Maine Historic Preservation Commission Historic Building/structure Survey Form

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SURVEY MAP NO .
SURVEY MAP NAME
MHPC USE ONLY
INVENTORY NO .
MAINE HISTORIC PRESERVATION COMMISSION
Historic Building/Structure Survey Form
1. PROPERTY NAME (HISTORIC) :
2. PROPERTY NAME (OTHER) :
3. STREET ADDRESS :
4. TOWN :
5. COUNTY :
6 . DATE RECORDED:
7. SURVEYOR:
8. OWNER NAME :
ADDRESS :
9 . PRIMARY USE (PRESENT):
SINGLE FAMILY
AGRICULTURE
COMMERCIAL/TRADE
FUNERARY
-
MULTI-FAMILY - GOVERNMENTAL - EDUCATION - HEALTH CARE
- INDUSTRY
- RELIGIOUS
- HOTEL
- LANDSCAPE
TRANSPORTATION
- DEFENSE
- SUMMER COTTAGE/CAMP
- SOCIAL
_ - RECREATION/CULTURE
- UNKNOWN
OTHER
10 . CONDITION : _ GOOD _ FAIR _ POOR _ DESTROYED, DATE
/ /
ARCHITECTURAL DATA
11 . PRIMARY STYLISTIC CATEGORY:
COLONIAL
- FEDERAL
GREEK REVIVAL
-
GOTHIC REVIVAL
- ITALIANATE
SECOND EMPIRE
12 . OTHER STYLISTIC CATEGORY:
COLONIAL
FEDERAL
-
GREEK REVIVAL
_
GOTHIC REVIVAL
- ITALIANATE
_SECOND EMPIRE
STICK STYLE
- _ QUEEN ANNE
SHINGLE STYLE
-
R. ROMANESQUE
-
ROMANESQUE
-- HIGH VIC . GOTHIC
STICK STYLE
_
_ QUEEN ANNE
SHINGLE STYLE
-
R. ROMANESQUE
-
ROMANESQUE
_ HIGH VIC . GOTHIC
NEO-CLASSICAL REV .
FOUR SQUARE
RENAISSANCE REV . - ART DECO
- 19TH/20TH C . REVIVAL
INTERNATIONAL
- ARTS & CRAFTS
- RANCH
BUNGALOW
IT
VERNACULAR
OTHER
- NEO-CLASSICAL REV.
FOUR SQUARE
RENAISSANCE REV . - ART DECO
- 19TH/20TH C . REVIVAL
INTERNATIONAL
- ARTS & CRAFTS
- RANCH
-
BU R NGALOW - VERNACULAR
OTHE
13 . HEIGHT :
1 STORY
-
5 STORY
11/2
STORY
2 STORY
_OVER 5(
)-
_ 21/2 STORY _ 3 STORY _ 4 STORY
14 . PRIMARY FACADE WIDTH (MAIN BLOCK ; USE GROUND FLOOR):
_ 1 BAY
_ 2 BAY
_ 3 BAY
_ 4 BAY
5 BAY
MORE THAN 5 (
)
15 . APPENDAGES:
SIDE ELL
REAR ELL
FRONT
- DORMERS - PORCH
- TOWER
ADDED STORIES
SHED
- CUPOLA
_ BAY WINDOW
PHOTOGRAPH :

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