TOWN OF AMHERST
Historic Preservation Commission
LANDMARK DESIGNATION APPLICATON FORM
Applicant Name
*
First Name
Last Name
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant Organization (if any)
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Part A. Property Identification
Building's common or current name
*
Building's historic name, if known
Street location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SBL#
Current owner name
*
First Name
Last Name
Current owner's mailing address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Part B. Description of Criteria for Designation of Historic Landmark, Site, or District
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The HPC may recommend designation of an individual property as a HISTORIC LANDMARK if it (select all that apply):
Is associated with the lives of individuals, or of people, or of events significant in the national, state or local history
Embodies the distinctive characteristics of a type. a period, or a method of construction
Represents the work of a master architect or designer, or possesses high artistic values
Represents a significant or distinguished entity whose components may lack individual or special distinction
Because of a unique location or singular physical characteristic. it represents an established and familiar visual feature of the neighborhood
The HPC may recommend designation of a property or a group of properties as a HISTORIC SITE if it/they (select all that apply):
Contain(s) significant historical or cultural sites where buildings or structures no longer exist such as a battlefield, cemetery, or former transportation facility; or sites which may yield information important to area history or prehistory
The HPC may recommend designation of an individual property as a HISTORIC LANDMARK if it (select all that apply):
Is associated with the lives of individuals, or of people, or of events significant in the national, state or local history
Embodies the distinctive characteristics of a type. a period, or a method of construction
Represents the work of a master architect or designer, or possesses high artistic values
Represents a significant or distinguished entity whose components may lack individual or special distinction
Because of a unique location or singular physical characteristic. it represents an established and familiar visual feature of the neighborhood
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Part C. Property Description
Building Material(s):
Clapboard
Stone
Stucco
Shingles
Cobblestone
Board and batten
Brick
Logs
Other
Structural system, if known
Wood frame: heavy timber
Wood frame: light members
Masonry load-bearing walls
Log
Plank
Metal
Other
Condition:
Excellent
Good
Fair
Deteriorated
Ruins
Unexposed
Integrity I:
Unaltered
Altered
Integrity II:
Original site
Moved
Date of move
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Month
-
Day
Year
Date
List all known alterations and when they occurred
Part A-C sources of information
Threats to Building:
None
Zoning
Development
Roads
Deterioration
Fire
Other
Related Outbuildings and Property: (use other for landscape features)
Barn
Garage
Shed
Carriage House
Greenhouse
Privy
Shop
Gardens
Stables
Well
Other
Surroundings:
Open land
Woodland
Scattered buildings
Densely build-up
Commercial
Industrial
Residential
Other
Interrelationship of building and surroundings...
In your own words, explain the significance of the interrelationship of the buildings and the surroundings
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Part D. Significance
Other notable features of building and site (i.e. style, details, interior features if known):
File Upload: Historical and architectural importance Narrative: Referring to the criteria set forth in the Town Preservation Ordinance, list those that apply and explain how the property meets those criteria.
*
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File Upload: Please attach any additional material which might be useful in considering the site for landmark designation, i.e. copies of newspaper clippings, magazine articles, old photographs, etc.
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File Upload: Photographs of structure including all exterior views (front, back, sides) showing complete elevations of all structures
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File Upload: Map or Plot Plan of the property's location is required. If more than one building is being considered on a property, or a property has notable landscape features, include a sketch plot plan of the property noting these buildings and/or features.
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Signature of Applicant
*
Date
/
Month
/
Day
Year
Date
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