Form 10-168e HPCA State Historic Preservation Office Review & Recomme

UNITED STATES DEPARTMENT OF THE INTERIOR
NATIONAL PARK SERVICE

OMB Approved
No. 1024-0009
Form 10-168e
Revised 2/2013

Historic Preservation Certification Application
State Historic Preservation Office Review & Recommendation Sheet
Rehabilitation—Part 2 / Part 3

Project Number:

Number

1

Preliminary done

(Property)

Non-standard billing

(Property)
Certified Historic Structure?

Type of Request:

Yes

pending

Part 2
Part 3 (Part 2 previously reviewed)
Part 3 (Part 2 not previously reviewed)
Amendment

Date application received by State
Date(s) additional information requested by State
,
,
,
,
Complete information received by State
Date transmitted to NPS
Property visit by State staff
(before)
(during)

,

,

(after)

SHPO REVIEW SUMMARY
Fully reviewed by SHPO
No outstanding concerns
,

Owner informed of SHPO recommendation
In-depth NPS review requested

rehab.

Number

2

STATE RECOMMENDATION

who meets the Secretary of the Interior’s Professional Qualification Standards, have reviewed this application.
The project:
meets the Standards.
meets the Standards only if the attached conditions are met.
does not meet Standard number(s)

for the reasons listed on reverse.

warrants denial for lack of information.
This application is being forwarded without recommendation.
For completed work previously reviewed, check as appropriate:
completed rehabilitation conforms to work previously approved.
completed rehabilitation differs substantively from work previously approved (describe divergences from Part 2 application on
reverse).

Date

State Official Signature

This is a review sheet only and does not constitute an official certification of rehabilitation.

,

Number

3

Number

4

ISSUES
Additions, including rooftop

Alteration of significant exterior features or surfaces

Alteration, removal, or covering of significant interior
finishes or features

Adjacent new construction, extensive site work, or demolition
of adjacent structures

Changes in significant interior spaces or plan
features (including circulation patterns).

Window replacements on any major elevation that do not match
historic configuration, material, and profiles

Damaging or inadequately specified masonry treatments

Other (explain)

Basis for Recommendation. Focus on how the issues checked in Number 3 are being addressed. Where denial is recommended, explain
fully. Comment on noteworthy aspects of the project, including any technical or design innovations, or creative solutions.

STATE EVALUATION OF PROJECT & CONCERNS

See attachments:
plans
specifications
photographs
other:
Items sent separately:
plans
specifications
photographs
other:
Other documentation on file in State:
INNOVATIVE SOLUTIONS/NOTEWORTHY ASPECTS
new technical process
creative design solution

noteworthy project

NPS COMMENTS

Date

National Park Service Signature

Recordkeeping Requirements The National Park Service does not require State Historic Preservation Offices to retain this form
Privacy Act And Paperwork Reduction Act Notice The information requested in this form is being collected from the State Historic Preservation Officer in order to enable the Secretary of the Interior to
gain the benefit of the State review of applications for Federal tax incentives for historic by owners of historic properties. Information collected on this form, including names and all written comments, is
subject to disclosure. Reporting burden for this form—including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form—is estimated to average 2.5
hours per response for Part 1; 5 hours per response for Part 2; 2.5 hours for an Amendment/Phase Advisory, and 3.5 hours per response for Part 3. Comments regarding this burden estimate or any aspect of
this form may be made to the Chief, Technical Preservation Services, National Park Service, 1201 “Eye” St., NW, Washington, D.C. 20005. A Federal agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this application and has assigned it control number 1024-0009.