2023 CPA Full Application

2023 CPA Full Application

CITY OF MEDFORD MASSACHUSETTS COMMUNITY PRESERVATION COMMITTEE FY24 FUNDING CYCLE

Due by September 30, 2023

Prior to filling out this application, you must have already submitted an Eligibility Determination Form to the Community Preservation Committee and be deemed eligible to apply. Eligibility Determination Forms can be found here.

Please note: The application form cannot be saved and returned to later. It is recommended that applicants write answers to the descriptive questions in a separate document, then copy and paste your response into the answer fields when ready to submit.

For more information, email Theresa Dupont (Community Preservation Coordinator) at tdupont@medford-ma.gov

Project Information

Project Name*

Project Location*

Total CPA Funding Request*

CPA Program Area*

Select or enter value

Project Summary*

Applicant Information

Applicant Name/Primary Contact*

Co-applicant Name (if applicable)

Property Owner*

Organization (if applicable)

Mailing Address*

Phone #*

E-mail*

Project Narrative

Describe the project, including the project location and the property involved.*

Why is this project needed? How does the project benefit the public? What population(s) will it serve? Has there been a public process, capital improvement plan, or site evaluation to document the needs or goals for this project? Is there community support for the project?*

How does the project meet the general and category-specific priorities outlined in the Medford Community Preservation Plan, including how the project incorporates sustainable practices and design? How does the project meet the specific criteria in the Community Preservation Act Funding Allowable Uses table?*

Scope and Budget

Required Attachments:

1) Download and complete a CPA Budget Summary Form and attach to this application.

2) A separate, detailed line item budget with outlined tasks/deliverables must also be submitted with this application.

Total Project Cost*

Total cost to complete the project, including all non-CPA funded tasks

CPA Funding Requests as % of Total Project Costs*

Provide a detailed outline of the tasks that will be carried out as part of this project. Please indicate if some tasks will use funding from a different source.*

Will the project require future phases or funding over multiple years? If so, please describe.*

If not, please answer with N/A.

Describe all successful and unsuccessful attempts to secure funding and/or in-kind contributions, donations, or volunteer labor for the project. Describe any cost-saving measures to be implemented.*

If funding is not available to cover the full cost, can this project be phased or reduced in scale?*

Is the project going to result in a requirement for ongoing maintenance? If yes, please explain how this will be managed.*

Project Management

Describe the applicant:*

Are they public, private non-profit, private for-profit, an individual, a partnership, or another type of entity? What is their history and background? Provide any additional relevant information.

If the proposal entails multiple co-applicants, describe the process of coordination between coapplicants in planning for the project application, as well as how the organizations will work together to carry out the project.

Indicate who will have responsibility for managing the finances, and overseeing completion of the project scope, as well as who will have responsibility for maintaining the asset after the conclusion of CPA funding.

Identify and describe the roles of all known participants, including the project manager.*

Feasibility

Physical improvements may be required to become handicapped-accessible. If applicable, will you have an architect or similar professional to ensure compliance with ADA/MAAB Regulations? Please explain.

Historic Preservation projects will be required to follow US Secretary of Interior's Standards for historic preservation. If applicable, will you have a qualified historic preservation professional to ensure compliance? Please explain

Feasibility Checklist

Physical improvements may require permits and approvals from other City departments and/or entities. Please consult with the Building and Engineering departments, or other applicable departments, to identify any environmental or regulatory conditions that may apply to this project.

Select any permits below that will likely be required to complete the proposed project. The CPC is providing the below information as a courtesy and does not represent a comprehensive list of required permitting and/or approvals.

If the project is for open space or historic preservation acquisition, a Conservation Restriction (CR) or Preservation Restriction (PR) is required. For other projects in these program areas a CR or PR may be required at the discretion of the Committee. A third party holder of the CR must be identified.

Building Department

Check off any known approvals/permitting needed from the Building Department.

Select or enter value

Zoning Relief

The Building Department will make determinations on whether the project is allowable "by right" or if the applicant must seek zoning relief in the form a variance, if the project does not meet current zoning regulations and/or dimensional requirements. Check the box to acknowledge.

Demolition/Alterations

Demolition or alterations to any building 75 years of age or older requires review by the Historical Commission, which may include an 18 month demolition delay. Check the box to acknowledge.

Engineering Department

Check off any known approvals/permitting needed from the Engineering Department.

Select or enter value

Fire Department

Select or enter value

Board of Health

Select or enter value

Environmental Assessment

Acknowledge any known site condition issues

Select or enter value

Include the following attachments, if applicable and available:*

ALL APPLICANTS must include a completed copy of the CPA Budget Summary Form. Please submit the following additional attachments, if relevant.

A separate, detailed line item budget with outlined tasks/deliverables
Record plans of the land
Natural resource limitations (wetlands, flood plain, etc.)
Zoning (district, dimensional and use regulations as applies to the land)
Inspection reports
Environmental assessment reports or evidence that the proposed site is free of hazardous materials, or that there is a plan for assessment and/or remediation in place
Massachusetts Historic Commission Historic inventory sheet or finding of historic significance by Medford Historic Commission
Existing conditions report
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 (unless undetermined for projects subject to and yet to complete the public procurement process)
Evidence that appropriate professional standards will be followed if construction, restoration or rehabilitation is proposed
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
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 Committee in considering the project

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