HISTORIC PRESERVATION RESOURCE IDENTIFICATION FORM

**You must have the instructions and the code sheets to complete this form.**

 

TYPE ALL ENTRIES:

1.   PROPERTY NAME:                                        

2.   RESOURCE NAME:                                        

3.   ADDRESS:                                              

4.   CITY:                                                 

5.   VICINITY:                                             

6.   COUNTY:                                               

7.   COUNTY CODE:                                          

8.   LOT:                                                  

9.   BLOCK:                                                

10.  PLAT NAME:                                            

11.  SECTION:                                              

12.  TOWNSHIP:                                             

13.  RANGE:                                                

 

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14.  RESOURCE TYPE:                                        

15.  HISTORIC FUNCTION:                                    

16.  CURRENT FUNCTION:                                     

17.  AREA OF SIGNIFICANCE, PRIMARY:                        

18.  AREA OF SIGNIFICANCE, SECONDARY:                      

19.  DESCRIPTION OF SIGNIFICANCE:                          

                                                      

                                                      

20.  DOCUMENTATION SOURCES:                                

                                                      

                                                      

                                                      

                                                      

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21.  NAME OF PREPARER:                                     

22.  THEMATIC SURVEY PROJECT:      PROJECT NAME:          

                                                           

23.  DATE OF PREPARATION:                                  

24.  PHOTOGRAPHS:             YEAR:                         

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                                            Revised 12/01/89

BUILDING CONSTRUCTION DESCRIPTION

 

25.  ARCHITECT/BUILDER:                                    

26.  YEAR BUILT:                                           

27.  ORIGINAL SITE?     DATE MOVED:                        

     FROM WHERE?                                           

28.  ACCESSIBLE?                                           

29.  ARCHITECTURAL STYLE:                                  

30.  FOUNDATION MATERIAL:                                  

31.  ROOF TYPE:                                            

32.  ROOF MATERIAL:                                        

33.  WALL MATERIAL, PRIMARY:                               

34.  WALL MATERIAL, SECONDARY:                             

35.  WINDOW TYPE:                                          

36.  WINDOW MATERIAL:                                      

37.  DOOR TYPE:                                            

38.  DOOR MATERIAL:                                        

39.  EXTERIOR FEATURES:                                    

40.  INTERIOR FEATURES:                                    

41.  DECORATIVE DETAILS:                                   

42.  CONDITION OF RESOURCE:                                

 

43.  DESCRIPTION OF RESOURCE (Present & Historic):         

                                                     

                                                      

                                                      

                                                      

 

44.  COMMENTS:                                             

                                                      

                                                      

                                                      

                                                      

                                                      

                                                      

 

45.  PLACEMENT: