Application For Certificate Of Appropriateness Page 2

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Other - Please Specify
_____________________________________________
9. Description of Proposed Improvements: ______________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. Existing Materials/Construction:
Wood Frame
Brick
Stone
Block
Stucco
Other: __________________________________________________________
11. Proposed Materials/Construction:
Wood Frame
Brick
Stone
Block
Stucco
Other: __________________________________________________________
12. If materials differ from existing, explain reasons: _____________________________________
________________________________________________________________________
________________________________________________________________________
13. Will material samples be provided for review/approval by Commission?
Yes
No
14. Are material samples available for review/approval on site?
Yes
No
Location: ________________________________________________________________________
I understand the work will not begin until the Landmarks Commission completes its review of this
application.
Signature: ___________________________________________________ Date: _________________
Please print name: __________________________________________________________________
___________________________________________________________________________________
COMMISSION ACTION:
Approved
Approved with Conditions Disapproved
Signature: ___________________________________________________ Date: _________________
Conditions:________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Comments/Recommendations: _______________________________________________________
________________________________________________________________________
________________________________________________________________________

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