Rev. 1/19
TOWN OF MIDDLEBURG
10 West Marshall Street, PO Box 187
Middleburg, Virginia 20118-0187
540-687-5152 FAX 540-687-3804
CERTIFICATE OF APPROPRIATENESS
Applicant Name: ________________________________ Business Name:
Mailing Address: ________________________________ Phone #:
________________________________ email:
Contractor Name: ________________________________ Phone #:
email:
PROPERTY ADDRESS: ________________________________ Parcel #:
Prop. Owner Name: ________________________________ Phone #:
Mailing Address: ________________________________ email:
________________________________
Project Description
❑ New Construction ❑ Exterior Alteration ❑ Addition ❑ Demolition ❑ Sign(s)
Minor Actions: ❑ Repainting ❑ Storm Doors/Storm Windows ❑ Minor Landscaping Structure
Summary of Work
___________________________________________________________________________________________
FOR ALL APPLICATIONS:
Submit one copy of all materials either 1) in hard copy, with no materials exceeding 11”x17” (tabloid) in
size, OR 2) electronically via .pdf format to townplanner@middleburgva.gov. Electronic submission is
preferable, but not required. Material samples (such as paint cards, hard samples of siding, roof materials,
etc) can be brought to the review meeting in person.
Written Description - Describe clearly and in detail the nature of the project. The HDRC uses the adopted
Historic District Design Guidelines as a basis for review of applications. Applicants should carefully review their
proposal relative to these guidelines prior to submission and INCLUDE how it relates to these documents.
Photographs - A minimum of three views of the area(s) under review
Specifications of Materials - to include, but not limited to: roofing, siding, windows & doors, trim work, color
scheme, chimneys, shutters, utilities and mechanical equipment locations and specifications, exterior lighting,
fencing, walls, and paving. (Include Manufacturer's specification sheets whenever possible.)
The applicant or a representative must be at the meeting to answer any questions the Committee may have
and to discuss any possible changes or suggestions.
All projects must also comply with all applicable Codes and Ordinances (Building Code, Zoning, etc).
(cont. on next page)
