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Home My WebLink AboutTown clerk Mote; Complete top of form and forward both sections and fee to local licensing authority (City or Town Clerk. Do not make application to department:of Public Safety. City or Town orth AvIdavtr Date 3 AVJUSf 2021 APPLICATION FOR CERTIFICATE OF REGISTRATION In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned hereby certifies that ®sq o od RT 12S 1rojcct LLC 5o50 Ti 2;I�LtMan S}r� aiS�,°rtcense u '�- 135 Allcn ibwrt, PA IS 104 �� ``-- :-�� Addross is the holder of license granted 'V1_��17 Da a"�, r the lawful use of the building(s) or other structure(s) situated or y: to be situated at 1'+S0 �$gVV4 Street Straor and number ' as related to the KEEPING,STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES. Nor,} Ayt ober City orrown - Note:This application for certificate of registration must be signed by the holder of the license ff said license was granted prior to July 1, 1936, otherwise by the owner or occupant of the land icenge .d Re ive Submitted by y Signature by am 1 slaw wneeter Owner owupanr or nolder "IA k- SO 7i ljkma�t SF. sidle � 3S Allen*wvl. Of=/True i _SO nad ass I �eh�•firrreirr,G`a� rix��u%cea—2� ��;a.caz�� C�"—airr,,�City or Town lb—)6-4 %J�VtIDate' IQ%)Y '1 10-0(9-1 r� REGIST llIO T his is to certify that v d�� r® �P L cs no/ r has, in accordance with --the ��provisiions of-Chapter 148, Secti 13, of the General Laws, filled with me a certificate of registration setting forth that LLC- is the holder of the license granted r for the lawful use of the building(s) or other structure(s)situated or onto to be situated at , I SO Osgood $}Yee Str"r and number as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES. Signature and ofSczW Titlo Note:A certificate of registration must be 61ety on or before April3oth of each year. THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES -5(revised 7196) GIS Coordinates LAT. a G9b SV@� License LONG. Massachusetts General Law, Chapter 148 §13 FP-002 License Number (Rev. 1.1.2015) 0 New License ❑ Amended License After notice and hearing,and in accordance with Chapter 148 of the Mass. General Laws, a license is hereby granted to use the land herein described for the purposes described. Location of Land: j S-0 CL OO& S ,L� O3L( , b' 00) Number,Street and Assessor's Map and Parcel ID Owner of Land: �c,ep� �^ P:R,J-C-CV , t-j_-b Address of Land Owner: s os-o s:,„ •�e- Lff' . tAjj egA Ao-�1 . PA I'�7 oq Flammable and Combustible Liquids, Flammable Gases and Solids Complete this section for the storage offlammable and combustible liquids, solids, and gases.All tanks and containers are considered full for the purposes of licensing and permitting. (Attach additional pages if necessary.) PRODUCT NAME CLASS MAXIMUM UNITS CONTAINER QUANTITY gal.,lbs, UST,AST,IBC, cubic feet drums 21- AVJ /�1�n1��lf�f� a, ]�,no o LP-gas (Complete this section for the storage of LP-gas or propane) ❖ Maximum quantity(in gallons) of LP-gas to be stored in aboveground containers: List sizes and capacities of all aboveground containers used for storage )C It e00 ❖ Maximum quantity(in gallons)of LP-gas to be stored in underground containers: ler List sizes and capacities of all underground containers used for storage Total aggregate quantity of all LP-gas to be stored: 14,DOD 911p,1s Fireworks (Complete this section for the storage of fireworks) .• Maximum amount(in pounds) of Class 1.3G: ❖ Maximum amount(in pounds)of Class 1AG: Maximum amount(in pounds) of Class 1.4: Total aggregate quantity of all classes of fireworks to be stored: THIS LICENSE OR A CERTIFIED COPY THEREOF MUST BE CONSPICIOUSLY POSTED ON THE LAND FOR WHICH IT IS GRANTED. i Exulosives (Complete'thls section far the storage of implosives) *;• Maximum amount{�tt pounds)of Class 1J. Number:of_magazines used"far storage: Maximum amount 0 pounds);of Class 1:3: Number ofmagazines used.for-storage: •.�' Maximum amount{m'pounds)of Class 13 Number'.of magazines used for"storage:: Maximum.amount(in pounds).of Gass 1A ;Number of magazines used<for storage: ({j E i Maximum amount(jn,p.aunds)`.of CI"ass 1.5: Number of magazines used.for storage: Maximum:amount(rr poundst:of Class 1.6e Number o£magazines used for storage: t Licensing Authority Use< 4 pon the corid hon that the liceinsed activity.will comply with all:applicable aws, codes, This license is granted°u miles and regulations,including but not limited-to::Massachusetts"General.La'%v,Chapter 148; Arid the Massa,husctts,F xe,Code($27 CnrIR 1:00)-as amended:The;license holder'rnay not store materials in,an amount exceeding the:capacities herein specified unless.and until any amended license has`b en-granted. ADDITIONAL R.ESTI2ICTIONS: I f 7A A. . Si ture of Licensing Authority Title Dafe. THIS LICENSE OR A�CERTIFIEID'_COPY'THEREOF MITST`EE CO&SpiCIOUSLY POSTED,'.ON,THE-1 LAND FOR WHICH IT Is GI E NTED. FP-ON"(Rev. 1 1.2b t s) Page 2 Department of IndustrialAccidents Office of Investigations Lufayeae City Center EI 2Avenue deLufayette,Boston,AM 02 111-1 75 0 ' svww.mass govIdia Workers'Compensation Insurance Affldavit:Builders/Contractors/Electriclans/Plumbers Applicant Information Please Print Lcaibl Name(A ssincss/Ocbzniuuon lndi.idwl):Mao Gas Address:630 Sunderland Rd Cit lStalelZi :Worcester,MA01604 Phone#;508797-5878 Arc you an employer?Check the appropriate box: type of protect(required): 1. to erwith I am a ere 23 4• ❑ re 1 area general contractor and I ❑ p y have hind the sub-contractors 6 ❑New constfuctroa employees(full and/or part-time).* listed j ld on the attached sheer 7 ❑Remodeling I❑ 1 am a sole proprietor or parmcr- ship and have no employees Thesub conuactnrs lave g ❑Demolition corking for me in any capacity. employ=and have workers g. ❑Building addition o corkers'cam insurance comp.insurance.; - � p" 5.❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their ❑ g p 11. plumbin re sits or additions 3 ❑ l am x t,am�wnu doing all work right of exemption per biGl Roof � myself.[No workers'comp. c.152.§1(4),and aT luvY no 1`❑ ro insurance required.)' 13.0Other`"��dP employ,=.(No mvrkers' i camp.insur=rc requited.] _ MyappG t h¢tcha3sboaptmustalsofltlauthesoccaabeaor+shasio6drir imoM1dcccn wm=uzlaf 'Hoaiyane:s mho subedt this affidavit Indicating ihty aze aerie;r11 uviY tad thtti hire tattnde eonttattus muss subxit a¢en affidavit in�di.dA ` Cmteactm than chec%thu boi matt en.CMt ere addffle"rhod'towlns ther_nse of d.rabt¢netY'nn»!sae ub'd+CotuX those coptayxs.tithe tab-cato'rt¢rshave ama loyr+.s.rbry mutt lmnid.their wa1k='comP•t�T¢=� am an employer that it providing norken'comperuadon Insaranrr joy aty p,splo,,m Below is the polltY and jab slte Information. Insurance Company Name:Burt Insurance Paltcy�or Self--iay.Lie:l: OG27216-4-20 Expiration Da lob t Ci /Stetem .N Andover.MA 01845 •� lob Site Address:i600 Osgood Si ty P vtrnch a copy of the workers'compeiisation policy deciaradon page(sbosving the policy number and expiration date). Failure to secure coverage as rcquircd underwellresA of t m penaldes in the form of a STOP WO ORDEGL c.152 can lead to the,imposition Of criminal R and fine fine up to S1.500.00 and/or one-year Imprisonment, as)(up to 5250.00 a day against the violator. Be advised that a copy of this swcment may be forwarded to the Office of !nvarigatiors of the Dl or insurance coverage verification. I do hereby y u�r Penalties ofpvlury that the inJarmaaon provided above is true and correct Date: iieriaC rc� -� r Phone . Official use only. Do not write in this area,to be completed by city or fawn ofj7daL Permit1license k City or Town: issuing Authority(check one): 1❑BoardofHealth 2❑BulldingDepartment 3❑ClryffovvaClerk 4❑Eleetrlcslinspector S lumbhig inspector 6❑Other Phone tit Contact Person: /BS>. 1 x J • 5 6 ] B NAF® PRIMARY ACCESS ROAD 9.8.2- 1 \ �- \ Active Fire NAF ccess Hydrant D A ' 1 ` �� Route 'y��' < >�b , /� .m.e.,aroc•i." —wu�-R�u Gate#3 '.tl f, e i Na 'dPorol: f ACCESS ' I� % Fuel Cell "room cn:� "m®oI. v, code-zsss ILLpOAR +tilj 1 — a \�Y- -\\ � � '.. � � '�� , Building 20&21 RN.�,,,, t��"-3��{� �u ® �{' � 4-'�•�„��- % Jr S x t/mo��wj, 15 I 0 1 \\ � I —\1,. �T; .•� •-" ruum�i"om' .YI� -t- `- D rnm�.wa� I �� J I j�l li x/Ix/x, RuucnN loo PwsE x R \ IF ��• i �l I ill REVISIONS Propane Gas Farm P s04",uRE EER— FNGWEER Y"Llc Na 38118 LANSAN EmnWrm°Im�PnI sN-- RAN. .,m amse.,oaron.. w.nmmn \ I I 1600 OSGOOD STREET Ar �'° � ✓% ��f` mm �<l 'I\: ,✓ UTILITY PLAN- \ OVERALL f l� _y mciu o. Q N. MOO \ ! 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