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o4Socrlf 8�`�'o HISTORIC PRESERVATION COMMISSION <br /> 11W v4, OF SOUTH BEND AND ST. JOSEPH COUNTY <br /> w (a County--City Building,South Bend,TN 46601 <br /> l n.,tce <br /> A a http://wwwsouthbendin.gov/governmcntldepariment/communrtyanvestmen <br /> Phone:574/235.9371 Fax: 574/235.9021 <br /> 865 Email:hpcsbsjc(asouthbendin.gov <br /> A Certified Local Government of the National Park Service Elicia Feasel,Historic Preservation <br /> Administrator <br /> APPLICATION FOR A—CERTIFICATE OF APPROPRIATENESS <br /> OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br /> Date Receied• Application Number: <br /> Past Revievs: ❑ YES (Date of Last Review) ❑ NO <br /> Staff Appraal authorized by: - Title: _- <br /> Historic Prservation Commission Review Date: - — <br /> I Local Landmark ( j Local Historic District(Name) _ -- <br /> ❑ National Landmark I 1 National Register District(Name) _- <br /> Certificate Df Appro riateness: <br /> Denied ❑ Tabled ❑Sent To Committee ❑ Approved and issued: <br /> Address o1Property for proposes work 60649 Hickory Road South Bend IN 46614 <br /> (Street Number—Street Name—City—Zip) <br /> Name of Property Owner(s): <br /> Ben and Carrie Modlin Phone#: (574) 340-5674 <br /> Address olProperty Owner(s): 60649 Hickory Road South Bend IN 46614 <br /> (Street Number—Street Name—City—Zip) <br /> Name of Clntractor(s): Self Phone#: <br /> Contracts Company Name: <br /> Address olContractor Company: <br /> (Street Number—Street Name—City—Zip) <br /> Current Le of Building: Single Family <br /> (Single Family—Multi-Family—Commercial—Govermnent—Industrial—T/acant—etc) <br /> Type of Balding Construction: <br /> Wood Frame <br /> (Wood Frame—Brick—Stone--Steel—Concrete—Other) <br /> Proposed Work: (more than one ❑Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br /> box may bi checked) <br /> Removal of decayed existing siring,animal feces,Dal habitat exchrsion,beehives,mold,waterlogged and damaged material,removal of wet <br /> Descriptim of Proposed Work: <br /> celulose insula'rn from within the wall cavity.Installation of new fiberglass bait insulation,new exterior Sade sheathing.tyvek house wrap•new •new Celect Cellular Composite PVC wood <br /> simulated sidircand architectural trim material.Construction methods to follow the manufacturer's written specifications.Please see supporting documentation. <br /> modlincarrie@gmail.comand/or contractor e-mail: coachmodlin@gmail.com <br /> Owner e--tail: / <br /> X and/or X <br /> Signaturcof Owner Signature of Contractor <br /> By signing this application!agree to abide by all local regulations related to project and to obtain a Building Department Permit,i f applicable. <br /> —APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />