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EDYTHE M. AMBROZ, AIA
_-----ARCHITECT
P O BOX 1086 NMTHAMPTON. MA i1 i 061
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The following is a list of the requirements to be filled for the 638 program:
1 . A copy of each license for each dwelling unit. This if for this unit and
not for the vendor.
2. If no license has been issued, give me a copy of affidavit for this
dwelling unit (this will have to be for this dwelling unit and riot the
vendor).
3. A letter from the state stowing approval of your choice of the compliance
category.
4. List how many residents and staff ratio at each dwelling unit.
5. Will need a layout of the building, showing required equipment and
locations of bedrooms and show the fire escape plans. List the type of
doors and locks.
6. What is the sprinkler status, ( in most cases the sprinklers are not
required but are highly recommended).
7. Give the breakdown of the srnoke detectors (location and type) .
8. Fill out the information sheet for building officials as part of permit
process.
9. List interior finishes for the exitways and exitway corridors, showing the
fire rating of the material .
INf-U4 TICtI 110 BE 14-OV1I11) `10 IfJCAL II nMiG OF'FrIC`IAIS
AS IWZP OIL ME Pffdf I' PMCiS,S
1. Vendor Name
2. Vendor Address
3. Vendor Telephone #
4. Vendor Executive Director
(or person with administrative responsibility)
5. Address of Group Dwelling Unit
6. Telephone # at Group Dwelling Unit
7. Name of Group Dwelling Unit Program Director
(on site)
8. Number of Residents to be Served at Group Dwelling Unit
(maxim= number)
9. Compliance Category for Which Certification is Being Sought: A B C
(Circle One)
10. Ccupliance Option for Which Certification is Being Sought (within category
selected above)
11. Certification is Being Sought for Additional Group Dwelling YES NO
Units Within the Same Building.
If yes, state address
12. License # of Construction Supervisor (if applicable)
NOM: Reapplication is required if a more restrictive ompliance Category is
necessary due to changes in client classification.
N=: A building permit may be required.
NOTE: ydl/-f/4 -- fee of Seventy-Five dollars will be required for the
Certificate of Inspection per unit.