APPLICATION FOR CERTIFICATION OF APPROPRIATENESS
Cookeville Historic Zoning Commission
Cookeville Regional Planning Commission
Certificate (File) No. ____________ Date Filed: ______________
1. NAME OF APPLICANT: _____________________________________________________
Address: ___________________________________________________________________
Telephone (Day): _________________
Relationship to Owner: ___ Lessee ___ Contractor ___ Architect ___ Other:
(explain) ___________________________________________________________________
2. NAME OF OWNER: ________________________________________________________
Address: _______________________________________
Email: _________________
3. LOCATION OF PROPERTY (Address, Lot and Parcel No.):_________________________
__________________________________________________________________________
4. TYPE OF WORK:
A. ___________ Exterior alteration or repairs.
B. ___________ New Construction: 1)____Primary Structure;
3) ___ New Addition;
2)____Garage;
4)____Other
C. ___________Demolition: 1)____Whole Structure; 2) ____Part of Structure.
D. ___________Relocation of Structure
5. DESCRIPTION OF WORK: (See page 2 of this application for additional information to be
submitted with the application. A copy of all information which is submitted with an
application must be retained by the Cookeville Historic Zoning Commission.)
6. SIGNATURE OF APPLICANT:________________________________________________
Date:______________________
7. Return application to: Cookeville Historic Zoning Commission
P.O. Box 998
45 East Broad Street
Cookeville, TN 38503-0998
FOR STAFF USE ONLY
Date Received______________
Approved ____________ Disapproved ______________ Approved as Modified _____________
Date Acted On __________________
Email: ____________________________
Telephone:
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Page 2 INFORMATION TO BE SUBMITTED WITH YOUR APPLICATION.
(Attach the following information for each category of work proposed).
1. EXTERIOR ALTERATION OR REPAIR
A. Check each work item for which approval is requested.
____Architectural feature ____Parking lot (paving, ____Satellite dish
(decorative ornamentation) entrance drive, landscaping) ____Security grilles on
____Awning or canopy ____Porch (columns, cornice, trim windows or doors
____Curb Cut railings, flooring, trelliswork, Shutters ____
____Deck ____Sidewalks steps, ornamentation)
____Door ____Material changes (wood, brick, ____Siding
____Fence metal, etc.) ____Signs
____Guttering ____Mechanical system unit ____Solar collectors
____Light Fixture ____Retaining wall ____Storm window/doors
____Masonry cleaning, ____Roof (change in shape, features, ____Windows, skylights
tuckpointing, or painting or materials) ____Other
B. List and describe in detail all work to be done for each item checked. Include the
following materials when appropriate:
1) Sketches, photographs, specifications, manufacturer’s illustrations or other
description of proposed changes to the building’s exterior. Detailed drawings are
required for major changes in architectural features.
2) If application is for a fence, include a site plan in addition to the information in item
1.
3) If material changes are proposed, please provide a description of them. The
architect’s specifications or brochures should suffice; however, the Commission may
request samples of new materials.
2. NEW CONSTRUCTION: Describe the nature of the proposed project. Include the following
materials when appropriate:
1) Site plan with measured distances.
2) Elevation drawings of each façade and specifications which clearly show the exterior
appearance of the project.
3) Samples or other description of materials to be used.
4) Drawings or other description of site improvements such as fences, sidewalks, lighting,
pavement, decks, etc.
3. DEMOLITION OF STRUCTURE
A. Describe the structure’s condition and reason for demolition.
B. Describe the proposed reuse of the site, including drawings of any proposed new
structure or landscaping.
4. RELOCATION OF STRUCTURE
A. Explain what will be moved, why, and proposed changes.
B. If a building will be moved into a district from outside, include photographs.
C. Include a site plan of the proposed location in the district and describe any site features
which will be altered or may be disturbed, including foundations, walls, vegetation, etc.
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