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Home My WebLink AboutBuilding Permit #585-11 - 990 FOREST STREET 3/3/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J67 / Date Received Date Issued: '3 < IMPORTANT:Applicant must complete all items on this page LOCATION C��,—E SIL &T Print PROPERTY OWNERL tel- F09AS iE Print ict yes MAP NO: Os PARCEL:—� ZONING DISTRICT: Historic sine ShoprV iotllage yes yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El Me family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -� r ��Fl_o`odplan i®Wetlands - - `MWatershecliDisict= I _ py.Water/Sewer._ DESCRIPTION OF WORK TO BE PERFORMED: A, -TbAL1�Y-�� '1Z-C IST I AI6= Identification Please Type or Print Clearly) OWNER: Name: I ** *- y2 A S Phone: Address: CONTRACTOR Name: GT (OS'l aT1�R(L-�CSA/ Phone: Cam Address: Eb I help y6 u Supervisor's Construction License: JExp. Date: 31 - r. ►z Home Improvement License: 1 O L�3!`o Exp. Date: � 2�a 4 ARCHITECT/ENGINEER I� 1 Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON 925.00 PER S.F. Total Project Cost: $ FEE: !/ Check No.: b Receipt No.: �)-3i ;` NOTE: Persons contracting with unregistered contractors do not have a cess to the g fund Si nature-77 of:contact. - Si-`natu�e:of=A""`ent/Owner:. -<>-�------ Location qqo f�R,,, 'r" C77 No. -5 'S— / Date NORTH TOWN OF NORTH ANDOVER Of t•`•e ,�,�•G 0 w A Certificate of Occupancy $ CMUs t�' Building/Frame Permit Fee $ 'n Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d�6�- Check # 2392- 5 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools'. :-.t ;❑ Y 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 .' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer COnnect!Qn/Signature 8< Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT r Temp Dumpster on site yes no z 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 Doc:.Building Permit 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 o 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) ❑ 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) L3 Copy of Contract ❑ 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 n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals 'gat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doe: Doe.Building Permit Revised 2008mi ORTH To" of And I;L _= LAKE O '� dover, Mass., • 3• � 1 COCHIC M Ew ICK AERATE D P?�� 5 `Ss BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... .......................................1.........2-.. T�...................................... ..................................... Foundation V has permission to erect..............:............:............ buildings on .,.. .. ............... ......!2�...1............................................... Rough to be occupied as1�` �� l1►Std Chimney t............. ............ ......... ,..-.................................. ................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS 3 UNLESS CONSTRUC STARTS ELECTRICAL INSPECTOR Rough ................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE j smoke Det. t r 40 bb',i;hingron STr=e! Wes rbori xugh, AAA 0?58 r Tei 500.536.9500 Fax 508.336.313 wwvv csgr.>.corn Conservation Services Group Fax To: From: �-}-� Amanda Van Ness Fax: Pages: '4) Phone: Date: J Re: ) o ro O, t CC: O Urgent ❑ For Review O Please Comment O Please Reply O Please Recycle • Comments: Std 3/1 6 8 -' 30 i r CERTIFICATE OF COMPLETION Conservation Services Group MICHAEL FORASTE Phone(eve): (978)975-5488 990 FOREST ST Phone(day): NORTH ANDOVER MA 01845 3324 E-Mail: SitelD: S10000887185 Contract ID: S10000887186-0432011C Sub-contractor Work Order#: HRH_20110221 Location Description. Quantity Installed' AFL Attic Floor 6.25"Fiberglass Batting 75 AFL Open Attic 4"Cellulose 876 OVERALL Propavent 2'or 4' 68 Contract ID: S10000887185-0432011CAS Sub-contractor Work Order#: HRH_20110221 Location Description Quantity Installed OVERALL Air Sealing-Hours 8 PLEASE NOTE:The Inspection of the house is for the purpose of finding CUSTOMER AUTHORIZATION OF CERTIFIED WORK out whether the Contractor completed the work. I confirm that the measures listed above have been completed to my CUSTOMER SHOULD NOT RELY ON THE INSPECTION FOR satisfaction. I have received a copy of the Certificate of Completion and ASSURANCE THAT THE CONTRACTOR'S WORK NECESSARILY hereby authorize the release of any final payments to the Contractor. I COMPLIES WITH ALL LAWS AND STANDARDS RELATED TO understand that this Authorization of Completed Work does not in any SAFETY. manner void any warranties provided to me by the Contractor. It was the Contractor's sole responsibilty to assure that the measures were installed properly and safely. In addition, this Post-installation Inspection does not replace inspections by licensed inspectors where required by state or local law. It is the duty of the Customer to obtain such required inspections. Inspector's Signature Customers's Signature Date Date rnncarvatinn Sprvires Grouo-40 Washington Street-Westborough, MA 01581 -800-480-7472 CONTRACTOR WORK ORDER Conservation Services Group Printed: 2/21/2011 Contractor Information 1 Customer/Site Details Dave Hope MICHAEL FORASTE Phone(eve): (978)975-5488 HRH 990 FOREST ST Phone(day): 57 Chase St NORTH ANDOVER MA 01845 3324() Site ID: S10000887185 Methuen, MA 01844 Appointment Details Completion Deadline: Location Description Quantity Unit$ Total$ Notes/Revisions Work Order: HRH 20110221 AFL Attic Floor 6.25"Fiberglass Batting 75 1.40 105.00 AFL Open Attic 4"Cellulose 876 1.07 937.32 OVERALL Propavent 2'or 4' 68 3.20 217.60 OVERALL Air Sealing-Hours 8 70.00 560.00 Total for Work Order HRH 20110221 : $1,819.92 i Grand Total: $1,819.921 Road Blocks rnnservation Services GroUD-40 Washinqton Street-Westborough, MA 01581 -800-480-7472 Conservation Services Group Residential Air Sealing Work Order Printed: 2/16/2011 Customer/Site Details MICHAEL FORASTE Phone(eve): (978)975-5488 990 FOREST ST Phone(day): NORTH ANDOVER MA 01845 3324() Site ID: S10000887185 ----- -- -- -- -------- --- �_Appointment Details Assigned Crew: CONTRACT Date: Start Time: Stop Time: _._.--.__..._._.___.__.._.. _ __ ------- -- -- --- -------_-- ..___.__..._...---...-------- ._.______ .__--__......._-- . Home Information .1 -- -. Building Volume: 22,680 Heating Fuel: Oil(gals) Distribution Type: Hydronic basebo � MVG: 1,859 Pre CFM 50: 5,216 R --- oad—Bloc---ks ---------- — - Existing Condition Minimum headroom in work area-> Attic: 5'+ Basement: 5'+ Crawlspace: Storage Volume-> Attic: Medium Basement: Medium Crawlspace: Knee wall: Existing Attic Insulation-> Blown: N Batts: Y Attic Area: Open Fireplace: N Woodstove: N Number of Bath Fans: 2 Areas to be Treated Attic Basement Living Area Y Chimney j N Crawlspace Area N Plumbing Y Top Plates/Wet Wall Y Sill Plate N Floor Molding Y Bath Fan ! Y Chimney N Ceiling Molding Y Electrical ChaseWres Y Plumbing/Dryer Vent N W/S Windows N Therma Dome Y Electrical Chase/Wires i N Caulk Doors/Windows N Duct Sealing N Interior Basement Door N W/S Door Y Access Hatch# (in N Duct Sealing I N Door Sweep N Exterior Basement Door ! N Fireplace 7 INCH FB 8 HOURS, 876X1.25 IS 1096 SQ FEET, 1859 MVG ----------- Specialty Items Job Information Start time: Stop time: AS Techs: Pre CFM 50: Post CFM 50: CFM 50 Reduction: Combustion Safety Test Completed Y N, Pass or Fail? Estimated AS time accurate Y N,AS Spec Accurate Y N Return Visit Needed? Y N Notes: c;nnservation Services Group-40 Washington Street-Westborough, MA 01581 -800-480-7472 MassSAVE Planview Diagram Customer dn(;J.,j � Home Phone (1774) 11W - SK 4 Y Address `ISO —5r Work Phone ( ) - Town Al- Cell Phone (}fit ) - 433 Any limitations for access by large truck? NO�_YES If yes,describe Any specific directions or landmarks? NO YES If yes,describe Energy Specialist who spec'ed job: Cell Phone# (M=5 ?o S z File reviewed by Office# 508-836-9500 ext Cell# NOTES d rN CS %Vo le rz C, 1y -14-1 pb F >F�e� v� A4-r% � 2 �s z- 4— Existing Conditions - X=Access D=Vents Note inside square: R=roof, S=soffit, G=gable, RV=rid a vent, CS=continuous soffit, CDE=continuous drip edge, T=turbine Install -- O=New Access: Note in circle: C=ceiling,W=wall, S=sheathing Temp unless noted otherwise A =Vents Note in triangle: R= 8"roof, S=soffit, G=gable, M = 12"mushroom, ST= 12"Stack(flat roof) MassSAVE Plainview Diagram Customer Home Phone (rffg)—??4- - 34%T Address SQ O Fart A.* S^ Work Phone ( ) - Town N- A,-� Cell Phone (JLY/ ) 3k _ - 111-15 Any limitations for access by large truck? NO YES If yes,describe Any specific directions or landmarks? NO YES If yes,describe Energy Specialist who spec'ed job: EZZF Cell Phone# fi D; File reviewed by Office# 508-836-9500 ext Cell# NOTES gA I ZS �UgS-t� (+K -S � v S`►vM�C ITA- Z y Z*A G5 Existing Conditions -- X=Access ❑=Vents Note inside square: R=roof, S=soffit, G=gable, RV=ridge vent, CS=continuous soffit, CDE=continuous drip ed e, T=turbine Install -- O=New Access: Note in circle: C=ceiling,W=wall, S=sheathing Temp unless noted otherwise 0 =Vents Note in triangle: R= 8"roof, S=soffit, G=gable, M= 12"mushroom, ST= 12"Stack(flat roof) `L Massachusetts- Department(If Public S;tfetN VVIBOMA of Building Rc.�ulutions and Stand;u•ds Construction Supervisor License License: CS 57754 Restricted to: 00 WILLIAM D HOPE a*, 57 CHASE ST METHUEN, MA 01844 c Expiration: 3/4/2012 ('nnmis.i mer Tr#: 18748 Office Milk;Cmor airsAird e1� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: LRegistration: -._101730 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/29/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 HRICONSTRUCTION:INC William Hope t 57 CHASE STREET-, g�� e METHUEN,MA 01844;. �— . Undersecretary Not valid without signat e ACORD,. CERTIFICATE OF LIABILITY INSURANCE112/14/2010 ANDD/YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Emond&Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 857 Turnpike Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Ste.133 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Farm Family Casualty Insurance HRH Construction P.0.Box 5184 INSURER B: North Andover, MA 01845 INSURER C: INSURER D: 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. INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR INSR TYPE OF INSURANCE DATE IMMIDD/YY) DATE(MMIDDfYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 NTED ✓ COMMERCIAL GENERAL LIABILITY DAMAGE PREMISESS(Ea.occucwrence) $ 50,000 LAIMS MADE ✓I OCCUR 2005X0775 11/20/2010 11/20/2011 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO-JECT [7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS 200104287 03/16/2010 03/16/2011 BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 OCCUR FICLAIMS MADE 2001E1159 07/12/2010 07/12/2011 AGGREGATE $ 1,000,000 $ 1,000,000 DEDUCTIBLE $ 1,000,000 RETENTION $10,000 $ WORKERS COMPENSATION AND WC STATU-OR Sl O R EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICER/MEMBER EXCLUDED? 2005W6827 12/07/2010 12/07/2011 E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I$ 500 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations by named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /— The Commonwealth of Massachusetts c Department oflndustrialAccidents �Mai Office of Investigations .rr,. 600 Washington Street Boston,MA 02111 . 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Prinf Legibly Name(Business/Organization/Individual): 4_1.( U"I maw IXLC Address: pIA uiL City/State/Zip: �, 6%tMLV= 1`t1 k Phone##: X2163 Are�u an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 2— 4. ❑ I am a general contractor and I 6. ❑New construction einployees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.[�Other IkiSLA.AMLW comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. r Insurance Company Name: WA Policy#or Self-ins.Lic.#:Zinb5 N A 68 Expiration Date--it 12- pp t Job Site Address: rm F—ST � City/State/ZipA. YAJ✓,L'M A- Mk_-0"S 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 may be forwarded to the Office of Investigations of the DIA for insurance'coverage verification. I do hereby cerci y and sins and penalties ofpeijury that the information provided above is true and correct.' Signature: LOV ^� r Date: Phone#• 1(4 rT� Official use only. Do not write in this area,to be completed by city or town offcial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other 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 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 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 workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy 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 confinnation 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 pen-nit 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 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 pen-nit/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 pen-nit not related 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749- www.mass.gov/dia