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Burlington Historic Preservation Commission APPLICATION FOR CERTIFICATE OF APPROPRIATENESS MAJOR WORK ITEM I (we) the undersigned do hereby respectfully make application for a Certificate of Appropriateness for the following plans and proposals to be undertaken within the boundaries of the following Burlington Historic District: West Burlington Glencoe Mill & Mill Village Property Address: Applicant’s Name, Address and Phone: Owner’s Name & Mailing Address (if different from above): TYPE OF MAJOR WORK: (please check one and refer to pages 9-12 of the Design Review Guidelines for a list of major work items) New Construction or Addition Major Exterior Alteration or Repair Demolition of Structure(s) Relocation of Structure(s) Major Landscaping Other: ***see page 2 of this application for other required information to be submitted*** A complete application, including required items (see page 2) and all additional information requested by Planning Department Staff and/or the Design Review Committee must be received by the Planning Department no later than 15 working days prior to the next regularly scheduled meeting of the Burlington Historic Preservation Commission. The commission meets on the second Tuesday of each month at 7:30p.m. in the Planning Conference Room, Municipal Building, 425 South Lexington Avenue. Any questions may be directed to the Planning Department at 222-5110. Due to a high volume of applications and/or the scope of a project, you are strongly encouraged to submit your application at least one week prior to the submission deadline. This time is necessary for the Design Review Committee Chairman or his/her designated appointee to ensure the “completeness” of the application. It is the applicant’s sole responsibility to see that a complete working application is submitted by the 15-working day deadline mentioned above. Final drawings to be presented at the public hearing must be submitted to the planning department no later than 5 working days prior to the meeting date. SUBMIT APPLICATION TO: Mail: City of Burlington Planning Department Post Office Box 1358 Burlington, NC 27216-1358 Fax: (336) 513-5410 Applicant’s Signature and Date: For Office Use Only Date Received and Initials: Project Number: Certified “Complete” by (name and date): Map/Block/Lot Number: ---PAGE BREAK--- (MAJOR WORK) DIRECTIONS FOR INFORMATION AND MATERIALS TO BE SUBMITTED AS PART OF A COMPLETE APPLICATION 1. New Construction or Addition On the last page of this application, describe clearly and in detail all work to be done and attach the following applicable items: A. Full site plan and floor plan with dimensions and measurements showing location of any existing structures or proposed improvements. Plans must include a scale (quarter inch scale preferred for floor plans). Site plans must also include property lines and a north arrow. Major grading requires a scaled topographic plan. B. Architectural elevation drawings of each facade with measurements and specifications which clearly show the exterior appearance of the project, such as siding material and dimensions, window style and dimensions, roof pitch, etc. Drawings must be submitted at true scale (quarter inch scale preferred). C. Samples of materials or manufacturer’s illustrations of materials being used, such as masonry, siding, shingles, etc. D. Photographs of existing site or similar projects (optional). Note: Planning Department staff will provide basic photography and video services. 2. Major Exterior Alteration or Repair Same requirements as New Construction or Additions. Note: Architectural elevation drawings are only required for affected elevations. 3. Major Landscaping A. Scaled site plan of property locating building footprints, property lines, existing landscape features and any proposed deletions, additions or re-location of both natural and landscape features. Such features include but are not limited to plants, site grading, fences, walks, driveways, drains and lighting. Caliper of trees should be indicated as measured from four feet above the earth’s surface. Major grading requires a scaled topographic plan. B. Samples of materials or manufacturer’s illustrations of any physical landscape features such as fences, walks, driveways, drains and lighting. C. Photographs of existing landscape and similar physical features (optional). Note: Planning Department staff will provide basic photography and video services. 4. Demolition of Structure(s) A. Written information: on the last page of this application, describe the structure, give the reason for demolition, describe the proposed reuse of the site as well as new landscaping. B. Photograph of existing structure. Note: You may contact Planning Department staff for photography services. 5. Relocation of Structure(s) A. Written information: on the last page of this application, give the reason for relocation, describe any proposed structural changes and site features which may be altered or disturbed. Such features may include foundations, walls, driveways, vegetation, etc. B. Photograph of existing structure. Note: You may contact Planning Department staff for photography services. 6. Other Please contact Planning Department staff at (336) 222-5110. Property owners or a representative are strongly encouraged to attend the meeting. Copies of all information submitted with an application must be retained by the Burlington Historic Preservation Commission. page 2 ---PAGE BREAK--- (MAJOR WORK) WRITTEN INFORMATION Please attach any scaled drawings, maps or other information to the back of this application. page 3