Historic inventory form

• Survey Name

• Client / Site

• Prepared by

• Personnel

Survey Information

• Survey Number

• Survey Name

• County

• Automatic Date & Time

  Date

Location

• Address & Lat/Lon Coordinates
  Address

• Township Range Section (T: R: S: )

Structure / Location Information

• Historic Name (if known)

• Present / Other Name (if known)

• Ownership

  Private

  Public

• Historic use (if known)

• Current use

Historical Information

• Construction Date

• Significant Date / Period

• Areas of Significance

• Architect

• Builder / Contractor

• Original or Significant Owner

• Previously Surveyed?

  Yes

  No

  N/A

• Previous Survey Name & Number

• On National Register?

  Individual

  District

  n/a

• District Potential

  C

  NC

• National Register Eligible?

  Select individually Eligible District Potential Not Eligible Not Determined

  • individually Eligible
  • District Potential
  • Not Eligible
  • Not Determined

• History & Significance on Continuation Page?

  Yes

  No

  N/A

• Sources of Information on Continuation Page?

  Yes

  No

  N/A

Other Information

• Current Owner / Address

• Form Prepared By: (Name & Organization)

• Survey Date

  Date

• Revision Date

Architectural Information

• Category of Property

  Building(s)

  Site

  Structure

  Object

• Additional Info

• Vernacular or Property Type

• Architectural Style

• Plan Shape

• Number of Stories

• Number of Bays (first floor)

• Roof Type

• Roof Material

• Chimney Placement

• Structural System

• Exterior Wall Cladding

• Foundation Material

• Basement Type

• Front Porch Type / Replacement

• Windows

  Historic

  Replacement

• Window Pane Arrangement

  Drawing

• Acreage (rural)

• Visible from public road?

  Yes

  No

  N/A