24D-185 (18) Z4 i) .' 155
Initial Construction Control Document
T0 be submitted `viththm bui\Clin(-' permit application by o
Rc ^ teredDewiuoProfeavouul
fbr�vo���crtbc8"' edition ofthe
�osnozhusctts State� Code.. 780M[K, Section 107
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Project Title: A Date:
Project: Check (x) one or both as applicable: Ne-,v construction Existinu ConStRICUOII
\ NIA Rc��,istcoionNumbcc |D\13r~pim1ion date: D/fVr`umu �nu� aud } bo,e
prepared ur directly supervised the prepanUtiOn ufo|| design plans. computations and specifications cooccodog':
6tructunJ �Jcchuuicu]
Protection Electrical Other:
for the abo�,enumcd project and that to,the best o[mykiic'�v|edge. information. and belief such plans. compumdons and
spc6Gcurloos meet the applicable provisions o[the NJmaucbuscns State Building Code, ('788 C��R),and accepted
enuinceringpmcdcos for the proposed project. l understand and agrec that |(or nov designee)duui| perFonntbe ucccxaory
proi'essional oarvicey and br present on the construction site on o regular and periodic basis to:
i Revievr for con Corinance to this code and the design concept. shop drawings. samples and other submittals by dle
'
contractor in accordance with the requirements of the construction documents.
2 P -fbroI the duties for registered design professionals in 780 C>IR Chapter 17,as applicable.
] fie prcaentuz intervals appropriate co the stage ofcomStmCtioo to 6coo,oe geucra||yfnnni||urwith the progress and
quu|icVoftbe work and to determine iF the xorkis being performed inu manner cmaiuzcntni/h r6e approved
constzuc600 documents and this code.
Nothing in this doounocntrc|icvos the contractor of its responsibility rcgardingtbtfpnopisionyof780CMKl07
When rcqni,ed 6v the 6uUdina-wfOcixi } s6uU submit Gc|6/poogress reports,(see i,cm l)together with perdoco\
onmmzots, in fbon acceptable to the building official.
Dpouoump|cdon o[thc vork, I shall SUbmit to the building official R | 1.St'LICtIOn Control Douomenz'.
Enter io the space to the rig
c|ec�onicsi-noture and y
)�r1V AWERST '
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P6onmnamhec Email: '-'
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Nmr |,|odi"at,vit hno pnlioud«�ennbn�c^npvuuiopuan 4spcO cal'imnxmmroxpr,�pared n,4oe,I ly/upC r vim4 I mhu' wC1.0,;Co-
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Ver,,ioji 06 11 2013