HomeMy WebLinkAboutBuilding Permit #921 - 262 SOUTH BRADFORD STREET 6/22/2012Permit NO: q 7/ )
Date Issued:
LOCATION
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
--� It d
1� I —k""
IMPORTANT:
must
all items on this
/3/.
PROPERTY OWNER—_Z/-/'al r -nm
I
Pdnt
MAP NO: PARCEL:- )(0 ZONING DISTRICT: Historic District
Machine Shop Village
yes
TYPE OF IMPROVEMENT
of
Residential
Non- Residential
New Building
One family
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
erp7a;ir—,�replac�emen
Assessory Bldg
Derno i ion
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
Ur_0L#K1r I I Ut- VVUKK I BE PREFOJIMED:
OWNER: Name: Identification Please Type or Print Clearly) -6v
- 3'f ;'05p�'v lmes&gu Pho �- pw/C7
were
CONTRACTOR Name: a
Pho
Address: 0 f) t' 7- 5 A. u jw /,,, el
S,upervisorl's Construction License: (25 S1337 Exp
i
ezla
Date: 3
Home Improvement License: 774e Exp. Date:_��3-
ARCHITECT/ENGINEER AJ Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 01) FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
8;-i- - -- ' - -S--ignat'u"re- of- contractor - 0,4
.gnature of Agent/Owner—
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 Reviewed on
COMMENTS J\J C�
,-HEALTH
COMMENTS
DATE REJECTED DATEAPPROVED
C) I I �)— Sianature
�'j � � -"' � ce
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Con nection/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 2 1 A —F G min.$100-$l 000 fine
NOTES and DATA — (For department use
El Notified for pickup - Date
Doc.Building PeTmit Revised 2008
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
ii Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Li Building Permit Application
o Certified Surveyed Plot Plan
Ei 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)
• 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
Lj 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
Li Engineering Affidavits for Engineered products
NOTE: All d.umpster 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location 694�L4 S� -
No. � 2A Date JQ
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $-Lp �6, 00
Foundation Permit Fee $-
Other Permit Fee $-
TOTAL $-
Check #
25444 \j Building Inspector
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CALLAHAN CONSTRUCTION
Design - Build - Remodel
312812012
Contract Summary
Homeowner / Client: Contractor:
Brian Marshall Callahan Construction -S/-
262 South Bradford Street P.O. Box 75
North Andover, MA 01845 Andover, Alf -4 01810 /t/.4jr/W AWAIAM,
t
Fed ID #: 81-0604385 - CS license # 5133 7 - HIC license #118419 104
Project Description:
Renovations projects and costs are detailed below.
Proiect #1
Strip and Re -roof the Main Roof [approximately 25 Square]. Provide all the materials
and labor to complete thefollowing work detailed below.
Main Roof:
1) Permit: Secure Permitfor stripping and re -roofing entire home
2) Trash: Remove debrisftom site in a certified trash,container
3) Labor: Strip and re -roof entire roof
4) Install new 30#felt on existing deck
5) Install 6 " of insulation on top offelt paper
6) Install 2 x 6 KD lumber around the entire perimeter of the main roof
7) Install 1 x 8 Azek as afascia [As per diagram provided by the homeowner]
8) Install I x 6 Azek as a shadow board
[Asper diagram provided by the homeowner]
9) Install Y2 " x 4 x 8 sheets of Fir plywood over newly installed insulation
10) Fasten plywood with 8 " screws as specified in the provided diagram
11) Install 8 " white drip edge to entire roofperimeter
12) Install ice and water shield onfirst 5'of eave
13) Install 15#felt paper overly newly installedplywood deck
14) Install 30 year GAF or IKO or Certainteed Architectural 30yr shingles to entire
roof surface
15) No ridge vent will be installed
16) Install I @ RoofBoot (2'), 1 @ Electric Boot, I @ Kitchen roof vent,
I @ Drain vent Boot (4')
17) Clean up entire area of nails and debris
Initials ofparties involved: HomeowneroGontractor— Date: 6 / 15"- 1 A /--
Small Roof.- [Approxiately 7 Square]
]) Permit: Secure Permitfor stripping and re -roofing entire home [same as above]
2) Trash: Remove debrisftom site in a certified trash container
3) Carpentry: Add 8 " gable end extension of soffit andfascia
4) Labor: Strip and re -roof entire roof
5) Install 8 " white drip edge on perimeter of roof
6) Install drip edge on 5'of roof eaves
7) Install 15#Jelt paper over remaining deck
8) Install GAF or NO or Certainteed Architectural 36yr shingles to entire roof
9) Install stepflashing where shingles meet the adjacent wall surface
10) Install I @ Roof vent
Total Job Cost: $39, 000. 00
Approximate Time to completejob: I Week
Cottage Roof.
Repairs to roof on Cottage [TBDI
TotalJobCost: $1,050.00 [Timeframe included in above project]
Generalforfollowing Projects:
I * 30 Cu. Yd. Trash Container Cost $500. 00.
Proiect #2
Install Two Pella ProLine, Contemporary Sliding doors 96 " x 80
with black exteriorfinish, Low -E Advanced Argon Gas, and Screen
1) Demo existing doors and dispose
2) Install new doors as specified
Total Job Cost: $6,750. 00
Approximate time to complete the project: I Day
Project #3
Install new "E " Deck window same size as the existing slider located in the dining room,
as well as, 2 @fixed insulated glass at the gable end of the home [Size: I 'x 8x 3 1
1) Demo existing slider and dispose in the trash container
2) Install new "E " Deck window
3) Demo fixed glass and dispose
4) Install new insulatedfixed glass
5) Install new stops to hold window in the same location
Total Job Cost: $5,750. 00
Approximate time to complete the project. 2 Days
Initials ofparties involved: Homeown�!�bntractor EC- Date: C/ IT -1,2"o—
Proiect #4
Replace existing deck off of the living room gable end with 2 " x 4 " Western Red Cedar
Decking Material installed to match the existing style
(Approximate size is: 18 "0 " x 10'0')
The existing metal railing will be removed and re -installed once deck is complete
[Painting of the railing will be done by others]
Total Job Cost: $4, 000. 00
Approximate time to complete the project: 3 Days
Proiect #5
Electrical:
1) Electrical Permit
2) Install new electric panel on the lower level
3) Install new GFIs in 2 @ Bathroo;m;s�a�@ Kitchen [Total 3]
e t
Costfor Digging and backfilling e trenchfq, the electrical line to the main
panel is located in the excavation.poZ�062oofll the project.
Total Job Cost: $3,750. 00
Approximate time to complete theproject: 2 Days
Proiect #6 Redgate Properties Inc. willperform thefollowing work
1) Paint the cottage
2) Remove Deck in theftont of the house
3) Repair & Replace railings on exterior stairs
�)Remove Horse Stall and Lean-to addition on the side of the garage
'5� Install sleeve on the main oil line
6) Service the Oilfurnace in the Main House
7) Install new Slant -fin Baseboardfor Living/DininglKitchen
8) Kitchen Appliances
itchen Cabinets
I eplace stairsftom driveway down to entry
H) Install Hardwoodflooring to LivinglDininglKitchenlHall
12) Wall to Wall carpetfor three bedrooms & Family Room
Total Job Cost: $25,288. 00
Approximate time to complete the project. I month
Initials ofparties involve& HomeowneZ_r�r�ontractor 0,A Date: 6 / 4-1 -1,Y-2--
Payment Schedule And Terms
The Homeowner shall pay to the Contractor in respect ofsaid work and materials, the
sum of $86, Q880- 00 determined above, subject to additions and deductions as herein
provided, to be paid asfollows.
Payment Deposit:
Due when Project 41 is complete and the bank inspects and signs off $36,045.00
Hold back of 10% $4,005. 00
Due when Dumpster is delivered:
$450.00
Hold back of 10% $50. 00
Due when Project 42 is complete and the bank inspects and signs off
$6,075.00
Hold back of 10% $675. 00
Due when Project 43 is complete and the bank inspects and signs off
$5,175.00
Hold back of 10% $5 75. 00
Due when Project 44 is complete and the bank inspects and signs off
$3,600.00
Hold back of 10% $400. 00
Due when Project #5 is complete and the bank inspects and signs off
$3,375.00
Hold back of 10% $3 75. 00
Due when Project #6 is complete and the bank inspects and signs off
$22,759.20
Hold back of 10% $2,528.80
Final Payment:
Balance Due [Total Hold back when the Job is complete]
$8,608.80
Plus any additional costs $TBD
Thefinalpayment shown above, plus or minus any adjustments made by any change
orders, is due andpayable upon substantial completion ofall items listed in Project
Description. For the purpose of this contract "Substantial Completion " is defined as the
time when any one of thefollowing three conditions are met, first, the point at which the
Building/Work ofImprovement is suitablefor its intended use, second, when the Building
Department issues the Occupancy Consent, or third when final Building Department
approvalftom the city or town occurs.
Terms of Scheduled Payments:
Payments are due andpayable by the Homeowner within 48 hours of notification
by Callahan Construction, that a particular payment is due.
Change Orders:
Payment of Change Order is due upon approval of Change Order by the Homeowner.
Special Order Items:
Special orders are payable in full prior to their execution.
Initials ofparties involve& Homeowne Contractor 64-1— Date: � / 6�-IOY L
Ai7yeement Terms
A. EXPIRA TION OF THIS A GREEMENT.
This Agreement will expire 30 days after i
f it is not accepted in writing by
the Homeowner.
B. CONTRACTAGREEMENT.
This agreement represents and contains the entire agreement between the parties hereto
and there are no verbal agreements. This contract may be modified or amended by
written order only, and signed by both parties.
C. CHANGE ORDERS.
1. CONCEALED CONDITIONS.
This agreement is based solely on the observations the Contractor was able to make
with the structure in its current condition at the time this agreement was signed If
additional concealed conditions are discovered once work has commenced which
were not visible at the time this agreement was signed, Contractor will stop work
andpoint out these unforeseen concealed conditions to Homeowner; so that the
Homeowner and Contractor can execute a Change Orderfor any additional work.
Concealed condition Change Orders are not assessed an administrative charge.
2. DE V1A TION FR OM SCOPE OF WORK.
Any alterations or deviationsftom the scope of work referred to in this agreement
involving extra costs of materials or labor will be executed upon a written Change
Order issued by Contractor and should be signed by Contractor and Homeowner
prior to the commencement of additional work by Contractor. Three Change Orders
will be allowed without an administrativefee: thereafter, a $50. 00 administrative
fee will be assessed to each Change Order. Due to scheduling there is the possibililY
that Change Orders will cause delays in the length of the project.
D DISPUTE RESOLUTION
Any controversy or claim arising out of or related to this Agreement involving an amount
of $2, 000. 00 or less must be heard in the Small Claims Division of the Municipal Court
in Woburn, Massachusetts. Any controversy or claim arising out of or related to this
Agreement which is over the dollar limit of the Small Claims Court must be settled by
binding arbitration administered by the American Arbitration Association in accordance
with the Construction Industry Arbitration Rules. A judgment upon the award may be
entered in any Court havingjurisdiction thereof The prevailing party in any legal
proceeding related to this Agreement shall be entitled to payment of reasonable
attorney'sfees, costs and expenses.
IYA
Initials ofparties involved: Homeowneg5��ontractor %.-- Date:
STA TUA TOR YDISCLOSURES:
1. Contractor certifies that he is registered with the Commonwealth ofMassachusetts as
a Home Improvement Contractor, MC # 118419, and as a Construction Supervisor, CSL
#05133 7.
2. Acceleration of contract: No contract shall contain an acceleration clause under
which any part or all of the balance notyet due may be declared due andpayable
because the holder deems himse�f insecure. However, where the Contractor deems
himse�f to be insecure, he may require as a prerequisite to continue said work, that the
balance offunds due under the contract, which are in possession of the Homeowner,
shall be placed in ajoint escrow account requiring the signatures of the Contractor and
Homeownerfor withdrawal.
F. RIGHT OF CANCELLA TION. -
The homeowners may cancel this transaction at any time prior to midnight of the third
business date after the date of this transaction.
MGL c. 93, s. 48; MGL c. 140D, s. 10; MGL c. 255, s. 14; as may be applicable.
G INSURANCE ENDORSEMENT
The Homeowner is responsible for any and all physical loss or destruction of materials
once the materials are delivered to his home. Callahan Construction strongly
recommends that the Homeowner purchases an Insurance Endorsement on his existing
Homeowner's Insurance Policyftom his insurance agent. If said agent will not issue the
appropriate policy, Callahan Construction's office will be glad to offer names of agents
who will be able to provide that service.
H WARRANTY
Callahan Construction will warranty all Labor & Materialsfor one (1) year.
L EXCLUSIONS TO KA RRA NTY
Repair to thefollowing items is specifically excludedftom Callahan Construction's
warranty. Damages resultingftom lack ofRomeowners Maintenance; damage resulting
ftom Homeowner neglect or ordinary wear and tear; deviations that arise such as the
minor cracking of concrete, minor stressftactures in plaster board due to the curing of
lumber; minor warping and deflection ofwood,- minor shrinking/cracking ofgrout,- minor
shrinking and gapping of hardwoodflooring; minor shrinking and gapping of interior
trim boards; andfading ofpaint andfinish exposed to sunlight.
J. HOME IMPROVEMENT CONTRACTORS:
All Home Improvement Contractors and subcontractors shall be registered and any
inquiries about a contractor or subcontractor relating to registration should be directed
to:
The Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170,
Boston, MA 02116, Phone: 617-973-8700
Initials ofparties involve& HomeownZe��7Contractor 0& Date: 6
Submitted t,o Homeowner by:
Date:—� A,
Colin Callahan — President
DO NOTSIGN THIS CONTRACTIF THERE ARE ANYBLANK SPACES
No work shall begin prior to the signing of this contract. Allparties are to be in receipt
of a signed copy this contract.
I have read and understood, and agree to, all the terms and conditions contained in the
above Agreement.
Date:
Homeowner
Date:
Homeowner
All home improvement contractors shall be registered and any inquiries about a
contractor or subcontractor relating to a registration should be directed to:
The Office of Consumer Affairs and Business Regulation
Ten Park Plaza, Suite 5170,
Boston, MA 02116,
Phone: 617-973-8700
Massachusetts - Delmilment of Public S;IfctN
Board of Buildint-1 Regulations and S(andards
Construction Supervisor License
License: CS 51337
COLIN S CALLAHAN
PO BQX 75
ANDOVER, MA 01810
e
Office of Consumer Affairs & B siness Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 171996 Type:
Expiration: 5/10/2014 DBA
CRAFTSMEN, INC.
Expiration: 3/10/2013
Tr#: 12382
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumir Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
COLIN CALLAHAN
940 FOREST ST
N. ANDOVER, MA 01810 Undersecretary Not valid without signature
The Commonwealth ofMassachusefts
Department ofIndustriqlAccidints
Ce OfInvesfigations
600 Washington Street
Noston., MA 02111
vmmass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors)ElectriciansfPlumbers
Applicant Information Please Print Ledbly
Naine, (Busin ess/Organ�zatioriffndividual): 0/11 dfflj�!J_
Address: tl., o
Phone#: ?/V — �� - Yq3 e)
Are you an employer? Check the appropriate box: - Type of project (required):
1 -0 1 am a employer with 4. El I am a general contractor and 1 6. [J New eonstraction
employees (fall and/or-part-titne).* have hired the sub -contractors 7. N-Ire-modeag
2. El I am a sole proprietor or partner- listed on the attached sheet. t
ship and�have no employees These sub -contractors have 8. E] Demolition
working forma in any capacity. workers' comp. insurance.
9. El Building addition
[No workers' comp. insurance 5. @'Ve area corporation and its ME] Electrical repairs or additions
required.) officers have exercised their
3. F1 I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself [No workers' comp. c. 152, § 1(4), and we have no 12. El Roof repairs
insurance required.] employees. [No workers' 13. Ei Other
comp. insurance reqairedj
Mny applicant that checks box#1 must also fill out the section bel6wshoViiigtheir workers' compensation policy information.
I Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContraotors that check this box must attached an additional sheet sho*g the name of the sub -contractors and their workers' comp. policy information.
am an ein
ployer that isprovi(fing workers' compensation Insuranceformy employees. -Velow Isthepolicy andjob site
information.
Insurance Company Name%
Policy # or Self -ins. Lie. fi: Expiration Date: I
Job Site Address-, City/State/Ziv:
I - -
Attach a copy of the workers' compensation-polley declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A ofMCIL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one�-year imprisonment, as wellas civilpenalties 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 ffic DIA for insurance coverage verification.
I do hereby certl-& under thepains andpe i ry thatthe informationprovided above fs true andcorrect,
I
Sipnstnriv (17-4 _2� e Art iV1
- 9
Official use onb). Do not write in this area, to he completed by city or town official
City or Town: PermitffAcense Y
Issuing Authority (circle one):
1.33oard of Health 2.130ding Department 3. City/Town Clerk 4. Electrical Lisp ectorMplumbing Inspector
6. Other
ContactPerson: Phone
Information and Instructions.
Massachusetts General Laws chapter 152 requires allemployers to provide workers' compensation for their employees.
Pursuant to this statute, an employeeis defined as".. ..every person in the service of another under any contract ofhire,.
express or implied, oral or written."
An ein
VoYeijs defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
Of the foregoing engaged in aj oint enterpris c, and including the legal repres antatives of a dece as ed employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. Howeverthe
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe
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 bean 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 ofits political subivi , sions shall
enter into any contract for the performance ofpublic work untff acceptable evidence of compliance with the insurance
requirements of this chapter have b oen presented to the contracting authority."
Applicants
Please fill Out the Workers' compensation affidavit completely, by checkffig the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not requited to carry workers' compensation insurance. If anLLC orLLP does have
employees, a policy is required. Be advised that this affidavit maybe submittodto the Department of Industrial
Accidents foT confirmatiori 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 Deparhn'ent of
Industrial Accidents. Should you have. any questions regarding the law or ifyou are required to obtain a workers'
compensation poliGy, please call the Department at the number listed below. Sell-111sured 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 printedlegibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office ofluvestigations has to contact you regarding the applicant.
Please be sure to fill in & permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple pennit/license applications in any given year, need only submit one affidavit Indicating current
policy information (ifnecessaty) and under "Job Site Address; the applicant should write "all locations in -(City or
town)." A copy of the affidavit that has b e on officially stamp c d or m arked by the city or town may b c provided to the
applicant as proofthat a valid affidavit ii on file for fature permits or licenses. Anew affidavit must be Mqd out each
year. Mere a homeowner or citizen is obtaining a license or&�ermit not related to any business or commercial -venture
(i.e. a dog license or p* ermit to bum 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 q n
please do not hesitate to give us a call. �ucstio. s,
The Department's address, telephone and fax number:
Tho Commoawoajt� of M-assachust'-fts
De,partment of IndusWal Accidents
offke of 11tivestigAtions
600 Washiooji ft��t
BostonXA02111
Tel, # 617-727,4900 at 406 or 1-877�MAS
SAFE
Revised 5-26-05 Fax 0 61W727-7749
www-massgov/dia