Fillable Please submit to the Housing and Building Department (Village of Newburgh Heights)

Fill Online, Printable, Fillable, Blank Please submit to the Housing and Building Department (Village of Newburgh Heights) Form

Use Fill to complete blank online VILLAGE OF NEWBURGH HEIGHTS (OH) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Please submit to the Housing and Building Department (Village of Newburgh Heights)

On average this form takes 8 minutes to complete

The Please submit to the Housing and Building Department (Village of Newburgh Heights) form is 1 page long and contains:

  • 0 signatures
  • 23 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Newburgh Heights

BROWSE VILLAGE OF NEWBURGH HEIGHTS (OH) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
VILLAGE OF NEWBURGH HEIGHTS
Home Maintenance Grant Program
Application
Please submit to the Housing and Building Department
3801 Harvard Avenue, Newburgh Heights, OH 44107, Email kpagsuyoin@newburgh-oh.gov
Phone: 216-641-4654
PROPERTY ADDRESS TO BE CONSIDERED
APPLICANT INFORMATION
First Name:
Last Name:
Date:
Street Address:
Apartment/Unit #:
City:
Phone:
E-mail Address:
Submitted
Are you a Senior Citizen?
YES
NO
Birthdate (Proof of Age Required):
Are you a Military Veteran?
YES
NO
Copy of DD214 (Veterans Only)
Do you own the property being considered for
the Grant?
YES
NO
Proof of Ownership Required
Do you reside in the Village of Newburgh
Heights?
YES
NO
Proof of Residency Required
PROJECT DETAILS
Estimated Cost of Project: $________________________
Amount Requested for Reimbursement: $ _____________
(Receipts required)
Will you be performing the work? YES NO
(Reimbursement is for materials only when property owner completes the
repair)
Describe Project.
List Contractors
PROJECT INSPECTION (Office Use Only)
Pre-Inspection before Project Started? YES NO
Inspector/Date:
Inspection of Finished Project: Satisfactory Unsatisfactory
Inspector/Date:
Inspector Recommend Reimbursement? YES NO
Grant Approved/Date: YES NO
Approved by Building Commissioner:
Amount Approved for Reimbursement: $ ________________________
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to a reimbursement being granted, I understand
that false or misleading information in my application or inspection may result in my in being denied reimbursement funds. I agree and consent to the
required inspection for a reimbursement grant. Improvements must comply with all applicable state and local codes and regulations, including the Ohio
Building Code and Residential Code, and be reviewed and approved by the Building Commissioner.
Signature:
Date:
Ohio
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Please submit to the Housing and Building Department (Village of Newburgh Heights)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 19 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document