Eligibility Form PVHabitat Fall 2022.pdfCOMMUNITY PRESERVATION ELIGIBILITY
DETERMINATION FORM
The purpose of this form is to make sure that all project applications applying for Community
Preservation Act funding are eligible for funding. Please refer to Appendix-E in the
Community Preservation Plan when filling out this form. This form must be approved in
order for an application to be accepted.
Project Title: Victoria Bismark Farm project
Project Sponsor/Organization: Pioneer Valley Habitat for Humanity
Contact Name: Megan McDonough, executive director
Property Owner, if applicable:
Mailing Address: PO Box 60642, Florence MA 01062
Daytime phone #: 413-586-5430 x106 Fax #:
E-mail address: megan@pvhabitat.org
CPA Program Area (check those that apply):
� Open Space � Historic Preservation
X Community Housing � Recreation
Project Purpose (check those that apply):
� Acquisition X Creation � Preservation
� Support � Rehabilitation/Restoration
Project Summary: Please provide a brief description of the project.
Pioneer Valley Habitat will build three 1,250-1,350 sq ft energy-efficient three-bedroom
homes on Burts Pit Road, on land that was once the location of the state hospital. All will
be visitable by persons with mobility impairments and one will be adaptable for someone
with mobility impairments. Home prices will be set at under $200,000, sold to families
earning up to 60% of the AMI and deeded affordable in perpetuity.
For CPC Use Eligible: _____ Not Eligible: _____ Date: __________ Reviewer: ____________________