196 pleasant CC Doc-initial
Trial Version 10_09_2012
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: _____________________________________________________ Date: _____________________
Property Address: _________________________________________________________________________________
Project: Check one or both as applicable: New construction Existing Construction
Project description: _________________________________________________________________________________
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I ______________________________ MA Registration Number: _____________ Expiration date: _____________, am a
registered design professional, and 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 ___________________________________
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted 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.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
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.
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 building official a ‘Final Construction Control Document’.
Enter in the space to the right a “wet” or
electronic signature and seal:
Phone number: ______________________________ Email: _______________________________________
Building Official Use Only
Building Official Name: ________________________________________ Permit No.: ______________ Date: _____________