Small Grants Project Application

CITY OF MEDFORD, MASSACHUSETTS COMMUNITY PRESERVATION COMMITTEE Applicants seeking grants of up to $5,000 for projects with a total cost of up to $10,000 should use this form. A total of $50,000 over the funding year. Reach out to Danielle Evans, Community Preservation Coordinator, devans@medford-ma.gov, for more information.

Applicant Information

If the property owner is not the applicant, submit evidence that the applicant has permission of the property owner to carry out the project. For any project involving City-owned property or acquisition, the City Authorization Cover Sheet is required, which must be signed by the Mayor and a City staff member designated by the Mayor to be a liaison for the project.

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All City departments must coordinate with the Mayor's office and receive authorization to apply for CPA funds. If yes, please attach to this application a City Authorization Cover Sheet, signed by the Mayor and a City staff member designated by the Mayor to be a liaison for the project. Link to cover sheet: http://preservemedford.org/sites/default/files/CPA%20City%20Authorization%20Cover%20Sheet_2022.pdf

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City of Medford must be co-applicant on all projects on City property. If yes, please attach a signed authorization cover sheet at the bottom of this application. Link to cover sheet: http://preservemedford.org/sites/default/files/CPA%20City%20Authorization%20Cover%20Sheet_2022.pdf

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Project Information

Address and Assessor Parcel Id#

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You can check designation at mhc-macris.net.

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Budget Summary

Please attach a completed Budget supplemental form at the bottom of this application. Link here: http://preservemedford.org/sites/default/files/Medford%20CPA%20Application%3A%20Budget.pdf

Describe how CPA funds will be spent and itemize all projected expenditures. Attach additional pages if necessary.

Project Details

Attach additional pages/documentation if necessary.

Every Applicant must include a completed Budget supplemental form: http://preservemedford.org/sites/default/files/Medford%20CPA%20Application%3A%20Budget.pdf Include the following attachments, if applicable and available: • Documentation that you have control over the site, such as Purchase and Sale agreement, option, or deed; or explanation of how the proposed project will proceed in the absence of site control • Description/documentation of site conditions or limitations relevant to the proposed project, including natural resources (wetlands, flood plain, etc.) or hazardous materials • Massachusetts Historic Commission Historic inventory sheet or letter of historic determination from Medford Historical Commission • Visual materials: Photographs, renderings or design plans of the site, building, structure or other subject for which the application is made • Names and addresses of project architects, contractors, and consultants • Letters of support sufficient to document clear endorsement by community members and groups, and, where appropriate, by municipal boards and departments • Any other information useful for the CPC in considering the project • Authorization Cover Sheet (if your project is on City property): http://preservemedford.org/sites/default/files/CPA%20City%20Authorization%20Cover%20Sheet_2022.pdf

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