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 11x17 (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)
Application # COA ____________
COA application p. 2
Rev. 1/19
PLUS:
For SIGNS Detailed, scaled drawing showing dimensions, style and size of letters, colors, sample and type of
material, proposed location on the building elevation (or the site, for freestanding), and details of type (if any) of
illumination. A COPY OF THE SIGN PERMIT APPLCATION MUST ALSO BE INCLUDED.
For NEW CONSTRUCTION, ADDITIONS, MAJOR RENOVATIONS
Architectural Drawings:
- Dimensioned outline of the building (min. scale of 1/4" = 1')
- Dimensioned elevations of new construction and adjacent existing elevations (min. scale of 1/4" = 1')
- Site Plan(s) (for new construction and additions)
- Site Section(s) (when requested by HDRC)
PLEASE NOTE:
All materials must be submitted in such a manner that their review does not require professional
interpretation.
All materials submitted will become the property of the Town of Middleburg.
Acknowledgement of Responsibility
I, the PROPERTY OWNER OR AUTHORIZED AGENT, understand that all applications requiring review by the HDRC
must be complete and must be submitted fourteen (14) days before the HDRC meeting date; otherwise
consideration will be deferred to the following meeting. I agree to comply with the conditions of this certificate
and all other applicable Town regulations and to pursue this project in strict conformance with the plans as
approved. I understand that no changes are permitted without prior approval of the Town and that failure to
follow approved plans is a violation of the Zoning Ordinance punishable as provided therein.
Owner/Agent signature: Printed Name:
OFFICE USE ONLY
Date Filed: Fee amount: Date Paid: COA #:
Minor Project: Exclusion Approval, or COA required per Zoning Administrator
HDRC Action: Approval Conditional Approval Denied Date: _____________________________
HDRC Comments/Conditions: ___________________________________________________________________
___________________________________________________________________________________________
If Appeal, Town Council Action: Approval Denied Date: ____________________________________
Town Council Conditions: ______________________________________________________________________
Approved: ______________________________________________________ Date: _____________________
Zoning Administrator
THIS CERTIFICATE EXPIRES ONE YEAR FROM THE APPROVAL DATE IF THE AUTHORIZED ACTIVITY HAS NOT BEEN
COMMENCED AND DILIGENTLY PURSUED. NO DEVIATIONS FROM THE APPROVED PLANS ARE PERMITTED
WITHOUT PRIOR APPROVAL.
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