TOWN OF SHREWSBURY
Shrewsbury, Massachusetts 01545
Historic District Commission
APPLICATION FOR CERTIFICATE OF APPROPRIATENESS
Pursuant to the Historic District Acts (M.G.L., Ch. 40C, as amended) and the Shrewsbury Historic District
By-Law, application is hereby made for certification of exterior work within the Shrewsbury Historic District.
TO BE COMPLETED BY APPLICANT
: Please answer sections A – E. In sections A and B check as many
features as apply to complete project.
A. Category of Work Proposed
1. ( ) New Construction
2. ( ) Reconstruction
3. ( ) Restoration
4. ( ) Alteration
5. ( ) Relocation
6. ( ) Demolition
7. ( ) Other (specify): ________________________________________________________________
B. Type of Structure or Exterior Feature
1. ( ) New Building
2. ( ) Existing Building
a. Built in the year ____________
b. Type of exterior change proposed
( ) Limited to roofing or siding
( ) Limited to placement and details of doorways, windows, shutters or lighting fixtures
( ) Other appurtenant fixtures (specify): ______________________________________
( ) Major structural change
3. ( ) Fence or wall
4. ( ) Sign
5. ( ) Terrace, walk, driveway or parking lot other than at grade level
C. Location of Structure or Exterior Feature
1. Street Address ____________________________________________________________________
2. ( ) Visible from Public Way
3. ( ) Not visible from Public Way
D. Description of Work Proposed
Please print or type on reverse side. Use additional sheets as needed. Copies of architectural sketches,
plans, scale drawings or photographs when required will be retained by the Commission.
E. Owner’s Authorization
1. Owner’s Name: ___________________________________ Telephone #: _______________________
2. Owner’s Address: ____________________________________________________________________
3. Applicant’s Name (if different): _______________________ Telephone #: ______________________
4. Applicant’s Address: __________________________________________________________________
5. Architect (if any): ____________________________________ Telephone #: _____________________
6. Contractor or Builder (if any): ____________________________ Telephone #: ___________________
7. Signature of Owner: ____________________________________ Date: _________________________
__________________________________________________________________________________________
FOR COMMISSION’S USE:
Date Received: _____________________________________________________________________________
Receiver: _________________________________________________________________________________
Application Number: ________________________________________________________________________
Waivers of Hearing Received: _________________________________________________________________
Date of Preliminary Review: __________________________________________________________________
Date of Review of Final Drawings: _____________________________________________________________
Date of Public Hearing and Approval of Final Construction Drawings: _________________________________
Type of Certificate Issued (circle one):
Appropriateness Non-Applicability Other ______________________________
Date of Issuance:
Approved: __________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
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