Gramercy Park Homeowners Association

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					                           CHANGE REQUEST FORM


Homeowner(s) Name:


Phone # - Day:                        Phone # - Night:                               Lot #

Contractor:                                                         Telephone:

Description of Proposed Improvement:

(Please provide as much detail as possible; use reverse side if more space is needed for description)

All submittals must be accompanied with the following:

   1.   Architectural drawing and/or pictures
   2.   Description of materials
   3.   Sample of shingles and siding.
   4.   Copy of plat with outline of structure (including fencing)
   5.   Property survey showing improvement(s) other than fencing

Proposed start date:                                 Proposed completion date:

NOTE: Remember to allow a minimum of thirty (30) days after submission to the Board of Directors to
receive approval. The Board will meet the 2ndt Monday of each month to review new change requests and
conduct homeowner site visits. Every change request will be responded to in writing within 30 days from
the day all final documentation has been received. Your request will receive prompt attention and will be
processed as quickly as possible.

All submitted plans become the property of the Canterbury Homeowners Association and will not be
returned, but filed for future references and verification. Canterbury homeowners should mail their Change
Request Form and all necessary additional documentation to: Canterbury Homeowners’ Association

                                             P.O. Box 513
                                             Fayetteville, GA 30214

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Last Updated: June 9, 2003
Requests for RUSH or EXPEDITED approvals may be delivered to any member of the Board of Directors.
Please allow 7 days turnaround time for a determination on such requests.

Important Notice: For your protection, inquire with the city and/or county about permit requirements
before starting any work on your property involving new construction, alterations, modifications or

Approval of any structure by the Canterbury Homeowners Association Board of Directors is in no way a
certification that the structure has been built in accordance with any governmental regulation(s) or that the
structure complies with sound building practice or design.

Neither declarant, the association, the board, nor the officers, directors, members, employees and agents or
any of them shall be liable in damages to anyone submitting plans and specifications to any of them for
approval, or to any owner of property affected by the declaration by reason of mistake in judgment,
negligence or nonfeasance arising out of or in connection with the approval or disapproval or failure to
approve or disapprove any such plans or specifications; nor shall any of them assume liability or
responsibility for any defect in any structure constructed from any such plans and specifications.

Canterbury homeowner hereby acknowledges that he/she has read both pages of this form.

 Signature:                                                                          Date:

Board Determination:

         Plan Accepted

         Plan Accepted with Specific Conditions:

         Plan Denied with Explanation:

         Plan Pending:

Board President
 Signature:                                                                          Date:

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Last Updated: June 9, 2003

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