HomeMy WebLinkAboutBld-20-003525 ,Og
1.7 s TOWN OF YARMOUTH BUILDING DEPARTMENT
� '�'-I y. 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
ary.ne 6.:
SIGN PERMIT APPLICATION
Date I`'l l Z 0 i 1 Application Accepted Permit No.$W7W -off-® - Or) 35- ✓-
Applicant Instructions
1) Applicant shall complete both sides of application.
2) One application form is required for each sign. Each sign will be assigned its own permit number.
3) Applicant shall attach separate 8 %"x 11"sheets including the following diagrams:
A) Design,dimensions and colors of the proposed sign
B) Freestanding Signs:provide certified plan by a professional land surveyor that describes how the proposed
sign meets the zoning requirements included in Zoning Bylaw 303.5.6 or 303.5.4.2 (as applicable). A
stamped and sealed"as-built"will be required before the permit will be issued.
C) Attached Signs: show length of portion of building frontage that is occupied by applicant.
D) Temporary Signs: show location for sign
4) Sign permits are$40.00 each,payable at the timeof application.
Address of proposed sign W I�w JT�?( Er VAN Lt L. Historic District
Name of Business for proposed sign E4NI Cr- Aimee i C -
Name of Business owner—e N f / 0.t ( Coe
Mailing Address of Business owner lb a NOL f4 1a 2\./ N STEL.L,- . C et orte., NC
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Business Owner Phone:Business (50 S-) • 13 3 2- Home
Name of Building Owner a W U t 0 W i ce[' UN Ct (o Phone(11`{ )Z`i 2-- it S�
CC3tz f 'I
3 Z Sign BuilderPL-�tC4DLL0 14 5165N CC MO y Sign Materials �o IC Uic1 �N
o c.l a i ( l r J s
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Sign Builder Address Z {t4CL•-T3t-L W (. W de 5 1 AA4 016,0 5 Phone 50g g ;1332..
Singly Occupied Building Business Center N Internal Light External Light N
Ott 0 2. Freestanding Sign Size:?- NOS. (11/4 &5T 11,)(D S CC UR& JI(ate — D I E. p'
Attached Sign Size:
Temporary Sign Size:
Dates:
Please complete other side of Sign Permit Application
All Permits are subject to the approval of the Sign Inspector
I hereby agree to conform to the provisions of Town of Yarmouth Zoning By-law Section 303 governing sign
construction and installation. I further agree that this sign will not be altered,added to or changed in any way unless
a new permit has been issued. Sign Permits are not valid until the Building Commissioner issues Use and
Occupancy Permits (where applicable). Freestanding sign permits are not valid until the "as-built" from a
professional land surveyor h been recei ed.
Signature of Applicant: Date I Z(1? ko i tt
Property Owner Authorization: I hereby authorize the applicant to act on my behalf in all matters related to this
sign application. (Signature) JO5)+( Crectqc 1 04E2_ Date
SLL ATh4-
Approved by: Date /2 l7
With the following conditions:
I have read and understood the conditions of this Sign Permit listed above:_
MA6-554-PB_86 Willow St Print Book 12/3/19,7:02 PM
Site Number: MA6-5,21.1213 Site Name: 86 Willow St Recommendation Completed: 10-07-2019 f
Address: VVillow StBANK OF A M E R I C A �� CIty/State: Yarmouth Port,MA 02675 DaterPrin 8-2019: 12/04/2019
Existing Photo g Proposed Photo 4
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Existing Proposed '
Asset Zone: Sign Asset Type: Exterior Overall Height:
Asset Type: Exterior Sign Number: EXT-002 Overall Width:
Sign Number. EXT-002 Sign Type: Custom Logo Height:__._
Existing Sign Type: Monument Description: Custom Tenant Panel,4'x 21" Letter Height:
Face Material: Action: Custom Illuminated: Non Illuminated
Graphics Material: Vinyl Comments: Match the existing face size and color,and match gold copy style on existing panels.Monument is double faced,therefore 2 pieces.
OveraU Height: 76- Restoration Notes: Field verify dimensions of space shown in photo morph prior to fabrication to verify if specified graphics will fit in area.See control
Face Height: 4" documents for product specification and master agreement for installation requirements.Clean surface of all residue.
Face Width: 21'
Illuminated: Non Illuminated
Electrical:
Wall Material:
Sign Comment:
moniglt
https://signchart4.monigle.net/printbook.php?site_id=bfgx122&layout=tabloid Page 4 of 8
BANK OFAMERICA ���/
AUTHORIZATION AND CONSENT FORM
Landlord/Owner: Joseph Creney
Leased Premises: 86 Willow St.
Unit 6
Yarmouth P rt,Ma
Landlord Contact:
Print Name: ,Sci\n . l ✓e�✓l , �f
Telephone Number: 11 ' Z g _ q fo(.o(o
Re: Bank of America Signage Rebranding
To Whom It May Concern:
I am a duly authorized representative of 86 Willow Dr.Yarmouth Port,the Landlord/Owner at the
referenced lease premises.
In my capacity as Landlord's official representative,I do hereby authorize the bank to perform all work
associated with the sign conversion. I further authorize the[FP Name here]or its representatives
to obtain in Landlord's name all permits for the sign conversion hereby consented to by Landlord. Costs
associated with permit acquisition and signage replacement will be at Bank of America's expense.
Landlord/Owner:
By: al?, �-
Date: I ( /1 / i?
Please return to:
Ed Griffin
CBRE
25 Ladyslipper Dr
Shrewsbury,Ma.01545
774.242.9156
Ed.griffm@cbre.com
2 of 2
Client#:122011 PHILSIG
ACORDnw CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Huntington Insurance,Inc.
NAME:CONCT
T Diane Pavilonis
PHONE
310 Grant Street,2nd floor (ac.No.Ext):412-667-6538 I r ,No): 877-489-9126
Pittsburgh,PA 15219 AD RD-MAiLF_ss: diane.pavilonis@hunting#on.com
888 576-7900 INSURER(S)AFFORDING COVERAGE NAIC S
INSURED INSURER A:Phoenix Insurance Co 25623
INSURER B:Travelers Property Casualty co of Amer 25674
Philadelphia Sign Company
INSURERC:TravelersIndemniryco 707 W Spring Garden St25658
Palmyra,NJ 08065 INSURER D:Travelers Casually 8 Surety Co otAmer 31194
INSURER E:RLI insraanee Compoey 13056
COVERAGES INSURER F:
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.
INSR ADDL SUBR
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP
A X COMMERCIAL GENERAL LIABILITY (MM/DDlYYYY)I(MMlDD/Y1 YY) LIMITS
66046139679PHX18 12/31/2018 12/31/2019 EACH OCCURRENCEE S 1,000,000
I CLAIMS-MADE X OCCUR PREMISES(ERENTE RENTED
s 100,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
Gall AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $2,000,000
PRO-
POLICY X JECT II LOC PRODUCTS-COMP/OP AGG S2,000,000
OTHER:
$
C AUTOMOBILE UABILITY 8101L69956818 12/31/2018 12/31/2019 COMBINED SINGLE LIMIT
X ANY AUTO (Eaaatiderm s1,000,000
OWNED SCHEDULED BODILY INJURY(Per person) S
AUTOS ONLY AUTOS
HIRED NON-OWNED BODILY INJURY(Per accident) $
X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE
(Per accident) $
B x UMBRELLA LU16 X S
OCCUR CUP2K99578918 12/31/2018 12/31/201' EACH OCCURRENCE $20,000,000
EXCESS LIAR CLAIMS-MADE
DED I XI RETENTION SO AGGREGATE $20,000,000
c WORKERS COMPENSATION UB6K7875Z5 PER S
AND EMPLOYERS'LIABILITY 06/01/2019 06/01/2020 X I —
ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N STATUTE ER
R In R EXCLUDED? N N!A E.L EACH ACCIDENT S1,000,000
(MandatoryOFFICE In NH)
describe under E.L.DISEASE-EA EMPLOYEE S1,000,000
IDESCRIPTION OF OPERATIONS below
D Leased Equip E.L.DISEASE-POLICY LIMIT $1,000,000
6602N345269TIL19 02/07/2019 12/31/2019 $150,000
E Installation Fltr ILM0301919 02/01/2019 02/01/2020 $100,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
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.
AUTHORIZED REPRESENTATIVE
I
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of A ORD6 2J15 ACORD CORPORATION.All rights reserved.
#S1620724/M1618947
PADI1
s
The Commonwealth of Massachusetts
Department of Industrial Accidents
A`' Office of Investigations
. 600 Washington Street
Boston,MA 02111
www.mass.zov.dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 11.40ezP1414Si ,y
,,,,11 �` r C ' S O �4NLi
Address: 1 b�."W• .}I�Giti &Ale. ) -I-.
City/State/Zip: (A-(•IA(►L41.1 T 0 TOCo Phone#:_ - (C118) tie to• 6I37
you an employer?Check the appropriate box:
Type of project(required):
1.Are\ I am employer with O� 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction
2. 0 I am a sole proprietor or partner- listed on the attached sheet.# 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. Workers'comp.insurance. 9. ❑Building addition
(No worker's comp.insurance 5. 0 We are a corporation and its 10. ❑Electrical repairs or additions
l •) officers have exercised their 11. 0 Plumbing repairs or additions
3. 0 I am homeowner doing all work right of exemption13. C the re
Myself. � 10°P per MGL 13. Other �
y (No workers'comp. c.152,§1(4),and we have no
Insurance required.)t employees.[No worker's
Comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: .
tHomeowners 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 attach an additional sheet showing the name of the sub-contractors and their workers'comp.policy information
I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site
information. I
Insurance Company Name:T+ Ye LICES I(vim Nt,( CO.
Policy#or Self-ins.Lie.#:101.17(K-i Q3Z S L S` IT Li 3 V Expiration Date: Ce 'L `ZV 19
Job Site Address:S(o tO I CL ��T City/State/Zip: ,(I no IAA( 144
Attach a copy of the workers'compensation policydeclaration
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. 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 a the violator.Be advised that a'copy of this statement may be forwarded to the Office of Investigations of the DIA
for insura rage vPr+fi.ation
I do hereb under the o •s of perjury I i/the information provided above is true and correct.
Signature: I Al
Date:
Phone#(618) y g6. 0131.
Official use only.Do not write in this area,to be completed by official.
Town of Clinton: 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 Person: Phone#: