Phone:

Email:

Applicant Contribution: What resources have you already committed to the project and what additional resources do you expect to commit before viability is established?

Newburgh Housing Remediation Fund Feasibility Loan Fund Application for Lead and Asbestos Testing

Address: _________________________________________________________________

_________________________________________________________________

___________________________ Cell: _______________________________

_________________________________________________________________

1 Community Capital New York 7 W. Cross Street, Hawthorne, NY 10532

914.747.8020 ext 12

Applicant: Please give a brief summary of your development track record making particular note of projects that are similar in scope. Note any projects you are involved in that are currently under development and their anticipated completion date:

Type of Business: ___ Sole Proprietor ___ Corporation

___ Partnership ___ Not for Profit Corporation

Applicant Name: _____________________________________________ Principal Name (if different): ________________________________________________________

Prospective Development Team:

Developer Name: _________________________________________________________________

Address:

Phone:

Email:

_____ψψψψψ___ψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψψ

_ψψψψψψψψψψψψψψψψψψψψψψψ__ Cell: ______________________________

_________________________________________________________________

Contractor Name: _________________________________________________________________

Address:

Phone:

Email:

_________________________________________________________________

__________________________ Cell: ______________________________

_________________________________________________________________

Architect Name: _ ________________________________________________________________

Address:

Phone:

Email:

________________________________________________________________

__________________________ Cell: _________________________________

________________________________________________________________

In In addition to the development team, is there any other person or organization involved in your project?

Project Summary:

Project Address: ___________________________________________________________________

Census Tract (6 Digits): _______________________

Current Owner of the Building: _______________________

Is there a purchase contract with an inspection contingency? ____ Yes ____ No

Property Description: (square footage, number of floors and type of construction) :

Please attach photo(s).

Existing: _____ Residential Units

_____ Sq Ft Commercial Space

Proposed: _____ Residential Units

_____ Sq Ft Commercial Space

If yes, will you occupy: Residential Space

Yes No

Commercial Space Both

Yes No If no, will rehabilitation of the property create homeownership opportunities?

Inspection:

Name of the LEAD Inspector you will be using: ___________________________________________

Address: ____________________________________________________________________

Phone: ___________________________________ Cell: ____________________________

Email: ____________________________________________________________________

Please attach a copy of the inspector’s license from NY State.

Cost of the inspection: ____________

Name of the ASBESTOS Inspector you will be using: _________________________________________

Address:

Phone:

Email:

____________________________________________________________________

_________________________________ Cell: _____________________________

____________________________________________________________________

Please attach a copy of the inspector’s license from NY State.

Loan amount request: ____________ (This is the cost of the Inspection)

I understand that Community Capital New York will pay the inspector(s) indicated upon receipt of a

complete inspection report(s) and that these reports may be made available to future potential

developers and/or the City of Newburgh if I decide not to proceed with the project.

Signature: _______________________________________________________________________

IN ADDITION:• Please attach a pro forma that estimates how much remediation the project can support before it becomesinfeasible. List the assumptions you have made in generating this estimate.• Please attach the proposal from the lead/asbestos inspector to this application.

If you have questions or need assistance, contact Kim Jacobs at 914.747.8020 ext. 12

Community Capital New York 7 W. Cross Street, Hawthorne, NY 10532

914.747.8020 ext 12

Project Summary Continued:

Do you intend to occupy the renovated building?

Please email completed application to kjacobs@communitycapitalny.org. If you have questions or need assistance, contact Kim Jacobs at 914.747.8020 ext. 12