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  • Heating System, Housing Rehab, and Lead Paint Safe Somerville Program Application

    City of Somerville Office of Strategic Planning and Community Development-Housing Division
  • About this Application

  • The City of Somerville is currently accepting applications to participate in the Heating System, Housing Rehab, and Lead Paint Safe Somerville Program ("the Programs"). This form consists of initial questions required for consideration of acceptance into the Programs.

    This form is "Step 1" of the application process. Additional documentation will be required tocomplete the application. Your application will not be considered for eligibility unless steps 1and 2 are completed.

    Step 1: Please complete this form in its entirety and click "submit." A staff member will contactyou to answer any questions and discuss next steps.

    Step 2: Deliver additional required documentation to EITHER:

    OSPCD-Housing Division ATTN: Andres Bueno (Lead Paint Safe Somerville), 93 Highland Avenue, Somerville, MA 02143.

    OR

    OSPCD-Housing Division ATTN: Ken Joyce (Heating System/Housing Rehab Program), 93 Highland Avenue, Somerville, MA 02143.

    Please make an appointment to hand-deliver applications and materials by contacting 617-625-6600 ext. 2577. Leave a message with your name, phone number, and preferred drop off time. A staff member will respond.

    Step 3: When we receive completed applications and all requested income documentation forall applicable units on the property, we will determine your eligibility and contact you with nextsteps.

    Please note:

    • All information provided will be treated condentially.
    • Once submitted, you will have the option to print this form.
    • If multiple units of a property are applying for the program, one application will need to becompleted per unit. All residents of that unit must provide applicable income documentation.
    • A staff member will contact you within two (2) business days of receiving this form.
    • Income limits are the same for the Heating System, Housing Rehab, and Lead Paint Safe Somerville programs.
    • The Heating System program applies to the homeowner's unit only.
    • The Lead Paint Safe Somerville and Housing Rehab program applications are based on the income of the occupants of the property. Tenants may qualify; however, tenants must have consent from the property owner to participate.
    • Any work that begins before acceptance into the program is not eligible for retroactive funding or reimbursement.
    • There are specific restrictions and conditions associated with all of our funding sources. Funding for our programs is limited. Funding will be available based on completeness of the application, City priorities, and income eligibility. For the Lead Paint Safe Somerville program, units with children under the age of six (6) and expectant mothers will be prioritized. Vacant units may also qualify for the program. Please contact 617-625-6600 ext. 2584 to discuss program requirements.

    Questions? Contact the Housing Division at 617-625-6600 ext. 2577 or allhousingdivision@somervillema.gov.

  • First, let's make sure you qualify.

    Please enter information for the unit of the property that is seeking funding. Owners, please note: tenants may qualify you for participation in the program. If you have nine or more persons in your unit, please contact program staff for income guidelines at 617-625-6600 ext. 2584 (leave a message).
  • Based on your response, it looks like the estimated household income will likely qualify for the program. Please continue filling out this form.

    This is not an official acceptance into the program. We will need to review the requested income documentation before an official determination is made.

  • Based on your response, the estimated household income will likely not qualify you for the program. Please call 617-625-6600 ext. 2584 for more information. 

  • General Information

  •  -  - Pick a Date
  • If you are interested in participating in a program but do not have permission from your landlord and wish to be contacted by a City staff member with next steps, please complete the information below and submit the form. A City staff member will contact you within two (2) business days.

  • Tenants cannot qualify fo the heating system program.

  • Applicants of the Lead Program are required to have received the pamphlet "Protect Your Family From Lead Paint in Your Home." Please click the links below to obtain a copy. Once you have read the pamphlet, please check the box below.

    • English
    • Spanish
    • Arabic
    • Russian
    • Somali
    • Vietnamese

    This pamphlet is also available in hard copy at the Housing Environment Office during normal business hours. If you have any questions, please contact 617-625-6600 ext. 2584.

  • Unsure? Applicants can go to the Assessor’s Database to access this information. Please note only homes constructed before 1978 may participate in the Lead Paint Safe Somerville Program.

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  • Tenant Application: Additional Required Information

    You must have your landlord's consent before participating in the program.
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  • Tenant Certification

  • I/We certify that, under penalty of perjury, all information on this application to the best of my/our knowledge is true. I/We understand that false information given is sufficient grounds for rejection of this application. Furthermore, verification may be obtained from any source herein.

    Lead Paint Hazards in Accordance with 24CFR35.

    I/We owners of the property certify that the City of Somerville Office of Strategic Planning and Community Development (OSPCD) has provided the DISCLOSURE NOTIFICATION pamphlet; Protect Your Family from Lead in Your Home. I/We have been made aware of the hazards of lead that may affect the occupants of the property for which we are seeking assistance. I/We understand that as a condition of receiving assistance, I/we will be required to include Lead Hazard Reduction Activities that employ Safe Work Practices as part of the total rehabilitation project. Further, I/we have been made aware of my/our disclosure, protection and relocation rights and responsibilities.

    Penalty for False and Fraudulent Statement, U.S.C.

    “Title 18, Section 1001, provides: ‘Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies…or makes any false fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five (5) years or both.'”

  • GENERAL AUTHORIZATION FOR RELEASE OF INFORMATION 

    If you are receiving a rental subsidy, please fill out the information below.

  • I hereby give you permission to release this information to OSPCD. I would appreciate your prompt attention in supplying the information requested to OSPCD within five (5) days of the receipt of this request. I understand that a photocopy of this authorization is as valid as the original.

    Thank you for your cooperation in this matter.

    THIS AUTHORIZATION IS VALID FOR A PERIOD OF ONE (1) YEAR FROM THIS DATE.

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  • Homeowner Application

    Additional Required Information
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  • Asset Information

  • Please complete the Self Employment Statement and have it notarized. You may schedule an appointment with City staff to have it notarized at 617-625-6600 ext. 2584. The City can provide a notary. The City can also provide a hard copy of the form if the applicant does not have access to a printer.

  • Please fill out the No Income Statement and have it notarized. You may schedule an appointment with City staff to have it notarized at 617-625-6600 ext. 2584. The City can provide a notary. The City can also provide a hard copy of the form if the applicant does not have access to a printer.

  • Please provide proof of any child support received (copy of custody agreement, letter from the Department of Revenue, or other official documentation).

  • If you do not have a bank account, please complete the No Bank Account Statement and have it notarized. You may call 617-625-6600 ext. 2584 to schedule an appointment to have the form notarized. The City can provide a notary. The City can also provide a hard copy of the statement if you do not have access to a printer.

  • Fixed Income Information

    Please list sources of fixed income for all household occupants below. If you do not receive income from a source below, please leave the table blank.
  • Student Information

    In the table below, please list household members over 18 considered to be full-time students. If this does not describe anyone in your household, please leave the table blank.
  • Rental Income Information

  • Please complete the tables below.

  • Occupant Information

  • Homeowners: Representations and Certifications

    Lead Paint Safe Somerville Program
  • C. Tax Contribution Compliance

    The owner is in full compliance with all laws of the Commonwealth of Massachusetts and ordinances of the City of Somerville relating to taxes and to contributions and payments in lieu of contributions.

    D. Non-Discrimination Compliance

    The undersigned agrees that there will be no discrimination on the basis of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, presence of children, marital status, source of income or military status, in the sale, lease, rental use, advertisement or occupancy of the property that is rehabilitated with funds provided by the Somerville Office of Strategic Planning and Community Development ("OSPCD"). Regulations issued by the United States Department of Housing and Urban Development and the Massachusetts Commission Against Discrimination pursuant to Title VII of the Civil Rights Act of 1968 and the Massachusetts General Law, Chapter 151B, Section 4, shall apply.

    E. Owners’ Permission to Enter and Inspect

    I/We hereby give my/our permission for the employees of the City of Somerville OSPCD to inspect my property including conducting heating system analysis as a condition of applying for assistance through OSPCD Housing Program. Further, I/We relieve the City of Somerville, its employees and/or agents from any and all claims of damages or liability arising from the performance of property inspections by the City of Somerville’s OSPCD.

    F. Lead Paint Hazards in Accordance with 24 CFR 35.

    I/We owners of the property certify that OSPCD has provided the DISCLOSURE NOTIFICATION pamphlet; Protect Your Family from Lead in Your Home. I/We have been made aware of the hazards of lead that may affect the occupants of the property for which we are seeking assistance. I/We understand that as a condition of receiving assistance, I/we will be required to include Lead Hazard Reduction Activities that employ Safe Work Practices as part of the total rehabilitation project. Further, I/we have been made aware of my/our disclosure, protection and relocation rights and responsibilities.

    G. Certification

    I/We certify that, under penalty of perjury, all information on this application to the best of my/our knowledge is true. I/We understand that false information given is sufficient grounds for rejection of this application. Furthermore, verification may be obtained from any source herein.

    Penalty for False and Fraudulent Statement, U.S.C.

     “Title 18, Section 1001, provides: ‘Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies…or makes any false fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five (5) years or both.’”

    Applicant’s Right to Appeal

    If you believe that you have been discriminated against regarding any decision made on this application because of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, the presence of children, or marital status, you may appeal that decision.

    Additionally, if you feel you have been wrongfully denied assistance for any reason, you may appeal that decision. Appeals must be made within 15 days of receiving the denial letter. All appeals must be sent in writing to Housing Director, City of Somerville, OSPCD, 50 Evergreen Avenue, Somerville, MA 02145. 

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  • Homeowners: Representations and Certifications

    Heating System and Rehab Programs
  • C. Tax Contribution Compliance

    The owner is in full compliance with all laws of the Commonwealth of Massachusetts and ordinances of the City of Somerville relating to taxes and to contributions and payments in lieu of contributions.

    D. Non-Discrimination Compliance

    The undersigned agrees that there will be no discrimination on the basis of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, presence of children, marital status, source of income or military status, in the sale, lease, rental use, advertisement or occupancy of the property that is rehabilitated with funds provided by the Somerville Office of Strategic Planning and Community Development (OSPCD). Regulations issued by the United States Department of Housing and Urban Development and the Massachusetts Commission Against Discrimination pursuant to Title VII of the Civil Rights Act of 1968 and the Massachusetts General Law, Chapter 151B, Section 4, shall apply.

    E. Owners’ Permission to Enter and Inspect

    I/We hereby give my/our permission for the employees of the City of Somerville OSPCD to inspect my property including conducting heating system analysis as a condition of applying for assistance through OSPCD Housing Program. Further, I/We relieve the City of Somerville, its employees and/or agents from any and all claims of damages or liability arising from the performance of property inspections by the City of Somerville OSPCD.

    F. Lead Paint Hazards in Accordance with 24 CFR 35.

    I/We owners of the property certify that OSPCD has provided the DISCLOSURE NOTIFICATION pamphlet; Protect Your Family from Lead in Your Home. I/We have been made aware of the hazards of lead that may affect the occupants of the property for which we are seeking assistance. I/We understand that as a condition of receiving assistance, I/we will be required to include Lead Hazard Reduction Activities that employ Safe Work Practices as part of the total rehabilitation project. Further, I/we have been made aware of my/our disclosure, protection and relocation rights and responsibilities.

    G. Certification

    I/We certify that, under penalty of perjury, all information on this application to the best of my/our knowledge is true. I/We understand that false information given is sufficient grounds for rejection of this application. Furthermore, verification may be obtained from any source herein.

    Penalty for False and Fraudulent Statement, U.S.C.

     “Title 18, Section 1001, provides: ‘Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies…or makes any false fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five (5) years or both,’”

    Applicant’s Right to Appeal

    If you believe that you have been discriminated against regarding any decision made on this application because of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, the presence of children, or marital status, you may appeal that decision.

    Additionally, if you feel you have been wrongfully denied assistance for any reason, you may appeal that decision. Appeals must be made within 15 days of receiving the denial letter. All appeals must be sent in writing to Housing Director, City of Somerville, OSPCD, 50 Evergreen Avenue, Somerville, MA 02145. 

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  • Tenant Statistical Information

    The following information is used to assist this office in reporting to our funding sources. Information will be kept completely confidential.
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  • Homeowner Statistical Information

    The following information is used to assist this office in reporting to our funding sources. Information will be kept completely confidential.

  • Investor-Owner Application: Additional Information

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  • Representations and Certifications of the Property Owners

  • C. Tax Contribution Compliance

    The owner is in full compliance with all laws of the Commonwealth of Massachusetts and ordinances of the City of Somerville relating to taxes and to contributions and payments in lieu of contributions.

    D. Non-Discrimination Compliance

    The undersigned agrees that there will be no discrimination on the basis of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, presence of children, marital status, source of income or military status, in the sale, lease, rental use, advertisement or occupancy of the property that is rehabilitated with funds provided by the Somerville Office of Strategic Planning and Community Development (OSPCD). Regulations issued by the United States Department of Housing and Urban Development and the Massachusetts Commission Against Discrimination pursuant to Title VII of the Civil Rights Act of 1968 and the Massachusetts General Law, Chapter 151B, Section 4, shall apply.

    E. Owners’ Permission to Enter and Inspect

    I/We hereby give my/our permission for the employees of the City of Somerville OSPCD to inspect my property including conducting heating system analysis as a condition of applying for assistance through OSPCD Housing Program. Further, I/We relieve the City of Somerville, its employees and/or agents from any and all claims of damages or liability arising from the performance of property inspections by the City of Somerville OSPCD.

    F. Lead Paint Hazards in Accordance with 24 CFR 35.

    I/We owners of the property certify that OSPCD has provided the DISCLOSURE NOTIFICATION pamphlet; Protect Your Family from Lead in Your Home. I/We have been made aware of the hazards of lead that may affect the occupants of the property for which we are seeking assistance. I/We understand that as a condition of receiving assistance, I/we will be required to include Lead Hazard Reduction Activities that employ Safe Work Practices as part of the total rehabilitation project. Further, I/we have been made aware of my/our disclosure, protection and relocation rights and responsibilities.

    G. Certification

    I/We certify that, under penalty of perjury, all information on this application to the best of my/our knowledge is true. I/We understand that false information given is sufficient grounds for rejection of this application. Furthermore, verification may be obtained from any source herein.

    Penalty for False and Fraudulent Statement, U.S.C.

     “Title 18, Section 1001, provides: ‘Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies…or makes any false fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five (5) years or both,’”

    Applicant’s Right to Appeal

    If you believe that you have been discriminated against regarding any decision made on this application because of race, color, national origin, ancestry, age, sex, religion, disability, sexual orientation, the presence of children, or marital status, you may appeal that decision.

    Additionally, if you feel you have been wrongfully denied assistance for any reason, you may appeal that decision. Appeals must be made within 15 days of receiving the denial letter. All appeals must be sent in writing to Housing Director, City of Somerville, OSPCD, 50 Evergreen Avenue, Somerville, MA 02145. 

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  • Statistical Information


  • Please click submit to finalize your application.

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