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1. Applicant Information

•Applicant Name(s):

•Mailing Address:

•Phone:

•Email:

 

2. Property Information

•Property Address:

•Year Built (if known):

•Brief history or significance of the property:

•Copy of Town Assessment Card

 

3. Ownership Certification

 

☐ I certify that I am the legal owner or authorized representative of the property described above.

 

4. Project DescriptionDescribe the proposed work (materials, methods, scope, and budget). Include documentation of financial need.

 

5. Preservation PurposeExplain how the project preserves the historic character of the structure and benefits the public.

 

6. TimelineProposed start date:Proposed completion date:

 

7. Budget Estimated Total Cost Grant Request ($)

 

8. Contractor Information (if applicable)

•Contractor Name:

•Experience with historic properties:

•Contractor bids or documented costs of the project:

 

9. Public Visibility & Access

 

Is the structure visible from a public way?

☐ Yes ☐ No

Will the project contribute to the public understanding of Granby's history? Explain:

 

10. Certification I certify that:

 

•Grant funds will be used solely for approved historic preservation purposes

 

•No funds will be used for political, lobbying, or non-charitable purposes

•I understand SBHS retains discretion and control over the use of funds

•I agree to provide documentation and permit reasonable oversight

Signature: ________________________

Printed Name: _____________________

Date: ____________________________