Permit Session Cover Sheet

Commonwealth of Massachusetts Land Court Department of the Trial Court Case No. PERMIT SESSION Civil Cover Sheet First Plaintiff Locus Address/Description First Defendant City/Town Part I - Threshold Requirements for Permit Session: This action is based on a claim or claims set forth in G. L. c. 185, § 3A (a) to (d), inclusive and the underlying project or development involves 25 or more dwelling units; or the construction or alteration of 25,000 square feet or more of gross floor area. (Check one or both boxes that apply.) Part II - Uniform Counsel Certificate: To be filled out by Plaintiff(s)' Counsel at the time of initial filing. All other counsel shall file an SJC Rule 5 certificate within ten (10) days of their initial entry into the case, whether by answer, motion, appearance or other pleading. I am attorney-of-record for: above-entitled matter. A. , plaintiff(s) in the In accordance with the Supreme Judicial Uniform Rules on Dispute Resolution (Rule 1:18, Rule 5), which states in part: "Attorneys shall: provide their clients with...this information about court-connected dispute resolution; discuss with their clients the advantages and disadvantages of the various methods of dispute resolution; and certify their compliance with this requirement on the civil cover sheet or its equivalent . . ." In accordance with Land Court Standing Order 1-12, I certify that I am aware of the requirement to, "...serve a copy of the "Limited Assistance Representation (LAR) Information Sheet" upon all defendants at the same time as service of the summons, complaint, and civil cover sheet is made", and I will comply with this requirement. B. I hereby certify that this action meets the threshold requirements for the Permit Session, that I have complied with SJC Rule 5, and will comply with Land Court Standing Order 1-12. BBO# Signature of Plaintiff(s) Attorney or Plaintiff, if self-represented Date: (Please Print Name) (Filling out both pages of this form is mandatory.) 01/2013 American LegalNet, Inc. www.FormsWorkFlow.com -1- Land Court Permit Session (Must Be Completed) 1. Using the list below, please number, with the Number 1, the primary count on which you base your complaint. and 2. Place an "X" next to each other count in your complaint. and 3. Is this complaint verified ? and 4. Are there any related cases filed in the Land Court Department ? If yes, please provide the Case No.(s) and 5. Are there any related cases pending in any other Department or Administrative Agency? If yes, please provide the Case No.(s): Department/Agency Yes No Yes No and 6. Is there a jury claim? and 7. Is there preliminary injunctive relief sought ? and 8. Are you a nongovernmental corporate party? complying with SJC Rule 1:21. PSZAC G. L. c. 40A, § 17 - Appeal from Zoning/Planning Board G. L. c. 41, § 81BB - Appeal from Planning Board PSEXP PSZJA PSZEN G. L. cc. 240, § 14A, 185, § 1 (j ½ ) - Validity of Zoning PSW G. L. c. 40A, § 7 - Enforcement of Zoning G. L. c. 40B, § 21 - Affordable Housing Appeal G. L. c. 21 Department of Environmental Management G. L. c. 30 § 61-62H Environmental Impact of Projects Conducted by Agencies G. L. c. 30A State Administrative Procedure (not listed here) G. L. c 40B, § 22 Review by Housing Appeals Committee PSIFGNR If yes, then this filing must be accompanied by a statement Yes No Yes No PSHDA G. L. c. 40C Historic Districts Act G. L. c. 40R Smart Growth Zoning and Housing Production G. L. c. 43D Expedited Permitting G. L. c. 91 Waterways G. L. c.131 Inland Fisheries, Game and Natural Resources G. L. c. 131A Massachusetts Endangered Species Act St. 1956, c. 665 Boston Zoning Code Other Claims under G. L. c. 185, § 3A sec. (b), (c) and (d) G. L. c. 249, § 4 Certiorari G. L. c. 249, § 5 Mandamus PSSGZ PSZAD PSAHA PSDEM PSEIP PSMESA PSBZC PSOTA PSSAP PSHAC PSCNC PSMAN For Land Court Use Only Approved for filing in the Permit Session ____________________________________ Recorder 01/2013 OR PSTRALC - Case Transferred from the Land Court to the Permit Session PSTRANS - Case Transferred from other court to the Permit Session American LegalNet, Inc. www.FormsWorkFlow.com OR -2-