HomeMy WebLinkAboutMERRIMACK VALLEY OIL COMPANY 1-3 MASSACHUSETTS AVE Department of Fire Services
' Office of the State Fire Marshal
oj` cb•
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2018
(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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
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.
Rec ve I
... .. 2018.........
. ......................
By .. .... (Signature)
(OW'ci i (Clerk) (State whether owner,occupant or holder)
(Address) 0%��
I
The Commonwealth of Massachusetts
Department of Industrial Accidents i
O,fffce o,f Investigations j
600 W4uh ngton Street
Boston,MA 02111
www.massgov/dia
Workers'Compensation Insurance Affidavit, general.Businesses
Applicant Information Please Print Le:ribLy
Business/Organization Name: O• -fit C
Address: �2 /11 A lj . V e
City/State/Zip: / 7%14,41,-t 04V3_ Phone#; g
Are you an employer?Check the appropriate box: Busin Type(rNulred):
1;❑ I.am a employer with employees(full and/ 51 Retail
orpert-time).* 6, [1 Restaurant/Sat/BatingEstablishment
2.❑ I 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. j
^o workers'comp.insurance required] 8• ❑Non-profit j
3.10 We are a corporation and its officals have exercised 9. F1 Entertainment j
their right of exemption per c, 152,§1(4),and we have 10.❑Manufacturing
no employees, [No workers'comp..insurance required]'
4,❑ We are°anon-profit organisation,staffed by volunteers, 11.❑Health Care
with no employees.[No workers'camp,instuencereq,] I2.❑Other r+e �1eu�, 0 1 de ri�� i Sr'� ice
*Any applicant that chocks box#`I must also fill out the section below showing their workers'compensation policy information,
**if the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organi2zti6n should chcok box iKl.
I am an employer that is provldin8,workers'compensation insurance for my employees. Below is the policy Information,
Insurance Company Name:_ 14SJ rC t eJ ed l=n.02 loL{,-) �-;'U. corn"rut
Insurer's Address: 3 V 7-6 f-d Ave n K e
City/state/Zip: 13u I�%A 0 /
Policy#or Self-ins,Lic:#IWCC-5-00•-SOl S J G�a tY,2 4 Expiration Date:_. /J,1.1 i/ ,2
Attach a copy ofthe workers'compensation policy declara tion.page(showing the policy number and expiration date)..
Failure to secure coverage as required under Section 25A ofMGL c.1. 2 can lead to the Imposition of criminal penalties of a
fine up to S1,500.00 and/or one-yearimprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up.t"25t1,Oa a.day againsttlie violator; Be advised that a copy of this statement may ne:forwarded:to the Office of
Investi `ons of the.DIA for insurance coverage verification.
I do hereby cerllfy,ws#the pacts a en ltl erJirry that the information provided above is true/anal correct
Si nature: (�� Date: Ilk
Phone#: Cf 17k d< .3—
Off cial use only: Do not write In this area,to be completed by city or town official
City or Town: Permit/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 M
www.mass.gov/dia
r
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 40959
POLICY NO. WCC-500-5018198-2017A
PRIOR NO. NEW
ITEM
1. The Insured: MVO Inc
DBA:
Mailing address: 3 Massachusetts Avenue FEIN:"-"`0228
North Andover,MA 01845
Legal Entity Type: Corporation
Other workplaces not shown above: See Location
2. The policy period is from 12/31/2017 to 12/31/2018 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident
Bodily Injury by Disease $ 1,000,000 policy limit
Bodily Injury by Disease $ 1,000,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 0080575
INTER SEE CLASS CODE SCHEDU E
Minimum Premium $545 Total Estimated Annual Premium $14,630
GOV GOV Deposit Premium $3,821
STATE CLASS
MA 8350 State Assessments/Surcharges
$14,299.00 x 4.5600% $652
This policy,including all endorsements,is hereby countersigned by 'IV," 7 G— 12/21/2017
Authorized Signature Date
Service Office: Peoples United Ins Agcy Inc
54 Third Avenue 10 Commerce Way Suite 3
Burlington MA 01803 Raynham, MA 02767
WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.
t ��wlg•^'^�!ri` � �ll//%//Zl'?l//�Gllf?l' -e /���/.0 7/I���
�y b Department of Fire Services
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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass. Avenue
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.
Re i
........2017.........
By (J n�zoccupant
...(e). .
(Official Title) lerk) i .�' •...'.(Sta or holder)
(Address)
Apr, 12. 2017 11 : 59AM No, 1391 P, 1
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v Department of Fire Services
Office of the State Fire Marshal
P O_Bo, 1025,Statc Road.St,, MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2016
flap or townil nxno
NOTE: (onit,I etc top and bouoTr ol'lonn and 1'onvand both sca ot, nod lee m local Idecnsing Aa lhonts o, iI, or l'msn CLrkl.
DO NOT RETL RN 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): Merrimack Valley Oil Co.
(ADDRESS): I-3 Mass Avenue
is the holder of the hcensc grained (Date): 7/29/I985 Iorthe lawful use of the buildings t a c,h,:
structure(s) situated or to be situated at (ADDRESS): 1-3 Mass. Avenue
NOR3'It ANDOVER. MA 01845
Ifip or laxat
as related to the KEEPING, STORAGE. MANUFACTURE OR SALE OF FLAMMADLES OR EXPLOSIVES.
NO[L: This certificate of registration most be signed by the holder of the license if said license was granted prior la duh L 193k
Otherwise w the owner or occupant of the land licensed. �/
(jjjy
Re d �� 2076_.__- ._...__ t7�i� n. t)r�. '� ...
S'
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Wllial'Id", 141 `,Ou,hcthcanat ..rats orh.ld rl
SS
j.L ............. ....../✓... ........i. M
tAddru., �7��cVJ,
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office Of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Aplllicant Information
Please Print Legibly
llusitiess/Organization Name: M do — cf h "P j
F Aress:
MaS,
Ciry/State/ztp: N /ft}
Phone#:_ 97✓ Gee' 3/3/
Are yqu an employer?Check the appropriate box: Basin Type(required): -
1. I sin a employer with errtployees(full and/ 5. [r. Retail
or pares:imcj
2.G I am s sole proprietor or Partnership and have no 6' ❑ estaurant/Bar/Eating Establishment
employees working for me in any capacity. 2• ❑OtHce and/or Sales(irwl real estate,auto,etc.)
[No workers'comp,insurance required] a. ❑Non-profit
3.❑ We are a corporation and its officers have exercised
their right of exemption per c. 152, §I(4),and we have 9. ❑Entertainment
no employees.[No workers comp. insurance required]" 10.❑Manufacturing
4.❑ We are a non-profit organization,staffed by volunteers, 11•❑Health Care
with no employees.[No workers'comp.insurance req,] 12.❑Other
'AnY applicant Nat chocks box NI mint also fll om Ne section h "con
Neir workers'compemerion yoliry iNorme[ion.
"IrNe mrponk oEFcers aveexempted themselves,but the, "con has oil eremployees,aworkers'wmpensafion pelioy a required aidsuchan
o�geniration should check box ill.
t am ml employer that Is p ov tang wor ars cotnpens Islas ance form employees. Below is the policy information.
Insurance Company Name:
Insurer's Address:
City/S:ate/zip: / L-r_ .v . _Z—
Policy#or Self-ins.Ll,#_G 't.u/ %if d fj f 7 S S t r
Expiration Date:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).,
Failure in secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/m'ore-year im>•risom^+ent,as well as civil penalties in me fora.; Of a STC'}vrn oY�e DrR and_:u,c
Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office a
Investigations of the DL4 for insmene coverage verification
!do!ereby ce Illy unite PZ of peryury that the information provided above (r and correct.
SiznetuIs,
/� //!• t/
Pone# r_3 31
3/
Official useonly. Do not write In this area, to be completed by city or town gfJlclidn: Permit/License#hority(circle one):Health 2.Boilding Department 3.CiVrown Clerk 4.Licensing Board 5.Selectmen's Ofrice
son:
Rhone#:
www.mna.gov/din
RX Date/Time 12/16/2015 10:14
AC ne: 5P86595250
Eagle Insurance Group, LLC FAX:8666769319 Ph. P•001
RO®
16� CERTIFICATE OF LIABILITY INSURAACE D pMmw n
THIS CERTFICATE IS 133UE0 AS A MATTER OF INFORMATION ONLY ANO CONfER3 NO BIG rF3 UPOF! THE CERTIFICATE HOLDER. 15
CERTIFICATE GOES NOT gFFIR INSURANVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED T E HOLDER.
T IS
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING AFFORDED
ORDED R(SI, HE POLICES
REPRESENTATIVE OR pR000CER,AND THE CERTIFICATE HOLDER.IMPORTANandT: C"thee eHl3, h holder Ic rt in p.UDI B.m INSU el the pollcy0es)must He endoged II SURROGATION IS WAIVED, Buried the terms holder
er in . s roe Annoy,certain policies may raqulre an endorsement. A slatemenl on this so,Pf Cab aloes no cooler lights to the
cDUCDcate holtler in lieu of such endorsements). ktl to
PRODUCER
Eagle Insurance Group, LLC AIC
NA.0 Michael Bates
Ten Commerce Nay '"ue°H`,g_(508)659-5250 FAx ---
suite 3 XPR mi chaelbat tuc N° leeg aTEa3v
AD ALL_ss_ es@eagleinsuranc rou
11aYnham _M p net
MA 02767 INa11REgLy)AEFORDWGCOR,,so,
INsutEEA t♦DI GCrhng America InSUCance Y.
N -el a1343
3 Massachusetts Ave INSLRERO ---
INSURER D', —�--
Nar[h Andover MA 018E5 INPURERE__
COVERAGES CERTIFICATE NUMBERpL151216o3360ENF: --
THIS IS TO CERTIFY 1HAT THE P41CIE8 OF INSURANCE LIgiED 3ElGW HgVE OEEN ISSUED TO.THE INSUR OEIS
NAMIEOC BOMBECF, THE POLICY PERIOD
INDICgTEO. NOTWnHSTgN01NG qNy gEWIREMENT, TERM OR CONORION OF qNV CONTRACT OR OTHER DOCb MENi
CERTIFICATE MAY BE ISSUED OR MAV PEgTA W, THE INSURANCE AFFORDED BY THE POIICIEB DESCRIBED HEPEIN IS SUBJECT TO qLl THE TERMS,
FXCLUSI(Ni5AN0 CCNpITIQ450F SUCH POLICIES.LIMR35HCWN MAYHAVE EEEN REDUCED BY PAID C1f\IMS. VRTH RESPECT TO NHICH THIS
IN
L]N NnNcc
X COMMER[WL GENEMLLIABILITV POLICY MIMEEN MM�IpNEmFP PCLICYI%pT
MM/nOry!Vy
A CLgIMSMMF OCCUR GCH GLNRRENCE LIMITef 3,000,000
EOo[0000]]ssis Ili/3l/]019 3]/31/itla PREMISES ej t 3001 000
_ MEO EM(My one
�1 f
6ENl AGGREGATE LlMlr IWFLIFS PEN PCPSONILLBMV ry,LRy 'f p=00�0Oo
'Y PCLICV FRO( L� OC ('GENERN.AGGREGgiE E Y,000,000
OTHER GRODUCII COMFOPAOO f 2,000,000
AUTOMEDITE unn,
X µ 'Mca90 IncludrE'+ f
A rPJro oI -Ie,sIncLE LIMIT f 7,000,DOD
�U.O O SCHEDlnm `..1ILa NI, e.R""I t
os 11U. exocoot llssls II'I'I �—
'X MIREEAUT05 $ NO'HO" 0 112131/2015 1]/31/2O1a BODILY INLRY!per ecpaennlf WTOS +MM995s eeeaa 1—I, PNOPFRiy pyrgGE
Pollution End[ Inctuaed + PM _o n f
X Les"LLA TRIP OCCUR Meaic aNs {
A E-Ohre Ul PIMSMgOE EAU UCW RRFNCE f
3 0�O ,O 000
OP, RETENTION ON e..vo001Ts -G-F t WLMERSCOMPENSATON lz/ "115 1Pn1/.
gr-0 EMPLOYEES LUIel {
AN/PROPTIETORRARTNERIEYECUTIVG r In
ICE FqH
q OFFICEWMENN,E%LLI10E% F NIA
0 nuelwyOMl 17,115 fLECH AECIOF.gT S 11000,000
acoOaR 1vT1 Hass lznvi vela DESCRIPTION OF OPFRATOmseelw �L—E IASE-E9 EMOLCYF s l oDO .10
I vrr:e se-Poucv umn— t� l uDo oDD
I
DESERPTION DF oeEMnONe ILOCAnONz IveHICLEs NCORp rOr,A Operations of the Insured
CERTIFICATE HOLDER _
(978)5A9-a051 CANCELLATION
EVidence Of IIISUSaIlCR SHOULD ANY OF THE AR:'. /E OESCRIEEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATI THEREO( NOTICE WILL BE DELIVERED Be
ACCORDANCE W ITN THE-OLICY Pn 3WSIOIIB.
AUTNORMEDREPRS,NOA,M
Michael. Cnx/MIKEB
ACORD 25(2014101 @1988-201 ACORD';ORPORATION. All Nghtsreserved.
I The ACORD name and are registered marks If At )RD
IN5025¢Uuon
NOTICETO N ICE
EMPLOYEES
TO
EMPLOYEES
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017
617-727-4900 - http://Www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &3Q this will give you notice
that 1 (we)have provided for payment to our injured employees under the above-mentioned chapter by
insuring with:
1-101,gerfing America Insurance Com an
NAME OF INSURANCE COMPANY
161 North Clark Street 48th Floor Chica o IL 60601
ADDRESS OFINS
EWGCD000175515 URANCECOMPANY
POLICY NUMBER 12/31/2015 to 12/31/2016
Eagle Insurance Grou LLC 10 Commerce Way, Suite 3 EFFECTIVE DATES
NAME OF INSURANCE AGENT Ra nham MA 02787
ADDRESS 508-659-5250
M.V.O. Inc. 3 Massachusetts Avenue PHONE#
EMPLOYER North Andover MA 01845
ADDRESS
EMPLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) December 30 2015
MEDICAL TREATMENT DATE
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
1
Provisions of the Workers' Compensation Act. A copy of the First Report of Injury
injured employee, The employee may select his or her own physician. The reasonable cost of the ser-
vices provided by the treatingJ rY must be given to the
physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
TBD
NAME OF HOSPITAL
ADDRESS
�s::'•'_er <` e/ft.¢ 1tiG{:rl7ML OL [LCILLCORM.6
z
Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April30,2014
(City or Town) (Date)
NOTE:Complete top end bonom 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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
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.
Received .........2014......... ....✓... ...(./../.`...../.'u..-.�.'..—..........
(Signemm)
By ... .. 4ntultC(v.zt_......... .......... UI .Sr.............................
(icial Title) (Clete) (Store whether owner,occupant or holder)
...................(Add.)
...........................
Address)
The Commonwealth ofMassaehusetts
Department of Industrial Accidents
Off ice of Investigations
600 Washington Street
Boston,AM 02111 .
wwre.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses _
Applicant Information Please Print Legibly
Business/OrganizationName: 11111d Tr c Des Imi rl-i—A 0; P,A/e,
Address: 3 M"C �✓-�
City/StaWzip: a&4 ;IrC/�lA�if4oaeR:�1F-G �l3/
An you an employer?Check the appropriate box: Bus�tin Type(required):
1.❑ Into a employer with employees(full and/ 5. (y�Retail
or pert-time).• 6. ❑RestaurentBar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no g ❑Office and/or Sales(incl,real estate,auto,eie.)
employees working for me in any capacity. S. 0 Non pmfit
ANWo workers' comp.insurance required]
3. e are a corporation and its officers have exercised 9. ❑Emar num ent
their right of examptlon per c. 152,§1(4),and we have 10.0Manufacturing
no employees. [No workers'comp.insurance required]' 11.❑Health Care
4,❑ We are a non-profit orgenimtion,staffed by volunteers,
with no employees.INo workers' camp,insurance seq.] 12.❑Other
*Airy epplicat Nor ch,ch boxal oral shell,em the r,mm below showing their wakcn'mmpmsstion policy humnstion,
•slfna mryaea olfiven hwe ucmpmd themvelvm,butte wryontion by atha cmPloyas,a wurkere'eemperesim Policy a n,ad and such an
orypnivtier dould cheat boxal.
I am an employer dun is providing workers'comp ssariiors insuran/ce for my employees. Below is thepolicy Information.
ur Insance Company Name:
insur Y er's Address: D Aak 3.Zp
City/Stale)Zip: Q u a J day INA/ s S06 0
Policy#or Self-ins.Lie# .2 '/S- 2 S2 - 2 Expiration Date:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to sacure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
fine up in g1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance covemga verification.
I do hereby certlfy, inderthepaTswedpenydasVp ury that the information provided above is true and cornea
pre / h ) Doc'
Pho # 902'k-
Ofclat use only. Do not writ,In this area,to be completed by coy or town official
City or Town: Permit/License#
Issuing Authority(circle am):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
- www.mea.gov/die
RX Date/Time 04/11/2014 09:42 507 455 5200 P.004
64/11/2014 10:07: 16 AM 507-455-5200 Page 4
ACORd" °PIE(Le40014 '
CERTIFICATE OF LIABILITY INSURANCE D , m4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS
CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR
PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT It the cis illute holds 1..ADDITIONAL INSURED,Me po icy(ISS)mist G endorsed. If SUBROGATION IS WAIVED,sunject to the terms
and cendltionH.N the policy,contain pelicles may require an on OME xd.A Make and m this certilicste does DOE confer rIOML to SHE Certificate IwlEer
in Ilea CI s ich enmrsem s.
PRODUCER cAMERDT CLIENT CT CENTER
FEDERATED MUTUAL I NSU RANCE COMPANY P
HOME OFFICE:P.O.BOX 328 iicRile !M 88&333A049 uc X.:SDT446<ES4
ONATONNA,MN 55050 I' 'LCLIENTCONTACTCPNTEROFFOINSCM
INS IAIC#
R A.FEDERATED MUTUAL INSURANCE COMPANY 13935
usUIRD 245-2U-2 UNPURER e:
MVO INC,MERRIMAC VALLEY OIL COMPANY IMVIIERc
3 MASS AVE
NORTH ANDOVER,MA 01815 IXsu.,A.:
X[VRERE:
COVERAGES CERTIFICATE NUMBER: IS REVISION NUMBER:0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT TERM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CUIMSTYPE .
OF INSURANCE Uaa XYLEM PoVCY FR PoLICY ON UNITS
WARD P
N OERIRALLIA.lLtTY EACH OCCURRENCE f1,00010010
X COXMFRCIPL OENCRK MPNLITr MIAOE TO RLNTEO 51W,00O
CLNMEMAO[ OOCCU, M.....(Mp.n.EFrwN EXCLUDED
A N N 8922977 12/31=13 12T31/2014 .lR -Riss-ADVI.NUIIY f1,000,000
OENLRILIOOREOATE 92,000,001)
OFNL NMIRLO 17 L M."T A71:R PRODUCTS-COMPIOP Are S2.000,000
X PgICY %
NLE LIPeRIry ,I,IND O\INOLE LIHI}
PY Oµr AUTOIUODILY INJURY(P.r pmn)
AM P. T
oulnoAUTERMREOIU. W
X VMNRCLVI LIM X OCWR [PCX OCCVRMNCE S1.000,OW
A EXCE\e LIAM OURES MAGI N N 99229TB 1241142013 12MMO14 APOR[ORTE f1,000.000
DEO I INETYPNOR
WORNLRLCOMPENEATgX X IaSTLIYS}� EN
AND EMPLOYERS'UANILITY LLMCN VICOLNT
A einc[lODUP :'R CCwO o[x[WrIW .l. N M979 1203141013 12I31=14 �
(WNso'..XNl CLDNEAM EAEMPLOYEE S,IG],000
DESCRIPTION OF OPERATIONS YIw' LLN\LMf•Pp0. YMT
$500,000
OELCRIPT IDN OF OImPlIsm I LOCRION\I KNICILE V.0 ACORO IN,AIRIER.Pon.r4 LN.Nb,II men p.n Is MWn NI
CERTIFICATE HOLDER CANCELLATION
24s252-2 iS 0
TONN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
120 MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
NORTH ANDOVER,MA 01845-2420 ACCORDANCE WITH THE POLICY PROVISIONS.
wrxoRMIO NEPREFENTATIVE
0 19gd010 ACCORD CORPORATION.AS IISMe reserved.
ACORD 25(NION5) T,,ACORD NEIRe MITI to"are r"Ismored marts W ACCORD
Cdrfrrfdr ,ea�� of ✓/ladd�
a
Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025,Slate Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2015
(City or Town) (Dote)
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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
NORTH ANDOVER, MA 01845
(City.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. ,�t�f
Received ...........................2015......... ...,�irG1NMr!.v'- ..U.s1bk'.'.::.........
�N'� (Slgnetua)
By ....................................... ...... „+•n ............................
(Official Title) (Clerk) (State whether owner,occupant or holds
&woQ�rr,,OO Q O pp (Address)
LN1P.[i�L ofOjl CLG/U(d.CK2
Department of Fire Services
` G Office of the State Fire Marshall
ao 4 s. sn. P.O.Box 1025,State Road,Slow,MA 01775
REGISTRATION
North Andover, April 30,2008
(City or Town) (Dmo)
This is to certify that Merrimack Valley Oil Co.
has, in accordance with the provisions of Chapter 148,Section 13,of the General Laws, filed with me a certificate of
registration setting forth that: Merrimack Valley Oil Co.
is the holder of the license granted(Date)7/29/1985
for the lawful use of the building(s)or other structure(s)situated or to be situated at: 1-3 Mass.Avenue
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
l.6R r � ..Z. '&.....
(Signature and Oflicisl Tide) Clerk
Note:A certificate of registration must be filed on or before April 301"of each year. _.
(THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES.)
EXPIRES APRIL 30,2016
TOWN OF NORTH ANDOVER
OFFICE OF THE TOWN CLERK
120 MAIN STREET
NORTH ANDOVER,MASSACHUSETTS 01845
Joyce A.Bradshaw,CMMC Telephone(978)688-9501
Town Clerk Fax (978)688-9556
d„osra�o
•encwA
E-mail ibradshaw(&,townofnonhandover.com
TO: All License Holders—Proof of Workers' Compensation 2015
Included in the renewal package for 2015 is the attached form which must be
completed and returned with your renewal of the Underground Storage Tank
Certificate of Registration.
Massachusetts General Law Chapter 152 Section 25A requires that all employers
conducting business in the Commonwealth of Massachusetts must carry a valid workers'
compensation policy at all times. Proof of this coverage will be verified with the
insurance carrier directly or the Department of Industrial Accidents (DIA), Office of
Insurance at 800-323-3249.
The Office of the Town Clerk will retain a copy of the enclosed Workers'
Compensation Affidavit. If you have any changes in your insurance carrier or have any
questions please contact our office at(978)688-9501.
Please return the completed form with your license renewal to Town Clerk's
Office, 120 Main Street, North Andover, MA 01845. We appreciate your assistance and
cooperation.
Sincerely, ��
Jo ce A. Br Q akw TownClerk
RX Date/Time 07/01/2015 07:43 507 455 5200 P.004
07/01/2015 8: 15:09 AM 507-455-5200 Page 4
Fedwi�tacl hloimiI Copy - forts aild fomtat may vai,Yftoro ViiLjwW -.
WC Page'I
WORKERS COMPENSATION AND EMPLOYER'S UABILITY INSURANCE POLICY
AMENDED INFORMATION PAGE
MUTUAL COMPANY FEDERATED MUTUAL A
PARTICIPATING INSURANCE COMPANY // policy No. 9022075
NONASSESSABLE POLICY Pmcesslng Office: ' Prior Policy No.
P.O. Box 3. HOME
E OffICE:D ATONNA Account No- 245.252.2
NOCI Carrier Code: 16446 Owatonna. MN 55OW0328 HOMMINNESOTA 55086
Producer y Agent: Phone: 800.533-0492
ROBERT E HEVENER
ITEM 1, NAMED INSURED AND ADDRESS:
MVO INC Entity Type.Corporation
3 MASS AVE FEIN 04:2MOM
NORTH ANDOVER MA 01S4e
Sea Extension of Information Page "Hamad lnsurad"
Other workplaces not shown above:See Extension of information Page'Other Workplaces of the Insured"
ITEM 2. POLICY PERIOD: The policy period is from 12-TI-2014 to 12-31.2DIB 12:01 A.M. Standard time, at the
insured'a mailing address.
ITEM 3. COVERAGE:
A. WORKERS COMPENSATION INSURANCE: Part One of-the policy applies to:the Workers:Compensatton law
of the states listed hers MA
B. EMPLOYERS LIABILITY INSURANCE;. Part Two of the:policyapplies to work In each #late listed in Item 3.A.
The limits of our liability under Part Two are: Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $900.000 policy limit
Bodily Injury by Disease 1151 each employee
C. OTHER STATES INSURANCE: Pan Three of the policy applies to states, if any, listed here: Ail slalas
azcopt states deatgbated-In path 3,A. and NO ON WA WY
D. ENDORSEMENTS: This policy includes these endmements and schedules; See Extension of inlormation.
Page"List of Endorsements'
ITEM 4. PREMIUM:The premium for this policy will be determined by our Manuel of Rules, Classifications, Rates, and
Rating Plans. All irdormation required below is subject to verification and change by audit to be made
ANNUALLY.
m. is n
Lac. Was Cole Est.Tool
tbn per StOo Anm✓✓
Na. No. No. pnvjfi0 M Opwatore Am. Rennin Rearm. pn:mlium
Sae Extension of IMormelion Page 'Schedule of Operations"
Minimum Premium Total Estimated Annual.:Premium 014,434
We Total State.Surcharges $768.
Total Estimated Coal $15,202
Deposit Amount $15,202
This Infortnallen Page,with'PGN.ICY PROVISIONS".and:attached endorsements,.If any,complete:this.policy.
Authorized Representative and Date Signed
WC 00 00 01 A(04-02)
WC,F•l A(10-00) Issue Date:04-23-2015
I
The Commonwealth ofMoasachusetts
Department oflndustrialAccidents
Office of Investigations
600 Washington Street
Boston,AM 02111 -
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name:j j V 6
Address: .3 ' LSS 43 tt
City/3tateiZip: &AIWMAone M 41 V- `Q 34 31
Are you an employer?Check the appropriate box: Busines;,Type(required):
1.❑ Ism a employer with employees(full and/ 5. &Rctail
or part-time).* 6. ❑Restsumm/Bor/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no ?, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
INo workers'comp.insurance required] 8. ❑Non-profit
3. We ere a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per e. 152, §1(4),and we have 10.❑Manufacturing
no employees.[No workers'comp.insurance required]'
4.❑ We am a non-profit organization,staffed by volunteers,
with Health Care
with no employees.[No workers' camp,insurance mq.] 12.❑Other 6 s ryf rr
-Airy eppliceat kit clacks wail mua dro fill out the nefion below slawin ivsd warkorr cowpmaelion polity irdormalron.
•-,Rios otflcne hrveexempktl Nemselvo,but Ne mryonsion Mathv employxo,aworken'wmpeivaEon polity urtgei,M and rush en
or,asirainion should check boxal.
I am an employer thus is providing workers'compemadon Wurance for my employees. Below Is the po[tcy holormadom
Insurance Company Name: /t l AeAkk/i 4c ora.s e P
Insuner's Address: .. A6L 3AP
city/State zip: Osaia 1 jh Ak 1 /11 i✓ d-Z o% 0
Policy#or Self-ins.L1c;# `1 N� •a S2• '2. Bxpiretion Date: a lx la
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expTlr�edon date).
Failure to secure coverage as requirW under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or ono-year imprisomnent,as well net civil penalties in the farm of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
Idahernebycerrift under the pains andpenaltles afph ury thin the increwmen provided above is use and correct.
Slenatura /5�ie4 / Date: 414r
vhoms#. 9]`• 3/3 /
O&IN use only. Do not write In this area,to be comp/ded by city or town offuial
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health L Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
xmw.msss.gov/die
00 M:C.fnv UfL2 CdMm-a.ru� OL �LddCiGJZ![60rt(1.
{
of Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2013
(City or Town) (Due)
NOTE:Complete top and bosom 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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7.129/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass. Avenue
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 he signed by the holder of the license if said license was granted prior to July 11 1936,
Otherwise by the owner or occupant of the land licensed.
Received.
. ................ ... ..2013......... ..................... .........................................
By .. G�:�'�`�I L.L. :'`*--. ........ (Si�uum)..........................
((Official Tide) (Clerk) '••'•• (Slue whether owns,occupant or holder)
......................................................
(Address)
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Washington
Strons
eet
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization
"N�am�e:tN a W
Address: AVI&t
City/State/Zip: o one
Arc-7lpu an employer?Che k tr a appropriate box: Business Type(required):
I.Lvd 1 am a employer with0.Sl—ILZL employees(full and/ 5. []Retail
or Part-time).' 6. ❑Restaurant/Bar/Eating Establishment
2.❑ I 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] $. ❑ Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing
no employees. [No workers'comp. insurance required]•
4.❑ We are a non-profit organization,staffed by volunteers, I I.❑Health Care
with no employees. [No workers'comp. insurance req.] 12. Othe \ W p
'Any applicant thu checks box 01 must also fill out am section below showing their workers'compensation phey information.
**If the coryorate officers have exempted themselves,but the corporation his other employees,a workers'emo creation policy is regnired and such an
orpniestion should check box 1fl.
l am an employer that is providing workers'cc—of�rrpensation insurance for my employees. Below is the policy information.
Insurance Company NNaime:F p lVly]�(`�.]L
Insurer's Address: C—\
CiryiSmtc/Zip: 1, - (��(�
Policy#or Self-ins.Lic.#��t_CM_\ t 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 of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify,,y�ujnder the pains and penalties of erjury that the information provided above is true and correct.
Signature: _� (/lp,d&e7Yl��2 �A Date:. Jvk,ill 1)
Phone#: \"%- (r)O —aa
Official use only. Do not write in this area, m be completed by city or town oJrcial
City or Town: Permit/License 4 -
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.msss.gov/dice
�pta:.�-~tYrt'�i [�f� Ll�l'{INr./L vy ✓re.G46CLLI44/Q�
� JJJ
gg' 2
Department of Fire Services
-- Office of the State Fire Marshal
P.O.Box 1025,Stale Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2012
(City or Town) (Dire)
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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
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 bolder of the license if said license was granted prior to July 1,1936,
Otherwise by the owner or occupant of the land licensed.
Received 4RA,LPY........2012.......
.. �.f�.0. .. .................
ne
By ..G(ili..�..... .......... IStgnatu ..........................
(Official Title) (Clerk) (Sum whether owner,wcurnat or holder
......................................................
(Address)
des'•• U�ze atQeaG�t f� ✓/l.aad.nc�irtde�a.
Af �
Department of Fire Services
a----' � Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30, 2010.
(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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass,Avenue
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.
Received /n/�A,�J v?Q.......2010......... ... ......... ///�/,n?"^-:!!.!`�.......
y (((// ( ��Y��.VLI..................................
(Offreial ,it,
(Clerk) (Score whether owner,occu ent or holder)
i-3s �..l9rxb��r�. olSyc�"
(Address)
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wrongfully operating without workers'compensation insurance, please submit a
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�15:�°�..J/,f V14G W1/N/NN✓✓GQ� Vy ✓/r.M({(1CLGINtQQif�CQ.
3�
Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover April 30,2011
(City or Town) ( eei)
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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
NORTH ANDOVER,MA 01845
(City or Town)
as related to the KEEPING, STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES,
NOTE: This certificate ofregistration most 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.
Received . ... ..� .. ..201 I......
.
By .... A/fY'X..... ..Y.:-..
.. �............................
ffi,nd Title) (Clerk) (state whether owner,occupant or holder)
(Address)
= The Commonwealth ojMassachusets
_ Department of Industnal Accidents
AOh&d
600 Washington Street
Boston, Mass 02111
Worken' Cam evaativu lasnnatt AiTttavk-Gene.•-al Bvsiaes7p
/1 g11d�lt7�c� atatK M F3
work site Notion(full eddees): S4M e;
I am a ale proprietor and have no one Bosuns Type: Q Retatl❑RestammdBadFatmg Establishment
working in an Y caPamty. Office[j Sal=(inC - g Wal}n�;ate,.oat efe� �,1
I an an tmplo_ya with ploytes (Intl &part time). Other �'�nQyppUjpttj'iA.1 t!\ (�nA A11 \ I AiJILy'(y
I am m®ploy-(providing workers'mmpeasmm for my employees working an this jab.
rnmoavvmsee ,M
drv: haveN-
ka.maaee�7o �hlk
I am a ale proprietor and have hued the independent cantrxtors listed below who have the following wvkers'
compensation policy
mmvavv v.nr.
env: L N•
ivmreveern - Hev r
van.navle:. .
nddx.c
city. have N• ... . .
iriraroeee ev
majigiz
Pave b sour.w.enr.••+.entred order S.xtYn 25A Ntnq,73k m W Y thr 1mp..ltYe sferhntnl pmnls N.fhr sty 71.SaLM vdw
.v yan'DaprMemmt�.rdseWnpm.kW heb.(N.6T0l wOAY OADER.vN.nu.f71 N.M.47.a m.ta twleneod flot.
c.pr.f thY.nnmew mq b.I r.rrdd a th.0I14e Nlmat¢a1Yi.NMr11fA frr e..nap.rrabtYa
7 de k,.bp (Jar tie p—ieytyaM�p/�/p.a/(��o/psrJav)'AN fry l otoo oo oo provided-bare i-our mood coo p
Sigoehae za,6
ammo.]tve..Ir d.e.t cork--b.dd..rr blv wvgdeW gclry or mno.lnd.t
-try.r:.con: psmM/Ilerue a.
�1MJWInr Dep.rtmevt
❑check If Immedute repea.e b requnJ Dl.icsmivr R«rd
(]9eketmeu'.O(14e
[JB®ah D.p.rtm.w
om.ct peno.: ph.ve M, (]Other
--' ,.,ramload,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover Apr1130,2010.
NOTE:Complete top and bottom of form and forward both sections and fee to i (qry or Town)
DON T RET RN FORM TO (Dare)
In accordance with the provisions of Cha ter 1qg HE DEPARTMENT OF FIRE licensing Authority(City,or Town Clerk),
D Section 13,Of the General Laws,the undesilCed hereby certifies that:
s the holder of the license granted(Date): 7/29/19E5
hucture(s)situated Or to be situated for the lawful use of the buildin s
at (ADDRESS): 1_9 SOor other
NORTHANDOVE Mass Avenue
(city mTo") R'MA Ol S45
related to the KEEP
Noie: This eertirinCte ofTORACE, MANUFACTURE OR SALE
Othe registration must be signed by the holder OEPLAMMABL rsvise by the owner or occupantof the license if said license we OR EXPLOSIVES.
of the land licensed. granted prior to July 1,19Jh,
clued
�
y/�[J111 .......2010......
ORcial
ne) (Clark) �rygi8namre
.. (sime whether owner,ofcu mt a,holder)•..•..•..••.
__ (Address)
-� 9.*ISTRATION
North Andover Apri130,2010.
NOTE:Complete top and bottom of form and forward bosh sections and fee[o local Licensi(city Or `n)Authors (city (Dan)DO NOT RETURN FORM TO THE DEFpRTMENT OF FIRE SERVIC
accordance with the provisions of Chapter 148,Section 13,of the General Laws,the undersigned hereby certifies that:
r Town Clerk)
ITLE HOLDER): Merrimack Valley Oil Co.ADDRESS): 1-3 Mass Avenue
he holder of the license granted(Date): 7/29/1985
for the lawful use of the building(s)or other
lcture(s)situated or to be situated at (ADDRESS). 1-3 Mass.Avenue
NORTH ANDOVER, MA 01845
(City or Town)
elated to the KEEPING, STORAGE,MANUFACTURE OR SALE
NOU: This certificate olregistration must be signed b OF FLAM MABLES OR EXPLOSIVES.
Otherwise by the owner or F y the holder of the license if said license was granted prior to Jul
Y 1936,
occu ant of the land licensed. 1.
V /(modal (Clad,.•!T1114, zhn
ignuore
................
3/(Stem whetherder acu f
et o •der).•.....
•'• •i•r•'rMeJ. or hol ...•..
,. k�•.19 � . OlBr
(Addres:)
NOTE: COMPLETF AND BOTTOM OF FORM AND NG AUTHORITY �RWARD BOTH SECTIONS
DO NOT RETURN FORM TO AND EE CA DEPARTMENT OF PUBLICTY RSAFETY TOWN CLER%).
The q mmadmealth of SF 1jUgEft8
Department of Public Safety—Division of ire Prevention
ro
CERTIFICATE OF REGISTRATION
NORTH
O RTH .......OVER...................AUT1.1L......... 19.....
............... ICV a �.�
Twnl (Oe41
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
herebyy certifle9 that 1 3 MASSACHUSETTS AVENUE _NORTH__ANDOVER
MERRIMACK VALLEY OIL COMPANY..................... Address .... .........
............................................... . .
IN.m.el wu..onin.nl JULY 29,
is the holder of the license granted.............. ...........................................................19..851or the lawful use
of the building(s) or other structure(s) situated or to be situated at.1c.3..MAaSA RU E�TeTs.AYENU.E.......
me related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
N.OR. ...TH...ANDOVER.. . ..............................................................
... . . ........
' ICiIY ae Town I
Now Thb r prior
r a J t, 1. 1936, the 6e ab, th br the adds of Iheof the land Ii..& wu[r+nted
[riw m Julr 1. 193b,otheeniee by the owns w, e-/ry/gpm
Received ....ltB ... ...............................19.9.1... .......... ` ......................................
(��� /� /] ///�y(//� aleeMmel
b94a�F�•�••••'•�'•'• A�'^^""'^"' MERRIMACK VALLEY OIL COMPANY..............................
`^L.I.A.lrl l..X..(/.IR f,,.+............................... IY.u.w\wWe emt. ew°pM w IiWdnl
.............. . ....
t0416.1 Tllhl 1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
..............................................................................................
IAdWvI
09/23/94 14:44 a UST PROGRAM ij�001
NOTE: COMPLETE T�ND BOTTOM OF FORM AND FORWARD BOTH SECTIONS
DA14D FEE TO LOCAL LICENSING ATHORITYO NOT RETURN FORM TO DEPARTMENT OF OR
SAFE YCLERK).
\ The am monfU221114 Of c4fln6 t4119Etts
Department of Public Safety—Division of lire Prevention
J
CERTIFICATE OF REGISTRATION
,,,,,,,,,,,,,,,_NOR IOW..r ANDOVE,$••,-•_APRIL,•,30 49._95.
W Tm,.l me,el
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that 1 3 MASS. AVE.
PAYTOBREALTY TRUST Address ....................................................................................
..........................................................................
IN.. .a helJer of lieeMel JULY 29 , 19.85..for the lawful we
is the holder of the license granted..............ua.t--................-........at-e-..... ................
„1,,,3„MASS. AVE.:....
of the buildings) or other structures) situated or to be situated at................... . .. ..............
18b.n..J awbxl
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FI ILMMABLES OR EXPLOSIVES.
......... •.....*.............."""""•' 110 ,000 GALS. UNDERGROUND FUEL OIL
............................. ..................
�Cay e.Te.n,
ut
,the holder of
Note, Thb�a to July 1.. 1936,Mherrim hr A h e k
u.uv or occ.Pen of,hr I.nd lce -•s.ed. lie-led
Received19........ ...........................................se.................................................
by ....................................................................I.....
.....-.......................................................................................
18u,.wluthe, o.no, eee.p.n, .r h.Werl
................................................................................
(OTeIJ Tlael
' IAaLwI
pe tlyOl =jjfult 4 of fflM jpWgftS
Department of Public Safety—Division of lire Prevention
REGISTRATION NOTH ANDOVER — APRIL 30, 95
.....................icii.ae.r .... .............................'n:i.... 19........
PATOB REALTY TRUST ......... ..............hw, in accordance with the
Thisis to certify that................................................................
provisions of Chapter 148, Section 18, of the General Laws, filed with me a certificate of registration set-
ting forth that....................... REALTY TA14AZ.......................is the holder of the license granted
•-.•„JULY 29, 19„85 for the lawful use of the building(a) or other structure(a)
1 3 MASS. AVE. . ...................................................
situated or to be situated at..................... ..........................u"u -...-................ ..
isa.n .M nana"110,000 GALS. UNDERGROUND FUEL OIL
as related to the KEEPING,STORAGE.MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
...........................................................................I..............
Iaimvure oa Datltl TaMI
Note: A ceeJaote of r.O.uelion mus, be fited on or before APAI 3011% of e.ch I-r-
(THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES.)
NOTE: COMPLETE TOP AND BOTTOM OF FORM AND FORWAKD BOTH bECTIONS
AND FEE TO LOCAL LICENSING AUTHORITY (C1T�OR TOWN CLERK).
DO NOT RETURN 1WRM TO DEPARTMENT OF PU C SAFETY.
Elie (IlJntmoltfnettl#h of �flnssttclluse##s
Department of Public Safety—Division of FSre Prevention
I� 1010 COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATION
ocroaea, iy .
NORTH ANDOVE$, A ...... 19. .�J..f...............................................
IOlty oe T.wnl M.t.)
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
herebycertifies that -
_Pa tob Realt3'._T,ru s st.............................. Address ......1-3..Maa—Ave.............................................
....... .. .
IN.me of hotter of K«n.el
is the holder of the license granted........lu1y...29.,...19Z.5............................. ..19.BS..for the lawful use
of the building(s) or other structure(s) situated or to be situated at1,-a..Ma&S.e.^.AYT��.....................:..
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
....._North.AndoyAr,•................................................liar..TcwN 110a B 000 gallons Underground fuel oi:
t
Note:This co,ifate of registration must be signed by the holder of the license if said license was panted
Prior to July 1. 1936.othcrwl.,by,he owner or occupant of the land licensed. -
Received ..................................................19........ ..............................................................................................
is,...:usA
by ..........................................................................
............................................................:.::..............................
................................................................................
saute whetFo .caner, «evp.nl .r h.W.4
IOIDrIal Title) -
.............................................................................................:
[Add,.)
(�111e (90nintonfnettl#ll of Illttssttcljixse##s
Department of Public Safety—Division of Fire Prevention
lit 1010 COMMONWEALTH AVE., BOSTON
REGISTRATION dcTaeEQ
.North Andover. . AFaft
.. . .. . ......................................................... 19.. .
Lehr at T.ws1 ID.uI
This is to certify that..................Iiayt.Ob...Realty...Trust.....................has, in accordance with the
provisions of Chapter 148, Section 13, of the General Laws, filed with me a certificate of registration set-
ting forth thatF..a,".t.oh..Realty..Trust............................................is the holder of the license granted
............J.IJly...29.• •••••.••••1985... for the lawful use of the buildings) or other structures)
1-3 Mass. Ave.. . ...............................................
situated or to be situated at...............................s .............. . ...............................,.
ssu.et .ne x.meer)
as related to the KEEPING, STORAGE,MANUFACTURE.OR SALE OF FLAMhy�BLF4 q� LOSIVES.
110,000 underground fuel oil """'-'• ' -"•••" •'� ; r" "- 4 .....................
. .nd o
Note: A rertifiate of regi>tration .oust be filed on or before April 30,6 of r.ch year.
(THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES.)
DO NOT RETURN ;ORM TO llEPARTDIENT OF `PU IC SAFETY.
SIN-
e (>Zummulchlettlfl� sttl Ijuseffs
:. .
Department of Public Safety—Division of FSre Prevention
- Iwo COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATION
NORTH„AND OVE$,,,AT?$IL,....� .... 19..._...
.. .. . ..
ICi , or To.n1 Iastel
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that
.Elio ob,_Rea1tY.._Trust st............................. Address ......1-3..Mass...A.ue..............................................
IN.—of hods or tie.nul
is the holder of the license granted........T.ulg...2g,....198r5........................... ....19.�S:.for the lawful use
of the building(s) or other structures) situated or to be situated ate.-. ..Ma.RS......AN.t:................._.....
:..
IS,res, .nd namharl .
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES. .
North,_Andgvgr.................................................. 110 000 gallons Underground fuel o=
...........: a B g
tcitr or Town I -
Note: This certificate of registration must be sinned by the holder of the license if said license was granted
prior to Julr 1. 1936,other.rias br the owner or oecupa t of the land It....ed. -
� .a ...195.3 ............. :. ...�.�' .........................
Received ..�j.. .... ... Isia•s,a.el
.. ... ... ..... ... .d.... ............... to
/ .............................................................:.:..............................
(St.,. .A
L �.�� . .[°� ........................... IS ,e e,her v.eb :eu Mp.nl .. er)
1 :Fetal TtNel '
Uaaral
i. so
NOTE: COMPLETE TOP OD BOTTOM OF FORM AND FOOARD BOTH SECTIONS
AND FEE TO LOCAL LICENSING AUTHORITY (CITY OR TOWN CLERK).
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
fle ( anmT0169alth of Azzadjuzeffs
Department of Public Safety—Division of Fire Prevention
:. , 1010 COMMONWEALTH AVE., BOSTON
111UUU��� CERTIFICATE OF REGISTRATIOWJ , / I9Y
............._NORTH ANDOVEIj ..eo�....... 19..._...
.............................. .
ICIV or Town) (Dol.)
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that
Pa ob. Aea,1tY...Trust.............................. Address ......1-3..Mass...Ave.............................................
f the of license
gran 19.0.9..for the lawful use
is the holder of the license granted........Jlt1 2 ].9 �......•• .•
of the building(s) or other structure(a) situated or to be situated ad-a..Ma SrS.,.^. me........................:..
as related to the KEEPING, STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES. .
North,.Andg.Y.gF................................................:.. 110,000 gallons Underground fuel oil
R_.. ...,:... own)
(c. orT
Nmc:This rolifirme of rcgistraiian muss be signed br the Folder of the license if said ticcnsc.s grmted
Pr; o Jrr f 936,oiher//+u77e br the owner or occupe(n}��oo�fthefA�•dncenscd. ,f s
.. . .19.7......r� ..........................:...ut!."•.�s'_ ' "' ..fnl.J(O.l..>r.^..wiv.�............
Received
.........jjt;]ML LONG
by ..........................1'ClArli MyRiMXRK.........................
120 Main street .......................................r, Z...............:................................
"'•"' (Sole wAether ew no vp.nl or Warr)
........................M�.AAdaza4MA.omm................. . . .
(OMdtl Title)
..............................................................................................:
(Aaarno)
• '3� ?. �o
NOTE: COMPLETE TOP AFD BOTTOM OF FORM AND FOARD BOTH SECTIONS
AND FEE TO LOCAL LICENSING AUTHORITY (CITY OR TOWN CLERK).
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
U•�jE �II1tt11tD1ifUEi[I�� DI �tlssttclpzsEtts
Department of Public Safety—Division of FSre Prevention
1010 COMMONWEALTH AYE., BOSTON
CERTIFICATE OF REGISTRATION
NORTH ANDOVE.$...Ap$I�L,....��... 19.. .
........................(city or Town) (Ora)
In accordance with the provisions of Chapter 149, Section 13, of the General Laws, the undersigned
hereby certifies that
Past ce Rea that ru.,s..t............. .. Address ......1=1.Mass...Aue.............................................
....... ............
................
(N.aw ar hold..ofli«n..) 19.a5..for the lawful use
is the holder of the license granted........Su1g...2Q.,...J,9 �. -'•" '
............... ....
of the building(s) or other structure(s) situated or to be situated atd.-�.. (s.Seli.an A.V.la.................._:..
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
North.,AndgyEF.................................................. 110,000 gallons Underground fuel oil
....... ........
a.Townt
Note: This ccrtifirate of registration must be signed by the holder of the license if said license was Varied
prior to July 1, 1936,otherwise by the owner or occupant of the land licensed.
.. . . ...... ....... ... ...........Received 19..%.� ..........
. .......:.........by O.
............................
..................
120 • streetlaute whether owner,«fupanl or holden
hAfdlAvM&A 01846........... -
..............................................................................................
(Addre.t) -
NOTE: COMPLETE TOP f�f���IIIID.. BOTTOM OF FORM AND FORWARD BOTH SECTIONS
DAND FEEO NOT RETURAl�FORM TO DEPARTMENLICENSING IT OF ITY (PL�.IOC SA
FETY.
YCLERK).
Ole (9Vn'lnlDltf ga1t4 of A50tttllusetts
Department of Public Safety—Division of Mre Prevention
3010 COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATIO
NORTH ANDOVE$ . 19/..__.
........................TH................... .. g
wnl took)
In accordance with he provisions Chapter 48, f 13, f the al Laws, the undersigned
P
hereby certifies that .
Pa . .ob,_Rea1tY...Tr. st................... .. ....... ress .... . .. s....Ave..... ..............
of bald. of lire...)
is the holder the licen a td.... ...J.ul y... ........:....... .............19 .5:.f awful use
of the building g((s) or othe structure ) situate to be ituated at .3..Ma."t .nd nY.t4x....................:..
rl
as related to the KEEPING, TO RAGE M A OR OR ALE OF FL LEE OR EXPLOSIVES. .
.,..._North,.And vEF.......... ............. .................. . 1000 llons Underground fuel it
Ic;,r err wnl
Nmc: T s anlfir of his 'o moss be ni cd by t ho of the If th if aid flan k.0 panted
e ac by he o.+ o<cup. f the 1. lic�rn/(wd.
Received ..19�..'.... .................
......... .. ..by ..... ....................... .... ..... 1
.... ............. ............... . .:.:..............................
............... Iat.N whnlur owns, ooes,art kr!oden
-
• OIG<itl Titl 1
- (Addreu)
012 ommonfvett t11 of A55adjusdlo I
$= Department of Public Safety—Division of Ftire Prev e tion
it
1030 COMMONWEALTH AVE., BOSTON
I(
REGISTRATION
.,...North Andover .. . RIL......... 19........
...................................................
(City or Town) (Doak)
This is to certify that..................F-aytrClb...Real..tiy...Tz.ust......................has, in accordance with the
provisions of Chapter 148, Section 13, of the General Laws, filed with me a certificate of registration set-
ting forth thatRavt.oh..Realty..T.rust............................................is the holder of the license granted
............July..29.....................................1985... for the lawful use of the buildings) or other structure(a)
1-3 14ass. Ave.. . ..............................................
situated or to be situated at...............................is.............. . ...............................:.
. wi.rr, k.a xvmtkn
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAN0 BLF$ LOSIVES.
4TT9.. .....................
10,000 underground fuel oil ....................
"""""""""
(s, e ..ao r
Nme: A ccrGficnte of resia,.alion ,nost be filed on or before Apdf 30,h of .rh yor.
(THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES.)
FORWO BOTH SECTIONS
�f AND EITY TOWN CLERK).
COMPLETE TOP A BOTTOM OF FOR.
NOTE AND FEE TO LOC LICENSING AUTHORITY
G SAFETY.
FORM TO DEPARTMENT OF pLB
LI
DO NOT RETURN
no @Iamznan£v IIif LJ�LU✓+
ulDepartmentofPublic Safety—Divisionof FSre Prevention
CERTIFICATE OF REGISTRATION
NORTH.ANDOVE.R..........+T.1J,}ty.31. 19......55
........................iciu=,T^'", the undersigned
provisions of Chapter 143, Section 13,of the General Law-,
. .......................
In accordance with the P _ ryl�s....A-" ...........................................
- . the lawful
hereby certifies that ...,_,19.�.5..for °�
t Realt T
ob...............Y...._F' .@fir........................... .. Address
P.at... ... a.n et nau.,en rr^«, 2g,...�985............
ranted........111,19... be situated at3.-3...Maad.....AA.�..........................
situated or to 1-'^`
othe holder of the rtother structures) MABLES OR EXPLOSIVES.
of the building(s) STORAGE,MANUFACTURE OR SALE OF FLAM Underground fuel oil
110,000 gallons
KEEPING, .•.•.•„_,,,... ,ed
as related to the "•'sr'
h A.nd4.Y.¢.T....e'nr -el ........................
........
'
b .he bolder o the i
erHfirv. c ieve,ion mvet he e`er`he o ncr or occupnn,°<e nee if r,
• •the LLndrliceneed
Nmev Thin c 1. 1936,o,hcrwiee by
yrior,o Juy
F
. .1!1.�;.....e... .. .... . ......... .. ...
Received -
by......................
..........N311&3 3 NMOlp...............
.....................isuu:e u.•,.«r,«w
9RI4
30
114............... . uaa. .,
..............
NOTE: COMPLETE TOP D BOTTOM OF FORM AND FOMWAR BOTH SECTIONS
AND FEE TO 1,01 LICENSINGDO NOT RETURN FORM TO DEPARTMENT AUTHORITY
F(PUBLIC SAFETY ltlx
CLERK).
C` IIe (1ZommanG?ettltl� I{ttssttclpzssfts
Department of Public Safety—Division of FSre Prevention
�. lolo COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATION /
NORTH ANDOVE.)j...AZEIL.....__..... 19.0/
. .......................
' (City or Tool tD.4)
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that
Pa ob,_Rea1tS:..Tru.S.>•.............................. Address ......1-3..Mass...A..ue.............................................
•...••.�.._ 1N...a holds,of nee.rl
8 ...............I................19.i3.5..for the lawful use
is the holder of the license granted........Su1 2g.,...].JS�. •
of the buildings) or other structure(s) situated or to be situated at1.-3..M&.65...^A.Y. .f....................:..
as related to the KEEPING,STORAGE,MANUFACTURE OR•SALE OF FLAMMABLES OR EXPLOSIVES.
North..And4y e<x................................................ 110,000 gallons Underground fuel oi]
"' 1Cltr e,To+nl
Note This certific.le of,c dsteaion most be i aned by the holder of the Ccense if..;a license..,p.nted
prI.,to Julr 1, 1936,mherr'.<6 the owner or«copy y. of�the 6 d 6cenxd.
, r �(pl /4f.,
/ .....................19��. ............:..W- .... .......................
-- Received ...... ...y....
.. . .. ...................
.. ... . .....
...................................................:.........:.:...........
notaol
IOlada Thiel
tAddree,l
NOTE: COMPLETE TOP0�1D BOTTOM OF FORM AND FORWARD BOTH SECTIONS
AND FEE 1.0 DO NOT RET_URIJ�'ORM TO LICENDEPARTMENT OF NG AUTHORITY (PAWIOC SAFETY.TOWN CLF.RK).
Ole Tonmtoufileafll of Ai M lc MIN
Department of Public Safety—Division of Mre Prevention
lolo COMMONWEALTH AVE., BOSTON .
-n
CERTIFICATE OF REGISTRATIO ��/ ��y�
NORTH .ANDOVER... FBI .....� .... 19..—
ICa>.er Turn) (D+td
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that - Address
Pad. ob. Rea1t3:..Trust................. ......1-3..Mass_..Ave.............................................
.... ..
I the of censer g ran 19.05.for the lawful use
is the holder of the license granted........du1y...2g.,...yg 5.••-.--
.....:......... ....
of the building(s) or other structures) situated or to be situated ate.-3..Ms�eS.,.^.AY ........................
as related to the KEEPING, STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
•...•_North. Andovgr.................................................. 110,000 gallons Underground f-ue1 oil
:.
Note: Thi+certi6rmc of regislretion muss be signed hr the holder of the lice.-if.-id lice.- tr+s gr+.led
prior to July 1, 1936,otherwise hr the o.+.cr off,oc<up t f th+ e End lic c./s�d.
Received ...../...,�... '1..t. ..0. .....................
.... ..... ... + tunl
by .....X 5...: ......................
�Ktlts-r" Sl+te vFetAer evner. aeuV+ ter holder
......................................................
.........................
....................._10
.;tl Titlel
SING AUTIi0R1TY (CITY OR N CLERK).
NOTE: COMPLETE TOP AND BO OM OF FORDO AND FORWARD TA SECTIONS
AND FEE To LOCAL LI llEPARTDIENT OF PUBLIC SA ETY.
DO NE El
FORM
Gjmmmtfnealtl fff c T't
Department of Public Safety—Division of FSre Prevention
1010 COMMONWEALTH AVE., BOSTON
EGISTRAT1 3
CERTIFICATE OF R __��0�1�
NORTH„ANDOVE.. •.. EH1L!••-/ •-• 19-
....................... loatel I
ICay or To..)
In accordance with the provisions of Chapter 148, Section 131 of the General Laws, the undersigned
hereby certifies that ......1-3..Mass..A.ue..................................
Pad ob.RealtY...........-Pt............... .............. Address .....:..............19.05..for the lawful use
Tru t
".. tN.me of Fota.r of t'menul y 1gg5............
.. ..........
is the holder of the license granted........J.ulg... �,'"' tst..ct .na numbarl '
of the buildings) or other structures) situated or to be situated ate.-3..Ma.S.s..... V. '"'"'""""""
a3 related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
.•••• 11 s Underground
gallon fuel oil
._North._AndovP..i.....................
tCay e.To.'nt cd br the holder of the Pccnac if uid liccn.c..0 panted
�
rtifi<We of reaiatretion moat be"a"the owner o xcu ant of the I•nd liven
Note:This cc 1936.oth<r.+in<br
<iur iC 1 . G.... ....w ""' ......, . ... .
Recety ••.
b tsub�'tntM...no, :mv.n
....... ttal Titlel .............
y�,s ��i�� 19.T. 7. _ c
NOTE ANDPFEE TOOLOCAITLICEAS+NG MAN FAUTI O11TY (C'O1TY- TOWN CLERK).
_ DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY. -
Tile Tanimmtfnalth of �ttssttcljllsetts
.- .
Department of Public Safety-Division of 1.1re Prevention
303o COMMONWEALTH AVE., BOSTON -
CERTIFICATE OF REGISTRATION
NORTH ANDOV$$..,AFRIL....,3G... 19.'5
" (Lib or Tern)
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that Address ......1-3..MasS_..Ama.................. _
Pad„ ob,_Realty._Thu.�s..1•r............................. 19.�5:.for the lawful use
IN.e•e of fidhe of strut uel oil
�... ....................
is the holder of the license granted........Sul 2�-,.•�Y9 �.���••- •��••
tstr... ..a enmfirn
of the building(s) or other structure(s) situated or to be situated ate.-�..):�(&..45......A.Y.�..........................
as related to the KEEPING, STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
..............................................
.............................
•................... 110,000 gallons Underground f i
icib er re.nt
Mote:Thir rrrtifrrte of b
rc6isbetion then+ rcrb�the o.oer andd h«<uP. t Iif f rheI idcored. -
' prior to July 1, 1936,o _
...............�M j
...............
Receivedby .................................0A0UN`J H196M.............: ._................................
.........---...:........,.::......:.:-..._..........._
y310 NM 01................ sae.firms e.nrr, xe'eP.nl.r hewbt
.............:.................... IiC1 131N10
tosart.. 03AI373Y. _ , .....................'^..............._.
D BOTH SECTIONS
COMPLETE TOP A BOTTOM OF FORM AND FO
B TOWN CLERK).
NOTE* AND FEE TO LOC LICENSING AUTHORITY (CITY
DO NOT FORM TO DEPARTMENT OF PUBLIC. Sh1IffE41>
ett1# I1T sgtTc
'The antti h
Department of Public Safety—Division of Fire Prevention
-- `- 1010 COMMONWEALTH AVE" BOSTON
CERTIFICATE OF REGISTRATION
............._NORTH..ANDOVE$...A>'BlI'%(Daft) 19.$_rI•
(ev or t^+•t
provisions of Chapter 148, Section 13, of the General Laws, the undersiHned
. .. ..............
In accordance with the P .............. Address ......1-3'•Mks`..A.V.e....................... . .. .
hereby certifies that - 19.0.5- or the lawful use
t f
.Py�..9b•_Re&1ty...T.E:11. i :�..i..d.. 7.uly...29"-..0obe s;......... . d ^„meat
IN^me of(„tyr ranted (svret .^
is the holder of the r other structure(s) situated or to be sttua OF at�.�MA LES OR EXPLOSIVES-
of UFACTUREORSALE OF 0 gallons Underground fuel 017
of the STORAGE,MAN 000
110�
EEPING, u v r -
as related to the X . ......................
t be ei{ned br(he holder of the 6cenw if w,d licenw w
North..AndRX„�.I:......o:'ro:�i..... f
upm o[t e Icnd lic<nrcd
.� � tifirvu of rcaidntlon mua the owner or
Notrz Tb^error m Julr 1. 7936.n ...
hitm.....9111w.............. .... .. ..... .. ...
. . . - Recetvedl�l•1Yr.
cant •a�ao ................._. ...........................
.........................iee:...�
........................ :. ...................
1 .R.•. la-)pY109fM A 47,
.�
C�nmmmiulrulth Lit ,,nsBurhusrtts
1 � DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION
'I 1010 COMMONWEALTH AVENUE. BO J UN
8 19 85
-`. ' tqW ar Tawnt toast
APPLICATION FOR LICENSE
For the lawful use of the herein drerrilml huildina or other structure..., ,pplioatiion is hereby made in accord-
ance with the pra�'isionn of Chapter 149 of the Grner:d I uaw" far a hrrnse to we the lend on which such building.... or other
etrueture_. is/arc or is/urc to be situutnl, tool only to such estop ns shown on plot plan which is filed with and made a
part of this appliestian.
Mass. Ave. Inters[a[e„495......................_.......
Nor
Location of land th_Arrdovexr,_MA. ................Nenrest crass street...................
Trust ....Address .._ s..............................................................
Pa,(L4S8"Ih.dl�$ ....._ ... two- (2)
Owner o[ land... ........................ .........
.. ..........
NnmlvT of buildings or other slmctnres to whi,h Iln+ :7 PGrnuon applies. .... - .
...fiL0SAV.................. ....... ..
offices and service ar¢a 110r 000 gallons
Occupancy or use of such buildings
______ ..Underground
Total capacity of tanks in gallons:—Aboveground oil._.........._......................._............................................._................................
Kind of fluid to be stored in tanks....._.._......
...............................
1f18� ................_... - rt .Wvnnaq
Appror —Disapproved ......./. ..... .. lus..wn
......
.. .. ._.... .. ..........................................
Note: Complete top of farm and forward bath sections and tee to locai licensing
authority (City or Town Cierk). Do not make application to department of Public Safety.
� � �c<»>rrrearuuea� c���aaaac�ZuaeL�
City or Town NnRTN ANUOVER Oate ��/P/C .30, y100,3
APPLICATION FOR CERTIFICATE OF REGISTRATION
In acmrdan®with the provisions of Chapter tab, Section 13,of the General Laws, the undersigned hereby certifies that
MERRIMACK VALLEY OIL CO.
.w..n,wsaesm
1-3 MASS. AVENUE
a the holder of license granted_ ]19 R/A s s tar the lawful use of the building(s)or other structum(s)situated or
to be situated at 1-3 MASS: AVENUE
as related tc the KEEPING, STORAGE, MANUFACTURE OR SAL OF PLAMMASLS.S OR EXPLOSIVES.
NQRTA AA[13LFR 'A nt R/ S
Note: no application for oamrrmfe of ragisfratlon must be signed by the holder of the license if said lioense was
granted pncr to July 1, 1936, otherwise by me owner or oCupenr of u; Ogden
Receiveo '— imr c 3 AGO Submitted by ll'A
by �ii�nrs a° tiix MERIMACK VALLEY OIL COMPANY
v w.
s...y, __ S s ve.
Nolih Andrn Pr MA 01845
Note: 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.
_ � �a�mrma�.uuea� o�G�czc/u�aeL�
,.� '1�ghanrcnrento��iire FJia�uired— JJvuiacorrc o�cJnxe �J'-rev�o�Z
CRy or Town NORTH ANDOVER Date APRIL 30, 1998
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148, Section 13, of the General Laws. the undersigned hereby certifies that
MERRIMACK VALLEY OIL COMPANY
.a..amavde'ae.
1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
Haan..
is the holder of license granted_JULY 29, 1W for the lawful use of the buildings)or other structure(s)situated or
to be situated at 1-3 14ASSACHUSETTS AVENUE
sa..re,a,w,„e
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
NORT11 ANDOVER
uyo-ra.,,
Note.'This application for cmdffcate of registration must be signed by the holder of the license if said license was
granted pnor to July 1. 1936, otherwise by me owner or ocnupant of the land l/i7censed.
Received /9 Submitted by � y/_�
by P' t0iDu.N /n
.ZiRmf cTL✓71 ���� 1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
once rm
r_ 09/23/94 14:44 6 UST PROGRAM Zoos
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 DEPARTMENT OF PUBLIC SAFETY.
The Qlann VUfttrAt4 of film if tsEttsi
Department of Public Safety—Division of Fire Prevention
V'—av�
CERTIFICATE OF REGISTRATION
NORTH ANDOVER .............APRIL..30 r..••.. 19„•.26
................................
IQty w rewnl lawl
In accordance with the provisions of Chapter 148, Se Lion 13, of the General Laws, the undersigned
hereby certifies that
..MERRIMACK„VALLEY„OIL.CQ............................ Address ...J.-3..JdASSAGI.IU.SkTTS..AV.ENllE.....t1QRA'11,.,ANRQ11$R, MA
;ath e!lelnse!gran SLILY 29
is the holder of the license granted...................>......................................................19..b5..for the lawful use
of the building(a) or other structure s) situated or to be situated at.....
k-S..MlASSAGHAS.IwTTS..AV.kNQI:....
�6� �l,. !En.et.ee ...6.r!
NOPr9l"thk KEEPING,STORAGE,MANUFACTURE OR SALE OF FLA.IIMABLES OR EXPLOSIVES.
..........................................................................................
rclw er T...I
Nwe: This eertifir.w of reEiumie,....t be eiEn d by the holder of the linens if rid lieeute wse atanted
piw to July 1. 1936,otherwi.e h, the o..nv1'or,-.rp/}snt of�t/q/e 4nd,(Iice..d.
Received ....: (jQe. .�.... !..(..f�.l`.F..........19........ ...........N.{y(Q.a.«..Lr..11xtt)Atx.. ...............................
by •••yn•'Q••�(R; '/^X"'T• � "'�•••' MERRIMACK VALLEY OIL CO.
4a-ez "_.�....:... ................................... ........... ..........................................
�4A1(;r..................................... !sux.ru,..o..... ...ev..t.r A.w.l
............... ...... ............ ..
IOEN.i n!x! 1-3 14ASSACHUSETTS AVENUE, NORTH ANDOVER, MA
..............................................................................................
(AO l
Note: Complete top of form and forward both sections and fee to local licensing
authority(C1171'ar Town C1erk� Do not make appfication to department of Public Safety
a?, _, � �oormirna�acuealG� a�C-�/G�a�aacfzr,�e��n/a
:. ��han�inanC_QC�isvre CJ nwleouet, — �%ytdeo�rt o��vrB :l"irev�/xlaan
T Cityor Town NORTH ANDOVER Date APRIL 30, 1998
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148, Section 13. of the General Laws, the undersigned hereby certifies that
MERRIMACK VALLEY OIL COMPANY
1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
yes...
is the holder of license granted_JULY 29, 1985 for the lawful use of the building(s)or other structures) situated or
to be situated at 1-3 MASSACHUSETTS AVENUE
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
NORTH ANDOVER
u w re
Note:i his abdiication forcardfipte of mgambfon must be signed by the holder of the license if said license was
granted prior to July 1, 1936, otherwise by the owner or acucant of the land Ifcensed.
Received
Submitted by
b nn
Y
nre.
sur.�.w,.e..,.,.amde
1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
oemr,-r
ma
sy� �canvtnoozcueall� c�C�/�a.QaQac�zccaeCla n
'�®® qr5 e1tarGrnerzCo���'v re C1ew+�ices_iOlGrrda,�,wunzdCl'Go e C-%am/c ✓D10?amc
WW
City or Town NORTH ANDOVER Date APRIL 30, 1998
REGISTRATION
T his is to certify that MERRIMACK VALLEY OIL COMPANY
ueew
has, in accordance with the provisions of Chapter 148, Section 13, of the General Laws, filed with me a certificate of registration selling
forth that MERRIMACK VALLEY OIL COMPANY ld the holder of the license granted
JULY 29 1985 om for the lawful use of the buildings) or other strucume(s)stuated or
to be situated at 1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
Suew.o,wee..
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMA13LES OR EXPLOSIVES.
U � synwu..,e r
Note:A rardhrare of mcirsmation m be(Jed on or before Apn130rh of each year.
THIS REGISTRATION MUST SE CONSPICUOUSLY POSTED ON THE PREMISES
�T-s lrensea t%I
Note: Complete top of form and forward both secticns and tee to local licensing
authority (Cfty or Town Clerk). Do not make application to de
partment of Puhl' Safety _
U/(mU/h.Q�ILLl1�j2aGLf2 6L UI��Q/.lQCGCJ��J.
Clty or Town -NnuTA AnmOVER pate AOR/_ [V, i{(�
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance,with the provisions of Chapter lag, SWjOn 13. of the General Laws, the undersigned hereby card,, that
MERRIMACK VALLEY OIL CO.
1-3 MASS. AVENUE
4s the holder of license grantetl_ o.n for the lawful use of the building
(s) or amen mvC.ure(s)situated or
to be situated at 1-3 MASS." AVENUE
su..ew.uw..
as related to the KE?ING, STORAGE. MANUFACTURE OR SAL OF FLAMMA84ES OR EXP!OSIVES.
NORTH AMOURR MA nio—
s row,
Note: This appGcafcn fcrcamroate of mg1stra0on must be signed by the holder of the license if sad license was
granted phor rd July 1, 1926, otherwise by the owner or ocupent of f e farad lidansed.
Received ////AJ F
Suomifted by
dy Mot ,Z° F/err
flQ//lJ firn.f �.-i m C1la �r .
am..,. 3 Massachusetts Ave.
Nndh Andover, E.
TOWN OF NORTH ANDOVER
OFFICE OF
TOWN CLERK
120 MAIN STREET
NORTH ANDOVER,MASSACHUSETTS 01845
O, NORTM.14
Joyce A.Bradshaw 3z
Town Clerk 8 Telephone(978)688-9501
FAX(978)688-9556
Jr4CN115C
April 17,2002
To Whom It May Concern:
Enclosed please find your 2002 Registration Renewal Form(s)for above ground and/or underground
storage tanks listed at the address(es)on the enclosed form(s).. Renewals are due April 3&of each year.
The fee for renewal is$100 per site.
Please sign the top portion of the registration form and retum it with the appropriate fee,payable to the
Town of North Andover, 120 Main Street,North Andover,MA 01845. The bottom Portion is Yours to be
displayed along with Your license.
You immediate attention in this matter is greatly appreciated.
Very holy,
jr arwt L.Eaton,
Assistant Town Clerk r
Enc.
(
�rGd
Nate: Complete top of form and forward both sec5ens and fee to local licensing
al uMority (CiTy art Town Clerk). Do not make application to department of Public Safety.
F � (panvmaruuea,�C a�//�/��aaaczc�elZy
Le�ia�GrxeicCp��ure C9'.yueces— .7Jfifsiupey a��iirs a✓'feve-n�Con
City or Town North Andover Date April 30, 1999
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter lea, Section 13, of the General Laws, the undersigned hereby certifies that
1-3 Mass. Avenue '""''
is the holder of license granted 7/99/oR„S for the lawful use of the building(s)or Omer structures)situated or
to be situated at 1-3.Mass. Avenue
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
North Andover
c+rs a„
Note:This application for cartizrafe Of registration must be signed by the holder of the license if said license was
granted pnor to July 1, 1936' otherwise by the Owner Or ocJpanr of the land licensed.
Received aw Submitted by
M
by
----------------------------------------------
oemr rr
vmm
�aomm,�a aza a�� Lu�aeG7t �7
a1Je�oxGneentp�C�'fixe GJewrries— Gimdex. .mdC-q C�/aml ✓-ir«�rama
City or Town North Andover Date April 30, 1999
REGISTRATION
Merrimack Valley Oil Co.
ibis is to parity that
has, in accordance with the provisions of Chapter 148, Section 13,of the General Laws,filed with me a certificate of regunradon setting
Merrimack Valley Oil Co. -
form that is the hostler of the license granted
7/29/85 for the lawful use of the building(s)or other structures)situated at
om
to be situated at
suw.v,e m.oc.
as related to the KEEPING, STORAGE,MANUFACTURE OR SALE OF ru1MMAS/L�ESQOR EXPLOSIVES.
./
Nara:A ceraMeam at mgntault n must be filed pn or belore Apal Mar of each year.
THIS REGISTRATION MUST BE CONSPICJOUSLY POSTED ON THE PREMISES
p.a(name Pain
TOWN OF NORTH ANDOVER
OFFICE OF
TOWN CLERK
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Ot Ma sr��y
Joyce A.Bradshaw $'
Town Clerk .°. ` • : Telephone(978)688-9501
FAX(978)688-9556
'T+1CX11++
March 29, 1999
Merrimack Valley Oil Co.
1-3 Mass Avenue
North Andover,MA01845
Dear Sir:
Enclosed please find your 1999 Registration Renewal Form(s)for underground storage tank(s). Renewals
are due April 306 of each year.
The current fee is$100.00 per site.
Please sign the top portion of the registration form and retum it with the appropriate fee, payable to the
Town of North Andover, 120 Main Street,North Andover, MA 01845. The bottom portion is yours to be displayed
along with your license.
Your immediate attention in this matter is greatly appreciated.
Very truly,
�j et� L
(Assistant Town Clerk
enc.
TOWN OF NORTH ANDOVER
OFFICE OF
TOWN CLERK
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
OF NO•Try,qe
Joyce A. Bradshaw
Town Clerk . i Telephone(978)688-9501
yam, FAX(978)688-9556
Y•7S���.✓' 4q•
Yff�
April 10, 1998
Merrimack Valley Oil Company
103 Mass Avenue
North Andover,MA 01845
Dear Sir:
Enclosed please find your 1998 Registration Renewal Form(s)for underground storage
tanks. Renewals are due April 3&of each year.
The current fee is$100.00 per site
Please sign the top portion of the registration from and return it with the appropriate fee,
payable to the Town of North Andover, 120 Main Street,North Andover, MA 01845. The
bottom portion is yours to be displayed along with your license.
Your immediate attention in this matter is greatly appreciated.
Very truly
�Gf V,
et L.Eaton,
Assistant Town Clerk
enc.
.oR= TOWN OF NORTH ANDOVER
o y
Joyce A. Bradshaw, Town Clerk TOwNB=lNG
'ss,�wuet� (509)688-9501 120 Main Sheet
Fax(508)688-9556 North Andover,MA 01945
March 31, 1997
Merrimack Valley Oil Co.
1-3 Massachusetsts Avenue
North Andover, MA 01845
Dear. Sir:
Enclosed p�lease find your 1997 registration renewal form(s) for
underground stdrage tanks. Renewals are due April 30th of each year.
The current fee is $100 per site.
Please sign the top portion of the registration form and return it with
the appropriate fee payable to the Town of North Andover, 120 Main Street,
North Andover, MA. The bottom portion is yours to be displayed along with
your license.
Your immediate attention in this matter is greatly appreciated.
/Very trul
Lti�yere�6OArr✓'�ctaV
Joyce A. Bradshaw,
Town Clerk
enc.
JAB/je
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 DEPARTMENT OF PUBLIC SAFETY.
The @Iomnta iuralf4 of I5S=fPI0&0
i Department of Public Safety—Division of Mre Prevention
. i�
CERTIFICATE OF REGISTRATION
` NORTH M.D.a.ER....................QERIL... Ua......... 19....27
tClty er T.wnl IIAIei
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
here certifies that
MER. MACK VALLEY OIL COMPANY Address ....1-3..MASSACHUSETTS,AVENUE,t,.NORTH ANDOVER
..................................... .... ......
IN—of holder f I nael
is the holder of the license granted...............1ULY 29, 19...N.for the lawful use
of the building(s) or other structure(a) situated or to be situated at.1r.a.MASSArHUSETT-R.AIIENIIE.......
len«.vW ..W,l
as related to the KEEPING,STORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES,
NORTH ANDOVER
.........................................................................................
Cib oe To."
«Note: This eertifiee of reldavuion mo.t be sinned by the holder of the It..if Wd liven«w..teamed
prior to July 1. 1936,whcrwi.e by the wrier or occupant of the brad lirenrei
Received ...................... ........................19........ ..............................................................................................
(aian.u.el
by .......................................................................... MEARI
................................................................MACK VALLEY OIL COMPANY..............................
................................................................................ ISW.e wWwr eri.ee. ««pa.e or Mwnl
(ornrl.I nn.I 1-3 MASSACHUSETTS AVENUE, NORTH ANDOVER, MA
..............................................................................................
IAdL.rl
Toe (9=n nfUra1tfl of ttsstttf�uSEtts
Department of Public Safety—Division of Fare Prevention
REGISTRATION
.
NORTH. . ... .....ANDOVER.....................APRIL 30. ..... 19......27
. . . . ....(city or Torin) ......IOuel
This is to certify that..MERRIMACK,VALLEY OIL COMPANY
. .. . . . ....I .....O ....EK.........................has, in accordance with the
provisions of Chapter 148, Section 13, of the General Laws, filed with me a certificate of registration set-
ting forth that.... .............................is the holder of the license granted
JULY 29, 19.A. , for the lawful use of the building(s) or other structure(8)
situate,: or tf be situated at..Ic3..MASSAGHILSETTS..A.VZNUE.,..NW.7:H..ANDQ1!EA.............................................
Ien«t .rid N..WH
as related to the KEEPING,STORAGE.MANUFACTURE QIQS�AbLE.OHl�l41 V Fc OR EXPLOSIVES.
\� LP � T�+'r� / TCt✓a' LE/Ur
..........................................................................................
(Sm.«n... o,Ee1J TItNI
Note: A certifieste of reai. —6. mmt be filed on or before April 3011 of esch rear.
(THIS REGISTRATION IIUST RE CONSPICUOUSLY POSTED ON THE PREMISES.)
w s`ss
Note: Complete top of form and forward both sections and fee to local licansing
authority (City or Town Clerk). Oo not make application to department of Public Safety.
a; �anvrreo�rccUea�C o�G��a�aac�ucael�r
City or Town North Andover April 30, 1999
Oate
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned hereby certifies that
—1V12LlI n''^L 11,11ay Ql C',
1-3 Mass. Avenue °�""°r'�"" -
is the holder of license granted_ 7/S9E for the lawful use of the building(s)or other structure(s)situated or
to be situated at 1-3_Mass. Avenue
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
North Andover
Note: This application forcardffcate of regis126on must be signed by the holder of fhe license if acid license was
yy,�., granted prior to July 1, 1936, otherwise by Me owner or occupant o1 a land ficlensed...
Received ZLCW /9 /J /nS Submitted by
by �7cr ns� ,2� c�a"16W'
G(✓✓ Lf�= �' C/.C�ez.E vpkTHANDOVER MA018Af
anen rv.
Note: Complete tap of term and famard bath sedans and fee to local licensing
authar@y (Ciiy or Town Clerk), Oa not make applioatien to department of Pucfic Safety.
�„} �acnvrnaryccuea.� r���a�aczc�iaaeGlit
�' � =/�rl/XGr/te�ILCI��,/-L/K4 C/I%'UGCe1— �//tJ(d(ryh p��!/MN ✓�19'UB77.�,L6YL
City0r Town NORTH ANDOVER Date 30 a�
APPLICATION FOR CERTIFICATE OF REGISTRATION
In addomarim with the pravimcns of Cheater tab, Section 13. of the General Laws, the undersigned hereby cardfies that
MERRIMACK VALLEY OIL CO.
.w.snm.aeay.
1-3 MASS. AVENUE
�y
is the holder of license granted 21901R s ma for the lawful use of the building(s)or other suucture(s)situated or
to be situated at 1-3 MASS: AVENUE
sww,l.m.m.
as Mated to the KEEPING. STORAGE. MANUFACTURE OR SALE OF FLAMMASLES OF EXPL OSiVES.
NORT14 ABMQY.ER MA OIAAC
ary rw.
Nate:This acoAcatmn for certificate of m9avaben must be signed by the holder of me Hearse if said license was
granted prier to July 1, 1936, omerwlae by Rre owner cr ocapam of a land licensed.
Feceived Wei/ n
.a?'l -�000 Submitted by ��
by SJivr1C� �rG1'e12
iMERRI
3Mass=:.`tu'.ettsAve.
__----_. North U
Nate: Complete top Of form and forward both sections and fee to Iecel licensing
authority (City or Town Clerk). 00 not make appliption to department of Public Safety.
Vj4 yCJex�s— T ✓�-
City or Town NORTH ANDOVER Date Aq&/L 30 i?W
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 1As. Becton 13, of the General Laws, me undersigned hereby cardfies that
MERRIMACK VALLEY OIL CO.
.wM.nneo.usa�.
1-3 MASS. AVENUE
is me nolder of license granted_ T 429/As n for the lawful use of me building(s)or other strutture(s)situated or
to be sivated at 1-3 MASS: AVENUE
s...,mm..ew
as related to the KEEPING, STORAGE, MANUFACTURE OR SAL OF FLAMMASLES OR EXPLOSIVES.
MnRT{I A"n.. R MA 11965
rrrdt
Note: This applicadan for certrcafe of regismison muse be signed by the holder of me license if said/;cans. was
granted prior to July 1, 1936, omen se by me owner or o¢upanr of the land Rcensed.
Pecetvee N Submitted by
m
by
wm1 rr
�•a '=I\ � l(iO�J27/I➢2O/IZU/+°QGGiL C����CLCl1.11QP.�
�_t .S
@_y City or Town NORTH ANDOVER DateA&I(. _�D c?Gbd
REGISTRATION
Tnu a to Early that MERRIMACK VALLEY OIL CO.
has. in accordance with the provisions of Chapter 148, Section 13, of the General Laws, filed with me a certificate of registration setting
form mat MFRRTMAfK VAi 7 FY OTi rn is the holder of the license granted
7/29/85
o.n
for the lawful use of the building(s)or other structureis)situated or
to be mtuatec at 1-3 MASS. AVENUE' NORTH &XDQ2EII, 5
se.e.,,a m.w.
as rented to the KEEPING, STORAGE. MANUFACTURE OR SALE OF FLAMMA6LES OR EXPLOSIVES.
Non:A cel0Qelis or nysaaaon mutt be filed on a beldre AN COM of escn yeer.
rweea]981
THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES
.g tr
A�0.4e.:.^N^.s(it V� 1.tHN�N�iMtf[i,Lf{L <p. ✓/l-e[O,OSI.Gfl4LdP�W.
FG ✓✓✓
vDepartment of Fire Services
JL D
Office of the State Fire Marshal
P.O.Box 1025,State Road,Stow,MA 01775
CERTIFICATE OF REGISTRATION
North Andover Apri130,2009.
(City or Town) (Dale)
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): Merrimack Valley Oil Co.
(ADDRESS): 1-3 Mass Avenue
is the holder of the license granted(Date): 7/29/1985 for the lawful use of the building(s)or other
structure(s)situated or to be situated at (ADDRESS): 1-3 Mass.Avenue
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.
Received ... GJ.4fF..ae?........2009.........
L./.
By ... ....
Bi f�J.u.•/•u'..r ...........................
Ocial Title (Clerk) (Stele whether owner,occupant or holder)
MA
(Address)
S
— __ The Commonwealth of Massachusetts
Department of Industrial Accidents
ARWAFARVABNOW
_ 600 Washington Street
Boston,Mau 02111
Workers'C eaaatlaa Lasarasee AtHdavlt-General Businessn
Darns y L
tv I l][' rl l D J1W at",
art are 1,catim ifdl addreaal: .
[—,1 I am a rile prup.iuor a1X1 have m oae BWne 7ypm r�nO Reti@�(j[']�!BWanrmvBwMatmg E=bhsbnan
�I am an®plaWty P� u 0��71� Stl ( B RS fio m Fte.)
employees(fall R time). OWer 74.C• Cn.:.rt-1 M_V
I am ®employer providing wQYers'c®peosmm for my employees wmling on this
nz nee• — _
Iry Dhoas N:
I am a sole proprietor and have hired the independent cmtract rs listed below who have the following werka'
compensatiao polices:
.ddms•
mmoavz vim .. - _
addxr
ci .
innvavtt eo. r,')75'Li lY1111 e1
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.myrn'hap.Mamrr m nd r eha p.marr m fb.I.rr N.STOP wotilc OaDPJt.vd.nm.f 51MM.dq epimr m< 1 iodendr tbt.
..y.t thi mtoear vr4.frwrde/d/n�7tlr Omis Nlwatlptlsm NM.DG M1r e.map rmlMeM
/da ken*oe�s�ifr A.?ao.r/ I jer��rp GY�tie inJermmiowpravlld aMre 4`6'Y al_nrrwR
Sigmtue
print Dams r(:3wci4ei c M , Q:/�i
.taemtm..dr a.mrwrtvu,rm...mr.6.ttmpLnayeaymrwa.meYl
elrymn...: praa�ar0a/ Otiaadmr Pmarer.vr
❑.heck nlmmndl.n rnp.me a requVed EIL..mhe 6..rd
Os.rem.m'.on..
Onttue Deyrrm.vr
.ntaet peno.: ph..p; DOther
tm�.srµ IDml
The Commonwealth of Massachusetts
- Department of Indusirial Accidents
_ Marr.,ANNEv
_ 600 Washington Street
Boston,Mass 02111
WwkeW Coomensadw L araw Amdnit-General Hatchet
'--bnti (PoR addmNk -
❑ I w■sOle proprietor and have ao me Bastim Type: ❑ReUR❑Restaarmt/Bm/Eabng Estebhshmeat
kin!in aw v?aaotY• n Office n Sale!6vc11114IM2 Real F_Bowe. Antos xse.l
I am m em l witlt tw w fall d: time . Lj Other
I am m®Player p1widing erkaa ad pensabm for my employes waking m Pobjak
rom av vmex _
.ddrer:
p=a mk ptopricmr and have hired Memo raotractas tiatrd below who have the BtRaa'nteLwQkt:a'
comp—t-pobr _
m .
.ddreu• 1 ^
AMR
or
-
V
P.Yar.Y...r.r...:•0 r rnlor.i�r Srdn 2SA NMQ.]!!mr r.e Y dy Ya..ara Nedrtv.IprWr N.d.7Y7I�MN dhr
.m,y,.•dp.h.rrr r...e r shaPmaln r tlr Frr N.STOP wOa1C OpDHa W.Ihr NlleaN.b•a•Y••r 1 aaYe.bar M.er
�.y.f dr m:o..e r)rA Frw.NM F xb Ottr+.f ha.rtlptrm H W mA rr r.rae.mM+era
/d.APrdP fhr/afn. 1 1�arrn.U/.,vmla.P...ud.o-...oi. dnrrtK
rdat Osm- / if1/ Ll/� rm^°P —
FEOI —k
a mmedrr xs.p.vr r r"g nodi]Rmtd.AM%v.O
Client#: 14829 MVOIN
ACORD- CERTIFICATE OF LIABILITY INSURANCE 1U6 D«Yrrl
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Conifer Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody ,MA 01960
978532-5445 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A'. American Home Assurance Ca./AGG 19380
M.V.O., Inc. DBA INSURER B: National Union Fire Insurance Co. 19445
Merrimack Valley Oil Company INSURED
3 Massachusetts Avenue INSURER O:
North Andover,MA 01845
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOT WITHSTANDING
MY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
USE ADD TYPE OF INSURANCE POLICY NUMBER DATE EFFECTIVE POLICY E%PIMTION LIMITS
LTR NSR GATE MAVDDIYY DATE MM O
A GENERAL LIABILnY 9725713 12/31/08 12/31/09 EACH OCCURRENCE $1 000 000
cc-MESCAL GENERAL LIABILITY MEN SEES TOEA aNaTEp $50000
CLAIMS MADE aOCCUR RED CAP(WHY—wrs°"1 $10000
X C.
ntractual Llab PERSONAL&ADV INJURY $1000000
GENERAL AGGREGATE $2 000 000
GEWL AGGREGATE LIMIT APPLIES PER: PRO... COMP*PAGG $2000000
POLICY PRO LOG
JECT
A AUTOMOBILE LIABILITY 7591098 12/31/08 12/31/09 COMBINED SINGLE LIMIT $1,000,000
X ANY AUTO (Ea xcue"II
ALL OWNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (Perperwnl $
X HIRED AUTOS BODILY INJURY
X NON OWNED AUTOS IPeracutlenU $
X MC890 PROPERTY DAMAGE
X MM9955
GARAGE LIABILITY AUTOONLY-EAACCIDENT $
ANY AUTO OTHER THAN EAPCC $
AUTO ONLY. AGG $
B E%LESSNMBRELLA LIABILITY BE3055834 12131/08 12/31/09 EACH OCCURRENCE $1000000
X OCCUR CLAIMS MADE AGGREGATE E7000000
E
DEDUCTIBLE $
X RETENTION S 10000 $
A WORKERS LONPENSATNNI AHD 9723522 12/31/08 12I31109 X WCBL MO %
EMPLOYERS LIABILITY EL EACH ACCIDENT $1000000
ANY TEMPRIETORAARTNER,EXECUTIVE
OFFICERIMEMBER EXCLUDED] ELpIBEASE-FA EMPLOYEE $1,Ogg O00
NYn aewN]°IAtl«
SPECIAL PROVISIONS ceI°w ILL.DISEASE POLICY LIMIT 1$1000000
OTHER
DESCRIPTION OF OPERATXINS I LOCATIONS I VEHICLES I E%CLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
s HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
North Andover DATE THEREOF,THE ISSUINGINSURER WILL ENDEAVOR TO MML In DAYS WRITTEN
Town Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
120 Main Street IMPOSE NO OBLIGATON OR LIABILITY OF ANY FIND UPON THE INSURER ITS AGENTS OR
North Andover,MA 01845 REPRESENTATIVES.
A�.L yTFOfl2ED REPRESENTATIVE
-k.
ACORD 25(2001/08)1 of 2 #M58344 BOO B ACORD CORPORATION 1980
Cllentit: 14829 MVOIN
ACORD- CERTIFICATE OF LIABILITY INSURANCE a$/27109 DDYYYY
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Energi Insurance Services Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody ,MA 01960
978531-1822 INSURERS AFFORDING COVERAGE NAIC9
MSURED WsLFSRA: American Home Assurance Co./AGO 19380
M.V.O.,Inc. DBA INSURERS: Navigators Insurance Company
Merrimack Valley Oil Company INSURERC:
3 Massachusetts Avenue
INSURER 0'
North Andover,MA 01845 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTX X0. TYPE W INSURANCE POLICYNUMBER POALILYNNFEDCTNE POD.F MWI EWMIPON M.
A GENERALUABILnY 4882921 12/31/08 12/31/09 EACHOCCURRENCE $1000000
COMMEPCIPL GENERAL LIABILITY OAMAGETOnEd REm'D 550 OOO
CW MS MPDE OOCCUR MED EXPIMyOMgNm) $10000
PERWRAL&ADVINI $1000000
GENERALAGGREGATE s2,000,000
GENLAGGREGATE LIMIT APPLIES PER: -PRODUCTS-COMPIOP AGO E2000000
F0.10Y F
PE RC, 7LOL
A AVIOMOBIIEIIA& 4082504 12/31/08 12/31/09 COMBINED SINGLE LIMIT
X ANYAUTO RE.....) $1,000,000
ALL O'NNEDAUTOS BODILY INJURY
SCHEDULED AUTOS (Prr ) 5
X HIRED AUTOS BODILY INJURY
X NONvOWNED AUTOS (Pnarreum) 5
PROPERTY DAMAGE S
(Per adowne)
GARAGE LIABILITY AUm WRY-EAALLIDENT $
ANVAUTO OTHERTHAN EAACC s
AUTO ONLY: AGO 5
B EXCESNUMBNELUDAMul TBD 12/31/08 12/31/09 EACH OCCURRENCE $1000000
X OCCUR CLAIMS MADE AGGREGATE $1 ODD 000
E
DEDUCTIBLE 5
X RETEMION $10000
A WORNERSCOMMIRSATwNAND 1096245 12/31/08 12/31/09 WC sraru- OTH
EMPLOYERS UABILnY
ANYPROPRIETOFARTNSIPEXECUFFME E.L EACNACGDEM E1000000
R
OFRCERWEMBER EXOLUDEW E.L.DISEASE-EA EMPLOYEE $1000000
n E d.sarl,e Ana.,
SPEC A.PROVSI0NS Eebw E.L.DISEASE-PMICY Dun $1000000
OTTER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IEXCLUSIONS AWED BY ENDORSEMENT I SPECIAL PROVISIONS
Workers Comp Information"
Voluntary Compensation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY Of ME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATRON
North Andover DATE THEREOF,THE I..UN.MSURER WILL BNDEAVO0.TO MAIL In DAYSWRmEN
Town Clerk NOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO$HALL
120 Main Street IMPOSE NO OBUBAUI ON OR LIABILITY OF ANY RIND UPON TIE WSURER.ITS AGEMS OR
North Andover,MA 01845 RWREscxrATIvas.
A HORIZED REPRESENTATIVE
N.
ACORD 25(200IMB)1 of 2 #58861 APD 0 ACORD CORPORATION 1988
I,
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsemenl(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 not confer rights to the certifcate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does 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 25Z(2001108) 2 of 2 #58861
Client#: 14829 MVOIN
ACORU- CERTIFICATE OF LIABILITY INSURANCE 121210""
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Conifer Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EMEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody ,MA 01960
978532-5445 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: American Home Assurance CD.IAGG 19380
M.V.O.,Inc. DBA INSURER B: National Union Fire Insurance Co. 19445
Merrimack Valley Oil Company INSURER o
3 Massachusetts Avenue INSURER D:
North Andover,MA 01845
INSURER
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LOR NSR TYPE OF INSURANCE POUCYNUMBER POLICY DATE MFFDCIYTE OLICY MMMTON �
A GENERAL LUENRY 7566094 12/31/07 12/31/08 EACH OCCURRENCE $1000000
COMMERLI4 GENERAL LUBILITY OAMAGES(Be X'EOnd
neel $50000
CLAIMS MADE OOCCUR MEDE%P(Anyonepersen) $10000
X Contractual PERSONAL S ADS INJURY $1000000
GENERAL AGGREGATE s2 00O 00O
GHv-AGGREGATE LIMIT APPLIES PER'. PRODUCTS-COMWOPAGG s2000000
POLICY PRO. LOC
ACT
A AVTONOwLEIJABR-TY 7586817 12/31/07 12/31/08 COMBINED SINGLE LIMIT $1,000,000
X ANY AUTO (Eandanp
ALL OWNED AUTOS
BODILYPV INJURY s
SCHEDULED AUTOS (PM peuml
% HIRED AUTOS
X xaNGwxee Auras
(emeL len1� s
X MCS90 PROPERTY DAMAGE
X MM9955 ae,accident)
$
GARAGE LWBILRY AUTOONLY-EAALLIDENT $
ANY AUTO OTHERTHAN EA ACC $
AUTO ONLY'. ADS $
B E%CESSIUMBRELIA LIABILITY BE3833645 12/31/07 12/31/08 EACH OCCURRENCE $1000000
X OCCUR 7 CLAIMS MODE AGGREGATE $1000000
§
DEDUCTIBLE $
X RPTENTIaN $10000 5
A WORKERSCOMPEMSATIONAND 7569465 12/31/07 12/31/08 % I we STATU oTR T�j
EMPLOYERS IIABILOY
ANY PROPRIETICAPARTNEWEXECUTIVE E.L.EACHACCIDENT $1,000,000
OFFICERRAEMBER EXCWDED4 ELDEEASE-EAEMPLOYEE $1,000,000
SEECIAL e"Ve under
PROVISIONS UeImv E.L DISEASE.POLICY LIMIT §1000,000
OTHER
DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL �11 DAYS WRITTEN
Town Clerk NOME TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
120 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
North Andover, MA 01845 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
�/M 4--
1
ACORD 25(2001108)1 of 2 #M55876 BDO o ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(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 an endorsement. A statement on this certifcete does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does 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.
ACORO 25-S(200V08) 2 of 2 #M55876
TOWN OF NORTH ANDOVER
OFFICE OF
TOWN CLERK
120 MAIN STREET
NORTH ANDOVER, MASSACHUSETTS 01845
pOPTN
Joyce A. Bradshaw is ✓, q
�
Town Clerk Telephone 8) 1, FAX(978)8)688-9557-9557
�O°uxusC
Merrimack Valley Oil Co.
1-3 Mass Ave.
North Andover, MA 01845
March 16, 2006
To Whom It May Concern:
Enclosed please find your 2006 Registration Renewal Form(s) for above ground and/or
underground storage tanks listed at the address(es)on the enclosed form(s). Renewals are due
April 30'h of each year.
The fee for renewal is $150 per site.
Please sign the top portion of the registration form and return it with the appropriate fee,
payable to the Town of North Andover, 120 Main Street,North Andover,MA 01845. The
bottom portion is yours to be displayed alone with your license.
Your immediate attention in this matter is greatly appreciated.
Very truly,
Q 40"a�'
Joyce Bradshaw
Town Clerk
Enc.
Nate Complete top of farm and forward both sections and fee to local licaroing
authority (City or Tomat Clerks Do not make application to departmem of public Satery.
� C\_ i-0c7�maouuCea� a�Caacfzuae��lnjl`d
�, Je7liarGnrent o��'rire GJ'a�vrces — L'ritAebe6n of ;lvrue>el
CRyar Town NnRTN ANpoyER Date I a
APPLICATION FOR CERTIFICATE OF REGISTRATION
In amrdance with the provisions of Chapter IAB, Section 13,of the General Laws, the undersigned hereby certifies that
MERRIMACK VALLEY OIL CO.
rrwwnesasas
1-3 MASS. AVENUE
is the holler of license granted 7/2 o/R�_for the lawful use of the building(s)or other structure(s)situated ar
to be situated at 1-3 MASS: AVENUE
sw..cl..mr
as related to the KEPING. STORAGE,MANUFACTURE OR SAL OF FLAMMABLS OR EXPLOSIVES.
MORTIT ANnnWR MA Ot RLG
Note:no application for cert HM&of regisoadon must bra signed by the holder at the/kdrsa if saM license was
granted poor M Jtuy 1, 1 M, otherwise by the owner or oc�upsm of the two Ikensed
Pemrvad Submitted by
by
ad rr
----------------------------------------------
e..e
e y�c � e eke e A� —� "�°' °N`d��"�°c� ✓�w »a
City or Town NORTH ANDOVER Date li,�D a=
REGISTRATION
This is to cardfy Nat MERRIMACK VALLEY OIL CO.
unno
has in aaardance with the provisions of Chapter 148, Section 13,of the General Laws, filed with me a caMficate of registration setting
form Nat _ MERRIMACK VAT i FY OTi rn is the holder of the license granted
7/29/85
ar
for the lawful use of the building(s)or other structures)situated or
to be muted at 1-3 MASS AVENUE' NORTH AN➢O[
suv..e,.ae.
as related to the KEEPING, STORAGE, MANUFACTURE OR SAL OF FLAMMA13LEES OR EXPLOSIVES. -
Nor,:A nrdeoe of ra0atrae61 Malt se Ned Rn or o,fors April 7OM of eso,yea,.
THIS REGISTRATION MUST 3E CCNSPICUCUSLY POS7EO ON THE PREMISES
R.5(nwsW)Ai6)
Note: Complete top at farm and forward both sections and fee to local licensing
authority (City or Town Clerk). Do not make application to deparbnent of Public Safety.
F � ��r2LGi� a���A%%laaaaol�ae�rtn�i
F� �e�iaaLwerzCr���ure CJep'uic� — L'v+�wears o��iiiir® ;l,�eve�eCearc
City or Town NORTH ANDOVER Date
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148, Section 13,of the General Laws.the undersigned hereby cantles that
MERRIMACK VALLEY OIL CO.
.v.�.ame.ae..
1-3 MASS. AVENUE
.me.
is the holder of license granted 7/90/AS ow for the lawful use of the building(s) or other strucure(s)situated or
to be abetted at 1-3 MASS: AVENUE
as eaimed to the KEEPING,STORAGE. MANUFACTURE OR SAL OF FLAMMABLES OR EXPLOSIVES.
NORTH ANnnuro Me n1RLS
arc rover
Nate: This application for cenlficam of registration must be signed by the holder of the dcansa if said license was
granted phw ro July 1, 1936, otherwise by the owner or occupant of the land licensed.
Revived Submitted by
svarNr
by
ara.
_-----------------------____—___—/ --�_, _—__--_--.
� �i OiIY(/rYLO/YGCU2LLGLiL C�� /2�2L(Q
"�.��q �efianrGmertCo��vxa�eN�icrei — "L�in¢7axr�rKo<mcdC/tara�e�air�C ✓xa�aarra
City or Town NORTH ANDOVER Date
REGISTRATION
his is to certify that MERRIMACK VALLEY OIL CO.
has, in accordance with the provisions of Chapter 148, Section 13,of the General Laws, flied with me a certificate at registration setting
forth that MERRIMACK VALLEY RY OTT rn is the holder of the license granted
7/29/85
for the lawful use of the building(s)or other sbucture(s)situated or
ow
to be situated at 1-3 MASS. AVENUE: NORTH ANDOVER. MA 01865
5urrwmmwr
as related to the KEEPING,STORAGE.MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
sow•.im anw rw.
Note'A carlibcro at rerp5tra0on must be Glen on or before April 30M of saUt year.
THIS REGISTRATION MUST BE CONSPICUOUSLY POS i cD ON THE PREMISES
R=(rewsea'r9e1
Nate: Complete top of form and forward both sections and fee to local licensing
authority (City or Town Clerk). Do not make application to deperbnent of Public Safety.
� �c7�momcuea,CC�i o���aQaac6auaelZ.�
JJe�ranGrneraCa��vA. c5' �— L'vwnciirA ��� � a>z
City ar Town NORTH ANDOVER Date
APPLICATION FOR CERTIFICATE OF REGISTRATION
In aczrdance with the provisions of Chapter tab, Section 13, at the General Laws.the undersigned hereby certifies Gut
MERRIMACK VALLEY OIL CO.
.wM.amur>c�..
1-3 MASS. AVENUE
�d
is the holder of license granted 7 f 90 IR S for the lawful use of the bi iiding(s)or other strucure(s)situated or
to be situated at 1-3 MASS: AVENUE
as related to the KEEPING, STORAG-c, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES. -
NORTH AldQVFR MA QIRLS
Note:7776 application for certificate of regismigon must be signed by the holder at the ficanse N sad license was
granted prior to July 1, 1936, otherwise by the owner or acupant of me land licensed.
Recaimd Submitted by
by
amm rr thou
----------------------------------------------
� ���� c�C?/�CaQaao�zccaeG�`a
�efrLe a<g� rifle e�1e — d��AO ti d e5'cae C�%�r/ ✓ A
City or Town NORTH ANDOVER pate
REGISTRATION
This is to certify that MERRIMACK VALLEY OIL CO.
has, in waordance with the provisions at Chapter 148, Section 13, of the General Laws. filed with me a certificate of registration setting
form mat MRRRTMACK VALLEY FY OTT. CO is the holder of the license granted
7/29/85
for the lawful use of the building(s)or other structure(S)situated or
om
to be attested at 1-3 MASS AVENUE NORTH ANDOVFR MA 01845
as related to the KEEPING, STORAGE MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
symm..conm,ra.
Note.A catdrfote at rapsaaton music.Ned on or baton,Ap6130m at each year
THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES
:?g!mmsaa 15s1
Note: Carnplets top of tarn and forward both sections and fee to local licensing
authority (City or Town Clerk). Do not make application to department of Public Safety.
Cltyor Town NORTH ANDOVER Date
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions of Chapter 148, Sectian 13, of the General Laws, the undersigned hereby cardfies that
MERRIMACK VALLEY OIL CO.
s...wme.w.u�.
1-3 MASS. AVENUE
.vwu
is the holder of license granted 7/9a/RS —for the lawful use of the butlding(s) or other structure(s)situated or
to be=ated at 1-3 MASS: AVENUE
as related to the KEEPING, STORAGE, MANUFACTURE OR SAL OF FLAMMABLES OR EXPLOSIVES.
NDRTN AN11nVRR MA rIIRAS
rrrd ice.
Note: This application for ardfrcare of registmadon must be signed by the holder of the license if said Ilcense was
granted prior to Juty 1, 1936, omerwrse by lire owner or occupant of the land licensed.
Received Submitted by
ter.
------------------------/ /---�-------------------
r. .t
Ali O/IYf/YYLMZL(J22Ltt2 G�VU
6 gefcaxGmennCa�'�rvxeexvccrs— LGrtdex�rounulCJCoaa�e�airt� ✓"Aownc
Cltyor Town NORTH ANDOVER Date
REGISTRATION
This is M certify mat MERRIMACK VALLEY OIL CO.
has, in accordance with the provisions of Chapter 148, Section 13.of the General Laws, filed with me a certificate of registr umn setting
farm that - MRRRTMACK VAT T FY OTT CO is the holder of the license granted
7/29/85
0— for me lawful use of the bmlding(s)or other structure(s)situated or
•
to be situated at 1-3 MASS AVENUE' NORTH ANDOVER MA 01845
5arwmmer
as related to the KEEPING, STORAGE.MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
syn..+.,ea nw
Note:A available of registraden must as Ned on or before April 30m of each year.
THIS REGISTRATION MUST BE CONSPICUOUSLY POS i cD ON THE PREMISES
�5(rans¢o]N61
Note: Complete top of tam and forward both sections and fee to local licensing
authority (City or Town Clerk). Do not snake application to department of Public Safety.
Je�ll!//LIILClLCp�V'(/Xe�11�/LC@1— liI/UCCGfilL p��r/.B :l.•bUB�Ldn
City or Town NnRTH ANDOVER Date
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the pravisions of Chapter 148, Section 13.at the General Laws,the undersigned hereby candies that
MERRIMACK VALLEY OIL CO.
v.�.arm.dem
1-3 MASS. AVENUE
is the holder at license granted 7/9 195 for the lawful use at the building(s) or other structure(s)situated or
on.
to be situated at 1-3 MASS: AVENUE
as related to me KEEPING. STORAGE, MANUFACTURE OR SAL OF FLAMMABLES OR EXPLOSIVES.
NORTH AN➢OVFR MA UIH45
Nate:This applicadon for carefrrate of registratlon must be signed by the holder of the license if said license was
granted prior to July 1, 106, otherwise by the owner or acupanr of the land Ikensed
Received Submitted by
w. aymu.
by
alnmr rm .m.a.
---__----------------------------------------"
g �efiaix!maan.Cb��rixe�ewaxces— "Glmdaxr�rararzdVCara�.e C�om� �no�rxamc
City ar Town NORTH ANDOVER Date
REGISTRATION
This is to certify that MERRIMACK VALLEY OIL CO.
has. In acardance with the provisions of Chapter 148, Section 13, of file General Laws, flied with me a certificate of registration setting
faith mat _ MERRIMACK VAi T FY OTT CO is the holder of the license granted
7/29/85
for the lawful use at the building(s)or other structures)situated or
or.
to be situated at _ 1-3 MASS. AVENUE: NORTH AN➢OVER, MA OI 845
Smeuwmmrr
as related to the KEEPING, STORAGE, MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
sylw..momm ra.
Note.A cersbcre of regiseaCan musty Ned on or before April3017,of eaor year.
THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES
R.5(reNsea;561
6�9Client#: 14829 MVOIN I
&00-- CERTIFICATE OF LIABILITY INSURANCE 03;28/0
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Conifer Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody ,MA 01960
978532-5465 INSURERS AFFORDING COVERAGE NAICIS
INSURED INSURER AI American Home Assurance Co./AGG 19380
M.V.O.,Inc.DBA wsURERB'. National Union Fire Insurance Co. 19445
Merrimack Valley Oil Company
HoUPERC,
3 Massachusetts Avenue
INSURER O:
North Andover,MA 01845
INSURER
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RISK GOT POPCYEFFECTME PDLICYEXPIRATgN
LTR NOR TYPE OF INSURANCE POLICY NUMBER p T DDNYIl1Mli$
A GENERAL LMMILTTY 7566094 12131/06 12131/07 EACHOCCURNENCE $1000000
coMMERIX4L GExERwLL4BIury DALUGETO RENTED $50,000
CAMS MADE OOCCUR APED EXP(My onepmon) $10000
PERSONAL 6 AOV INJURY $1 00O 000
GENE.AGGREGATE S2,000,000
GENLAGGREGXEE LIMIT APPLIES PER PRODUCTS-COMPI AGO f2000000
POLICY ma LOO
A AUTOMOBILE LIABITY 7586817 12/31/06 12/31/07
X µYAUTO IIIa [JINGLE LIMIT $1,000,000
ALLOWNEDAUTOB
BODILY INJURY $
SCHEDULED AUTOS IPe,OYLn0
X HIREDAVr04 BODILY INJURY
X NOMOWXEDAUTO$ (per...II) $
PROPERTY DAMAGE $
IPn eageM)
GARAGE LIABILITY AUTO QVLY-EA ACCIDENT $
ANY-0 OTHER TWAT EA ACC f
AUTO ONLY'. AGG S
B EXCIUSIBMBRE11AUJMMUTY BE3833645 12/31/06 12/31107 EACH OCCURRENCE $1000000
X ..UP F CIAIME MADE AGGREGATE $1 000 000
f
DEDUCPBLE s
% HETBNTION $10000 1
A WORXERSCOMMNSAIOMµD 7569465 12/31/06 12131/07 WCSTAM OTH-
UGI
FINK-WERM LABILITY EX
ANY FROPRIETONPµTNEWEXECUTVE EL EACHACCIDEM $1000000
OFFICERMEMBER EXCLUDED) EL.DISEASE-EA EMPLOYE $1000000
sIr6 e.d—oNeund
PECIALPRONSIoxSNelow El BECAME-PaICYLIUT $1000000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS VEHICLES IEXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL.REGARDING
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
The Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAT. In OAY$WHmEX
Town Clerk NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIE LEFT,BUT FAILURE TO DO SO$HALL
120 Main Street IMPOSE NO OBLIGATION OR LABILITY OF µy KIND UPON ME INSURER ITS AGENTS OR
North Andover, MA 01845 REPRESExTATIvE$.
AD
FOR
,,,IZE ZEO gEPflESEXTpTIVE
ACORD 25(2001108)1 of 2 #53864 RBU 0 ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certifcate does not confer rights to the certificate holder in lieu of such endorsement($).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement($).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does 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 254(300108) 2 of2 #53664
Nate: Complete top of farm and forward both sections and fee to local licensing
authority (City or Town Clerk), Do not make application to department of public Safety.
�, �c�;��rcaauueafCli o�� iilaea�zc6ucaeLly
� rrencq�
9 Cityor Town NORTH AN OVER Date i ( 0 061
APPLICATION FOR CERTIFICATE OF REGISTRATION
In aCprdarlm with the provisions of Chapter 148, Section 13,of the General Laws. the undersigned hereby certifies that
MERRIMACK VALLEY OIL CO.
1-3 MASS. AVENUE
is the holder of license granted Z/9g/AS for the lawful use of the building(s) or other struc:ure(s)Situated or
to be situated at 1-3 MASS: AVENUE
as related to the KEEPING,STORAGE MANUFACTURE OR SAL OF FLAMMAOLES OR EXPLOSIVES.
NORTH AA VR n1A/ 9
Note: This appAtaa'on forcerd6cate of ragismnon must be signed by the holder of the license 6 said license was
granted prior to Juty 1, 19-76, olnemma by the owner or=upanr a Me land licensed.
Received
_30
Subm/�i'tt �yy
by _S�1LLYl4UI J//� l
The Commonwealth ojMassaehuseus
Department of Industrial Accidents
r' AWNr
_ 600 Washington Sneer
Boston,Meta. 02111
workers' Burnam
1
)0 C
❑ I m a sole prooc or and have no one Bsdam Type: ❑Reuil Office O S�(ianVBi rl �eal Fsla[S� n
waking m any aapaaltY., ,. (��+I
®_ I am m onploya with employers Mall &part time). H other --_—_--
I am ®®ploys proved-g—v 'oompmsaii—far mY—ploym w kms m thes)ob.
.ddrcx-
vbn a:
fo n
I am a sole pmoc[a and have hired*a mdeymdeot cmtraaba H"bdww who lure ma wwwNswvtee ne
compee v-pourer: . .
Ader f L
star! - ..
r.aenbxex..wxeOx j+pb Wwaxon25ANMGL152m W4dr1ap"Y Meef4Y -p M..f.fargp%s2 M.M. d%r
s y.x.•anrat•xt r wi x e4apmW4 b ttw hrx N.sror woar OADHR.d.lis Na1tN.M•Igepele.l r I eaab.bd Yet
c.pr er thY abls.m eeq b hrnrdd 4 tlr 011k.Nlnx<IP Ws NM.dA M e�ma.nrlaelbb
army►mAwdwpdw"d perfvpfbstbe u<fs xmisapr.vided.bare b Awe ddCATAM
SiR ✓1'Ail O3/.Yp. l� � A4
�,�e U�,hl )E M c`�L3ai Ery p6or:��17R)(oR3.313 I
.(hbl me..b' 4xtwrMebdtlt etr 4M.myletd b7 eiryx Owe.fhbl
<Kr x bwv: pxmluacexe a QlWddbr 11<p.rtmex
�I.t.mbr HwN
❑<hxk ubm<dbb<xp.x..,wwr.a Os<t«�.e'<orn<.
p..xa sw<avaf
03/28/2007 15:41 FAX 978 531 4857 B R YCCARTBY IM001/002
IN
ACORD. CERTIFICATEALIABILITY INSURANCE U31207PRONCER CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONConifer Insurance Agency,Inc. AND CONFERS NO RIGHB UPON THE CERTIFICATEDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR10 Centennial Drive R THE COVERAGE AFFORDED SY THE POLICIES BELOW.Peabody MA 01980975532-5445 ERS AFFORDING COVERAGE NAICOpA American Home Assurance COJAGG 19360M.V.O.,Inc.DBAIB. NationalONonmMinsurance Co. 19445Merrimack Valley Oil CompanyAC•3 Massachusetts AVMYeR D:North Andove4 NA 01805a E
COVERAGES
THE POLICIES OF INSURANCE LISTED SELDIN HAVE BEEN ISSUED TOTHE INSURm NAMED Aatl+E FORTHE PCUCY PERIOD INOIC�ATED.N0IWITHBTAnOWc
ANY REQUIREMENT.TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICN THIS CEROFICATE MAYBE 154Um OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS eU61EOTTO AlA THE TERMS.EXQUSIONS AND CONDITIONS OF SUCH
p, IGIES.AGGREWTE LIMI SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
n uMnc
TWF OF IILSNRMICE PIaILYNDIa1PR
A ava:wauraam 755W% 12A1/O6 12f31/07 EAala RENEDABINCE i500000D
cowBrmu GExBRIULUBEm
WIN&WDB Oa,DV0. PGRSDN000
MED lMrwlV.I 51 00O
PER5Ow1 LA0vw.lOm r1 DDD D
GENEMLAGGREGATE s2 ON 000
DDM1A401MSAMLNmAFPIrEB PER: IYIWUCR-cDMPaxnac a2000000
Pain 'A0 a
A AI]msoessLPa¢nr 75M17 17/91106 12191107 COMBIN[DSNGIEUMT f1,W0,000
X Axr Aum IE.eNaeMl
A ONNEDAUTO6 eODILr IruLRY f
BONEDIA,Dan[S cnro.T�l
X HREOAums Boxy UNuRY E
X NDNaNNEPANGe
PvOPfR"DAXAGE
tMEfflR� M-I
nY Dr Y-EAAOcIDE]auACC AUm ONLr ADG BE3B33M t2131108 1V31107 EACH OC RRENCE f1 FOLAIMSIMO[ AGGNFOATEE f 0
q .cOulwAnox un 739483 12151/OS 12/31/07 wr: Aru aTw
MIrLmTAs•IueAm EL FADH D x '1000000
AM PROPRIE II.1.nERSMECUTNE
OFFIGERIMEMBCRRC1110ED] ELDIBFh4E•FABIIR f1 DDD.DDD
Ir arx"i PR�Ovi"si.MM, e1000.000
mNU
oaoTIp OFOPmAIIW IIACATIONa/VMMR.61 QCL1161dY Aram RElO0R991nITllFLM1FIWveNXa
CERTIFICATE HOLDER CANCELLATION
eNNm-10Fn1EABONE DEELW an POUCIE9 BECANEaYF➢9aF0Mn1EIVPNAnoN
The TOWn Of North Andover DPiETHFAEOF,TNEISSUIXGINWRERWILLmOFAYORWO —11. DAYENMIEN
Town Clerk NOnDETOTNE CEAnRCATE HOLDER NAMEDTOTHEIFFT.0UrFAILVRETOD0 mENA�
120 Main Street MPOSENO 0"ArON OR LIPBIInY of ANY KIND MMTHE WAIMM rts AGEEDIS M
North Andover,MA 01"s RESRFSENTA
AU]HORU[D RE/P'RESENTAWVE
:4A {
ACORD]512u01108I 1 D12 053854 RBU 0 ACORD CORPORATION 1888
03/28/2007 15:42 FAE 978 531 4857 B H McCARTHY 0002/002
IMPORTANT
It the arldcate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. Astatement
on thla certificate does net 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,cerram policies may
require an endorsement. A statement on this certificate tloes not confer rights to the cartifate
holder In lieu of such endomemCnt(s)-
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the cedFcate holder, nor does It
affirmatively or negatively amen, extend or alter the coverage afforded by the policies listed thereon.
ACOM 26A(2001/0s) 2 of 053864
qw
ony and fee to local Iicen t
and forward barn secd erd of Public Safety
of form ficatien to deparun
fea�rnpfete top pa not make aPP
♦ aufhontY (City/ or Town Cierk�.
� a
B �pppVEg�Date
C❑� J Gay or Town S1iLu°'�"—
TION FOR CERT'FmCA�EwOFthe RE�dsmI dSTYRATION
APPUC n,3.
on.+d Chapter,da,Secdo
Ina a,rdance wN,the Pro'" OIL Co ,W,,,a"m+a'�"'
MERRIMACR VALLEY cturHsl situated or
AVENUE s or other sw
1-3 MASS. tar me lawtul use of the building(s)
u•
h the holder of license grant AVENUE s°'u'"O" P'_OSiVES.
1-3 MASS. c OF FLAMMABLE-ORIX
to be situated at RE OR SAl—
related to the KE=PING. STORAGE MANUFACTU
ord a."
be —ri d by the holder of theHas I
pc!rise
11,ri said license was
zf: do must the owner or oo Pant of fps land licensed
lkaem for certlfioare of refit ottp.n„he by
Nore-Th6�pgranted prior to Jury 1 1�6'
Submated by
Flej�
. GATE INV ICE._ AM UN 53-705M 113
Mvo M.V.O., INC.
0BA MEHPIMACK VALLEY OIL 18043
3Me chus SAVM-
NMhAndo W013C5
CMECK n @
1 LLARS gMOUN! LU
PAY
pA� -TO THEO EH OESGHIFiION CMECKN
Imh
Ba knorlhdwn
MeasuM1usetu
m018[)L m 1: 2 & hl ?OSL S1: 820,0069 ? Slim
Note: Complete top of form and forward hold sections and fee to local licensing
authority (City at Town
Clerk). Do not make application
�todepartment of Public Safety.
I _.
l(JCi/YI/I97.0?2C/18CLLL/L �. UI� ZLLQ2�
1 ✓lraumn.G,aan
��iizext a�C'rv/e - revcc�— iAxxon o��iive
7
` City or Tal NORTH ANDOVEA Date l��r�
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accrdance with the provisions of Chapter 148, Section 13. of the General laws, the undersigned hereby cenifies that
MERRIMACK VALLEY OIL CO.
nma,m.se'a.v
1-3 MASS. AVENUE
's the holder of license granted ]/9a/R S for the lawful use of the building(s)or other structure(s)situated or
to be situated at 1-3 MASS: AVENUE
smw.e,..,w.
as related to the KEEPING,STORAGE,MANUFACTURE OR SAL OF FLAMMA13LES OR EXPLOSIVES.
NORTrI AUI1nin:R MA n i ltA S
G..Iwn
Note: This application for certificate at reglsmabon must be signed by the holder of the license it said license was
granted prior to July 1, 1936, omern a by the owner or occupant at the land licensed.
Received Submitted by
by
aem rr ma.
.--------------Q_%_-----__—___--_____-----------
� � IGOiIYI/IYLd)ZUIBQAGiL G��%I�GCZQQC7.CiLV/b�L6
S®®3/9yg. Jef+a�A�menC`/' '4xe ex'uU;G1— LI/n6e%r�rarHza7C:lCOrA C57.,a 1✓Dfo ams
City ar Town NORTH ANDOVER Data tii-1'tl(..'1�1, , J
REGISTRATION
This is to certdy that MERRIMACK VALLEY OIL CO.
has, in acardance with the provisions of Chapter 148, Section 13, of the General laws, filed with me a certificate of registration setting
forth that is the holder of the license granted
7/29/85
for the lawful use of the bulding(s)or other stmcture(s)situated or
om
to be situated at 1-3 .LASS AVENUE" NORTH ANDOVER MA 01845 -
se...a,..�c.r
as related to the KEEPING, STORAGE,MANUFACTURE OR SAL OF FLAMMABj.ES OF OF IRS
sy.a...manu,rs
Note,A Card tie of regsirston rtnru be filed on or before April Win at each year.
THIS REGISSRA MON MUSS BE CONSPICJOUSLY POSTED ON THE PREMISES
P-5(m sed'yM
iNote: Complete top Of farm and forward both sections and fee to local licensing
aut hority (City or Town Clerk). Do not make application to department of Public Safety.
_ � �rirrunwa2caerz`Cl2 r��lczaaaclzuaeCZ.t
ae�a7L °�- vueao-n o��Jrs ✓. .ue.eCtcre
City or Town NORTH ANDOVER Date �/_✓1�Q 190 0/
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions at Chapter lag. Section 13. of the General Laws, the undersigned hereby certifies that
MERRIMACK VALLEY OIL CO.
wm.wrm.>od.,.
1-3 MASS. AVENUE
s the holder of license granted 7/90/R S —for me lawful use of Me buildings)or other slNaurels)situated or
to tie ssuated at 1-3 MASS.' AVENUE
as related Wine KEEPING, STORAGE. MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES.
NORTH AN11nVFR MA MA/ S
Grvw o�
Nora: This application for certificate of registration must be signed by the holder of the license if said license was
granted pnor:o July 1, 1936, otherwise by the owner or occupant of the land licensed.
Recsive0
Submitted by
tin
av
crc,e.a ,my
_ _ _ _____________________________________.
_ _, � �oorrrrnarLcuecalC�z c�� /`a.�aacLcuaellil
��� � �re�rt���.� e`1�r,>,� _'lC�r�r�,�r�tdcl�"tara��%�r.� ✓"'-,�onm
City or Town NORTH ANDOVER pate
REGISTRATION
'nis Is to sanity that MERRIMACK VALLEY OIL CO.
nos, in accordance witn the provisions of Chapter 148. Section 13. of the General laws, filed with me a certificate of registration semrg
Tom Nat MRRRTM&CK VAT T FV OTT rn Is the holder of the license granted
7/29/85
a..
for the lawful use of the buildings) or other smanturets) situated or
:a be situated at 1-3 MASS. AVENUE' NORTH ANDOVER MA OIA 5
5uxrananunw.
as related to the KEEPING, STORACE. MANUFACTURE OR SAL OF FLAMMABLES OR EXPLOSIVES.
90
Nets..A certificate of regaseanan must be filed an or before ApM 30M at each year
'THIS REGISTRATION MUST BE CONSPICJOUSLY POSTED ON THE PREMISES
rensea].9fi1
Note: Complete top of form and forward both sections and fee to local licensing
aulthority (City or Town Clerk). Do not make application to department of Pubfic Safety.
;_ �G!Y'2iI7'LOi/2C(JCrZLLiL a�� /��aaaac�iuQeL�3
S �efiaaa(rneneCp��vre c-`l�.xvrcas — '�vwaca�s a��vrs
�y �
Clry or Town NORTH ANOOVER pate )(-�r"+A(y�
J
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the provisions at Chapter 166. Section 13. of the General Laws, the undersigned hereby cerdhes that
MERRIMACK VALLEY OIL CO.
xrm.unaeror euv.
1-3 MASS. AVENUE
m�
is the holder of license granted 2129/A s�_for the lawful use at Me buil6ng(s)or other structure(s)situated or
to be situated at 1-3 MASS: AVENUE
as related to the KEEPING, STORAGE,MANUFACTURE OR SAL OF FLAMMAELES OR EXP!OSIVES. -
NnRTH AN110VFR MA n1AAN
Cbarw.r
Note: This application for certificate at Weiraton must be signed by the holder of Me license it said license was
granted prior to July 1, 1936, otherwise by Me owner or occupant of the land licensed.
R Submitted by /rl c
by l71,V Elm
61vv 3 L14w ,Qde�AA�1do�✓ram H ® � b'�F
The Commonwealth of Massachusetts
Department oflndustrial Accidents
Aff9V#1AMAdWAWff
600 Washington Street
Boston,Mass. 02111
Workers' Com enation Insurance Affidavit-General Businesses
AM
ssA- c14� S� 'i' TS eQ /ct.� p / q
> I_a t f{ /Qn (O✓e/� sare 111� O /Vli•J nhwnx
work site location(full addrovsk
❑ I am a sole proprictor and have no one Business Type: El Retail❑Restaurant/Bar/Eating Pslabhshm®t
working in any capacity. Office❑ Sales(including Real Estate, Autos etc.)
I am an �pl /O empio "oh & art time. Other
an an employer providing workers' compcosation fm my employees working on this job.
con eo name•
address:
ity. ohnneN -
iemnvice co. lie N
I am a sole proprietor and have hived the tudependent contractors listed below who have the following workers'
compensation polices: /
dd
. y Phone N•
ivsurevee eo. il° #
sddr.as: :sS, SQ.TrSi/V `�f
alder eR ! , ppyyLL1,, �' 683-3/J?
Mmrnnee aro. Q
F.,-
re to scan coven6e n requtrW under Satbv 25A of MGL 152 cvv lad to the Impo.Mov of crtmlovl pevaltb of•tins qp to siSm-ao avd/or
ova ynn'Imprbovmeot a weB a chH pevakla re the form of.STOP WORK ORDER.vd.Bve ofrlao.ao•day vgvimt mn 1 udienmod th.t e
copy of tbb mtemeot may be for.varded to the O/ike of IvvnHevHom of the DIA for eovenp verilintbn
f do hereby cad r the palm andpe/ng y"'oofPc i.ry the infarmab/ayprovfded vbove is ha and ragrraY
Sigvatme ,r/e ,17 - . i Date q /0 S
Print name !f'/ /ry A S �- (e LT c�leM1- rlono
em.ml me Doty ere vat write to this area to be complakd by city or or m ottkW
city or town: percof Ueoae# OBca,natA�B:.:;d
�Lk.min❑check H immediate rnpome h required O] IootmeEIH.Itb D
roam.[person: phone#; DOther
lma=e SM xp»
PAYTOB REALTY TRUST 2228
3 MASSACHUSETTS AVE. 53260/113
NORTH ANDOVER, MA 01845Dat 'Lp �•¢ �
Pay /
to the —/ $ oo�
Order of /
Dollars B .e
NORTHMARK BANK (�
,NORTH A`N-DONE"RM'A01865
M•
u-00222&i' 40 1 1 30 2 60 31: 100 3 1 5 5 30B'
isg
w to
rd bath 5O t° d deQa�netd�ipubl cs5atetY'
w to 9°t Sorm and Sorwa0 application
Note'Comporlow ClerK}!)o at Me
to
authoriSY (C� Gt� p" " Gl7icurc�D
TD</yN Oat
Q _N/LZl', 'y,.a"'' a��' ✓ L 30 d00�
O,tyorrown OF FIEGIS TRATION
FOR CERTIFICATE ed hereby ce pfies that
T10 N Genre'lawn.
be undersign
Ap p L1C A o 0m d chapter taa.Seclio^1E. he
yroe+d� ted Or
In ab ME FIMACR VALLEY OIL CO. r1Y"' c:o
pier sauaurels;situa
�"' �i L'.z buildingls)
1-3 MASS.
ranted .� ,,,,,e N^^" c OR ECP�-OSVES.
I,.nolcer a:licarue 9 AVENUE RE OR SAL, LAMMAEL-S
1-3 MASS
to be satiate at VORAGE•MANUPACT� was
-- a sad license
TO Me KE c++°r °�"
MWd !d6 oNen'/ ned by the Jokier f t eela�nd licerusad
pre of reTs..t"r ubsty Ne��er br 0 f
Nole: This aPO' P^a JuN t L g36. Submitted by I.Ja,,,,,,emc""
m- M o
�` _
v
The Commonwealth of Massachusetts
r = - Department of Industrial Accidents
wroffammooff
600 Washington Street
Boston,Mass. 02111
t Workers, Com ensatton Insurance Affidavit-General Businesses
� MASsi}GHctiS�TTS fFl�eri/ue_
addreas: (9?� G 83 -3151
�( ftnld aVQ.P st t �t/P ri 'Q hone N �
IVQRT
w. S SAve
w k site lac.liw full m'
❑ jam
a mle proprietor and have uo one Business Ty e: ❑ftetatl❑itestaurant/Bar/Eatiug Establishment
working in anY capscrfY. ❑Ufficr❑ Salec(including Aeol Estate, flutes etc.)
I am an em toyer with o emplo Cull & art tine). ❑Otha s
I am m employs Pro"iding workers' camp®cation for mY emPloyets working oo this Job.
con an vane•
address:
hone N-
ci
h a
ivsuravee ea.
I am a sole Proprietor and bare hived the independent conumms listed below who haw the following workers'
mmPmsatica polices: - -
con ev nave-
eddies-
hove a•
ei
Ih N
ivsuravce ea
eon ev ne
2 lG 4 ss ke Huse T-rS 3 _ R3/
AI Q7 /f 1� �� 10✓� /Y/a- h a
new.
(�1b16�
�l Tlome Ss n1ce.C.v� lie N W C` O6 / 3 'jJ ,
ivsur.vee eo.? pt'" t. _
Feame to aum�n ova weY.s�Livn pemltgwL'm the form ofv STOP WOIIIC ORDERand.five ofg'1rUU.Uoaday a;aWt nv�ttuvdenmod r that.
om ynn'imPrho
LOPE of the staemcnt msy be rorrv+rdcd to the Omee of Imot$apom of the DlA for nvmge rerak.von
/do hereby L'ertii uvdjr the pdna andyendriu vf/peq'u hat the /�oNan pravidedUaa�ve is true and^�e
Sigyntme ', L/ N/•/Mick/slV Q'✓e IV !ter 3 - 313/
Phwe
Print name_c—sr—�— •'
oficvl use orb do not write In this am to be completed by city or town amcini
permlWceme# �BWldial Deryrtmeot
Lity or town E3Lkcmivg Board
pselect.w.once
❑cheek a Anne Into rmpome hrequired Ootbcr DeP.rtvem
Other �
phone#;
coot.c�Mpenaa:
,cent
Note: Comple of form and forward both sections and a local licensing
authority (City or Ttntm Clark). Do not make a/pp6c:ation tto�department
/of Public Safety. �
lli�/IYU177.OiI'GLl�Jy2CLGLiZ G�C:�//��CLQQaC�2�G�ftL
' � Je`cairJiirtenCo��'rirc Vvwicen — �utxciarr, o��rrire :l.+�uvnr�.an
a
a
Clty or Town NORTH ANDOVER Date *&L—Jd ag001
APPLICATION FOR CERTIFICATE OF REGISTRATION
In accordance with the pmvisians of Chapter 148. Section 13, at the General Laws, the undersigned hereby certifies :hat
MERRIMACK VALLEY OIL CO.
...m.w.aa.e�,.
1-3 MASS. AVENUE
u the holder of license granted o%2l Auer the lawful use of the building(sl or other stmaure(s) situaieo or
to be situated at 1-3 MASS: AVENUE
as related to the KEEPING, STORAG`c. MANUFACTURE OR SAL OF FLAMMAELES OF EXPLOSIVES.
e e
Nate: This application for cartificare at registration must to signed by the holder of the license N said license was
granted pnor;a July 1, 1936, otherwise by the owner or occupant a(the land licensed./� ^ `
Received �U�I/nJ�S��r00� Submitted by 14"A {a�/- j L
a.rNtr-
� Ht�t .due dao A dwy M1�-etY 4�
r� �D
COMPLETE TOP ANDOPTTOM OF FORM AND FORW BOTH SECTIONS
AND FEE TO LOCAL CENSING AUTHORITY (CITY TOWN CLERK).
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
The Tmtlmmlfueulfh of r�zsoadjuseffs.
Department of Public Safety—Division of )are Prevention
1010 COMMONWEALTH AVE., BORTON -
CERTIFICATE Op�F(� REGISTRATION
A V 6i11._, 0.,_.,... 3,
RTH..At�QQVER..:.. . . .. 19i :..
(CIy er T...) - (a.4I
n accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
y certifies that _
T.F....PAY..1R.....4ZL...SAIFS...M',Address An3._Mass.....Ave. :................................... i
IN.me of AW"r of Rmhue)
e holder of the license granted........Prom.I.Quall...'tF,.flSl�e9f).....................19........for the lawful use
,e building(a) or other structures) situated or to be situated at.....a,r.3..ASs.SH.,....AV..@......................
Isowe: ..d eum4rl
as related to the KEEPING.
STORAGE,MANUFACTURE OR SALE OF FLAMTIABLES OR EXPLOSIVES.
.....NORTH ��AND04ER........................... 110,000 gals Fuel Oil .
Nme: Thi. rr"ifir.le of tnei.toGon must be.iseed by the holder of the license if rid 6renw.a.panted
prior to July 1, 1936, otherw6e by the owner or or p.m of the .na ursu.ed.
oeived ..................................................19........ ...... ,(.�{lg :�..... .r!RL�1J.-.-.1%i......
........................
Isla.uuro ..
..........................................................................
..............................................................................................
...................................................... Ist.4 sEelAeF e.—I —P..1 .r)ww.o
IOI4L1 TIMI ., _
..........................................:...................................................
IAddrn.)'
[NTF,, COMPLETE TOP AN0BOTTOM OF FORM AND FORAD BOTH SECTIONS /
AND FEE TO LOCAL LICENSING AUTHORITY (CITY OR TOWN CLERK).
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
`(Mlle (1lammonf tealth of Assurllueetts
Department of Public Safety—Division of Are Prevention
1010 COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATION
NORTH...ANDOVER.:42r-�...�q:....... 19.8v
ttas uc T..nl - maulnaccordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that
...............T,,.F' ...FAY._ZR.....0L...SALF.IS...IAPAddreas 3.-3._Mess...._Ava:................................................
IN+"I'"'I"of lieemel
is the holder of the license granted........E3:e.Y1.RU.flAy...Cx?.'.aT.l1'ibd.....................19........for the lawful use ;
of the building(s) or other structure(s) situated or to be situated at.....1=3..A19AAS ...A.X.9......................
(91-1 aaa nnmlal)
as related to the KEEPING,►IS�1TORAGE,MANUFACTURE OR SALE OF FLAMMABLES OR EXPLOSIVES,
............NORTH...ANGOV,ER ANGOV,ER........................... iio,000 gals Fuel Oil
Nola: Thi«ce.f beT+t'of rcg"lotion most he e!"ad l.r the holder of the lieenae if—id lie n-..+a sr.md
77pp� Wd pfin1 to Jatb wa 936, other."'hr the o.ner «cu +m of the land licensed. -
Received ..N!......................B..G..................19........ .. ... x� ............
H340hy NtaoN
_. ............................by ...................... )y3.}a.NM(114,f
.� ....
9 0'V3 IONVyO ......:.. ........ ....... ..... .._
hle) ...... .................. . 19,ne.M1e nv,xeoP+nl nr MMer1
..................................._.....[....a...............................
..............
laddreul
NOTE: COMPLETE TOPdkND 1 TOM OF FORM AND FO ART♦OTH SECTION
AND FEE TO LOMhL L NSING AUTHORITY CI OR TTOOWN CLERK), r
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
The (9ummar&Z ith of cSSttchixsE B
Department of Public Safety—Division of Are Prevention
1010 COMMONWEALTH AVE., BOSTON
CERTIFICATE OF REGISTRATION
NORTH..ANQOityIR.:� P �... �.e...... �9..8.�.
In accordance with the provisions of Chapter 148, Section 18 cof the General Laws, the undersigned
hereby certifies that
................T,,k:.....ZI..Im....OIL...ULU..IWAddress .l.'3..�1R s.....Milt...
rN.me or holder of aw.rl ........................................... . .
is the holder of the license granted.......Yzev.1.Qua ,x�..Qga)yx9f).....................19........for the lawful use
of the building(a) or other structure(a) situated or to be situated at......7,-3..A`1b,S.q,,,,.fj y.Q......................
(sneer mood nmel
ee;e)g(fd the KEEPIN�STORAGE,MANUFACTURE O OOLE Oa 1s MMA LES OR EXPLOSIVES,
7111RI7► \ 1a�1 of rcaratruion ool be caned by the hold o role liceme if rid liceme ny seen d�1 Pr d ulr 1, 1936,otherwi.e by the or of
R to
,._......... u..................19........
vN . .. n I . ................................
.� ', v,/ ................................................ . .............:............:........
......... ......... a{.............................. rwu.hxh....,er. t«hwa.rt
.r ...fill
<i.Ol BO 9U LO 900 ..................................._. ...........................:............
s �
SECTIO
NOTE: AN PFEE TO LOCA�'f.ICENS NG AUTHORIT FORMY (COTY 11 TOWN CLERK)N3 �r
DO NOT RETURN FORM TO DEPARTMENT OF PUBLIC SAFETY.
ffhe (ff=UWnfnettlt4 of CA&SOadjuatts
Department of Public Safety-Division of Pyre Prevention
_ 1030 COMMONWEALTH AVE., BORTON
CERTIFICATE OF REGISTRATION
NORTH. ANGOVER.-Api•i1...3A...,... 19_80
ICiv or Toast - tests)
In accordance with the provisions of Chapter 148, Section 13, of the General Laws, the undersigned
hereby certifies that 1- Mess Ava ...........................
.................T.wk'^. .Elie'...ZI1......O.ZL...S9ItF.,S...I$C Address 3......... .................
INwme of Adele.of 11--sk
is the holder of the license granted........Ex:d.V.S.Q17or to beZsitua6•A-.at.--••••----•••19....a. ...r the lawful use
Istru, sad Musts,)
of the building(s) or other structure(s) situated or to be situated at.....a.r.,3..klbsp.^-- YQ.....................
as related to the KEEPING STORAGE,MANUFACTURE O ,SALE OF FLAMMABLES OR EXPIASIVES.
{NORTH AI I/F4%sR .......................... IIo,Goa gals Fuel o�>,
-•.----••-- No,r: Thin rcrti sistr"ion mwt be dared hr the 'der of the"Must in uid li<en.e Nu sled
prior tcL 1936,other.'w<hr the o..Mo oecupam of the 'ed•
d Ir
Received n ' ......19........ ......... .... .Y.....:••................... ..... ...........
................... Was. t
S
by R.PS.(ggg..
y ...............
..... Iade.hew.eMnre,se.p.m
a.
Q
T. F. FAY, JR. OIL SALES, INC.
3 MASSACHUSETTS AVENUE
NO. ANDOVER, MASS. 01845
April 22, 1980
Town of North Andover
Licensing Commissioner
No. Andover, Mass.
Att: Mr. Daniel Long
Dear Sir:
Please be advised that T. F. Fay, Jr. Oil Sales, Inc.
is the new owner of the property at 1 - 3 Massachusetts
Avenue, and would like to have a new license made out
to that name.
The previous license was made out to William 9. Barron, Jr.
If you have any questions regarding this matter, please
feel free to call me at anytime.
Ve�yours,
David J. Fay
Vice President
,y]�99 18 fY
1
22 42 6�
® OFFICE OF •
LICENSING COMMISSIONERS
NORTH ANDOVER, MASSACHUSETTS
April 17, 1980.
Thomas F. Fay
Fay Oil Sales
3 Massachusetts Ave.
North Andover, Mass.
Dear Mr. Fay:
It has been brought to the attention of the Licensing
Commissioners that the latest registration for the storage
of inflammable materials at 1-3 Massachusetts Avenue was
filed July 2, 1974 by William and Florence Barron. This
is contrary to your certificate recorded February 24, 1979
covering the same premises.
According to the provisions of Chapter 148, Section 13, the
owner or occupant of premises where inflammable materials
are stored, is required to register annually, no later than
April 30th with the Town Clerk's office,a certificate of
registration setting forth the name and address of the holder
of any license for the storage of inflammable material.
Would you please contact Daniel Long, Town Clerk, at the
Town Building, to take care of this matter.
Thank you.
Very truly yours,
Licensinwce,,.41
ioners
RRJ:aml i{alph R. airman
cc: Daniel Long, Town Clerk.