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Building Permit #Exception - 1445 GREAT POND ROAD 5/1/2018
L • NoRTy BUILDING PERMIT of KLED ,bq1 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION ~ _ permit No#: Date Received ORATED �SSACHUS�� Date Issued: - IlYRORTANT:Applicant must complete all items on this page ANTI I_ Nr !PROPER�T`(�f WNER i -... '`1�l ----------- _ ,. -. ' TPnnt+ 1�DDYearructure: yes no: �SMAP QIf1 d-iPARCEL-..� ... .ZONINGfDISTRICT '_`Historic®istncfM eye ono' ,� ' -m Y` �. r `' � gMach�ne;ShopVillage ,Ye ,} no A TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial XRepair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic `O 1Nell ❑ Floodplain :+ dWetlands ❑h Wat shed Distract 4 ` ®_urate_r/Sewe_ r.: >~ :.. -f DESCRIPTION OF WORK TO BE PERFORMED: plc ` ems Stitt 0r- 7 Identification- Please Type or Print Clearly OWNER: Name:�'iIKe,� ff�►n1 PL(SKAAJe/2 Phone: g7��9v Address: �S Phone: p� 7,S e -Contractor-Name:1�L�llDt�O ;L. 71 Supervisor's►saonstruetion,Licensel , C,t J/ t Expfe tray-it �'..,� i t j' � ` ry �Q Horne lrn rove ent License , < l - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i t'®tal Project Coit: $ A FEE: $ V Check No.: Receipt No,- NOTE: Persons contracting wztli unregistered c ntractors don have:access to the guaranty fund 3 ' Signatu�e_of_Agent(Owner Signatur eorifractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 F -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop.requires approval of Electrical Inspector lies No - ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine I NOTES and DATA— (For department use) i I vee ti;w � (2-1 ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 Plans Submitted ❑ Plans Waived Ell Certified Plot Plan ❑ Stamped Plans ❑ TypF l'F SEWERAGE DISP S Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS �v Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124.Main Street Fire Department signature/date COMMENTS Office of Consumer Affairs d13usiness Regulation j .;✓ie HOME IMPROVEMENT CONTRACTOR I ' Type,' Corporation 1 -_ �strationExni�ation 0_,I =180372 11/09/2018 William J.Zannoni Inc:.'- I William Zannoni t .806 Salem Rd Dracut, MA 01826 ,,�_M - i Undersecretary ._.,;l. r Massachusetts Department of Public Safety I � Board of Building Regulations and Standards License: CS-050281 Construction Supervisor I WILLIAM J ZANNONI 806 SALEM RD DRACUT MA 01826 nn ,, ��/►1-^� l_Jl_� Expiration: Commissioner 10/15/2018 CA N �� i North Andover MIMAP November 29, 2016 j 60 01 663.0008` 090.0-0022 r � �y r rf '/ 062.0-0023 00". r -• -0039 WZY 01 oe lr.' r P ,fir 062:0-007.3 : � 062.0-0020or 062.0=0071 #151"1 0,62.0.-00599` s ka #slOryS QA! .R 090:0-0040 41 1#1475 #1463 o j062.0-0009 j00 / / ; "a. 06or ✓/.' . 062.0 00.60 , 2.0-0072 ,�, ,/ / r #1407 / #.•1.427 090'C-'0041 .. . � #1439 /11' ►✓ �, f',� J� /, 1 001 01, oll 10oo01 1 2/0`0028 #15181 ' 09O.0=0026 l: / 38 / 133 #140 ;1478 0620027r 062.0-0026 ✓�✓ a . r 062:0-0040 1430 062.0-0025C'002 0-0099.o 10 or y +U % #180 0062:0J0024 f _, 090.0-0025 6250-0095 :_:_•: 062.0-0079 #34/ R2 0 MVPC Bo Zoning Overlay Zoning Municipal Boundary ©Adult Entertainment Distdc . Busine s 1 District 0 Machine Shop Village Ove R Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line Ea Watershed Protection Dist E Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 0 Historic Mill Area ■Busine s 4 District &ORT#q Valley Planning Commission(MVPC)using data provided by the Town of Interstate ©Medical Marijuana 0Genen Business District Of «an q� North Andover.Additional data provided by the Executive Office of Major Road 0 Downtown Overlay District O Planne Commercial Dev ? e�< ' �e 00 Environmental Affairs/MassGIS.The information depicted on this map is Roads 0 Historic District •1 Conid Development Dist 3. L for planning purposes only.It may not be adequate for legal boundary U Osgood Smart Growth(40 Ci Corrid Development Dist O -- definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER 471 Easements ;: Hydrographic Features 6 Corrido Development Dist F p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri I i District ❑Parcels Streams Industri 12 District # WWOP # THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY # ^ # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands G Industri 13 District # o # ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF t Lands G Industri 1 S District 'o .. THIS INFORMATION :'f Exempt Reside ce 1 District Reside ce 2 Distrix SSACNUSE 7 R—ide ce 3 District l deice 4 District 1"=179 ft ^{}.de ce 6 Distric y de ce 6 District �a a esidential District 12/02/2016 10:22AM 9784752171 HOWE INS PAGE 01/01 I !' DATE. IMWODIYYIIY) CORP' CERTIFICATE OF LIABILITY INSURANCE 12/02/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER : NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND dR.A ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT"CT�l BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policypes) must be a dors If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy,certain policies may require an endorsement. A state ent o this certificate does not confer rights to the certificate holder In lieu Of such endornement(s)- PRODUCER Ph.; (976)476.0400 Fax: (978)475-2171 CONTACT DiVid UIS THE HOWE INSURANCE AGENCY PHONEal. rAX 4 PUNCHARD AVE A/C No : (If78) 5-0400 (9r8)475 2171 ANDOVER MA 01810 E-MAIL dlouls howelns.com ODRESB: URER(S) AFFORDING COVERAGE NAIL S INBLRERA Naiio all Grange Mutual V41LLIAM J ZANNONI INC INSURER : Natio al Grange Mutual 806 SALEM ROAD INBuRERG firave t9 DRACUT MA 01826 INSURERD: INSURER E INSURER P COVERAGES CERTIFICATE NUMBER: 26573 i REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED.T 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 PiOLICI3 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY k1D CLAIMS, INBR TYPE OF INSURANCE INGR BU n POLICY NUMBER POLICY EFF" vM oCv EXP LIMITS A omlakAL LIAbILIT/ MPE39171 •0212911 02/26/17 EACW ACCURp.G.MCR $ 2,000,000 X COMMERCIAL GENERAL LIABILITY I DA $ 500,000 � PREMIBEB a oca,re CLAIMS-MADE IAI OCCUR MED.EXP(Any one person) S 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 I GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 4,000,000 PROPOLICY F—IJECT LOC ! $ B kl0911.9 LIABILITY M1 B39171 0924/161 09124/17 COMBINED SINGLE LIMIT AVTQ1 1 (Ea eccldanp $ 1,000,000 N Y ANY AUTO BODILY INJURY(Per person)) $ ALL OWNED SCHEOULED AUTOS X AUTOS BODILY INJURY(Per aaoidenl) $ HIRED AUTOS NON-OWNED PROPERTYDAMAOE $ AUTOS r acdden S UMBRELLA LIAB OCCUR EACH OCCURRENCE S ExcEss LIAR CLAIMS-MADE i AGGREGATE S DED I IRETENTION$ $ WC STATU- C WORKERS COMPENSATION U132E95219-8 01/14116 01/14117rE.L TORYLIMITB ER $ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ 1,00„000 oFPICER/MEMDNR EXCLUDED? F N/A i DISEASE-EAEMPLOYEE $ 1,00„000 (Mandatory in NH) 1byes,desoffbm unaar DISEASE-POLICY LIMIT S 5,00"000 DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addltlonal Remarks Sohadule,If more sp a is required) i I i I CERTIFICATE HOLDER CANCELLAT10 TOWN OF NO ANDOVER SHOULD ANV C THE ABOVE 13ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATHIIN DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE I IATH THE POLICY PROVISIONS. AUTHORIZED !REPRE NTATIVE Attention: FAX#978-688-8542 Christine J.Grange ACORD 25(2010/05) (O 968-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks f ACORD ata IDNe—OL -1511 t t'-3+I fi 'HClVWV4 P �r Z't�u�5 SDC o(L 5 4,1 Pv Ft CL'' r.Plate ZAN. a �( ( 12/01 Ref l Scale l i= D(- Lfjow 00 '45 42 1p AX o S To �--=_ �. .�..� �o�u►-Q��ice` �t L C �. tic t°L /-)�vue- 737 Nw ,� acs t' '-'y ;yrs ,..:�__.. .. `' d'`� �VV• — i 31' 21' 10, u x 6 N i 121N SONO TUBE 11 Cx6 3-2xl2L.n I I C I Plan View Pelham Building Supply ZANNONI(Irl ANDOVER) �� l 6 Atwood Rd PO Box 553 12/01/16 • I ...r.. Ref:Deck16336 pew Scale:3116"=I' �7 �2 � 603-635-7555 LTi .7 s�' WM.I ZANNONI,.INC. GENERAL CONTRACTING 806 Salem Road.Dracut,MA 01826 Ph./Fax(978)689-3444 License No,050281 PROPOSAL November 15,2016 To: Mike&Heidi Pliskaner 1445 Great Pond Road N. Andover,MA hpliskaner@yahoo.com (978.)390-5369 JOB: Deck,Landscaping,and Gutters We Shall Provide Labor and Materials To Do the Following: (1) New Deck: A New Deck,Approximately 31 Long and 16' D-ep. We Shall Raze the Existing Deck and Construct a New Larger Deck-in the Same Location,But Extending 5 Ft. Wider,and 6 Ft. Beyond the Former Deck Peri meter. The New Deck Shall Be Framed of New P.T. Lumber,But We Shall Salvage and Use S ome of the Old Lumber, Specifically Rim Joists,Some Floor Joists; and Some Bracing. This Deck Shall Also Have: • 6 Posts on Concrete Footings Consisting of 6 x 6 P.T. upport Posts Under Each Corner and Along the Outer Perimeter,With Proper Bracing at 45 degree Angles. • Decking of Composite Materials, Specifically Trex Transcend,Lava.Rock Color. • lHandrail System 42"High On All Perimeter of Composite 4 x 4 Posts(Trex Reveal),and • Complete P.T..Lumber Frame System,of 2 x 10 or 2 x 12 Joists, 16"O.C. Galvanized Metal Hangers, Anchors,Bolts As Required and Proper. Cost $ 18,500.00 (2) Landscaping: A) Remove Existing Asphalt Paving Under Deck Truck Away, B) Pour a.Concrete Pad,Approximately 16' x 6' Under Deck,Adjacent to House in Front of Overhead and Passage Doors. C) Lay Crushed Stone Base Throughout a 10' x 32' Area Under the Remainder of the Deck Area and Slightly Beyond. D) Replace Existing 7' x 2' Timber and Block Wall with a New Wall of Concrete Landscape Blocks, Grey in Color. E) Replace All Existing Wood Timbers on the Perimeter of the Garden Area Between the Deck and the Driveway Along the House,and Leading to the Side Door,With New 6 x 6 P.T. Timbers. Also,Lag in Three Sets of Level Timbers Leading to the Door and Acting as Stair Treads. They Shall Contain Large Pieces of Limestone ane?/or Bluestone Treads, Surrounded by Crushed Stone. Area Same as Existing. F) Layout Per Plans Approved by Oviner. Cost $ 4900.00 j I WM.J. ZANNONI, INC. GENERAL CONTRACTING 806 Salem Road,Dracut,MA 01826 Ph./Fax(978)689-3444 License No.050281 Proposal Continued: (3) Gutters: The House Needs a Gutter and Downspout System Along the Side Above the Walkway Leading From:the Driveway to the Back Door.. Also,a.Length of Gutter Along the Perimeter of the Slzed Roof Above the Door Entrance. Two Downspouts,One to the Left of the Door,and One on the Corner of the Garage Where the Walkway Begins. Color Shall Be Dark Brown. Layout Shall Be As Described,and To Approval of Customer. Cost $ 475.00 We Shall Provide All Necessary Permits and Insurances. f Acceptance: -C.{► Date: I� The Conunonwealth of Massachusetts _ Department of IIzdustrial Accidents r 1 Congress Street,SuUt 100 " _ d Boston,HA 02114-2017 ' � w www mass.govldia -Wa�:kers'Comp,ensationbsuraned Afi"Zdavit:Builders/Con-ExactorslElectTczczans/'lnmbexs. TO BE FILED WIM THE PER1VMT'NG AUTHOSt�'. Please kjt2t Le 'bI A �licant Information Name(Business/Orgayiizaiion/individual): Ax� Address: �o s Cl Phone City/Statelzip: Axe you an employer?G..eck flue app. Type ofzproject(required); 6prlafe box: � _em loyees R&andlor part time).* 7. n N&*V6nstraoti0n 1.1141 am a employer with P 2.E]Elam.a s a Iaproprietoror1,arinershipand havenoemployee9Worl-hgfor mein $. nRemOdelvig any capacity.[No workers'comp.insurance required] 9. n Demolition 3.n I am ahomeowner doing all work mays 51Z[Noworkers'comp.insurancerequired.]T 10 n Building addition 4.n I am a homeowner and will be hiring contractors to conduct an work on my property. I will 11.0 Electrical repairs or additions ensuretbai all contractors eitherhave,workers'compensation insurance or are sole proprietors withno employees. 12,[]Plumbing repairs or additions 5.n I am a general contractor and Ihave hiredthe sub-contractors listed on the attached sheet 13•n Roof repBll3 These sub-contractors have employees and have workers'comp.insurance. 14." Other 6,n We are a corporation and its,officers have exercis ed their right of'exemption per MGL c. 152,§1(4),and We have no e Ipldyees.[No workers'comp.insurance required.] licy *Any applicant thatch.... bbx#1 must also flI outer e etra�gl showingothen h°e outside rk contractors omoust submit a new affidavit indicating such i Homeowners who submit this affidavit indicating y Contractors that check this Box must aall ttached ka additional shoe Provide their workers'Dome sub-contractors oli o numher and state whether or not fliose entdies have emplayees. Ifthe sub-contractors have employees,they must PP Y yam an employer that is providing-worken compensation insurancefor my employees. Below is tliepolicy andjo�i site information. Insurance Company Name: —gj _ Expiration Policy#or Self-iris.Lic. 2- y ^ n �,�5 City/State/Zip: 11/t1�'V� fob Site Address: Attach a copyofthevvoxkexs' compeztsationpoficy declaration page(showingthepolicynnmbex ande�pixatz 500 00 . secure coverage as required under MGL c.152,§25A is a criminal violation punishable d a fine Oy a ab f-up to $250.00 a Failure to s WORK ORDER an p a TOP m of S • s civil enalttes in the fox and/or one-year imprisonment,as well a P day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for]assurance coverage verification. I do liereby certify under the auras andpenaZties Of PI, that the information provided above is true and correct. Date: — Si ature: bi Phone#: "-? *- -37 Z-S Official use only. Do notwrite in this area,to he completed by city or town offaciaZ Permit/License# City or Tovvn- Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City]Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written.." An employer is db&6d as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trustee 6f an individual,partnership,association or other legal entity,employing employees:•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the common,ealth for any applicaAtwh6 has not produced-acceptable evidence of compliance with the insurance coverage req'ui'red." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Pleasa fill,out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)andphone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP d6es have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Iudustrial.Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatiori policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write•"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town-may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each Year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permitto burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number_ The Commonwealth of Massachusetts Depar naent of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA-02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia