"This institution is an equal opportunity provider and employer.
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online
at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a
letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of
Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email
at program.intake@usda.gov.”
Ulster County Economic Development Alliance
P.O. Box 1800, 244 Fair Street
Kingston, NY 12402-1800
Tel: 845.340.3556
Michael P. Hein
County Executive
Ellenville Million
Main Street Façade Program
Application Form
Cover Sheet
PROJECT NAME: ______________________________________________________________________
APPLICANT NAME: ____________________________________________________________________
APPLICANT PHONE NUMBER: ___________________________________________________________
APPLICANT’S STREET ADDRESS: ________________________________________________________
APPLICANT’S MAILING ADDRESS: _______________________________________________________
CITY: _______________________________ STATE: __________________ ZIP: ___________________
TELEPHONE: ____________________________ FAX: ________________________________________
FEDERAL TAX ID NUMBER: _____________________________________________________________
Application Date: _______________________
1. Project Address: _________________________________________________________________
2. Does the applicant own the commercial building? Yes ○ No ○
3. If the answer to question 2 is No, attach a letter from the building owner providing approval of the
project proposal.
4. Will the services of an architect be used? Yes ○ No ○
5. Describe the proposed improvements: ________________________________________________
6. Estimated total project cost: ________________________________________________________
7. Proposed start and completion dates:_________________________________________________
8. What is (are) the existing use(s) of the building? _______________________________________
9. Will this project proposal result in a change in the building’s use? Yes ○ No ○
If Yes, to what? __________________________________________________________________
10. Check List: Attached?
A. Drawings and plans of the building which Yes ○ No ○
illustrate all proposed work, including
any structural work or repair, paint colors,
awnings (sample of material), signage, etc.
B. Information on the methods and material Yes ○ No
to be used.
C. Itemized cost estimates of all proposed work. Yes ○ No
D. Copies of building and zoning permits. Yes ○ No ○
11. The undersigned affirms that:
A. The information submitted herein is true and accurate to the best of my (our)
B. I (we) have read and understand the rules of the Ellenville Million Main Street Façade
Program and agree to abide by its conditions and guidelines.
C. I (we) understand that all work completed on the project must be by approved methods
and with approved materials. Any variance from that which is agreed upon, without
prior approval, may result in the forfeit of any funds from the Ellenville Million Façade
12. The undersigned applicant agrees to comply with the requirements of this program as outlined in
the Ellenville Million Main Street Façade Program Rules.
Signature of Applicant(s):
_____________________________________________________ Date: _____________
_____________________________________________________ Date: _____________
Ellenville Million
Main Street Façade Program
Certificate of Approval
The Village of Ellenville Building Inspector conducted a final inspection of the property located at
________________________________________ on
______________________________, 20_____. All improvements comply with the application and
the Ellenville Million Main Street Façade Program rules. The Village of Ellenville is hereby
authorized to issue payment.
The Village of Ellenville
____________________________________________ Date: _____________
Building Inspector