Curb Cut Complaint Form printable pdf download

Curb Cut Complaint Form

The Commonwealth of Massachusetts

Department of Public Safety

Docket Number

Architectural Access Board

____________

One Ashburton Place, Room 1310

(Office Use Only)

Boston Massachusetts 02108-1618

Phone: 617-727-0660

Fax: 617-727-0665

CURB CUT COMPLAINT FORM

Section 21, 521 CMR

PLEASE BE ADVISED THAT THIS FORM IS A MATTER OF PUBLIC RECORD AND WILL

BE DISCLOSED UPON REQUEST.

1. List the name of the street/intersection believed to be in violation of the Rules and

Regulations. Please give EXACT street locations. (Use separate forms for each

street/intersection)

Address: ______________________________________________________________

City/Town: _____________________________________________________________

2. In order for the Board to take action on the complaint, the following work must be completed

or in the process of being performed. Please check where appropriate:

____ Curb cuts are currently under construction, repair, or reconstruction.

____ Curb cuts have been repaired, reconstructed or constructed on:

____ between June 10, 1975 - August 31, 1996. Approximate date: ______________

____ after September 1, 1996.

3. Please check the following items which you believe are in violation and please identify the

location of the violation by the closest street address or telephone pole number:

____ Curb cuts are not provided where an accessible route crosses a curb. (Section 21.2)

____________________________________________________________________

____ Curb cut is not provided at each corner of intersection, located within the crosswalk

and/or the pedestrian path of travel. (Section 21.2.1)

____________________________________________________________________

____ Curb cut is not perpendicular to the curb at the street crossings and/or does not have

a level landing at the top. (Section 21.2.1)

____________________________________________________________________

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Curb Cut Complaint Form