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Indj ✓ <br /> FORM B - BUILDING In Area no. Form no. <br /> MASSACHUSETTS HISTORICAL COMMISSION <br /> Office of the Secretary, State House, Boston <br /> OCT 75 <br /> �nLev M � o <br /> ress <br /> nerg <br /> s <br /> sent use �T •� oT ._�Cil tf�I <br /> sent owner <br /> iVT <br /> cription: <br /> it <br /> source <br /> ' Cv✓hs <br /> 4. Map. Draw sketch of building location ArchitectGGI C ( 'S✓G , � 1 , <br /> in relation to nearest cross streets and _'.& <br /> other buildings. Indicate north. Exterior wall fabric <br /> Outbuildings (describe) <br /> Other features I tan. tvi'ds- Ar <br /> » fin Altered Date <br /> Moved Date <br /> 5. Lot size <br /> One acre or less V Over one acre <br /> Approximate frontage <br /> Approximate distance of building from street <br /> '1 <br /> O NOT WRITE IN THIS SPACE 6. Recorded by �n <br /> USGS Quadrant <br /> Organizatio .- D M!�/l <br /> HC Photo no. <br /> Date Rr^r; ' <br /> (over) PJAY 14 197b <br /> C <br /> 3M-2-75-R061465 <br />