CHARLES D. BAKER
GOVERNOR
Commonwealth 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
UNDERSECRETARY OF
CONSUMER AFFAIRS AND
BUSINESS REGULATION
LIEUTENANT GOVERNOR
COMMISSIONER, DIVISION OF
PROFESSIONAL LICENSURE
SECRETARY OF HOUSING AND
ECONOMIC DEVELOPMENT
Docket Number: __________
(Staff Use Only)
REQUEST FOR ADJUDICATORY HEARING
RE:__________________________________________________________________________________
(Name and address of building as appearing on application for variance)
I, _____________________________________, do hereby request that the Architectural Access Board
conduct an informal Adjudicatory Hearing in accordance with the provisions of 801 CMR Rule 1.02 et.
seq. as I am aggrieved by the decision of the Board with respect to Section(s) _______________________
of the Rules and Regulations of the Architectural Access Board, 521 CMR.
I understand that I may request such a hearing within thirty (30) days of receipt of the Notice of Action.
Date:________________ _________________________________________________
Signature
PLEASE PRINT: _________________________________________________
Name
_________________________________________________
Address
_________________________________________________
City/Town State Zip Code
_________________________________________________
E-mail
_________________________________________________
Telephone
PLEASE NOTE:
This form must be received by the Board within thirty (30) days after receipt of the Notice of Action.
