Related Correspondence Prior To 5-7-19 Public Hearing

OREGON SHPO CLEARANCE FORM INSTRUCTIONS Do not use this form for ODOT, Federal Highway projects or to record archaeological sites SECTION 1: PROPERTY INFORMATION: o Include complete address and agency project number and name, if applicable. o Check YES if there are any buildings on the site. Check NO if it is a vacant parcel (in which case it will be evaluated for archaeology and the potential impact on surrounding buildings only.) o Check YES if your research (look on our website at htti)://heritaaedata.prd.state.or.us/historic/ and/or call your local planning office) shows the property is listed. Check NO if you find that it is not listed. o Fill in the construction date. Check box if date is estimated. o Describe the siding and window types and materials. Examples: double hung wood windows; vertical wood siding. o Check to what degree the property has been altered. Ask yourself, would the original owner recognize the building, or have there been many changes that obscure the historic features? SECTION 2: APPLICANT DETERMINATION OF ELIGIBILITY: o Check the ELIGIBLE box if the building is listed (National Register OR Local landmarks register), has previously been evaluated as eligible, or is 50 years of age AND the majority of the exterior historic features are retained. o Check the NOT ELIGIBLE box if the building is not yet 50 years old, or if in your opinion there have been many and/or major changes (e.g. additions, siding and/or window replacement, porch enclosures). o Applicants who acknowledge that the property meets the minimum qualifications for listing in the National Register but choose to contest this determination must complete a Determination of Eligibility (DOE). The DOE must demonstrate that the property is not eligible for the National Register using the Criteria listed in National Register Bulletin 15, "How to Apply the National Register Criteria for Evaluation." The DOE maybe submitted on continuation sheets or as a separate document. SECTION 3: APPLICANT DETERMINATION OF EFFECT: o Check the NO EFFECT box if the property is NOT ELIGIBLE for listing in the National Register or if the work will not replace or alter the appearance of any of the building's exterior features. o Check the NO ADVERSE EFFECT box if the property is ELIGIBLE for listing or is already listed in the National Register and the work is visible (e.g. re-roofing with same materials, window or siding repair, adding a vent) but will not remove or obscure historic features. o Check ADVERSE EFFECT if the property is ELIGIBLE or listed in the National Register and the work includes major changes, such as replacing the siding or windows. SECTION, 4: PREVIOUS ALTERATIONS - o List the changes that already occurred to the building, including siding, windows, doors, porches, additions including dormers, or if the property was moved. Include the approximate date of each alteration. The information can be provided in list format. SECTION 5: PROJECT DESCRIPTION: o Clearly describe what is being repaired or replaced, and how that work will be done. What materials and installation process are proposed? Include sufficient information (e.g. close-up photos, product specification sheets) so we can compare what exists with what is proposed. The information can be provided in list format. SECTION 6: FUNDING SOURCE: o Check the federal or state agency funding the project; or check "other" and fill in the agency name. SECTION 7: AGENCY CONTACT INFORMATION: o List the name of the organization submitting the Clearance Form SECTION 8: ATTACHMENTS: o Photos: Include photos of the entire building, especially the elevations that can be seen from the street. Include close-ups of features that will be impacted by the project. o Additional Information: When applicable, include window specifications, plans or diagrams that illustrate pertinent existing conditions and/or proposed work o Continuation sheets for additional Section 4 or 5 narrative or to append a formal Determination of Eligibility (DOE) or Finding of Effect (FOE). These materials may also be submitted as a separate document. Oregon State Historic Preservation Office Page 5 Revised 2/18/2014