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KIMBERLEY DRISCOLL MAYOR CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT 98 WASHINGTON STREET SALEM, MASSACHUSETTS 01970 TEL: [PHONE REDACTED] FAX: [PHONE REDACTED] CITY OF SALEM SIGN PERMIT PROCESS All exterior signs, awnings, and interior signs that can be seen from the exterior are required to have a City of Salem Sign Permit before a sign can be fabricated and installed. Please be aware that in some areas of the city, review by a governing board must take place before a City permit can be issued. These areas include the Urban Renewal Area (governed by the Salem Redevelopment Authority) and Local Historic Districts (governed by the Salem Historic Commission). Please note that it takes roughly three weeks to receive a sign permit and in areas governed by a review board it may take longer. Before any sign application can be reviewed, the following material must be submitted with the application: Scaled Drawing of Sign (including dimensions) Color Scheme Letter Style (font) Letter Size Method of Attachment Method of Lighting Building Frontage (width of building on public way) Photograph of Building (current conditions) Photograph of Building (with proposed signage) The Building Inspector may require additional pertinent information to insure compliance with the City of Salem Sign Ordinance and any other applicable laws. Sign Application Fees There is a twenty-dollar ($20) minimum permit fee for each application. If the estimated cost of fabrication and installation is $2,000 or more, a fee of $10 per $1,000 plus a $5 application fee will be charged. For example, a $12,000 sign project would have a $125 fee. Proof of Workers Compensation Insurance Applicants must provide a Workers Compensation Insurance Affidavit from their sign erector that includes workers compensation insurance information. Electrical Permit A licensed electrician must install any sign with ancillary lighting and sign boxes must be UL listed. An Electrical Permit must be obtained from the City of Salem Electrical Department, 48 Lafayette Street, and be submitted with the sign application before a sign permit will be issued. Surety Bonds for Signs or Awnings Hung over a Public Way Any sign or awning hung over a public way or sidewalk shall require a surety bond in the sum of one thousand dollars ($1,000.00) conditioned to save harmless the City from any claims. This bond must be placed on file in the City Clerk’s office. A copy of such bond must be submitted with the sign application before a sign permit will be issued. Contact your insurance provider to obtain the surety bond. Liability Insurance for Portable (A-Frame) Signs Proof of adequate liability insurance with a minimum limit of $1,000,000.00 for each occurrence must be provided to the City Clerk and remain in effect for as long as the portable sign is used. The portable sign must be indicated as being included in the liability coverage. The City, and in the Urban Renewal Areas, the Salem Redevelopment Authority, must be listed as additional insured(s). A copy of the insurance certificate must be submitted with the sign application before a sign permit will be issued. 08/24/10 rev ---PAGE BREAK--- 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 Salem, Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to □ Erect, □ Alter, □ Repair a sign on the following described buildings: Street Address Zoning District □ Urban Renewal Area □ Entrance Corridor □ Historic District □ None Property Owner: Name Use of Building Telephone 1st floor Sign Owner: Name 2nd floor Address 3rd floor Telephone 4th floor E-mail How many businesses are in the building? If a corporate body, name of responsible officer Frontage Sign Erector: Name Building linear feet Construction Sup’s License No Applicant’s Space (if multi-tenant) linear feet Address Property linear feet Telephone Mail Sign Permit to E-mail □ Sign Owner □ Sign Erector □ Other: Proposed Signs (If more than three signs are proposed, attach additional sheets) Sign 1 Sign 2 Sign 3 □ Surface □ Right Angle to Building □ Free Standing □ Awning □ Portable (A-Frame) □ Other (specify) □ Surface □ Right Angle to Building □ Free Standing □ Awning □ Portable (A-Frame) □ Other (specify) □ Surface □ Right Angle to Building □ Free Standing □ Awning □ Portable (A-Frame) □ Other (specify) Sign Materials Sign Materials Sign Materials Sign Dimensions Sign Dimensions Sign Dimensions Sign Area sq ft Sign Area sq ft Sign Area sq ft Sign Height (if free standing) Sign Height (if free standing) Sign Height (if free standing) Estimated Cost of Net Work $ Existing Signs Signatures Type Sign Area To Be Removed? Sign Owner Sign Owner’s Authorized Representative Property Owner □ Surface □ Right Angle to Building □ Free Standing □ Awning □ Other (specify) sq ft sq ft sq ft sq ft sq ft □ yes □ no □ yes □ no □ yes □ no □ yes □ no □ yes □ no Internal Review Planning & Community Development Department Historical Commission w Approval Building Inspector 08/24/10 rev ---PAGE BREAK--- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _ Address: City/State/Zip: Phone *Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information. † 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. Insurance Company Policy # or Self-ins. Lic. Expiration Job Site Address: 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 $250.00 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: Date: Phone 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Phone Type of project (required): 6. New construction 7. Remodeling 8. Demolition 9. Building addition 10. Electrical repairs or additions 11. Plumbing repairs or additions 12. Roof repairs 13. 1. I am a employer with employees (full and/or part-time).* 2. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers’ comp. insurance required.] 3. I am a homeowner doing all work myself. [No workers’ comp. insurance required.] † Are you an employer? Check the appropriate box: 4. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers’ comp. insurance.‡ 5. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, and we have no employees. [No workers’ comp. insurance required.] ---PAGE BREAK--- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers’ compensation for their employees. Pursuant to this statute, an employee is defined as “...every person in the service of another under any contract of hire, express or implied, oral or written.” An employer is defined as “an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.” MGL chapter 152, §25C(6) also states that “every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.” Additionally, MGL chapter 152, §25C(7) states “Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.” Applicants Please fill out the workers’ compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers’ compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers’ compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under “Job Site Address” the applicant should write “all locations in or town).” A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department’s address, telephone and fax number: The Commonwealth of Massachusetts Department of I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # [PHONE REDACTED] ext 7406 or 1-877-MASSAFE Fax # [PHONE REDACTED] www.mass.gov/dia Revised 7-2013