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a - Application -for- Certificate of Appropriateness Historic Preservation Commission of South Bend & St. Joseph County 227 West Jefferson Blvd - South Bend IN 46601-1830 Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@niichiana.org A Certified Local Government OFFICE USE OtN-Li'>»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USEONLY Date Received�L%—J 20 Application Number. 200�.ZQS Past Reviews: ❑ YES (DATEOFLISTREVIEWI ❑ NO Staff Approval authorized by: Title: Historic Commission Review Date: F cal Landmark /❑� National Landmar k I tional Register District (N ):cal Historic District (N—). Certificate of Appropriateness: ❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued 20 Address of Property for proposed work: 900 block Riverside Drive Current Use of Building: N- A (Single Family - Mind -Family - Commercial - Coretnmera- IndueMal - Vacant - eta Type of Building Construction: (Wood Frame- Brick -Stone-Steel - Concrete -Other) Proposed Work: ❑ Inkind ❑ Landscape ❑ New � Replacement(mwi..kind) (more than one box may be checked) ❑ . Demolition Description of Proposed Work: See Attached, Replace damaged street light The replacement for the destroyed pole is not in kind, the luminaire is replaced with one identical to that destroyed. The owner is the City of South Bend. 0.v t d(�i vppp a.ta dkoppana@ci.south-bend.in.us Owner/Contractor: Fax: 23 5 - ':71(1 1 e-mail: (This office wilt correspond with e n it one designee) Signature of Owner Signature of Contractor APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. S:reaM-b--dSren Nom ) City: South Bend Owner's Phone No: 235-9926 (Ernie Jewett) Name of Property Owner(s):rFluNn City of South Bend Address of Property Owner: 1316 County -City Bldg. Contractor(s) Name: TBD Contract Company Name: Contractor Address: City: Contractor's Phone No: Current Use of Building: N- A (Single Family - Mind -Family - Commercial - Coretnmera- IndueMal - Vacant - eta Type of Building Construction: (Wood Frame- Brick -Stone-Steel - Concrete -Other) Proposed Work: ❑ Inkind ❑ Landscape ❑ New � Replacement(mwi..kind) (more than one box may be checked) ❑ . Demolition Description of Proposed Work: See Attached, Replace damaged street light The replacement for the destroyed pole is not in kind, the luminaire is replaced with one identical to that destroyed. The owner is the City of South Bend. 0.v t d(�i vppp a.ta dkoppana@ci.south-bend.in.us Owner/Contractor: Fax: 23 5 - ':71(1 1 e-mail: (This office wilt correspond with e n it one designee) Signature of Owner Signature of Contractor APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE.