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Ciry OF SOMERVILLE, MASSACHUSETTS. OFFICE OF STRATEGIC PLANNING & COMMUNITY DEVELOPMENT JOSEPH A. CURTATONE Mayor: _DInsi0N OF INSPECTIONAL SERVICES Buneowe pepagrenr 1, Kelly A Como, as Keeper of the Records forthe City of Somerville, Mayors Office of Strategic Planning and Community Development, Inspectional Services Division, hereby certify that the documents herewith are true and accurate copies of documents in the custody ofthe Inspectional Services Division relative to the following property & ADU — B copies Signed under th pains and penalties of peru, ts YS dye MHD), 20M DPWe | Fravey n> Souanvats Massacnuserts 02145 (617) 625.6600 Ex $600 « TTY: (617) 40001» Fa (617 66-2624 ‘womnsomeritema gr Bawe Igee Ol FOR OFFICE USE ONLY vee, AYO. DIVISION OF INSPECTIONAL SERVICES accerteo wf bg hay CITY OF SOMERVILLE oarenece: Yo) OF Pi aON FoR AMT TO BOLD ATER REA pareissu> 9 ~ 29-07 (oF THE MASSACHUSETTS STATE BUILDING CODE DATE DEW: * Epp =CD] PLEASE TYPE OR PRINT CLEARLY IN INK PERMIT NO: [NAME AND ADDRESS OF PROPERTY OWNER J Ay 7 LOCATION OF PROPERTY NOLAND STREET) (7 Z Biceafhigy — wu] soosf we | LL TREAD ADHES oF MTOR Sei’? AE ICS HEGISTRATIONNIMEER 3 CDE. aLensoNe CHAM AND ADDRES OF BURDERUCENSE HOLDER TA Aia7é 77 More? 1 aoe SPEG\SOATE const suree uc. Wo OBO 3H3._11¢ R60. No = casa AO. [Ss zonneost. OB) TYPE OF PEATE NEW 1D ADDITION . GERTIACATE OF OCCUPANCY ARO REPAIR __QDENOUTON ALTERATION _C OTHER 7 CURRENT USES) fiuzt/ae. PROROSED USE) ADSM 1a {1 sei) 5A RESIDENCE. INDICATE NUMBER OF DELLING UNS _ {se GROUP [s.esmuaren constmucrion cost ff /5L ¢¢ 0.66 Lhe oa. (he 10, WHAT 15 THE CONSTRUCTION NTE? TANS SUNMETTED BOYES “CLNO. HAAOE DIMENSIONS AREA RONTYAR —_REARYARD ——RUGETSIDE_—_—_—UT SIDE 12 FROROSED SETBACKS HONTYAR —_REARYAR ——_RUGHT'SDE___LET SDE a TEIN gr RCRREGT) IAL SUANE OE ne SOS DOES THE PROPOSED PROJECT REQUIRE A VARIANCE AND/OR SPECIAL PERMITY —O.YES (NO IBYES, AND A DECISION HAS BEEN ISUED, PLEASE GIVE DECISION NUMBER [sncroanoncwmes ayn orEET__os_AN0_ AYE. ch coi SLATHOM re wasre psrosan company [Zz Liisi s/o DISPOSAL SITE ADDRESS {7 DEMOUITION: HAS DEPT, NOTIFICATION FORM BEEN COMPLETED” _ALYES_U NO DETAILED DESCRIPTION OF PROPOSED CONSTHUCTION {DO NOT INDICATE "SEE ATTACHED PLANS: PLEASE BE STECTEC) 77 fer ealeg- Cte Lawn tl Cihodee: Wiithevewen , Lie 5240-4 hs rave pies ZA viAlléa Tg leie_ei UE olo biw (eee a igdun_f fell yen teal ‘is fs 0k Bex All Elutace Leah tig fUVELLS bbe Plats. J Se ROE ‘Nek rrowoeD THe ABOVE NASRSAATION AND IT 18 CORRECT TO Ngetoeun engin, a eM we ff \ CITY OF SOMERVILLE ckhnm Wl shomesrero Y DATE RECD: DIVISION OF INSPECTIONAL SERVICES ‘ACCEPTED BY: PLCATION FOR A PERT TO BUILD ACER REPAIR DATE ISSUED cr 8 MASEACHUSETS STATE BORDING CODE aT DO PLEASE TYPE OR PRINT CLEARLY IN INK ‘PERMIT NO: TIDCATON OF ROPER WO ANDSTREED. | VAL Pica adw MPD] woo or {NAME AND ADDRESS OF PROPERTY OWNER Tage asl 2: NAME AND ADDRES OF ARCHTTEC/ENGINEER EGISRATION NOER ramon “CNAME AND ADDRESS OF BTID UCRSEHOWDER —PTaw-, FS wlhwen Timo Ap SOS Se3s| (CONST. SUPER. LIC. NO..O.B, = == HC REG. NO. SIGNATURE (REQ). Se ZONING DST Jy | TPEOF Pet 0 NEW 1 ADDITION 'D CERTIRCATE OF OCCUPANCY ewarD REPAIR S.DEMOLITION CD ALTERATION, OTHER 7. CURRENT USES) {4 = Prorosep uses) Rea fa. a 1 FUSES) A RESIDENCE DICATE MINER OF DWELLING UMTS) // se cxour {2 ‘ESTIMATED CONSTRUCTION cost “#4 GOO — TG00 = Tn WHATS THE CONSTRUCTION TFET TASS YS OND Ti LOT DIMENSIONS AREA TONTYARD —_REARYARO——RUGHTSDE UT SIDE 12 FROPOSED SETBACKS TONTYARO __REARYARO—_‘RUGHTSDE =F SDE 1 GIT OF STHUCTURE TOTAL SQUARE FOOTAGE NUMIER OF STORES 1H DOES THE PROPOSED PROTECT REQUIRE A VARIANCE ANDOR SPECIAL PERMIT YES ONO |F YES, AND A DECISION WAS BEN SSUED, PLEAS IVE DEON NUMER TES PROPOSED WORK WITHIN ASTORIC DSTRICTY © YES [JNO IF YES GVE COMMISSION AFFRONAL DATE Te WASTE DEPOEAL COMPANY }.¢ A TD, spn sal DISPOSAL TE ADDRESS veett Chtpond 2 2 £) 17 DEMOLITION HAS DEFT. NOTIRCATION FORM BEEN COMPLETED? © YES _O1 NO. DETAILED DESCRIPTION OF PROPOSED CONSTRUCTION {D0 NOT INDICATE “SEE ATTACHED PLANS” PLEASE BE SPECIFIC) AU Demage ea Fie Pat well p Ps "ARE THE FOLLOWING INCLUDED: