Fillable Ninth Edition 780 CMR 107.6 Construction Control Document (Town of Brookline)

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Ninth Edition 780 CMR 107.6 Construction Control Document (Town of Brookline)

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Ninth Edition 780 CMR 107.6 Construction Control Document
Construction Contractor Services Certification Pursuant to Section 107.6.3
Name of Contractor: ____________________________________________________________________________
If a Corporation, name of responsible Corporate Officer:
_______________________________________________________________________________________________
If a DBA or Partnership, name of individual:
_______________________________________________________________________________________________
I hereby certify that, to the best of my knowledge and belief, construction performed under permit number
______________ issued on ___________ has been completed in substantial accord with the approved
construction documents, with all pertinent deviations specifically noted per Section 107.6.3 of the
Massachusetts State Building Code (780 CMR), 9
th
Edition Base Volume.
Name of Project: ____________________________________________________________________________
Address of Project: ____________________________________________________________________________
List of Pertinent Deviations:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Print Name: ____________________________________________________________________________
Signature: ____________________________________________________________________________
Date: ____________________________________________________________________________
Notarized by: ____________________________________________________________________________
Standard Notary Statement:
This document shall be submitted to the Responsible Registered Design Professional (RDP) and, when
requested, to the Building Official in accordance with 780 CMR section 107.6.3 (9
th
edition) at the completion of
all construction projects performed pursuant to 780 CMR Section 107.6 Control Construction.
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Ninth Edition 780 CMR 107.6 Construction Control Document (Town of Brookline)

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Completed 2 August 2020

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