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0185-189 ESSEX STREET 911-2004
COMMONWEALTH OF MASSACHUSETTS
_ CITY OF SALEM
GIS#: 1080 �I
;Map: 135
Block: - - - SIGN PERMIT
Lot: 10233
Permit: Sign
Category_ GSI N
Permit# 911-2004 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2004-1309
Bst.Cost: $0.00 Contractor: License:
!Fee: $20.00 _Concept Signs
#of Fixtures:i Owner: ROMAR REALTY TRUST
Applicant: PAMPLEMOUSSE INC.
AT: 0185-189 ESSEX STREET
ISSUED ON: 27-Apr-2004 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK-
911-2004
ORK:91I-2004 SIGN PERMIT T1S
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS.
Snature: -4"�44T_
Fee"rvpe: Receipt No: Date Paid: Check No: Amount-.
SIGN PEC-2004-001393 27-Apr-04 1505 $20.00
GeoTMS®2004 Des Lauriers Municipal Solutions.Inc.
CITY OF SALEM
DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT
MEMORANDUM
TO: Denise McClure, Deputy Director
FROM: Frank Taormina, Planner
SUBJECT: Sign Application — Pamplemousse
DATE: April 8, 2004
Location: Urban Renewal Area
Address: 185 Essex Street
Date Received: 3/25/04
Building Frontage: 48 linear ft on Essex St. and 42 linear ft on Central St.
Maximum allowed: 48 sq ft on Essex St. and 42 linear ft on Central St.
Proposed Signage: The proposal includes the change in location of the existing 37" x
38" hanging wood carved sign from 99 Washington St.to 185 Essex
St.over the existing doorway in the rounded corner of the building at
the intersection of Central and Essex Streets.
Total Area of Sign: 9.7 sq ft
DRB Approval: 3/24/04
SRA Approval: 4/7/04
Recommendation: This application has been approved by the Design Review Board and
approved with the DRB recommendations by the SRA. I recommend
approval as approved by the SRA.
Please let me know if you would like more information regarding this topic.
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,Dstail Must be Correct, Complete and Legible. Separate
Application Required for Every Sign.
� ff
gApplication for Permit to Erect a Sign it+ ���VL�u
Salem, Massachusetts til_ h�iT>
DEPT.PFX
TO THE BUILDING INSPECTOR:
The undersigned hereby-applies for a pennit to ✓ Erect,_Alter,_Repair
a sign on the following described building:
Location and No. 1 �4`Y I Zoning/District
Name of Property Owner
Name of Sign Owner���( � Lh
Address
If Owner is a corporate body, name of responsible officers
Name of Licensed Sign Erector
Address��(�» %�� Salem License No.
Use of Building: Ist Floor 3rd Floor
2nd Floor 4th Floor
Type of Sign: _Surface, _ Right Angles to Building, —Free Standing
Other (specify) Height:
Sign Materials
Sign Dimensions
Sign Area SF
Sign Area SF
Existing Signs: Surface: g SF
Right Mgles: Sign Area
Free Standing: Sign Area SF
Other: Sign Area SF
Signs to be Removed: Type Sign Area SF
Frontage: Building FT Property FT
Signature of Owner_ ��tiLly 1 �4 GI —
Signature of Owner's Authorized Representative
Address ( r�r (bi l r44 V 5k
Estimated Cost Telephone
of New Work5
Signature of Property Owner
AP ROV 'S
Salem Inning Department Superintendent of Streets Historical Commission
ON REVERSE SIDE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND BUILDING
FNTRA N(-F:
No....- - PL OF LOT
A' ICATION FOR PERMIT FOR Show Location of Present Structure SHOW S SIZE, COLOR AND LOCATION *BUILDING;
E ALTERATIONS, REPAIRS AND and Signs LOCAT I OH OF OTHER SIGNS AND BUILDING ENTRANCE
DEMOLITIONS
See attached plan.
...._.__CLASS BUILDING
......................._.».._. ;
L LOCATION �.......
Nd.........
,
CONDITIONS ------- --._:
I Permit Granted
FROM MYER DANA PND SONS PHONE NO. : 6179280034 Mar. 12 2004 09:53AM P1
PERM" Cdr(-`Fj,B-�'�3'.I' P*rmnNumbe�.
� {T'-�-��MUST BE OBTAINED BEFORE BEGINNING FORK
L�T?pN MUS' BE SUSMTfTED IN DUPLICATE,ONE 59T TO BE FILED Wry"THE PthNNINC
DEPARTMENT.AND ONE W(BEARING THE APPROVAL OF THE PLANNING DEPARTMENT)TO BE
FILED VV"THE bVILDING INSFECTOR.
London. t P g Must be Comet Complete and Legible. SeCarate
Applkmdan Required iter Every 54VL
A-piicxtion for permit to Erect a Sign
saaern,nnusrchuseass,,,�._..,- ---
To THE BUILDING INgP*CrM
• (ora pen tit Akwr_Repair
The undarsignad h�Y buliPOM
I a sign on the fiollVMn6
Locarlon and No
' Name of Pmnperty Ownw 5 lj'
Nun*of Sign Owner _
Addrtirs �� {
If owner is a comorae body,nalm of re PwAblle 00kw
Name of Licensed Sign Elatdux� � lv�C —""�
Salam Ucenw Wo.
Addms`
3rd Flaw
Use of 9ullding: �Floor qth FIW
Type of Sign-. SWJ l*M&to Build4tg, *SiwidB'i
�Othw owacify) Height
Sign Mawlals SF
m*
sign DiWOns Sign Arae
SP
Sign Mss .
S SF
Exlsdr�Sfitm Right M5Sian Ara5F
Frau Sundlnlp, Sign Area SF
Other. Sign Area
5F
Sip Ata
S b*RMnoved TM_�—•—- FT
Building ,.. _--� P"opasty
FrorRa� --� f
5lg&Um of ownces Audhod2ed ROMWUd ve
�. AddMU
7Esu bad
t tYaw work
City of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form
Please complete form and make two copies.
Date Received p
Amount Received
Form of Payment Check Cash
CHECK PAYMENTS:
write check number
CASH PAYMENTS:
write client initials
EZ/Sign Permit Application Fee
Conservation Commission Fee
Payment received for
Planning Board Fee
what service?
Old Town Hall Rental Fee
Other
Name of staff person
receiving payment
Additional Notes
i
1505
PAMPLEMOUSSE, INC. 10J2o1770,
I 55 WASHINGTON STREET
SALEM, MA 01570 u4'I'I-
$
)HUEREI'' li - -
--_ DOLLARS
308
Eastern Bank
.+b.EM UNwaamoanx.com ' n
x:01130 L ? 9131: 06 00 26177011' 1505
Original Check and Form: DPCD Finance
Copy 1: Client
Copy 2: Application File
Salem
® Redevelopment
Authority
DESIGN REVIEW BOARD RECOMMENDATION
Pamplemousse (185 Essex Street) — Proposed signage
PROPOSAL:
The proposal includes the change in location of signage from 99 Washington Street
to 185 Essex Street. The proposed location is over the existing doorway in the
rounded comer of the building at the intersection of Central and Essex Streets.
RECOMMENDATION.-
At
ECOMMENDATION:At their meeting on March 24, 2004, the DRB recommended approval of the sign
location as submitted.
120 Washington Street • Salem, Massachusetts 01970 • (978) 745-9595, Ext 311 • Fax (978) 740-0404
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DESIGN REVIEW BOARD PROPOSAL
Pamplemousse (185 Essex Street) — Proposed signage
PROPOSAL:
The proposal includes the installation of one 38" x 37" hanging sign along Essex
Street. It will be exactly the same sign that was previously approved by the DRB, in
the new location along Essex Street.
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HOME • KITCHEN • BATH
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135 ESSEX STREET 288-12
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIS #: 111150
Map: 3 i
BloLot: 0233 SIGN PERMIT
Lor.
Pennir Sign - - -
I
Category: A-FRAME SIGN
.Permit# 288-12 PERMISSION IS HEREBY GRANTED TO:
Project # IJS-2012-000817
Est. Corr. I$iU.UO Contractor: License: Expires:
Fee Charged: $0.00 BUSINESS OWNER
Balance Due:S.00 Owner: ROMAR REALTY "CRUST,DANA MYER R,DANA ALAN G TRS
4of*Fixtures:_ Applicant: BUSINESS OWNER
DlgSate # AT. 185 ESSEX STREET
UseGroup
ConstClass
ISSUED ON: 28-Sep-2011 AMENDED ON. EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
A FRAME SIGN 28"'X 39'FOR PAMPLEMOUSSE
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOL ION OF ANY OF
ITS RULES AND REGULATIONS. (�J .�—�
Signature:
Fee'rype: Receipt No: Date Ilaid: Check No: Amount:
SION RLC-20122-000893 -8-Sep-II 0 S0.00
(;vi msp.2011 Des Luuriers municipal Solutions.Inc.
�YjPermit Number ° "!C i+0 y N
APPL FOR PERMIT TO ERECT A SIGN AUG 15 2011
NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED `"i ANNINO&
off Location, Ownership and Detail Must Be Correct, Complete, and Legible ;''Y!111 WPMENT
A. b
Salem, Massachusetts
Date
To the Building Inspector.
The undersigned hereby applies for a permit to n Erect, n Alter, n Repair a sign on the following described buildings:
Street Address Zoning District
❑Urban Renewal Area ❑ Entrance Corridor
❑ Historic District ❑None
• v cul tUse of Building
Telephone floor
• b Q q 2 floor C
Address - Com- 3 floor
Telephone �(_ (' 4 floor
E-mail �•(� How many businesses are in the building?
If a corporals body, name ) l2� Frontage
of responsible officer G
• I Building linear feet
Construction Sups License No Applicant's Space(if multi-tenant) linear feet
Address Property linear feet
Telephone Mail Sign Permit to
E-mail in Sign Owner o Sign Erector ❑Other. 71
Si n 1
Sign 2 St n 3
❑Surface in Surface ❑Surface
❑Right Angle to Building in Right Angle to Building ❑Right Angle to Building
❑Free Standing in Free Standing a Free Standing
❑Awning ❑Awning ❑Awning
_VPortable(A-Frame) in Portable(A-Frame) c Portable(A-Frame)
r Other(specify) ❑Other(specify) in Other(specify)
Sign Materials I tLtt/f (t l U, _ Sign Materials Sign Materials
Sign Dimensions2-K41
it 3c, 6 Sign Dimensions Sign Dimensions
Sign Area C• Sign Area Sign Area
sq ft ft sq It
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
$ GV
Existing Signs
Type Sign Area To Be Removed? Si Owner
Surface sq ft a yes ii no
/I
-w Right Angle to Building sq ft ❑yes - no ( " `�—
❑ Free Standing sq It n yes ij no Sign Owner's Authorized Representative
❑Awning sq it ❑yes o no
u Other(specify) sq ft n yes in no
Property Owner
Internal Review
l[
Planning&Community Devel ment Department 77 Histoncal Commission
�7
Approval
Building Inspector
0824110 rev
Diane Manahan
Pamplemousse
185-189 Essex Street
Salem, MA 01970
August 9, 2011
Design Review Board
c/o DPCD
City of Salem
120 Washington Street
Salem, MA 01970
Dear Members of the Design Review Board:
1 am writing for approval of my portable A frame sign in front of my business. The sign
is 28' x 39' and is stable.
The signs has a 2' wood frame painted C2 Al Green. One side of the sign has our logo
and wine tasting information as shown in the attached in the photograph. The other side
is white and will be used to fill in weekly specials and promotions.
I would like to locate the sign in front of the tree planter near the entrance as shown in the
attached plan. The location meets the minimum 5' clearance and is within 10' of the
entrance(actual placement is 7').
My business has its own entrance and there are no other businesses in the building.
Thank you for your consideration.
Sincerely,
"Ulu i
k��
Diane Manahan
Pamplemousse
4P
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IF nn
pnerr.+rt.w
" Salem
Redevelopment
Authority
Design Review Board Proposal
August 24, 2011
185-189 Essex Street (Pampiemousse): Discussion of proposed portable sign
Com Iles? I Portable Sign Requirements
Y N ? Dimensional Requirements:
X - less than orequal to 6 square feet 28"X39"=7.589f
X - no more than 24" wide
X - within 10' of entrance door
X - minimum of 5' 42"absolute clearance from obstruction
Y N ? Other Requirements:
X - zoning: must be 81, 132, 84 or B5
X - no trademarks other than establishment's
X rices,telephone numbers, and Internet addresses shall not be greater than four inches tall
X - no changeable letters, animation, movement, or sound
X - only one sin permitted per entrance
X - cannot be located in front of handicap walkways, or block building entrances, exits, and fire escapes
- design (color, fixed lettering style, symbols and material)complements and is compatible with the
design of the establishment's primary sign(s), abutting properties, and the general streetscape in
the immediate vicinity of the establishment
X - must be made of durable, rigid material such as, but not limited to, wood, plastic or metal, in an A-
frame style
X - must be internally weighted so that it is stable and windproof.
X - must have$1,000,000 liability insurance including naming the City and the SRA
NA - if a shared entrance, must share sign with other business es
Other Compliance Issues NONE
neon sign:
non-static signs:
illegal signs:
other:
Standard Conditions:
- If a shared entrance, if other business wants to share, this business must collaborate
- The sign may be placed outside only during the hours of the establishment's operation.
- No sign shall be placed within the public right of way for the duration of a declared snow emergency.
- No sign shall be placed within the public right of way on October 31.
The sign must be free-standing and shall not be affixed, chained, anchored, or otherwise secured to the ground or to
any pole, parking meter, tree, tree grate, fire hydrant, railing, or other structure.
Additions such as flyers, ribbons, balloons, illumination, electrical components, speakers and the like shall not be
added to any portable signs.
Additional Recommended Conditions:
/^1 ® mTE(MMroomYY)
CERTIFICATE OF LIABILITY INSURANCE Ogl23i'o11
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 AMEND, 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 pollry(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
R
PRODUCER •r=
Culver Insurance Inc. PHONE . 97B 7 753 a o: 978 7443628
20 Central Street MAB.71WBUREA
�� mCO
Suite 003
Salem,MA o1s70 s APPORmec cOYERAGe NAIL p
INSURERce Co an 612
INSURED 19;:
Pamplemousse,Inc 185 Essex St A 189Salem,MA 01970-3728noa Com an 812
INSURER F=
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LNSR POLICY EFF POLICY EIS LIMITS
TYPEOFINSURANCS POLICYNUa9ER mnlrrYY MING
A aENERALl1A91LItY BP156030 9/2512011 912512012 EACH OCCURRENCE a 2000000
LOMMERCIALGENERAL LIABILITY D ES EeAm� f 500000
x CLANSWADE ❑OCCUR MED sXP An we
pelsan
$ 10000
PERSONAL&ADV INJURY 3 2000000
GENERAL AGGREGATE a 4000000
awl.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S 4000000
POLICY PRO- LOC 3
C M ED SNGLE LIM
AUTOMOBILE LIABILITY EA godde
BODILYINJURY('erpemw) 3
ANYAUTO
AUTO6WED SCHEDULED BODILY INJURY(Per acckan) a
NON-OWNED PROPERTY DAMAGE a
HIRED AUTOS AUTOS er m
3
UMBRELLA LIAR OCCUR EACH OCCURRENCE f
EXCESS LIA8 CLAIMS•1IADE AGGREGATE f
3
DED RETENTION WC STAYU- OTH-
D WORKERS COMPENSATION WC15603Q 9/2612011 9/25/20'12
AND EMPLOYERS LIABILITY YlN
ANY PROPRIETORRARTNER,EXECMVE❑ NIA E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED'/ EL DISEASE-PA EMPLOYE 3
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ifrsdwi OFOPERATIONS bales+ E.L.DISEASE-POLICY LIMIT 3
DUSCRIPTIONOFOPERATIONSILOCAnONSIVEHICLES (4aacN ACORD 101,40d1Bonal PamalxA SenedUla,Xmom epeeabRgUlredl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Salem ACCORDANCE WITH THE POLICY PROVISIONS.
The Salem Redevelopernenl Authority
120 Washington Street AUTHORMED REPRESENTATIVE -
Salem,MA 01970
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
TO 39Vd 30Nv8nsNI ?J3/tino 8ZS£4bL8L6 99:TT TTOZ/£Z/80
ACORp® CERTIFICATE OF LIABILITY INSURANCE =011""'
08/2312011
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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INBURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IILIPORTAU.- If the Certificate holder Is an ADDITIONAL INSURED,the policyym)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and Conditions of the Polioy,rRrtain poiicles may require an endorsement. A statement on this certlNcate does not confer rights to the
certificate holder in lieu of such andgrsemen s).
PROWCER CONTACT
Culver InSumnsoe Inc. NAME
20 Central Street P"q"S • 741-1753 FAX
IA� 978
SuRe 003 EMAIL o: 978 744.3528
ADD EAC msn.com
Salem,MA 01970 IN 6 AFFORMNSOOVERAGE MAICt
INSURER A:NGM Insurance Company512
MSUR®
Pamplemousse,Inc INSURER B•
165 Essex St 111189 INSURERC:
Salem,MA 019703726 INSURER D: MGM IASUMBOE COMDanY 612
MURER E-
NSURERr:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 CONTRACTOR 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.
NLTR TYPEORNSURANCE ' FOU F NP�CY uMna
POLICY NU BER
A GEIERALUMauty SPI55wap 9/252011 79"
RRENCE t 2000000
COMMERCIAL GENEPAL LABILITY t 500000
X CLW84WE �OCCUR
MED EXPone ) i 10000
t ADV INJURY t 2000000
GGREGATE s 4000000
LTLAGGNfiGAIE
APPLES PFR .COMPlOPAGG I 4000000
POLICY PRO" LOC i]BED
BILRUABILRT N EDMIT
ANY AUTO BODILY INJURY(Perpereon) S
OYMED SCHEDULED
OS AUTOS BODILY INJURY(PrreP.I" t
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Salem THE EXPIRATION DATE THEREOr, NOTICE WILL BE DELIVERED IN
The Salem Redevalopement Authority ACCORDANCE WITH THE POLICY PROVISIONS.
120 Washington Street
Salem,MA 01970 AUTHORRU)REPRESENTATIVE
91988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and Ingo are registered marks of ACORD
TO 39Hd 39NVi inSNI Nwino BZSEVOLBLE bS:TT TTOZ/EZ/BO
INGM INSURANCE COMPANY POWER OF ATTORNEY
A mrnesrd The MBin GuwtAmmka Group
S-806514
KNOW ALL MEN BY THESE PRESENTS: That the NGM Insurance Company,a Florida corporation having its principal office
in the City of Jacksonville,State of Florida,pursuant to Article IV, Section 2 of the By-Laws of said Company,to wit:
"SECTION 2.The board of directors,the president,any vice president,secretary,or the treasurer shall have the power
and authority to appoint attomeys-in-fact and to authorize them to execute on behalf of the company and affix the seal
of the company thereto,bonds,recognizances,contracts of indemnity or writings obligatory in the nature of a bond,
recognizance or conditional undertaking and to remove any such attomeys-in-fact at any time and revoke the power
and authority given to them."
does hereby make,constitute and appoint Lisa M Culver its true and lawful Attomey-in-fact,to make,
execute,seal and deliver for and on its behalf,and as its act and deed bond number S-806514 dated August 12, 2011
on behalf of ....
Pamplemousse Inc*"
in favor of City Of Salem Licensing Dept
for One Thousand and 00/100 Dollars($ 1,000.00 )
and to bind NGM Insurance Company thereby as fully and to the same extent as if such instrument was signed by the duly authorized
officers of the NGM Insurance Company;this act of said Attorney is hereby ratified and confirmed.
This power of attorney is signed and sealed by facsimile under and by the authority of the following resolution adopted by the Directors
of NGM Insurance Company at a meeting duly called and held on the 2nd day of December 1977.
Voted: That the signature of any officer authorized by the By-Laws and the company seal may be affixed by facsimile to any
power of attorney or special power of attorney or certification of either given for the execution of any bond,undertaking,
recognizance or other written obligation in the nature thereof; such signature and seal,when so used being hereby adopted
by the company as the original signature of such officer and the original seal of the company,to be valid and binding upon
the company with the same force and effect as though manually affixed.
IN WITNESS WHEREOF,NGM Insurance Company has caused these presents to be signed by its Assistant Vice�en General
Counsel and Secretary and its corporate seal to be hereto affixed this 1 I rh day of March.2011. ;� uM �� '
NGM INSURANCE COMPANY By:
Bruce Fox
Assistant Vice President, General Counsel and Secretary
State of Florida,
County of Duval
On this 11th day of March,2011 before the subscriber a Notary Public of State of Florida in and for the County of Duval duly
commissioned and qualified,came Bruce Fox of the NGM Insurance Company,to me personally known to be the officer described
herein,and who executed the preceding instrument,and he acknowledged the execution of same,and being by me fully sworn,deposed
and said that he is an officer of said Company,aforesaid:that the seal affixed to the preceding instrument is the corporate seal of said
Company,and the said corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority
and direction of the said Company;that Article V,Section 2 of the By-Laws of said Company is now in force.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed by official se
TMN!.%IILPOT t
Cmm/ODT1193
IEglrw tOlYNr1
4........... V4b rVPYAYIFK.
1,Brian J Beggs,Vice President of the NGM Insurance Company,do hereby certify that the above and foregoing is a true and correct
copy of Power of Attorney executed by said Company which is still in force and effect. IN WITNESS WHEREOF, I havehfreunto
set my hand and affixed the seal of said Company at Jacksonville,Florida this 12 day of Auqust 2011 16mGu CF,"",
a� � �O<k-
_YYYYYY 1923
WARNING: Any unauthorized reproduction or alteration of this document is prohibited.
TO CONFIRM VALIDITY of the attached bond please call 1-603-358-1343.
TO SUBMIT A CLAIM: Send all correspondence to 55 West Street, Keene,NH 03431 Attn: Bond Claim Dept.
or call our Bond Claim Dept. at 1-603-358-1229.
LICENSE OR PERMIT BOND
BOND NO. S-806514
KNOW ALL MEN BY THESE PRESENTS THAT WE,
Pamplemousse Inc of
186 Essex Street salem, MA 01970 as Principal, and
NGM Insurance Comnanv a Florida corporation with its principal
office at 220 Salina Meadows Pkwy Ste200 Syracuse, NY 13221-4742 , as Surety,
are held and firmly bound unto
City Of Salem Licensing Dept
in the sum of One Thousand and 00/100 Dollars
($ 1,000.00 ), for the payment of which sum, well and truly to be made, we bind ourselves, our
personal representatives, successors and assigns,jointly and severally, firmly by these presents.
The condition of this obligation is such, that whereas the Principal has obtained, or shall obtain, a license or permit from
the Obligee for sign
at 186 Essex Street for the term commencing on the 12th day of
August 2011 and ending on the 12th day of August , 2012
NOW, THEREFORE, if Principal shall faithfully observe and comply with all terms of the underlying license or permit,and
all Ordinances, Rules and Regulations, and any Amendments thereto, applicable to the obligation of this bond, then this
obligation shall become void and of no effect, otherwise to be and remain in full force and virtue.
The Surety may, if it shall so elect, cancel this bond by giving thirty (30) days written notice to the Obligee and the bond
shall be deemed canceled at the expiration of said period; the Surety remaining liable, however subject to all the terms,
conditions and provisions of this bond, for any act or acts covered which may have been committed by the Principal up to
the date of such cancellation.
PROVIDED, HOWEVER, that this bond may be continued from year to year by certificate executed by the Surety hereon.
Regardless of the number of years or terms this bond remains in effect, and regardless of the number and amount of
claims that may be made, the maximum aggregate liability of the Surety is limited to the penal sum of the bond.
SIGNED, SEALED AND DATED on this 12th day of August 2011
Pamplemousse Inc
By
NGM Insurance Company
By
Lisa M Culver Attorney-in-Fact
68-QQ-0002-08
Permit Number
APPLICATION FOR PERMIT TO ERECT A SIGN
PERMIT MUST BE OBTAINED BEFORE SIGN IS FABRICATED AND INSTALLED
Location,Ownership and Detail Must be Correct,Complete,and Legible
?,JA- k
City of S , ic s
TO THE BUILDING INSPECTOR: /
The undersigned hereby applies(for a permit to ✓ Etect_Alter Repair a sign on the following described buildings:
Location and No. IM- 1 FP
kd ��i1EZoning/District
Name of Property Owner m —D111 na� w
Name of Sign Owner h oA I w �� , , Address
If Owner is a corporate body,name of responsible officer
Name of Licensed Sign Ector Salem License No. Leop_ X4
Address
Use of Building: 1•'Floor Ad' I 3b Fluor
2°a Floor 4'"Floor
Frontage: Building linear ft Property linear ft
Type of Sign Proposed: Surface Right Angles to Building Free Standing Awning
Other(specify)
Proposed Sign Materials Q I lw Y nx/1
Proposed Sign Dimensions �1 �i/ 1` I (i�l Sign Area �u� Z sq ft �^^
Existing Signs: Surface: Sign Aseasq ft n
Right Angles: Sign Arca sq ft 2,/
Free Standing: Sign Area sq ft
Other: Sign Area sq ft
Signs to be Removed: Type Sign Area sq ft
Signature of Owner
dv
Estimated Cost of Net Work Signature of Owner's Authorized Representative
_
Address
s pr
Telephone
Signature of Property Owner
APPROVALS (Department Use Only):
PLANNING&COAIMUNrrY DEVELopmENT MSTORICAL COA0,1ISSION BUILDING INsrECIOR
City of Salem
Storefront Improvement Program
General Conditions
1. I have read and understand the guidelines of the Storefront Improvement Program.
Kmberley Driscoll
Mayor 2. I understand and agree that all work completed prior to final approval is ineligible for
Lynn G.Duncan funding.
Director, DPCD
3. I understand that if accepted into the program all constructions costs exceeding $2,000 will
require the payment of prevailing wages as stated in the federal Davis-Bacon Act.
4. I understand that to be eligible for this program I must be current with all city taxes and
fees and be in compliance with all city ordinances and regulations.
5. I understand that the City of Salem reserves the right to make changes in the conditions of
the Storefront Improvement Program as warranted.
6. I understand that I am not officially accepted into the Storefront Improvement Program until
my design is approved by all necessary parties and I receive a commitment letter from the
city.
Signature of Applicant vad Date �= i
Property Owner Authorization
If the applicant is not the property owner, please have the property owner, or an authorized
representative, review the information submitted, sign below, and check the Conflict of Interest
Disclosure.
As owner of the property at l�i`> �S �7fSG� I agree to the
above conditions and authorize the said business owner to make exterior improvements to my
property as part of the Storefront Improvement Program.
Signature of Property Owner
or Authorized Representative ` Date
Conflict of Interest Dislosure
Are you, the applicant, a member of a City of Salem Board or Commission?
yes V no
Are you, the property owner, a member of a City of Salem Board or Commission?
yes no
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