1.) Name _______________________________

Phone ________________________

Address _______________________ Lot# ________

2.) Briefly describe the proposed change ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

3.) Will there be changes or modifications in basic utility services or existing structures to accommodate the proposed changes ? __________

Please indicate with a Yes or No beside any of the changes that would be made.

4.) Please list below the major construction materials which will be used in this project. Be as specific as possible. ( Exterior materials must conform to those used on the original building or be sufficiently compatible.

_______________________________    ________________________________
_______________________________    ________________________________
_______________________________    ________________________________
_______________________________    ________________________________

5.) If the proposed project is an additional or alteration that would change the structural appearance and/or lot, please attach the following information.

A. Plot plan indicating the location and dimensions of the project
B. Blueprints or working drawings indicating all necessary dimensions and elevations.
C. If available, a photograph or drawing of a similar completed project.

6.) Project Schedule:

A. The project will be done by

Homeowner _______ Contractor (s) ________

If being done by contractor provide the Name ____________________

Both _____________

B. Approximate project start date after approval ____________________
Approximate  project completion date _________________________

C. Please indicate any building permits that will be required. ___________________
_____________________________________________________________________
 

I understand that under the Declaration and the rules and regulations, the Committee/Board will act on this request and provide me with a written response of their decision. I further understand and agree to the following provisions:

1. No work or commitment of work will be made by me until I have received written approval from the Association.
2. All work will be done at my expense and all future upkeep will remain at my expense.
3. All work will be done expeditiously once commenced and will be done in a good workman-like manner by myself and/or licensed and insured contractor.
4. All work will be performed at a time and in a manner to minimize interference and inconvenience to other unit owners.
5. I assume all liability and will be responsible for all damages and / or injury which may result for performance of this work.
6. I will be responsible for the conduct of all persons, agents, contractors, and employees who are connected with this work.
7. I will be responsible for complying with, and will comply with, all applicable federal, state and local laws, codes, regulations and requirements in connection with this work, and I will obtain any necessary governmental permits and approvals for the work. I understand and agree that the Association, it's Board of Director's, it's agent and / or the Committee have no responsibility with respect to such compliance and that the Board of Director's and/or its designated committee's approval of this request shall not be understood as the making of any representation or warranty that the plans, specifications or work comply with any law, code, regulation or governmental requirement.

Note: All submitted materials shall remain the property of the Association. You may wish to make a copy for your personal records.

I hereby acknowledge that I have read and understand the Architectural Change Standards set forth by the Board, as well as the Declaration of Covenants and Restrictions.

Homeowner's Signature _____________________________________________
Date _________________

Mail the form to  ( GlennWoods H.O.A Inc P.O.Box 421406 Indianapolis In 46242
 

Do not write below this line

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Board / Committee Action
(  ) Approved as submitted
(  ) Deferred
(  ) Additional information required : _________________________________________
_______________________________________________________________________
(  ) Other ______________________________________________________________
_______________________________________________________________________
(  ) Denied _____________________________________________________________
_______________________________________________________________________
Comments ______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
 

Board Member Signature : ___________________________ Date ____________