APPLICATION -- CERTIFICATE OF APPROPRIATES

PROVIDENCE HISTORIC DISTRICT COMMISSION

Department of Planning and Development
400 Westminster Street, Providence, RI 02903 (401) 351-4300

APPLICATION FOR CERTIFICATE OF APPROPRIATENESS

For Office Use Only

	Application Number:	Date Accepted:
	Date Received:	Accepted By:
	Type of Review:	Construction Style:
	In-House Public Hearing	Architectural Style:

APPLICATIONS MUST BE SUBMlTTED AT LEAST 14 DAYS BEFORE A PUBLIC HEARING. PLEASE CONTACT THE PHDC STAFF FOR HEARING DATES AND FILING DEADLINES.

PLEASE PRINT OR TYPE

PART I - GENERAL INFORMATION

PROPERTY ADDRESS:	Plat: Lot:
Property Name (if any):	Historic District:

OWNER Name:	Telephone:
Mailing Address:	Zip Code:
APPLICANT Name:	Telephone:
Mailing Address:	Zip Code:

ARCHITECT/DESIGNER Name:	Telephone:
Mailing Address:	Zip Code:
CONTRACTOR/ BUILDER Name:	Telephone:
Mailing Adress:	Zip Code:

I certify that all information contained in this application is true and accurate to the best of my knowledge. (Both signatures required. Please print or type name underneath signature.)

Applicant:_________________________

Owner:_______________________________

PART I I - DESCRPTION OF PROPOSED WORK:

Approval Sought (check one):

Conceptual

Final

Application Category (check as many as necessary):

	Alterations/Minor Modifications			Repair/Replacement in Kind
	Awnings			Roofs/Gutters/Downspouts
	Chillers/Condensing Units			Shutters/Blinds
	Demolition			Signs/Storefronts
	Fences/Gates			Site Improvements/Driveways/Walkways
	Moving of Structures			Storm Windows/Doors
	New Construction/Additions

Page -2-

BRIEFLY BUT COMPLETELY describe the entire scope of work: what you propose to do, where on the property the work will occur, and how the work will be accomplished. For large projects, an itemized list is recommended. Attach additional pages if necessary.

PART III - DOCUMENTATION

See PHDC Standards and Guidelines for checklists of documentation requirements for your specific project. INCOMPLETE APPLICATIONS CANNOT BE ACCEPTED FOR REVIEW. Mark each piece of documentation according to the list below. All documentation except materials samples and models will be retained by the PHDC as part of the public record. All documentation must be labeled and dated. Drawings must show dimensions and scale, and should illustrate existing as well as proposed conditions. Place a check mark next to each exhibit you have submitted with this application.

EXHIBIT 1 - Application Form (signed by property owner and applicant)

EXHIBIT 2 - 35mm Photographs (color or B/W, minimum size 3.x5" prints. No instant snapshots.)

EXHIBIT 3 - Drawings, e.g. Elevations, Plans, Sections (each labelled separately: Exhibit 3A, 3B, etc.)

EXHIBIT 4 - Shop Drawings, Product Literature, Specifications

EXHIBIT 5 - List of Abutting Property Owners Names and Mailing Addresses (omit for in-house reviews)

EXHIBIT 6 - Financial Data (demolition proposals only)

EXHIBIT 7 - Model (new construction proposals only)

EXHIBIT 8 - Material Samples

EXHIBIT 9 - Other Information (specify):

EXHIBIT 10 - List of Expert Witnesses or Owner's Representatives

PART IV - MISCELLANEOUS

Application Fee ($ _________. See attached schedule for applicable fee.)

Please check any of the following statements which apply to this project:

This application is filed in response to notice from the PHDC of work done without prior approval.

This project will also require zoning variances.

One or more expert witnesses will appear at the public hearing to testify in favor of this application. A list of the names, addresses and professional qualifications of witnesses is attached as Exhibit 10. (Please note that the PHDC may limit verbal testimony so that all public comment may be entered in the record in a timely fashion. Written testimony may be submitted.

An attorney, architect, contractor or other representative will appear on the applicant's or owner's behalf at the public hearing. The name and business address of this representative is attached as Exhibit 10.

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