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171 <br />�J <br />0 <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building, South Bend, IN 46601 <br />http://www.southbendin.gov/government/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Timothy S. Klusczinski, President A Certified Local Government of the National Pads Service Alicia 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 Received: `'1 %� �' t Application Number: Zoi b — 64 I Z A <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate Of App ro riateness: <br />Denied ❑ Tabled <br />Address of Property for proposed work: <br />Name of Property Owner(s): <br />Local Historic District (Name) Ley'lr <br />dNational Register District (Name) �`�'�" RAI- <br />11 <br />AI- <br />❑ Sent To Committee ❑ Approved and issued: <br />802 Forest Avenue, South Bend, IN 46616 <br />(Street Number --Street Name—City—Zip) <br />Karen Graubart Phone #: 607-351-7546 <br />Address of Property Owner(s): <br />Name of Contractor(s): <br />802 Forest Avenue, South Bend, IN 46616 <br />Nick Donovan <br />(Street Number—Street Name—City—Zip) <br />Contractor Company Name: Peacock and Company <br />Address of Contractor Company: <br />Phone #: 574-289-4992 <br />1147 Mishawaka Avenue, South Bend, IN 4661.6 <br />(Street Number—Street Name—City—Zip) <br />Current Use of Building: Single family <br />(Single Family--Mtilti-Family —Commercial—Government Industrial—Vacant—etc) <br />Type of Building Construction: Wood frame with siding <br />(Wood Frame—Brick—Stone ---- Steel—Concrele—Olhei9 <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: I request permission to tear down a collapsing deck addition to side of hch <br />pack Trom street. i also request permission to replace it wan a lo-prorlle wooaen or composite uecqi <br />street. The house has sidina so no historica character is beina attectea. ana so i reauest Dermissiom <br />m street of siae <br />Owner e-maiil:(�kbgraubart@gmail.com and/or Contractor e-mail: ndonovan@peacockandco.com <br />Y-`* V v <br />X k, � and/or X <br />Signature of Owner Signature of Contractor <br />By signing this application 1 agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />