63 BRIDGE STREET - SIGN PERMIT 63 Bridge Street
Brake and Clutch
City of Salem Sign Permit Application Worksheet
RECEIVED
9-Jun-15 INSPECLnNAL SERVICES
Brake and Clutch
r" 63 Bridge Street 1015 JIIIiIII I P 6: 71
Zoning(res/non-res) I
Entrance Corridor(YIN) N
U J Lot frontage 54 feet
I Building or tenant frontage 54 feet
#of businesses on site 1
Bldng dist from street center <100 feet
Multiplier 1
1
Building and Blade Signs
maximum area permitted 54.00 sq ft
- total proposed sign area 96.00 sq ft
sign 1
length 120.00 inches
height 96.00 inches
sign 2
length 48.00 inches
height 48.00 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 0.00 sq ft(per side)
maximum#of signs permitted 0 signs
maximum height permitted 0.00 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
propos d sign height It
Application meets standards set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
The proposed signage is replacing existing approved signage at this
location. Although the proposed signage exceeds what would typically
be recommended at this location,the Planning Department has
discretion to approve an additional amount,and because the new
proposed signage replaces existing signage of the same dimensions, it is
compliant with the sign ordinance.
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Permit Number
APPLICATION FOR PERMIT TO ERECT A SIGN
NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN Is ERECTED
Location, Ownership and Detail Must Be Correct, Complete, and Legible
yti =
Salem, Massachusetts4/27/15
Date
To the Building Inspector:
The undersigned hereby applies for a permit to ❑Erect, ❑Alter, IN Repair a sign on the following described buildings:
AddressStreet
63 Bridge St ❑ Urban Renewal Area ntrance Corridor
❑ Historic District u None
'' • Frank Lives ' ' Building
Telephone 978-745-2500 1 floor Commercial
• Frank Lives Brake&Clutch Inc. 2 floor
Address 63 Bridge Street 3 floor
Telephone 976-745-2500 4 floor
E-mail Franke@BrakeAndClutch.com How many businesses are in the building?
If a corporate body, name Frontage
of responsible officer
•
Privatera Signs Building linearfeet
Construction Sup's License No NA Applicant's Space(if multi-tenant) linear feet
Address I Property I Cj A linear feet
Telephone 976 204 6553 Mail Sign Permit to
E-mail n Sign Owner c Sign Erector c Other:
Proposed Signs(if more than three sqns are proposed. attach additional sheets)
Si n 1 Sign 2 1 Sign 3
s Surface ❑Surface u Surface
❑ Right Angle to Building a Right Angle to Building c Right Angle to Building
❑ Free Standing c Free Standing c Free Standing
c Awning a Awning c Awning
❑Portable(A-Frame) ❑Portable(A-Frame) Portable(A-Frame)
❑Other(specify) ❑Other(specify) Other(specify)
Sign Materials Sign Materials Sign Materials
aluminum square tubing and polymebl}ams 3/4 pvc
Sign Dimensions 8, X 10, Sign Dimensions 4' X 4, Sign Dimensions
Sign Area Sign Area Sign Area
sq ft sq ft sq ft
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
$ ff,2,6312 Oa
Existing Signs
Type Sign Area To Be Removed? Sign Ow r
e Surface sq It u yes ❑no
N Right Angle to Building sq It e yes a no
u Free Standing sq It ❑yes a no Sign O ner's Authori&WRepresentative
n Awning sq It c yes n no
❑Other(specify) sq It c yes c no
Prope caner
Internal Review
Ptahjp&Community Development Department Historical Commission
p .
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Building Inspector
0824/10 rev
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EXISTING SIGNAGE (WILL BE REFACED/REPLACED)
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_..._. _ve Date: May 11th, 201`: _
Western Surety Company
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LICENSE AND PERMIT BOND
KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 62390930
Thatwe,Brake and Clutch Inc.
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Of 14,Leal._ ,State of Massachusetts as Principal,
and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of
Massachusetts , as Surety,are held and firmly bound unto the
City of Salem State of Massachusetts , as Obligee, in the penal
sum of One Thousand and 00/100 DOLLARS (S1.000.00 ),
lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made,
we bind ourselves and our legal representatives, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been
licensed Sion Permit
by the Obligee.
NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply
with the laws and ordinances, including all amendments thereto, pertaining to the license or permit
applied for, then this obligation to be void, otherwise to remain in full force and effect 'until
May 11th , 2016 , unless renewed by Continuation Certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, by First Class
U.S.Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration
of thirty& g'�jb.flays from the mailing of said notice, this bond shall ipso facto terminate and the Surety
shalb', e�ieupod. lieved from any liability for any acts or omissions of the Principal subsequent to said
d}L�x. �I�Qi}e�ss•.oj lle number of years this bond shall continue in force, the number of claims made
ag jjn}l fris boh' iI the number of premiums which shall be payable or paid, the Surety's total limit of
Ii{tfinlit shall not be 8etmulative from year to year or period to period,and in no event shall the Surety's total
146 ty3b a RdaimYs?exceed the amount set forth above. Any revision of the bond amount shall not be ;
CU Lye.
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Datede lith day of May 2015 ;
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� erakp and Clutch- inc v
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Principal
WESTE SURECOMPANY
By
1 Paul T.Bruflat, 86nior Vice President
Form 532-12-2011 °
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Western Surety Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the Slates.of.Alabama, Alaska.Arizona, Arkansas, California, Colorado, Connecticut.
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts,Michigan, Minnesota,Mississippi, Missouri,Montana,Nebraska, Nevada, New Hampshire,New Jersey,
New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America,does hereby make,constitute and appoint
Paul T. Bruflat _ of Sioux Falls
State of South Dakota its regularly elected vice Presidep-t—.
as Attorney-in-Fad,with full power and authority hereby conferred upon him to sign,execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed,the following bond:
One S+on Permit City of Salem
bond with bond number 62390930
for Brake and Clutch. Inc.
as Principal in the penalty amount not to exceed: $ 1.000 00
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company
duly adopted and now in force,to-wit:
Section 7. All bonds, policies. undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate
name of the Company by the President, Secretary,any Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the
Board of Directors may authorize. The President, any Moe President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attorneys-in-Fact or agents who shall have authority to Issue bonds,policies,or undertakings in the name of the Company. The corporate seal is
not necessary for the validity of any bonds,policies,undertakings.Powers of Attorney or other obligations of the corporation. The signature of any
such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Vice President with the corporate seal affixed this 11th day of May
___2015
ATTEST WESTEN URET COMPANY
._ �y)--%r� -_..__.- BY 2 -
L Nelson.Assistant Secretary Paul T ruflat,Vice President
a1NreHyi�_
3rn;y F':v.
STATE OF SOUTH DAKOTA 1 `•., v A'V fk E
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COUNTY OF MINNEHAHA O``:. ""
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On this 11th day of May 2015 ,before me,a Notary Public,personally appeared
Paul T. Bruflat and L. Nelson
who,being by me duly sworn,acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
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My Commission Expires August 11,2018 Notary Public
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CNA SURETY Transaction Report & Invoice
CNA surety Principal Information: 10:
PO Box 957269
St Louis, MO 63195-7289 Brake and Clutch, Inc.
63 Bridge Street
Salem, MA 01970
Agency Code: 20-16924
Gilbert Ins. Agency, Inc.
137 Main Street (Rte 28)
Reading, MA 01867-3922
YOU CAN PAY ONLINE BY VISITING ONLINEPAY.CNASURETY.COM
Transaction Description: Transaction Effective Date: 05/11/2015
BondiP011cy#: 62390930
Written By: Western Surety Company
Description. Sign Permit City of Salem
Obfigee: City of Salem
i
Effective Date: 05/11/2015 Gross Premium Charge: $100.00
Expiration Date: 05/11/2016 Commission Amount $30.00
Current Penalty: $1,000.00
Renewal Method: Net Amount Due: $70.00
Chang De etail:—
i
Agmt: You may remove sblb blow to use as a bgangrcred'a invoice
CNA Surety INVOICE
CO.p So Po
p EFFECTIVE DATE ANNIVERSARY OATS PROCESS 11 PENALTY
0601 I 62390930 I 05/11/2015 05/11/2016 I 05/11/2015 ( $1,000.00
PRINCIPAL Brake and Clutch, Inc.
63 Bridge Street, Salem, MA 01970
RISK STATE MA WRITTENBY Western Surety Company
DESCRIPTION Sign Permit City Of Salem 1
OBLIGEE City of Salem
AGENCY COOE $100.00
20-1692'1
Yap aged is: Gilbert Ins. Agency, Inc.
137 Main Street (Rte 28)
Reading, MA 01867-3922 Western Surety Company
1 oc Roe CERTIFICATE OF LIABILITY INSURANCE 5�ii�2o 5
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 policy(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).
PRODUCER NAMEC Barbara McDonough
Gilbert Insurance Agency, Inc. PMONE (781)942-2225 FA% (781)442-222fi
137 Main Street E'MAu .bmcdonoughggilbertinsurance.com
INSURERS AFFORDING COVERAGE NAIC4
Reading MA 01867-3922 INSURER A:Aarle sville/Nationwide 26182
INSURED INSURER B:Gra hic Arte Mutual
Brake and Clutch, Inc. INSURER c:
63 Bridge Street INSURER D:
INSURER E:
Salem MA 01970 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL1472501142 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.
Tq TYPE OF INSURANCE IC NU BER POLICY EFF POLICY EXP Lel fs
GENERAL LIABILITY EACHOCCURRENCE 5 1,000,000
X COMMERCIAL GENERAL LVIBIUTYNTED
P o n S 100,000
A CLAIMS-MADE OCCUR A.70496e /1/2014 9/1/2015 MED EXP we endo S 5,000
PERSONAL L AOV INJURY $ 1,000 000
GENERAL AGGREGATE E 2,000,000
CENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000
JFcT X POLICY PRO- 3
3
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT11000,000
A ANY AUTO BODILY INJURY(Per person) S
ALL OVMEO X SCHEDULED aA 00000038405) /1/2014 /1/2015 BODILY INJURY(Por aagded) $
AUTOS AUTOS
X HIRED AUTOS X AUTOb�ED PROPERTY O E S
3
filar I
X UMBRELLAUAB- X OCCUR EACH OCCURRENCE 5 10,0007000
A E%CESS LIAR CWMB+4ADE AGGREGATE 3 10,000,000
DEO I X I RETENTION 79449E /1/2014 /1/2015 E
B WORKERS COMPENSATION 465050 9/23/2014 D9/23/2015 WC STATU- OTH
AND EMPLOYERS'LIABILITY YIN1.n. FR
ANY PROPRIETORIPARTNEWE%ECUTIVE --I EL EACH ACCNENT E 100,000
OFFICERIMEMSER E%CLUOE07 N/A
(Mandalory In NH) EL DISEASE-EA EMPLO 3 100,000
P yea,doartmte untler
DESCRIPTION OF OPERATIONS belay EL DISEASE-POLICY LIMIT 3 500 000
A Garagskeepers Comp 6 BA79459F /1/2014 /1/2015 34DD,DD0 Land $500 per auto
Collision (direct damage) Dedudide s pre Idea $500/2,500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Randa,Sdrodule,If non apace Is nqulnd)
Certificate holder is included as additional insured with respect to the operations of the insured per
written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Salem
120 Washington Street
Salem, MA 01970 AUTHORIZED REPRESENTATIVE
M Gilbert, CIC/BARBAR
ACORD 25(2010105) 01986-2010 ACORD CORPORATION. All rights reserved.
INS026(201005)01 The ACORD name and logo are registered marks of ACORD
City Of Salem Department Of Planning g & COmmunity Develo
Receipt and Tracking Pment
'Plea 5e
comP/ete form and 9 Form
Date Received � 7 2Q1S make Iwo copies.
i Amount Received
35. WForm of Payment
ClCheck
oratioMoney Order
n ❑
CASH Pgyf LEient InforNTS: client initials
❑ Sign Permit Application Fee
Payment received for what 0 Conservation Commission Fee
service? ❑ Planning Board Fee/ZBA
❑ SRA/DRB fee
❑ Old Town Hall Rental Fee
Name of staff ❑ Other:
Person receiving
Payment
Additional Notes ' Y
BRAKE&CLUTCH INC. -- —
63 BRIDGE STREET EASTERN BANK 31123
SALEM,MA 01970 SALEM,MA 01970
� (978)745-2500 53-179/113
(800)312-1117 8/3/2015
w� f
,q�( City of Salem
I` $ ""35.00
!' Thirty-Five and 00/100
City of Salem0 f
sign permit
I
SIGN PERMIT _
11'03ii23n' i:0ii30i798j: 09 Laaa 111.
LCOPy '- Application File