City of Madison, IN
Historic District Board of Review
Application for Certificate of
Appropriateness (COA)
For Sta Use Only
HDBR Meeng Date: _______________
Acon: ______ HDBR/Sta COA
______ HDBR Extended
______ HDBR/Sta Denied
______ Sent to HDBR by Sta
Date Received:
Applicaon Requirements
All exterior changes visible from the
public right-of-way (streets/alleys) within
the Madison Historic District requires a
Cercate of Appropriateness (COA).
Applicaons must be complete before
the HDBR or Sta can begin the review
process. Submit this applicaon form, all
supplemental documentaon as required
(see page 2), and the applicaon fee.
Applicaon Deadline
Applicaons for January-November are
due by 4:00 p.m. on the rst Monday of
the month. Applicaons for December
are due by 4:00 p.m. on the fourth
Monday of November.
Applicaon Submission
Return one copy of this completed
applicaon, applicaon fee, and all
supporng documents to:
City of Madison, IN
Oce of Historic Preservaon
101 W. Main St., Madison, IN 47250
Phone: (812) 274 - 0283
Fax: (812) 265 - 3349
Email: preservaon@madison-in.gov
A fee is not required for Sta review
projects. Please check with sta before
wring a check. The applicaon fee
(payable by cash or check made out to
Madison City Plan Commission) is $15.00
for projects which require HDBR Review
and $2.00 for each nocaon sign.
Applicaon Hearing
Complete applicaons submied by the
deadline will be heard before the
Madison Historic District Board of
Review at their regular meeng held
every fourth Monday of January
November and on the third Monday of
December. The meengs are at 5:30 p.m.
in the City Hall, 101 W Main St, Madison,
IN 47250.
*Applicant Mailing Address:
Name(s):______________________________________________________________
Mailing Address:________________________________________________________
(Street Number - Street Name - City - State - Zip Code)
Phone Number:__________________ Email Address:________________________
Owner Mailing Address:
Name(s):______________________________________________________________
Mailing Address:________________________________________________________
(Street Number - Street Name - City - State - Zip Code)
Phone Number:___________________ Email Address:_______________________
*Note: If the applicant is not the owner, the legal noce and nocaon signage will include both the
Applicants name and the Owners Name. Applicants must have owners permission to do proposed work.
Project Informaon
Address of property for proposed work: ____________________________________
(Street Number - Street Name)
Type of Project (Check all that apply):
Contractor: ___________________________________________________________
[ ] New Building
[ ] Addion to Building
[ ] Rebuilding, Restoraon,
Rehabilitaon, Remodel
[ ] Fence or Wall
[ ] Sign
[ ] Relocang a building
[ ] Demolion
[ ] Other _______________________
Please read the following statements. Your signature below acknowledges that you
have read the statements and aest to their accuracy:
I understand that the approval of this applicaon by City Sta or the HDBR does
not constute approval of other federal, state, or local permit applicaons.
I understand that I (or my representave) will need to aend the HDBR Hearing.
If no representaon is present at the meeng, the applicaon will be deemed
incomplete and will be placed on the next months agenda.
I have reviewed the City of Madisons Historic District Guidelinesin preparing
this Applicaon.
___________________________________ _________________
Signature of Applicant/Owner Date
click to sign
signature
click to edit
City of Madison, IN
Historic District Board of Review
Application for Certificate of
Appropriateness (COA) Page - 2
Project Descripon
If the proposed scope of work will include more than one type of project please
divide the descripon into secons.
(Example: 1. south side, replace 2 upper wood windows with wood windows; 2.
roof, replace metal roof with asphalt shingles)
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[ ] Connued on addional sheet
Required Supporng Documents
The following list includes the supporng
documents necessary for review of a
parcular project. For site plans all four
(4) setbacks from property line MUST be
labeled. Only one (1) copy of each
supporng document is necessary.
Repair, Replace, or Repair/Replace:
[ ] Structure Plan - Elevaons (Only
required if making changes to
openings or adding/removing
features)
[ ] Site Plan MUST have all four (4)
setbacks labeled. (Only if changing
footprint)
[ ] Photographs (current/proposed) with
capons
[ ] Samples/brochures
New Buildings and New Addions:
[ ] Structure Plan - Elevaons (Only
required if making changes to
openings or adding/removing
features)
[ ] Site Plan MUST have all four (4)
setbacks labeled.
[ ] Floor Plan
[ ] Photographs of proposed site and
adjoining properes with capons
[ ] Samples/brochures
Sign and Fence/Walls:
[ ] Photograph of Exisng with capons
[ ] Sketches/Photo of proposed
[ ] Samples/brochures
[ ] Addional Informaon Sheet
Moving Buildings:
[ ] Map showing exisng locaon
[ ] Map showing proposed locaon
[ ] Photographs of structure with
capons
Demolion:
[ ] Photographs with capons
City of Madison, IN
Historic District Board of Review
Application for Certificate of
Appropriateness (COA) Page - 3
Check all
that
apply
Building Element Guideline
Page #
Approval Types Exisng Material Proposed Material
Additions Commercial: 62-63
Residential: 68
HDBR
Awnings Commercial: 34-35
Residential: 35
STAFF
Brickwork/Masonry Commercial: 36-39
Residential: 36 - 37
HDBR/STAFF
Chimneys Commercial: --
Residential: 38
HDBR/STAFF
Deck Commercial: 60
Residential: 64
HDBR/STAFF
Demolition Commercial: 71-72
Residential: 80-81
HDBR
Doors & Entrances Commercial: 40-42
Residential: 39-42
HDBR/STAFF
Fences and Walls Commercial: --
Residential: 73
STAFF
Fire Escapes & Staircases Commercial: 43
Residential: 43
HDBR/STAFF
Foundations Commercial: --
Residential: 44
HDBR/STAFF
Garages & Outbuildings Commercial: --
Residential: 45
HDBR/STAFF
Gutters & Downspouts Commercial: 44
Residential: 46
STAFF
Infill Buildings and New
Construction
Commercial: 64-66
Residential: 69-71
STAFF
Lighting Commercial: 45
Residential: 47
HDBR/STAFF
Pools, Fountains,
Gazebos and Pergolas
Commercial: --
Residential: 75
STAFF
Porch Columns & Railings Commercial: --
Residential: 51-52
HDBR/STAFF
Porches Commercial: --
Residential: 49-50
HDBR/STAFF
Ramps and Lifts Commercial: 61
Residential: 65-67
HDBR/STAFF
Roofs Commercial: 47
Residential: 53-54
HDBR/STAFF
Shutters Commercial: --
Residential: 55
HDBR/STAFF
Siding Commercial: --
Residential: 56-58
HDBR/STAFF
Signs Commercial: 48-51
Residential: 59
STAFF
Storefronts Commercial: 52-55
Residential: --
HDBR/STAFF
Storm Doors and Storm
Windows
Commercial: 40-42, 56-59
Residential: 39 - 42, 60 - 63
STAFF
Utilities Commercial: 70
Residential: 78
STAFF
Windows Commercial: 56-59
Residential: 60-63
HDBR
HDBR/STAFF
Other: ______________________________________