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Preservation Division. Planning staff can answer any questions (City of Lake Worth Beach)

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COMMUNITY SUSTAINABILITY
PLANNING ZONING HISTORIC PRESERVATION
1900 2ND AVENUE NORTH
LAKE WORTH BEACH, FL 33461
561.586.1687
Planning, Zoning & Historic Preservation Division | Department for Community Sustainability
City of Lake Worth Beach | 1900 2
nd
Avenue North | Lake Worth Beach, FL 33461
This application is required for ALL applications submitted to the Planning, Zoning and Historical
Preservation Division. Planning staff can answer any questions you have regarding the applications and
the processes during Planner On-Call hours:
Monday – Wednesday, 10:00 a.m. – 1:00 p.m. | Tuesday – Thursday, 12:00 p.m. – 3:00 p.m.
Please make an appointment with planning staff if you require more than 15 minutes with a staff
member. NOTE: PRE-APPLICATION MEETING REQUIRED FOR ALL CASES TO BE REVIEWED BY THE
HISTORIC RESOURCES PRESERVATION BOARD.
Application Type (select all that apply):
Exterior Alterations (roof, windows, doors, etc.)
Addition New Construction Demolition Relocation
Other:
PROJECT INFORMATION
Project Location:
Legal Description: ___________________________
PCN: 38-43-44-___-___- - Historic District: _________ Contributing?:
# of buildings/structures on property: ___ What type?: _____________________________________
Current Use: _____________________ __ Change of Use Proposed?: __________________________
Total Estimated Cost of the Project:
Are you requesting consideration of Economic Hardship? ____ If yes, please include required checklist.
FOR OFFICE USE ONLY
HRPB Project No.
Associated Project Nos.
Submittal Date
Sufficiency Date
Project Planner Assigned
Total Fee Amount
$ _______________ PAID ______________ DUE _____________
CERTIFICATE OF APPROPRIATENESS APPLICATION
Northeast Lucerne
1
Certificate of Appropriateness Application Page 2 of 7
APPLICANT INFORMATION
Project Manager/Contact Person:
Company:
Address:
(Street Address) (City) (State) (Zip)
Phone No.: E-Mail Address:
Applicant Name (if different from Project Manager):
Company:
Address:
(Street Address) (City) (State) (Zip)
Phone No.: E-Mail Address:
Owner Name:
Address:
(Street Address) (City) (State) (Zip)
Phone No.: E-Mail Address:
OWNER’S CONSENT (IF APPLICABLE)
(“Owner”) certifies that it is the owner of the property
located at
(“Subject Property”) and expressly consents to the use of the Subject Property as described in this
application and to all conditions that may be agreed to as a part of the approval of this application,
which may be imposed by the decision making board.
Owner hereby authorizes , as agent, to file this application
and represent Owner at any and all meetings and hearings required for the approval of this application.
Owner’s Signature: Date:
Name/Title of Signatory:
STATE OF )
COUNTY OF )
The foregoing instrument was acknowledged before me this _______ day of _____________________, 20__, by
________________________________________ who is personally known to me or who produced a
______________________________ as identification. He/she did not take an oath.
(NOTARY SEAL)
(Signature of Notary Public)
(Name of Notary)
January
19
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Certificate of Appropriateness Application Page 3 of 7
PROJECT INFORMATION
DESCRIPTION OF WORK:
Provide a detailed description of work to be done as a result of this application (attach additional sheets if necessary).
PRIOR APPROVALS:
Indicate any prior planning, zoning, historic or building approvals that you are aware of for the property (attach additional
sheets if necessary).
REQUIRED ATTACHMENTS FOR ALL APPLICATIONS
CERTIFICATE OF APPROPRIATENESS APPLICATION
Fill in all applicable fields and do not forget to include all required signatures.
APPLICATION CHECKLIST
Include all additional items as specified on each project specific application checklist if
applicable.
ĚĚŝƚŝŽŶĂůinformation may be required by Staff depending on the scope of each project.
JUSTIFICATION STATEMENT
Must address all compatibility criteria set forth in Section 23.5-4 Historic Preservation as
applicable. See page 7 of this application for details. See the back of each applicable
“Application Checklist” for details on additional specific criteria.
PHOTOGRAPHS
A minimum of one photograph of all elevations effected by the proposed project, including
detail shots of significant architectural features.
Digital, 35 mm, or disposable cameras. No Polaroids or Google Earth images.
Certificate of Appropriateness Application Page 4 of 7
AFFIDAVIT OF COMPLETENESS AND ACCURACY
INSTRUCTIONS: To be completed by the individual submitting the application (owner or authorized agent).
Project Location: Submittal Date:
STATEMENT OF COMPLETENESS AND ACCURACY:
I hereby certify all property owners have full knowledge the property they own is the subject of this application. I
hereby certify that all owners and petitioners have been provided a complete copy of all material, attachments
and documents submitted to the City of Lake Worth relating to this application. I further certify the statements or
information made in any paper or plans submitted herewith are true and correct to the best of my knowledge. I
understand this application, related application material and all attachments become official records of the
Planning, Zoning and Historic Preservation Division of Lake Worth, Florida, and will not be returned. I understand
that any knowingly false, inaccurate or incomplete information provided by me will result in the denial, revocation
or administrative withdrawal of this application, request, approval or permit. I further acknowledge that additional
information may be required by Palm Beach County to process this application. I further acknowledge that any
plans that I have prepared or had prepared comply with the Fair Housing Standards. I further consent to the City of
Lake Worth to publish, copy or reproduce any copyrighted documents submitted as a part of this application for
any third party. I further agree to all terms and conditions, which may be imposed as part of the approval of this
application.
Check () one: I am the property owner authorized agent.
(Name - type, stamp or print clearly) (Signature)
(Name of Firm) (Address, City, State, Zip)
STATE OF )
COUNTY OF )
The foregoing instrument was acknowledged before me this _______________ day of _____________________,
20__, by ________________________________________ who is personally known to me or who produced a
______________________________ as identification. He/she did not take an oath.
(NOTARY SEAL)
(Signature of Notary Public)
(Name of Notary)
19
January
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signature
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signature
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Certificate of Appropriateness Application Page 5 of 7
SIGN POSTING AGREEMENT
(REQUIRED FOR ALL APPLICATION TO BE REVIEWED BY HISTORIC RESOURCES PRESERVATION BOARD)
Applicant:
Property Owner:
Contact Phone No.:
Property Location:
I, , hereby affirm that I
will post the notification sign(s) provided to me for a minimum of ten (10) calendar days before the
scheduled date of the hearing of Planning and Zoning Case No. .
Signature: Date:
Name/Title of Signatory:
STATE OF )
COUNTY OF )
The foregoing instrument was acknowledged before me this _______ day of _____________________,
20__, by ________________________________________ who is personally known to me or who
produced a ______________________________ as identification. He/she did not take an oath.
(NOTARY SEAL)
(Signature of Notary Public)
(Name of Notary)
19
January
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signature
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signature
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Certificate of Appropriateness Application Page 6 of 7
Criteria for Granting Certificates of Appropriateness (Section 23.5-4(k)1)
In approving or denying applications for certificates of appropriateness, the City shall, at a minimum,
consider the following general guidelines:
A. What is the effect of the proposed work on the landmark or the property upon which such
work is to be done?
B. What is the relationship between such work and other structures on the landmark site or
other property in the historic district?
C. To what extent will the historic, architectural, or archaeological significance, architectural
style, design, arrangement, texture, materials and color of the landmark or the property be
affected?
D. Would denial of a certificate of appropriateness deprive the property owner of reasonable
beneficial use of his property?
E. Are the applicant's plans technically feasible and capable of being carried out within a
reasonable time?
F. Do the plans satisfy the applicable portions of the general criteria contained in the United
States Secretary of the Interior's Standards for Rehabilitation then in effect or as they may be
revised from time to time? The current version of the Secretary's Guidelines provides as follows:
(1) A property shall be used for its historic purpose or be placed in a new use that
requires minimal change to the defining characteristics of the building and its site and
environment.
(2) This historic character of the property shall be retained and preserved. The removal
of historic materials or alteration of features and spaces that characterize a property
shall be avoided.
(3) Each property shall be recognized as a physical record of its time, place and use.
Changes that create a false sense of historical development, such as adding conjectural
features or architectural elements from other buildings, shall not be undertaken.
(4) Most properties change over time; those changes that have acquired historic
significance in their own right shall be retained and preserved.
(5) Distinctive features, finishes and construction techniques or examples of
craftsmanship that characterize a historic property shall be preserved.
(6) Deteriorated architectural features shall be repaired rather than replaced,
wherever possible. In the event replacement is necessary, the new material should
match the material being replaced in composition, design, color, texture, and other
visual qualities. Repair or replacement of missing architectural features should be based
on accurate duplications of features, substantiated by historical, physical, or pictorial
evidence rather than on conjectural designs or because the different architectural
elements from other buildings or structures happen to be available for relocation.
Certificate of Appropriateness Application Page 7 of 7
(7) Chemical or physical treatments, such as sandblasting, that cause damage to
historic materials, shall not be used. The surface cleaning of structures, if appropriate,
shall be undertaken using the gentlest means least likely.
(8) Significant archeological resources affected by a project shall be protected and
preserved. If such resources must be disturbed, mitigation measures shall be
undertaken.
(9) New additions, exterior alterations or related new construction shall not destroy
historic materials that characterize the property. The new construction shall be
differentiated from the old and shall be compatible with the massing, size, scale and
architectural features to protect the historic integrity of the property and its
environment.
(10) New additions and adjacent or related new construction shall be undertaken in
such manner that, if removed in the future, the essential form and integrity of the
historic building and its environment would be unimpaired.
G. What are the effects of the requested change on those elements or features of the structure
which served as the basis for its designation and will the requested changes cause the least
possible adverse effect on those elements or features?
H. Such other supplemental guidelines for restoration and rehabilitation of historic properties
which the HRPB may from time to time adopt.
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Completed 18 January 2021

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