2. 
4. Date
   Date
6. Address of Property
8. Applicant name
9. Phone
11. Applicant address
13. E-mail
15. Property owner name
16. Phone
18. Property owner address
20. E-mail
22. Block/lot #
23. Zoning district
25. **A Certificate of Appropriateness must be recommended by the Historic Review Commission and approved by Borough Council prior to issuance of a Building Permit.
27. REQUIREMENTS:
29. Dependent upon the scope of the project, the building inspector will determine which of the requirements are necessary in each case to accompany the application in order for the commission to make an informed decision.
31. 1. Photographs: 3” x 5” (or larger) photographs, in color if possible, showing the existing structure from all four (4) sides, its relationship with other structures on site or on adjacent property and is relationship on its block.
33. 2. Site Plan: Scale 1inch = 20.0 feet, identifying all property lines, metes and bounds, all structures, paved areas, acreage noted and adjacent properties with owners name noted.
35. 3. Floor Plan or Plans: Showing detail for any affected area ¼ inch = 1.0 feet, detail and note affected area.
37. 4. Elevations: Showing detail for any affected areas ¼ inch = 1.0 feet.
39. 5. Prospective and/or other renderings: If necessary to enhance the presentation.
41. 6. General product specifications/cuts: Noting products to be used, i.e., doors, windows, walls porches, light fixtures, etc.
43. 7. Samples: Finish materials as may be necessary to enhance the presentations, i.e.; Bricks, siding, shingles.
45. 8. Historic Information: Any available documentation of the history of the site and the structure and its architectural style would be useful to the commission in its deliberations.
47. 9. Sections:
49. Submitted Materials:
51. A. Photographs

    1. Provided
    2. Accepted
52. Date
    Date
53. B. Site Plan

    1. Provided
    2. Accepted
54. Date
    Date
56. C. Floor Plan(s)

    1. Provided
    2. Accepted
57. Date
    Date
58. D. Elevations

    1. Provided
    2. Accepted
59. Date
    Date
61. E. Perspective/Renderings

    1. Provided
    2. Accepted
62. Date
    Date
63. F. General Product Specs.

    1. Provided
    2. Accepted
64. Date
    Date
66. G. Samples

    1. Provided
    2. Accepted
67. Date
    Date
68. H. Historic Information

    1. Provided
    2. Accepted
69. Date
    Date
71. I. Sections

    1. Provided
    2. Accepted
72. Date
    Date
74. Signatures:
76. Owner Signature
77. Applicant Signature
79. Owner's Representative Signature
80. Date of Historic Review Committee Meeting
    Date of Historic Review Committee Meeting
82. Recommendation:
84. Secretary Signature
86. Sewickley Borough Council at its regular meeting on ______________________, approved/denied this application.

    1. Approved
    2. Denied
88. President of Council Signature
90. *Original signature mandatory. Please print, sign, and submit to the Building Inspector.*
Leave This Blank:


91. Print Only

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