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HomeMy WebLinkAboutBuilding Permit #474 - 23 STACY DRIVE 12/13/2011Permit N0: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Issued: 0- /J IMPORTANT: Appli C2 Date Received must complete all items on this Print MAP NO: PARCEL: ZONING DISTRICT a2l, Historic District yeno Machine Shop Village ye no 100 year-old structure yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition ❑ Two or more family ❑Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic O.W.e11' i, ❑ F1oodplatns 0 Wetland's. D Watershed�Distnct OWNER: Name: (: Address: 5 pb` DES CRI -F 11UN UP W UF -K l U tit; rP-tU Utcivir li: Pl a Type or Print Clearly) 0� p_ ffNA--tJa . x - of �� CONTRACTOR Name: - � ��v Phone: ll Address:/r`1����`"✓�' S� ��'C�Y`l� Q�' Supervisor's Construction License: 1 Home Improvement License: 1� ARCHITECT/ENGINEER, Exp. Date: Exp. Date: Phone: Address: Reg. No. la..l3�lzor� �Ibl12) FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 2 Total Project Cost: $�� FEE: $ Check No.: ;e5-1 Receipt No.: cl�_ qS11 NOTE: Persons contracting with unregistered contractors donave access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS' DATE REJECTED 11 DATE APPROVED Reviewed on Siqnature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comm Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date J Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe: Doc.Building Permit Revised 2008mi O Location 0 &LI/ No. Date I — / NORTH TOWN OF NORTH ANDOVER 3 O � w 9 � s �o Certificate of Occupancy $ s�cHus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24E- L 1 Building Inspector m m m /�momw VI m y v m _v y C � CO) Cl) 10 0 CD n Z y 06 r o CL y aCc -0 loo CO o v CD CDCL o s rF cr�CD CDo CD ww C CD t/)• C. 0 y -• o co C CO) O CD Z CD O CD O CCD O z l+ otjy o tTj � ;o r � r L ?? E n b ql a C/) C/) C/) a a O O n l J u wo 0 V p n O� 7d � O 7d .�. V J r^ G. fr1 i n: H: C 0 0 Z o. S O 0 a m O c a to CD toC 0 0 CLDOCA m W E� O d C.c SCD H y CL o o c7 mCA �acl m =rd•~n 0 m CD .-w of y .POOH C m� a O 0 O � 2:5. O � O H !7 LA. y a� CCD O H C,)= d O H MM4 D1 y a s �m U2 O ca N ,� O O IS �m C.) =r CDPC I H = C: C CD: y = .-i CD oo 9 CD: m o+ a L c'o C-3 C c 0 0 `0°� d z l+ w o tTj c ;o n� C) r L ?? E n Pd x ql a G C/) C/) a a O O wo 7d � 7d G f z oni 0 Date. f �— i his certifies that .................. has permission to perform ...RL—, PW. J� 1 7� ..�1�d-4�r wiring in the building of .... fes. V(, - at ........J`�'�.....� ....... , h Andover, Mass. ,�`, Fee.. � .� .ric. No... ,,� ,�.�i4........ ... ELECTRICAL INSPECTOR Check # ContownweAL of M7adeaclum,& .LJaParfinan# o�.fira �arvicaa BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1� -Z Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the MassachuseM Electrical Code (Iv1E ), 5� CMR 12.00 (PLWE PRINT IN INK OR TY�P� INF �1TION) Date: City or Town of: 16IL" �p (�e,� To the Ins ector o By this appilcation the undersigned gives notice of his or her intention tn .,Prf,,_ +i. - Location f Wires.: Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjuncti9p with a�( buil f ing permit? Yes ❑ Purpose of Building---- N. s Existing Service Amps / Volts New Service Amps _ / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f 2e,5 c,cZ one No. No , l��Gj (Check Appropriate Boz) Utility Authorization Noj 3 D b2 7, Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Com letion ojthe jolloivine tohle .,,�„ !,o .,,,.;..e,► x.. ,G., r_____.__ r,,,, No. of Recessed Luminaires of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers fii ters KW Hydromassage Bathtubs No. of Ceil.-Susp. (Paddle) Fans No. ol Tota Transformers gyp Na. of Hot Tubs Generators KVA Swsmming Pool H1 d"11 in- No. of Oil Burners No. of Gas Burners No. of Air Cond. Total Tons eat Pump um er ons J Totals: Space/Area Heating KW Heating Appliances KW No. of No, of Signs Ballasts Yo. of Motors Total HP ❑ Liu. 01 r.mergency Lighting Battery Units FIRE ALARMS No. of Zones Wo. o election an Initiating Devices No. of Alerting Devices o. of ge-rMo-n—S"l-n-p ❑ inuwcipai F1 Other oCal Cennprtinn of Devices or Auacn avditional detail if desired, or as required by the Inspector of wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 1-%.- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability, insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof of s e to the permit issuing o ce. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �/ Tom' �� %Z j� , I certify, under the ains a rd pei N of erjrrry, t/ t thein rniatlon on tis appkcatl>�l is true and 0 eta FIRM NAME: v G rC 6p � LIC. No .7j Licensee: �,phe'7 �/ ��j Signature LIC. NO.: (1fapplicableen"exem t " in the license number I , j Bus. Tel. No.• Address: t 2 -( AA A *Per M.G.L. c. 147, S. 57-61, security w requires Dep ent of Public Safe S License: Alt Lic. No.�� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, l hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No.PERMIT FEE. S i G PRESERVE SERVICES carpentry I painting, roofing, gutters Great North Property Management 3 Holland Way Exeter NH, 03888 (603) 436-4100 sue.teichmann@greatnorth.net 203 WASHINGTON ST. #256 SALEM, MA 01970 PHONE: 978.745.8745: FAx: 978.745.3476 SALES@ PRESE RVESERVICES.CO M Date Bid: 8/18/2011 Estimator: Sean O'Connor Email: sean@preserveservices.com Mobile: (978) 395-7737 PROJECT ADDRESS: Prescott Village Unit 23 ( S -1 -AC y - tZ �-t a I �JlZ h , "icta t'h. ROOFING ESTIMATE COMMENTS Replace the roof above unit 23. PRIOR PREPARATION PERMITTING: All permits will be obtained in accordance with the law as required. ROOFING PREPARATION COVERING: Tarp the exterior of the house so as not to damage the siding. SHINGLE REMOVAL: Remove all layer(s) of old shingles. NAILING: Re -nail roof decking as necessary. OTHER: Remove the low profile aluminum vent. UNDERLAYMENT FELT: Install 15 lb felt on all areas not covered by ice and water shield. ICE AND WATER SHIELD: Install 3 feet of ice and water shield on eves and valleys. Install as necessary on other areas. FLASHING DRIP EDGE: Install drip edge on all perimeters. VENTILATION RIDGE VENT: Install ridge vents. ROOFING MATERIALS ASPHALT SHINGLES: Install 3 tab shingle 25 year. PRICING Basic $ 2250 Sales Tax $ 0 Total Price $ 2250 including Labor & Material Payment Terms: 20% deposit (day of start); 30% progress; 50% ehd of job Mc/Visa/Amex Sean O'Connor Installation Note: Customer Sig a e If you have an older home that has dimensional lumber for roof decking you will need to cover your attic because shingle debris may fall into the attic and create a mess. *Above additional prices includes all discounts and coupons discussed prior to estimate. The above quote is valid for 60 days. *Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all work performed for a period of 2 years. If any problems occur we will cover the cost of labor and materials. For the warranty to be valid the invoice that was presented at the time of completion must have been paid in full. Materials: The duration of the manufacture's warranty is specified in the materials section above. Licenses: Home Improvement Contractor (MIC): 123553 Protection: It is required by law that roofing contractors have a home improvement contractor license. If a contractor is properly registered, you are entitled to limited protection by the Residential Contractor Guaranty Fund up to $10,000. (The above is a only a summary of Massachusetts General Law 142A) To check our Iicense or our competitors go to: http://db.state.ma.us/homeimprovement/licenseelist.asp and license 123553. Constructor Supervisor (CS): 93403 The construction Supervisors license is under an individual's name, not a company name. To check Sean O'Connor, owner of the Kyron Inc. DBA Preserve, license go to: little//db.state.ma.us/dps/licenseelist.asp select Construction Supervisor and license 93403. Insurance: Worker's Compensation: Our policy is under Kyron Inc. DBA Preserve Services Protection: Covers the injury of a worker employed by the contractor doing work at your home. To check our policy or our completions go to htti)://niass.gov/dial on this page go to "check worker's compensation proof of coverage" our license is under Kyron Inc. Liability Insurance Our policy is under Kyron Inc. DBA Preserve Services and has limit of $1,000,000. Protection: Covers your property in the event of accidental damage up to a dollar limit specified on the policy. To check our policy we will have to contact our insurance company. _ DATE (CMDDUYYYY) Coles Ii�lTdMCATE OF UtxiBUTY IMSURAM C'; 5/20/2011 THIS CERTIFICATE IS ISSUED AS A I:ATTER OF INKMATION 0.1LY ALM CO",'PERS NO RIGHTS UPONTHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFF1Ri`7ATNELY OR t!EGATWELY AG'2:tlD, EXTEUD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ^'G TlNSURER(S}. AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTRUTE A CONTRACT BETUEEN THE ISSUING REPRESENTATIVE OR PRODUCER, AND THE CERTIFCCATE HOLDER. d ese On this en Imo: must ba ondo=d. if SUBROGATION IS WAIVED, subject to M PORTANT: If iG oettiflcab holdar 1v an ADDITIONAL I�SUREds tho endoPolicy( } tho tomes eluf eonditlores Of #m policy, certain Poke= ffM roquirs rs�Tlent A atatemerlthistlfieatod= not confer rights to tF>tr c9lu ieeto holder in lieu of such endoMOmo s Boynton Inuuranc a [1P3PimUCt ER(181)469-1269 onInsurance Agency RiVOr Park Street nnnneiD9 ommm Byron Inc. DBA Preserve Services 203 Washington Streot,US6 Snlem,NA 01970 _-- _ - - - •- •----- .. , A -- _- @i Nwwaw OC18Q1H01 1,11rrA=0- CO RAGES Ur -K I Irawt r c nae. -+acs--- -- --- _— THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. m TYPE OF C43URA?= POL=y m;r- R IDIS y�(Y EACH OCCURRENCE 1 1,000,000 X CO='-zRCIAL GENERAL LIABILITY A I CLAIS,101ApE FOOCCUR MAX013100002122 /23/2011 /23/2012 DA61AGE TO RENTED PRU4M1Ea0=vMmWJ 1W EXP WV ora pm=Q S 50,000 1 5,000 PERSONAL a ADV INJURY $ 1,000,000 CENERALAGGREGATE S 2,000,00 GEWL AGGREGATE MIT APPLIES PER: PRODUCTS - CO`.:PI(W AGG $ 2,000,000 x Poucw PO' Loc S AVTOMOM UNIM T1/ - C�${NED SINGLE LLMIT (En 1) S ANY ALTO BODILY INJURY (Per pwem) S ALL OWNED AUTOS BODILY V UURY (Per coddvd) S SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Pa V=mert) $ 1 NON -OWNED AUTOS $ U."BRI9AALtAD OCCUR EACH OCCURRENCE 1 AGGREGATE i EXCESS LL40 CLAMS -MADE DEDUCTOLE S 1 RETENTION S $ w►xsR10->rs co�PE►nAT1oN .1'1Y AND WPLOYE= LJACJY 1 N ANY PROPRIETORIPARTNEIMMECUtIVE OFRCER12 m� EXCLUDE 0 (C-ft!nryr 00 NIA 56�0523N00910 /20/2011 /20/2012 xYue srATt> 0TH ER EL EACH ACCMENT S 100,00 EL DISEASE - EA $ 100,000 OESC � OF OPERATIONS bdow EL DISEASE -POLICY LgRT 1 500 000 D J OF OPERATMUS I LMDONS I VEJQCLES (Alttslt ACOAD IM, Aid ft=lz Sdcts!% @ atm span b mqu5,eq SHOULD ANY OF THE ABOVE QED POUCIES BE CANCELLED BEFORE THEE EX)r►OtATION DATE THEREW, WTD 041.L 13E DELIVERED Di ACCORDANCE VO H THE POLICY PROVLSWUS. AUTHOR93M R��lrATNE kalLcmI ACORD 25 (2009109) - - ®1918-2009 ACORD C0RFaUTtO= All rfg, b ITLS0�5 (2no9o9> This ACORD nm-, end logs .:Lee mgaierod matt of ACORt! tent o� �o131i� �:etc�"; •,tt� Uzi ;a it" tions �ttse3 Sl:inc+{irci y CS 93403.''`. occrAN SAO r 26 cvAESTNU Spy EM; MA p1970 . �ptrati©n:1?13i�11 /eat ,, t 'lf n � rBdsiII � eg on Of[{ee o onsamer airs _� CTOR `= HOME IMPROVEMENT CONTRA TYPe: _= RIstmation:. 123553 DBA 47 a� � Exp►rat�on 31.612013 :_ =f _N Sean O' Connor 203 VVAS"'NGTON T ; .. -� _ Undersecretart SALEM, MXO J970 The Commonwealth of Massachusetts Department oflndustrial Accidents Office ofInvestigations' 600 Washington Street Boston, MA 02111 yY ` www.massgov/d'ia i licant Information Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization&dividual): Address: 010 City/State/Zip: _ _SA_U� f�� Phone #: Are you an employer? Check the appropriate box: I am a employer with 4. ❑ I am a general contractor 2. ❑employees (full and/or part-time).* I am a sole proprietor or and I have hired the sub -contractors listed partner- ship and have no employees on the attached sh5et. t These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation and its 3. ❑required.] I am a homeowner doing all work ,officers have exercised their right of exemption per MGL myself [No workers' comp. c. 152, §1(4),and wehaveno insurance required.] r employees. [No workers' comp, insurance re 'd Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. El Building addition 10. El Electrical repairs or additions 11-ElPlumbingrepairs oradditions 12.❑Roof repairs quire ] 13.E] Other '•`Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' r----- u •nrnn n employer that is providing workers' compensation insurance information. for my employees. Below is tlae policy and job site Insurance Company Name: _/ .— -- Nel Policy # or Self-ias. Lic. #: Expiration Date:./ Job Site Addressa3 � City/State/Zip: 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 ofMGL 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. rdo hereby certly under las afns and enalties ofperjury thatthe informationprovidedabove , true7ndcofrecl..>i nature: i{ �7 r Bate: � Official use only. Do not Write an this area, to be completed by city or town official. City or Town: -permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Cie rk 4. ElectxicaI inspector 5. Plumbing Inspector Contact person: Phone #: 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 defined 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 of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartiuents 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 be 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 commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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 Please fill out the worke'rs', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) andphone number(s) 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 does have employees, a policy is required. Be advised that this affidavit may be 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 Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,; please call the Depa'rfinent at the number listed below. Self-insured companies should enter their self-insurance Iicense 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 referencd 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 (ifnecessary) and under "Job Site Address" the applicant should write "all locations town)in (city or " 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 notrelated to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: L" COJ-OMOR-Weart ; 01:Massaehosetis Depaz'moiat of 111dustzial Accidents Office of Invesbigation 400 Washington Sliroet Boston} MA. 02111 Tel. # 417-727,4900 ext 404 or 1..877-MASSM,� Revised 5-26-'05 Fax # 6M727-7749 Www.mass.govjdia