An application was received from representing Lou's Harvard Square, requesting permission for a projecting blade sign at the premises numbered 13 Brattle Street. approval has been received from Inspectional Services, Department of Public Works, Community Development Department and abutter

June 26, 2025 City of Cambridge, MA Primary Location Applicant 1170808 13 Brattle St Sign/Awning Permit • Robert Tuttle Cambridge, MA 02138 Status: Active 2 [phone removed] Submitted On: 6/19/2025 @[email removed] Owner A NE Neon Co, Inc. GAZIT HORIZONS (9 BRATTLE) 150 Kuniholm Drive Unit 3 LLC, Holliston, Massachusetts 01746 1696 NE MIAMI GARDENS DRIVE NORTH MIAMI BEACH, FL 33179 General Information What option best describes this application?* Sign(s) Description of Proposed Work* Blade Sign 107.75" × 28" With Neon Letters Estimated Cost of Sign(s) in dollars * 7636 Describe any existing signs or awnings that will remain (including the size of the remaining signs/awnings).* Replacing Existing Sign

Cambridge City Council approval may be required. Will one or more of the proposed signs extend six (6) inches into the public sidewalk?* Yes You must submit a Projected Sign Application and Abutter's Form to the City Clerk's Office. Sign Information Sign Text* Food Drink Music LOU'S Illumination* Type of Sign* Internal Projecting Height of Sign (feet)* Width of Sign (feet)* 8.11 2.4 Area of Sign (square feet)* Height from the ground to the top of the sign (feet)* 20.8 19.6 Height from the ground to bottom of the sign Sign Material* (feet)* aluminum 10.7

Projection from the Building (inches) Weight of the sign (Ibs)* 28 200 Width of Building Facade for Associated Use Is the sign an accessory to a first floor store?* (feet)* Yes 50 Contractor Contractor Name* TIMOTHY J FISHER Address* 26 Fieldcrest Drive Telephone* E-mail* [phone removed] [email removed] License Number* License Expiration Date* 01/18/2027 CS-101710 Contractor's Signature Date* Signature of Licensed Contractor* 06/19/2025 Timothy J Fisher

Community Development Approval • Sign requires a variance from the Board of Zoning • Sign conforms to requirements of Article 7.000 Appeal - - a Comments • Exempt under Article 7.000 - City Clerk Internal & Bond Number Attachments REQUIRED Drawing of Sign(s) Lou's R-1.0.pdf Uploaded by Robert Tuttle on Jun 19, 2025 at 12:47 PM Contract with Sign Company REQUIRED NENeon - Lou's Estimate 44982.pdf Uploaded by Robert Tuttle on Jun 19, 2025 at 12:48 PM Proof of Insurance REQUIRED CERTIFICATE OF INSURANCE Cambridge pdf Uploaded by Robert Tuttle on Jun 19, 2025 at 1:20 PM

REQUIRED Signed contract between property owner and applicant Signage Application 6.19.25.pdf Uploaded by Robert Tuttle on Jun 19, 2025 at 12:56 PM Workers Comp 05.08.2025.pdf Workers Comp 05.08.2025.pdf Uploaded by Robert Tuttle on Jun 19, 2025 at 12:57 PM prior approval.pdf prior approval.pdf Uploaded by Patrick Conte on Jun 20, 2025 at 10:41 AM Lou's -Removal and Installation 1.00 REV02.pdf Lou's -Removal and Installation 1.00 REV02.pdf Uploaded by Robert Tuttle on Jun 23, 2025 at 11:50 AM signcertificationform_2024.pdf signcertificationform_2024.pdf Uploaded by Robert Tuttle on Jun 24, 2025 at 9:53 AM amended sign certification signcertificationform_2024_Tue_Jun_24_2025_09-45-20.pdf Uploaded by Patrick Conte on Jun 24, 2025 at 9:57 AM harvard sign-off.pdf harvard sign-off.pdf Uploaded by Patrick Conte on Jun 24, 2025 at 12:16 PM asana sign off.pdf asana sign off.pdf Uploaded by Patrick Conte on Jun 24, 2025 at 12:16 PM 13 Brattle St_signcertificationform__CDD review.pdf 13 Brattle St_signcertificationform_CDD review.pdf Uploaded by Evan Spetrini on Jun 24, 2025 at 12:43 PM projecting sign application (002).pdf projecting sign application (002).pdf Uploaded by Patrick Conte on Jun 24, 2025 at 2:44 PM 13 Brattle St CNA modify existing projecting sign.pdf 13 Brattle St CNA modify existing projecting sign.pdf Uploaded by Sarah Burks on Jun 25, 2025 at 11:12 AM green cards.pdf green cards.pdf Uploaded by Patrick Conte on Jun 25, 2025 at 12:42 PM

Record Activity Robert Tuttle started a draft Record 04/10/2025 at 8:45 am Robert Tuttle added file Lou's R-1.0.pdf 06/19/2025 at 12:47 pm Robert Tuttle added file NENeon - Lou's Estimate 44982.pdf 06/19/2025 at 12:48 pm Robert Tuttle added file Signage Application 6.19.25.pdf 06/19/2025 at 12:56 pm Robert Tuttle added file Workers Comp 05.08.2025.pdf 06/19/2025 at 12:57 pm Robert Tuttle added file CERTIFICATE OF INSURANCE Cambridge pdf 06/19/2025 at 1:20 pm Robert Tuttle submitted Record 1170808 06/19/2025 at 1:21 pm OpenGov system altered approval step Community Development Plan 06/19/2025 at 1:21 pm Review, changed status from Inactive to Active on Record 1170808 OpenGov system altered approval step Review for Completeness, changed 06/19/2025 at 1:21 pm status from Inactive to Active on Record 1170808 OpenGov system assigned approval step Review for Completeness to 06/19/2025 at 1:21 pm Branden Vigneault on Record 1170808 OpenGov system assigned approval step Community Development Plan 06/19/2025 at 1:21 pm Review to Evan Spetrini on Record 1170808 Robert Tuttle added a guest: [email removed] to Record 1170808 06/19/2025 at 1:21 pm Robert Tuttle added a guest: [email removed] to Record 1170808 06/19/2025 at 1:22 pm 06/20/2025 at 10:41 am Patrick Conte added file prior approval.pdf to Record 1170808 Robert Tuttle added file Lou's -Removal and Installation 1.00 REV02.pdf to 06/23/2025 at 11:50 am Record 1170808 Robert Tuttle added file signcertificationform_ 2024.pdf to Record 1170808 06/24/2025 at 9:53 am Patrick Conte added file signcertificationform__2024_Tue_Jun_24_2025_09- 06/24/2025 at 9:57 am 45-20.pdf to Record 1170808

William Pugliese approved approval step Review for Completeness on 06/24/2025 at 10:05 am Record 1170808 06/24/2025 at 12:16 pm Patrick Conte added file harvard sign-off.pdf to Record 1170808 06/24/2025 at 12:16 pm Patrick Conte added file asana sign off.pdf to Record 1170808 Evan Spetrini added file 13 Brattle St_signcertificationform__CDD review.pdf 06/24/2025 at 12:43 pm to Record 1170808 Evan Spetrini approved approval step Community Development Plan Review 06/24/2025 at 12:43 pm on Record 1170808 OpenGov system altered approval step Department of Public Works Review, 06/24/2025 at 12:43 pm changed status from Inactive to Active on Record 1170808 OpenGov system altered approval step Historical Commission, changed 06/24/2025 at 12:43 pm status from Inactive to Active on Record 1170808 OpenGov system assigned approval step Historical Commission to Eric Hill 06/24/2025 at 12:43 pm on Record 1170808 OpenGov system assigned approval step Department of Public Works Review 06/24/2025 at 12:43 pm to Brian McLane on Record 1170808 Eric Hill reassigned approval step Historical Commission from Eric Hill to 06/24/2025 at 1:32 pm Sarah Burks on Record 1170808 Brian McLane approved approval step Department of Public Works Review 06/24/2025 at 2:25 pm on Record 1170808 Patrick Conte added file projecting sign application (002),pdf to Record 06/24/2025 at 2:44 pm 1170808 Sarah Burks added file 13 Brattle St CNA modify existing projecting sign.pdf 06/25/2025 at 11:12 am to Record 1170808 Sarah Burks approved approval step Historical Commission on Record 06/25/2025 at 11:12 am 1170808 OpenGov system altered approval step City Clerk Review, changed status 06/25/2025 at 11:12 am from Inactive to Active on Record 1170808 OpenGov system assigned approval step City Clerk Review to Lori Perez on 06/25/2025 at 11:12 am Record 1170808 06/25/2025 at 12:42 pm Patrick Conte added file green cards.pdf to Record 1170808

Timeline Due Label Status Activated Completed Assignee Date / Review for Branden 6/24/2025, 6/19/2025, Completed - Completeness 1:21:22 PM 10:05:27 AM Vigneault / Community Evan 6/19/2025, 6/24/2025, Completed Development - 12:43:58 PM 1:21:22 PM Spetrini Plan Review / Historical Sarah 6/24/2025, 6/25/2025, Completed - Commission 12:43:58 PM Burks 11:12:50 AM V Department Brian 6/24/2025, 6/24/2025, of Public Works Completed - 12:43:58 PM McLane 2:25:20 PM Review City Clerk 6/25/2025, Active - Lori Perez - Review 11:12:55 AM / City Council Inactive - - Approval Inactive - V Bond - Robert $ Sign Permit Inactive - - - Fee Tuttle V Building Inactive - - - Inspector Review - Inactive - - B Sign Permit

CAMBRIDGE HISTORICAL COMMISSION 831 Massachusetts Avenue, 2nd Fl., Cambridge, Massachusetts 02139 Telephone: [phone removed] E-mail: histcomm@cambridgema.gov URL: https://www.cambridgema.gov/historic RIDGE HISTO Chandra Harrington, Chair, Susannah Barton Tobin, Vice Chair; Charles M. Sullivan, Executive Director Joseph V. Ferrara, Elizabeth Lyster; Jo M. Solet, Yuting Zhang, Members Gavin W. Kleespies, Paula A. Paris, Kyle Sheffield, Alternates COMMISSION CERTIFICATE OF NONAPPLICABILITY 13 Brattle Street Property: Applicant: Gazit Horizons (9 Brattle) LLC Attention: James Rafferty, Esq. The Cambridge Historical Commission hereby certifies, pursuant to Chapter 2.78, Article III of the Code of the City of Cambridge and order establishing the Harvard Square Conservation District, that the work described below does not involve any activity requiring issuance of a Certificate of Appropriateness or Hardship: Modify previously-approved non-conforming projecting sign to remove the arrow and amend the letters to read "LOU'S". ISD# 1170808 All improvements shall be carried out as shown on the plans and specifications submitted by the applicant, except as modified are incorporated by above. Approved plans and specifications reference into this certificate. This certificate is granted upon the condition that the work authorized herein is commenced within six months after the date of issuance. If the work authorized by this certificate is not commenced within six months after the date of issuance or if such work is suspended in significant part for a period of one year after the time the work is commenced, such certificate shall expire and be of no further effect; provided that, for cause, one or more extensions of six months each may be allowed in time for periods not exceeding writing by the Chair. Date of Certificate: June 25, 2025 Case Number: 5315 Attest: A true and correct copy of decision filed with the office of the City Clerk and the Cambridge Historical Commission on June 25, 2025. By Charles M. Sullivan slo, Executive Director. .... this Twenty days have elapsed since decision. the filling of this dec • Appeal has been filed No appeal has been filed Date • City Clerk

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] PAULA M. CRANE DONNA P. LOPEZ DEPUTY CITY CLERK CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT Date 06/20/2025 To Whom It May Concern: President & Fellows of Harvard College Cambridge, As Owner of Agent of of the _approval_XX Massachusetts, I do hereby declare my disapproval installment of: Canopy over the sidewalk entrance: Awnings over the windows: at 13 Brattle Street labeled: Food, Drink, Music, Lou's Projecting sign: of said property June 20, 2025 Date Signed: Justin Stratman, Managing Director, Harvard Housing & Real Estate, 1350 Massachusetts Ave, Cambridge, MA 02138 Address: ABUTTERS: PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED SIGN/AWNING AND RETURN IT TO THE APPLICANT WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

DRAWING NUMBER R-1 DRAWING TITLE Rendering Lou's Exterior Blade Sign & COP Chocolates SCALE As Shown FOOD DRINK MUSIC DATE 04/23/2025 Scale:N.T.S. Rendering Lou's 13 Brattle St Cambridge, MA 02138 Internally Illuminated Stencil Cut Aluminum Face Backer w/ Cream Vinyl Application, Translucent White Acrylic w/ White LEDs Faces and Returns Painted Dark Green (exact color T.B.D) Cream Vinyl Application Behind (Font T.B.D.) Clear Neon Red Tube 12mm Double Stroke REVISIONS 28" FOOD DRINK MUSIC Scale:3/4" = 1'-0" Blade Sign Elevation 107 3/4"- [phone removed] 150 Kuniholm Drive Unit #3 Holliston MA, 01746 NEON COMPANY INC

DRAWING NUMBER 1.00 DRAWING TITLE Lou's Sign Renovation Brattle St With White Acrylic Painted Aluminum PMS 5535C Green Stencil Cut Aluminum Internally Illuminated White Graphics With Outline Exposed Red Neon As Shown FOOD 26.94 SQ. FT. Scale NTS 137.25" Proposed Sign 107.75" DATE Remove existing sign and Install Refurbished Sign 04/10/2025 le St Lou's PROJECT 13 Brattle St Cambridge, MA 02138 REVISIONS REV 02 6/23/25 Revised Sizes Scale NTS Proposed Renovation of Existing Sign BAR: [phone removed] Scale NTS Existing Conditions 13 Brattle St. Cambride, MA 150 Kuniholm Drive Unit #3 Holliston MA, 01746 NEON COMPANY INC

Estimate Ne Date Estimate No. NEON COMPANY ONe 4/21/2025 44982 150 Kuniholm Dr. #3, Holliston. MA 01746 [phone removed] CUSTOMER PROJECT Lou's 13 Brattle St. Cambridge, MA 02138 Total EACH Description Qty Refurbish Beat Bar Double Sided Neon Sign 4,936.00T 4,936.00 Strip Down Existing Sign To Frame Reface With .063" Aluminum, Paint Faces And Returns Green Top Cabinet - "FOOD DRINK MUSIC", Stencil Cut Aluminum Face, 1/2" Translucent White Acrylic Push Thru Lettering, Internally Illuminated With White LEDs. "LOU'S" 12mm Double Stroke White Neon, White Vinyl Backer Application Installation Labor 2,700.00 2,700.00 Not Included In Pricing: Electrical Feed To Sign, Police Detail, Permits Or Any Associated Fees. Permits Will Be Billed Separately. Terms: Subtotal $7,636.00 50% due on signing, 50% due upon completion. $308.50 Sales Tax (6.25%) Total $7,944.50 Approval Signature John Mogoldrick

Application and Petitions Order Applications & Petitions #2 June 22, 2015 ORDERED: That, in accordance with the provisions of an ordinance relative to placing and maintaining signs, the Commissioner of Public Works be and hereby is authorized to grant a permit to Beat Hotel for a sign at the premises numbered 13 Brattle Street, Cambridge, Massachusetts. Provided that, before erecting the above named sign the petitioner shall file with the City Clerk a bond in the sum of Three Thousand ($3,000.00) dollars, conditioned to save harmless the City of Cambridge from all claims for damages arising from the installation, maintenance and use of said sign. COUNCILLOR CARLONE VOTED IN THE NEGATIVE View attached file

2 CITY OF CAMBRIDGE IS JUN 15 PM 4 11 OFFICE OF TRE CITY CLERK PERMANENT SIGN OR STRUCTURE THAT WILL OBSTRUCT THE PUBLIC WAY WÓRES TRANSIX TYCHES Cambridge, _ _ 20_ To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. The undersigned respectfully prays that Beat Hotel (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at B Brattle Street (ADDRESS) Type of Sign: falariate turned doubt is a en unin, ses theat bulls Reading matter to go on sign: Beat Bransese Bar Size: 60" ХіЧ4" _ Weight: 160 lbs Public Way Obstruction: 96" 48" (Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk) 96" Top:_ Height Above Grade: Bottom: 240" NOTICE - REGULATIONS [Section /2.08.010 Municipal Code - Encroachments onto Streets] Section 1212.0 State Building Code - Projecting Signs] • A projecting sign shall be constructed wholly of incombustible materials. • All signs must meet requirements of Zoning Ordinances and Building Code. • Note: Section 12.12.220 provides in part "every owner who maintains a ... structure in or over a street.. shall do so onty on the condition that such maintenance shall be considered as an agreement on his part io keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify ond save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such.. structure." PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HISIER KNOWLEDGE AND UNDERSTANDING UNDER PANS AND PENALTY OF PERJURY. 413/15 50 Chunch At., Cumbridge 111 wner or authorized agent) (Property (Tel. Nó.) 13 (11A) Brattle Street, Cambridge MA [phone removed] (Address) (Tel. No.) (Busing other)

exact placement TRDI open face channel letter It stencil cut text double stroke neon 11w theatre bulb not actual colors TBD BAR le stencil cut taxt 2. 11w theatre bulb Tood Natural Date: Sign Type: DOUBLE SIDED PROJECTION SIGN BAR BRASSER Approved By: Drawing Date: 03/17/15 118" 67" 100" 1.0.0 60"- Drawing number: BAR Proiect Name: BEAT BRASSERIE projection BRASSER 1/10th scale height of sign of sign) to battom 240" to top of sign bostonsign Tol R17.028.2114 Fay [phone removed] www.bostonsign.com 40 Plympton Street Boston, MA 02118 depth of sign: 30" weight: 160Ibs (through-bolted to brick wall) projected from building: 60" height of sign: 144" to top of sign: 240" to bottom of sign: 96"

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] PAULA M. CRANE DIANE P. LEBLANC CITY CLERK DEPUTY CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT Date To Whom It May Concern: As Owner of Agent of Cambridge, of the approval Massachusetts, I do hereby declare my disapproval installment of: Canopy over the sidewalk entrance: Awnings over the windows: Projecting sign: of said property. Date Signed: Address: ABUTTERS: PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED SIGN/AWNING AND RETURN IT TO THE APPLICANT WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

CITY OF CAMBRIDGE Community Development Department City Hall Annex, 344 Broadway, Cambridge, MA 02139 SIGN CERTIFICATION APPLICATION Please fill out this application to indicate the number, type, and dimensions of signage for your building. If you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements: • All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued, including City Council approval if necessary, for signs in the public way. • Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For questions or additional information, please contact cddzoning@cambridgema.gov. APPLICANT INFORMATION Applicant Name: Robert Tuttle / NE Neon Co Phone: [phone removed] Email: [email removed] Sign Address: 13 Brattle St Cambridge 02138 CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

PROPOSED SIGN Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign requires an individual form to be filled out. For further information on sign types, see the below page. Sign text: Lou's Food Drink Music Sign type: Projecting Sign (including awnings) Area in square feet: 20.80 Dimensions: 107" L H × 28" Placement height in feet: 11'-5" Depth from façade: 36" Illumination: Internal Sign frontage in feet: +/-100 Area of existing signs to remain: 0 COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION FOR INTERNAL USE ONLY Sign conforms to requirements of Article 7.000: Choose option. Sign requires a variance from the Board of Zoning Appeals: Choose option. Comments: Signature: Date CDD Representative CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

NATURAL ILLUMINATION AND EXTERNAL 2W1000 WITH CONDITIONS INTERNAL ILLUMINATION SQ FT FREE SIGN STAN- DING MAX AROVE 2 SIGNS PER LOT FREESTANDING SIGN A free standing sign is attached to or part of a any other structure. self-supporting structure and is not attached to EXTERNAL NATURAL AND ILLUMINATION OF SIGNS PER SIGN FRONTAGÉ - PARALLEL TO STREET _LENGTH OF BUILDING 5Q FT MAX 60 ABOVE WALL SIGN OVERVIEW BY SIGN TYPE sign area is parallel to the plane of the building. A wall sign is affixed so its exposed face and all APPROVE COUNCIL MUST IF PROJECTION EXCEEDS 6*, CITY MAX AROVE SIGN FRONTAGE - PARALLEL TO STREET LENGTH OF BUILDING GROUND SQ FT MAX 131 ONE SIGN PER GROUND FLOOR ESTABLISHMENT CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION ONLY •EXTERNAL NATURAL AND I LEIMINATIOA PROJECTING SIGN Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or requirements, consult Article 7.000 of the Zoning Ordinance. advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an a building face, including marquee, canopy, and awning mounted signs. A projecting sign is attached to and projects from

CITY OF CAMBRIDGE Community Development Department City Hall Annex, 344 Broadway, Cambridge, MA 02139 DONATA SIGN CERTIFICATION APPLICATION Please fill out this application to indicate the number, type, and dimensions of signage for your building. If you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements: • All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued, including City Council approval if necessary, for signs in the public way. • Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For questions or additional information, please contact cddzoning@cambridgema.gov. APPLICANT INFORMATION Applicant Name: Robert Tuttle / NE Neon Co Phone: [phone removed] Email: [email removed] Sign Address: 13 Brattle St Cambridge 02138 CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

PROPOSED SIGN Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign requires an individual form to be filled out. For further information on sign types, see the below page. Sign text: Lou's Food Drink Music Sign type: Projecting Sign (including awnings) Area in square feet: 20.80 Dimensions: 107" L H × 28" Placement height in feet: 11'-5" Depth from façade: 36" Illumination: Internal Sign frontage in feet: +/-100 Area of existing signs to remain: 0 COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION FOR INTERNAL USE ONLY Sign conforms to requirements of Article 7.000: Choose option. Sign requires a variance from the Board of Zoning Appeals: Choose option. Comments: Signature: Date CDD Representative CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

NATURAL ILLUMINATION AND EXTERNAL - 00000 INTER CONDONE N FREE SIGN I DING MAY 15° ABOVE GROUND 2 SIGNS PER LOT FREESTANDING SIGN self-supporting structure and is not attached to any other structure. A free standing sign is attached to or part of a EXTERNAL NATURAL AND BUILDING: INI IMITED 4 OF SIGNS PER SIGN FRONTAGÉ - - PARALLEL TO STREET _LENGTH OF BUILDING 5Q FT MAX 60 ABOVE GROUND WALL SIGN OVERVIEW BY SIGN TYPE A wall sign is affixed so its exposed face and all sign area is parallel to the plane of the building. APPROVE EXCEEDS 6° CITY COUNCIL MUST MAX SIGN FRONTAGE - ABOVE PARALLEL TO STREET GROUND LENGTH OF BUILDING SQ FT MAX 13 ! ONE SIGN PER ESTABLISHMENT GROUND FLOOR CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION ONLY EYTERNAL ILLUMINATION NATURAL AND PROJECTING SIGN advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or requirements, consult Article 7.000 of the Zoning Ordinance. temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an a building face, including marquee, canopy, and awning mounted signs. A projecting sign is attached to and projects from

CITY OF CAMBRIDGE Community Development Department City Hall Annex, 344 Broadway, Cambridge, MA 02139 SIGN CERTIFICATION APPLICATION Please fill out this application to indicate the number, type, and dimensions of signage for your building. If you are unsure of the type of sign and/or allowable dimensions, please review the following pages of this application and Article 7.000 of the Zoning Ordinance. Please note the following additional requirements: • All signs must receive a permit from the Inspectional Services Department (ISD) before installation. Community Development Department certification action does NOT constitute issuance of a permit or certification that all other code requirements have been met. Do not contract for the fabrication of a sign until all permits have been issued, including City Council approval if necessary, for signs in the public way. • Any sign or portion of a sign extending more than six (6) inches into the public way/sidewalk must receive approval from the Cambridge City Council and a bond must be posted with the City Clerk. For questions or additional information, please contact cddzoning@cambridgema.gov. APPLICANT INFORMATION Applicant Name: Robert Tuttle / NE Neon Co Phone: [phone removed] Email: [email removed] Sign Address: 13 Brattle St Cambridge 02138 CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

PROPOSED SIGN Please fill out the information below and attach a sketch of the proposed sign to the application. Each proposed sign requires an individual form to be filled out. For further information on sign types, see the below page. Sign text: Lou's Food Drink Music Sign type: Projecting Sign (including awnings) Area in square feet: 20.80 107" Dimensions: H L Placement height in feet: 11'-5" Depth from façade: 36" Illumination: Internal Sign frontage in feet: +/-100 Area of existing signs to remain: 0 COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATION FOR INTERNAL USE ONLY Sign conforms to requirements of Article 7.000: Choose option. Sign requires a variance from the Board of Zoning Appeals: Choose option. Comments: Signature: Date CDD Representative CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION

T190O ILLUMINATION AND EXTERNAL WITH CONDITONS INTERNAL ILLUMINATION MAX 30 STAN- FREE SIGN - DING 15' MAX ABOVE GROUND 2 SIGNS PER LOT FREESTANDING SIGN self-supporting structure and is not attached to A free standing sign is attached to or part of a any other structure. EXTERNAL NATURAL AND "BUILDING UNLIMITED # OF SIGNS PER CICK CRONTAGES PARALLEL TO STREET- LENGTH OF BUILDING SQ FT MAX FROLINN WALL SIGN OVERVIEW BY SIGN TYPE A wall sign is affixed so its exposed face and all sign area is parallel to the plane of the building. ¡APPROVE IF PROJECTION EXCEEDS 6", CITY COUNCIL MUST 20° SIGN FRONTAGE - MAX AROVE PARALLEL TO STREET GROUND LENGTH OF BUILDING 5Q FT MAY 12 ONE SIGN PER GROUND FLOOR ESTABLISHMENT, CITY OF CAMBRIDGE • CDD • SIGN CERTIFICATION APPLICATION ONLY EXTERNAL NATURAL AND ILLUMINATION PROJECTING SIGN Please note that this guide is intended to provide an overview of requirements by sign type. Sign shall mean and include any permanent or requirements, consult Article 7.000 of the Zoning Ordinance. temporary structure, device, letter, words, model, banner, pennant, insignia, trade flag, or representation used as, or which is in the nature of, an advertisement, announcement, or direction and which is designed to be seen from the outside of a building. For further information on specific a building face, including marquee, canopy, and A projecting sign is attached to and projects from awning mounted signs.

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] PAULA M. CRANE DONNA P. LOPEZ DEPUTY CITY CLERK CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT Date 06/20/2025 To Whom It May Concern: As Owner of Agent of _Cambridge, DO Brattle SOlare, LD, Owner of 1-8 and 17-41 Brattle Street, of the Massachusetts, I do hereby declare my disapproval approval installment of: Canopy over the sidewalk entrance: Awnings over the windows: at 13 Brattle Street labeled: Food, Drink, Music, Lou's Projecting sign: ONOMONE _Date - Mans Calua Address: 1-8 Brattle Street; 17-41 Brattle Street, Dalbride, MO 00108 ABUTTERS: IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

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DATE (MM/DD/YYYY) ACORD® 001 D0D000 CERTIFICATE OF LIABILITY INSURANCE 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 SUBROGATIONIS 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 endorsements). 180 WOLLS 000000 SOCO 0100 INSURERS) AFFORDING COVERAGE NAIC# 00400 INSURERA: Twn OtDFre DEranCe DoO Dand INSURER B: INSURED 00 0000 00 MO INSURER C: 100000MOLM DRO, OO0 O INSURER D: DOLLISTOO MO 01740 INSURER E: INSURER F: REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: TOIS IS TO DORTFO TOOT TOO DOLMWS OF ISOROOOO LISTOD BOLOW DODO BOOO ISSOOD TO TOO ISOROD DOMOD OBODO FOR TOO DOLIO DORIOD DWOTODMOTWOSTOODWO 000 ROOOROMOOT, TORM OR DOODTOO OF OOO DOOTROOT OR OTOOR DODOMOOT WTO ROSOOOT TO WOWO TOLS DORTMOTO MOO BO ISSOOD OR MOO DORTOW, TOO MSOROOOO OFFORDOD BO TOO DOLMMS DOSORBOD DOROM IS SOBWOT TO OLL TOO TORMS, OOOLOSIOOS DOD DOODTOOS OF SODO DOLWISILIMTS SOOWO MOO 0O00 BOOD RODOOOD BO DOD OLOMSO POLICY EFF POLICY EXP ADDL SUBR LIMITS INSR POLICY NUMBER TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/Y YYY) INSR WVD LTR 0000 O0OORRO00O 00,000,000 DOMMORDUL DODOROL LOBILTO DOMOOD TO ROOTOD 01,000,000 OLOMS-MODO • ODOOR OROMISOS Ina ollErrenten 010000 MOD 000 @nOone Cercond • Deneral Labtito DORSODOL D ODO MCDRO 110000004 11000000 08 SBO 001088 0000,000 DODOROL OOOROOOTO 04,000,000 00O0 000ROOOTO LIMO DOOLMS DORO DRO- DRODOOTS - DOMDOO DOO 04,000,000 DOLMO LOO MOT OTDORO DOMBWOD SWOLO LIMIT 00, 000,000 AUTOMOBILE LIABILITY BODIO MEDRO Mer Cercono 0OO DOTO SODODOLOD OLL OWOOD BODIO mEDRO mer allidento 18 SBO 001088 110 000000 1101 000004 DOTOS DOTOS DRODORTO DOMDOO DOD-OWOOD DIROD mer allidento DOTOS DOTOS 0000 OODORROOOD ODDOR 01,000,000 UMBRELLA LIAB OLOIS- EXCESS LIAB 01,000,000 DOORODOTO 11001000 18 SBO DO1088 MODO 110 00D04 DOD O ROTOOTOO 010,000 WORKERS COMPENSATION ISTOToTO I AND EMPLOYERS' LIABILITY YIN 0400000 000D00T 01,000,000 18 WOO 0B8000 101 D0D004 01,000,000 01,000.000 DAL/DISTEST - DOLDO LIMI DISORITOO OF OGOROT ODS below 010000 Dam Olam Lmt OMOLOOMOOT DROOTMOS 18 SBO 001088 010,000 Otterate LIt DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Tore uttal to the intredmOteration CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ottof Daubrdde BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED OtDall IN ACCORDANCE WITH THE POLICY PROVISIONS. 700 MOSSOOOOSOTTS 000 AUTHORIZED REPRESENTATIVE DOMBRIDOO MO D0100 Suoan d. Castareda © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25(2016/03)

0710 5270 1153 Postage Certified Mail Fee Total Postage and Fees _ Adult Signature Required • Return Recept (electronic) Return Receipt (nardcopy) L Certified Mall Restricted Delivery Domestic Mail Only ang Apt. No., or PO Box No: • Adult Signature Restricted Delivery S U.S. Postal Service™ y 2023 PSN 7530-02 000-9047 Extra Services & Fees (check box, add fee as appropriate) CERTIFIED MAIL® RECEIPT 02139 Here sanTo FresidaBe Fellas of Havel Colege UN 2 0p031035 For delivery information, visit our website at www.gsps.com® See Reverse for Instructions 1153 0710 5270 8368 02 Postage Sent To Certified Mail Fee • Adult Signature Required Total Postage and Fees Retum Receipt (hardcopy) • Retum Receipt (electronic) Domestic Mail Only • Certifled Mall Restricted Dellvery • Adult Signature Restricted Delivery S PS Form 3800% January 2023 PSN:7530 U.S. Postal Service™ Extra Services & Fees (check box, acc fee as appr NC 28203 CERTIFIED MAIL® RECEIPT Cander Ba Suite 210 02139 For delivery information, visit our website at www.usps.com JUN 2 PHere925 BATRAL SQUARE See Reverse for Instructions Al batesavor LP clo Asana Putres Li

tiw theaten bulb not actual colors TBD BAR 11w theatre hutb Sign Type: DOUBLE SIDED PROJECTION SIGN BRAS-ER 67" 100" 118" 1.0.0 Drawing Date: 03/17/15 Approved By: Project Name: BEAT BRASSERIE Drawing number: projection 1/10th scale of sign (height of sign) to bottom 240* to top of sign www.bostonsign.com bostonsign 40 Plympton Street Boston, MA 02118 Tel. [phone removed] Fax 617+482-4825 depth of sign: 30" weight: 160lbs height of sign: 144" (through-bolted to brick wall) to top of sign: 240" to bottom of sign: 96" projected from building: 60"

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUI CAMBRIDGE, MASSACHUSETTS 0213 PHONE [phone removed] FAX [phone removed] PAULA M. CRANE DIANE P. LEBLANC DEPUTY CITY CLERK CITY CLERK Cambridge, June 18 → 2025 To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. The undersigned respectfully prays that Lou's Harvard Square (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at 13A Brattle Street (ADDRESS) Type of Sign: electric projecting sign (state whether electric or otherwise and material used in construction) Reading matter to go on Sign: Food, Drink, Music, Lou's 107"x28" Size: Weight: 200lb - Public Way A. 36" Obstruction: в. 11'5" (Also exact distance from bottom of sign to sidewalk) (Give exact distance sign is to extend over sidewalk) Bottom: 11'5" Top: 20'5" Height Above Grade: NOTICE - REGULATIONS Section 1212.0 State Building Code- Projecting Signs] [Section 12.08.010 Municipal Code - Encroachments onto Strects] • A projecting sign shall be constructed wholly of incombustible materials. • All signs must meet requirements of Zoning Ordinances and Building Code. • Note: Section 12.12.220 provides in part "every owner who maintains a... structure in or over a street... Shall do so only on the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such. structure." PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY. , 1927100. Attorenfor Owner 907 Mass Ave, Cambadge MA 6i7 (Tel. No.) (Property own (Address) [phone removed] 907 Mass Ave, CambracMA - Attorney for Operator (Tel. No.) (Bupiness owne)

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] DIANE P. LEBLANC PAULA M. CRANE CITY CLERK DEPUTY CITY CLERK Cambridge, June 18 _ 2025 To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. The undersigned respectfully prays that Lou's Harvard Square (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at 13A Brattle Street (ADDRESS) Type of Sign: eleciric projecting sign (state whether electric or otherwise and material used in construction) Reading matter to go on Sign: Food, Drink, Music, Lou's 107"x28" Size: Weight: 200lb - Public Way Obstruction: A 36" в. 11'5" (Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk) 11'5" Height Above Grade: Bottom: Top: 20'5" NOTICE - REGULATIONS [Section 12.08.010 Municipal Code - Encroachments onto Streets] Section 1212.0 State Building Code - Projecting Signs] • A projecting sign shall be constructed wholly of incombustible materials. • All signs must meet requirements of Zoning Ordinances and Building Code. • Note: Section 12.12.220 provides in part "every owner who maintains a... structure in or over a street.. shall do so only on the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such. structure." PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY. Attorentor Oroner 907 Mass Ave, Cambrdje MA Liz, 192-7100. (Property ow orthorized agent) 492-4100 / 617 Attorney for Opelator 907 Mass Ave, Cambrae MA (Address) (Tel. No.) (Business owner)

CITY OF CAMBRIDGE INSTRUCTIONS FOR OBTAINING PERMISSION FOR PERMANENT SIGNS AND AWNINGS THAT PROJECT OVER THE PUBLIC WAY MORE THAN SIX INCHES 1. Complete the Building (Sign) Permit Application on line at the Inspectional Service Department or on a personal computer. Inspectional Services Department is located at 831 Massachusetts Avenue, [phone removed]. Items that must be scanned and attached to online application: Sketch or drawing of sign or awning • Copy of sign company's contract Insurance 2. Projected Sign Application and Abutter Forms are available at City Clerk's Office, Room 103 City Hall, 795 Massachusetts Avenue, [phone removed]. 3. Complete application. Application must be signed by business owner and property owner black ink only. You must measure and state the distance by which the sign or structure will project over the public way. This application is signed under the pains and penalties of perjury. If you have difficulty ascertaining the distance, you may wish to use a surveyor. Complete the abutter forms. After completing steps (1) - (3), file the application with the City Clerk. The completed application can be dropped off at the City Clerk's Office or e-mailed to Iperez@cambridgema.gov. 4 The Clerk will place the application on the agenda for a City Council meeting for its consideration. • During the months of September through June, the City Council meets every Monday at 5:30 p.m. except for Monday holidays. During July and August, the City Council holds one summer meeting. Applications must be received at the City Clerk's office on the Thursday prior to the Monday meeting. • After the City Council has approved the petition, the City Clerk will send the petitioner an unexecuted bond form. 5. Petitioner must have the bond form executed by a Surety Company and then return it to this office. 6. When the executed bond is returned to the City Clerk's Office, the City Clerk will approve the application that bond is acceptable. ISD will issue a building permit to the petitioner, so long as all building permit requirements have been met. The petitioner can obtain the sidewalk obstruction permit from DPW. Revised December 11, 2017

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] HAX [phone removed] PAULA M. CRANE DIANE P. LEBLANC CITY CLERK DEPUTY CITY CLERK June 18th Cambridge, - 2025 To the Honorable, the City Council of the City of Cambridge: EACH PETITION MUST BE ACCOMPANIED BY A DRAWING OF PROPOSED SIGN, INDICATING DESIGN AND DIMENSIONS AND LOCATION ON PREMISES. The undersigned respectfully prays that Lou's Harvard Square LLC (NAME OF BUSINESS) be granted permit to erect a sign of the following specifications in front of premises located at 13 Brattle St, Cambridge MA 02138 (ADDRESS) Type of Sign: Electric, Blade Sign (state whether electric or otherwise and material used in construction) Reading matter to go on Sign: "LOU'S" 107"H x 28"W x 17"D . 200 lb Size: Weight: Public Way 28" 11' A. B. Obstruction: (Give exact distance sign is to extend over sidewalk) (Also exact distance from bottom of sign to sidewalk) Height Above Grade: Bottom: 11' Top: 20' NOTICE - REGULATIONS [Section 12.08.010 Municipal Code - Encroachments onto Streets] Section 1212.0 State Building Code - Projecting Signs] • A projecting sign shall be constructed wholly of incombustible materials. • All signs must meet requirements of Zoning Ordinances and Building Code. • Note: Section 12.12.220 provides in part "every owner who maintains a ... structure in or over a street... shall do so only on the condition that such maintenance shall be considered as an agreement on his part to keep the same and the covers thereof in good repair and condition, at all times during his ownership, and to indemnify and save harmless the City against any and all damages, cost or expenses which it may sustain, or be required to pay by reason of such...structure." PROPERTY OWNER OR AUTHORIZED AGENT HEREBY STATES THAT INFORMATION IS TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND UNDERSTANDING UNDER PAINS AND PENALTY OF PERJURY. John DiGiovanni 50 Church St, 5th Floor, Cambridge MA 02138 [phone removed] (Property owner or authorized agent) (Address) (Tel. No.) Thomas Keane 175 Portland St, Suite 4, Boston MA 02114 [phone removed] (Business owner) (Address) (Tel. No.)

OFFICE OF THE CITY CLERK CAMBRIDGE CITY HALL, 795 MASSACHUSETTS AVENUE CAMBRIDGE, MASSACHUSETTS 02139 PHONE [phone removed] FAX [phone removed] TTY/TDD [phone removed] PAULA M. CRANE DIANE P. LEBLANC DEPUTY CITY CLERK CITY CLERK ABUTTERS FORM FOR SIGN/AWNING PERMIT Date To Whom It May Concern: As Owner of Agent of Cambridge, of the approval Massachusetts, I do hereby declare my disapproval installment of: Canopy over the sidewalk entrance: Awnings over the windows: Projecting sign: of said property. Date Signed: Address: ABUTTERS: PLEASE COMPLETE FORM WHETHER OR NOT YOU APPROVE OF THE REQUESTED SIGN/AWNING AND RETURN IT TO THE APPLICANT WITHIN SEVEN (7) DAYS FOR INCLUSION IN THE APPLICATION. SIGN/AWNING APPLICANT: PLEASE FILL IN DATE THAT FORM WAS DELIVERED TO ABUTTER (TOP RIGHT OF THIS FORM)

The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Legibly Applicant Information Name (Business/Organization/Individual): NE Neon Co Inc. Address: 150 Kuniholm Drive Unit #3 Phone #: [phone removed] City/State/Zip: Holliston, MA 01746 Are you an employer? Check the appropriate box: Type of project (required): 4. • I am a general contractor and I 1. LX I am a employer with 3 6. • New construction have hired the sub-contractors employees (full and/or part-time).* 7. Remodeling listed on the attached sheet. 2. L I am a sole proprietor or partner- These sub-contractors have 8. L Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. L Building addition comp. insurance.‡ [No workers' comp. insurance 10. Electrical repairs or additions 5. L We are a corporation and its required.] officers have exercised their 11. Plumbing repairs or additions 3.L L am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. 12. • Roof repairs c. 152, §1(4), and we have no insurance required.] f 13.E Other Signage employees. [No workers' comp. insurance required.] *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. Corkin Insurance 180 Wells Ave, Newton MA 02459 Insurance Company Name: 08wecab8xe6 Expiration Date: 11/16/2025 Policy # or Self-ins. Lic. #: Job Site Address: 10 Old Colony Rd City/State/Zip: South Boston MA 02129 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. 05/08/2025 Date: Robent Tuttle Signature: [phone removed] Phone #: Official use only. Do not write in this area, to be completed by city or town official. Permit/License # City or Town: Issuing Authority (check one): 10 Board of Health 20] Building Department 3]City/Town Clerk 4. Electrical Inspector 5L Plumbing Inspector 6.LOther Contact Person: Phone #: