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HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County —City Building, South Bend, IN 46601 <br />http: //www. southben din.gov/government/department/community-i nvestment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Michele Gelfman, President <br />JUL 2 6 2023 a _;� <br />(gam S�1 Zf' <br />Adam Toering, Historic <br />Preservation Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />A Certified Local Govemment of the National Park Service <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOA(«««OFFICE USE ONLY <br />Date Received: <br />Past Reviews: <br />Application Number: — <br />❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate Of Appro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: 1410 E. Wayne Street, South Bend, IN 46615 <br />( <br /> <br />Address of Property Owner(s): 1410 E. Wayne Street, South Bend, IN 46615 <br />Name of Contractor(s): <br />(Street Number —Street Name —City —Zip) <br />Contractor Company Name: <br />Phone #: <br />Address of Contractor Company: <br />Current Use of Building: <br />Type of Building Construction: <br />(Street Number —Street Name —City —Zip) <br />(Single Farm/—:'Multi-FamilyCommercial—Government—Industrial—Vacant—etc.) <br />Proposed Work: (more than one <br />box may be checked) <br />(Wood Frame —Brick —Stone —Steel —Concrete —Other) <br />X❑ Landscape ❑ New ❑ Replacement (not in -kind) ❑ Demolition <br />Description of Proposed Work: Remove an oak tree next to the detached garage that is declining and <br />presents a hazard according to the two arborists that have inspected the tree. We are still receiving <br />estimates and have not decided which company will remove the tree yet. <br /> <br /> <br /> <br /> Signature of Contractor <br />By signing this application l agiee 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 />