ARB Local Designation Form

TALLAHASSEE-LEON COUNTY
LOCAL REGISTER OF HISTORIC PLACES NOMINATION FORM APPLICATION

Contact: Historic Preservation Officer, Tallahassee Trust for Historic Preservation , Inc.,
423 East Virginia Street, Tallahassee, FL 32301
Phone: 850-488-7334 Email: miketaltrust@comcast.net Fax: 850-488-7333

I. IDENTIFICATION

Name of Property:_______________________________________________________________

Property Address:_______________________________________________________________

Name of Property Owner:_________________________________________________________

Owner’s Address:_______________________________________________________________

Owner’s Telephone:______________________________________________________________

Contact Person’s Name:___________________________________________________________
(if different from owner)

Contact Person’s Address:__________________________________________________________

Applicant’s Name and Address:_______________________________________________________
(if different from owner)

Applicant’s Telephone:______________________________________________________________

Real Estate (RE) Number:____________________________________________________________

Attach Legal Description or provide copy of survey:_________________________________________

Attach property location map with footprint of property(s).____________________________________

Is the subject property listed on the National Register of Historic Places? ______ If yes, please attach a copy of the National Register Certificate and the National Register of Historic Places Registration Form. Has a Florida Master Site File Form been completed? ______ If yes, please attach a copy.

Check the appropriate type of historic resource to be listed on the Local Register:

_____ Site

_____ District

_____ Building

_____ Structure (other than Building)

_____ Object

II. HISTORY OF RESOURCE

Original Date of Construction:_____________________________________________________________

Original Architect/Builder:________________________________________________________________

Original Owner:_______________________________________________________________________

Historic Use of Site:____________________________________________________________________

Check the following, if available:___________________________________________________________

Original Construction plans _____
Abstract of title _____
Historic photographs_____

List research source(s) in documenting the above historical information on separate sheet of paper:

CRITERIA FOR LISTING ON THE LOCAL REGISTER

This Section To Be Completed By Historic Preservation Officer

(X) indicates all applicable criteria :

Individual Listing Criteria of a Site, Building, Structure or Object:

____ It possesses integrity of location, design, setting, materials, workmanship, feeling and association.

____ It is associated with events or persons that are significant to local, state, or national history.

____ It embodies the distinctive characteristics of a type, period, or method of construction.

____ It represents the work of a master, possessing high artistic values.

____ It represents a significant and distinguishable entity whose components may lack individual distinction.

____ It has yielded, or may be likely to yield, information important in prehistory or history.

District Listing Criteria

A site, building, structure or object shall be designated as contributing to that district if it meets the following criteria:

____ The property is one which, by its location, design, setting, materials, workmanship, feeling, and association adds to the district’s sense of time and place and historical development. (a property is not considered contributing if the property’s integrity of location, design, setting materials, workmanship, feeling and association have been so altered that the overall integrity of the property has been irretrievably lost.)

____ Structures built within the past fifty (50) years will be considered to contribute to the significance of a district, when a strong justification concerning their historical or architectural merit is given, or the historical attributes of the district are considered to be more than fifty (50) years old.

General Condition of the Site: Excellent ____ Fair ____ Poor ____

IV. CURRENT CONDITION OF THE SITE

Current Use of Site:_________________________________________________________________

Intended Use of Site:________________________________________________________________

Have any additions or alterations been made to the historic resource? ________ If yes, please explain. Include type and date of alteration.

______________________________________________________________________________

_____________________________________________________________________________

Do you anticipate making any substantial alterations to this historic resource in the future?_______ If yes, what?______________________________________________________________________________

NARRATIVE DESCRIPTION OF THE SITE

(Briefly describe the historic resource and its setting. Describe its major physical characteristics. Assess the integrity of the historic resource as it now exists, as compared with its original location, design, setting, materials, and workmanship.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

STATEMENT OF SIGNIFICANCE

(Briefly describe the importance of the property to the local community, the state, or nation. Identify the property’s association with significant persons or events, or its architectural or archaeological distinction.

List sources used to document the above information. One can use citations from books, articles, wills, city and county records, or other source material.)

(Please attach current black and white photographs of the property(s) documenting all major character defining features, no smaller than 3 ½ by 5 inches, from all sides of the property or historic resource.)

VIII. OWNER AWARENESS STATEMENT

As the Owner, or the Official Representative of the Owner, of the subject property identified in the Application above, I am aware of this proposal for listing in the Tallahassee-Leon County Local Register of Historic Places. I have been advised of the procedures for review of this application for listing the subject property by the Historic Preservation Officer. I have also been advised of the effects of listing the subject property on the Local Register of Historic Places. I understand that I will be notified of the dates and places of the public meetings at which the application will be considered by the Tallahassee-Leon County Architectural Review Board, the Tallahassee- Leon County Planning Commission and the City of Tallahassee Commission and/or the Leon County Board of County Commissioners and that I will be given the opportunity to submit written comments and to appear in person in support of, or in opposition to the listing of this property.

Signature : _________________________________________ Date : ____________________
Owner of Property

In my opinion, the property ___ meets ___ does not meet the Local Register Criteria.

Signature: _______________________________ Date:_______________________
Historic Preservation Officer

The Tallahassee-Leon County Architectural Review Board recommends listing the subject property on the Local Register of Historic Places.

Signature: _______________________________ Date:_______________________
Chairperson, Tallahassee-Leon County
Architectural Review Board