19-012 (5) The Commonweal ',h of /9--C.;1,
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Massachusetts
Department of Public
Safety
One Ashburton Place , Room 1301
Boston , Massachusetts 02108-1618
Phone ( 617 ) 727-3200 -
Fax ( 617 ) 727-5732
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CONSTRUCTION CONTROL DOCUMENT
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Project Title: V 41WF4&7_( Z/IU, rdl,Pl T1010 Date: `
Project Location: 1-467, /UUr'1W1qVP�W, -04
Scope of Project: - 7 c F A,1,v!71 QAJ 7 �_—_x/67//1,14r *))"?11UL-1
In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code
Mass. Registration Number Z&4-3
being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised
the preparation of all design plans,computations and specifications concerning:
Entire Project Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [ Electrical [ ] Other(specify)
for the above named project and that to the best of my knowledge,such plans, computations and specifications meet
the applicable provisions of the Massachusetts State Building Code,all acceptable engineering practices and all
applicable laws for the proposed project.
Furthermore, I understand and AGREE that I shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the
documents approved by the building permit and shall be responsible for the following as specified in section 116.2.2:
1. Review of shop drawings,samples and other submittals of the contractor as required by the construction
contract documents as submitted for the building permit, and approval for the conformance to the design
concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with
the progress and quality of the work and to determine, in general, if the work is being performed in
a manner consistent with the construction documents.
I shall submit per' A' a form acceptable to the building official,a progress report together with pertinent
comments. ' l_ the work, I shall submit to the building official a final report as to the satisfactory
comple ion "ajdrit3 ect occupancy.
ignature > e � rset G essronal:
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