HRAB 09-18-01 Meeting AgendaCOUNTY of FREDERICK
Department of Planning and Development
MEMORANDUM
TO: Historic Resources Advisory Board
FROM: Rebecca Ragsdale, Planner I
RE: September Meeting Agenda
DATE: September 12, 2001
540/665-5651
FAX: 540/665-6395
The Frederick County Historic Resources Advisory Board (HRAB) will be meeting on Tuesday,
September 18, at 7:30 p.m., in the first floor conference room of the Frederick County
Administration Building, 107 North Kent Street, Winchester, Virginia. The HRAB will discuss the
following items:
AGENDA
Review of a Conditional Use Permit (CUP) application for a Country General Store on Cedar
Creek Grade. The site contains the historic house known as Homespun, in which the
proposed business would be located. The application will be represented by Mr. R. J. Turner.
2. Presentation by Ms. Wendy O'Sullivan of the National Park Service regarding the creation
of a new national park at the Battle of Cedar Creek.
Other
Please contact this office if you will not be able to attend this meeting. Thank you.
Access to this building is limited during the evening hours. Therefore, it will be necessary to enter the
building through the rear door of the four-story wing. I would encourage committee members to park in
the county parking lot located behind the new addition or in the Joint Judicial Center parking lot and
follow the sidewalk to the back door of the four-story wing.
107 North Kent Street • Winchester, Virginia 22601-5000
ITEM #1
Homespun Gifts & Gardens
Mr. R. J. Turner has requested review of a Conditional Use Permit for a Country General Store,
"Homespun Gifts & Gardens." The property is located at 949 Cedar Creek Grade, just outside the
City of Winchester. Included is a description of the proposed business and photos provided by the
applicant.
Homespun dates from the late eighteenth century and has a very unique floor plan. Ownership of the
property can be traced, in part, since its original construction but the exact details are not clear. The
house was once part of a plantation complex that totaled 466 acres. This is revealed on an 1858
engineer survey of the property conducted for a previous owner, John N. Bell.
Staff consulted the Rural Landmarks Survey Report and Homespun is listed as a property potentially
eligible for the State and National Register of Historic Places. What is today Cedar Creek Grade was
a major road by 1810, and it was popular to build homes along that way. This is mentioned in the
photocopied pages, "They Built Their Homes on Cedar Creek" which are included. Staff has also
included other information gathered relevant to discussion: summary made in the Rural Landmarks
Survey about the significance of Homes, information presented on the Rural Landmarks Tour
about Homespun, a newspaper article featuring renovations that took place on the house, and the
Historic Landmarks Commission survey form.
ITEM #2
Wendy O'Sullivan Presentation
Wendy O'Sullivan ofthe National Park Service will be giving apresentation about the Park Service's
plans for a new national park at Cedar Creek. Ms. O'Sullivan is a project manager and the new
representative to the Shenandoah Valley Battlefields National Historic District. She will discuss the
processes behind creation of a new national park and the planning that is taking place for Cedar
Creek.
UACOMMITTEESUiRAB\Agendas\2001 Agendas\Sep18, 2001agenda-pd
Conditional Use Permit Application
for
949 Cedar Creek Grade
in Frederick County, Virginia
Looking south at the front of the, building
Looking north at the back of the building
Homespun Gifts & Gardens, as the name implies, will sell a variety of items
with and Early American theme. An on premises kitchen will pFoduce apple and
vegetable specialties from the Homespun Gardens (caramel apples, zucchini
bread, relishes) as well as candies and cookies. One of the buildings eight
rooms will serve as an office; all other rooms will be furnished with merchandise
for sale. The merchandise will include furniture, bedding, throws, pillows, games
and toys, books and stationery, toiletries, garden accessories, pottery, vases and
candles. In addition, customers will be offered the opportunity to select; plants,
cut flowers, vegetables and pots from the gardens. The hours of business
operation, initially, will be 10:00 a.m. to 6:00 p.m. Tuesday through Saturday,
closed Sunday and Monday.
There will be no service of gas or other petroleum products, alcohol for
consumption on the premises, fried food, and no restaurant or deli operation.
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949 CEDAR CREEK GRADE'
ROBERT W WHfTE PROPERTY
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Figure 2.12
The Bell House, also known
as Homespun, was originally
owned by John Miller and left
to his daughter Rebecca Miller
Bell in 1815. Located on the
outskirts of Winchester, it
remained in the Bell family
until the Civil War, when John
N. Bell lost the property to
creditors while being held as a
prisoner of war. Stewan Bell
Sr., a grandson, bought the
property back and finished pay-
ing off the debt seventy-five
years later.
(Photo by John G. LewO
1791--1830 33
r
The Bell Hoarse, located along Cedar Creek Grade west of
Winchester, is another highly unique log building that was con-
structed in the latter part of the eighteenth century (Figure 2.12).
Preliminary investigation indicates that the house is a variation on a
dogtrot plan, which consists of two pens separated by a central
breezeway under a common roof. The Bell Hm se is composed of two
large log cells connected by a frame section, all under the same roof.
Each log pen is m -o stories and has its own exterior -end stone chim-
ney with a brick stack. The end chimney on the east log portion
acts as a central chimney because of a side stone and brick addition.
It is not known if the central frame section between the log units
was originally an open breezeway that was later enclosed. It appears
that both log pens were constructed at the same time, probably dur-
ing the last decade of the 1700s. The Bell House is one of only a few
known buildings with this type of plan in the county. The dogtrot
plan is most common in the lower Midwest and South, where the
climate is wanner and the central breezeway affords a cool and shady
place.
The Bell Hoarse, located along Cedar Creek Grade west of
Winchester, is another highly unique log building that was con-
structed in the latter part of the eighteenth century (Figure 2.12).
Preliminary investigation indicates that the house is a variation on a
dogtrot plan, which consists of two pens separated by a central
breezeway under a common roof. The Bell Hm se is composed of two
large log cells connected by a frame section, all under the same roof.
Each log pen is m -o stories and has its own exterior -end stone chim-
ney with a brick stack. The end chimney on the east log portion
acts as a central chimney because of a side stone and brick addition.
It is not known if the central frame section between the log units
was originally an open breezeway that was later enclosed. It appears
that both log pens were constructed at the same time, probably dur-
ing the last decade of the 1700s. The Bell House is one of only a few
known buildings with this type of plan in the county. The dogtrot
plan is most common in the lower Midwest and South, where the
climate is wanner and the central breezeway affords a cool and shady
place.
36 wINCIIESTER AND VICINITY
"THEY BUILT THEIR HOMES ON CEDAR CREEK"
A
This house on Cedar Creek was built before there was a Winchester.
It is the ancestral home of the Richards family.
Among the ;Indians, the bears, the panther,, the wildcats,
the deers and the wolves, pioneers built their homes on Cedar
Creek before tliere was a Winchester and even before Fred-
erick County *as laid out, in 1739. In the year George Wash-
ington was born 1732, Joist Hite a German, came from York,
I'a. as the firs`: settler in the Valley. His family consisted of.
his wife Anna Maria, their fire sons, John, Jacob, Isaac,
Abram, and Joseph, and their three daughters: Mary Bow-
man, .Magdelena Chrisman, and Elizabeth Froman. All of
these children `were by his first wife who died in 1738. There
were no children by his second wife whom he married in 1741.
George Bowman, son-in-law settled on Cedar Creek, Jacob
Citrisn,an settled at Christman's Spring now known as Vau
Cluse and Patti. Froman settled on Cedar Creek nine miles
West of the Bowman settlement.
Among other farniiies that came in with Hite, were Robert
McKay, Robe -t Green, William Duff, Peter Stephens, founder
of Stephen City and others making up sixteen families Hite
was to settle on his land. Following on the heels of the first
IIite immi;,ration, john Richards, pioneer of the Richards
family and ancestor of the author of this sketch, came from
Devonshire, England and located his grant feat a large tract
of land along upper Cedar Creek and its drains. (This grant
was direct front the Crown.) He then proceeded to settle
other families. fourteen in all following the Hite immigration.
This was in 1735.
yet; WINCIIESTER AND VICINITY 37
ancestor that this 1luiescent spirit of the Indians offered them
the opportunity of acquiring considerable strength as to
f. number and the accumulation of considerable property and
improvements, before Indian hostilities commenced. During
this period malty good dwelliuw, houses were erected. 5otiie
of these were built of stone and later became of great inipor-
taltce as places of protection and security against the attacks
of the lndians. fn 1751, lames t\'ilson erected a stone house
which is now standing. In 1753, C ol. Jolt', Hite built a stone
house at Bartonsville once occupied b} I1Ir. and Mrs. Robert
��•. Ilarton. This was considered by far the finest dwelling liouse
west of the lilac Ridge. (In 1739, henry Richards, born ,n
I)evonshire, England, son of Peter Richards, brother of John
I6cliards, the first settler on thec,�� repair. The old ords estate riginal
i11
house that is still standing in g P g
mmense logs is still beinn used. The meadows
barn, built of i
of this old Richards estate extend for about two miles along
t edar Creek. The last of the old slave houses which },ousel
se
ia very large number of slaves have fallen down.)
�C t► the brow of a hill overlookin- this estate is the Richnr�ls
re many old fam
Cemetery wheilies connected by marriage
are buried lames :N-1. Richards who was born March 20, 107
`1 and died ill 1997 and Margaret E. Richards, his wife who V:as
horn September 13, 1919 and died in 1907 grandparents of the
author of this sketch arc buried here. Some of the old fam-
ilies pioneers that settled on these upper drains of Cedar
Creek are: the Frys, keckleys, Brills, Orndorfis, Williams,
++ Russells, Richards, Richard, Beans, DjcSlween, Coopers,
t. Whites. Turners, Goughs, Vances, Hinielrights, Wilsons,
Pifers, Findleys. Where did these first settlers get their sup-
plies and what did they do for amusement? There -,:ere no
radios, no telephones, no automobiles, no stores, no kerosene
' for lamps for John D. Rockefeller had not yet refined the
crude oil. There were no roads leading to Winchester .which
was not built until nearly ten years later. The first Frederica:
Ccnnrty Court was held on November 11, 1743 and at the
March term; 1745 the Court appointed Samuel Glass, Nathaniel
Cartmell, Vance Marks, Paul Froman and others "to lay out
` the best and nearest route to the county seat and mark the
way through the big timbers, said road to commence at Fro -
man's Ittin oii C edar Creek. pass by the Cartmell Springs at
the head of Opequon--and thence to the County Scat."h
Tis
road is the Cedar Creek Gracie. The early settlers lead work
to do. Every member of the family would help t:•ith 5(mie
task. The tallow: candles had to be made, the corn nitist be
ground into meal, leather must be tanned, shoes and dresses
Dere homen,acle. ;\ln,ost every home had a looril incl tl.�
ladies made their own clothing. J Big trees were cut down and
the loos used for building houses with the help of neiglibors.
FREDERICK COUNTYRURAL LANDMARKS SURVEY
CHAPTER 15: RECOMMENDATIONS
an earthen fort that was constructed in8 1 un e r General
Joseph E. 'Johnston s command to guard
om
approaching northern troops.
Homespun 34-180: This large 19th -century dwelling appears
to be a dog -trot plan. it consists of two very large log,
two-story rooms attached by a central frame hall. This is
the only plan of this type identified in the survey.
Gano House 34-185: Although in fairly deteriorated
condition, the Gano House is a unique 19th -century
architectural resource in Frederick County. Unlike any
th
other dwelling of this period identified in this survey, the
Gano House features a stone 1 1/2 -story service wing with a
pair of exterior chimneys that is sited at a right angle to
the main house. Located in the northwestern -most portion of
the county, it is one of the few significant historic
buildings in the area.
Stephens Fort 34-197: This hexagonal -stone structure located
on the site of sidered Baac as annes" iron or
ks in Marlboro, is
locally con 18th -century fort used to protect
settlers against Indian attacks. Although, Jeff O'Dell, an
architectural historian at the VDHR, recently inspected
the
site and believes that it is in fact an ice house,
local
citizens still maintain its use as a fort. Other
architectural historians who have viewed the building agree
with Mr. O'Dell. Whatever its use was, there is no other
building like it in all of Frederick County.
Family Drive -In 34-300: Constructed in the early 1950s,
this as a 1 consequence of the automobile. t as a new olding It is type"
developeddped he
most intact resource of its type in the county.
Cedar Creek Battlefield 34-303: The site of the battle that
took place on October 19, 1864 that assured the Union troops
control of the Valley until the and of the War, is currently
being purchased form developers by a non-profit
organization. The National Trust Property, Belle Grove, is
at the center of this battlefield.
Zig-Zag Trenches 34-314, Hilandale Earthworks 34-321: These
two sites are part of a series of earthworks located south
of Winchester that were constructed by Union troops in the
Fall of 1864, after they had gained control of the area.
Star Fort 34-322: Constructed 86commandStar Confederate Fort troops
under General Stonewall Jackson's
unique for its star-shaped plan.
Third Battle of Winchester 3 4 6: This battlefield Ota
determined eligible by the VD
RURAL LANDMARKS TOUR --October 23, 1588
Winchester- Frederick County Historical Society
e✓ West Va.
Virginia
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s7,t Clear Brook
Jool
Fred. Co. i71
( Fairground
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KENILWORTH
751
Stephenson Charles W. and Joline Orndoff
CLERIDGE
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SHALOM ET BENEDICTUS
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Hotel)
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FREDERICK COUNTYK
Opequon
(CLARKE COUNTY.
RACE MILLS FARM
E.C. and Marjorie
Copenhaver ,3
Cedar Creek Grade
ses ernstown.
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NOTES ON WINCHESTER -FREDERICK COUNTY HISTORICAL SOCIETY TOUR
"Explore the Frederick County Landscape"
Sunday, October 23, 1988
Proceeds will benefit a survey of Frederick County Sites and Structures
1., Homespun - located � mile west of Route 11, south on Cedar Creek Grade (#622).
This large house stands on the crest of a hill on Cedar Creek Grade. For
✓ years travelers on that road have watched as it crumbled and piles of junk col-
lected inthe surrounding yard. Now it has been purchased by Mr. Robert White,
who is slowly, but carefully restoring it to its former elegance.
Names of early property owners are uncertain but at some unknown time it came
into the Miller family. The will of John Miller, probated on December 2, 1815, left
one-half of his 458 acre farm, known as "Homespun" to his daughter, Rebecca Miller
Bell, and the other half to his son, Dr. Godfrey Sperry Miller. It remained in the
Bell family until the Civil War when John N. Bell, whose property was devastated
while he was held prisoner -of -war, lost his land to his creditors. Mr. Stewart Bell,
Sr., a grandson bought it back and finished paying off the debts 100 years later.
The structure appears to have been two log houses that were joined together,
thus forming a large central hall. The east end of the building is of stone on
the first floor and brick on the second floor. There are large fireplaces and the
woodwork in the spacious rooms is quite handsome.
The house is in the process of restoration at this time.
2. Race Mills - (Follow Route 622, Cedar Creek Grade west approximately 5 miles). This
residence, now restored and owned by Mr. and Mrs. Edward C. Copenhaver, stands on
land which was granted to Samuel Glass by Joist Hite on November 6, 1742. It is located
on Cedar Creek Grade, which was at one time the only road running north and south
through this area. The original Glass Mill on the Opequon Creek adjoins the property.
In 1833, the Glass family sold the house and mill to Robert Smith. It was then
purchased in 1851 by Caspar Rinker and remained in the Rinker family for 99 years,
when it was bought by M.C. Copenhaver. In 1952, his nephew, E.C. Copenhaver and his
wife became the current owners.
The center section of the house is believed to be designed as a typical Irish -
Ulster home with one middle door and two windows on either side. A two-story wing was
added around 1810. At the time the property was purchased by Caspar Rinker it in-
cluded the dwelling, dam, mill race, mill, saw mill, dwelling and other buildings, some
of which are still in existence today.
3. Opequon Presbyterian Church - (turn west beside 7-11 at Kernstown)
The present Opequon Presbyterian Church is located on land donated in 1736 by
William Hoge, who also gave two additional acres to be used as a "burying place".
A group of residents organized as a Presbyterian congregation in 1736 or 1737 and
met in a log meeting house.
Itinerant ministers served for a number of years and in 1755, the Rev. John
Hoge, grandson of William Hoge, became the first "settled" minister. After 18 years,
he asked to be relieved of his duties as minister "on account of none payment."
In 1790, a stone structure replaced the log meeting house, and this building
continued in use until it was severely damaged during the First Battle of Kernstown
in 1862. In 1863, services were discontinued, except for occasional ones in a stone
school house that was about 40 feet north of the present structure. A small congrega-
tion made repairs to the structure after the war, but in 1873, a fire during a Sunday
morning service, left only the walls standing.
In 1897, the present sanctuary was completed. The west and south walls were
built on the foundations of the 1790 structure, and many of the stones in the walls
and the graveyard fence are from that early building. In order to raise money for
this structure descendants of those buried in the ancient graveyard were contacted
a�
to THE WINCHESTER STAR, Wednesday, November 23, 1988
Newsmakers/Frederick County M:�°
Stat Phot by Scutt MasonHomespun Farm, built in the 18OOs, is being renovated by its current owner, Robert White.
Homespun Gets
Another Chance
Not only is Homespun Farm
one of Frederick County's histor-
ic structures, but its ownership
has included some of the area's
foremost citizens, including
former Winchester Mayor
Stewart Bell.
Located just west of Win-
chester and perched on a hill just
a few feet from Cedar Creek
Grade, Homespun has seen bet-
ter days.
The earliest owners of Home-
spun Farm are.unknown, but in
1815 it was bought by John
Miller, who deeded the property
to his children Rebecca Miller
Bell and Dr. Godfrey Sperry
Miller.
During the Civil War, then -
owner John N. Bell lost Home-
spun to credi!o_s :vhi?e !,a was a
prisoner of war. Roughly 100
years later, Bell's grandson,
Stewart Bell, paid off the old
debts and bought the house back.
There have been other owners
since Bell, most recently Robert
White, who bought the house and
one acre last February from
Glynnell Headley.
"Everybody wanted to tear it
down and I wanted to remodel
it," he said of the house.
The two-story stone, wood, and
brick house was constructed in
stages during the 1800x, accord-
ing to local historian Virginia
Miller.
The mid-section of the house is
believed to be the oldest, follow-
ed by a western wing made of
wood. An eastern wing of stone
Star Plato by Wendy Gavin Gregg
(Front row, left to right) Barbara Mason, Josh Matt Feltner celebrate Mickey Mouse's birth -
Van Hoy, William Funk, (back row, left to day during a class party at Apple Pie Ridge
right) Emily Thomas, Shanta Green, and Elementary School.
and brick were added later in the
century.
In the log section, there is ex-
tensive chinking and daubing be-
tween the logs.
The floors appear to be made
of yellow pine, Miller said, a
common usage for the tree that
is now extinct in the northern
Shenandoah Valley due to exten-
sive use.
The home is now in consider-
able disrepair, although White
hopes to make it livable by next
spring.
Class Salutes
Mickey
In Linda Shaw's special
education class at Apple Pie
Ridge Elementary School, stu-
dents learn by association.
They've learned, for instance,
that September is the month
when school starts and October
is when Halloween occurs.
To remember November, the
logical association would be
Thanksgiving, but this year
Shaw selected a mor
monumental occasion in the ey,
of her students—the 60th bird
day of Mickey Mouse.
Shaw, her aide, Sharon Robi.
son, and their eight student
threw a party for the revert
rodent, complete with cake and
balloon launch.
'Each of Shaw's eight studen.
released two balloons with the
names, school address, and
mention of Mickey's birthday.
"We were hoping one made
to Disneyland," Shaw said.
Idle no. 34-180
_ 1 o HISTORIC LANDMARKS COMMISSION Negative no(s). 1.20-M
�5SURVEY FORM
Historic name Dr. William A. Bell (Lake'
Common name
Homespun
County/Town/City Frederick Atlas
Street address or route number Rt. 622
USGS Quad Winchester
Date or period
late 18th -early 19th C., early to mid
Original owner John Miller (?)
Architect/builder/craftsmen 19th C.
Original use Residential
Present owner Robert White
Source of name
WFC Historical Society files
Present owner address Winchester, Va.
Source of date
architectural evidence
Stories 2
Present use Residential
Foundation and
wall const'n log on stone foundation w/
Acreage
stone & brick addition
Rooftype Gabled w/ standing seam metal
State condition of structure and environs Good
State potential threats to structure Expansion of Cedar Creek Grade
Note any archaeological interest Unknown
Should be investigated for possible register potential? yes __X_ no —
Architectural description (Note significant features of plan, structural system and interior and exterior decoration,
taking care to point out aspects not visible or clear from photographs. Explain nature and period of all alterations
and additions. List any outbuildings and their approximate ages, cemeteries, etc.)
This house is highly unusual in that the right 3 -bay section is a log dog -trot type house
that is 2 log pens connected by a frame covered breezeway. Each log pen has an ext. end
stone chimney w/ brick stack. The east end chimney on the log section is now a central
chimney because of the side stone & brick addition. The log portion has batten doors
w/ a 4 -light transom over the front & rear entrances. It also has 6/6 windows, 2 4 -light
attic windows in the west gable ends, and is covered in weatherboard sidiing. It appears
that both log pens and the breezeway were all built at the same time. The 2 -story brick
& stone side addition is 2 bays asymmetrical. The first floor is laid in ransom rubble
stone and the second floor is laid in 5 -course American bond brick. It has 6/6 windows
w/ wooden lintels, a stepped brick cornice, and an ext. end stone and brick chimney. It
also has a 1 -bay vernacular shed -roofed stoop. Tree brick and stone have been painted.
Tlie house recently had the addition of 2 -story 2 -level rear porches made of modern pres-
sure treated lumber. The replaced the original rear porch. Beneath the east log section
is a basement w/ an entry on the south side. The entire log section sits on this basement.
Additions to the house include a modern rear deck; new snap -in 6/6 windows in the log
section and new weatherboard siding.
Outbuildings include a 1 -story stone meathouse; a frame corn crib, and several frame sheds.
The property sits immediately off of Cedar Creek Grade (Rt. 622) amid several mature trees.
A 2 -rail split rail fence is located in the front.
A highly rare example of a double pen log dwelling attached by a frame connector.
Interior inspected? Yes.
Historical significance (Chain of title; individuals, families, events, etc., associated with the property.)
1815 John Miller left house & approx 225 acres to daughter Rebecca Miller Bell
- It remained in Bell family until Civil War when John N. Bell lost the property to
creditors while he was being held prisoner -of -war. Mr. Stewart Bell, Sr., a grand-
son bought the property back & finished paying off his debt 100 years later.
Form No. VHLC-01-004
Sources and bibliograpny
Published yc :'c`Us (ono}_ artit•les, etc.. with bibliographic data.)
Primary sources (Manuscript documentary or graphic materials; give location.)
Names and addresses of persons interviewed
etc 1
Site plan (Locate and identify outbuildings, dependencies ana stgrr„rt.ai« ��rv�•»r --
,
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4
Date
Name, address and title of recorder 6/92
Maral S. Kalbian
(Number of stories, unusual architectural features, additions, remodelings, and
any features not apparent in photographs)
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6. HISTORY
Briefly note any significant events, personages and/or families associated with
the property. (Detailed family ,genealogies are not necessary.) Please list any
additional sources of information. Only material contained on the form will be
forwarded to the Review Board members.
t
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Are there.any known manuscripts or family papers, drawings, or old photographs
that could be made available to the VHLC staff? Yes V/ No
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4. GENERAL. DATA
A.
Date or Dates
of Building(s):
(-7'�)O 5 ---�
B.
Outbuildings:
Yes k/1_ No
C.
Approximate Acreage:
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�C,&IMAL. FAP�rv-N
D.
Architect or
Carpenter/Mason (if
known):
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E.
Use:
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5. GENERAL ARCHITECTURAL DESCRIPT ON
(Number of stories, unusual architectural features, additions, remodelings, and
any features not apparent in photographs)
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6. HISTORY
Briefly note any significant events, personages and/or families associated with
the property. (Detailed family ,genealogies are not necessary.) Please list any
additional sources of information. Only material contained on the form will be
forwarded to the Review Board members.
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Are there.any known manuscripts or family papers, drawings, or old photographs
that could be made available to the VHLC staff? Yes V/ No
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7. PHOTOGRAPHS
Two interior and two exterior photographs, black and white, must be provided.
Photographs of other buildings on the property would also be helpful. Thu inclusion
of photographs is essential to the completion of this application. Without
photographs, the application cannot be considered.
8. IAP
Please include a map showing the location of the property. A sketch map is
acceptable, but please note street and route numbers. Any outbuildings on the
property should also be noted. Please include a "north" arrow.
9. Is the property Incoming Producing? Yes No ✓ If so, will the applicant
seek the Rehabilitation Tax Credit? Yes No Z
iC. APPLICANT INFORMATION
NAME: KQ6iQT W-WV}1TI� TELEPHONE: (Z03)
ADDRESS: '4 - l?oSCAW�ti1 �1110QK� _
CITY/STATE: \1t S Tl ZIP CODE: O
SIGNATURE: E � l,,DATE:,
ATE:
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