANEL BOARD COMPLETE R&NOVATIONS/COOLERSS/FREEZERS/COPIER/KENO /ATM/ICE CIG MERCBANDISR Completion of the following table may be waived by the Inspector of Wires. No_of Recessed Luminaries 5 No,of Cell-Sus Paddle Fans No.of Total P• (Paddle) Transformers KVA No. Luminarle Outlets No.of Hot Tubs Generators KVA No, of Luminaries 28 Swimming Pool Above grnd El1:1In grnd No.of Emergency Lightning Balte Un'Its No. of Receptacle Outlets is No.of Oil Burners FIRE ALARMS/No.of Zones 4 No. of Switches s No.of Gas Burners No.of Dedication and 4 Initiatin Devices No. of Ranges No. of Air Cond. I Total Tons 5 No.of Alerting Devices 6 No.of Waste Disposers Heal Pump No Tons KW No.of Self-Contained Totals: _ Detectionfglertin Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other No. of Dryers H¢ating Appliances KW Security Systems l.J No.of Devices or E uivalenf No.of Water Heaters 1 KW s No. of Signs No. of Ballasts Data Wiring: 8 No.of Devices or Equivalent No.of Hydromassage Bathtubs No,of Motors Total HP Telecommunications wring y No.of Devices or Equivalent OTHER Attach additional detaus Ir daelied or as,equircd by the Inspector of wigs. Estimated Value of Electrical Work 15,000 (When required bu municipal policy) Work to Start 09-21-09 Inspections to be required in accordance with MEC Rule 10,and upon. Completion INSURANCE COVERAGE: nl Uess waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance Including"completed operation"coverage or Its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECKONE: INSURANCE 0 BONDF-1 OTHER ❑ (SPeclfy): I certify,Under the pains and penalties of perjury,that the Information on this application is true and complete.. LIC NO.: 17117A _ FIRST NAME: GC-DENECO INC LIC NO.: 207-459-9337 Licensee DENNIS HARTIGAN Signature (lf ter"exem applicable,enpt"in the license number line.), BUS.Tel NO: 761-569-7760 Address P o. 1o85 PORTSMOUTH N H 03602-1085 Alt.Tel No: Per M.G.L.c, 147,s, 57-61,security work requires Department of Public Safety-3- License: Li..No: OWNERS INSURANCE WAIVER: I am aware that the Licensee does not have the liability Insurance coverage normall required by law. By my signature below,I hereby waive this roqulrement 1 am the(check one) Owner Owners Agent ❑ Owners Agent Signature Tel No. PERMITFEE:$ 770.00 011 ji ;ell�le I n e � ■ ■ ■pp 1 6 II E oPX�9TIN6-NOT I STOROVATONmmoo I.I al OSTOREFRONT REtYT,ATION hEXISTINb-NOT p eg PART OF WORK REN FIRST FLOOR PLAN ......�. ° ° a4u Fill __________ __ __ ------------------ / W< .........-.,�... —y ■ ■ ■ I I I wow - I / 1 p�]LE T ELEVATION nPROW ELEVATIONI L7= p�p 9 � F / El ® ® «^ ® 0 ® O DOOR ELEVATION FRAME ELEVATION NUNDOW ELEVATION LOCUS PLAN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V�m_ ,,4 600 Washington Street i Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): S ion Address: ( a City/State/Zip: Phone #: --OD9 Are you an employer?Check the appropriate box: Type of project(required): LU U 1 am a employer with y"2O 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.t ❑ g required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.9 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �( Insurance Company Name: (� ro ` n 1 ma n� e Ias tAraii 'e Ca . Policy#or Self-ins.Lic. C Q Q Q- (�7 g Expiration Dated �� 'f ' 10/O Job Site Address: cur t nok Pf V e- City/State/Zip: �Y;�tm ]Y114 Attach a copy of the workers' compensation 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 herebyM the pains and penalties of perjury that the information provided above is true and correct Signat� 1 //11ftJ9Z) - E111A hf5i4lVate• ZI— ZC)ICI Phone#: Off— EM - M99' X ' 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#: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. 0077209-00 WC 009-86-4478 13072 ------------------013-82-1109-00 �• �• • � � PENN Y SIGN DESIGN, INC. 170 LIBERTY STREET BROCKTON, MA 02301-0000 EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE • WC990610 LD# MA UI#: ••a . .ee• TREIBER AGENCY GROUP LLC WORKERS COMPENSATION AND EMPLOYERS 377 OAK STREET CS 601 LIABILITY POLICY INFORMATION PAGE GARDEN CITY, NY 11530-0000 INSURED ISPRE POLICYNUMB R CORPORATION RENEWAL 0044 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 3 POLICY PERIOD 1241 A.M.standard time at the insured's mailing address FROM 11/01/09 TO 11/01/10 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 500.000 each employee C. Other Stales Insurance: Part Three of the policy applies to the states, If any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI JA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SO TN TX UT VA VT WI WV D. This policy Includes these SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Oasaificelions Code Number Remuneration $100 of Re- R'elmunl Annual❑3 Year mune ntlon Annual ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE • WC7754 TAXES/ASSESSMENTS/SURCHARGES $1 ,256 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $338 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $18,074 If indiWed below,interim adjustments of premium shall be made: ❑ Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM 09/22/09 PARSIPPANY 82 rca_ Issue Date IsautnO Offlae Authorized Representative WC 00 00 01 39967(Fiev'0 04L M) Massachusctts- Dc"artmcnt of Puhtic Safety Board of Building Fte,mlatinn.and Standard% construction Supervisor License License: GS 88112 Restricted to: 00 RALPH R FERRIGNO JR 70 HEATHER HILL DR BRIDGEWATER. MA'02324 �y Ezpuation: 8/212010 ( mnni..iuner TrW 1095 City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please complete form and make two copies. Date Received ; u Amount Received Form of Payment Check ❑ Cash Client Information �� S CASH PAYMENTS: client initials ❑ 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: Copies Name of staff person receiving r� titi� payment / Additional Notes LC 1 Il 32727 S"County MASSACHUSETTS z �vinp Bant 170 LIBERTY ST.,BROCKTON,MA 02301 53.7085,2113 I SIGNDESI9Ni PH.50&5B��B'FAX5�5 BBBB 1/20/2010 sign and graphic WOWS 8 PAY TO THE ORDER OF Town of Salem $ Seventy-Five and 00/100 ####*#R**f*fi##if*M*i#iii***fi#i**#iii##fi*####*i##ffit*#tfi* *#!f i*f#fi#iflfiiif* *i#1fi###i*i#QQ R8 e Town of Salem S 3 v W MEMO AUTM ZEO 9IGNANHE `�o 44�M n'032 ? 2 ?11' 1: 21L3 ?08591: 11' 2706888 511' Original Check and Form: DPCD Finance Copy 1: Client Copy 2: Application File