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Y <br />Application <br />- FOR - <br />Certificate of Appropriaten ess <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCIAP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONL¢YS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: CVe7 ,1 c,1-0/T�/ Application Number: ozO /'t' — A0,066 <br />Past Reviews: � S (Date of Last Review) ❑ NO C <br />Staff Approval authorized by: (_ ,( �/�%�UJ�— /0,0/3 <br />-Historic Preservation Commission Review e: <br />D"'Locai Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Title: <br />aoiZI_ioo4 6 - <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 11518 Adams Rd., Granger, IN 46530 <br />(StreetNttmber— StreetName—City—Zip Code) <br />Name of Property Owner(s): Thomas Schlereth and Wendy Clauson - Schlereth Phone #: 574.277.2374 <br />Address of Property Owner(s): 11518 Adams Rd., Granger, IN 46530 <br />(Street Number— Street Name—City--Zip Code) <br />Name of Contractor(s): Tim Van Overberghe <br />Contract Company Name: Van Overberghe's, LLC <br />Phone #: 574.315.8752 <br />Address of Contract Company: 25261 Gordon Rd., South Bend, IN 46619 <br />(Street Number— Street Name—Cit)--Zip Code) <br />Current Use of Building: Single Family <br />(Single Famib}–Mztlti Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: Wood Frame <br />(Wood Frame—Brick--Stone—Steel—Concrete—Other) <br />Proposed Work: ❑✓ In -Kind ❑ Landscape ❑ New ❑✓ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: See attached <br />4M6 - /O66 3 <br />i / 6106 C <br />Owner/Contractor F #: ,/5y4. 89.99 9 <br />(Staff will espon ith nl ne d gnee) <br />e-mail: -TeA& -i-i"M @ V0X10 bui 'a . COM - <br />and/or X <br />A <br />