HomeMy Public PortalAboutCertificate of Appropriateness
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Application #
___________________________
Fee: $
Date Paid_________________
Check # __________________
MAP_____________________
LOT______________________
CERTIFICATION OF APPROPRIATENESS
PLEASE READ REVERSE SIDE FOR REQUIREMENTS
NOTE: ALL FEES DOUBLED IF WORK IS STARTED BEFORE OBTAINING APPROVAL
Address of Proposed Work___________________________________________________________________________________________________
Owner Name______________________________________________________________________________________
Owner Mailing Address__________________________________________________________________________
Owner Email______________________________________________________________________________________
Contractor Name_________________________________________________________________________________
Company Name __________________________________________________________________________________
Contractor Address__________________________________________________________________________________________________________
Contractor Email____________________________________________ Contractor Phone_______________________________________
Please check the categories that apply:
Exterior Building Construction Building Type Exterior Building Structure
New Building House Paint Fence
Addition Garage Solar Panels Wall
Alteration Commercial Shed
Other Other
Briefly describe proposed work (and complete attached specification sheet):
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
____________________________________________________________
Applicant Signature
=======================================================================
This Certificate is hereby ___________________________ Date ________________________________________
_________________________________________________ _________________________________________________
_________________________________________________ _________________________________________________
_________________________________________________ _________________________________________________
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ADDRESS:___________________________________________________________________________________________________________
SPECIFICATION SHEET
PLEASE COMPLETE ONLY THOSE PORTIONS WHICH APPLY TO YOUR APPLICATION
Foundation Type____________________ Amount Visible____________________
(NOT TO EXCEED BETWEEN 12” OR 18”)
Siding Type____________________ Amount Visible____________________ Exposure____________________
Color ____________________ Material_________________________
Trim ALL WINDOWS & DOORS TO BE TRIMMED WITH 1x4 1X5
Size of Corner Boards____________________ Color____________________ Material____________________
Rakes____________________ 1 st Member ____________________ 2 nd Member____________________
Depth of Overhang__________________
Windows-MUST PROVIDE SPEC SHEET Type____________________ Manufacturer__________________________
Grilles or True Divide____________________ Size____________________ Color____________________
Skylights Type____________________ Manufacturer_____________________________________
Size____________________ Color____________________
Roof Type____________________ Pitch____________________ Color_________________________ (7 PITCH MINIMUM)
Height to Ridge ____________________ Style____________________
Fencing- ALL STOCKADE TYPE FENCING MUST HAVE “GOOD” SIDE FACING OUT
Type____________________ Height____________________ Color____________________
Chimney
Type____________________ Size____________________ Color_________________ Material_________________
Deck
Color____________________ Material____________________
Railing Color____________________ Material____________________ Manufacturer_______________________
Shutters Color____________________ Material____________________
Garage Doors- MUST PROVIDE SPEC SHEET Size of Opening____________________ Style____________________
Material____________________ Color____________________ Manufacturer_________________________________
Gutters Type____________________ Color____________________ Material____________________
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Storm Windows & Door- MUST PROVIDE SPEC SHEET
Type____________________ Color____________________ Material____________________
Entry Door (Front & Side)- MUST PROVIDE SPEC SHEET
Type____________________ Color____________________ Material____________________
Attic/Roof Vent
Type (Gable Louver, Ridge Vent, etc.)_______________________________________________________________________
Landscaping Plans
Please describe any Landscaping Plans_______________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Driveway
Type__________________________________________________________________________________________________
Type of Steps
_____________________________________________________________________________________________________________
Exterior Fuel Tank Screening
_____________________________________________________________________________________________________________
Other
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
IMPORTANT: ALL FEES DOUBLED IS WORK IS STARTED BEFORE APPROVAL.
IF CERTIFICATE IS APPROVED, APPROVAL IS SUBJECT TO THE 10 DAY APPEAL PERIOD PROVIDED
IN THE ACT.
This Certificate expires one year or upon the date of expiration of any Building Permit Issued, whichever
expiration date shall be later. You must file an extension before the expiration date.
**The Homeowner, Agent or Contractor must attend the hearing, failure to do so may result in denial of
the application*
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WAIVER OF 45 DAY DETERMINATION
OPTIONAL
The applicant/authorized agent understands and agrees that the determination of the submitted
application for a Certificate of Appropriateness may not be made within 45 days of the filing of
such application.
The applicant agrees to extend the time frame within which a determination is to be made as required by the Old King’s Highway Regional Historic District Act.
Section 9- Meetings, Hearing, Time for Making Determinations
“As soon as convenient after such public hearing; but in any event within forty five (45) days after the filing of
application, or within such further time as the applicant shall allow in writing, the committee shall make a
determination on the application.” (Page 11, Old King’s Highway Regional Historic District Bulletin)
Applicant understands that the review of this application will be scheduled as soon as the situation
allows.
Applicant/Authorized Agent Name____________________________________________________________________
Applicant/Authorized Agent Signature_________________________________________________________________
Date_______________________ Property Location____________________________________________