39A-023 (8) maimmin
Initial Construction Control Document da73
f ( l !/, To be submitted with the building permit application by a
+, t`i Registered Design Professional
I ; for work per the 8th edition of the
am Massachusetts State Building Code, 780 CMR, Section 107
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Project Title: /k%C 4� (�� , J Date: 7 I )1
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Property Address: 1 ` -4,___ 1T „ iy^mo i(AAN 7 v10- - -
Project: Check one or both as applicable: I] New construction Existing Construction
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Project description: AJ,X) !NTC3t--4cP— �k( .w (7c C cL S 5y.1 K-
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C "Q G� -1✓ gn i 5A-(1t-72. -1 Y7 SRL lit/ /
I i 1�;e A MA Registration Number: -7-72.7; Expiration date: c" l (Ili am a
re: tered design professional, and I have prepared or directly supervised the preparation of all desi pl ,
computations and specifications concerning:
Architectural [ ] Structural [ ] Mechanical
'1 ] ire Protection [ ] Electrical [ ] Other
for the above named project and that to the best of my knowledge,information,and belief such plans, computations and £:y
. specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted s:'
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engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the [` `-
contractor in accordance with the requirements of the construction documents. ii
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. i
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the •uilding official a`Final Construction Control Document'.
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Enter in the space to the right a"wet"or t. Dy C i
electronic signature and seal: ' `��' 9,ci Fc\i ;
•r 5 NG. 3270 ,
1116*.e.
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Ir1ASS. (.vM(��
Phone number: G2- Cr r :<"\,... Email: ee. .DI r h��r:t• (CNA
• .":Official Use Only
Building Official Name: Permit No.: Date: _
Version 06_11_2013
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