Fillable Form Aab Variance (Commonwealth of Massachusetts)

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Form Aab Variance (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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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:_____________
(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 name and address of the building/facility:
_________________________________________________________________________
_________________________________________________________________________
Page 2 of 5 Rev, 3/19
2. State the name and address of the owner of the building/facility:
_________________________________________________________________________
_________________________________________________________________________
E-mail:___________________________________________________________________
Telephone:________________________________________________________________
3. Describe the facility (i.e. number of floors, type of functions, use, etc.):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
4. Total square footage of the building: ___________________Per floor:_________________
a. total square footage of tenant space (if applicable):_______________________________
5. Check the work performed or to be performed:
___ New Construction ___ Addition
___ Reconstruction/Remodeling/Alteration ___ Change of Use
6. Briefly describe the extent and nature of the work performed or to be performed (use
additional sheets if necessary):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
7. Are you seeking temporary relief? Yes____ No____
a. If temporary relief if sought, what is the proposed deadline?
_________________________________________________________________________
8. State each section of the Architectural Access Board's Regulations (521 CMR) 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, 3/19
9. Is the building historically significant? ____yes _____no. If no, go to number 10.
9a. If yes, check one of the following and indicate date of listing:
____________ National Historic Landmark
____________ Listed individually on the National Register of Historic Places
____________ Located in registered historic district
____________ Listed in the State Register of Historic Places
____________ Eligible for listing
9b. If you checked any of the above and your variance request is primarily based upon
the historical significance of the building, you must complete the ADA Consultation
Process of the Massachusetts Historical Commission, 220 Morrissey Boulevard, Boston,
MA 02125.
10. 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.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
11. 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) _______
12. List all building permits that have been applied for within the past 36 months, include the
issue date and the listed value of the work performed:
Permit # Date of Issuance Value of Work
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Use additional sheets if necessary.)
13. List the anticipated construction cost for any work not yet permitted:
________________________________________________________________________
14. Has a certificate of occupancy been issued for the facility? Yes____ No____
If yes, state the date it was issued: _____________________________
15. To the best of your knowledge, has a complaint ever been filed on this building relative to
accessibility? Yes____ No____
a. If so, list the AAB docket number of the complaint ______________________________
16. For existing buildings, state the actual assessed valuation of the BUILDING ONLY, as
recorded in the Assessor's Office of the municipality in which the building is located:
________________
Is the assessment at 100%? _____________
If not, what is the town's current assessment ratio?_______________
Page 4 of 5 Rev, 3/19
17. State the phase of design or construction of the facility as of the date of this application:
______________________________________________________________
18. 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:_______________________________________________________________
19. State the name and address of the building inspector responsible for overseeing this
project:
________________________________________________________________________
________________________________________________________________________
E-mail:__________________________________________________________________
Telephone:_______________________________________________________________
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, 3/19
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;
Obtained a letter from the owner of the building permitting you to
seek variance;
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: The Board has instituted a zero-tolerance policy for
incomplete applications, failure to follow these instructions (as found on
page 1 of the application) will result in the Application being returned to you
via regular mail.
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Form Aab Variance (Commonwealth of Massachusetts)

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Completed 25 July 2020

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