ISLE OF WIGHT LOCAL LIST
NOMINATION FORM

Buildings, Structures, Parks and Gardens
of Architectural or Historic Interest

Details of person making the nomination 
Name      

Address      

Telephone No      

Email*      

*To save paper, follow-up correspondence by email is preferable.	This form, together with relevant supporting information should be sent to: 

Conservation and Design Seaclose Offices
Fairlee Road
Newport
PO30 2QS

E: local.list@iow.gov.uk
T: 01983 823552
F: 01983 823551	
An expert panel considers all nominations. Decisions are based on a majority view of whether a nomination meets set criteria. A letter will be sent to you notifying you of the Panel’s decision*.  

Local listing does not protect a feature in the way that statutory listing does, but some protection is given under the Government’s new Planning Policy for the Historic Environment (PPS5).  In considering the impact of a proposal on a locally listed feature, the local planning authority should consider the particular nature of the significance of the heritage asset and the value that it holds for this and future generations, in order to avoid or minimise conflict between the heritage asset’s conservation and any aspect of the proposals.	Date Rcvd		
	IWC Ref:		
	Panel Date		
	Panel Comment 

	

For IWC use only	
Details of Building, Structure, Park or Garden
Brief description (e.g. 1930’s dwelling, stone chapel, pillar box, garden) 
     

Address      

Post code      

Parish      

Grid Reference (if known)      		
Data Protection: Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular request.  The Isle of Wight Council (“the Council)” is the data controller.  By completing this form you consent to the Council contacting you by email or nominated method in relation to your request.  The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Council’s Access to Information Policy.  Disclosure will only be made where in all the circumstance’s it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent, for the purpose of crime prevention or detection, so far as is in accordance with the law. The details you supply to us shall only be used for purposes relating to the compilation, consultation and publication of the IOW Local List.  
	
The following questions are important for the support of your nomination – at least one of the questions numbered 6 – 8 should be addressed fully. Nominations should NOT be used to frustrate development proposals.  Please note, any application that does not provide sufficient information will be returned.	
1. Is your nomination on the Council’s Historic Environment Record database? Please contact the HER Officer for further information. Email  archaeology@iow.gov.uk or telephone (01983) 823810 	
Yes   	No   	If yes please give further details. 	
     

	
2. How old is the main part of the building, structure, park or garden?  Please tick	
Pre-1700          	1700-1840        	1840-1914        	1914-1940        	Post 1940        	
3. If a definite date is known, what is it?	
Date	     	Source	     	
4. Is the building, structure, park or garden in a recognisable form, retaining historic features and layout?  Please tick	
Completely intact
 	Largely intact
 	Partially intact
 	Largely spoilt
 	Completely spoilt
	
5. If it is a building, is it occupied?  Please tick	
Yes   	No    	If yes, name and address of owner if known. 	
     

	
6. If it is a building, is it a rare example of its type, displaying a notable level or architectural or technological innovation or virtuosity?  Please tick	
Yes   	No    	If yes, please explain (e.g., early local example of design, style, materials or workmanship relative to the area). 	

     

	

7. Does the building, structure, park or garden, relate to the development of the area?  Please tick	
Yes   	No    	If yes, please explain (e.g., does it have significant, historic association with established features such as road layout, burgage plots or landscape features?) 	
     

	
8. Does it have any historic association with any notable person(s) or event(s)?  Please tick 	
Yes   	No    	If yes, please explain (e.g., give the name of the former occupant, architect, builder, national or local event). 	
     

	
9. Does it contribute to the visual character of the town or village or form a significant (positive) landmark?  Please tick	
Yes   	No    	If yes, please explain (e.g., does it form a focal point, is visually dominant, of high architectural quality?).	
     

	
Supporting information.  
A map should be included in order to identify the location of the building, structure, park or garden.  	
Map           		Photographs	                 	Other