your application! - Gloucester Main Street Preservation Trust

Façade & Interior Improvement
Grant Program Application
Date application submitted _____________________________________________________________
Applicant Name _________________________________________Tax Payer ID#_________________
c Building Owner
c Tenant
Property Address ___________________________________________________________________
_______________________________________________________________________
Phone number where you can be reached during the day ________________________________________
Email Address _____________________________________________________________________
Name of Property Owner, if different from applicant ___________________________________________
Property Owner Contact Information if different from applicant __________________________________
________________________________________________________________________
________________________________________________________________________
Type of improvement proposed: (you may check all that apply)
c Exterior Façade c Sign
c Site
c Merchandising Assistance Grant
c Tenant Improvement Grant
c Other
Please submit the following information in the order listed below by April 30, 2015, 3PM to the Main Street
Preservation Trust office. Please provide 8 copies held with a binder a clip at the top left corner. Failure to submit
in this manner may remove your application from consideration.
c A. 8 ½ x 11 sheet of paper with typed name of business, address, contact name for project, phone number, and
email in no less than 16 font.
c B. Grant application with all information provided and signed
c C. Written summary of proposed scope of work
c D. Photographs clearly showing existing conditions of the building to be improved
c E. Two cost estimates provided by an appropriately licensed contractor
c F. Exact samples of paint, colors, materials, etc. that are being proposed with project
c G. The property owner’s written approval, if owner is different from applicant
c H. All required permits where applicable
c I. If applicant is not the property owner, provide a lease valid for a minimum of one year
c J. Paragraph explaining how the business supports the growth and sustainment of the Gloucester Village.
c K.W9
Façade, Interior & Merchandising
Grant Program
www.gloucestervillage.com
Façade Improvments
Total Cost of Improvements ____________________________________________________________
Grant amount requested (50% of cost up to $20,000) __________________________________________
Source of matching funding ____________________________________________________________
Has funding been secured? ____________________________________________________________
Interior Improvments
Total Cost of Improvements ___________________________________________________________
Grant amount requested (50% of cost up to $10,000) __________________________________________
Source of matching funding ____________________________________________________________
Has funding been secured? ___________________________________________________________
Merchandising Assistance
Total Cost of Assistance _______________________________________________________________
Grant amount requested (50% of cost up to $2,500) ___________________________________________
Source of matching funding ____________________________________________________________
Has funding been secured? ____________________________________________________________
I understand that in order for my request for a façade and/or interior improvement grant to be approved, I must agree
to work with the Design Committee and to follow the Gloucester Village Main Street Design Guidelines for Façade
and Interior Grants. I understand that the Façade & Interior Program is a competitive award process and that submittal of this application does not guarantee funding. I also understand that monies are granted on a reimbursement
basis following completion of work and approval by the Design Committee. I also understand that any changes
made to the project after the grant approval, which have not be approved by the Design Review Committee, will not
be eligible for funding and may disqualify the entire project for the grant funding. I also certify that if I am a tenant of
the aforementioned property, that I have obtained authorization from the property owner to complete the project. I
am a current member of the GMSA and understand that if awarded a grant of $5,000 or more, I am committing to a
3 yr. term of membership in the GMSA. I understand this amount is expected to be paid prior to receiving the grant
payment. For membership fee info, please contact the GMSA at (804) 695-0700.
Signature of Applicant __________________________________________________Project_________
Signature of OWNER if different from Applicant ______________________________________________
TO BE COMPLETED BY DESIGN COMMITTEE
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