Division of Professional Licensure
Office of Public Safety and Inspections
1000 Washington Street, Suite 710, Boston, MA 02118
First and Last Name Phone Number E-mail
Address of Testing Site City/Town Zip Code
Mailing Address Same as Above
City/Town State Zip Code
Type of Property
Residential Condo House Addition
Year Built Year Addition Built
Type of Foundation Test
Visual Core Test
Date Test
Total Invoice Amount Number of Cores
Company/Engineer Name Phone Number E-mail License Number
(If available)
Optional Questions
Did your foundation test positive for pyrrhotite? □ YES □ NO □ I don’t know
Damage Level (If given)
No Visible Damage Minor Degradation Minor to Moderate Degradation
Moderate to Severe Degradation Severe Degradation I don’t know
Where is the location of the damage?
Concrete Floors Only Concrete Wall Only Floors and Walls I don’t know
Does your house have any of the following characteristics? (Check all that you know, skip if you don’t know.)
Waterproofing on the exterior of the basement Routine use of dehumidifier in the basement
Waterproofing in the interior walls Gutters
Finished Basement or partially finished Damage was in the partially finished portion
Please enclose the following to complete your application:
Proof of Home Ownership (Condos: proof of foundation ownership - usually the association declaration)
(Examples of homeownership include mortgage statements, tax bills, copies of deeds, etc.)
Testing / Visual Inspection Report / Results
Pictures of Foundation Damage (If not in Report)
Invoice or other Documentation of Costs (Such as a cancelled check)
Dated Records of House Addition (If applicable)
List of Other Units that Share Foundation (For Condos)
I certify that the information entered above is complete and accurate.
Mail applications to:
Office of Public Safety & Inspections, Crumbling Foundations
1000 Washington Street, Boston, MA Suite 710, Boston, MA 02118
Question to Cesar.Lastra@Mass.gov or call 617-826-5202.
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