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N E W Y O R K S T A T E H O U S I N G F I N A N C E A G E N C Y - page 3 / 6

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CULTURAL RESOURCES ASSESSMENT

In order for the Agency to complete its statutory review obligation under the New York State Historic Preservation Act of 1980 (SHPA), it will be necessary for all loan and grant applicants to complete this Cultural Resources Assessment Form and return it for an impact determination to:

New York State Office of Parks, Recreation

and Historic Preservation

Historic Preservation Field Services Bureau

Peebles Island, P.O. Box 189

Waterford, New York 12188-0189

Attn:   Mr. Jim Warren

Loan and grant applicants may telephone Jim Warren at (518) 237-8643 (Ext. 3283) for assistance in completing this form and, if necessary, to answer questions regarding other SHPA procedures for obtaining an impact determination letter from the Office of Parks, Recreation and Historic Preservation (OPRHP).

For further information regarding the Agency’s SHPA review procedures, in general, or for assistance with specific project review information, please contact Len Sedney, Director of Environmental Services (Ext. 468).

A copy of all materials submitted to OPRHP must be submitted to the Agency’s Environmental Services Unit at 641 Lexington Avenue, New York, New York 10022.

SECTION A (To be completed by all applicants)

1.Project name:                                                                                                                       

2.Project Location: (include county)

3.Applicant/Project Sponsor Name

4.Applicant’s Address:

5.Applicant’s Telephone:                                      

6. Applicant’s Representative:                                                                                                 

7.Check Funding Agency or (Agencies):

a.NYS HFA Loan Amount$                         

NYS HFA  Grant Amount$                         

b.NYS AHC  Grant Amount$                         

c.Other State/Local/Federal$                         

Identify                             

SECTION B(To be completed by applicants proposing new construction on a previously undeveloped site or the undeveloped portion of a partially developed site.)

1.Attach photographs (photocopies are not acceptable) of the entire site and environs.  The photographs should be dated and indicate the view (e.g., view of the site from the north; view from the site looking east, etc.).  Clearly demarcate the development parcel within the boundaries of previously developed sites.  Identify surrounding buildings and/or structures.

2.Attach a location map pinpointing site boundaries.  The map must include a “north” indicator.  A local or county street map (or appropriate portion of map) is usually the most detailed reference map.

SECTION C (Applicants with projects involving the demolition, renovation, restoration, or expansion of

HFA Form 1510/14

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