HISTORIC RENOVATION GRANT PROGRAM

Application

Indiana Office of Community and Rural AffairsOne North Capitol, Suite 600Indianapolis, Indiana 46204

(317) 233-3762, (800) 824-2476

December 2017

APPLICATION COMPLETION CHECKLIST

Please ensure that all the following information is included with the application. Incomplete applications will not be considered.

For proper staff consideration, the grant proposal MUST include ALL of the following parts, forms, and documentation (unless indicated as if applicable). Please place the information in the application in the following order so that the OCRA staff can review the information efficiently. Use tabs or some other mechanism to separate appendices and number pages for easy referencing. Do not use binders for hard copy submissions.

Application: Electronic submission via thumb drive One (1) Original Copy, received at the Office of Community and Rural Affairs

Cover Sheet Is the first two pages of the Application Is Local Match at least 65% of the Total Eligible Project Cost? All blanks completed

Table of Contents

State Form 56288: Request for Determination of Eligibility for the National Register of Historic Places and the Indiana Register of Historic Sites and Structures (if applicable)

State Form 52889: Application for a Certificate of Approval (required)

Project Narrative, all questions answered

Project Completion Timetable

Project Budget Scope of Work (be as detailed as possible) Line Item Budget (be as detailed as possible) Table of Matching Funds Estimates for all work to be completed (estimates must be from a qualified professional on their letterhead)

NOTE: The grant award is considered taxable income in the year that it is used.  Awardees should consult with their legal counsel or accountant for more information.

The following forms, completed and attached

Site Control Certification Site control

Status of local tax payments – up to date?

APPENDIX A: Information Proof of Eligibility National Register # and screenshot of file from DHPA SHAARD online database Photographs (all photos in application must be in color) Maps

Historic District map with property clearly identified in district (if applicable)Designated Main Street map with property clearly identified in district (if applicable)

Site Plans Drawings/other plans/specifications (drawings must be done by a licensed architect, professional) Proof of available local match funds (i.e. bank letter – do not provide bank account information) Completed and current W9, if applicable Proof of not-for-profit status (Indiana Secretary of State, IRS), if applicable Other supporting documentation (i.e. letters of support, if applicable)

HISTORIC RENOVATION GRANT APPLICATION(COVER SHEET – 2 pages)

PROPERTY NAME:      PROPERTY ADDRESS:       CITY:       COUNTY:       ZIP+4:      

Property is listed individually in the Indiana Register of Historic Sites and Structures (State Register)The following information can be obtained from the State Historic Architectural and Archaeological Research Database (SHAARD) https://secure.in.gov/apps/dnr/shaard/welcome.html:

NR# (NR-****):State Register listing date:

Property is a contributing building in a historic district listed in the State Register The following information can be obtained from the State Historic Architectural and Archaeological Research Database (SHAARD) https://secure.in.gov/apps/dnr/shaard/welcome.html:

NR# (NR-****):State Register listing date:

Name of Historic District:       : Property is individually eligible for listing in the State Register of Historic Sites & Structures To find out if the

property is listed or eligible for listing in the State Register, go to http://www.in.gov/dnr/historic/2829.htm for instructions on how to find State Register listing status and information, if applicable, or how to obtain a Determination of Eligibility from the Indiana Department of Natural Resources Division of Historic Preservation and Archaeology (DHPA). Please note that determinations of Eligibility will only be issued for individual sites; there is no provision for determinations of eligibility for historic districts for the State Register. Additionally, a current determination of eligibility does not insure listing a property in the State Register at a later date.

PROPERTY OWNER:       PROPERTY OWNER ADDRESS:       CITY:       COUNTY:       ZIP+4:       PHONE:       FAX:      E-MAIL:      FEDERAL I.D. /TAX NUMBER:      

Property is currently occupied by someone other than the property owner

TENANT’S NAME:       PHONE:       FAX:      E-MAIL:      What actions have been taken to notify tenant of proposed project and the potential, if any, for loss of business or displacement that may arise during the projects proposed work?      

PROPERTY CONTACT (NAME):       CONTACT ADDRESS:       CITY:       COUNTY:       ZIP+4:       PHONE:       FAX:      E-MAIL:      

Check all that apply:

Property is in a designated as a current program year Stellar Community Property is located in a designated Indiana Main Street district Property is in a National Register Historic District

BRIEF TITLE OF REHABILITATION PROJECT:       PROJECT FUNDING SOURCES (Ensure lead applicant match equals 65% of overall eligible costs.)All grant request amounts needed to be rounded to the nearest dollar.

AmountGrant Request      Lead Applicant Match      Other Private Sources       List sources:      TOTAL MATCH      TOTAL PROJECT COST      

In what Indiana Senate District(s) does this project fall under?       State Senator(s) representing this district:      In what Indiana House of Representatives District(s) does this project fall under?      State Representative(s) representing this district:      In what US Congressional District(s) does this project fall under?      

If you need a determination of eligibility for your property:

REQUEST FOR DETERMINATION OF ELIGIBILITY FOR THE NATIONAL REGISTER OF HISTORIC PLACES AND THE INDIANA REGISTER OF HISTORIC SITES AND STRUCTURESState Form 56286 (4-17)INDIANA DEPARTMENT OF NATURAL RESOURCESDIVISION OF HISTORIC PRESERVATION AND ARCHAEOLOGY

This form is intended for use by persons or groups seeking a determination of eligibility for listing in the National Register of Historic Places (National Register) or the Indiana Register of Historic Sites and Structures (State Register). Those seeking information for Federal Review under Section 106 of the National Historic Preservation Act of 1966, as amended, or State Review under Indiana Code 14-21-1 Sections 14, 16, and 18, should contact Environmental Review staff at the Division of Historic Preservation and Archaeology (DHPA) for guidance.

Please indicate by check mark if you are seeking a Determination of Eligibility for the Office of Community and Rural Affairs Historic Renovation Grant Program. Determinations for this program will only be accepted for single resources or complexes of related resources. See below for information regarding determinations for historic districts.

Determinations of Eligibility for historic districts will only be accepted for National Register listing. Indiana Code 14-21-1-15 and 14-1-1-17, which pertain to the State Register, do not have a provision for listing districts in the State Register only; districts are listed in the State Register through the National Register listing process. Please contact National Register staff at the DHPA for further information.

For unusual property types or non-architecturally significant properties, please contact the DHPA National Register staff for additional guidance.

The DHPA staff will respond to your request within thirty (30) days. Additional information may be requested.

Not every old building or resource is eligible for listing in the National or State Registers. In order to be eligible for listing, a property should be at least fifty (50) years old, maintain a certain degree of architectural integrity, and have significance at the local, state, or national level in one of the following four categories:

Events - Properties associated with events that were important to our history Persons - Properties associated with the lives of persons significant in our history Architecture/Design - Buildings, structures, or objects with architectural or engineering importance. They may be the work

of a master, or possess high artistic value. Groupings of properties may share a common heritage, such as a historic district. Information - Resources that have yielded, or may yield in the future, important information about our prehistory or history.

For more information on the National and State Registers, please visit http://www.in.gov/dnr/historic/3654.htm.   

This form and accompanying plans and maps may be submitted in hard copy or as digital files on CD. Photographs should be submitted on CD.

Applicant InformationName     Company or Organization (if applicable)     Mailing Address (number and street, city, state, and ZIP code)     Telephone number(     )      

E-mail address     

Property InformationHistoric name (if applicable)     Address (number and street, city, state, and ZIP code) / Location     City     

Township     

County     

Indiana Historic Sites and Structures Inventory survey number (xxx-xxx-xxxxx) *     

* From the State Historic Architectural and Archaeological Research Database (SHAARD) (https://secure.in.gov/apps/dnr/shaard/welcome.html)

or the applicable county interim report which can be found at local libraries).

DescriptionDescribe the historic and current physical appearance of the building, buildings, and/or property. Include information about materials, such as type of siding, windows, or masonry, if appropriate. If more than one building or resource is present, include a brief description of each. For each building or resource determine which ones contribute to the significance of the property and which ones do not. Resources that contribute to a property are those that are at least fifty (50) years old and retain historic integrity. Resources that are less than fifty (50) years old and/or have been significantly altered from their original appearance should be considered noncontributing. Describe the interior layout of key buildings. Include information about significant alterations to resources and the overall property. Include dates of alterations if known. (Space will expand to accommodate text.)     

SignificanceProvide a brief discussion of why the property is significant: architecturally - it is a good example of an architectural style or type; historically - it is associated with important events or persons; and/or archaeologically - the property has the potential to yield important information about history or pre-history. (Space will expand to accommodate text.)     

HistoryProvide a brief history of the property including information regarding former owners and uses. (Space will expand to accommodate text.)     

Maps and PlansProvide an overall site plan of the property with a clear boundary indicated. This can be an internet-based satellite or aerial map with a hand-drawn boundary. The site plan can also be hand drawn and does not have to be to-scale, but should be an accurate representation of the layout, placement, and relationship of the resources and the overall property.

Provide floor plans for each key building. The plans do not have to be to-scale, but should be an accurate representation of the layout and size of rooms and spaces.

Include a north arrow and street names on plans and maps.

PhotographsProvide digital, full-color photographs. Each should be labeled with a distinct number. The photographs should be labeled on the site plan and floor plans indicating their location and direction. For a single building, ten (10) to twelve (12) photos should be sufficient. For large buildings, multiple buildings, or unusual resources, submit enough photos to adequately document the resource(s). For exteriors, provide photos of each façade of key buildings (more than one façade can appear in a photograph). For properties including more than one building, provide a view of each building. It is acceptable to include more than one building per photograph. For interiors, provide full-room views of all principal spaces.

Submit to: Indiana Department of Natural Resources

Division of Historic Preservation and Archaeology402 West Washington Street, Room W274

Indianapolis, Indiana 46204Telephone Number: 317-232-1646

The following CoA must be completed and sent with Application:

INSTRUCTIONS FORAPPLICATION FOR A CERTIFICATE OF APPROVAL

Part of State Form 52889 (R / 10-17)

BACKGROUND

Indiana Code § 14-21-1-18(a) and (b) require that a certificate of approval be obtained before using state funds to alter, demolish, or remove an historic site or historic structure, if it is owned by the state or if it is listed in either the Indiana Register of Historic Sites and Structures or the National Register of Historic Places. The application must be submitted to the Department of Natural Resources, Division of Historic Preservation and Archaeology (“DHPA”), and heard by the Historic Preservation Review Board (“Review Board”).

A state administrative rule regarding the certificate of approval process, 312 IAC 20-3-3, took effect on December 1, 2003. The rule requires that a completed application for a certificate of approval be filed with DHPA at least forty (40) days prior to the Review Board meeting at which the application is to be considered. The rule also requires that the application be submitted on a form to be provided by DHPA. This is the form to be used for the application.

DETERMINING WHETHER A CERTIFICATE OF APPROVAL IS REQUIRED

If the state agency or its applicant for funding is not certain whether or not the project will alter, demolish, or remove a site or structure that is historic, then the state agency or applicant may ask for DHPA’s technical advice on the historical, architectural, or archaeological significance of sites or structures, or on the project’s impact on them, before applying formally for a certificate of approval. Depending on the nature of the project and the properties it could impact, the Director of DHPA or his staff may recommend that additional information be provided for the benefit of the Review Board, such as the report of an archaeological investigation of an undisturbed parcel of land, a structural report on a structure proposed for demolition, or photographs of work areas and detailed plans and specifications of proposed rehabilitation work.

Consequently, it would be advisable for the applicant to consult informally with the DHPA staff well before the forty (40) day deadline for filing the application for a certificate of approval, so that the staff could advise the applicant whether any of those additional items will be needed prior to the Review Board meeting. Similarly, the DHPA staff informally can advise the applicant of any other, obvious information deficiencies or of questions that the Review Board likely would want to have answered before the Review Board meeting.

COMPLETING AND FILING THE APPLICATION FORM

Once it is determined that an historic site or historic structure will be altered, demolished, or removed and that a certificate of approval will have to be obtained, please complete the form below. Attempt to respond to the numbered items below on the application form. If you have an electronic copy of this form, you may enlarge the space provided between questions in order to accommodate your written response. If any of the requested information will not fit into the spaces below the appropriate numbered item, then you may provide that information on additional sheets that you may attach. Also, indicate where that information may be found (e.g., “Continued on attached sheet” or “See response on page 1 of the attachment” or “Photographs attached”). If any requested item of information is inapplicable, then please explain.

Please file one (1) copy of the application form and of any attachments to the DHPA at least forty (40) days prior to the meeting at which you wish to have the application considered by the Review Board . You will be notified by DHPA staff if an additional eleven (11) copies are needed for Review Board consideration. To be deemed filed, the application must be received at the DHPA office no later than 4:45 PM on the day that is forty (40) days prior to the date of the meeting. The Review Board typically meets on a Wednesday in the last half of January, April, July, and October.

You may check with DHPA to ascertain the date of the next meeting and the date on which the forty (40) day deadline falls. BEFORE THE REVIEW BOARD MEETING

The agenda, staff comments, and applications for certificates of approval are mailed to Review Board members about two (2) weeks prior to the next Review Board meeting. The applicant’s principal contact person will receive a copy of the staff comments after they have been prepared for the Review Board members and prior to the meeting. To save on postage and copying costs, the DHPA staff prefers to send the agenda and staff comments by e-mail, so please provide an e-mail address for the principal contact person on the project.

The principal contact person and/or another representative of the certificate of approval applicant who is knowledgeable about the details of the project should plan to attend the Review Board meeting. Typically, an applicant is given a few minutes to explain the project or to highlight key points, and the Review Board members often ask questions about the application.

EXPIRATION DATE

By board policy, a certificate of approval granted by the Indiana Historic Preservation Review Board shall be in effect for two (2) years from the date of issuance, unless otherwise specified. An applicant that requests an extension to a certificate of approval prior to its expiration, is automatically granted a temporary extension until such time as the board may act upon the request to approve or deny further extensions of time.

MAILING OR DELIVERY ADDRESS FOR THE APPLICATION

Indiana Department of Natural Resources Division of Historic Preservation and Archaeology402 West Washington Street, Room W274Indianapolis, Indiana 46204-2739

FOR MORE INFORMATION

Questions about issues pertaining to structures should be directed to the Historic Structures Review Section of DHPA. Questions about archaeological matters should be directed to the Archaeology Section. Either section may be contacted at 317-232-1646 or at dhpa@dnr.in.gov.

APPLICATION FOR A CERTIFICATE OF APPROVALState Form 52889 (R / 10-17)DEPARTMENT OF NATURAL RESOURCESDIVISION OF HISTORIC PRESERVATION AND ARCHAEOLOGY

Please provide the information requested in the numbered items below, or explain why it is inapplicable. Expand response spaces as needed or attach additional sheets for complete explanation.

1) Identify the state agency that will be spending or providing the funds and the entity (local government, not-for-profit organization, etc.), if any, that is applying for or that has received the state funds.     

________________________________________________________________________________________________

2) Provide the name, mailing address, telephone number, and other pertinent information (e.g., facsimile number and e-mail address) of the principal contact person for this application. The principal contact person may be an official or an employee of the state agency, of the applicant for funding, or of the state agency’s or the applicant’s consultant or other agent.      

________________________________________________________________________________________________

3) Provide the address, if any, and the nearest city or town, township, and county of the proposed project area.     

________________________________________________________________________________________________

4) Provide a detailed description of all construction, demolition, landscaping, earthmoving, rehabilitation, and installation activities (i.e., scope of work).     

________________________________________________________________________________________________

5) Provide a detailed explanation of how, and to what extent, land, buildings, structures, or objects, in or adjacent to the project area, could be physically altered or visually modified or obscured.     

________________________________________________________________________________________________

6) Describe the current and past land uses within the project area. In particular, state whether or not the ground is known to have been disturbed by construction, excavation, grading, or filling, and, if so, indicate the part or parts of the project area that have been disturbed and the nature of the disturbance. Be aware that agricultural tilling generally does not have a serious enough impact on archaeological sites to constitute a disturbance of the ground for this purpose.     

________________________________________________________________________________________________

7) State the known or approximate dates of construction of structures (including buildings, bridges, monuments, picnic shelters, historic districts, etc.) and any other historical information known about the land and structures within the project area. It may be necessary to consult a local history text, the interim

report of a local historic sites and structures inventory, the county historian, or a local historical or historic preservation organization for this information.     

________________________________________________________________________________________________

8) State whether or not any other structures could be sold, leased, altered, demolished, or removed as a result of the acquisition or construction of a new facility, and, if so, provide the information in 5) and 6), above, for those structures.      

________________________________________________________________________________________________

9) Attach a map, or a good quality photocopy of a map, identifying the location of the project, and showing the relevant portion of the city or town, county, or U.S. Geological Survey quadrangle. Be sure that streets, roads, highways, railroads, rivers, lakes, etc., are clearly identified and that the boundaries of the project area and of any property to be sold leased, altered, demolished, or removed are clearly outlined in a dark ink (highlighter and pencil marks do not photocopy well).

If there are other properties within or adjacent to the project area that are or may be at least fifty (50) years of age, then they should be identified on the map and keyed to written descriptions in the letter and to any photographs included with the letter and map.

________________________________________________________________________________________________10) Attach recent photographs (exterior and, if possible, interior) of any structures that may be fifty (50) years old or older

and that could be impacted in any way (such as by demolition, rehabilitation, expansion, sale, taking of right-of-way, or visual modification or obscuration) by the project.

________________________________________________________________________________________________11) Provide a site plan for projects that will involve new construction, additions to existing buildings, changes in right-of-

way or earthmoving activities, showing the footprint of existing and/or proposed buildings or structures with the location of all construction, changes in right-of-way or earthmoving activities on a particular lot or lots depicted as precisely as possible.

________________________________________________________________________________________________12) For projects involving the addition to, or the rehabilitation or restoration of, an historic structure, provide copies of

architectural or engineering plans or specifications. Provide only those sheets that help to depict character defining features of the historic structure and how they will be altered. Reduce any plan or elevation sheets to no larger than 11” x 17”. If pertinent notes on the sheets are too small to read in reduced form, then they should be reproduced elsewhere in the application in larger print. Similarly, if the applicant believes it would be useful to provide copies of specifications for the treatment of historically or architecturally significant features, then please reproduce only the most relevant pages from the specifications.

________________________________________________________________________________________________13) If an historic site or historic structure will be altered, demolished, or removed as part of the project, then identify any

alternatives that were, or reasonably could be, considered that would not have as great an impact on the historic site or structure. Discuss the advantages and disadvantages of those alternatives and their feasibility. If there are no feasible alternatives, please explain.     

________________________________________________________________________________________________14) Certificates of approval granted by the Indiana Historic Preservation Review Board expire two (2) years from

issuance, unless otherwise specified or extended by action of the board. If requesting a longer timeframe for completion, please note the time (in years) and briefly state reason(s) below.     

________________________________________________________________________________________________

PROJECT NARRATIVE(LIMITED TO FOUR (4) PAGES TOTAL)

1) Briefly describe the building and give a short summary of the building’s history. What was the original use of the building and what is the building’s current use? Will any persons or businesses be displaced during the timeframe of the project? (It may be necessary to consult a local history text, the interim report of a local historic sites and structures inventory, the county historian, or a local historical or historic preservation organization for this information.)

2) If known, what planning has been completed in the last five years? Describe any substantial work that has been performed on the building to include all construction, demolition, landscaping, earthmoving, rehabilitation, and installation activities (i.e., scope of work).

3) Provide a detailed explanation of how, and to what extent, land, buildings, structures, or objects, in or adjacent to the project area, could be physically altered or visually modified or obscured. If so, how will the applicant work with other properties on issues that may arise? (Please include any correspondence with adjacent property owners and / or local preservation commission or local government authorities.)

4) What is the planned use of the building following this project? If the building is rehabilitated, will it have a new use? Describe changes that will be made to the building in order to accommodate this new use. Will these changes impact historic features? Refer to the Secretary of the Interior’s Standards for Rehabilitation in evaluating your project. What plans are in place to maintain current ownership? Please include any lease details, names and summary of any tenants who will be leasing the units as well as approximate dates of occupancy. These details should help to assure as to the dates the property will be used for trade or business.

5) Describe any additional work that needs to be done following the completion of this project. What is the plan for routine maintenance and long-term preservation of the building?

6) How is this project important to the long term community and economic development activities of the area? If the project is in a designated Indiana Main Street district, how is this project part of the group’s overall strategy? Please include excerpts of plans if possible.

7) Describe the public benefit of this project. Is the building easily visible from public places? Is it important to the history of the community or an important local symbol or landmark?

8) Please indicate the expected number of full time jobs, part time jobs, new businesses and new housing units that will be created in regards to this project.

December 2017 12

PROJECT COMPLETION TIMELINEBeginning with the application submission date, outline below a reasonable timeline for project completion. Include all significant milestones, emphasizing those related to grant award, drawdown of funds, final plans submission and completion. (All projects awarded funding must be completed within 18 months of contract execution.)     

December 2017 13

PROJECT SCOPE OF WORKThe project Scope of Work (SOW) is a key component to this grant application. A well-written SOW clearly defines the tasks/work that will be accomplished during the grant period. During the grant application process, the SOW can demonstrate to grant reviewers whether or not the grant applicant is aware of all the requirements a project may have, as well as the appropriate priority and planning involved.

Clearly provide a detailed project SOW and include any necessary related items. Refer to the Secretary of the Interior’s Standards and National Park Service Preservation Briefs for technical assistance (https://www.nps.gov/tps/how-to-preserve/briefs.htm)

December 2017 14

Sample Scope of Work (please delete and replace with your scope of work)

West Façade - Portico–Scope of Work1. Repoint and repair cracks in the masonry at windows. Repair the masonry around the HVAC unit after HVAC replacement occurs. Match all surrounding masonry and mortar in composition, color, size, and shape. Match existing wall pigmented wash. (Refer to any attached photographs or renderings of windows)2. Remove all loose paint, scrape windows, door, and wood trim. Lightly sand painted surfaces. Apply a primer and two finish coats of paint to all painted surfaces. Follow all applicable laws and regulations concerning lead paint. 3. Remove paint and finish down to bear metal at rusted areas of fluted columns. Remove all surface rust. If rusted areas have significantly pitted the metal, or have rusted through areas, fill those areas with an epoxy sheet metal patching system. Sand smooth to match adjacent surfaces so that the patch is not detectable. Apply corrosion inhibiting primer and two coats of finish paint to the columns. Apply texture to match existing finish. (Refer to any attached renderings of work to be done)

PROJECT BUDGETLine Item Budget

Grant Request Local Match Ineligible Total Professional Fees(all professional fees are local ineligible match only) $ $

Program Costs These include specific details including cost breakdown for each item, the quantity and the price

$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $$ $ $

Costs Subtotal $ $ $

Total Grant Funds $ $Total Match $ $

Total In-kind $ $Total Project Budget $

Clearly define number of items and cost of each in the tablePlease itemize all scope of work budget details. Application will not be approved if budget does not add up.All grant request amounts need to be rounded to the nearest dollar.Please assure your amounts are accurate and consistent throughout the application

NOTE: The grant award is considered taxable income in the year that it is used.  Awardees should consult with their legal counsel or accountant for more information.

December 2017 15

PROJECT BUDGET Table of Matching Funds

This form must be completed for all projects and documentation of financial commitments from all sources is required. Please note any match contributed to the project on this form.

Source of Project Funds Local Match Ineligable Total

Total Funds*If financing is required by the applicant, a bank letter outlining preliminary approval of match funds

including interest rate and collateral requirements must be attached.

December 2017 16

PROJECT ESTIMATES (Attachments)

All estimates shall be on the letterhead or forms used by a qualified contractor, tradesperson, or building product supplier. The property owner is encouraged to select the contractor, subcontractor or tradesperson(s) most qualified to perform the work planned. The choice of the contractor used is at the sole discretion of the property owner. A change from the companies or individuals originally submitting estimated for your application is acceptable as long as the approved scope of work is completed. Selection of the lowest price is not required. In fact, a higher bid that utilizes more appropriate materials or provides evidence of skilled workmanship may increase your chance of being selected for funding.

December 2017 17

SITE CONTROL CERTIFICATION

As Applicant, I hereby certify that the following activities have been completed respective to all interests in real property which are related or involved with the project:Yes N/A

All project-related sites, parcels, easements and other real property interests have been identified. All subject parcels, easements or interests are unencumbered to the extent that the same

may be dedicated to the project by the owner(s) of title. All options and easement agreements completed and fully executed by owner(s) of record. All subject parcels are current on tax payments. Proof will be required upon award announcement. Site has a lien on property (liens may include voluntary or involuntary

Please describe any voluntary liens on the property:      Please describe any involuntary liens on the property:      

Applicant

      _______________________________Typed Name and Title Signature

Date:      , 20     

December 2017 18

Include the following attachments in Appendix A:Proof of Eligibility: Attach documentation to verify the property meets the requirement of one of the following: listed individually in the State Register (include National Register (NR) number), is a contributing resource in a historic district listed in the State Register, or is individually eligible for listing in the State Register. To find out if the property is listed or eligible for listing in the State Register, go to http://www.in.gov/dnr/historic/2829.htm for instructions on how to find State Register listing status and information, if applicable, or how to obtain a Determination of Eligibility from the Indiana Department of Natural Resources Division of Historic Preservation and Archaeology (DHPA). Please note that Determinations of Eligibility will only be issued for individual sites; there is no provision for determinations of eligibility for historic districts for the State Register. Additionally, a current determination of eligibility does not insure listing a property in the State Register at a later date.Maps: Attach color maps identifying the location of the project and showing the relevant portion of the city or town, county, or U.S. Geological Survey quadrangle. Be sure that streets, roads, highways, railroads, rivers, lakes, etc., are clearly identified and that the boundaries of the project area and of any property to be altered are clearly outlined. If the property is in a designated Indiana Main Street community, you must include a copy of the Main Street defined downtown area map and your property clearly identified in this larger area map. If the property is listed as part of a district please include the district map with the subject building highlighted. Instructions to find the map of the historic district can be found at (DHPA web link).Photographs: Attach recent photographs (exterior and, if possible, interior) of any structures that may be fifty (50) years old or older and that could be impacted in any way by the project. Applications must include photographs documenting the appearance and condition of the building’s exterior, interior, site and environment prior to the start of the stated project and what repairs will be done. Where such documentation is not provided, review and evaluation cannot be completed, resulting in denial of the requested funding. (For more information on labeling photographs go to page 14).Site Plan : Provide a site plan for the project showing the footprint of existing buildings or structures with the location of all construction, changes in right-of-way or earthmoving activities.Plans or Specifications: Provide copies of architectural or engineering plans or specifications. Provide only those sheets that help to depict character defining features of the historic structure and how they will be altered. Reduce any plan or elevation sheets to no larger than 11” x 17”. If pertinent notes on the sheets are too small to read in reduced form, then please provide a PDF copy of the drawings on CD. Please include any pertinent lease terms for occupancy of residents or businesses.** If there are other properties within or adjacent to the project area that are or may be at least fifty (50) years of age, then they should be identified on the map, site plans, and photographs so as to adequately show their relation to the project area and possible impacts of the project to that property.Proof of Local Match Funds: In order to be considered for this grant the applicant must provide a letter or statement from their bank confirming adequate funds to cover their portion of the budget. Confirmation must be at a minimum the total of the local match funds. Please do not include bank account number.IRS W9 Form: Please attach a completed Form W9 Request for Taxpayer Identification and CertificationProof of Not-for-Profit Status: If applicant is a not-for-profit organization, a statement from the IRS or Indiana Secretary of State must be provided.Other Supporting Documentation: Provide any additional documentation to show the importance of the project to the long-term community and economic development activities of the area or local Main Street group’s strategy.

December 2017 19

Appendix A guidelines(see samples and instructions below, remove samples for final application submittal)

Photographs

Applications must include photographs documenting the appearance and condition of the building’s exterior, site and environment prior to the start of project). Where such documentation is not provided, review and evaluation cannot be completed, resulting in denial of the requested certification.

Number of photographsApplicants must use their judgment as to how many photographs adequately "tell the story" of their building. Large or complex projects often require more photographs to illustrate the various elements and areas the building and site.

Labeling photographsPhotographs must be labeled with the following information:

Building name and/or address; View shown (e.g., north side); Description of the view (e.g., fascia damage, north wall); Description of work to be done to repair / restore / renovate / rehab area; Date taken.

Photographs must be numbered and keyed to both the description of proposed work in the application and photo keyed plans of the building and site.

Clarity of photographsPhotographs must be clear and must have sufficient resolution to show the details required for review of rehabilitation work. Photographs must be:

In color; Taken at a high resolution;

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Printed on photographic, not photocopy, paper. Professional printing is recommended for best results; Printed at least 4” x 6” in size. Do not stretch, or alter the aspect ratio of photo

Format of photographsPhotographs must be printed. Photocopied photographs (black and white or color), instant photographs, and photographs smaller than 4” x 6” are not accepted. Applicants may submit disks of digital photographs, only if printed photographs meeting all of the above criteria are also included in the application materials submitted for review.Applications with photographs that are not adequate for review will be placed on hold, and applicants will need to submit better quality photographs before review is completed of the application.

DrawingsDrawings or sketches done by an architect or qualified professional are required for proposed work to show planned alterations or new construction. They must be sufficiently detailed to show existing wall configurations and anticipated changes. Documentation should include floor plans and, where necessary, sections and elevations. All drawings and sketches submitted with the application should be numbered and should be keyed to the application narrative.Do not include unnecessary drawings. Typically, mechanical, plumbing and electrical plans generally do not contain information that is pertinent to this review. However, the placement and size of these features often impacts the character of historic buildings. A detailed description of the location, size, and finish of these features should be included in the narrative. OCRA staff can assist with the determination as to what drawings would be helpful in a particular project.

Maps and Site PlansAttach color maps identifying the location of the project and showing the relevant portion of the city or town, county, or U.S. Geological Survey quadrangle. Be sure that streets, roads, highways, railroads, rivers, lakes, etc., are clearly identified and that the boundaries of the project area and of any property to be altered are clearly outlined. If the property is in a designated Indiana Main Street community, you must include a copy of the Main Street defined downtown area map and your property clearly identified in this larger area map. Provide a site plan for the project showing the footprint of existing buildings or structures with the location of all construction, changes in right-of-way or earthmoving activities.

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