Dewsbury THI – Grant Application Form
advertisement
Dewsbury Townscape Heritage Initiative Grant Application PLEASE NOTE This application form must be completed and returned together with the required information (see checklist - item 24 of this form). You are advised to refer to the detailed guidance documents carefully and contact the THI Officer if you have any questions or difficulty completing the application form. 1.When completed this form, together with plans, quotations etc, should be returned to the Dewsbury Townscape Heritage Initiative Officer. 2.The grant will not be paid if work starts before grant approval has been given. PLANNING OR BUILDING REGULATION APPROVAL ARE NOT THE SAME AS GRANT APPROVAL. Please read Application and Guidance Advice Notes 1, 2, 3, 4 & 5 before filling in this form. 1. Address of the property at which the work is to be undertaken: ......................................................................................................................................................................... ......................................................................................................................................................................... Full name of applicant(s):................................................................................................................................ Address (if different from above):................................................................................................................... ......................................................................................................................................................................... Telephone:Landline:...................................................... Mobile:........................................................ Email address: ................................................................................................................................................. Website address: .............................................................................................................................................. Building on the past to secure the future www.kirklees.gov.uk/dewsburytownscape Application (continued...) Dewsbury Townscape Heritage Initiative Grant Application 2. Details if are you acting on behalf of the applicant: Name: .............................................................................................................................................................. Address: ........................................................................................................................................................... Telephone no: ................................................................................................................................................. Association to applicant: ................................................................................................................................. 3. Do you, or will you: (a) own the freehold? Yes No (b) hold a lease with an unexpired term of at least 10 years, without a break clause? Yes No 4. If you are applying as a leaseholder, do you have the freeholders permission to undertake the project? If permission is required please attach evidence of this to the application YesNo 5. Age, description and type of property, including any statutory designation (e.g. Grade II Listed): 6. Is planning permission required?YesNo If yes, date of approval: .............................................. and Ref. no.:.......................................................... Has a discussion with building control taken place? Yes No If yes, have building regulations been applied for? Yes No 7. Floor space occupied Sq m / Sq ft: ..................................................................... 8. Is the business registered for VAT?YesNo If yes, please give registration no: ............................................................................ 9. As a trading business are you registered with the Inland Revenue?YesNo 10. Is the business registered with Companies House?YesNo If yes, please give registration no: ............................................................................ 11. Are you, or have you been, a sole trader/partner/director of a business which has gone, or is in the process of going, into receivership/administration or liquidation?YesNo If yes, please give details: ................................................................................................................................. 12. Is the business registered as a charity?YesNo If yes, please give registration no: ............................................................................ 13. Have you made, or can you make, an insurance claim for any of the works detailed in your estimate?YesNo If yes, please provide details: ................................................................................... 14. Is the building insured?YesNo If yes, please attach details of the insurance company, type of insurance and expiry date. 15. Existing use of the property Please use this space to give us more information about what your property is used for - the products and services you provide at the property: ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... 16. Proposed use Please use this space to give us more information about what your property will be used for – the products and services you intend to provide at the property and if it is your intention to change or add further uses: ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... 17. Proposed scheme a) Please tell us about the proposal for which you are looking for funding and the timescale for implementation of the project. In assessing your application the grant board will consider the need for repair to the building, with regard paid to the special character and interest of the Dewsbury Conservation Area and the implementation of a comprehensive repair strategy. Your architect will be required to provide evidence to demonstrate the need for reinstatement. Please tell us how you will address these issues through submission of a summary from your architect: ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... b) If applying for a ‘Vacant Floor Space Grant’ please also supply a copy of your Development Appraisal for the proposed scheme? ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... ......................................................................................................................................................................... 18. Please provide details of your Architects and Agents: a) Architect practice name: ............................................................................................................................ Architect’s name(s): ........................................................................................................................................ Address: ........................................................................................................................................................... ......................................................................................................................................................................... Telephone no: work:.................................................. mobile:.............................................................. Email address: ............................................................... website: ................................................................... Are the conservation architects registered with any of the following: Royal Institute of British Architects (RIBA) Architects’ Registration Board (ARB) Chartered Institute of Architectural Technologists (CIAT) b) Please provide details if you are employing other agents such as a building surveyor for project management services or a structural engineer / specialist services Agent’s name: ................................................................................................................................................. Practice: ........................................................................................................................................................... Address: ........................................................................................................................................................... ......................................................................................................................................................................... Telephone no: work:.................................................. mobile:.............................................................. Email address: ............................................................... website: ................................................................... Please provide details of which professional organisation the agent is registered: ......................................................................................................................................................................... ......................................................................................................................................................................... 19. Cost of the project Please include as much information as possible and attach quotations from suppliers in all cases. This should be supported by submission of a fully priced schedule of works from the successful contractor. Estimated costs for eligible work Building repair work Price VAT Total Grant sought VAT Total Grant sought Total cost of repairs: Reinstatement of architectural features Price Total cost of reinstatement: Bringing vacant floor space back in to use Price VAT total Grant sought Total cost of vacant floor space works: Applicants often invest in additional, non-eligible, repairs and improvements at the same time as the grant-aided works. If this applies to you, it would be extremely helpful if you would indicate the nature and cost of such proposed works, so that we may assess the ‘add-on’ value of this grant scheme. Estimate of costs for non-eligible works Non-eligible work Price VAT total Grant sought Total cost of non-eligible work: 20. Does the application relate to whole or part of the property? Whole Part 21. Programme estimated start and completion dates? Start: .......................................................... End: ............................................................... 22. Have you previously applied, currently applying, or do you intend to apply for Lottery funding, or for funding from another distributing body or funding source?YesNo If yes, please give details and dates: ................................................................................................................ ........................................................................................................................................................................ 23. If you are related to, or a business partner of, any of the following, please identify the source(s): An elected member of Kirklees Council: .................................................................................................. An employee of Kirklees Council: ............................................................................................................ A corporate body with which any member or employee of Kirklees Council is associated An employee of the Heritage Lottery Fund: ............................................................................................ 24. Checklist - all applicants The following is the list of detailed information which must be submitted with the application. Please use it to ensure that you enclose all the documents required by your application, as your application cannot be processed without them. Items to submit 1 Evidence of interest /ownership of property(i.e. proof of leasehold or freehold) 2 Supply information of any monies outstanding, mortgage, restrictions or claims against the property. (refer to Advice Note 2 Summary of THI Grant Conditions, Encumbrance) 3 Statutory consents (e.g. planning permission, listed building, building regulations) 4 Proof of insurance for the property, works and any unfixed materials and goods delivered to the property. Provide names of insurance companies, type of insurance provided and their expiry date (to be submitted jointly with evidence from the Contractor) 5 Evidence and details of sufficient funds to cover your contribution towards the works 6 Evidence of grant offers from other sources, including current offers and applications 7 Full details of proposed works. To include specifications of works, site specifications and drawings of relevant elevations and details, photographs, schedule of works key mile-stones and expenditure profile 8 If you are a private company, sole trader or charity, you need to supply a copy of: - Your most recently audited accounts - Articles of association or memorandum of agreement 9 Summary sheets from at least three quotations or tenders (as applicable) 10 Copy of the lowest or winning tender accompanied by a fully costed schedule of works 11 If you’re proposing to accept a tender other than the lowest please submit your justification 12 Current value of the property, and for Vacant Floor Space Grants, a development appraisal, including development costs and anticipated value of property upon completion 13 Copy of architect’s fee quote and acceptance 14 Submission of receipt for planning fee, building regs. and any other eligible costs YES N/A 25. Declaration - for all applicants I declare that all the information given is truthful and accurate, and that information has not been deliberately withheld. I confirm that I have/my representative has (please delete as applicable) the power to accept the grant, subject to conditions, and the power to repay the grant in the event of conditions not being met. I understand that any misleading statements (whether deliberate or accidental) given at any stage during the application process, or any material information knowingly withheld, could render this application invalid and may require repayment of any grant received. I have read and acknowledge the grant conditions outlined in: Advice Note 1 ‘How to Apply for a THI Grant’, Advice Note 2 ‘Summary of THI Grant Conditions’, Advice Note 3 ‘Guide to Eligible Works’ and Advice Note 4 Financial Guidance Advice Note 5 ‘Conservation Manual’ & Drawing Requirements I accept our responsibilities for Health and Safety before and during the implementation of the project. I accept that grants are discretionary and subject to funds being available and that the THI Grants Board (made up of senior council officers, including: Project Executive and THI Project Manager) may wish to vary the scope or nature of the works after submission of the application. Signed: ....................................................................................... Date: ....................................................... Position: ........................................................................................................................................................... On behalf of:.................................................................................................................................................... NOTE: if your application is successful you shall be required to submit a copy of photo ID, passport or driving licence and 2 forms of proof of address, eg utility bills.
