2NDRY CONST. CONTROL DOC CITY OF S.UX. . .)ANSSACHUSETTS
BUMD]ING DEPAi FENT
' 120 WASHINGTON STREET, 310 FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
Kn BF.RI..EY DRISCOLL
MAYOR THosw ST.Pim
DIRECTO&OF KBLIC P1t0PE1tTY/8l'B.DNG CO\M SSIONER
SECONDARY CONSTRICTION CONTROL DOCUMENT
(for Professional Engineem/Architects responsible for only a portion of a controlled project)
Project Title: VAL *L 1 F j� r (0tt. lzt4��lte£_ nate-
Project location: V) Ji►S, } I '�� Q j�'�(7 _
Scope of Project: 4 ,1-PM r.-:.-. Z #LAD{OC- %i
6044 . VA .t ,jM-_4 N flu 15, zar—ML1T (;waZyj, �5�6'>✓
STfWVV. & IS a0%J 1vM_ t'a-)%,06T,00, CriuSSAO-k,&VIACO wr µMJC.<�k U.1S5 JZ661
In accordance with the sixth edition Massachusetts State Building Code,780 CtiIR SECTION 116.0:
1, `{b C._ _. _LL4 0�.1Mass. Registration Number
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 ( j :Mechanical
[ ) Fire Protection [ j 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.
Furthermore, I understand and AGREE that 1 shall perform the necessary professional services to determine that
the above mentioned portions of the work proceed in accordance with the documents approved for the building
permit.
Upon completion of the work, I shall submit a final report as to th completion of the above
mentioned portion of the work. f _
J*L.� 49
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Signature and SeaAof registered professional: .� NEW YORK
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