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DPNR –VISHPO Staff Use Only | Site Name: Date Received Reviewer: HONORABLE COMMISSIONER JEAN-PIERRE L. ORIOL This questionnaire is step 1, intended only to provide preliminary site information about the property to DPNR-VISHPO. Extended Deadline March 31, 2021 at 5:00 p.m. via submission at historic.recovery@dpnr.vi.gov or hand delivery at VISHPO Offices. Note: Grant Funds are available to impacted historic resources listed or eligible for listing in the National Register of Historic Places. Please check here for verification purposes https://www.nps.gov/subjects/nationalregister/database-research.htm Name & Location of Property (Govt. Non Profit, Homeowner, Other, etc.) Name: Address: City: Zip Code: Name & Address of Owner, Consultant, or Building Facility Manager Name: Address: City: Zip Code: Project Type: Development (Building Repair/Rehabilitation, Stabilization Archaeological, Landscape Preservation, Not sure) Building Repair and Rehabilitation Stabilization Archaeologic al Landscape Preservation Not Sure. Advice Required Project Type: Pre –Development and Planning (Historic Structures Report, Conditions Assessment including materials/analysis, Architectural/Engineering Plans, Engineering Study, Landscape Study, National Register Nominations eligibility/Economic Feasibility Study) Historic Structures Report Conditions Assessment Architectural Engineering Plans Engineering Study Landscape Study National Register Nominations eligibility Property Type: Archeological or Historic Site Residential Building Commercial Building A National Historic Landmark Non- Profit Building Government/Publi c Building Project Title: _______________________________ Estimated Project Cost: _______________ Which Storm: Hurricane Irma, Maria or Both? _____________ Capacity of Applicant to manage project: (List organization’s history, mission, or list if you are a private property owner) (Limit is 250 – 400 words) Please use an extra sheet of paper if needed. Historic property explanation of damages received from Hurricanes. Describe the general condition of the building that was damaged by Hurricanes Irma, Maria or both. Also, provide one photo and a general explanation of what repairs will be done if awarded a sub-grant. (Limit is 250 – 400 words) Please use an extra sheet of paper if needed. Page (1) DEPARTMENT OF PLANNING AND NATURAL RESOURCES (DPNR) | VI STATE HISTORIC PRESERVATION OFFICE (VISHPO) EMERGENCY SUPPLEMENTAL HISTORIC PRESERVATION FUND (ESHPF) HURRICANES IRMA AND MARIA DISASTER RECOVERY PROGRAM – FUNDED BY NATIONAL PARK SERVICE (NPS) I am seeking reimbursement for historic preservation repairs that were completed after Hurricanes Irma and Maria. O Yes or O No Owner Signature and Date: ________________________________________________ Phone: _______________________________________ Submitter's Name and Address or (Permission by owner to submit this form, if name is not the same as listed above). Name: Address: City: State: Zip Code: Email Phone: Date: Signature: This Section for Department of Planning and Natural Resources - (DPNR) Internal Use Only ____________________________________________________________________________________________________ Reviewer’s Record Date Reviewed: _________________________________ Reviewer’s Remarks: ___________________________________ Preliminary Site Questionnaire: ( ) Approved ( ) Disapproved Reviewer’s Name: ______________________________________ Date: _______________________________________ ______________________________________________ ____________________ Commissioner Date DPNR DPNR-VI SHPO| Fort Christian National Historic Landmark, 5064 Fort’s Straede 1 | Charlotte Amalie USVI 00802 | Fort Frederik National Historic Landmark, 198 Strand Street, St. Croix 00840 Tel: (340) (776-8605) | Website: https://dpnr.vi.gov or submit via historic.recovery@dpnr.vi.gov Updated: 02.04.21 Page (2) Certification and Submission: I certify that the information in this application is accurate to the best of my knowledge, and that I am authorized to make this request. I agree to abide by all the terms and conditions set forth in this application and accompanying instructions, if selected for a Sub-Grant Award Agreement. I certify that no overlap or duplication exists between the proposed project in this application and any other active or anticipated project in terms of activities, costs, or time commitment of key personnel, including any application that was submitted for funding consideration to any other potential funding source, Federal or non – Federal.