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Home My WebLink AboutBuilding Permit #652 - 1600 OSGOOD STREET 5/28/2009 BUILDING PERMIT o*"°RT"�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedA�q,T.o �y n� � �SSACHl1`'E•C Date Issued: f IMPORTANT: Applicant must complete all items on this page LOCATION too 0.5 PROPERTY OWNER � S i's�t I✓L Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial teration No. of units: Commercial Repair, replacement Assessory Bldg Ot ers: Demolition Other �Qw Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ±f c t Identificatio lea a Type or Pri Clearly) OWNER: Name: 5e S h I C ul Phone: Address: ,$-7"Ylcs<-rc^z:..•.,.. �uc� '.,.:r�Z--x.iv� ..•v 4 ,_ s. CONTRACTOR Name: / ¢c.c.s .,nom Phone: t5�- 9�;6 Address: f2- 4h , CJ�r-y_ �S'L-2c. •, rt c. 14A- n z_c�,c Supervisor's Construction License:GS ?8 O ZS4- Exp. Date: AS/2It c, Home Improvement License: Exp. Date: ARCHITECT/ENGINEER d l'=P�� 1 Co I%j C6� Phone: 1 d" t— 7 yq'7 3 23 LJe0 1F-,^5,A P-er'^ Address: i nA L n vA 1tth o 2061 Reg. No. 21 FEE SCHEDULE:BULDING PERMIT:$12.00 PE $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ _ FEE: $ �i Check No.: Receipt No.: o29 10,6 NOTE: Persons contractin �nregistered contractors do not have access to the guaranty fund signature of Agent/O _ _ Signature of contractors ''- '�-� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENTOD `� d COMMENTS re al r�� / CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract . ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans(One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location /('00 O-S-'lOO cr J'?— No. Date 4��2.F9 TOWN OF NORTH ANDOVER 3? ' �c • � s Certificate of Occupancy $ /DU ;�SSACNUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J Check # X06 err � 2LtJli / Building Inspector Mai 28 2009 3: 24PM HP LASERJET FA}{ 508-966-2172 p. 2 The Cowwnwealfh ofManachuse&N Department o,f Ind trial Ae denfa office of Inve ' utiorrs - 600 Yashin x S&rd 1J if .Boston, M4 02111 www mass v/dia . Workers' Compensation Insurance Affidavit: dere/Contractors/EleatHciansMlambers A InformatiGn. Please Print L 'bl Name(Businrssf poiza6an4ndividuall: Petroleum' Engineering Inc. Address: 12 William way City/sti te/4r. Bellingham, MA 02019 ani~ 508-966--1500 . ------------------ Are you as empbyer?Cheek.,the appropriate box: " Type of project(requites: CS 12am a employer with 25 4. ❑ 1 am a general ut=or uld I 6. ❑No-constructiati . employees(full and/or part-time),* have lured the ounbactors 2-❑ 1 am a:solz proprietor or partner- listed on the d sheat.Y 7• C Rt modeling ship and have no employees These su&co ra have 8. ❑ Demolition working f+ar main any capecity. workers' comp.insurance. 9. ❑Building addition [No woricers,comp, insurance 5. ❑ We are a empm aficm and.its 10.Q.Fslearricel required.] officers have cised teir rqx=or additions 3.❑ 1 kin a homeowner doing all work right of exempti on per INCL 1 L❑Plumbing repairs or additions myself [t+io•wot#cers'camp. c, 152., §1(41 ain d we have no 12.0 Roof repairs insursmc:required]f -*r4Ao'Yr as. [No wotkmp I3.❑ cutup. insurance required] •Airy appliaeltt fitit Cracks ha#t mar etao fiH oetthe senden below thawing Gurir, ate'boaftPaneetion paphey infli anon. Romaownera who submtt ttas a itlavit indiceting Gley aredaing ail vrt rk and Ibm h onside eonnawrs salst submx gnaw affidavit indiasiingraclt �oeniators Nast CheoFt Nets haat tanm atbaleed ana3r9tiosai sheet sbewitrg tha name th&-b.awftetois and their waders'ag- Purley ir+itoroutia►. I am qtr etrgtloyer that is pr df tvorktrs`t etseptalrsadeal axis for rrey emPlo Def0 v ir-4e palfey aadM we . h�ar�iwt. lmmnwee Company Name: ' National Union Fire Ins. Co. WC5317133 1/1/10 Policy 9 or Self-ins. Lic,A Expiration Late: Bay State Biofuels, 1600 Osgood t. Job SifAddrosr Ciiy/31ste/Z;ip: No. Andover, PIA 01$45 Attach a copy of the workers'coaltpeotitttiou policy decEawatioo pap(showiaglho policy number and expiration date) Failure to secure coverage asrequired under Section 25A of M(3L c. 152 tom►lead to the imposition of criminal pcnaltin of a- fine up to$1,56x.00 and/or one-yaw ing ris mnent;as well as civil P4710fies in the form of a STOP WORK OgDER and a firr_ of up to$250.00 a day against the vioiatw. Be advised that a copy of this sent may be forwarded to the Office of Investigations of the FOIA-fur insurance coverage verification. I do herd.V certify+ruder the pains and penalties ofperjury that the ata pwvided above is aw me coned. 5/22/09 Phone Ralph F. Meier, president 508966-100 O, trial ase rm y. Do trot wale in thk area,to he warpieted by or town off dat City or Towel: Perm icense# - Issuing Alatliorify(circle sue): 1. Board of Hen" 2.Bailding Ilepartment 3.Cltyrrown"Cie d EIewetnc�l laspeaor::1:G=Wb ilsg inspector 6.Other Contact Person: Phone#: MAY-28-2009 12:52PM From: 508 966 2172 ID:OZZY PROPERTIES Paee:002 R=95% __ May 28 2009 3: 24PM HP LRSERJET FAX 508-966-2172 p. 3 D CERTIFICATE OF LIABi1,ITV INSU NCE 0P10 ACDROR PETRO-1 05/22/09 PRODUCER THIS CERT FICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AXiA EAST Insurance HOLDER.7 HIS CERTIFICATE DOES NOT AMEND,EXTEND OR 73 Market Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield MA 01103 Phome:413-205-2942 rax:413-896-0190 INSURERS AFFORDING COVERAGE NAIC N msu2ED INSURER A: Evanston Insurance C:otIIpan INSURER B: PhilAdalyhia Dmuz®ca Camyani Petroleum Sagi.neering Inc. msuRERc: National Union Company 12 WRy Bellinghamam MR 02019 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTEDBFIOW HAVE BEEN ISSjED TO THE INSUREDNAI&O ABOVE FCQ THE IOLIC PERIOD INDICATED.NOTMTHSTAINCING ANY AEDUIREI+IENT,TERM OR CONCITI ON OF AN,CONTRFCT OR 0-1-ER DOCUMENT WITH RESPECT TO WHICHTHIN C5RTIFICATE MAY BE ISSUED OR IAAY PERTAIN,THE INSURANCE AFFORDED BY THE POLIC ES DE SCRIBED HEREIN IS SUE ACCT TO ALL THE TERVIS, -LUSIONS AND CONDITIONS Of SUCH POLICIES.AGGREGATE LIMITS SHOWN M-,Y HAVE BEEN REDUCED BY PAID CLAIMS. L7R N9 TYPE OF INSURANCE POLICY NUMBER DATE LMMR)DF/Y} DATE IMMIDD LIMBS GENERAL LIABILITY EACH OCGLNR£NICE $ lOOOOOO I A X COMMERCIAL GENERA�LUABILITY 08P100017SS 07/18/08 07/18/09 PREMISES(Ea 005 $50000 IM CLAS MADE FX]OCCUR MEO EXP(A7 w,-Person) IS5000 PERSONAL A AD'S 114JURY $ 1000000 7{ Pollution yiabils GENERALAGGPEGATE $2000000 GENLAGGREGATE LIMTAPPLIESPER: PR�tKTS-COAIPvOPAGG S 20ODOOD POLICY7 Floc AUTOMOBILE LIABILITY CONBINEDSINGLELIN IT $ iEa acciderd} ANY AUTO ALL OWNED ALFF05 30DILY INJJRY ,Per Person; $ SCHEDULED AAlTOS HIRED AUTOS BODILY INJURY $ per accident) NON-OY NED AUTOS PROPERTY DMMGE $ {Per acciderd J,IGARAGIA&LIN EA ACC AUTO ONLY-EAACCIDENT $ UTO OTHERTHPN $ AUTO ONLY: AGG $ MTBRELIALWBfi.RY EACHOCCURRE:NCE $4000000 R C ClA1MS MADE 08ErX0036 07/19/0 07/18/Q9AGGREGATE $4000°00 xTIBLE NTION $10000 $ YYCIRKERS COMPENSATION AND X TORY�IV11T5 ERIT . C EMPLOYERS'LIABILITY we 005-31-7133 01/01/0 01./01/10 E.L.EACHA==DENT $1000000 ANY FRCPRIETORIPARTtiERtEHECLI-IVE OFFICER/MEMBEREXCLUDED'T E.L.DLSFJ•SE-EAEMPLUYEE $1000000 Ir es,ieeoibe under EL DISEASi-POLICY LIMIT $1000000 SPECIAL PROVISIONS belcw LOTHEIRIme FHSD40561 03/11/0 03/11/10 DESCRIPTION O ERATTDNS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED 13Y ENDDRSE'TdENT I SPEGAL PR VISIONS RE: Bay state Biofuels *30 Days 43L & t2M/10 Days VIC CERTIFICATE HOLDER CANCELLATION NA01845 340ULD AN OF Tr£ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI•E EXPIRAT ON DATE THE DF,THE ISSUING WSURER WILL ENDEAVOR TO WAIL 'k DAYS WRITTEN NOTICE TD')4E CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO 9-ML Town of North Andover IMPOSE NO 3BLIGATION OR UASIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Building Department REPRIESENIATIVES, 1600 Osgood street Cihael QWED REPRESENTATIVE North Andover MA 01845 Hackett ACORD 25(2001!08) ®ACORD CORPORATION 1988 MAY-28-2009 12:53PM From: 508 966 2172 ID:OZZY PROPERTIES Pa9e:003 R=95% OFFICE OF BUILDING INSPECTOR _ TOWN OF NORTH ANDOVER ' CO STRUC CONT ao- L PROACT NUNBER. PROJECT TITLE:{. �'w 51r, —0 PROJECT LOCATION: 1(0 Q O —�-- I NAME OF 9UILDINQ: r'j d r NATURE OF PROJECT.—Cao—ct e e��a�1 IN NCE WITH ART7CL� 419 OF THE MASSACHUSETTS STATE BUILDING CODE=S 1. o R r — t° U I r c c c� REGISTRATION NO. Z 7 13EING A REGISTERED PROFESSIONAL ENNLNNEMARCHITECH HEREBY CEWIFY THAT t HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICA ONS CONCERNING: ENTIRE PROJECT 70 ARCHITEC ruRAL o STRUCTURAL a MECHANICAL CI FIRE PROTECTION LJ ELECTRICAL. 0 OTHER(SPECIFY) FOR THE ALCOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE,SUCH PLANS, COMPLITATIONS AND Sf''MFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE]BUILDING CODE,ALL ACCEpTAINI EMINEERING PRANCES. AND APPLICABLE LAWS AND ORES FOR THE PROPOSED USE AND OCCUPANCY. 1 FURTHER CERTIFY THAT I SHALT,PERFORM THE NECESSARY PROFESSIONAL SI:RNICES AND S EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOGUMI3VTS APPROVED FOR i'F BUILC ING PERMIT AND SHALL 8E RESPONSIBLE FOR THE FOL.LOIMNO AS SPECIFIED IN SECTION 118.0 4. Review, far 00nf0nTW=to the design concept,shop Mnples and adw submittals mAir h are submitted by the�'in�e wtth the requlrlmrrw1,2 of tN aonMruetion docurrlta 2. Review snit approval of the gustily control Pr'xedures for an c3ode`m"uirod a rltroiled rna%rials. 3. Be present at lntmvels qVmprjWz to the bmomM stale of connn to %*htte Programa and quanty of the w�tc and to detwMI ml tMrrrinat performed In a mariner conslstenl with tt+e CO docunwft + iE the worlt Is beim PURSUANT TO SECTION 116.2.2 1 SMALL SUBMIT WEMY, A PROGRESS REPORT TOGErMER WITH PMTINFNT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. CTtJfd. UPON COMPLETION OF THE WORD(.I SHALT,SUBMIT A FINAL REPORT AS TO THE MTISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR SUBSCRIBED AND SWORN TO BEFORE ME THIS,2.�`2w„ DAY OF tea; NOTARY aL,tC a + +MOPPM Notary Public My COA+1 WISSION SIRES Commonwealth of Massachusetts My Commission March 7, 2014 Ices MAY-28-2009 12:57PM From: ID:OZZY PROPERTIES Pa9e:002 R=100% Nab 28 2009 3: 25PN HP LRSERJET FAX 508-966-2172 p. 4 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the poli y(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require ai endorsement. A statement on this certificate does riot confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance cn the reverse side of this form d es not constitute a contract between the issuing insurer(s),authorized representative or producer, and the certificate holder,,nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. I i I ACDRD 25 J200108) MAY-28-2009 12:53PM From: 508 966 2172 ID:OZZY PROPERTIES Pa9e:004 R=95% Mai 28 2009 3: 25PM HP LASERJET FAX 508-966-2172 P. 5 DATE(MNYDDlYYN11 ACORD. CERTIFICATE OF LIABUTY INSU NCE PrTRoR 05122/09 PRODUCER THIS CER7 FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AX:iA LAST Insurance HOLDER,7 NIS CERTIFICATE DOES NOT AMEND,EXTEND OR 73 =Lrket Place ALTER THI COVERAGE AFFORDED BY THE POLICIES BELOW. spriagfield ISA 01103 Phone;413-205-2942 rax:413-886-0190 INSURERS FORDING COVERAGE NAICI$ INSURED INSJRER A Lvanston Insurance Company INSURER B: Philadelphia Tnswanee eerrpaaL Petroleum Engineering Inc. INsuRERc National Union Company Way Belltngbamam Mh 02019 INSURER D: INSURER E: COVERAGES 'T-E POLICIES OF INSURANCE LISTED BEL CW HAVE BEEN ISSJ£D TO TIE INSURED W)&D ABOVE FOR THE POLIO FERIOD IND CATED NOTIMTHSTANDING ANY FZEQUIRENENT,TERM OR CONDITION OF AN"CONTRACTOR 3-HER DOCLMIENI WITH RESPECT TO YVMCH THIS CERTIFICATE MAYBE ISSUED OR 14AY PERTAIN,THE INSURANCE AFFDRDEO BY THE POLICES DESCRIBED'iEREIN IS SUBJECTTO ALL THE TERNS,EDKCLLr.KM AND CONDITIN45 OF SUCH POLICIES.AGGREGATE L4MITq-SFiDWN MWY HAVE BEEN REDUCED BY PAID CLAIMS. LIR NSR TYPEOFINSURANCE POLrYNIFOLOY 12-1-15a WE Pour-YexFWATKM UMBER DATE(RIMJDD DATE(MMIDDIWI LIMITS GENERAL LIABILITY EAC--iOCCURz£N,CE ;$1000000 p, X COMMERCIAL GEhERALLIABILITY OBPKIC301756 O7/18/OB 07/16/09 PREMIS£s Eloc=urerre S 50000 CLAIMS MADE ®OCCUR MED EXP(Arlo on;person) $ 55000 PERSONAL SADV INJURY $1000000 7C Pollution Llabili GE NERAL A3GREGATE $2000000 GEN'L AGGREGATE LIMTAPPLIES PER: PRC'DUCTS-COl,1PIOP AGG $2000OOD POLICY 'X'�j LOC AUTOMOBILE LIABILITY CONBI ED SWKE LIMIT $ (Ea accidert) ANY AUTO ALLOWNEDAUTOS 300ILYINJLIRY $ ;Per person) SCHEDLLED AUTOS HIRED AUTOS BODILY INJURY $ per acddord) NON-OVVNED AUTOS PROPERTY CAKAGE $ (Per®ccideni, GARAGE LKELILIII' ALIO ONLY-EAACGDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGS $ EXCESSIUMBRELLALIABILTTY EACH OCCURRENCE $4000000 ]� OCCUR CLAIMS MADE OSFJT0036 07/18/0 07/18/09 AGGREGATE $4000000 S DEDUCTIBLE $ X RETENTION 510000 $ WORKERS COMPENSATIONAAC X TORY_IYfRS I I ER EMPLDYERS•LIABiLTTY WC 005-31-7133 01/OL/0 01/01/10 E.L.EACH A'CCiDEKT $1000000 C ANY PROPRIETOFWARTNIERIE:CECUTIVE OFFICEcMEMEER£XCLJDED? E.L.DiSEAS=•EA ENPIOYEE $1000000 I yes,describe under E.L.DISEAS POLICY LIMIT $1000000 SPECIAL PROVISIONS below OTHER B Crime PUSD40561 03/11/0 03/11/10 DESCRO TION OF OPERATIONS I LCCATIONS 1 ES f EY.CLUSIO S ADDED 13Y EINDOKSEWMI I SP CIAL PRC VISIONS 30 Days GL & UMB/1D Days WC CERTIFICATE HOLDER CANCEL TION BA01845 SHOULD AN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THERE OF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL * DAYS WRITTEN NOTICETO I HE CERTIFICATE HOLDER NAMED TO THB LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITYDF ANY KIND UPON-THE INSURER,ITS AGENTS OR Bay State Biofuels REPRESEMoklIVES. 1600 Osgood Street AUTHOR ZED REPRESENTATIVE North Andover MA 01845 Michael Hackett ACORD 25(2001AIS) 0 ACORD CORPORATION 1$88 MAY-28-2009 12:53PM From: 508 966 2172 ID:OZZY PROPERTIES Pa9e:005 R=95% Mai 28 2009 3: 26PN HP LASERJET FAX 508-966-2172 p. 6 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the poli y(ies)must be endorsed. A statement on this cernirate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 iot confer rights to the certificate holder in liea of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form d es not constitute a contract between the issuing insurer(s),authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001108) MAY-28-2009 12:54PM From: 508 966 2172 ID:OZZY PROPERTIES Paee:006 R=95% Mai 28 2009 3: 26PM HP LRSERJET FAX 508-966-2172 p. 7 From:Ernily Lingham FaAD, Paye 2 of Date:5QaMOD 01:49 PM Pagw2 of3 CORD CERTIFICATE OF LIABILITY INSURANCE aP� �16 °"TE`"�DI)NM' PETRO-1 05/27/09 PRODUCER THIS CERTIFI ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND INFERS NO RIGHTS UPON THE CERTIFICATE Lim Insurance Agency, Inc. HOLDER.TM CERTIFICATE DOES NOT AMEND,EXTEND OR 327 Union Avenue ALTER THE VERAGE AFFORDED BY THE POLICIES BELOW. Framingham MA 01702 Phone: SOB-672-0662 FaX:508-879-5299 INSURERSAFF RDINGCOVERAGE NAIC# NsuRED IPM ER,a P erless Insurance Company INSURER B: Petzleum Engineering, Inc. NSURERC: 12 WI11 iam My NSURER D. Bell agham MA 02019 INSURER E: COVERAGES THE POLICIES OF INSJRANCE LISTED BELOW HAVE BEEN ISSUED TO Tf-E INSJRED NAMEDABOVE FOR THE POLICY PEJ RJOD INDICATED.K0_"THSTANDM ANY REOU IREMENT.TERM OR GOND 1710N CFMY CCNTRACT OR OTHER DOWENT WITH RESPECT TO A4CH THIS CEF TIFICATE MAY EE ISSUED OR MAY PERTAIN--HE INSURANCEAFFCRI)EO BY TIIE POLICI ES DESCR•I BED HERE W IS EUBJECT TO ALL THE TERMS, AND CCND PIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOAN MAY HAVE BEEN RECLCE:EY PAID CLAIMS. LTR INME TYPE OF NSURIVI E POUCYNUMBER DATE JWMXffr, D ItTEINWI)DIM LIMBS GENERAL LIABILITY EACH OCOJRREISE 5 COMMERCIAL GENERALLABIII-1' REMISES(Ea occurence) I$ CLAIMS MACE 7 OCCUR MED E)P(Ary one Porsan) $ PFRSUVAL&ADY INJURY $ GENERAL AGGREGATE $ GENU AGGREGATE LIMITq�FLIES PER PRODUCTS-COMWOP ASS $ POLICY PR,T LOC AUTOMOBILE LWBIITY CGMBRIEDSNGLELMI- 11000000 A ANYauTo 8A6371207 01/01/09 01/01/10 IEescad") AL'_OWNED AUTOS BCOILY INJURY $ X SCHEDULED AUTOS IPot perconi X HIRED AUTOS BCDRYIN.RMY $ X NQ^J-C�NNEDAUTOS (Peracarorl) PROPERTYDAMAGE $ (Per aodcwq) GARAC:E LIABILITY ,•TIRO ON-Y-EAACCICENT S ANY ALTO OT--ER THAN EA.ACL B AUTO CAA YAGG $ EXCESSIUMBRELLA LABILITY EACH CCOUFUZENC=_ g UCCLIR a_LAIrrdS MADE AW4*GATE $ $ DEDUCTIBLE S RETENTION $ $ WORMERS COMPENSA7ION AND TORY LIMIlS ER EMPLOYERS'LIABILITY ANY PROPR:ETORPARTNERA7.ECUTIVE EL.EACH ACCIDENT $ OFF ICER/MEMBEREXCLUDED? EL.DIEEASE-EAEMPLOYEE $ R yes,clis.rrbe under SPECIAL PROVISIONS bebw EL.DfSEASE-POLICYLNT $ 07PER DESCRIPTION OF OPERATIONSILOCA'TIGNS IVEHICLES,EIXCLLMONSAODSORY ENMRSEMENri3FECAL PROV:61 CERTIFICATE HOLDER CANCELLATION aYse i SHOULD ANY OF ABOVE DESCRIM POLICIES EE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, ISSLRNGINSURER WILL ENDEAVORTO MAL 20 DAYS WRITTEN NOTIC E TO THE C E TIMATE HOLDER NAD TO THE:LEFT.MR FAILURE TO DO 80 SHALL Say state Biofuels KE 1600 Osgood 6t, IMPOSE NO OBLIOA ION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR N. Andover IMA 01845 REPRESENTAIWES. AUTHORIZED-WISPRE f ACORD 23(2001108) 41MACOAD CORPORATION 9991 i I MAY-28-2009 12:54PM From: 508 966 2172 ID:OZZY PROPERTIES Pa9e:007 R=95% Mai 28 2009 3: 26PM HP LASERJET FRX 508-966-2172 P. 8 FrowEmily Lingham Faxlo: Page 3 of 3 Oate;52&2COS 01:49 PM Page:3 of 3 A ORD. CERTIFICATE OF LIABILITY INSU NCE GP ITA0-D �1 05/27/09°"TE("u'DDhNY''' P1r PRODUCER THIS CERTIF CATE IS ISSUED AS A MATTER OF i wFORMATION ONLY AND C NFERS NO RIGHTS UPON THE CERTIRCATE DJM Insurance Agency, Inc. HOLDER.TH CERTIFICATE DOES NOT AMEND,EXTEND OR 327 Union !►Vlnue ALTER THE OVERAGE AFFORDED BY THE POLICIES BELOW. rtamingham MA 01702 Phoue:508-872-0662 FaX:S08-879-5299 INSURERSAF RDINGCOVERAGE MAC# INSURED INSURERA Peerless Insurance Ccapany INSURER& Petrplekml Lngineering, Inc. INSURER C' BellinghaaaaaL MAy02019 NSU 0�o: INSUPER Er COVERAGES THE POLICIES OF INSURANCE LISTED BELOWHAVE BEENISSLIEDTC THE INSURED I'ANIEC ABOVE FORTHE POLICY PE RIDD INDICATED.NOTWITHSTANDING ANY REOL IREKSYT,TERMOR COND TION CF ANY CONTRACT OR OTHER DOCIAIENT WITH RESPECT TO WHICH THIS CE ZTFICATE MAY BE ISSUED OR NAY?ERTAI.V,THE INSU ANCE.AFFCRDED SY TAE POLICIES DESCRIBED FEREIN IS SUBJECT Tr_ALL THE TERMS,EX IONS ANIO cpNDRIONSGF S.JCh POLICIES.AGGREGATE LIMITS SHOWN NAY HAVE BEEN REDUCED BY FAIR CLAIMS" LTR YSA TYPE OF NSURANCE POLICY NUNBEi DATE Mry PI L&;T L lDOIYYI LIMfT8 GENERAL LIABILITY - EACH OCCURRENCE I COMMERCIAL GENERAL LIABILITY PREMISES(Ea 6CCtJreAGet S CLAW MADE OCCUR AFD EXP GAM a no person) ; PERSONAL 8 ADV INJURY $ GENERAL AGORECATE ; GEN'_AGGREGATE LIMITAPPL ES PER: PRODUCTS•COMPIOP A.G3 S POLICY PRO .QCT LOC AUTOMOBILE LIABILITY A ANYAurD SM372207 01/01/09 01/01/10 CONIBIidamt) 6LEUNNT COMBNEE) $1000000 AL L OWNED AUTOS BOOT_"INJURY S X SCFEOl1LED AUTOS (Pot persol) X HIRED AUTOS BCOILYINJURY X NON-OWNED AUTOS (Per sccidadT S PROPER:Y DAMAGE S (Par acident) GARAGE LIABILRY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER7HFJd EAAr:C S AUTO ONLY: ASO S EXCESSILMBRELLALMBIUTY EACHGCCJRRENCE ; OCCUR F-1 CLAJMS MADE AGGREGATE ; S DEDUCTIBLE ; RETENTION $ s VVDWERS COMPENSATION AND TORI'CtMITS ER EMPLOYERS'UARCITY .ANY PP,OPRIETORPARTNERIEXECUTIVE -.L.EACH ACCIDENT b OFFICEWMEMBEREXCLUDED? _.L.OISEASE-EAEMPLDYEE S It yes,desOrbe oder SPEC IAL PPO"VISTONSbNar =.L.DISEASE-POLICY LIMIT ; OTHER CRIPTION OF 11P43".nONS 1 LOCATIONS I VEH (EXCL usioN5 ADDED BY ENDORSEMENT l TIPECtAL PROVISI Job: Say State Biofuels CERTIFICATE HOLDER CANCELLATIO N.mow SMULDAINY OF 71 E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,T11E ISSU NG INSURER WILL ENDEAVOR TO NAIL 20 DAYS VYRRTEN Town of North Andover NOTICE TOTHE C IFICATEHOLDERNAMED TOTHE LEFT.BL?FALURETODOBOBW,LL Bldg. Dept. IMPOSE NO 0BLIGJ TION OR LIABILITY OF ANY KIND UPON THE INSCREft ITS AGENTS OR 1600 Osgood Street (North Andover H& 01845 REPRmeNTA'rwk LUTHO RE ACORD 25(2001108) • IrACORID CORPORATION 1988 MAY-28-2009 12:55PM From: 508 966 2172 ID:OZZY PROPERTIES Page:008 R=95% May 28 2009 3: 27PM HP LRSERJET FAX 508-966-2172 P. 9 i I I - Nassach rtem- De{►:r,*tntenrof Pahlic Satets Board of'Building fq,`ufations and Standards Construction Supervisor License License: CIS 78024 Restricted.t9: . £` RALPH iii4 } ;. 12WILLIAM 'AY BELLINGH MAt�019 Expiration: 6/212010 (ooluli<siN cr Tv#s: 25176 MAY-28-2009 12:55PM From: 503 966 2172 ID:OZZY PROPERTIES Page:009 R=95% TAORTH Tovm Of A K E dover, Mass., A- COC HIC HE WICK y�. 7� RATED PPS\ �C `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System / / / BUILDING INSPECTOR THIS CERTIFIES THAT......✓.. l-�r-}.... 5. � ...... t...h./... .......................................................................... Foundation has permission to erect........................................ buildings on � o `� . g ................................. ........................................................ Rough to be ocCU led aS ��' ' �'`7`zisi �r !/ y Chimney p ........... > ... ...... ... ..../ .............. /...... ... .. provided that the person accepting permit shall in every respe conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to th Inspection, Alt ration and Construction of Buildings in the Town of North Andover. fir'' /'- -2h ., ?�vIfle o PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCPON STARTS Rough Y..//- .............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. BurnerFlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det.