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Building Name: Historic Name:
Owners:
Present Use: Historic Use:
Building Style:
Construction Date After: Construction Date Before:

Materials

Clapboard Asbestos Siding
Brick Brick Foundation
Wood Shingle Asphalt Siding
Fieldstone Other
Board & Batten
Stucco Cobblestone
Aluminum Siding Concrete
Concrete type: Cut Stone
Cut Stone type:

Structural System

Wood Frame Post and Beam
Balloon Load Bearing Masonry
Structural Iron or Steel Other
Explain::

Roof

Gable Flat
Mansard Monitor
Sawtooth Gambrel
Shed Hip
Round Wood Shingle
Roll Asphalt Tin
Slate Asphalt Shingle
Built Up Tile
Other Explain:
Stories: Dimensions:

Structural Condition

Excellent Good
Fair Deteriorated

Exterior Condition

Excellent Good
Fair Deteriorated
Location Moved When:
Alterations Explain:

Outbuildings

Barn Shed
Garage Carriage House
Shop Garden
Other Explain:

Environment

Open Land Woodland
Residential Commercial
Industrial Rural
Scattered Buildings High Building Density
Interrelationship of Building and Surroundings:
Features:
Architect: Builder:
Importance: Sources:

Threats

None Highways
Vandalism Developers
Renewal Private
Deterioration Zoning
Other
Explanation: