BLACK VEIL TATTOO STUDIO i
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City of Salem Sign Permit Application Worksheet
1bi'
6-Jun-19
The Black Veil Tattoo Studio
137 Boston Street
Zoning (res/non-res) B2 (non-res)
Entrance Corridor(YIN) Y
Cq Lot frontage 125 feet
Qr- Building frontage 33 feet(tenant space)
n #of businesses on site 2
u 1 Bldng dist from street center < 100
Multiplier 1
Building Signs
C maximum area permitted 33.00 sq ft
total proposed sign area 25.50 sq ft
sign 1 25.50 sq ft
width 204.00 inches
height 18.00 inches
sign 2 0.00 sq ft
width inches
height 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 36.75 sq ft
width 108.00 inches A
height 49.00 inches '
proposed sign height 11.00 ft
Application meets guidelines set
forth in the Salem Sign Ordinance Yes*
Recommend approval Yes
The building sign complies with dimensional requirements. There is an
existing freestanding sign at the site that exceeds dimensional requirements.
There are two businesses advertised on the sign; Black Veil Tattoo will be
replacing the lower of these two signs. Section 4-54 of the Salem Code of
Ordinances states that"A sign that does not conform with this article may be
repaired, provided that the cost of repair does not exceed 35 percent of the
replacement cost of the entire sign."Although the cost to replace the entire
freestanding sign was not provided, it is likely that refacing one of the two
business signs on this freestanding sign will cost less than 35% of the cost
of replacing the entire freestanding sign.
APPLICATION FOR PERMIT TO ERECT A SIGN
NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
r 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 ❑Erect, ❑Alter, ❑Repair a sign on the following described buildings;
MWITWINUMM Zoning
1-2 -1 z os Tvr( S i S►(c-E+'V%. n - n Urban Renewal Area nuance Corridor
tq"t o Historic District ❑None
Property Owner: Name C PGL PrS Use of Buildirig.
Telephone 3
1 floor f 3 -1• �oS•}'U tint ST.
Sign Owner:
• _ q, It r- 2 floor
Address /3'"i $es vet Sz ►'+l Wl l 3afloor
Telephone -T _O 4 floor
E-mail• 00
✓Y ; d: c Q rye How many businesses are in the building?
If a corporate body,name .
ofresponsible officer
V—Y-\ 0` �3" S S• Building ®n� linear feet
Construc lion Sup's Ucense No 0 0 0 _ o y Applicants Space(if multi-tenant) linear feet
Address _ �� rd S� Properly linear feet
Telephone I "TMail Sign Permitto
E-mail Gon .r MP JII p o .r 0'1,� ❑Sign Owner WSign Erector ❑Other.
- . .. -
Sign 7 _ I Sign 2 Sign 3
VSurface ❑Surface - ❑Surface
❑Right Angle to Building o Right Angle to Building ❑Right Angle to Building
❑Free Standing e(Free Standing ❑Free Standing
o AwningS� AITR -b
o Awning o Awning
o Portable(A-Frame) ❑Portable(A-Frame) ❑Portable(A-Frame)
n Other(specify) w ! ❑Other(specify) ❑Other(specify)
Sign Materials 0 a ' Sign Materials Sign Materials
CLcv l�
Sign Dimensions "Sr �� �25�5�`I Sign Dim=v N ✓moo N Sign Dimensions
Sign a ZOO x I� qcr tnmai I Ii Sign Area Sign Area
1 sq ft sq ftI sq It
Sign Height(f free standing) Sign Height(if freestanding) Sign Height(if free standing)
Estimated Cost of Net Work
Signatures
Type J Sign Area To Be Removed? Sign Owner
❑Surface sq ft ❑yes ❑no
❑Right Angle to Building sq it n yes ❑no
❑Free Standing sq ft n yes ❑no Si Owner's Authorized sentativ
a Awning sq ft ❑yes ❑no T
❑Other(specify) sq ft• ❑yes ❑no
Property Owner
Internal Review
Planding C6mnifihity Developm nt Department Historical Commission
Approval'
B ' n nspector
OSM4110 rev
Permit Number
APPLICATION FOR PERMIT TO ERECT A SIGN
i+ NOTE:BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
Location, Ownership and Detail Must Be Correct, Complete, and Legible q
, xr r — I,O _J l
Salem, Massachusetts I
Date
To the Building Inspector:
The undersigned hereby applies for a permit to 4 Erect, ❑Alter, ❑ Repair a sign on the following described buildings:
Street Address Zoning District
❑Urban Renewal Area � Entrance Corridor
0*14 stye ❑Historic District ^None
Property Owner: ' - I eUse of Building
Telephone 1"'floor -'ATTOt> $T U17tC)
Signewner: 1 ' 2" floor
-43
Address f` Arr yv4 r,� - .� 11-o l-4 �. S} L }�, 3 floor
Telephone �' �; (� �r�_ Lj 4-ff floor
E-mail �,1. t ��• � f) G G one How many businesses are in the building?
If a corporate body,name Frontage
of responsible officer
Sign Erector: Name
Building Z-Z linear feet
Construction Sups License No 200 Applicant's Space(if multi-tenant) 3 linear feet
Address S� (2t(� �'j" �j�j L Property f Zr linear feet
Telephone 77b '7 c S—S`5 OC> Mail Sign Permit to
E-mail �] � -��{��} []� �(-�D�i•C.O ❑Sign Owner m Sign Erector ❑Other:
... . . . . ... .
Sign 1 Sign 2 Slgn 3
*Surface ❑Surface ❑Surface
❑Right Angle to Building ❑Right Angle to Building ❑Right Angle to Building
❑Free Standing �GJ�£�- $Free Standing ❑Free Standing
❑Awning ❑Awning ❑Awning
❑Portable(A-Frame) ZOK x ❑Portable(A-Frame) ❑Portable(A-Frame)
❑Other(specify) ❑Other(specify) ❑Other(specify)
Sion.Materials Sign Materials �L I C 5 Sign Materials
WW VV�p C TI I -
Sign Dimensions �1 Sign Dimensions !�$/, Sign Dimensions
z--2 X z,�;
Sign Area . �- sq ft Sign Area -36 sq ft Sign Area
sa ft
Sign Height(if free standing) Sign Height(if freestanding) Sign Height(if free standing)
Estimated Cost of Net W k
$Existing Signs Signatures
�� a
Type Sign Area To Be Removed? Sign OwneF
to
atSurface sq ft ayes ❑no
❑Right Angle to Building sq ft ❑yes ❑no r
&Free Standing sq ft ❑yes ono Sign Owner's Authorized Represents e
❑Awning sq ft ❑yes ❑no
❑Other(specify)_ sq ft ❑yes ❑no
P p tty 0 er
Internal Review
Planning&Community Development Department Historical Commission
Approval
Building Inspector
OM4/10 rev
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
' Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledibls
Name (Business/Organization/Individual): 4he I qc f � _-Mary
Address: 1 r, /{m A
City/State/Zip: , (� d Phone#: Q
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I=a employer with 4. ❑ I am a general contractor and I
mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.V I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees These sub-contractors have
8: ❑ Demolition
working for me in any capacity. employees and have workers' g ❑Building addition
[No workers' comp.insurance comp.insurance..*
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I LFI Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.2'Other_STI&C,
comp.insurance required.] tJ
*Any applicant that checks box 41 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.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors 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. L
Insurance Company Name: ie rf�T�� $oI V + _
Policy#or Self-ins. Lic.#; �7J v7 Expiration Date:_ 113�
13 7 _
Job Site Address: Dot1'on1 }, S5VM �r�. 01 Q Jb City/State/Zip:... S Jie m� d 9 )d
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 S250.00 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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: _ ki (,t=r D o !e-
Phone#: 1 ` -I C U
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):
I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: