Fill - Free fillable Form Aab Amendment (Commonwealth of Massachusetts) PDF form

CHARLES D. BAKER

GOVERNOR

Co

mmonwealth of Massachusetts

Division of Professional Licensure

Office of Public Safety and Inspections

Architectural Access Board

1000 Washington St., Suite 710 • Boston • MA • 02118

V: 617-727-0660 • www.mass.gov/aab • Fax: 617-979-5459

EDWARD A. PALLESCHI

UNDERSECRETARY OF

CONSUMER AFFAIRS AND

BUSINESS REGULATION

KARYN E. POLITO

LIEUTENANT GOVERNOR

DIANE M. SYMONDS

COMMISSIONER, DIVISION OF

PROFESSIONAL LICENSURE

MIKE KENNEALY

SECRETARY OF HOUSING AND

ECONOMIC DEVELOPMENT

AMENDED APPLICATION FOR VARIANCE Docket:_____________

INSTRUCTIONS:

1) Answer all questions on this application to the best of your ability.

2) Attach whatever documents you feel are necessary to meet the standard of

impracticability laid out in 521 CMR 4.1. You must show that either:

a. Compliance is technologically infeasible, or

b. Compliance would result in an excessive and unreasonable cost without any

substantial benefit for persons with disabilities.

3) Please ensure that attached documents are no larger than 11” x 17”.

4) Sign the Application.

5) Burn copies of the application and all attached documents onto a Compact Disc (CD

or DVD only, no flash drives will be accepted).

6) Provide full copies of the application and all attached documentation, on both Paper

and CD/DVD to the:

a. Local Building Department,

b. Local Commission on Disability (if applicable in the town where the project

is located) (A list of all active Disability Commissions can be found at:

https://www.mass.gov/commissions-on-disability), and

c. The Independent Living Center (ILC) for your area.

(Your ILC can be found at: http://www.masilc.org/findacenter.)

7) Provide to the Board:

a. A completed copy of the application and all attached documents,

b. A copy of the CD/DVD,

c. The completed, signed, and notarized Service Notice (included as Page 4 of

this application).

8) The deadline for submission of amendments is at least 3 business days prior to the

date of a particular meeting of the Board. (The annual calendar of meetings can be

found on http://www.mass.gov/aab.)

In accordance with M.G.L., c.22, § 13A, I hereby apply for modification of or substitution for the

rules and regulations of the Architectural Access Board as they apply to the building/facility

described below on the grounds that literal compliance with the Board's regulations is

impracticable in my case.

1. State the name and address of the building/facility:

_________________________________________________________________________

Page 2 of 4 Rev, 12/18

2. What is the docket number of the existing variance: V___ - _____

3. For each new or altered variance requested, state each section of the Architectural Access

Board's Regulations for which a variance is being requested. (Please note the Board will

not consider requests for relief from Section 3, please list the specific items triggered

by Section 3 where relief is being sought):

SECTION NUMBER LOCATION OR DESCRIPTION

__________________ _________________________________________________

If requesting relief to 5 or more sections, use the Large Variance Tally Sheet available on the

“Forms and Applications” page of the Board’s website (http://www.mass.gov/aab)

4. For each new or altered variance requested, state in detail the reasons why compliance

with the Board’s regulations is impracticable (use additional sheets if necessary), including

but not limited to: the necessary cost of the work required to achieve compliance with the

regulations (i.e. written cost estimates); and plans justifying the cost of compliance.

________________________________________________________________________

Page 3 of 4 Rev, 12/18

Date:________________ ___________________________________________

Signature of owner or authorized agent (required)

PLEASE PRINT:

___________________________________________

Name

___________________________________________

Organization (If Applicable)

___________________________________________

Address

___________________________________________

Address 2 (optional)

___________________________________________

City/Town State Zip Code

___________________________________________

E-mail

___________________________________________

Telephone

Page 4 of 4 Rev, 12/18

SERVICE NOTICE

I, __________________________________________, as_________________________________

(name) (relationship to the applicant)

for the Petitioner ________________________________________________________submit a

(name of the applicant)

variance application filed with the Massachusetts Architectural Access Board on ________________.

(date variance submitted)

HEREBY CERTIFY UNDER THE PAINS AND PENALTIES OF PERJURY THAT I SERVED OR

CAUSED TO BE SERVED, A COPY OF THIS VARIANCE APPLICATION ON THE FOLLOWING

PERSON(S) IN THE FOLLOWING MANNER:

NAME AND ADDRESS OF PERSON OR AGENCY

SERVED

METHOD OF

SERVICE

DATE OF

SERVICE

1

Building

Department

2

Local

Commission

on Disability

(If Applicable)

3

Independent

Living

Center

AND CERTIFY UNDER THE PAINS AND PENALTIES OF PERJURY THAT THE ABOVE

STATEMENTS TO THE BEST OF MY KNOWLEDGE ARE TRUE AND ACCURATE.

________________________________________________________________________________

Signature: Appellant or Petitioner

On the _____________________ Day of ___________________________ 20 ________________

PERSONALLY APPEARED BEFORE ME THE ABOVE NAMED

________________________________________________________________________________

(Type or Print the Name of the Appellant)

________________________________ _______________________________

NOTARY PUBLIC MY COMMISSION EXPIRES

Before you send in your amendment, have you:

 Answered all questions on the application;

 Signed the application and included up to date contact info;

 Made a copy of your entire application, including all attached

documents, on CD or DVD;

 Flash drives are not permitted.

 Sent copies of the completed application, all attached documents,

and CD/DVD to:

 The local Building Department,

 The local Commission on Disability, and

 The Independent Living Center (ILC) for the region in which

the property is located; and

 Filled out the Service Notice (page 4 of the application) including

all parties and the method and date of service for each, and had it

signed and notarized

Please Note: Failure to follow these instructions (as found on page 1 of the application) could result

in your request not being docketed until such time as we have received a fully completed application.

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Fillable Form Aab Amendment (Commonwealth of Massachusetts)

Fill Online, Printable, Fillable, Blank Form Aab Amendment (Commonwealth of Massachusetts) Form

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