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.

Applicant Name / Primary Contact*

Co-Applicant Name

Property Owner*

Is the Owner the Applicant?*

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If No, does the applicant have site control or written consent of the property owner to submit an application?*

If yes, please attach documentation at the bottom of this application. If no, project will be deemed ineligible for this applicant.

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Is the applicant a City department?*

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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Is this project on City owned property?*

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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Organization (if applicable)

Mailing Address*

Phone Number*

Email Address*

Project Information

Project Name*

Project Location*

Address and Assessor Parcel Id#

CPA Program Area (check all that apply)*

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Is the resource in a Local Historic District and/or listed on the State Register of Historic Places?*

You can check designation at mhc-macris.net.

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If no, has the Medford Historical Commission made a determination that the resource is significant?*

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Budget Summary

Total budget for project (not to exceed $10,000)*

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

CPA funding request (not to exceed $5,000)*

CPA request as percentage of total budget*

Please specify how the total CPA funds request was determined.*

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.

Please provide a brief description of the project*

How does the project meet the general and category-specific priorities outlined in the Medford Community Preservation Plan?*

How does this project serve the public? What community need(s) does this project serve?*

If applying with a government entity as a co-applicant, describe how they will work together, how finances will be managed, and the work will be continued after the conclusion of CPA funding.

Is ongoing maintenance and upkeep required? If yes, please explain how this will be accomplished.*

Describe any permits, approvals, Massachusetts Architectural Access Board (MAAB) variance requests, or restrictions that are required for the project to go forward and the status for each.*

For Historic Resources Rehabilitation Projects: Describe how the proposed project complies with the U.S. Secretary of the Interior’s Standards for Rehabilitation, as required by the CPA legislation under the definition of rehabilitation.*

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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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