www. northwarks.gov. uuplanning North Warwickshire Borough Council Application for listed building Planning (Listed ) Act 1990 You can complete and submit this form electronically via the Planning Portal by visiting www.planningportal.gov.uUapply Publication of applications on planning authority websites Please note that the information provided on this application form and in supporting documents may be published on the Authorit/s website. If you require any further clarification, please contact the Authority's planning department. Please complete using block capitals and black ink It is important that you read the accompanying guidance notes as incorrect completion will delay the processing of your application. 1. Applicant Name and Address 2. Agent Name and Address Title: Title: Last name: Last name: Company AeR <Cr.J (optional): Unit: &sSou*tc!.. House I number: I House f----l I First name: (optional): Unit: I House name: I House I number: House l-----__l suffix: I House name: Address 1: 0o 8cr+ Address 2: So.r.,rrnr Address 3: 4\\,s oF t'l,tr -s82- Address 1: Address 2: Address 3: . Town: Town: County: County: Country: Country: Postcode: I Company \en*.rcp. suffix: I -rratq z.kA Postcode: 3. Description of Proposed Work Please describe the to alter, extend or demolish the listed {O (Zcrsoeg l+n O OOO*tr:- {BE W*cr,C Oe s>|& s\o.rlciue-O rN\64+}ftrL\ 4{v$ F\}faN&frt ln" A r{At,}aL \.tfns ftn,"cnnrer @ aa,ea-rf- Goarc- , ft.orr{cs5 k}cqt {+t+|,."8A A^.,O 4nl,\OAC\arfr\61era Ai)D rrCfr)nf-+r Rcrr^lTr,ef SDate:: 20'l 4-02-t 0 rS S8sision: 5975 5 I 3. Description of Proposed Work (continued) 4. Site Address Details Please provide the full postal address of the application site. Has the work already started without consent? ! ves d*o lf Yes, please state when the work was started (DD/MM/YYYY): E Unit: House name: I;#'6'",., Pxg;* Address 1: ll.----] il,"#i: [--l U(sr;"5a tlrruerr3..f S\o.$Sr Address 2: Address 3: (date must be pre'application submission) the work been completed without consent? Has [ves Eruo Town: A?m'z-srns. County: tUOSu* 4.Otat-ttCncetAAe. Postcode d-V4 r ezf (optional): Description of location or a grid reference. (must be completed if postcode is not known): the date when the work was completed (DD/MM/YYYY): lf Yes, please state (date must be pre^application submission) 6. Pre-application Advice 5. Related Proposals Are there any current applications, previous _ proposalsordemolitionsforthesite? [-J Yes d*o lf Yes please describe and include the planning application reference number(s), if known: Reference Description number Has assistance or prior advice been sought from the local authority about this application? ffVes E ruo lf Yes, please complete the following information about the advice you were given. (This will help the authority to deal with this application more efficiently). Please tick if the full contact details are not known, and then complete as much as possible: tr fficer name: 6€€ Ch^^*. Reference: Date (DD/MM/YYW): (must be pre-application submission) Details of A,Cg*ra{X,o-. 6xc 7. Neighbour and Community Consultation Have you consulted your neighbours or the local community about the proposal? f ves Mruo advice received? t$z \s t1trd/\cJ 8. Authority Employee / Membe_r any of ' am: statements apply to you? staff (b) an elected member [l.-- Ves E{o (c) related to a member of staff with respect to the Authority, (a) a member of I (d) related to an elected member Do these 9. Materials Please provide a description of existing and proposed materials and finishes to be used in the building (demolition excluded): o, E Existing (where applicable) <tnO o,4 Proposed Don't Know cr o External walls BCrrCj<*rr,r A^.G, csfl.tr..(- Roofcovering ,fir-4- nr-rs f\s+o Chimney 6n"..ra-.rcfi^o. Windows dmgsn- cillo,q*,t L\ L\ tr tr Lt tt tr v\ t^ Ceilings 6c"te!s lnternal walls O^r.tl"co,> t Floors ("nosr. k lnternal doors 4"t.lgr:e tA Boundary treatments (e.9. fences, walls) {0Dtapr,.rs,P-^< Vehicle access and hard standing tr tr tr q T 4 tr tr ,( u tr tr tr r/t V Noore (b."'tqA{,- Gr u..2. Lighting tr u u u\ fO${ Aaf tr h 4"'.aea Rainwater goods r vt External doors hAAtstrcD tr tr a4 v. r u 6l$r\r.iq A.Ar a( tr T tr t^ a tr Others (add description) Are you supplying additional information on submitted drawings or plans? flVes E Uo lf Yes, please state plan(s)/drawinq(s) references: A A*. 6oseDu/ufl- oc 7q,-ea+aa \rs{ Bern"r cfi.Grtutleo fio*L lO aS SBdd^a. 5975 S 10. Demolition 11. Listed Building Alterations Does the proposal include the partial or total demolition of a listed building? Do the proposed works include alterations to a listed building? lf Yes, which of the following does the proposal involve? lf Yes, do the proposed works include: (you must answer each of the questions) a) Total demolition of the listed building: I ves b) Demolition of a building within the curtilage of the listed building: c) Demolition of a part of the listed E tto @es Eno ffv"t Eruo c) Works to any structure or object fixed to the property (or buildings within its curtilage) internally or externally? paes f] d) Stripping out of any internalwall, ceiling orfloor finishes (e.9. plaster, floorboards)? @ves Euo a) Works building: ! to the interior of the building? b) Works to the exterior of the building? Ves lf the answer to c) is Yes: i) What is the W"t total volume of the listed building?(cubic metres) ii) What is the volume of the part to be demolished?(cubic metres) iii) What was the (approximate) date of the erection of the partto be removed? (MM/YYYY) (date must be pre-application submission) rno lf the answer to any of these questions is Yes, please provide plans, drawings, photographs sufficient to identiff the location, Please provide a brief description of the building building you are proposing to demolish: or part of the extent and character of the items to be removed, and the proposal for their replacement including any new means of structural support and state references for the plan(s)/drawing(s): &-r-A- S'\A &M- grnsu"r *l ./c,Oe"".r.aD Why is it necessary to demolish or extend (as applicable) all or part of the building(s) and or structure(s)? 12. Listed Building Grading 13. lmmunity From Listing Please state the grading (if known) of the building in the list of Buildings of Special Architectural or Historic interest? (Note: only one box must be ticked) Has a Certificate I f] ll* [-l Grade Grade Grade ll f I f] lF f ll I Ecclesiastical Grade Ecctesiastical Grade Ecclesiastical Grade Don't know of lmmunity from Listing been sought in respect of this building? ! ves Eltto [-l Don't know lf Yes, please provide the result of the application: l-l SDate:: 201 +O2-l 0 aS SRevisbn: 5975 S 1 4. Ownership Certificates One Certificate A, B, C, or D, must be completed with this application form CERTIFICATE OF OWNERSHIP - CERTIFICATE A Regulation 6 of the Planning (Listed Buildings and Conservation Areas) Regulationsl990 +<rtrT/The applicant certifies that on the day 21 days before the date of this application nobody except myself/the applicant was the owner* of any part of the land or building to which the application relates. * "owner" is o person with a freehold interest or leasehold interest with ot leost 7 years left to run. Date DD/MM/WYY): 2u: a5.2st5 r,:'=f'T'tflt"f[,1]['TE::T'J;1::H'.ffIil*, Resutations leeo Resuration 6orthe certify/ The applicant certifies that I have/the applicant has given the requisite notice to everyone else (as listed below) who, on the day 21 days before the date of this application, was the owner* of any part of the land or building to which this application relates. * "owner" is a person with o freehold interest or leasehold interest with ot least 7 years left to run. I Name of Owner Date Notice Served Address rslA signed - Applicant or signed - Agent Date DD/MM/YYYY): CERTIFICATE OF OWNERSHIP - CERTIFICATE C Regulation 6 of the Planning (Listed Buildlngs and Conservation Areas) Regulations 1990 I certify/ The applicant certifies that: o Neither Certificate A or B can be issued for this application o All reasonablestepshavebeentakentofindoutthenamesandaddressesoftheotherowners* part of it but I have/ the applicant has been unable to do so. * "owner" is a person with a freehold interest or leasehold interest with at least 7 years left to run. Name of Owner Address Notice of the application has been published in the following newspaper (circulating in the area where the land is situated: Signed - Applicant Or signed - Agent ofthelandorbuilding,orofa Date Notice Served On the following date (which must not be earlier than 21 davs before the date of the aoolication): Date DD/MM/YYYY,): 1 4. Ownership Certificates (continued) r,I[ll'j5'ffi,:f5,tHi:::t"1'5.;1t':Hi:fliP"*, Resutation 6 or the Resurations 1ee0 certify/ The applicant certifies that: o Certificate A cannot be issued for this application o All reasonable slgPs. have been taken to find out the names and addresses of everyone else who, on the day 21 days before the date of this. application, was the ownef of any part of the land to which this appliiation relates, but I have/ the apfilicant has been unable to do so. I x 'owner" is o person with a freehold interest or leasehold interest with ot least 7 years left to run. The taken were: f.,l9tic9 of the application.has been published in the following newspaper (circulating in the area where the land is situated): Or signed - Agent: 15. Planning Application Requirements - Checklist Please read the following checklist to make sure you have sent allthe information in support of your proposal. Failure to submit all information required will result in your application being deemed invalid. lt will not be considered valid until all information required by the Local Planning Authority has been Tk6 rnzr 32 copies zaniaa of ar other a+har plans 5^r drawings A.^.,,i^^- ^The original or ^,i^i^.r and ^r-^. and information necessary describe to the subject of the application: The original and 3 copies of a completed and submitted. t' dated -J M The original and 3 copies of a plan which identifies the which.the application relates and drawn to an J !a.nd !9 identified scale and showing the direction of North: V application form: [d The original and 3 copies of the completed dated Ownerihip Certificat6 (A, B, C, or D -'as applicable): The original and 3 copies of a design and access statement, ' if requiiea (see help tbrt and gutdince noies ioi aiijitjl D U l/we hereby apply for planning permission/consent as described in this form and the accompanying plans/drawings and additional information. l/we confirm that, to the best of mylour knowledge, any facts stated are true arid aicuiate and any oplnions given are the genuine opinions of the person(s) giving them. DAIE (DD/MM/YYW): 24 . o,3. zo r5 17. Applicant Contact Details 18. Agent Contact Details Telephone numbers Country f code: Telephone numbers Extension National number: number: Country code: Extension number: National numben Country code; f Country code: 19. Site Can Visit ,/ the site be seen from a public road, public footpath, bridleway or other public lf the planning authority needs to make an appointment to carry out a site visit, whom should they contact? (Please select only one) lf Other has been selected, please provide: Contact name: Email address: land? f]Aeent l(r"t Iruo fleppticant E 3J:itgfflfgi!:Hll,t3"