Fill - Free fillable Form Aab Variance Sidewalk (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

APPLICATION FOR VARIANCE Docket:_____________

Curb cuts/sidewalks (Staff Only)

INSTRUCTIONS:

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

a. Information on the Variance Process can be found

at: https://www.mass.gov/guides/applying-for-an-aab-variance.

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) If the applicant is not the owner of the building or his or her agent, include a signed

letter from the owner granting permission for you to apply for variance.

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

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

7) 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.)

8) 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 5 of

this application).

d. A check or money order in the amount of $50 dollars, made out to the

Commonwealth of Massachusetts.

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 exact location of the area in question (e.g. Northwest corner of Main St. and

Broadway) (use additional sheets if necessary):

_________________________________________________________________________

Page 2 of 5 Rev, 1/19

2. State the name and address of the owner of the project:

_________________________________________________________________________

E-mail:___________________________________________________________________

Telephone:________________________________________________________________

3. Describe the project (e.g. complete reconstruction of Rt. 20 from Main St. to Broadway):

_________________________________________________________________________

4. Check the work performed or to be performed:

___ New Construction ___ Repair

___ Reconstruction/Remodeling/Alteration

5. Briefly describe the extent and nature of the work performed or to be performed (use

additional sheets if necessary):

_________________________________________________________________________

6. Are you seeking temporary relief? Yes____ No____

a. If temporary relief if sought, what is the proposed deadline?

_________________________________________________________________________

7. 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)

Page 3 of 5 Rev, 1/19

8. For each 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.

________________________________________________________________________

9. Which section of the Board’s Jurisdiction (see Section 3 of the Board’s Regulations) has

been triggered?

3.2 ____ 3.3.1a ____ 3.3.1b____ 3.3.2____ 3.4____ Other (List Section) _______

10. Has the project been out bid? ______________________________________________

Has the contract been awarded?____________________________________________

8a. If the contract has been awarded, what date was it awarded?

______________________________________________________________________

8b. Has the project been completed?

______________________________________________________________________

8c. If work has been completed, state the date work began:

______________________________________________________________________

Completion date:_________________________________________________________

11. State the estimated cost of the total project:____________________________________

12. Has any other work been performed at this location within the past 36

months?_________

13. Is this project funded by the Massachusetts Department of Transportation?_________

14. Has the project been accepted by the City or Town?_____________________________

If yes, state the date that the project was accepted:______________________________

15. To the best of your knowledge, has a complaint ever been filed on this project relative to

accessibility? _______yes ________no

16. State the name and address of the architectural or engineering firm, including the name of

the individual architect or engineer responsible for preparing drawings of the facility:

________________________________________________________________________

E-mail:__________________________________________________________________

Telephone:_______________________________________________________________

17. State the name and address of the building inspector responsible for overseeing this

project:

________________________________________________________________________

E-mail:__________________________________________________________________

Telephone:_______________________________________________________________

Page 4 of 5 Rev, 1/19

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 5 of 5 Rev, 1/19

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 application, 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;

 Filled out the Service Notice (page 5 of the application) including

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

signed and notarized; and

 Included a $50 check made out to the “Commonwealth of

Massachusetts”.

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.

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

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Fillable Form Aab Variance Sidewalk (Commonwealth of Massachusetts)

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