4 CANAL ST - BUILDING INSPECTION City of Salem Sign Permit Application Worksheet
I'AsPRECEIVED.
ECTIONAL SL
9-Nov-15
Domino's ,
O
4 Canal Street N�d
Zoning(res/non-res) B5
Entrance Corridor(YIN) Y
Lot frontage(2 frontages) 318 feet
Building or tenant frontage 136 feet(combined)
#of businesses on site 1
LD Bldng dist from street center <100 feet
Multiplier 1
cocJ maximum area permitted 137.00 sq ft
total proposed sign area 58.06 sq ft
sign 1
Domino Logo Front Sign length 38.00 inches
height 20.00 inches
sign 2
Front Sign Type face length 142.50 inches
height 24.00 inches
sign 3
Domino Logo Front length 38.00 inches
height 20.00 inches
sign 4
Side Sign Type Face length 142.50 inches
height 24.00 inches
sign 5
length 0.00 inches
hei I
ht 0.00 inches
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 11.28 sq ft
length 56.00 inches
height 29.00 inches
proposed sign height 15.11 ft(approx)
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets standards set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
All building signage will be externally illuminated. Freestanding sign will
be installed on existing poll.
t .
y 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
SalemD ,Massachusetts 11/06/15
Date
To the Building Inspector:
The undersigned hereby applies for a permit to x Erect, 6Alter, ❑Repair a sign on the following described buildings:
Street Address District
4 Canal St Zoning 75s o Urban Renewal Area aiffntrance Corridor
❑Historic District o None
• David Jenks
Telephone 617 908 4413 1� floor Restaurant
• David Jenks2" floor
Address 4 Canal St Salem MA 3` floor
Telephone 617 908 4413 4 floor
E-mail How many businesses are in the building? 1
if a corporate body,name
of responsible officer
Barlo Signs Building 28'and 90' linear feet
Constnxtion Sup's License No Applicant's Space(if multi-tenant) linear feet
Address Qrr-eU �iu� Vff 0 Property linear feet
Telephone $� - 22"1-s(P 7 4 x 333
E-mail PM 1 o a o Sign Owner ign Erector o Other:
ed
Si Proposedn 1
sign 2 Sign 3
Surface d(Surface ❑Surface
o Right Angle to Building o Right Angle to Building o Right Angle to Building
o Free Standing o Free Standing y(Free Standing
❑Awning o Awning o Awning
o Portable(A-Frame) ❑Portable(A-Frame) o Portable(A-Frame)
o Other(specify) o Other(specify) o Other(specify) REPLACE CAB
SAME P01 P
Sign Materials BEA PLEXI Sign Materials BEA PLEXI Sign Materials BEA LEXAN
Sign Dimensions (A)3'3"X 15'7" Sign Dimensions 3'3"X 15'7" Sign Dimensions 2'5"X 47"
Sign Area 50.7 Sign Area 50.7 Sign Area
s ft s ft 25 sq ft
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if freestanding) NO CHANGE
Estimated Cost of Net Work
$ 18,000
Type Sign Area To Be Removed? Sign Owner
XSurface - sq ft dyes o no Authorization Enclosed
o Right Angle to Building sq It ❑yes o no
X Free Standing 26.2Bq It yes ❑no Sign wn 's uthorized Representative
o Awning sq ft o yes o no Barlo Signs-Jenn Robichaud
cXOther(specify)Replace Cabinet sq ft o yes ❑no
Existing Pylon Above Prop Owner
Au rization Enclosed
Internal Review
P1?jiing&Community Development Department Historical Commission
Approvrf
Building Inspector
V F,' 0812410 rev
M
CON MUNIIY DEVELOPMENT
Dep drtment ofiaadustrlad Avadents
iejefJArest.s • s
I Congress Street,Suite 160
Boston,Mi'02I14 20117
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ar ' s�"�-�►pe�tisatio>��►�a�°pie-ttiav><��iaideps%�nntrset�r�/�Iecta�cin�rstPl — -----
ARplicant Infformation e s� Tease Punt Legft
Name (Business/organ>ation/Individual)._
Address:
city/state/zip: A�®S I . Phone#:
Are y u an employer?Check th appropriate tion:
1.I�
Jam
a em to y 'ei.wi , 4• ❑ I am a general contractor and IType
employees(frilland/or part:time). of project(regtnred):
�e)* ` have hired the sub-contractors 6..ElNew construction:.:
2.❑ I am a sole proprietor or partner- . listed on the attached sheet. 7. ❑Remodeling
s and have noIo ees e sub-contractors Have
en1P Thesubt
y 8. ❑Demolition
working for me in any`eapaeity. employees and have workers' ]3uildin
[No workers'.comp.insurance comp.,insuranee.$ 9 Q , g addition
required,] 5. ElWe are a corporation and its 10.❑Electrical repairs or additions
er's
3.❑ I am a homeowner.doing all work offichave exercised their 11;❑Plumbing repairs or additions
myself.,[No workers' camp; right of exemption per IviOL .
insurance required:]t c 15 ; §1(4);and we have no
12.❑Roofrepaus
'.
13.❑Other' -employees. [Nq workers': . ,
,.. ... `. _. comp,.insurance`required. ,
*Any apphcanFihat checks box#1 must also 51t out the section below flowing their:workers'compensa{ionpolicy.info=a4ioa
t Homeowners wl[o submit this-affidamtlndicatmy they aredoing all�gorlc and theft hue outside coauactors must submit a new affidavit Indicating such.
tContracFo:s thaz check Uv�boz:must a4achetl au additional sheet showing thename of Etre sub-coutsdctocs and date d�riether ornot thosa enfifie.s have
employees If the snb-contractos have employees,dtey tiiiist pro�sd8 thea workers'comp policy number. ;`..
r tiiil art eaNpldy¢r thattspxovarh#g'tmorkets'co'mpe)tSatBn aastaratYce r to des: Below is the
Y PcY kxdjob sate
informghoN.
04 Policy#.ofSelf tqs LYe #, Expiration Date f�
J"obSrte?�ddrass �rP� AO City/State/Zip
Attaofhe workerscolor olicydn age(show
ing U4e policy,numbez and expna&on
Failure to se�ezi.. caYerage as required under,Secgon 2511 o€MCrL o. 152 can lead to the rt PcIsition uf.tpunrosl pepalttes.nf a
fine up to$1,S�Q Q0 and/or oueryeai impt5 soment,as well.as civil penalties rn fire£oxm of a STOP VVORIC i, 1, fine
of up to$250x,. a day against theviolator lie atiYvised thata cgpy;of thtastaterigept may tta;forwarded tq thg Office
Inveshgatlons ofthe Dli1 far msurat ce coveragei4' 'axon
1 do hereb cera utader tJte alas:aail es that tlae in armatfott provLded.ab Ye tc tr a PoASot'rge4
w5 �
Phone
#.
� 9
dat use'o11 Do not write in this apes;tale eampleteal by` ortowta of caal i
("ii Cy or Town isermif2lc@psc(l. i .
Is$mng Autli6►31y.(cirele pney, <
1 13oard of Health Z:BuddingOepartment 3.OWrown Clerk ;4.Electrical Inspector 5:Plumbing ins pee#or
G.`(?it4er % {
i
'OF
,G S
PROPERTY OWNER AUTHORIZATION
MUST BE SIGNED BY OWNER OF PROPERTY
(This verifies that you are authorizing Barco Signs to submit an application for permits ON BEHALF OF the owner of the property.)
As owner of 4 Canal St. Sale MA
(Fill in Property Address)
® I hereby authorize Jennifer Robichaud or , as an authorized
representative of Barlo Signs of Hudson, N.H., to APPLY FOR SIGN PERMITS for this site.
❑ I hereby authorize Jenn Robichaud or Authorized Representative of Barlo Signs of Hudson,
N.H., to APPEAR BEFORE THE P NTNG BOARD and/or SIGN REVIEW BOARD and/or the ZBA
for this site.
Property Owner's Signature:
Printed Name: I c /J ILS
Address: y Cl�hSAZ Sr�2�
Phone number: YY(3
We cannot apply for permits or hearings until we receive your authorization.
Please FAX this completed &signed form to 603-882-7680, attn: Bill Barnard
and MAIL ORIGINAL to Barlo Signs, 158 Greeley Street, Hudson, NH 03051.
lfyou have any questions, please call me at 1-800-227-5674 ext. 347 THANK YOU!
Date: September 23, 2015
Reference JOB NAME: Domino's Salem MA Job No: #3770
C:\Users\David\APPData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\IASDGXIH\POA Property Owner's Authorization 11.6.09.doc.
Rev11.6.09
Commonwealth of Massachusetts
Citv of Salem
120 Washington Sl,3rd Floor Salem,MA 01970(978)745-9595 x5641 -
Return card to Building Division for Certificate of Occupancy
Permit N B-15-1242 ,
FEE PAID: $00.00 PERMIT TO BUILD
_ ,.
DATE ISSUED:, 11/19/2015
This certifies that BARLO SIGNS
-_ has permission to erect, alter, or demolish a building, 4 CANAL.STREET Map/Lot: 340478-0
as follows: Signs SIGN PERM_IT.AS APPROVED FOR
DOMINO'S ._ . ,.
Contractor Name:
DBA:
Contractor License No:
11/19/2015
Building Officr 1 '' Date
This permit shall be deemed abandoned and invalid unlesmthe work authonzed by this peYmit iscommenced witfiin'siximgnths after issuance.The Building Official
may gram one or more extensions not to exceed six months:each upon written request. y'
All work authorized by this permit shall conform to the approved application and the approved construction documents for which.this permit has been granted..
Allconstruction,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 visiblelfrom access street or road and shall be maintained open for public inspection for the entireduration ofthe
work until the completion of the.same. --r
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 accesslo the guarantyfund"(as set forth in MGL c.142A).
Restrictions:
Bul1ding plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.