TOWN OF LAYTONSVILLE

HISTORIC DISTRICT COMMISSION

P.O. BOX 5158 Laytonsville, MD  20882*301-869-0042*Fax 301-869-7222*21607 Laytonsville Rd. Laytonsville, MD  20882

	Application Number: ________________  Date Filed: _________________________  Application Completed: ________________  Fee Paid: ____________________________  HDC Hearing/Review: __________________  Decision: ____________________________  Date of Decision: ______________________

HISTORIC DISTRICT WORK PERMIT

                     APPLICATION

Application packets are due by the close of business 27 days

prior to the regular monthly meeting.

SUBJECT PROPERTY ADDRESS:_______________________________________________________________________

Lot______________________Block________________Subdivision_______________________________________________

APPLICANT/OWNER/AUTHORIZED AGENT

Name____________________________________________________________Telephone____________________________

Address_______________________________________________________________________________________________

OWNER OF RECORD (IF NOT APPLICANT)

Name___________________________________________________________Telephone______________________________

Address________________________________________________________________________________________________

TYPE OF WORK (CHECK APPROPRIATE)

� Visible from public way

� Not visible from public way                   

� Fence/Wall                               �  Windows                                             �  Additions                                            �  In-kind Replacement

� Signage                                    � Siding                                                   � Relocation                                            � Utilities (meters, cables etc)

� Parking                                    � Roofing                                                                � Restoration/Repair                                                � Miscellaneous

� Install                                      � Porch/Deck                                           � Demolition

� Landscape                                               � Accessory Building                                              � New Construction

DESCRIPTION OF PROPOSED WORK:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Estimated cost: $

SUBMISSION REQUIREMENTS (SEE REVERSE)

I hereby have read, understand, and agree to the material presented on both sides of this form, and the attached Historic Area Work Permit Information.

APPLICANTS PLEASE NOTE:  Work may not begin until after receipt of the certificate of approval, and the issuance of any required building permit.

SIGNATURE:_________________________________________________________________Date______________________

Approved 12.15.2003 Revised 9/15/2004; 05/06/05; 06/09

REQUIRED DOCUMENTATION TO BE SUBMITTERD WITH APPLICATION:

1. Site Plan ( 1 copy regular size 24” x 35” or larger, and 1 copy at 8 ½” x 11”) showing:

1. Lot dimensions.
2. Building(s) location and dimensions
3. Driveways, walks, fences, patios, accessory buildings, planting areas, free standing signs (if any), existing and proposed.
4. North arrow, date and scale. 
5. If landscape plan, show placement, number, types, species, height/spread at installation and at maturity; spacing of all plantings must be shown.

2. Architectural drawings: showing labeled sections and elevation, north arrow,

            scale and date. All dimensions must be exact and not estimated. Preliminary

            plans are not acceptable.

3. Original photographs of area affected (all views from the public way). Photos must be 4 x 6 prints clearly showing the building and sections to be altered.

4. Samples, showing composition, color and texture of materials to be used.

5. Dimensions:  must be exact and not estimated

6. File fee:  $50.00  If a subsequent building permit is required, then the building permit fee will be waived.

7. SIGN DEPOSIT: A refundable sign deposit of $300.00 is required at the time of application.  It is refunded upon return of the Notice of Hearing sign in good condition.

8. Bond:  A bond in the amount determined by the Town and in a method acceptable to the Town may be required before the permit will be issued.  Call the Town Clerk to determine requirement.

9. NOTE:  Application must comply with Homeowners’ Association guidelines if applicable.

ACCEPTANCE OF APPLICATION

The material listed above along with the application fee and sign deposit is required to constitute a complete application.  Applications will be formally accepted for processing only after the staff has reviewed for completeness.  Applicants will be contacted if additional information is needed.

APPLICANTS PLEASE NOTE:  Work may not begin until after receipt of the certificate of approval, and the issuance of any required building permit.

ALSO OF NOTE:  Applicants may be eligible for historic preservation incentives or tax credits. Information is available upon request.

SIGNATURE: _______________________________________     Date:  _____________________________