REGISTERED ARCHITECTURAL AND ENGINEERING SERVICES
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: ___________________________________________
PROJECT TITLE: ___________________________________________
PROJECT LOCATION: ___________________________________________
NAME OF BUILDING: ___________________________________________
SCOPE OF PROJECT: ___________________________________________
In accordance with Section 116.0 of the Massachusetts State Building Code, I,_________________________________________ Mass. Registration No._________________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.
I further certify 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 for the building permit and shall be responsible for the following as specified in Section 116.2
1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents.
2. Review and approval of the quality control procedures for all code-required 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.
Pursuant to Section 116.4, I shall submit periodically, a progress report together with pertinent comments to the Milton Building Department. Upon Completion of the Work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy.
Signature________________________________
Subscribed and sworn to me this__________________day of___________________20 .
_________________________________ _________________________________________
NOTARY PUBLIC My Commission Expires On
Construction Aff.
CONSTRUCTION CONTROL
(Design Only)
\
In accordance with Section 116.2 of the Massachusetts Building Code, I, ____________________________________________
being a registered professional engineer/architect hereby certify that I have supervised the preparation of all design plans,
computations and specifications for the _____________________________and that, to the best of knowledge, such design plans, computations, materials and specifications conform to the provisions of the Massachusetts State building Code, all acceptable engineering practices and all applicable laws and ordinances for the proposed use and occupancy.
PROJECT NUMBER:_____________________________________________________________________________________
PROJECT TITLE:________________________________________________________________________________________
PROJECT LOCATION:____________________________________________________________________________________________
NAME OF BUILDING:____________________________________________________________________________________
NATURE OF PROJECT:___________________________________________________________________________________
__________________________________________________________________________________
_____________________________________________________
Signature
Subscribed and sworn to before me this ______________________day of______________________________20 .
____________________________________
Notary Public
My Commission Expires_____________________________________________
CONSTRUCTION CONTRACTOR SERVICES
CONSTRUCTION CONTROL
(Construction Only)
In accordance with Section 116.3 of the Massachusetts State Building code, I,_________________________________________
being a General Contractor, certify 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 for the building permit and shall be responsible for the following as specified in Section 116.3:
1. Execution of all work in accordance with the approved construction documents.
2. Execution and control of all methods of construction in a safe and satisfactory manner in accordance with all applicable local, state, and federal statutes and regulations.
3. Upon completion of the construction, he shall certify to the best of his knowledge and belief that such has been done in substantial accord with 780 CMR 116.3 items 1 and 2 and with all pertinent deviations specifically noted.
At completion of the construction, I shall submit to the Building Official a report as to the satisfactory completion and readiness of the project for occupancy.
Project:
Location:
_____________________________________________________
Signature
Subscribed and sworn to before me this_________________________day of_________________________2000
_____________________________________________________
Notary Public
My Commission Expires:________________________________________
CONSTRUCTION CONTRACTOR REPORT
MASSACHUSETTS BUILDING CODE SECTION
REPORT NO:
TO: Milton Building Commissioner- Permit Number_________________________________________________________
525 Canton Avenue, Milton, MA
PROJECT NAME OR NUMBER:____________________________________________________________________________
STREET ADDRESS:______________________________________________________________________________________
TOWN/CITY:___________________________________________________________________________________________
WORK:
GENERAL CONTRACTOR:
CONSTRUCTION SUPERINTENDENT:__________________________________________LICENSE #__________________
UP DATE PREVIOUS ISSUES:_____________________________________________________________________________
DATES COVERED:______________________________________________________________________________________
CONDITIONS:__________________________________________________________________________________________
COMMENTS:
WORK IN PROGRESS:
SITE VISITS:
RELATED ISSUES:
ACTION REQUIRED:___________________________________________________________________________________
ADDITIONS TO FILED PLANS:___________________________________________________________________________
STATUS OF COMPLETION: %____________________________________________________________________________
REPORTING ARCHITECT:_______________________________________________________________________________
IN COMPLIANCE WITH MASSACHUSETTS STATE BUILDING CODE, SECTION 116. CONSTRUCTION CONTROL AND APPROVED PLANS
ARCHITECT OF RECORD:_________________________________________________DATE:________________________
CONTROL CONSTRUCTION
FINAL REPORT 116.4.1
ON THIS_________________________________DAY OF______________________________2002_______BEFORE ME,
________________________________________________,A NOTARY PUBLIC DULY COMMISSIONED AND
QUALIFIED FOR THE COMMONWEALTH OF MASSACHUSETTS, PERSONALLY APPEARED____________________
_______________________, WHO BEING DULY SWORN, DEPOSES AND SAYS THAT HE HAS SUPERVISED THE
CONSTRUCTION OF __________________________________________________________________________________
(Street Address) (City/Town)
UNDER PERMIT #____________________________AND THAT THIS STRUCTURE CONFORMS TO THE SUBMITTED
PLANS AND TO THE CODES OF THE TOWN OF MILTON AND THE COMMONWEALTH.
FURTHER, THAT ALL REQUIRED APPROVALS AND MATERIAL AFFIDAVITS HAVE BEEN SUBMITTED, AND THAT THERE ARE NO VIOLATIONS OF LAW.
I, AS THE AFFIDAVIT ENGINEER AND/OR ARCHITECT HEREBY CERTIFY THAT I HAVE ON THIS
DATE_________________________INSPECTED THE PROPERTY LOCATED AT__________________________________
(Street Address)
AND FIND THAT THE LOCUS COMPLY WITH MY PLANS AND SPECIFICATIONS AND ALL RULES AND REGULATIONS OF THE CODES OF THE COMMONWEALTH.
THEREFORE, I REQUEST A CERTIFICATE OF OCCUPANCY FOR THE ABOVE ADDRESS.
____________________________________________________________
ORIGINAL SIGNATURE & SEAL DATE
SUBSCRIBED AND SWORN TO BEFORE ME THIS_______________________DAY OF________________2000
____________________________________________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES:____________________________________________________________________________
Final Report
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