HomeMy WebLinkAbout1503 OSGOOD STREETLLC i
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"� GIS Coordinates
%prtry/(goavx- o/ North Andover LAr
i
License
LONG.
"•�9 Massachusetts General Law, Chapter 148 §13
FP-2 License Number
(Rev.06-2009) ❑ 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: 1503 Osgood Street, North Andover MA 01845
Number,Street and Assessors Map and Famel ID
Owner of Land: 1503 Osgood Street LLC
Address of Land Owner: 1503 Osgood Street, North Andover, MA 01845
Flammable and Combustible Liquids,Flammable Gases and Solids
Complete this section for the storage of flammable 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
Gasoline 22,500 gallons 2 UST's
Diesel 7,500 gallons 1 UST
LP- as (Complete this section for the storage of LP gas or propane)
•3 Maximum quantity(in gallons)of LP-gas to be stored in aboveground containers:
z
List sizes and capacities of all aboveground containers used for storage
❖ Maximum quantity(in gallons)of LP-gas to be stored in underground containers:
List sizes and capacities of all underground containers used for storage
Total aggregate quantity of all LP-gas to be stored:
Fireworks (Complete this section for the storage offireworks)
;* Maximum amount(in pounds)of Class 1.3G:
:• Maximum amount(in pounds)of Class 1AG:
S
•:+ Maximum amount(in pounds)of Class 1.4:
Total aggregate quantity of all classes of fireworks to be stored: i
THIS LICENSE OR A CERTIFIED COPY THEREOF MUST BE CONSPICIOUSLY
POSTED ON THE LAND FOR WHICH IT IS GRANTED.
EXUlOS1VeS (Complete this section for the storage of explosives)
i
:4 Maximum amount(in pounds)of Class 1.1: Number of magazines used for storage:
444 Maximum amount(in pounds)of Class 1.2: Number of magazines used for storage:
44 Maximum amount(in pounds)of Class 1.3: Number of magazines used for storage:
❖ Maximum amount(in pounds)of Class 1.4: Number of magazines used for storage:
4:• Maximum amount(in pounds)of Class 1.5: Number of magazines used for storage:
$• Maximum amount(in pounds)of Class 1.6: Number of magazines used for storage:
1
Licensing Authority Use:
This license is granted upon the condition that the licensed activity will comply with all applicable laws,
codes,rules and regulations, including but not limited to Massachusetts General Law, Chapter 148, and the
Massachusetts Fire Code(527 CMR) as amended. The license holder may not store materials in an amount
exceeding the capacities herein specified unless and until any amended license has been granted.
ADDITIONAL RESTRICTIONS:
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signature of Licensing Authority TWO Date
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THIS LICENSE OR A CERTIFIED COPY THEREOF MUST BE CONSPICIOUSLY
POSTED ON THE LAND FOR WHICH IT IS GRANTED.
i
FP-2(Rev.05/2009) Page 2
(fig Department of Fire Services
yJ6'� orb
8N �� Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2017
(City or Town) (Date)
NOTE: Complete top and bottom of form and forward both sections and fee to local Licensing Authority(City or Town Clerk).
DO NOT RETURN FORM TO THE DEPARTMENT OF FIRE SERVICES.
In accordance with the provisions of Chapter 148, Section 13,of the General Laws,the undersigned hereby certifies that:
(TITLE HOLDER): Service Bury LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted(Date): October 24,2006 for the lawful use of the building(s)or other
structure(s) situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTH ANDOVER, MA 01845
(City or Town)
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
NOTE: This certificate of registration must be signed by the holder of the license if said license was granted prior to July 1,1936,
Otherwise by the owner or occupant of the land licensed. 0 gals gasoltn 8,000 gals diesel
Rec ...2017.... .... ...
Signature)
B ........... < 'v ...................
y (Official Title) ( le k) (State whether owner,occupant or holder)
IV
AW"' I `"� � (Address)
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 021II
www,massgovfdia
Workers' Compensation Insurance Affidavit: General Businesses
AP licant Information Please Print Le ibl
A&BusinesslOrganizationN�me:
Address: S'iQ �S dD y
city/slate/Zip: ih�O d�Lr � g hone
Are you an employer?Check the appropriate box: Business Type(required): k
11 am a employer with employees(full and/ 5. Retail
or part-time), 6, ❑RestamantBor/Eating Establishment
2,❑ I am a sole proprietor or partnership and have na
7. ❑Office and/or Sales OncI.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'camp.insurance required] 8• Non-profit s
3.❑ We are a corporation and its officers have exercised 9. (]Entertainment
their right of exemption per c, 152, §1(4),and we have I O.❑Manufacturing
no employees, [No workers'comp. insurance required]** 11.[]Health Care
4,F] We are a non-profit organization,staffed by volunteers,
with no employees.[No workers' comp, insurance req.] 12.[]Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**if the corporate officers have exempted themselves,but the corporation Jim other employees,a workers'compensation policy is required and such an
organization should check box#1.
t am an employer that is providln wMercpensa/' t:insuran far my ployees. below is tfie poflcy Information.Insurance Company Na
Insurer's Address:
City/Stoteaip:
'Policy#or Self-ins,Lie;# A%/ 6 Expiration Date: 1
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 i
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 Us statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb jinder the pains rued penalties of perjury-that ih '-formation provided above is true and correct
Date'
_ 5
Of clal use only. Do not write In this area,to be completed by city or town o,fJMal.
City or Town: Permit/License# 1
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4,Licensing Board 5,Selectmen's Office
6.Other
i
Contact Person: Phone P.
i
www.man.gov/die
s a� a/� WML/YGO./tAVCp�2 pd
s
Department of Fire Services
sea $^^ Office of the State Fire Marshal
P. O. Box 1025. Style Road.Stosc,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2016
(Gryo Io1c) (Dato
NOTE:Complete top mid bottom of for and fir msard both sections and Fee to local Licensing Authority I([to or"I own Clod:).
DO NOT RETURN FORM TO I BE DEPARTMENT OF FIRE SERVICES
In accordance with the provisions of Chapter 148, Section 13,ofthe General Laws,the undersigned hereby certifies that:
(TITLE HOLDER): Service Bury LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted(Date): October 24, 2006 for the lawful use of the building(s)or other
structure(s) situated or to be Situated at (ADDRESS): 1503 Osgood Street
NORTH ANDOVER, MA 01845
(Cary or I oen)
as related to the KEEPING, STORAGE, MANUFACTURE OR SALB OF FLAMMABLF.S OR EXPLOSIVES.
SOTS: This certificate of registration must be signed by the holder of the license if said license was granted prior to July 1,1936,
Otherwise by thegsdner or occupant of the land licensed. 29.000 gals gas line—8 WO gals diesel
By (signan e)
(0nlclel rae) ( leek) lSmw whdhcw,wncr neeupma or holder)
......................................................
The COmnronwealth ofAjassachuseft,
Department 0flndustrial Accidents
Office Oflnvesffgatdow
600 Washington Street
B0st0n,AM 02777
Workers' Compensation Insurance Affidavit: General Businesses
ApPlicantInformation
Business/Or Please Print Le ibl ganization Name: jl� �j ,v,,�, `��
Address:
( � V�
City/State/ZIP `� 157 �' I
Are you an employer?Check the a Phone#;
n ppropriate hox: Busin
: TY
wr eeinpluyer vidr arnployees(full and/ 5. _g s ape(required):
_
or Part-time),*
2, I am a sole proprietor or partnership and have no
6• ❑Restaurant/BarBating Establishment
employees working for me in any capacity, Z ❑Office and/or Sales(incl.real estate,auto,etc.)
I [No workers'comp.insurance required] 8. 0 Nan-profit
3. We are a corporation and its officers have exercised
thew right of exemption par c. 152, §I(4),and we have 9 Entertainment
n no employees. [No workers'comp, insurance required '" 10.E Manufacnuing
4.` We area non-profito ]rgew rker,,staffed by voltmteers, I1• Health Care
with no employees,[No wmkers' camp.insurance req.] 12.0 Other
'Am'aPplimn[Naz ehmW box MI mmt also FlI out the section below showing they workers•mmpmsalian polity info
+Ifthc mrporek officers have exempted rhanadves,but the ceryoreGan has aNc employees,a workers'
organi ahon shoultl check boz Ml, rmeeon.
compansafion policy is required aid such azt
!am an employer ikat is provddfng worker 'compensadon insuran a o>m Insurance Company Nam i f Year loyeas Below is Ore policy lnformaAt
Insurer's Address;
> ) - c —. .°l lll�
City/State2ip: If o I
/�F ZIJLt
Policy#or Self sl
Atteeh a copy of the workers compensation policy declaration page(showing Pe policy number and e ..
)Pailcs o 1,500 ayeraga at required undo-S¢minn 25A of iviOL c. i 52 can lead be the impusiden of crimira:penalties of s �
fine up to$I,SOC.00 and/or one-year imprisonment,as well as civil penalties in the form of fl STOP WORK ORDER and a fine
this
of up to$250,00 a day against the violator. m advised that a copy of nsu e s n the may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do lrereby cerrlfy under tke pains and penalties
IP ! rY thatd of ram provided above ��
1 ature� __ 4rrue and correct
Poe#: Date:
O ctaduse only, Dona!write in thLt urea,ro be conrplued by airy or town official
City or Town:
Issuing Authority Permit/License#
ty(circle one):
1.Board of Health 2.Building Department 3. Chy/'Pown Clerk 4.Licensing Beard S.Selectmen's Office
6.Other
Contact Person:
Phone#:
www.masxgov/din
4
Department of Fire Services
Oftiee of the State Fire Marshal
P. O. Box 1025.Stale Road SW,,. MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2014
(Cal nr lbwn) (Dill,,
NOTE: Complete mp and bottom of form and fon,arA both sce1i.n,anJ foe to local Licensing AWhorip (( o o, Town Clerk).
DO NOT RETURN FORM TO THE DEPARTMENT OF FIRE SERVICES
In accordance with the provisions ofChapher 148, Section 13,of the General Laws,the undersigned hereby certifies that
(I I I LE HOLDER): 1503 Osgood Street LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted(Date): October 24. 2006 for the Izwthl use(,['the building(s) or other
structure(s) situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTI I ANDOVER, MA 01845
Oh ,,,l om0
as related to the KEEPING, STORAGE, MANIIFACI'URE OR SALE OF FLAMMABLES OR EXPLOSIVES.
NOTE: This eeroriOue of«gistration must be signed by the holder of the liacnae d said license was granted prior to duly I,1936.
Otherwise bc the owner or occupant of the land licensed. 29000 phi g Ire 8,000 gal desel �-
ReKcceived d2 �2 014 .,. .
Ails
l / l /� CO
i
'tic) (CIak) pan tholJu]
�lILF .',�.r��
(Address)
Tire Commonwealth of Massachusetts
Department
Office of Investigations nts .
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.goi is
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please
,Print
�Legibly .
Business/Organization Name:
Address:
City/State/Zip:U0 �U�dye
'/ &0 e'� hoe#:
Areyonan employer?Check the appropriate box: Bus ines pe(required):
1.10 1 am a employer with employees(full and/ S. e[ail
or part-time)." 6. ERestautuouBar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp.insurance required] g. [-]Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§I(4),and we have 10.❑Manufacturing
no employees, [No workers'comp. insurance required] 11 ❑Health Care
4,❑ We are a non-profit organization,staffed by volunteers, [,-].,�H(e C
with no employees.[No workers' comp.insurance req,] 12.1's&t r GAS
*Any applicant that checks box#I mug also fill out the section below showing their workers'compensation pal icy information
--if the coryom¢office.have no.pad themselves,but fie ca pont ion has other employees,a workers'compensation pot icy is required and such an
organization should chock box#1.
I am an employer that s providing tyorkprs'eampens n insur�c�fo�my employees. Below Is fbe policy information.
Insurance Company Nam�e:y� L/7 N.C,�C.'••/-/6l
_ Insurer's Address: t-, � �- 1) Z
,
Chy/State/Zip:/,!�Ve%d'sl �j L O,j� Z4
U Jy�� c(
Polity#or Self-ins.Lic:# /t ���'"��S 'J O tX'7 3 Expiration Date:
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 ofMOL a. 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 w S50.00 a day against the violator. Be advised that e copy of this statement may be forwarded to the Offrs of
Investigations ofthe CIA for insurance coverage verification.
I do hereby cerf jy ynder the pains arsitpenaldes of peopythat the information provided above is true anJ rorrect.
Si ett>F� � ""u Date:
Official use only. Do nor wrhe M the area,to be completed by city or town official
City or Towm Permil/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4,Licensing Board 5,Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.govldia '
r
ci Department of Fire Services
seyh x^`�
Office of the State Fire Marshal
P.O. Bo% 1025,Stale Road,Slow. MA 01 T15
CERTIFICATE OF REGISTRATION
North Andover April 30,2013
(City or'I'o.ru (Uete)
NOTE: Complete top and bottom M form and forward both sections end fcc to meal Licensing AWhoritr or m or'I own Clerk).
DO NOT RETURN FORM TO TIIE DEPARTMENT OF FIRE SERVICES.
In accordance with the provisions of Chapter 148, Section I, of the General Laws,the undersigned hereby certifies that:
(I I I LF HOILIFLO. 1503 Osgood Street LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted(Date): October 24.2006 for the lawful use of the building(s)or other
structure(s) situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTH ANDOVER, MA 01845
(city or 1'mrn)
as related to the KEEPING, STORAGE„ MANUFACIURE OR SALE OF FLAMMARLES OR EXPLOSIVES.
NOTE:: 'Phis certificate of registration must be signed by the holder of the license if said license was granted prior to July 1,1936,
Otherwise by the owner or oroupant of the land licensed. _J9 Is gasoline 11000 gal;these]
Received of �t. lt ;1rc BK b.T7 .45 �..�, G��
(ofl T.11e) (Clerk) (SI I h0h,c,n,r umant orhJew,)
NOTICE OF ASSIGNMENT
EMPLOYER: COMBO I.D. STATUS OF EMPLOYER
MBM ENERGY GROUP INC 000967230 Corporation
1503 OSGOOD STREET
NO ANDOVER, MA 01845 COVERAGE GROUP
1018669
Coverage m under this assignent
The Waiver of Our Right to applies co Massachusetts
Recover from Others Endorsement operations Only. For coverage
is available on Pool policies, outside of Massachusetts, contact
Contact your agent for details the appropriate Pool or Plan for
that state.
INSURANCE COMPANY:
AGENT .TAMES OCONNET. _..SI EP 1 AGENCY LM INS CORP
OR DAMES ONN
PRODUCER: 754 BOS ST T ROAD ROAD INVOLUNTARY MARKET OPERATIONS
BILLERICA, MA 01821 P 0 BOX 9090
DOVER, NH 03821
� (800) 653- 1893
AGENCY FEIN:680610015
CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED
CODE 'TOTAL, ANNOAL PREMIUM
REMUNERATION
STORE: GROCERY STORES-RETAIL-NO HANDLING OE ACC6 $7a, 000 1 ,52 .$1 , 186
FRESH MEATS
EMPLOYERS LIABILTTY 100/100/5CD 9845
STANDARD PREMIUM $1, 18G
EXPENSE: CONSTANT 0900 $338
TERRORISM CHARGE 9740 $23
TOTAL POLICY MINIMUM PREMIUM $232
TOTAL ESTIMATED PREMIUM $1, 547
DIA ASSESS. 4 .28 $50
TOTAL EST. PREMIUM PLUS ASSESSMENT $1, 597
INSTALLMENT BASIS: Annual DEPOSIT PREMIUM: $1, 597
-- - -- niSiSNOT A a1LL
COMMENTS
Coverage etfettive 12 :01 AM on 12/12/12 .
CARRIER NOTE: The Bureau reviewed tlic cJasr`iflsati nd desCriptlo provided with the
application and determined that a charge to the clas ., e n ses provided on the application was
warranted. The classes listed on the Notice of Assignment arc correct based on the
infox'mation submitted.
Copies of the insured's four most x.-ecently filed FOr111 941s or ISR-ls did not accompany the
application as required in Part VI of the application. Please forward these records
immediately to the insurance company Listed above.
The Workers'Compensation Rating and Inspection Bureau of Massachusetts
101 Arch Street Boston, MA 02110
(617)439-9030 FAX(617)439-6055 www.wcribma.org
The Commonnwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
tvww.mass.govi'dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization game
Address: �' .�t2Y
¢
City/State/Zip:_,- Phone#: �l,�%LZ� p — 652�� o //
Are yo an employer? Check the appropriate box: Business Type(required):
1. 1 am a employer with employees(full and/ 5. El Retail
or Part-time).` 6, ❑ RestauranvEar/Eating Establishment
2,❑ 1 am a sole proprietor or partnership and have no 7, [:] Office anchor Sales (mcl.real estate, auto,etc.)
employees working for me in any capacity. g ❑ Non-profit
[No workers' comp. insurance required]
1❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c 152, §1(4),and we have 10.❑ Ntanufacntring
no employees. [No workers' comp. insurance required]" I I ❑ Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp insurance req.1 12.❑ Other
'Any app6cnm thin checks hiss pl must also fill out the senior belmv showing their workers mmpauation policy Information.
-If the ea,d ate effects have cwno,od themselves,but the corporation has other employees,a svPTI,cc wmpensation policy is mquitnd brad such an
onotheetion should check hex 4I.
I am an employer that is provub or It s'c Tp sa 'r tfnsuror p for empta� rces. Below is the policy information.
Insurance Company Name:� U
Insurer's Address: r "� ), 67� O -
� oW_1 V o� dui
CirylStatelZip'. - —
Policy tt or Self-ins.Lie. # ) _4_5�C Expiration Dace:
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
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 CIA for insurance coverage verification.
1 do hereby cent tier file pains andpenalties oft, . that the information provided above is(rue nd correct.
Date
Phone#'.
E01her
only. Do not write in this area, to be completed by car or town official.
n: Permit/License#
hority(circle one):
Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office
son: Phone#:
nxx mas, n,/d,a
3
sDepartment of Fire Services
Office of the State Fire Marshal
N jY
IL O. Ros III25. State Road,Stun_MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2012
tea>nrIm"a) (Who
NOTE:Complete top and bottom of form and Ibnvard boll,sccGons and fee to loco] Licee,ine Authority(01n or l own C'le,k).
DO No RETURN FORM TO THE DEPARTMENT OF FIRE SERVICES.
In accordance with the provisions of Chapter 148, Section 13, ofthe General Laws,the undersigned hereby certifies that
(TITLE HOLDER): 1503 Osgood Street LLC
(ADDRESS)'. 1503 Osgood Street
is the holder of the license granted (Date): October 24, 2006 for the Iawtul use of the building(S)or other
structure(s)situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTH ANDOV ER, MA 01845
((ay«'Inver)
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMAHLES OR EXPLOSIVES.
NOTE: This certificate of registration must be signed by the holder of the license if said license was granted prior to July 1,1936,
Otherwise by the owner or occupant of the land licensed. 29,000 gala gasoline—8,000 gals diesel
Received
is y ma)
`../ (orcmlr]Tro (fled, (}tall"huh.r nx,cr.ooetpm to holdul
....~�."..w.u?�'.`.:JJ�•'. 1� fin.y�..),-a , :�N .,z.�S
(Address)
The Commonwealth of Massachusetts
- - - Department ofIndastrial Accidents
Amarrrsarnret
600 Washington Street
Boston,Mara 02171
Workers' Com ensation Iasarance Affidavit-General Busiames
ob,#
Inch rfi>d.amne.t \�U"� V��- C S� c`� �✓`�.��.�1 C1R liL\1cf
I am a role pmprilxa and have no one Basizem Type: Q Rrtad❑Reslamant/Bm/Eatmg Estabhshmmt
working in any caP=tY• ❑Office❑Sales(including Real Estate,Antos etc.)
'�I am aD® 1 with "Z em to full do art time. ElOtherI am an employe providing waters'ccunp autm far my employes—king m this job.
1
'p.ev-vvm ea. -
I am a sole proprietor and have lured the independent contractors listed below who have the following werkes'
compeasstia polices: -
.care..•
ph."N. -
m em ea
evm nor
Inmrvnee
P.fhv.b..rm.mtenp r regHtW mdm 9een.n 25A HMGL 152..kW*tb.hvpnm.n HerwW P.trtmm H.fhr°P r tI•SM.m dhr
emye..'Inp.a..mmtm n4msltmpemnf+Wuwf He bTOP WRCORDRR. .m HSIM".dy.pintnv r mdn.b.d flat.
ray./Nr.vwee srb.Hra..dd ti fb Oflh..f hnmtlpeMm.ftb DIA t.e..tn.panlMWa
r d.hneby Certify an der the peim audpenaatea afpnj y Mar tAe infermatia.provded ab.te L true of crorre.t
Pm!name��4.' -'J` �.."'7 r Ph..#
sM%I...h d.rot nrlft in fhb.rn to be..pbt[d by tray er t .tlld.t
.a,.r laws: PernWlb.n.N DB L,Deprtnent
�Lictmma 9..N
❑cl v k if Wtdbr rnP h reswrtd Osehelw.w.om..
❑AaNh Ihpvrfinevt
mtect peom; Ph.m M, �Olher
I,....d W inn
w' 3
f i Department of Fire Services
a`
UC
Office of the State Fire Marshal
P O. lion 1025,Stale Road, Slow. MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2010.
Iris.yr I ) ID:vel
NOTE: Complcm tap and bollom of form and fnnvard bosh,,none and Icc to local Licensing Authonn (C'ily or Town(lerk).
DO NO'F RETURN FORM 'EO'I'ar DEPAWI NIFN'f OF FIRE SERVICES
In accordance with the provisions ofChapter 148, Section 13,of General Laws,the undersigned hereby certifies Ilml:
ITI'I LE HOLDER): Service Dury,LLC
(ADDRESS): P.O. Dox 67141
is the holderof the lieensv grunted (Date} Ocmber 24,2006 for the luwfid use of the huildirn, nr nthur
structure(s)situated or to be Sif hied at (ADDRLSS): 1503 Osgood Street
NORTII ANDOVER. MA 01845
(Color 11111n)
as related to the KEI''PING, STORAGE, MANUFACTURE:OR SALE OF FLAMMABLES OR EXPLOSIVES.
NOIE: This certificate of registration must be signed by the holder of the license if said license was granted prior to July 1,1936,
j Otherwise by the owner or occupant of the land licensed, av,dnn gals gn ohm %,000 gals Aiesel
Received .C /u �L _. .2010
J cann)
By . �� ,u i�l f r. .......
(Official-I iOc) fC'Ierkl ..................
19ia,M ,thcr mrncr. holdc0
.............................I........................
fAddressl
Proof of Coverage Search Page 1 of I
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1503 OSGOOD STREET LLC TRADA CORP 11503 OSGOOD STREET Report
LLC NORTH ANDOty MA
1503 oscooD ST '0184s Workplace Fraud
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Employer Name: 1503 OSGOOD STREET LLC TRADA CORP/ 1503 OSGOOD
STREETLLC
Address: 1503 OSGOOD ST Report
City/Town: NORTH ANDOVER, MA 01845 Workplace Fraud
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TRAVELERS INDEMNITY CO OF CT List
IEUB597BM66109 150 BALDWIN STREET SUITE A 08/1512009 10/04/2009
ELMIRA, NY 14901
TRAVELERS INDEMNITY CO OF CT
IEUB5978M66108 150 BALDWIN SIRELL SUIIEA 0811e2008 08/15/2009
ELMIRA, NY 14901 Education Links
GRANITE STATE INS CO
WC6380973 100 CONNELL DRIVE 08115/2007 08115/2008 Who Needs WC lnsurance7
BERKELEY HEIGHTS,NJ 07922
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This Proof of Coverage Application allows the public to search workers'
compensation insurance coverage information for policies in the Voluntary Market Related Links
and Assigned Risk Pool. Do not assume that an employer is operating without
coverage if your search results do not return policy information.An employer may Experience Rating History
still have a valid workers'compensation policy under a different business name or
may have an alternate method of coverage which includes licensing as as self Connecticut FOG Search
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With limited exceptions,every employer in the Commonwealth with one or more Classification Request Form
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policy at all times.If you are unable to find an employer or suspect an employer is I
wrongfully operating without workers' compensation insurance,please submit a
Workers'Compensation Investigation Referral Form or contact the Office of
Investigations at 617-727-4900 x214 or toll free at 1-877-MASSAFE(627-7233).
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Massachusetts Department of Environmental Protection I'
Underground Storage Tank Program
) Form UST FP-290
Notification for Underground Storage Tanks Regulated Under 527 CMR 9.00
Forward completed farm to Contact-. - •
MassDEP MassDEP Bureau of Waste
Bureau of Waste Prevention UST Program Prevention UST Program A, Facility Number
P.O. Be. 120-0165 617-556-1035 ext.2
Boston, MA 02112-0165 6. Date Entered _.
C. Clerk's Initials
c A. New Facility (see inso-ecaan..x1) B; B.Amended _ D. Comments
INSTRUCTIONS: Form OF 290 doelhcatel for Underground Slora9 Tanks)is to be completed for each
lo rgro calion containing undeund clad?,e tanks regulated under 527 CMR 9 00.If more than five tanks are
owned at this locepon,orolocopy the following page and staple continuation sheers to the form.The FP
290 must be completed In carload Although the tom may be photocopied the facility owner or usual
presentative must sign each copy separalki photocopied egmilun s are not suflmie d The local fire
department will issue the permit pomon of the FP 290,however,registration is not complete until the BE
290 is received and checked by the Underground Storage Tank Program Allquestions on[his form are to _In answered.Incomplete forms will be returnedt-New Facility"means a tank or tanks located at a site where tanks have net been previously located.
2'Facility street address must include both a street number and a street name.Post efhcr box numbers
vre not acceptable and will cause a registration to be returned.If geographic location of facility is not pro-
ided please indicate distance and direction from closest intersection,e.g.,(facility at 199 North Street is
treated)40, l C R tl(Intersection)GENERAL INFORMATION
Notification Repeatetl and location of the tank,and the type and quantity 0 substances stored
MassDEP UST FP-Gil Is to be used as collodion,Registration, such tank,or which were stored such tank before the tank ceased
and Permit for underground storage tanks and tank facilities regulated being In operation If the tank was removed from beneath the surface Of the
under 527 Cade of Ma cbusells Regulations 9.00,No regulated up- proved prior to the submittal of such notice to the teachers",If the tank
dergmund storage lank B iLty shall be installed maintained,replaced, abandoned beneath the surface of the p and prior to the submittal of
substantially modified or removed without a permit(FP 290)issued by the such notice to the department,such notice shall also specify,to the extent
head of the local fire department The owner of any storage facility shall known to the owner or operator,the dale the tank was abandoned in the
within seven working days notify the head of the local fire department and ground and all methods used to slapped the lank after the tank ceased
the Dept of Environmental Protection of any change In the name,address, being m operation,
or telephone number of the owner Or operator Of a storage facility duties[ EyrTfcn.(a)a farm oresidenlial tank of 1,100 gallons or lesscaPa. used
to regulation by Chaplet ppr Mass.General Law and by 527 CMR 9.00. for staring motor fuel for noncommercial purposes,or(bs A tank used for
Underground Storage Tanks storing heating oil for consumptive use on the lire es where stored
Each owner of an and rground lank fire)out into Operation on or after Jan. a reno[requiredloberad,nderedunde 527CMH 9.00.
t,1991,shall within thirty days after the tank is first put into operalion,n Any owner cone knowingly fails to notity or submil5 false lnfrrma
tify the Department el Environmental Protection(the department)of the ex bon shall Be sueetl to a civil penalty net to exceed$25,000 for each lank
Chance of such tank,specifying,l0 the extent known,the owner of the lank, forty@ch PILL
Cal
ian Is not given or for which false information is submitted
date of Installation, capacity,type,location,and uses of Such tank.By no (MGL Chapter 148,section 38H,527 CMR 9.00)
later than Jan.31.1991read
eacM1 owner of an underground storage tank that
was in operation at any time after Jan.1,1974,regardless of whether or Whereto Noti,"Re.completed ner(lcationforms should both designed by
not such tank was removed from beneath the surface of the ground at any the tank Owner.One copy will be provided to the fire department,and the lank
lime,shall guilty the drpabmenl of he existence of such lank, prefer owner shall send a separate copy to the address at the top of this page.
to the extent known,the owner of the tank,date ofinstallation,capacity, When to Notify?1.Owners Of storage tanks in use or that have been taken
Ine,location Of the lank.and the type and quantity of substances stared out of operation must notify within thirty days.
such lank,Or which were stored m such tank pelore the lank ceased
being in operation if the hank was removed from beneath the surface Of the Ownereand Operstorsof Reeg9 la[ed Storage-Tank Systems must maintain
ground prior to the submittal of such notice to the department.Such notice records co in that all leakdetection,iaventorycontrol and tightness
shall
also specify to the extent knowna
,th date the tank was removed testing rage lrements for Me Regulated Starage Tank System are current
Loin beneath the surface of the ground prior to the submittal of such notice These records must the readily available for l napectlon.
to the department The operaor of any tank that has no owner r whose
eer cannot be definitely aecMained,shall notify the department of the
istence of such tank specifying,to the extent known,any information —
relaLng to ownership of the tank,and dale Of installation,capacity,type.
1. OWNERSHIP OF TANK(S) H. LOCATION OF TANKS,
Owner Name(Corporation,Individual,Public Agency,or Other Entity) Give the geographic location of tanks by degrees,minutes,and seconds
Sclvicc Bury,LLC Example,Let,42.36,12 N Long.85,24, nw I
- - Lanwae�Z '93:N'"rJ Longitude 71 (o,"1'r W'
P.O. 13.67141 Comer of Occllard Hill Rde In, - end O.allood Sheet _
t .,.a<no�.. — c1�030sgood Street„��.w.>se,a,t.ce�,,.,,.ir,o..So II
r.==oi ama,oa lmms�,,,i.,awml coin N1,,1C 11 SIC,malnn.,.e.•wlau. -c n r
Chcslnm Hill NIA _ 01467 I507 Osggpd Suect
_� _. Yp me _. _- ...
.nm redo lea eox�o,azewmute eee�mmpm eel
M do ex N PCOr And.,cr N N 0184,
1-a _ _ -o _ - s . - ev.1
(61,)78 2004 ° 09f I861 Essex
Inse Nih ova.e,aacm _ . _. rr rM.I1 1of c„,
FP PRO(revised g7109)
Page 1
Note: Complete upper portion of form and forward to local fire department.
Do not make application to Department of Fire Service
l
F - �_ F J/e`w/M�imvm,C rl��r/He VP/r�Uueb — V�A.Ce OU�Uze V�e LT/irC C%U(,gi/4itn4
N
ea- ;
APPLICATION FOR LICENSE
For the lawful use of the herein described building...or other structure....,application is hereby made in accordance with the
provisions of Chapter 14B of the General Laws, for a license to use the land on which such building_..or other structure....is/are or is/
are to be situated,and only to such extent as shown on plot plan which is filed with and made a part of this application.
Lesatioi of land 1503 Osgood Street Nearest cross street Orchard Hill Road
(Slrtp R Num(w,f --�
Owner of land 1503 Osgood Street , LLC Address 2 Bridgeview Circle , Tynfi o MA
Number of buildings or other sisuciures to which this application applies 2 (main building and canopy)
Occupani or use of such buildings convenience store w/ drive—through doughnut shop
Total capacity of containers in gallons—Aboveground N/A Underground 291000 gal, gasoline
8 , 000 yga iese
Kind of fluid to be stared in containers:— gasoline & diesel 372000 gal total
E) Ay1rOiied EJ Disappro (J ,f-s 1503 Osgood Street , LLC
����do1 w'Dmr'r / Y-"' David Murra, y^a^^Ba�A�an ager
2 Bridgeview Circle , TyngsbO ro , MA
to mt -- -
�h&WadW6e1&
City or Town Norrh Andover Data OCTOBER 24, 2006 7
LICENSE
In accordance with the provisions of Chapter 148 of the General Laws,a license is hereby granted to use the land herein described
for the lawful use of the building_.or other structure....which islare of is/are to be situated thereon,and as described on the plot plan
filed with the application for this license.
Location of land 1503 Osgood Street Nearest cross street Orchard Hill Road
Owner of land 1503 Osgood Street , LLC Address Bridgeview Circle, Tyngsboro , MA
Nurnberof buildings or oche,structures to which this application applies (mai-n building and canopy)
Occupancy cruse of such buildings_ convenience store with drive—through doughnut shop
Total capacity of containers in gallons:—Aboveground N/A _ Underground 8,000 GAL. DIESEL
3 ,
Rind of l!uitl to be stored in containers:— gasoline and diesel
Rohrrisirs-Ifany: ,
THIS LICENSE ,�`AjJQ Qa TIFIED COPY THEREOF MUST BE CONSPICUOUSLY POSTED IN A PROTECTED
-.- F22 *:gpON THE LAND FOR WHICH IT IS GRANTED
TOWN OF NORTH ANDOVER
OFFICE OF
TOWN CLERK
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Oi RORiM,
00
Joyce A.Bradshaw,CMMC o -` e a Telephone(978) 688-9501
To
wn Clerk y� FAX (978)698-9556
MEMORANDUM
TO: Building Inspector
Fire Department
Police Department
FROM: Jan
As i own Clerk
DATE: October 4,2006
SUBJECT: 1503 Osgood Street Underground Storage Tanks
Please review the attached application from 1503 Osgood Street, LLC, David Murray,
Manager, 2 Bridgeview Circle,Tyngsboro, MA, for underground storage tanks to be located at
a new facility at 1503 Osgood Street.
This item will be on the October 241h Board of Selectmen's agenda.
Please send your recommendations to me by Thursday, October 19t6. Your can e-mail
them to me at ieatoii(dtownofnorthandover coin
Thank you in advance for your attention in this matter.
TOWN OF NORTH ANDOVER
OFFICE OF
LICENSING COMMISSION
120 MAIN STRLET
NORTH ANDOVER, MASSACHUSETTS 01 S45
O, MOMTH �
Mark J.t. Caggiana, Cha[rmau u "�'�O Telephone(978)688-9500
Daniel P. Lanen FAX (978)688-9557
Thomas Licciardello : # ;
Rosemary C. Smedile ';�+s,..,•^`t`+•
James M, Xenakis axueE'
July 19,2006
John Smolak
c/o 1503 Osgood Street
North Andover, MA 01845
Dear N m ak:
Enclosed please find an application for underground storage tanks, per your request. The
following is a list of items that are needed for such a license:
I. Plan showing the proposed site of tanks
2. List of Abutters—direct and across the street from site
3. Application
4. Fee -$150.00
1 suggested that you contact the Fire Department, Police Department, the Division of
Public Works and the Building Commissioner and let them know what your plans are for the
site. Once the application is filed, copies will be sent to the different departments for their
recommendation.
A public hearing will be scheduled with the Board of Selectmen (Licensing
Commission). A legal notice will be prepared by this office and sent to the North Andover
Citizen or the Eagle Tribune. The cost of the legal notice is to be paid for by the applicant.
It is the responsibility of the applicant to mail the notices to all abutters not less than
seven days prior to the hearing,by registered mail. A copy of the receipts of the mailing is to be
filed in this office within three(3)days of the publication.
If you have any questions, please do not hesitate to call me at 978-688-9501.
Very truly,
a
Ta �
net L. Eaton,
Assistant Town Clerk
Enc. p
�( 71Q4 `I— �12I y G )�l—iG .r
rl 4v51 _ ` g1
UST Unilorm Inspection Guide•9
SECTION 1
STORAGE OF FLAMMABLE AND COMBUSTIBLE FLUIDS
Licenses, Registrations and Permits
by WM Shaughnessy
When we speak of licenses, registrations and permits for the storage of flammable or combustible fluids we
speakof those licenses,registrations,and related permitsthat are granted in accordance with Massachusetts
General Law (MGL) Chapter 148 and the Board of Fire Prevention Regulations, Code of Massachusetts
Regulation(CMR), 527 CMR 9.00,527 CMR 14.00,and 527 CMR 15.00. To start off with we should have a
basic understanding of the difference between a license, a registration and a permit.
• Alicense is the permission by competent authority to do an act which,without such permission,would
be unlawful,a trespass,or a tort.A flammable or combustible storage license is applied for and granted
bythe local licensing authority.The license isgrantedto the land and notto an individual.Onlyone license
maybe issued to a parcel of land.This license maybe amended to reflectchanges in quantity,conditions
or restrictions.The license may be revoked or suspended by the issuing authority. If the license is not
used in accordance with its terms and conditions for a period of three weeks, it may be subject to
suspension or revocation.Information pertaining to the license and the license shall be maintained by
the city or town clerk.
• A registration is the acknowledgment by competent authority of the act of recording a formal or official
record.A flammable or combustible storage registration is applied forannually to the local city ortown
clerk. A registration maybe granted to an applicantwho is exercising a license.The registration attests
to continued use of the license. Only one registration may be granted for each license. Records of
registration shall be maintained by the city or town clerk.
• A permit is a written authority or warrant, issued by a person in authority, empowering the grantee to
do some act not forbidden by law but not allowable without such grant of authority.The law allows
certain small quantities of flammable and combustibles to be kept or stored on the land without a
license, but with a permit granted by the head of the local fire department.
We should also have an understanding of what constitutes a flammable or combustible.'
Combustible Liquid:Any liquid having a flash point at or above 100OF shall be known as a Class If or Class
III Liquid. Combustible liquids shall be divided into the following classifications:
Class 11: Liquids having flash points at or above 100°F and below 140°F.
Class IIIA: Liquids having a flash point at or above 140OF and below 2000F.
Class IIIB: Liquids having a flash point at or above 200°F.
Flammable Liquid:Any liquid having a flash point below 100°F and having a vapor pressure not exceeding
40 psia at 100°F.Flammable liquids shall be known as Class I liquids and shall be divided into the following
classifications
Class IA: Liquids having flash points below 73OF and having a boiling point below I00°F.
Class IB:Liquids having flash points below 730F and having a boiling point at or above 100°F.
Class IC: Liquids having flash points at or above 73OF and below 1000F.
The basis of keeping and storage,of flammables orcombustibles,is section 13,of Chapter 148,M.G.L.. This
General Law is rather lengthy,so I will reference only the relevant sections.In orderto apply fora new license
or to change the conditions or restrictions of an existing license, the applicant must apply for approval or
disapproval from the head of the local fire department.Whether the local fire official approves or disapproves
the application,the next step is a public hearing on the application. Not less than seven days prior to a public
1 527 CMR 14.02 7
i•
UST Uniform Inspection Guide•11
be established from time to time by ordinance or by-law may be charged for any such license. registration
or certificate of the head of the fire department, respectively. '
Failure to use a license for a period of three(3)weeks may be viewed by the issuing authority as cessation
of use. The head of the local fire department should initiate a review of said license. After a public hearing,
the license may be revoked,or additional conditions and restrictions may be applied. In a situation where the
terms and conditions of a license are never exercised or are previously exercised and then abandoned (a
grant) except for the annual registration, revival of the license after a period of several years may introduce
regulated articles or substances into a community environment which is very different from the environment
which existed at the time the license was issued. This raises issues of public safety and fire/explosion hazards
which must be addressed by the licensing authority prior to the exercise of said license.
Every license granted under this section,and every certificate of registration filed under this section,shall
be deemed to be granted or filed upon condition that if the land described in the license ceases to be used
forthe aforementioned uses,the holder of the license shall within three weeks after such cessation eliminate,
and in accordance with rules and regulations of the board,all hazardous conditions incident to cessation.°
If the license was properly issued but never exercised, hazardous conditions related to cessation of use,
probably would not exist. However, the terms and conditions deemed to be granted or filed at the time of its
issue would not have been fulfilled and this would place the license in default by cessation and subject to
revocation after due process by the issuing authority. An annual certificate of registration filed by the holder
of such a license,setting forth that the license was being exercised in accordance with its terms and conditions,
would falsely indicate to the issuing authority a condition of the license grant.
Massachusetts Code of Regulation 527 CMR 9.00,Tanks and Containers, uses the definitions"abandoned'
and"out of service", to further categorize storage containers subject to cessation of use.
Abandoned,in the case of underground storage tanks,shall mean out of service for a continuous period in
excess of six months where a license from the local licensing authonty is required under the provisions of
M.G.L.c. 148,s 13,and for a period in excess of 24 months in the case of any other underground storage
facility or an aboveground tank of 10,000 gallons capacity or less;and in the case of aboveground storage
of any fluid other than water,where a permit is required from the commissioner under provisions of M.G.L.
c. 148, s. 37, it shall mean out of service for a continuous period in excess of 60 months and it has been
deemed to be unsafe and a threat to the public safety by the head of the fire department and by the
Department of Public Safety Division of Inspectional Services.
Out of service, not in use in that no filling or withdrawal is occurring.'
Once the tank is abandoned or out of service it must be removed.
Any owner of a tank who has decided to abandon it and any owner of a tank which has been out of service
for a period of time constituting abandonment as defined in 527 CMR 9.00, shall immediately obtain a permit
from the head of the local fire department pursuant to M.G.L.c. 148,s.38A,and,527 CMR 1.00,and subject
to the directions of the head of the local fire department, shall have any product removed from the tank, all
openings propedysecured, and the tank removed from the ground.The product and tank shall be disposed
of in accordance with 310 CMR 30.00"Hazardous Waste Regulations,'at the owner's expense,as directed
by the head of the local fire department. 10
If it is detemtined that a fire or explosion hazard exists or is likely to exist as the result of the continued exercise
of a license,the local fire chief shall issue a cease and desist order.
7 Section 13, Chapter 148, M.G.L., sentence 6
8 Ibid,sentence 8
9 527 CMR 9.02
10 527 CMR 9.07H(2) H,1
1
UST Uniform Inspection Guide• 13
Regulation 527 CMR 14.03 section (2), requires a permit for the storage of any flammable fluid,solid or gas.
This permit is to be obtained from the head of the fire department, as provided by M.G.L.c. 148, s. 10A and
23. The head of the fire department may restrict the quantities to be stored under the permit.
The head of the fire department may limit the quantity of flammable fluids,solids or gases that may be kept,
stored,manufactured or sold under the authority of a permit to less than that specified in the foregoing table
where, in his opinion,conditions are such as to warrant his restricting the amount of such fluids,solids or
gases.'-
What this means is that a permit(in lieu of a license and registration or either of them)may be granted by the
Head of the Fire Department for the storage of certain quantities of flammable fluids up to a designated
amount.The Head of the Fire Department may reduce the quantity of product allowed by permit but may not
increase the quantity beyond that allowed by the regulation.
Exceptions to this permit process are granted to certain persons by 527 CMR 14.03 (6) and (7).
No permit will be required for the keeping or storage of any flammable fluid, solid or gas, in amounts not
exceeding those specified in the table,in any building or other structures used as a wholesale or retail drug
establishment, chemical laboratory, doctors or dentist's office, or other similar approved professional
establishment,provided that the provisions of 527 CMR 14.03 shall apply only to the keeping and storing
of such articles approved as appurtenances and essential to the professional conduct of the business with
which they are kept or stored.
Recognized tradesmen or artisans and those persons working under their supervision,will not be required
to obtain a permit for the keeping and use of any flammable fluid or gas, for use in connection with such
construction or repair,in any building or structure,in amounts not exceeding those specified in the following
table:
TABLE 2
Class I fluids, excluding gasoline, not to exceed ..................._..................5 gallons
Acetylene.............................................................................................40 cubic feet
and provided said flammable fluid or gas is removed from the building or structure upon completion of each
working day,and further provided a suitable fire extinguisher of at least A-1 rating is immediately available
where flammable fluids or gases specified in the foregoing table are being used.
In summation: A license for the storage of flammable or combustible fluids in quantities in excess of those
allowed by a permit is granted by the local licensing authority after approval or disapproval by the head of the
fire department and after a public hearing. A permit is granted by the head of the fire department.
A license is not owned be an individual as a personal privilege.A license once exercised is a grant which runs
with the land.The permanent record of a license is to be recorded and maintained by the city or town clerk.
A certificate of registration is annually filed by the holder or occupant of licensed land to inform the city or town
clerk to record (register) the license as still active and being exercised.
A city or town may develop its own form for the actual license and registration. The form of the license and
registration must contain,as a minimum,that information contained in Fire Prevention Forms, FP-2, License
and FP-5, Registration respectively.
A license,when exercised, is a grant running with the land.A parcel of land may only have one license for the
storage of flammable or combustible fluids.If the conditions,capacities or restrictions authorized by a license
are changed,a new license or an amended license must be obtained. A new application must be submitted
to the local licensing authority,the head of the local fire department must approve or disapprove,and a public
hearing must be held. If granted,the new license supersedes and replaces the old license, and will show the
18 527 CMR 14.03(5) 7
P
4
TOWN OF NORTH ANDOVER
OFFICE OF
BOARD OF SELECTMEN
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Thomas Licciardello, Chairperson
Mark J.T.Caggiano xonra Telephone(978)688-9510
Daniel P. Lanen FAX (978)688-9557
Rosemary Connally. Smetlile � L , -•• `
James M.Xenakis. '
October 4, 2006
Legal Ad Dept
North Andover Citizen
Please publish the following legal notice in the North Andover Citizen on Friday, October 13, 2006.
Town of North Andover
Board of Selectmen
Public Hearing Notice
Notice is hereby given that the North Andover Board of Selectmen will hold a public hearing on
Tuesday, October 24,2006, at 7:30 p.m, in the Board of Selectmen's Meeting Room, 120 Rear Main
Street, 2nd Floor,North Andover, MA, on an application from 1503 Osgood Street, LLC, 2 Bridgeview
Circle Tyngsboro, MA, for a license to store the following in underground storage tanks: 29,000
gallons of gasoline and 8,000 gallons of diesel fuel for a total of 37,000 gallons at 1503 Osgood Street.
Mark LT. Caggiano
Licensing Chairman
NAC: October 13,2006
Very truly yours,
Janet L. Eaton
Administrative Assistant
/jle
Bill: Smolak &Vaughan
Attorneys at Law
Jefferson Office Park
820 Turnpike Street, Suite203
North Andover, MA 01845
Tel: 978-327-5215
TOWN OF NORTH ANDOVER
OFFICE. OF
LICENSING COMMISSION
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Or NOPiry,
Mark J.T. Caggiano, Chairman 3+ .= �o
Daniel P. Lanen o 'telephone(978)688-9500
Thomas Licciardello fr FAX(978)688-9557
Rosemary C. Smedile 'y..,^ o �,.4�'
James M. Xenakis �ds�iPoaE
October 2, 2006
Eagle Tribune
North Andover, MA 01845
Dear Terri:
Please publish the following legal ad in the on
Town of North Andover
Licensing Commissioners
Public Hearing Notice
Notice is hereby given that under Massachusetts General Laws, Chapter 138, the North
Andover Licensing Commissioners will hold a public hearing on Tuesday, October 24,
2006, at 7:30 p.m., at the Board of Selectmen's Meeting Room, 120R Main Street, 2Pa
Floor, North Andover, MA, on the application received from 1503 Osgood Street LLC.,
David E. Murray, Manager, 1503 Osgood Street, North Andover, MA., for a Package
Store—Wine & Malt Beverages License,
Mark J. T. Caggiano, Chairman
Licensing Commissioners
Publish:
Very truly yours,
Janet L. Eaton,
Administrative Assistant
/jle
Bill to:
�' �Fce l�ntrrc¢rrtiJ o
c111
Department of Fire Services
en »� Office of the State Fire Marshal
P. O_gee 1025. Slate head_Sww.MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2011
(Ciry ur Torn') (Darr)
NOTE: Cornplcic top wet bononl of farm end forward both semen_,and tce to local 1T nsig o Authority(C'ily or T mrn Clerk}
DO NOT RE'I URN FORM 'FO THE DEPARTMENT OF FIRE SERVI( ES.
In accordance with the provisions of Chapter 148,Secfion 13, of the General f.aws, the undersigned hereby certifies that:
(TITLE HOLDER): 1503 Osgood Street LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted (Date): October 24, 2006 for the lawful use of the building(s) or other
structure(s) situated or to be situated at (ADDRESS) 1503 Osgood Street
NOR II I ANDOVER. MA 01845
(C'it) nr j )
as related to the KEEPING, S FORAGE, MANUFACEURE OR SALE OP FLAMMARLES OR EXPLOSIVES.
VU fF.: This eerti0cxte of registration must be signed by the holder of the license if said license was granted prior to July 1,1131,
Otherwise by the owner ar occupant of the land licensed. Miami,gals gasol ne N,000 gxh Aieoel
Re cived
13),
IOIf al III, (CJcA) ..... � ...
(sum wn,r.nccupamor harden __..
.............:.....
(Add,...l
The Commonwealth of Massachusetts
�{ - Department oflndustrial Accidents
6M Washington Street
Boston,Mass 011H
Workers' Co ensatiou Insar tom AtBdavh-General Businesses
eddrese
tv C \nz ny- ph r
worlr sit.lovfiav!fall ed hna.1:
❑ I am a sole proprietor and hen no one Business Type: ❑Retail RestamanUBadFating Establishment
Working in any capac ty ❑Office Q Salo(including Rod Estate,Amen uc.)
04 am an® 1 With ctoploy= fill & time . er
I am an®Pk}a providing w km'—Pmsatim for my®Ployees wmklug on this jab.
G\VvN b.a x• (A-W 1.Kt uJ s 1
I am a sole paole]etue and have hued We independent contractors lured below who hen the following workers'
compensation Polices: 1
romvwvr vrae: /J — -
.care.,•
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.rysn']apra.ebotr wag r.4ap.maW 4 d.fro Mb or wORK O&DER.wd.an.efnN.N.Br.ptrts Iiad.r.u.dth.ta
e.pf.f thl..b�ewt aqd brw._• •4 tb OAhe Nlv.etlpWs Ntlr IRAMe..e.p..rlllatba
r d.h.:rehr eerttfj mJs the p iva andprnaaio ofperlrry thatth..dnforaNiow pro.tJd abe.e is ens d c.rrsi
Ph..9
.trvf.l mealy d.me wrlbbthh.rs4be rmpletd br etty er 4w..MW
euy or b..v: paan/tee...e s pswmh.s t>.p.nae.e
❑cheek a Ivmedub regw.r h regwrW clLermiq tme.,.Onke
011—
oo�amrt perw.- ph.m M, �HHh Dep.remevf
d e�am (]Other
NOTICE OF ASSIGNMENT
M PLOVER: 0 COMBO LD. STATUS OF EMPLOYER
P ECX 67141
Y ED LLC 00091890, L1miLed Liabi ' tY ,,.,' ; Co- -
CH-STIJ''T HILL, XP 0246F COVERAGE GROUP
C9669=:2
Coverage under this assigcment
Tte r ver Our 3iaht m eppiies Co etts Massachus
Recover from1,Others Endorsement i operations on'"y. E'or coverage
vai�ah_e on Pool p 'c_ oc_side of Nassac'iusetts, e0rtaot
CJn,aCt your agent _or e -ai_s. the appropriate Fco- or Plan for
that s_a'e
,GENT COLDMAH E36ES7 & L-NER INSURANCE COMPANY:
IR -0 KEARN EY kD
;RANITE STA'I'c -VS CO
'RODUCER: NEEDHAM, MA C2494 RESIJJA.L MARKET OPERATIONS
P 0 PDX 409
PARS-PPANY, NJ C7154-04C9
IG ENCY FEIN:C 43293a6- (8,',C) 655-2259
-: -S-IFICATION OF CFERAT-ON FST'MATEJ RATE ISTLMA7-D
CCE TO-.AL ANNCA-, FREE--M
REM[1NERlI ION
;T03E: GROCERY STCREE-RF-'AI-NC RANLI -NC OF 80"o TS 7, 090
RETH MLr." '
�,PLOYERS LIABP_lTY ICU/_CC/50C 9811g
PRLM:, 9
[X2ENSE CONSTANT 51, PC
ERRJR_SM CHARGE fJO S332
974C
_ ,7AL POLICY M-9INUN PRE M`{ a23-.,^AL RSC-MACED 23E 'J M- M $232
I-A ASSESS. 6.81 . 1,531
$80
-0';AL EST. PREMIUM PLUS ASSESSMENT ------
NSTALLMENT BASIS: Ar..ioal DEPOSIT PREMIUM:
THIS IS NOT A BILL
:OMMENTS
-cverage of`ective -2:C- AM on OS/1C/I:
ATE OF NOTICE: CS PREPARED BY: Pdalette HOtfman
EXT 514
+ * VOLUNTARY DIRECT ASSIGNMENT + +
ETTERID: 3591439 COPY: o.,"_O_,,.,
The Workers' Compensation Rating and Inspection Bureau of Massachusetts
101 Arch Street Boston, MA 02110
(617)439-9030 - FAX(617)439-6055- WWW.WCribma.org
Commonwealth of Massachusetts
u 3`
'z ^� Department of Fire Services
Office of the State Fire Marshal
P.O. Ras 1025.Slate(toad. Slo 1. VIA 01715
CERTIFICATE OF REGISTRATION
North Andover April30, 2008.
(Cu'." I wn) (Dole)
NOTE: ( omplctc top and bumun oI lono and foncard both sections and fee to local Licatsing Awhonly(City.,r Tmsn C'Icrk)
DO NOT RE TURN FORM TO ]'OF,DFPA RTNIENT OF FIRE SERVICES
In accordance with the provisions of Chapter 148, Section 13, Ot the General Laws,the undersigned hereby certifies that
(TITLE HOLDER): 1503 Osgood Street LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted (Date): October 24,2006 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTI I ANDOVER, MA 01845
tcitt,,,n<���nl
as related to the KEEPING, STORAGE, MANDFAC'I URE OR SALE OFtFABI, ;S Ok-dd,
IVES.
SOTF.: This mrti0ea[e of registration must be signed by the holder of[he live as to July I,1936,
Otherwise by the owner or occupant of up,land Inen,,A. 29 ] 8,0l
Received /:5.._._ 1008....
Byd60.2t- n tau)
U .. .. ..............................
fChrk] ...6h 1 t. p so, WWI)
tso3....Qscod . Sf
t es,
The Commonwealth ofMassachusetts
Department of IndustrialfAccidents
h = - A&VAfAwtmokq
600 WashingtonV Strf.'et
Boston,ton, ,Class. 02111
Workers' Compensation hasanace Atndsvk-General Boslatsta
addR� I.S03 NO 1 +t
o a O I Y4S oh a 478 0010091
wok sits lamtiaa fMdl addreml:
❑ I am a wile propi" and have no one Buslam Type: ❑Retail❑Restaurmt/Bar/Eating Establishment
,--/ wading in my caparib Office ElSales(including Real EslaK Antos etc.)
Uv I am ao®ployv with VJ muployers(Poll g Part Ome). Other
I am An®PIOYW povviding s'
aukets'COMPe Bosun for rm�y—Ploym wmli on this job.
v aaan c" 11 N mmoaa yrJ OIC, i1xk IM l\.
ad t
dtv: n I mn•, N ;(. 070-q aloe R•
am ea ds evils - W C, ka so 71
I am a sole proprietor and have hard We mdepmdmt cantrectvs hated below who have the following workers'
c�petleatiu police:
romnbm wean:
add.*;
dtvt
i ea lw
.dd..;
eldr Phone Alt .
iRmra a ea
path b noon • raryb.d adn Seed..BA of MCI.In ne tree b Mr iapeeta.e Nertabd peuaNb..7a ar q b a1,TM.N eeJM1r
wDa DO bgpeaNir W the r.Of-nOr WORK ORDER and a ROD.rrlM.N s 6y.ptmt ma fuadnabed three
rapr.rthbrb frwarddbfba OflNe Nrmaapd.me/theDG M`se.sye.ernlnWa
I L her eaN the ire alf4a ofpnJery Ma f4 in/araRloa prerlJd aasroriis free anJ tarred
Si�atm. D.a w�a�a8
Print name rbaa..9�B-G49- 4�l y
.Mbluse.dy do not Drib In this ern b be napWe by city er Um QMW
aty.r bwe: prmlNNeme QBuWlar Dep.rtean
ank dlemrdtaa rapeoae b requNM remtq linty
El r
�Maleneaoh Oabe
tosser penoo: phD=P, �Othe h Departure[
(mks eM>ml
Note: Complete top of torn and forward bath sections and fee to local licensing
j authority (City or Town Clerk). Co not make application to department of Public Safety.
F �' �cm7/mc�rcc�aa�Gli G�'^/G�a%laapcfzc�eG`Z.t
Sv —%CfLZYf/1LPYEC 6��l/..4 F/M91LCC1 — y{(�p.2 dG �YolfMll[r",LG>L
City ar Tcwp NORTH ANDOVER Oate OCTOBER 26, 2006
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148. Section 10, of the General Laws. the undersigned herecy certifies that
1503 OSGOOD STRF,ET, LLC
TYNBBORO MA
is :he holder of license granted OCTOBER 24,.T.2006 for the lawful use of the buildings) or other s;ruc:urets; situated cr
o
!o be smawc at 1503 OSGOOD STREET, NORTE ANDOVER, MA
as related to the KE_?ING. STORAGE. MANUFACTURE OR SAL OF F!AMMASLES OF EXR�OSNES.
NORTH ANDOVER MA
Note: firs appl/dati"for"harloste of 1915:ration must be signed by then 1 o the license if sad license was
granfac char re July 1, 19,16, olherwrse dv tPe owner er pd-- ant f e la d lic nseo.
Fecawed Jr�/'��tztf .�)(re S=M,,gec ov
a,.
r
c� .u.
f Note: Complete upper portion of form and forward to local fire departm Do not make application to Department of Fire Services. ent.
le! lCful'�/l)22//2C[�(�9'[/kP ��a/Y9HC'4G — LV;�� `7' ♦ { ��� � ,�J,// �.�y����,,
y /jJ CCG �/2 C �.E Cltyor TOwn North Andover \
-�� - - Date Auge.L 20 2006
APPLICATION FOR LICENSE
"Osvislons of i or the lawful use of the herein described building._ or other structure_..,application is hereby made m accortlance with the
canse to
the
are to be situated,and oter nly to such anent as shown oln plot plan wh which is Filed with and made nd on which such holding
se of tills
structure.-..is/are oris/
ppiicefion-
Locetienofland 1503 Osgood Strce[
(sreersH„mren Nearest oross street Orchard Hill Road
Ownerolland _ 1503 Os ood--Street , LLC
-- —__ Adtlress- 1 1?rldge_view Circie , 'fyngsboro , MA
Number of buildings or other structures to which this application applies 2 (mai.n building and canopy)
1 Y)
Occupancyoruseofsuch buildings convenience store w/ drive-through doughnut shop
Total capacity of containers in gallons—Aboveground N/A
Underground 29, 000 gal . gasoline
Kind of fluid to be stored in containers - -_ asoli b , 000 ga rase
- �_-ne—& diesel hp00 sal • Lotal
dApple ❑ Disappro zd t 15 3 C 0 d treet , LLC
Dav td Murra a er -
� ro,ru, 2 ttridg ev icw Circle, 'fy p hero , MA
M..w'
Eaton, Janet
From: John P. Carney Ucarney@napd.us]
Sent: Tuesday, October 10, 2006 2.40 PM
To: Bradshaw, Joyce; Eaton, Janet
Cc: Richard M. Stanley
Subject: Underground Storage Tanks 1503 Osgood Street
The Police Department has no public safety concerns regarding the proposed
underground storage tanks at 1503 Osgood street.
1
SMOLAK & VAUGHAN John I S,n..I„k. L,
September 20,2006
BY HAND
Mark J.T. Caggiano, Chairman
Licensing Commission
c/o Board of Selectmen
Town of North Andover
120 Main Street
N. Andover, MA 01845
RE: Application for Flammables Storage License
Applicant and Owner: 1503 OSGOOD STREET LLC
Property: 1503 OSGOOD STREET
Dear Selectman Caggiano:
On behalf of the Applicant, 1503 Osgood Street LLC, enclosed for filing
please find an application for a flammables storage license for the underground
storage petroleum products at property known and numbered as 1503 Osgood
Street(the "Property"). The Property consists of approximately 6.1 acres of land,
and is located at the corner of Osgood Street and Orchard Hill Road on the
easterly side of Osgood Street and across the street from the former Lucent
Facility now known as Osgood Landing. The Property currently includes two
existing residential dwellings along with a number of old outbuildings, all of
which are vacant and in general disrepair.
The proposed project includes the construction of a proposed retail
gasoline service station for the retail sale of gasoline and diesel products, a 3,700
square foot retail convenience store, and accessory drive-through for a proposed
Dunkin Donuts facility. The proposed Project has been reviewed and approved
by both the North Andover Planning Board and Conservation Commission, both
of whom retained peer review consultants to confirm that the Project was both in
compliance with the Town's Zoning Bylaws and Wetlands Bylaws, as well as
with sound engineering practices for storm water management.
The license will permit the Applicant to install state-of-the-art underground
storage tank and related piping facilities for the Project. The proposed double-
walled fiberglass tanks provide rustproof construction,secondary containment,
.I,Iferson Office Park,N21I 1 u,npikc StrecI.Iu lc 203, No, NI A 0154�
AN N%NN SNIOLA RV'At Y:H A N.(DN
S ib10LAK & VALGHAN LI,P
Mark J.T. Caggiano, Chairman
Licensing Commission
September 20,2006
continuous leak detection, and a built-in precision test capability. The state-of-the-
art tank monitoring system provides continuous monitoring of the interstitial space
of the double-wall fiberglass tanks, providing leak detection which meets and
exceeds all applicable EPA and Massachusetts regulations for underground storage
tank facilities. The stormwater management systems are designed to prevent
impacts to groundwater, and drainage and runoff will be recharged onsite.
Stormceptors will provide pretreatment of stormwater runoff. From and
environmental and safety standpoint, the combination of double-wall fiberglass
tanks,a state-of-the-art monitoring system, and the sophisticated drainage system,
represents an effort by the Applicant to present a technologically superior facility
equipped to address any potential concerns. From an economic development
standpoint, the proposed Project will result in the redevelopment of a site which
has been vacant for a number of years, and represents one step in the Town's
efforts to redevelop the Route 125 corridor.
On behalf of the Applicant, we look forward to the hearing on this matter.
Very truly yours,
C
-/f ohn T. Smolak
Enclosures
Eaton, Janet
From: Bradshaw, Joyce
Sent: Tuesday, October 10, 2006 3:52 PM
To: 'John P. Carney; Eaton, Janet
Cc: Richard M. Stanley
Subject: RE: Underground Storage Tanks 1503 Osgood Street
Thanks - as always!
Joyce A. Bradshaw,CMMC7
Joyce A. Bradshaw, CM[MC,Town Clerk
120 Main Street
North Andover, MA 01845
Telephone: (978) 688-9501
Fax: (978) 688-9551
E-Mail: jbradshawaltownofnorthandover.com
-----Original Message-----
From: John P. Carney lmailto:jcarney@napd.us)
Sent: Tuesday, October 10, 2006 2:40 PM
To: Bradshaw, Joyce; Eaton, Janet
Cc: Richard M. Stanley
Subject: Underground Storage Tanks 1503 Osgood Street
The Police Department has no public safety concerns regarding the proposed
underground storage tanks at 1503 Osgood street.
1
Eaton, Janet
From: McEvoy, Jeannine
Sent: Thursday, October 19, 2006 2:08 PM
To: Eaton, Janet
Subject: 1503 Osgood Street
Janet,
A permit is in process for issuing for the gas station at 1503 Osgood Street. There are no outstanding issues. NAFD has
given a verbal OK and will come to the Bldg Dept to sign the form necessary.
jcanni�c McEvoy
Building Dcpmm"cm.
1
TOWN OF NORTH ANDOVER
OFFICE OF
BOARD OF SELECTMEN
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Thomas Licciardello,Chairperson
Mark J.T. Caggiano yoxrp Telephone(978)688-9510
Daniel P.Laren �o�. a+o FAX (978)688-9557
Rosemary Connolly. Smedile
James M.Xenaos.
Legal Ad Dept October 4, 2006
North Andover Citizen
Please publish the following legal notice in the North Andover Citizen on Friday, October 13, 2006.
Town of North Andover
Board of Selectmen
Public llearing Notice
Notice is hereby given that the North Andover Board of Selectmen will hold a public hearing on
Tuesday, October 24,2006, at 7:30 p.m. in the Board of Selectmen's Meeting Room, 120 Rear Main
Street, 2id Floor, North Andover, MA, on an application from 1503 Osgood Street, LLC, 2 Bridgeview
Circle Tyngsboro, MA, for a license to store the following in underground storage tanks: 29,000
gallons of gasoline and 8,000 gallons of diesel fuel for a total of 37,000 gallons at 1503 Osgood Street.
Mark J.T. Caggiano
Licensing Chairman
NAC: October 13, 2006
Very truly yours,
&/
anet L. Eaton
Administrative Assistant
/j to
Bill: Smolak & Vaughan
Attorneys at Law
Jefferson Office Park
820 Turnpike Street, Suite203
North Andover, MA 01845
Tel: 978-327-5215
Town of North Andover
Abutters Listing
REQUIREMENT: rif 40A,Section 11 states In part"Parties in Interest as abed In this Chapter shall mean the petitioner,
abutters,owners of land directly oppositeon any public or private way,and abutters to abutters within
three hundred(300)feet of the property line of the eastern,as they appear an the most recant applicable
tax lis',not withstanding that the land of any such owner is located in another city Or town,the planning
board of the city or town,and the planning board of every abutting city or town."
Subject Property:
MAP PARCEL Name Address
34 7 1503 OSGOOD STREET LLC 2 BRIDGE01111111110 CIRCLE,TYNGSBORO,MA 01879
Abutters Properties
Map Parcel Name Address
34 8 AAA Merrimack Valley, Inc 155 Parker Street, Lawrence, MA 01843
34 52 George Barker 1267 Osgood Street, North Andover, MA 01845
34 17 1 Properties, Inc 3 Dundee Park,Antlover, MA 01810
34 16 Merrimack Valley Federal CU 1600 Osgood Street, North Andover, MA 01845
34 50&51 Alhacado limited 45 Beechwood Drive, North Andover, MA 01845
61 6 George Barker 1267 Osgood Street, North Andover, MA 01845
This certifies that the names appearing on the
records of the Assessor Office as of
Certified by; Date
I Complete items 1,2,and 3.Also complete
Rem 4 if Restricted Delivery is desired. - +. _ ❑Agent
I Print your name and address on the reverse - ❑Addressee
so that we Can return the Carl to you. Received by(Punted Namef G. Date of Delivery
I Attach this card to the back of the mailpiece,
or on the front if space permits.
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3
�$ } Department of Fire Services
Office of the State Fire Marshal
a
1'. O. or, I025, Slate Road,Stow.MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2009.
(City orr 'a) (Date)
NOTE: Complete top and bole it form and forward both sections and Ice to local Licensing Authority(City or I ovot Clerk).
DO NOT RETURN FORM TO THE DEPARI'M ENT OF FIRE SERVICES.
In accordance with the provisions of Chapter 148, Section 13, of the General Laws,the undersigned hereby certifies that
(TITLEHOLDER) 1503 Osgood Street LLC
(ADDRESS): 1503 Osgood Street
is the holder of the license granted (Date): October 24. 2006 for the lawful use of the building(s)or other
Structurc(s) situated or to be situated at (ADDRESS): 1503 Osgood Street
NORTH ANDOVER, MA 01845
On or loan)
as related to the KEEPING, STORAGE, MANUFACFU RE OR SALE OFF .OSIVES.
N01'E: 'this certificate of registration must M1e signet by the hnWer of the lirens i i license wns gra ed prior tn.luly 1,1936,
Otherwise by the owner or occupant of the land licensed. ,0 0 sots aso I e-8,00 gals Diesel
Received .��e � 2009......... ....... ._ . .... .. _.___....... ...By
........
............
(Official Tiae) (Clerk) (state Mtnher owner,occupant or toldro
. 1.503....... . A .St:.......................
ire,,,
APR-30-2009 10:03 AhK FOWLER INSURANCE LLC 9786642209 P.00IT001
s�corzoa CERTIFICATE OF LIABILITY INSURANCE TE, /30/OL 0
4 30/09
FReading,
THIS CERTIFICATE R ISSUED AS A MATTER OF INFORMATION
PaF.rk
Street
Insurances, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
treet HOLDER. THIS CERTIFICATE ROES NOT AMEND, IETEND OR
ing, MA 01864 ALTER THE COVERAGE AFFORgED BY THE POLICIES BELOW,
INSURERS AFFORDING COVERAGE NAICk
d Street LLC =NITRPEA Travelers Insurance Copanyew Cir INSURER B
TYn966orc , MA 01879 N$URIR O.
AUPE
REEE
COVERAGES
THE PCLICIESCF INSURANCE LISTED SELOW HgVp SEEN ISSUED TO THE INSURED NAMEDABOVEFORTHE POLICY PERIOD INDICATED.NO1W ITF$TgrypING ANY REQUIREMENT TERM OR CONDITION OF My CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFl TED MAYBE ISSUED OR
MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EACLUSIC TI AND C WY PRRE SSL SUCH
POLICIES.AGGREGATE LIMITS SFIOM MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ETEfiP umm RULE Fff"T E POI CI'POUCY NUMBER EXPIPATON UNITS
A GXE HMNLFNRCILA"L G ENEPquws Pnx6=DHEr0rccu0RENCE a 00,000
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GENERALAGGREGATE S 2 00000000
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GEED EARN bR ucLLDeDT 8/15/08 8/15/09 ELEACHACQWNT P S 100 000
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OTTER EL Dls EisE.POIGYLIMn I s 500,000
W SCRIP¶ON OFOPERATONS I LOGTION9/VERICLE$IE%CLU MONS ADDED BY ENnO ELMONT/DESCENT PROVISIONS
Insurance verification
CERTIFICATE HOLDER CANCELLATION
SWMOMYOFTWADO4 DESCRIREOPOLICIE$BECAf .4LED9EEORETNEEYPIMVON
DATE TREREOF.THE DURING INSURER WILL ENDEAVOR TO MAIL 10 DAYS R RT,,R
Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF,BUT FAILURE TO DO SD P.,
120 Main st.
IMP06E NO OBLIGATION OR LIABILITY OE ANY HIND WON THE INSURER.ITS ADENT6 OR
North Ar1dover, M2 01845 REPRE6ENTATVES.
AUTHORIZED REPRESENT,
Lisa A. Dabriao CISR
ACORD 2512009/011 019BB-2009 ACORD CORPORATION. All Tights reserved.
The ACCRD URme and 1091 era Teglst9Ted marks Of ACp RD
TOTAL P.001