HOLDEN HISTORIC DISTRICT COMMISSION
TOWN HALL
HOLDEN, MASSACHUSETTS
APPLICATION FOR CERTIFICATION
(to be submitted in triplicate)
Pursuant to the Historic Districts Acts (General Laws, Chapter 40C as amended) and the Holden Historic District by-law, application is hereby made for certification of proposed exterior work within the Holden Historic District.
1. Type of Certification Sought .
Check one of the following:
Certificate of Appropriateness
Certificate of Nonapplicability
Certificate of Hardship
2. Location of Proposed Work .
Identify the location of the proposed work. Street and number is sufficient if the work is to be done on an existing building.
3. Description of Proposed Work .
Fully describe the proposed construction. Submit copies of plot plans, site plan, architectural plans and specifications where applicable. Check the applicable categories listed below. When the proposed work includes relocation or demolition, provide plans and specifications for restoration of the grounds. If alteration is proposed, check the exterior features listed under that heading that will be altered and describe in detail.
New construction Relocation Demolition
Alteration:
Chimneys Roofing
Roof accessories Gutters & rain leaders
Antennae Siding
Exterior trim Parking areas
Entrances Walks
Porches & verandas Steps
Exterior stairs Railings
Exterior doors Fences & walls
Door accessories Exterior ornaments
Windows Monuments
Shutters, blinds & accessories Signs
Awnings Decorative lighting
Paint Exterior lighting
Driveways Utilities
Other
4. Application of Hardship .
If this is an application for a Certificate of Hardship, indicate on a separate sheet the reasons: (a) why failure of the Commission to approve the application will involve substantial hardship to the applicants, (b) why no substantial detriment to the public welfare would result from approval of the application, and (c) why approval of the application would not result in substantial derogation from the intent and purposes of the Massachusetts Historic District Act and the Holden Historic District by-law.
5. Give the name, address and telephone number of the following persons:
Applicant:
Owner(s) (if different)
Architect (if applicable)
General Contractor or Builder (if applicable)
6. Signature of Applicant:
Signature of owner(s)
Date
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