Elm Street Facade & Landscape Application

Elm Street Façade &Driveway/ Landscape Improvement Grant Application

Indiana Borough Second Ward

Please return the application and required documentation to:

Victoria Rosenberger

Elm Street Project Manager

c/o Downtown Indiana, Inc.

39 North 7th Street, Suite 101

Indiana, PA 15701

Phone: 724-463-6110

Revised June, 2010

FAÇADE, DRIVEWAY / LANDSCAPE IMPROVEMENT APPLICATION

PLEASE PRINT INFORMATION CLEARLY IN BLUE OR BLACK INK

1). APPLICANT DATA:

Property owner name(s):__________________________________

______________________________________________________

Address:_______________________________________________

City:______________________ State:_________ Zip:__________

Day phone:____________________ Home phone:_____________

Fax #:________________________ Cell #:___________________

E-mail address:__________________________________________

For DESIGN Committee Use Only

Date/time stamp when application was received in office:

Date:________________

Application reviewed and deemed incomplete or complete:

Application Complete

Application Incomplete

If application is incomplete, highlight information missing.

Date:______________

Initials:

2). PROPERTY DATA:

Address of property for grant work:____________________________

The property must be located in the designated Second Ward

Neighborhood Area.

Is this property on the corner of two intersecting streets? __Yes __No

Building type (please check):

____ Commercial ____Single Family ____ Multi-family

____ Owner Occupied ____Tenant Occupied ____ Mixed-Use

Number of dwelling units:_________ (if applicable)

Number of tenants:_________ (if applicable)

Applicant notified that the project has been reviewed and approved/not approved by the Design Committee:

Approved

Not approved

Date:______________

Time:______________

3). INCOME GUIDELINES: (See Indiana Borough Elm Street Façade Improvement Program

Income Chart below and on page 6 of the Grant Program Guidelines)

A)How many people live in your household? _______ Find that number in ‘Household Size’ on

the chart below.

B) What is your annual (yearly) household income? This is the total income of all members of the

household that are 18 and over. $____________

C) Look at your household size number on the chart below, then to the right in the median

income column, see if your household income falls above or below the designated range.

D)Is your household income above 115% of the median income? ______

If yes, your grant funding is 50% of the total project cost with a 50% match of your private

funds. Please skip to box #4 - Design Plans.

E) If your household income is below or equal to 115% of the median income, then you qualify for

the increased grant funding of 90% of the project cost with only a 10% match of your private

funds.

Indiana County Median Income: $ 48,200*

*Median income per family size subject to change as determined annually by DCED.

*Household size is all persons, of any age, residing in a household.

For Office Use Only:

Percentage of funding household qualifies for:

_____________________

Household Size	115% of Area Median Income
1	$41,450
2	$47,400
3	$53,300
4	$59,225
5	$63,950
6	$68,700
7	$73,450
8	$78,200

4). DESIGN PLANS:

Please attach to the application:

The architect’s or contractor’s drawings/plans for façade or Driveway/ Landscape improvements

· Property owners are strongly encouraged to use a contractor/architect; however, on a case by case basis, the Design Committee may allow property owners to complete the grant work on their own, provided detailed plans and documented experience in completing house repairs are submitted with the application.

· If the work is to be done by the property owner, the application should only show the cost of materials for the project cost.

Photographs of the present building façade or Driveway/ Landscape

· Particularly, photos of the areas that you wish to improve should be submitted, i.e. peeling paint, deteriorating steps on porch, cracked porch columns, etc.

· Photographs must be in color and preferably 8”x10” size

· Please be sure to label your name and address on photographs. Please note that these photographs will not be returned.

Itemized Cost Estimate

· This should be provided to you by your contractor, and is a detailed description of the work to be completed (types and colors of materials to be used, etc).

· Your contractor’s bid must list labor and cost of materials separately.

· Please be sure to include your name and address of property on this information.

5). ITEMIZED COST ESTIMATES: *Be sure to include architectural fees.

	Example only: Type of Repair:	Number	Brand/size/color of material	Cost Estimate:
	Example: Porch repair	2	ACME Porch pillars	$ XXX.00
	Type of Repair:	Number	Brand/size/color of material	Cost Estimate:
	1.
	2.
	3.
	4.
	5.
	6.
	7.
	8.
	9.
	10.
	11.
	12.
	13.
	14.
	15.
	16.
	17.
	18. Total			$
19. Sales Tax [Total times 6%]					$
20. TOTAL PROJECT COST [Line 18, plus Sales Tax]					$
21. Amount of Façade Grant Money being requested: *Note: Amount cannot exceed more than $5,000.00					$
22. Enter the total amount of your private funds being invested into the building project. [Line 20 minus Line 21] This is Either 50% or 10% of the project cost, depending on your income.					$

6). CONTRACTOR INFORMATION:

Note: If using more than one contractor, please attach an additional page with the information

below for each contractor.

Company Name:______________________________________________

Contractor’s Name:____________________________________________

Address:____________________________________________________

City:_________________________ State:____________ Zip:_________

Phone:________________________ Fax #:_______________________

7). ARCHITECT: (if applicable)

Company Name:______________________________________________

Architect’s Name:____________________________________________

Address:____________________________________________________

City:_________________________ State:____________ Zip:_________

Phone:________________________ Fax #:_______________________

8) WORK TO BE DESIGNED AND COMPLETED BY PROPERTY OWNER:

Who will be completing the work on the project? _____________________

Relationship to applicant__________________

Do you have previous experience in home repairs? __Yes __No

If yes, please list types of jobs completed below:

IMPROVEMENT APPLICATION _____________________ ___________

Property Address Application Date

IMPROVEMENT APPLICATION _____________________ ___________

Property Address Application Date

9). Applicant’s Check list for required supporting documentation	Applicant please initial when complete	office use only
1)Architect’s or contractor’s façade drawing
2) Photographs of the present building façade (preferably 8” x 10” size and in color). Name and address written on these photos.
3) Itemized Cost Estimate – description of work to be completed including types and colors of materials to be used. Labor and materials are listed separately.
4) Copy of latest receipt for paid property taxes
5) Copy of latest receipt for paid school taxes
6) Copy of the deed to the property
7) Proof of homeowner’s insurance *This could be proof of payment for your policy (such as a copy of your last statement)
8) Copy of latest federal income tax return for all members of household over age 18 or if you are not required to file, please provide proof of income such as W-2’s, bank interest statements or 1099’s. Note: If you are over the income limit for reduced match, and will be matching funds dollar for dollar, this is not required.*
9) Proof of other income (social security, SSI, pensions, veterans’ benefits, child support, etc) – only if you qualify for reduced match.
10) Evidence of private funding. *Note: This may include a copy of checking/savings statement or copy of loan guarantees to substantiate your private funds.
11) Obtained Borough of Indiana building permit approval (if required). *Plans must be viewed by the Zoning office and given approval. You need not fill out an application for a permit until after your project is approved by the Design Committee.
12) Please also make a copy of this application for your record keeping.

IMPROVEMENT APPLICATION _____________________ ___________

Property Address Application Date

10). APPLICANT CERTIFICATION:

The applicant certifies that all information in this application and all information furnished in support of this application is given for the purpose of obtaining a grant under the Indiana Borough Elm Street Neighborhood Improvement Program, and is true and complete to the best of the applicant’s knowledge and belief. Verification may be obtained from any source herein. The applicant agrees to abide by all the requirements set forth in connection with any financial assistance made available by the Indiana Borough Elm Street Neighborhood Improvement Program. This application is not an application for a building permit. The applicant agrees to abide by all building and other requirements set forth by Indiana Borough or by law, and is responsible for obtaining any and all necessary building permits before commencing work.

PENALTY FOR FALSE OR FRAUDULENT STATEMENT, U.S.C. Title 18, Sec. 1001, provides: “Whoever, in any matter within jurisdiction or any department or agency of the United States knowingly and willfully falsifies…or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined not more that $10,000.00 or imprisoned not more than five years, or both.”

________________________ ________

Applicant’s Signature Date

DESIGN APPROVAL AND GRANT AUTHORIZATION:

This application has been reviewed by the Indiana Borough Elm Street Neighborhood Improvement Program Design Committee and conforms to the Indiana Borough Elm Street Neighborhood Improvement Program’s façade standards and guidelines.

This application is hereby authorized for grant funding up to a maximum of $______________. This commitment is good for thirty (30) days from the last signature date below or the start of the project construction, whichever comes sooner.

___________________________________ _____

Signature of Design Committee Chairperson Date

_________________________________ _____

Signature of Elm Street Project Manager Date

Each applicant and grant recipient understands and agrees that review and/or approval of the application and façade work by the Indiana Borough Elm Street Program and Design Committee, including without limitation, the designs, plans, specifications, materials, contractor, does not mean that the façade work conforms to applicable building codes or legal requirements nor does it mean that the façade work will be conducted in a good workman manner. Each applicant and grant recipient releases and discharges the Indiana Borough Elm Street Program, the Design Committee, its employees and agents from any and all liability, damages and expenses in any way related to review of the application, approval/denial of the application, and the façade work.

Attachment	Size
Facade Application Revised June, 2010.doc	166.5 KB

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