HISTORIC PRESERVATION EXEMPTION APPLICATION

APPLICATION TYPE

Type of Exemption/Relief Requested:

☐ Exemption from Certificate of Appropriateness (COA) requirement
☐ Economic hardship exemption
☐ Exemption from demolition delay
☐ Exemption from specific design standards
☐ Exemption from mandatory preservation requirements
☐ Religious property exemption
☐ Reasonable accommodation for disability
☐ Safety/emergency exemption
☐ Governmental/public use exemption
☐ Other: _______________________________________________

SECTION 1: APPLICANT INFORMATION

Applicant Name: _______________________________________________

Company/Organization (if applicable): _______________________________________________

Mailing Address: _______________________________________________

City/State/ZIP: _______________________________________________

Phone Number: _______________________________________________

Email Address: _______________________________________________

Applicant is:
☐ Property Owner
☐ Contract Purchaser
☐ Tenant/Lessee
☐ Authorized Agent
☐ Religious Organization Representative
☐ Government Agency
☐ Other: _______________________________________________

SECTION 2: PROPERTY OWNER INFORMATION

Owner Name: _______________________________________________

Entity Type (if not individual): _______________________________________________

Mailing Address: _______________________________________________

City/State/ZIP: _______________________________________________

Phone Number: _______________________________________________

Email Address: _______________________________________________

SECTION 3: PROPERTY INFORMATION

Property Identification

Property Address: _______________________________________________

Tax Parcel Number: _______________________________________________

Legal Description:
_______________________________________________
_______________________________________________

Historic Designation

Property is:
☐ Individually listed on National Register of Historic Places
☐ Contributing structure in National Register Historic District
☐ Listed on State Register of Historic Places
☐ Locally designated historic landmark
☐ Contributing structure in local historic district
☐ Listed on other register: _______________________________________________
☐ Pending designation

Historic District Name (if applicable): _______________________________________________

Date of Designation: _______________________________________________

Significance/Period of Significance: _______________________________________________

Property Description

Property Type:
☐ Residential - Single Family
☐ Residential - Multi-Family
☐ Commercial
☐ Industrial
☐ Religious/Institutional
☐ Mixed Use
☐ Vacant Land
☐ Other: _______________________________________________

Year Built: _______________________________________________

Architectural Style: _______________________________________________

Contributing/Non-Contributing Status: _______________________________________________

Gross Building Area: _______________ sq. ft.

Lot Size: _______________ ☐ acres ☐ sq. ft.

SECTION 4: PROPOSED WORK/ACTION

Description of Proposed Work

Detailed Description of Proposed Work or Action:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

Type of Work

☐ Demolition (complete)
☐ Demolition (partial)
☐ Major exterior alteration
☐ Minor exterior alteration
☐ New construction/addition
☐ Relocation
☐ Change of use
☐ Interior work affecting character-defining features
☐ Site work/landscaping
☐ Signage
☐ Other: _______________________________________________

Character-Defining Features Affected

List the historic features that would be affected by the proposed work:

1. _______________________________________________
2. _______________________________________________
3. _______________________________________________
4. _______________________________________________
5. _______________________________________________

SECTION 5: BASIS FOR EXEMPTION REQUEST

A. Economic Hardship Exemption

Complete if requesting exemption based on economic hardship.

☐ This section applies to my request

Property has been listed for sale:
☐ Yes - Date Listed: _______________ Asking Price: $_______________
☐ No

If listed, number of bona fide offers received: _______________

Property assessed value: $_______________

Current mortgage balance: $_______________

Annual property taxes: $_______________

Annual maintenance costs: $_______________

Annual insurance costs: $_______________

Rental income (if applicable): $_______________

Vacancy rate (if applicable): _______________%

Cost estimate for compliant rehabilitation: $_______________

Cost estimate for proposed work (with exemption): $_______________

Explain why the property cannot provide a reasonable economic return without the exemption:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

B. Safety/Emergency Exemption

Complete if requesting exemption due to safety concerns.

☐ This section applies to my request

Nature of Safety Concern:
☐ Structural failure/collapse risk
☐ Fire hazard
☐ Electrical hazard
☐ Environmental hazard (lead, asbestos, mold)
☐ Code violation creating immediate danger
☐ Storm/disaster damage
☐ Other: _______________________________________________

Describe the specific safety condition:
_______________________________________________
_______________________________________________
_______________________________________________

Date condition was discovered: _______________________________________________

Has the building been condemned or ordered vacated?
☐ Yes - Date: _______________ By: _______________________________________________
☐ No

Attach engineering report, building official order, or other documentation of safety condition.

C. Religious Property Exemption

Complete if requesting exemption for religious organization.

☐ This section applies to my request

Name of Religious Organization: _______________________________________________

Type of Organization:
☐ Church
☐ Synagogue
☐ Mosque
☐ Temple
☐ Other: _______________________________________________

Religious Activity Affected by Preservation Requirements:
_______________________________________________
_______________________________________________

Explain how the preservation requirements substantially burden the organization's religious exercise:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

D. Governmental/Public Use Exemption

Complete if requesting exemption for governmental use.

☐ This section applies to my request

Government Entity: _______________________________________________

Public Purpose/Use: _______________________________________________

Explain why exemption is necessary for the public purpose:
_______________________________________________
_______________________________________________
_______________________________________________

E. Disability Accommodation Exemption

Complete if requesting reasonable accommodation for disability.

☐ This section applies to my request

Nature of Accommodation Needed:
☐ Wheelchair ramp/access
☐ Elevator installation
☐ Door widening
☐ Bathroom modifications
☐ Visual/auditory aids
☐ Other: _______________________________________________

Explain why the accommodation cannot be achieved while meeting preservation standards:
_______________________________________________
_______________________________________________
_______________________________________________

F. Other Exemption Basis

☐ This section applies to my request

Describe the basis for exemption:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

SECTION 6: ALTERNATIVES ANALYSIS

Alternatives Considered

Describe alternatives to the proposed work that were considered and explain why they are not feasible:

Alternative 1:
- Description: _______________________________________________
- Reason Not Feasible: _______________________________________________

Alternative 2:
- Description: _______________________________________________
- Reason Not Feasible: _______________________________________________

Alternative 3:
- Description: _______________________________________________
- Reason Not Feasible: _______________________________________________

Mitigation Measures

Proposed mitigation measures to minimize impact on historic character:
_______________________________________________
_______________________________________________
_______________________________________________

SECTION 7: STATE-SPECIFIC VARIATIONS

California

• California Environmental Quality Act (CEQA) applies to historic resources
• Mills Act contracts provide tax incentives for preservation
• State Historical Building Code (SHBC) allows alternative compliance
• California Historical Resources Information System (CHRIS) review
• Religious Land Use provisions (RLUIPA) apply

New York

• State Historic Preservation Office (SHPO) review for certain projects
• New York City Landmarks Law provisions
• Economic hardship findings under local landmarks law
• Environmental Quality Review (SEQR) historic resource review
• Religious property exemptions under state law

Texas

• Texas Historical Commission review for state-listed properties
• Local historic preservation ordinances vary significantly
• Texas Antiquities Code for publicly owned properties
• Limited state-level regulatory requirements
• Strong property rights considerations

Florida

• Division of Historical Resources review
• Local historic preservation board procedures
• Special considerations for hurricane hardening
• Florida Building Code historic building provisions
• Ad valorem tax exemption for historic properties

SECTION 8: REQUIRED ATTACHMENTS

For All Applications

☐ Application fee ($______________)
☐ Property deed or proof of ownership
☐ Authorization letter (if applicant is not owner)
☐ Photographs of property (all elevations)
☐ Site plan showing property boundaries and structures
☐ Description of historic designation and significance

For Economic Hardship

☐ Appraisal by qualified appraiser
☐ Two years of financial statements
☐ Documentation of marketing efforts
☐ Cost estimates for rehabilitation alternatives
☐ Rental income documentation
☐ Pro forma analysis
☐ Evidence of denied financing

For Safety/Emergency

☐ Structural engineering report
☐ Building official inspection report
☐ Condemnation order (if applicable)
☐ Photographs documenting hazardous conditions
☐ Cost estimates for stabilization vs. demolition

For Religious Exemption

☐ Documentation of religious organization status
☐ Statement from religious leader
☐ Evidence of religious practices affected
☐ Analysis of alternatives considered

For Proposed Work

☐ Detailed plans/drawings
☐ Specifications
☐ Material samples (if applicable)
☐ Contractor qualifications

SECTION 9: CERTIFICATIONS

Applicant Certification

I hereby certify that:

☐ All information contained in this application is true and accurate to the best of my knowledge

☐ I have made good faith efforts to comply with applicable preservation requirements

☐ I have considered alternatives to the proposed action

☐ I understand that approval of this exemption may require conditions

☐ I understand that this application will be reviewed in a public hearing

☐ I authorize representatives to inspect the property

☐ I agree to comply with any conditions of approval

Property Owner Consent (if different from applicant)

I, the property owner, consent to this exemption application:

Owner Signature: ___________________________ Date: _______________

Printed Name: ___________________________

SECTION 10: SIGNATURES

Applicant Signature: ___________________________ Date: _______________

Printed Name: ___________________________

Title (if applicable): ___________________________

FOR OFFICIAL USE ONLY

Application Number: _______________________________________________

Date Received: _______________________________________________

Fee Paid: $_______________________________________________

Received By: _______________________________________________

Completeness Review

☐ Application complete
☐ Application incomplete - items needed:
_______________________________________________

Staff Review

Reviewer: _______________________________________________

Date: _______________________________________________

Historic Resource Verified:
☐ Individually designated
☐ Contributing to historic district
☐ Non-contributing
☐ Not designated

Exemption Category: _______________________________________________

Agency Referrals

☐ State Historic Preservation Office
☐ National Park Service (for National Register properties)
☐ Building Department
☐ Legal Department
☐ Other: _______________________________________________

Public Hearing

Historic Preservation Commission Hearing Date: _______________________________________________

Public Notice:
☐ Published: _______________________________________________
☐ Mailed to affected parties: _______________________________________________
☐ Posted on property: _______________________________________________

Commission Action

Decision:
☐ Exemption Granted
☐ Exemption Granted with Conditions
☐ Exemption Denied
☐ Continued to: _______________________________________________

Vote: _____ in favor _____ opposed _____ abstaining

Findings:
_______________________________________________
_______________________________________________
_______________________________________________

Conditions (if applicable):
_______________________________________________
_______________________________________________
_______________________________________________

Resolution Number: _______________________________________________

Date of Decision: _______________________________________________

Appeal Deadline: _______________________________________________

EXEMPTION CERTIFICATE

CERTIFICATE NUMBER: _______________________________________________

This certifies that the Historic Preservation Commission has granted an exemption from:

_______________________________________________

For property located at:

_______________________________________________

Exemption Basis: _______________________________________________

Scope of Exemption:
_______________________________________________
_______________________________________________

Conditions:
_______________________________________________
_______________________________________________

Expiration Date: _______________________________________________

Date Issued: _______________________________________________

Issued By: _______________________________________________

Title: _______________________________________________

(Official Seal)