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HomeMy WebLinkAboutMiscellaneous - 1600 OSGOOD STREET 4/30/2018 (83) / 1 Date...IA2, 1H............... NOwTry TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0 3SA CHU This certifies that. 5Q- C— ......... .... . . ... ........ ...................... ... ....... .....e ....................... has permission to perform ,winng in the building of..............................................................13............................................. at ....�.t............ .......................Aorth Andover,Mass. Fee.....t7�."7......Lic.No.2P:"* .................... TR LE ICAL INSPECTOR Check# J7 6-7 C), Z:5 vl\ ����i =.� � � ��.� � 1 � � �-s C) \�� f Commonwealth of Massachusetts O tial Use Only 1.41 �.� 0 Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),52 CMR 12.00 �— (PLEASE TRINT ININK OR TYPE ALL INFORMATION) Date: I C vj City or Town of: NORTH ANDOVER To the Inspector f ices: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 3 Location(Street&Number) /&00 0SCA t)pc( &4- S u!*-e 3096 Owner or Tenant Pod'&O-0 C �,(� Telephone No. V, Owner's Address Is this permit in conjunction with a building permit? Yes ©�No ❑ (Check Appropriate Box) Purpose of Building �)Lr-'sial i Ut<.l j weer wf j 7,� OtM64uthorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / 'Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: S eoe re ¢,e 1f yl S f`2 1064 a<2 o U+ 14t+ 1Y1�O 4()r-c! re ceP4 c C� Completion of thefollowing table may be waived by the Inspector of Wires. No.'of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA �-- r No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency ig ting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units I No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices _ No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: '" "'""""""""""" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No..of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: y Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of 4lectri al Work: (When required by municipal policy.) Work to Start: la X`f W 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTBER ❑ (Specify:) rcerrify,antler thepains rind penalties o perjury,that the information on this application is true and complete. FIRM NAME: _ m e,/4(,,1 C(e G l LIC.NO.: L$?O e�r(o Licensee: , CSO.,,? /`'l�-t<r�t.J Signatu c��. LIC.NO.:. Sv�C>!1F (If applicable,enter "exempt"in the license number line.) Bus.Tel.No. Address: -e l & Fie T lfJ`dv �l5 7 (o Alt.Tel.No.: ?tl S"6? 0/03 *Per M.G.L c. 147,s.51-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally tY required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ ) 15 Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance.with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ r Inspectors Comments: f Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of 1t1assachusetts - - Department of IndustriglAccidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.massgov/ciza Workers'Compensation bnsurance Affidavit:Suilclers/Cont°actors/Electr icxansNIi mbers Applieant Information Please Print LeaibXy Name(Businessiorganization/Individual): Address: (-/0 6rfe 1106 - City/State/Zip:%w era✓� /'A 00.74_ Phone#: Wl S jo p Are you an.employer?Check the appropriate box: Type of project(required): 1.❑ I am a em Toyer with 4. ❑ I am a general contractor and I 6. []New construction e yees(fall and/or part-time).* have hired the sub-contractors 2.MI am a sole proprietor or partner- listed on the attached sheet. 7. ElRemodeling ship and'haveno.employees. These sub-contractors have 8. ElDemolition workers'comp. worlon forme in any capacity. v' p 9. ❑Building addition g [No workers'comp.insurance 5. ❑ We are a corporation and its 10. ectrical rep airs or additions required.] officers have exercised.their . 3.(] I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself[Eo worke_rIa'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancere iced. employees.[No workers' ] 13.0 Other comp.insurance required.] Mny applicant that checks box41 must also fill outthe section below showing theirwbrkers'compensationpolicy information. f'Horneowners who submit this affidavit indicatingthey Are doing alt work and then hire outside contractors must submit a new affidavit indicating such. TContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is thepolley and job site information. Insurance Company Name: Policy#or Self in.s.Lic.#: Expiration Date: Job Site Address 100 10© °''J 5 O CA G( S-,4- SU l`_e 90-C pity/state /y Attach a copy of the workers'compensation•polley$eclaration page(showing the policy number and expiration date). Fail-are to secure coverage.as requiredunder Section 25A ofMGL o.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 iiasurance coverage verification. X do Hereby eertgy under the pains and penalties ofperjury that the information provided above is truce and correct, - Siawrta� Date: 4� a Official use oily. Do not write in this area,to be completed by city or town official. Cityor Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CIWT. own Cleric 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 M the service of another under any contract ofhire,- expxess o:rimplied,oral orwxitten." An.employes is defined as"an individual,partnership,association,corporation ox other legal entity,or any two or more of the Foregoing engaged in a j oint enterprise,and including the legal representatives of a-deceased employer,or the receiver or trustee of en individual,partnership,association or other legal entity,employing employees. 9X" ever the owner of a dwelling Douse having not more than.three apartmentsand who resides thereina or the o ccupant o£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 bean,employes." 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 insurancecoverage requi 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 Please fill.out the workers'compensailon affidavit completely,by checking the boxes that apply to your situation and,if lie'cessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with uo employees other than the members or partners,are notrequired to carry workers'compensationinsurance. If an LLC or LLP does have employees,apolicyisrequired. 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. jhe 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 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 andprinted legibly. The Department has provided a space at the bottom of the affidavit for you to fffl out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to fill inthe permit/license number whichwill be used as a reference number. In addition,an applicaut 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 pro of that a valid affidavit."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 ox permit not related to any business or commercial venture (i.e.a dog license orpermit 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: `z'heCoxrtmouma�t�o� fossachusP�s - Dep.attent offadustrial Aucld=M (aloe of11 esug.4-00ug 60 WasbiagM 1�Ce l Boston,MA 02111 ` `Q ,# IM- ' ,4 QQ Qx t 406 a 1-877,:1 Revised 5-26-05 FaX#617"727'7749 rt wa t Y BOARD C2 a .' ELEtR1CiANS ` E WING EN' ISSUES T FOLLOW LECTR!" I •, , AS A REG El AN C , , ,;' 4 rt 1 . UAON..:B MARTINS ::. x, ra. 40 GREYLOCIC RU r_ : Mq o1876 1226 $`;L O1 E .:.. " ' -,` C aONWEALTH Off'' us : .. a STT& � QAEto o ;. I'SSUES ELE:CTR 1;C I ANS REGIS FDLLOWING L1 .. MASTER FNSE AS q f DBA MAR EL,ECTR I,G OA:S B TINS ELECTR.:I C 4o MARTI'1G5 GREYEpCK R. �f • TEWI(S9 20886 M .018 >t r W p�131/166 1?2� 69869 i r` Date . . . TOWN OF NORTH ANDOVER t PERMIT FOR WIRING This certifies that . . . . . ! "i.j.L L has permission to perform . �'`. wiring in the building of . . �UU favjS�yti �y2� at . . 1(od P a5-q::Pt). . . >> . . . . . . . . . . . . orth Andover, Mass. Fee . . . . Lic. No. . . . . . . . . . . . . . . . " . . . ELECTRICAL INSPECTO Check# 30 w. 10950 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: T d 1!/ 121 1042 2 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfor{n the electrical work described below. Location(Street&Number) 160 Osl oddS`�l�c� " ('u <<t�i�� '�1 3r4 FLc`aN NGS Owner o Tena y ��p�'�i s Telephone No. Owner's Address 160 6S4cg,4 .St �J �.4"f ®`2 -51 PtN�t'fi Is this permit in conjunction with a building permit? Yes eg No ❑ (Check Appropriate Box) Q 2� Purpose of BuildingTepil- A µt1ASPL beS i j i-� Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑l„ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity / aks" Ll-t✓12Y d:C,rdfil Location and Nature of Proposed Electrical Work:6 �ldlk� 2a� 21',d F&,Jti Pe J'A d N« Sd--u(t:W931{ Completion o the followin table maybe waived by the Inspector of Wires. 1 No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones of No.of Switches No.of Gas Burners No. In Detection and InDetection Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices or Equivalent OTHER C C t12�i Lf e O o,.3 Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value 9f Electrical Work: (When required by municipal policy.) Work to Start: /;k Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury,that the information on this application is true and complete. 9 FIRM NAME: HIL LL E Lrcf Y`t � o. ►(- , LIC.NO.: 6 t�©J 14 Licensee: W S,y vi e, W. Sp i r_j Signature Q LIC.NO.: (Ifapplicable,e—nT"exempt"in 1he license number line.) Bus.Tel.NoJ—"3-74S'-f'722 Address: tl'cd Ave- S Alt.Tel.No.: *Per M.G.L c. 147,s. security work requires Department of Public Safety"S"License: 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,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. r 3�ns�OectQxs'copzme�ufs: (l app edore Sigaatae.-. Ulals) Pate Z YMALMSFAC' ON; �'assed� Ljr, �-, ' � ate-�ns�ectzonxec�uixed($50.OD)-•j � . d_itb�eeto s'c alfs: g is&ciors'Oigna no ft1s)Ts) Pate E' 3.EIDER GROM Edg'ECTION. Passed—[ NEW—[ � ate-ins�ectZo�xec�uiret�(��0.90)�j ] I'nspetozs'comments. (lnspectoxs' rgnatuxe-ao?n� aTs} Pate . assed.--[ } ated--je-5nspectonxequired($50A0} j ' is,�ectoxs'eo7mm.e�tfs: . (ios ectoxs',�zgaz tuxe no$nitials} hate ysed--•[ I WWI--•[ ]. �e-inspecttonxe0uired($56.00)-[ � ectoxs'covam.ents: , ' S ' " '04ISP ectare ggnatoxe uo xnitzals) date ' D)ORTAGS AM TODEYIEED OEC'AED XEFTON131TEP TE.P'XA TO BE INSPECTEDXg NOT The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV. 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition r [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑Other 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 and 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. Insurance Company Name: Polic5l#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 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. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sijznature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.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-contractor(s)name(s),address(es)and phone number(s)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 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 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 has been officially stamped or marked b the city or town may be provided to the town). A copy of the affidavit that y p y ty Y 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 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-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia