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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.st osephcountjindiana.com/departments/SJCBP/index.htn <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ON..L¢¢Y>>�>>>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: U'L��llYl,�.P.S .20/,� Application Number: -20 /7 — A0,06114 <br />Past Reviews: 3 �S (Dade ojlasl Review) NO <br />Staff Approval authorized by: ( ,( <br />Historic Preservation Commission Review e: <br />ErLocal Landmark <br />❑ National Landmark <br />Title: ` <br />❑ Local Historic District (Name) <br />❑ National Register District (Name) <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 />(Street Number— Street Name—Cit),—Zip Code) <br />Mme of Property Owner(s): Thomas Schlereth and Wendy Clauson - Schiereth 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—City—Zip Code) <br />Current Use of Building: Single Family <br />(Single Family—Multi 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 />/o410 3 <br />/ (�-06 C <br />—.6wner/Contractor F#:/574. 89.99 9 <br />(Staff will esponth nl ne d gnee) <br />X /G <br />o <br />e-mail: -Te*t- "�'i''� @ Va.r%O bu.i . CVM <br />M <br />and/or X <br />■ <br />