X. YES NO, f\~1-ll Nq o~.c xi$nt, tj a.r~.

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1 .ARLNGTON COUNTY, VRGNA HSTORCAL AFFARS AND LANDMARK REVEW BOARD APPLCATON FOR CERTFCATE OF APPROPRATENESS DESGNATED PROPERTY: Name of Historic District Address of Building OWNER: Name t.evt t. "5"'vc. Address(ifdifferent) Phone (Home) EM.All..: PERSON FLNG APPLCATON, F OTHER THAN OWNER: Name KaHN GRiM :t>'ba. J>tvt::e.S.tfti::o OM.sr: Address 4(5"4 :Pv $T". AlL, V z.zao± Phone (Home) Relationship to Applicant PROJECf ARCHTECfiENGNEERSCONTRACfORS: (Work) PURPOSE OF APPLCATON: _ Repair (change of materials) XAiteration _ Addition Fence _ Demolition _ New construction _ Relocation Outbuildings Tree Removal _ Grading Sign _ Other Will an application related to this property go before any of the following? _ Board of Zoning Appeals _ Planning Commission _ County Board _ Other (please specify) Does the proposed work require a building permit? s any demolition anticipated? _ YES ){NO X. YES NO, f yes, please describe b,... '\i.ck.ttb OVERVEW OF PROPOSED WORK (ATTACH ADDmONAL SHEETS F NECESSARY): Description: ove 4 «Lt....!'ot\lfl SkfS s;.u_ WeM. ti\lli!vj sfep!vv"rtzll\. f.sttn sh(le..,., tor, '>l'z. v\dle. c_\ tf'tt...s \o bui\ hs St:\.F s fpoc"'ft' f\ll Nq o.c xi$nt, tj a.r. L:\HAND_HP\COA\COA Application_23.docu Revised December 22

2 Historical Affairs & Landmark Review Board c/o Historic Preservation Program 2 Clarendon Boulevard, Suite 7 Arlington, VA 222 D Review Board Members: LETTER OF TRANSMTfAL Enclosed is an application for a Certificate of Appropriateness and the fouowing attachments: Drawing(s} ndicate scale on each drawing. Site Plan Plat Elevation Floor Plan Section Detail Photograph(s) Please indicate number of photographs. Color Black/White Material Samples/Manufacturer's Catalog Cuts Please describe all material exhibits. YOUR SGNATURE BELOW CONFRMS YOUR CONSENT TO THE FOLLOWNG:. understand that these materials will be placed in the Historic Preservation Program's building file for information about my property following the public hearing. 2. understand it is my responsibility to inform my adjacent neighbors of my building and construction plans for this project. 3. hereby grant permission to the County's Historic Preservation Code nspector to enter my property during the application and constrnction phases of my project. 4. L:\HAND_HP\COA\COA Application_23.docxx Revised December 22

3 . Application Checklist n order to facilitate the review by the DRC and the HALRB, use the Application Checklist provided below, and please check all that apply. General Application Form (see Appendix D) Vicinity Plat Plan Existing Condition Photographs Site Plan Outline of adjacent buildings North Arrow Names of adjacent streets Required zoning setbacks Location type of existing trees of 5" caliper or greater Location type of new replacement trees Elevations Windows Elevations Scale (/8" = ' min) Existing versus new construction Dimensions of new work Height of floors and roof ridge Type (e.g., double hung) Size (e.g., 3" wide x 42" high Style (e.g., 6 over ) Exterior Cladding Type (e.g., wood lap siding) Size (e.g., 6" weather) Trim Dimensions Miscellaneous Floor Plans Historical Photos Drawings County Arborist Report Perspective Drawings Renderings Model Floor Plan Scale (/8" = ' min) North Arrow Existing versus new construction Dimensions of new and existing work Area of existing new work Section(s) Drawing_l)etails Porch rail details (refer to standard) Wall Section Detail Eave Detail Other Catalog nformation (Samples and Specifications) Doors and Windows Cladding Siding Materials A Roofing Materials Other L:\HAND_HP\COA\COA Application_23.docxx Revised December 22

ARLNGTON A. VRGNA Job Address Arlington County, Virginia Department of Community Planning, Housing and Development nspection Services Division RESDENTAL BULDNG PERMT APPLCATON nty, /o.//lppl l aooh!

4 ARLNGTON A. VRGNA Job Address Arlington County, Virginia Department of Community Planning, Housing and Development nspection Services Division RESDENTAL BULDNG PERMT APPLCATON nty, /o.//lppl l aooh!l{is DiAH/ 7/59 Contractor S the permit Holder Contractor Home Owner B. c. J Single Family Dwelling Detached Sq.ft.( 2 J Single Family Dwelling Attachec! Sq.ft.( 3 J Two Family Dwelling Sq.ft.( Additions and Alterations 434 J Decks, Addition to Dwelling, 434 J Alterations to Dwelling. 438 Garages, carports Sq J Accessory Dwelling Unit ( Demolition 645 J Single family Dwellings 646 J Two family Dwellings Clearing and Grading Footing & Foun atton ( ) Sq. ft. Accusorv Building Other Work J Areplace/ Chimney lining J Move Building J Siding Roofing J Retaining Wall J Swimming Pool J Repair Damage Driveway J!!5. D.

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9 TruDefinition Duration Shingles AR Harbor Blue : Owens Coming Roofing at Lowe's Page of 3 TruDefinition Duration Shingles AR Harbor Blue To see product avotlabiiicy, you must set your Lowe'se location. tem# 3548 Model TDHB Find Your Store View Photos of this Collection r j Description...,r L Specifications Technical documents TruDefinltion Duration Shingles ere specially formulated to provide greater contrast and dimension to any roof. Through the use of multiple granule colors and shadowing, TruDeflnitlon Duration Shingles offer a truly unique and dramatic effect. The exclusive combination of color and depth s what makes TruDeflnitlon Duration Shingles like no other. TruDefimtlon Duration Shingles are available in popular colors with bold, lively contrast and complementing shadow lines for greater dimension. They feature a Limited Lifetime Warranty (for as long as you own your home)*, 3MPH Wind Resistance Limited Warranty, and an Algae Resistance Limited Warranty.* Beyond the outstanding curb appeal and impressive warranty coverage, they also come with the advanced performance of patented SureNall Technology. See actual warranty for complete details, limitations and requirements. Related Accessories fill!!... g r fill u Ait i)i.j g i!! Weatherlock G Granulated Self Sealing ce & Water Barrier 2 Sa Roll (36n x 66.7\) Weatherlock G Granulated Self Sealing ce & Water Barrier sa Roll (36 in )( 33.3 ft) Weatherlock Mat Waterproofing Underiayment 2 SO Roll (36n x 66.7 ft) Perforated Htp and Ridge Shingles wh Sealant Harbor Blue httn //Jnwp_c;: OWP.nc;:r.nmino r.om/hnmpnumprlnrnrhart<:lrnnfino"'hinoip<lltnaripf' rl,,ratinn_.. r/h '7 /') 'l /') (\ 'l

10 TruDefinition Duration Shingles AR Harbor Blue : Owens Coming Roofing at Lowe's Page of 3 TruDefinition Duration Shingles AR Harbor Blue llem tl 3548 Model# TDHB To see produol avallabllfly, you musl sal your Lowe'sC'ocallon. Find Your Store View Photos of this Collection Description Specifications Technical documents Algae Resistance Design Shingle Type Wind Resistance Years Bold Contrast, Deep Dimension Laminated 3 MPH Nominal Size 3 /4" X 39 3/8" Exposure Shingles per Square Bundles per Square Coverage per Square 5 5/8" sq. ft. See actual warranty for complete details, limitations and requirements. Related Accessories ll ll ii!! =...,_ J< ,...,_... i e i it Weatherlock G Granulated Self Sealing ce & Water Barrier 2 sa Roll (36n X 66.7 ft) Weatherlock G Granulated Self Sealing ce & Water Barrier sa Roll (36 n x 33.3 t) Weatherlock Mat Waterproofing Undertayment 2 sa Roll (36 n x 66 7 ft) Perforated Hlp and Ridge Shingles whh Sealant Harbor Blue htto://lowes.owenscominl!. com/homeowner/nrothttc:/ronfinuc:hinuipc:ltnttipfrhtrl'ltinnl'lr/h 7/')':t/')(

TruDefinition Duration Shingles AR Harbor Blue : Owens Coming Roofing at Lowe's Page 2 of 3 Starter Strip Pius Amber WoodStart Starter Shingle Chestnut WoodStart Starter Shingle Granite WoodStart

11 TruDefinition Duration Shingles AR Harbor Blue : Owens Coming Roofing at Lowe's Page 2 of 3 Starter Strip Pius Amber WoodStart Starter Shingle Chestnut WoodStart Starter Shingle Granite WoodStart Starter Shingle Sycamore WoodStart Starter Shingle Carbon WoodStart Starter Shingle Mesquite WoodStart Starter Shingle Timber WoodStart Starter Shingle Juniper ;::.... WoodStart Starter Shingle Autumn " DecoRidge Hip & Ridge Shingles Deck Defense High Performance 8" DecoRidge Hip & Ridge Shingles Maple Harbor Blue Roof Underlayment Harbor Blue High Ridge Hlp and Ridge Shingles Perforated Hlp and Ridge Shingles wh ProEdge Hlp & Ridge Shingles AR Starter Strip Shingle Amber with Sealant AR Harbor Blue Sealant AR Harbor Blue Harbor Blue

12 !:U co (DO C') co N N S6_7 45.' z z LOT 9B CO PARCEL 7A LOT 9A 2,927 sf u >..J <( W ::: w > z \ \ \ \ <( > ::: <( "") 2 <. (()..J.. OLD DOMNON DRVE Manuai/Hegg HOUSE LOCATON SURVEY JOB#: 5 FH53 AUGUST 2, 25 LOT 9A MAYWOOD ARLNGTON COUNTY, VRGNA APEX SURVEYS SCALE: "=25' 772 VCEROY STREET SPRNGFELD, VRGNA 225

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ARLINGTONCOUNTY, VIRGINI..-\. HISTORICAL AFFAIRS Ai~D LA..'IDl.\ll.<\RK REVIEW BOARD APPliCATION FOR CERTIF1CATE OF APPROPRIATENESS

$ARLINGTONCOUNTY, VIRGINI..-\. HISTORICAL AFFAIRS Ai~D LA..'IDl.\ll.<\RK REVIEW BOARD APPliCATION FOR CERTIF1CATE OF APPROPRIATENESS$ ARLINGTONCOUNTY, VIRGINI..-\. HISTORICAL AFFAIRS AiD LA..'IDl.\ll.