112 NORTH STREET - SIGN PERMIT 112 North Street
Dot& Ray's
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112 NORTH STREET 805-12
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIs #:_ I I o20 _
Map- 6 —- --S
Lot: : , SIGN PERMIT
Lot:
rPermit: 0392!Sign _—
Category_ SIGN
Permit#_ _ �805-12 -_ - ___I PERMISSION IS HEREBY GRANTED TO:
;Project# JS-2012-002336
Est.Cost: 5100.00Contractor: License: Expires:
Fee Charged:$20.00 (
BUSINESS OWNER
Balance Due:5.00 Owner: MARKOS GEORGE, MARKOS PAULINE
#of Fixtures: _ _Applicant: MARKOS GEORGE, MARKOS PAULINE
DigSafe# [AT.• 112 NORTH STREET
UseGroup
ConstClass
ISSUED ON: 19-Apr-2012 AMENDED ON. EXPIRES ON. 22-Oct-2012
TO PERFORM THE FOLLOWING WORK
INSTALL A FRAME SIGN FOR DOT&RAYS
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS.
Signature:
4 2f
Fee T,vpe: Receipt No: Date Paid: Cheek N'o: Amount:
BUILDING REC-2012-002562 I9-Apr-12 3010 $20.00
GeoTNIS,R)2012 Des Lauriers?lunicipal Solutions.Inc.
Permit Number ,Pef. �y
APPLICATION FOR PERMIT TO ERECT A SIGN
l�
NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
�4r Location, Ownership and Detail Must Be Correct, Complete, and Legible
Salem, Massachusetts
To the Building Inspector:
Date
The undersigned hereby applies for a permit to o Erect, D Alter, ❑Repair a sign on the following described buildings:
l ❑Urban Renewal Area ntrance Corridor
❑Historic District ❑None
GLb GL' koS Use Of
Telephone -7 �p ZZU 1-floor
.
•
OP°GC /1//9 S 2 floor 2
Address L 1� r �� 3 floor
Telephone T7,F , -7YY_ •730 4 floor
E-mail r How many businesses are in the building?
If a corporate body, name `
of responsible officer
' Building -P� linear feet
Construction Su 's License No Applicant's Space(if mul i-tenant) linear feet
Address Property 3 P linear feet
TelephoneMail Sign Permit to
E-ma:l Sign Owner c Sign Erector ❑ Other:
Sign I Sign 2 Sign 3
❑Surface ❑Surface ❑Surface
❑ Right Angle to Building in Right Angle to Building ❑Right Angle to Building
❑Free Standing ❑ Free Standing ❑Free Standing
❑Awning o Awning ❑Awning
,N42ortable(A-Frame) ❑ Portable(A-Frame) ❑Portable(A-Frame)
❑ Other(specify) ❑Other(specify) ❑Other(specify)
Sign Mate i
s /x-, S• Sign Materials Sign Materials
Sig Dimensions Sign Dimensions Sign Dimensions
5
Sign Area Sign Area Sign Area
S� s ft s ft s ft
Sign Height(if free atanding) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
$ / 0000
Existing Signs
Type Sign Area To Be Removed? Sign r
❑Surface sq ft ❑yes ❑noO,.0
Right Angle to Building sq ft c yes �
o o
ree Standing sq ft ❑yes d no Sign Owner's Authorized Representative
caning sq ft ❑yes "t
❑Other(specify) sq ft ❑yes ❑no
Property Owner
Internal Review
Plant &Community Uevelopment Department Historical Commission
Approval
Building In ector
oenano re.
/ 7 ® DATE(MMIOONYW)
AcoRv CERTIFICATE OF LIABILITY INSURANCE 3/16/2012
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 pollcy(les) 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).
PRODUCER CONTACT
Ambrose Insurance Agency, Inc. PHONEAX
aCNoEx ' 781-592-8200 1 as No:781-595-5820
56 Central Ave.
ADDRESS:
Lynn, MA 01901
INSURER(S) AFFORDING COVERAGE NAICtl
INSURER A:U.S. Llabllt
INSURED Dot & Ray's Lunch INSURER B.
George & Pauline Markos INSURER C.
112 North St. INSURER
Salem, MA 01970 INSURER E'
(978) 744-9730 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ir,AR ADDL Sualt POLICY EFF POLICY EXP
ra TYPE OF INSURANCE Islas IND POLICY NUMBER MMIDDIYYYY MWDD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE s 1,00-0,000-
x - 7ENTEU—
COMMERCIAL
OOO O0OXCOMMERCIAL GENERAL LIABILITY PREMISES lEa ocweenw $ 100,000
CLAIMS-MADE [X] OCCUR MED EXP(Any one person) $ 5,000
A CL1168858C 4/10/124/10/13 PERSONAL&ADV INJURY $ 1,000,000
X GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000
POLICY PRT LOC $
AUTOMOBILE LIABILITY
Ea a.to I $
ANYAUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS a001LY INJURY(Par amitlenl) $
HIRED AUTOS AUTOSED Per accident A A $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY YIN TORY LIMITS Eft
ANY PROPRIETORPARTNERJEXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? ❑ NIA
IMentlamry In Nm E.L.DISEASE-EA EMPLOYE s
If yea,tlesuibe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB i
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attaw ACORD 101.Additional Remarks Schedule.if more spew is required)
Restaurant
A-Frame Sidewalk Sign
City of Salem, MA as additional insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
120 Washington St. ACCORDANCE WITH THE POLICY PROVISIONS,
Salem, MA 01970
AUTHORIZED REPRESE ATNE
C 198k-t 0 CORD CORPORATION. All rights reserved.
ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD
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City of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form
Please complete form and make two copies.
Date Received I ?—
Amount
- ZAmount Received 26. OC)
Form of PaymentCheck Cash
Client Information �j c l ne Mq✓t�5
CASH PAYMENTS: client initials
Sign Permit Application Fee
❑ Conservation Commission Fee
❑ /
Payment received for what Planning Board Fee ZBA
service? ❑ SRA/DRB Fee
❑ Copies
Other:
Name of staff person receiving
payment LISc l� 1�nk
Additional Notes SIM
S
3010
DOT & RAYS RESTAURANT o9-9e
112 NORTH ST. PH. 978-744-9730 "� °"'�
I SALEM, MA 01970 53-174113
DATE
AYTOTHE
E PORDEROE
7?0-
L� DOLLARS e ---
3 EAST RN BANK
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_
BOSTON,
MA MA 02110
EASTEi1NBANKCOM
POR
IE EASTERN
110030 1011' 1:0 i 130 17981: 00 00__969 Z 14ii'
Original Check and Form: DPCD Finance
Copy 1: Client
Copy 2: Application File