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Burlington Historic Preservation Commission APPLICATION FOR CERTIFICATE OF APPROPRIATENESS MINOR 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 MINOR WORK: (please check one and refer to pages 8-9 of the Design Review Guidelines for a list of minor work items) Addition of Minor Features Minor Exterior Alteration or Repair Minor 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 may be submitted at any time for approval. If for any reason Planning Department Staff are not able to approve your application, it will be forwarded to the Historic Preservation Commission for consideration. Any questions may be directed to the Planning Department at 222-5110. 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: Written Description: if necessary, continue on page 2 For Office Use Only Date Received and Initials: Project Number: Certified “Complete” by (name and date): Map/Block/Lot Number: ---PAGE BREAK--- (MINOR WORK) DIRECTIONS FOR INFORMATION AND MATERIALS TO BE SUBMITTED AS PART OF A COMPLETE APPLICATION 1. Addition of Minor Features In the written description portion of this application, describe clearly and in detail all work to be done and attach the following applicable items: A. Plans showing the layout and dimensions of any new construction such as fences, signs, gutters or roof ventilators. B. Color schedule, samples or manufacturer’s illustrations of materials being used, such as masonry, siding, shingles, etc. C. Photographs of existing site or similar projects (optional). Note: Planning Department staff will provide basic photography services. 2. Minor Exterior Alteration or Repair Same requirements as New Construction or Addition. 3. Minor Landscaping A. Scaled site plan of property showing building footprints, property lines, existing landscape features and any proposed deletions, additions or re-location of both natural and physical landscape features. Such features include but are not limited to plants, fences, drains and lighting. Caliper of trees should be indicated as measured from four feet above the earth’s surface. B. Color schedule, samples or manufacturer’s illustrations of any physical landscape features such as fences, drains and lighting. C. Photographs of existing landscape and similar physical features (optional). Note: Planning Department staff will provide basic photography services. 4. Other Please contact Planning Department staff at (336) 222-5110. WRITTEN DESCRIPTION (cont.): page 2