La SHPO Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Personnel

Location and Geographic Information

• Name of Property

• Address

• Parish

• Locality:<br>

  City

  Community

  Vicinity

  Rural

• City/Community/Vicinity of:

• Topo Quad

  Yes

  No

  N/A

• Quad Size

  7.5

  15

• Range

• Township

• Section

• Lat/Lon Coordinate
  Address

• UTM Coordinate

• Owner Name:

• Owner Address:

• Tax Parcel

PROPERTY INFORMATION

• Type:

  Site

  Structure

  Building

  Object

• Level of Recognition:

  Select NHL NR Individual NR district/element DOE Local None

  • NHL
  • NR Individual
  • NR district/element
  • DOE
  • Local
  • None

• Previously surveyed?

  Yes

  No

• If Yes, When: Records Located Where?

• Govt Preservation Activity

  Select Section 106 Grant Tax Credit Local Ord. Other

  • Section 106
  • Grant
  • Tax Credit
  • Local Ord.
  • Other

• HABS

  Off

  On

• HAER

  Off

  On

• HALS

  Off

  On

• NR Eligibility

  Potential Individual

  Potential District

  Ineligible

• Condition:

  Excellent

  Good

  Fair

  Poor

  Ruin

• Remark:

• Integrity

  Select Unaltered Altered (Historic) Altered (Non-Historic)

  • Unaltered
  • Altered (Historic)
  • Altered (Non-Historic)

• Remark:

• Threats:

  Select Abandonment Neglect Alteration Development Government Action None

  • Abandonment
  • Neglect
  • Alteration
  • Development
  • Government Action
  • None

• Remark:

Date of Construction

• Construction Year

• Exact or Circa?

  Circa

  Exact

• Moved?

  Yes

  No

• When moved?

HISTORIC Function and Use

• Click on Category and Check all that apply for Historic Function & Use

• Historic Uses: Domestic

  Select Single Dwelling Secondary Structure Servant Quarter Multiple Dwelling Hotel Institutional Housing Camp

  • Single Dwelling
  • Secondary Structure
  • Servant Quarter
  • Multiple Dwelling
  • Hotel
  • Institutional Housing
  • Camp

• Historic Uses: Commerce / Trade

  Select Business Professional Organizational Financial Institution Specialty Store Department Store Restaurant Warehouse

  • Business
  • Professional
  • Organizational
  • Financial Institution
  • Specialty Store
  • Department Store
  • Restaurant
  • Warehouse

• Historic Uses: Institutional

  Select Capitol City Hall Correctional Facility Fire Station Government Office Custom House Post Office Public Works Courthouse Meeting Hall Clubhouse Civic School College Library Research Facility Religious Facility Church School

  • Capitol
  • City Hall
  • Correctional Facility
  • Fire Station
  • Government Office
  • Custom House
  • Post Office
  • Public Works
  • Courthouse
  • Meeting Hall
  • Clubhouse
  • Civic
  • School
  • College
  • Library
  • Research Facility
  • Religious Facility
  • Church School

• Historic Uses: Recreation / Culture / Landscape

  Select Theater Auditorium Museum Sports Facility Outdoor Recreation Fair Monument / Marker Work of Art Park Plaza Garden

  • Theater
  • Auditorium
  • Museum
  • Sports Facility
  • Outdoor Recreation
  • Fair
  • Monument / Marker
  • Work of Art
  • Park
  • Plaza
  • Garden

• Historic Uses: Agriculture / Subsistence

  Select Processing Storage Animal Facility Fishing Facility Horticultural Facility Irrigation Facility

  • Processing
  • Storage
  • Animal Facility
  • Fishing Facility
  • Horticultural Facility
  • Irrigation Facility

• Historic Uses: Industry

  Select Manufacturing Extractive Facility Waterworks Communication Facility Processing Site Energy Production

  • Manufacturing
  • Extractive Facility
  • Waterworks
  • Communication Facility
  • Processing Site
  • Energy Production

• Historic Uses: Defense

  Select Arms Storage Fortification Military Facility Coast Guard Facility Battle Site

  • Arms Storage
  • Fortification
  • Military Facility
  • Coast Guard Facility
  • Battle Site

• Historic Uses: Transportation

  Select Rail-related Air-related Water-related Road-related Pedestrian-related

  • Rail-related
  • Air-related
  • Water-related
  • Road-related
  • Pedestrian-related

• Historic Uses: Unknown, Vacant, Other

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If Other, describe:

PRESENT Function and Use

• Click on Category and Check all that apply for Present Function & Use

• Present Uses: Domestic

  Select Single Dwelling Secondary Structure Servant Quarter Multiple Dwelling Hotel Institutional Housing Camp

  • Single Dwelling
  • Secondary Structure
  • Servant Quarter
  • Multiple Dwelling
  • Hotel
  • Institutional Housing
  • Camp

• Present Uses: Commerce / Trade

  Select Business Professional Organizational Financial Institution Specialty Store Department Store Restaurant Warehouse

  • Business
  • Professional
  • Organizational
  • Financial Institution
  • Specialty Store
  • Department Store
  • Restaurant
  • Warehouse

• Present Uses: Institutional

  Select Capitol City Hall Correctional Facility Fire Station Government Office Custom House Post Office Public Works Courthouse Meeting Hall Clubhouse Civic School College Library Research Facility Religious Facility Church School

  • Capitol
  • City Hall
  • Correctional Facility
  • Fire Station
  • Government Office
  • Custom House
  • Post Office
  • Public Works
  • Courthouse
  • Meeting Hall
  • Clubhouse
  • Civic
  • School
  • College
  • Library
  • Research Facility
  • Religious Facility
  • Church School

• Present Uses: Recreation / Culture / Landscape

  Select Theater Auditorium Museum Sports Facility Outdoor Recreation Fair Monument / Marker Work of Art Park Plaza Garden

  • Theater
  • Auditorium
  • Museum
  • Sports Facility
  • Outdoor Recreation
  • Fair
  • Monument / Marker
  • Work of Art
  • Park
  • Plaza
  • Garden

• Present Uses: Agriculture / Subsistence

  Select Processing Storage Animal Facility Fishing Facility Horticultural Facility Irrigation Facility

  • Processing
  • Storage
  • Animal Facility
  • Fishing Facility
  • Horticultural Facility
  • Irrigation Facility

• Present Uses: Industry

  Select Manufacturing Extractive Facility Waterworks Communication Facility Processing Site Energy Production

  • Manufacturing
  • Extractive Facility
  • Waterworks
  • Communication Facility
  • Processing Site
  • Energy Production

• Present Uses: Defense

  Select Arms Storage Fortification Military Facility Coast Guard Facility Battle Site

  • Arms Storage
  • Fortification
  • Military Facility
  • Coast Guard Facility
  • Battle Site

• Present Uses: Transportation

  Select Rail-related Air-related Water-related Road-related Pedestrian-related

  • Rail-related
  • Air-related
  • Water-related
  • Road-related
  • Pedestrian-related

• Present Uses: Unknown, Vacant, Other

  Select Yes No N/A

  • Yes
  • No
  • N/A

• If Other, describe:

Form and Dimension

• Form

  Select Single Pen Shotgun Double Shotgun Camelback Hall-Parlor Saddlebag Creole Cottage Dog Trot Central-Hall Gable-Ell Bungalow Pyramidal Cottage Queen Anne Cottage Central-Hall, 2 Pile Cottage Bluffland Cottage Central-Hall L-House Double-Pen L-House Hall-Parlor L-House Creole House Central-Hall, 2 Piie House Queen Anne house Four Square Minimal tradition cottage Split Level Ranch Row House Warehouse Depot Skyscraper Commercial row building Freestanding Commercial Single-crib Barn Transverse-crib Barn Other

  • Single Pen
  • Shotgun
  • Double Shotgun
  • Camelback
  • Hall-Parlor
  • Saddlebag
  • Creole Cottage
  • Dog Trot
  • Central-Hall
  • Gable-Ell
  • Bungalow
  • Pyramidal Cottage
  • Queen Anne Cottage
  • Central-Hall, 2 Pile Cottage
  • Bluffland Cottage
  • Central-Hall L-House
  • Double-Pen L-House
  • Hall-Parlor L-House
  • Creole House
  • Central-Hall, 2 Piie House
  • Queen Anne house
  • Four Square
  • Minimal tradition cottage
  • Split Level
  • Ranch
  • Row House
  • Warehouse
  • Depot
  • Skyscraper
  • Commercial row building
  • Freestanding Commercial
  • Single-crib Barn
  • Transverse-crib Barn
  • Other

• Describe if Other

• Shape

  Select H U T L Cruciform Rectangle Other

  • H
  • U
  • T
  • L
  • Cruciform
  • Rectangle
  • Other

• Describe if Other

• Symmetrical / Vertical / Horizontal

  Select Symmetrical Asymmetrical Vertical Horizontal

  • Symmetrical
  • Asymmetrical
  • Vertical
  • Horizontal

• Dimension: Height

  Select 1 1.5 2 2.5 3 3+

  • 1
  • 1.5
  • 2
  • 2.5
  • 3
  • 3+

• Dimension: Width

  Select 1 1.5 2 2.5 3 4 5-10 10-20 20+

  • 1
  • 1.5
  • 2
  • 2.5
  • 3
  • 4
  • 5-10
  • 10-20
  • 20+

• Dimension: Depth

  Select 1 1.5 2 2.5 3 4 5-10 10-20 20+

  • 1
  • 1.5
  • 2
  • 2.5
  • 3
  • 4
  • 5-10
  • 10-20
  • 20+

Style

• Degree of Style

  High Style

  Elements of...

  No Style

• Dominant Style

  Select Creole / French Colonial Federal Greek Revival Gothic Revival Italian Villa Exotic Revival Victorian Gothic Italianate Second Empire Eastlake/Stick Queen Anne Shingle Style Romanesque Renaissance Colonial Revival Beau Arts Classical Revival Tudor Revival Late Gothic Revival Mission Italian Renaissance French Renaissance Prairie Commercial Style Chicago Craftsman Skyscraper Moderne Art Deco International Other

  • Creole / French Colonial
  • Federal
  • Greek Revival
  • Gothic Revival
  • Italian Villa
  • Exotic Revival
  • Victorian Gothic
  • Italianate
  • Second Empire
  • Eastlake/Stick
  • Queen Anne
  • Shingle Style
  • Romanesque
  • Renaissance
  • Colonial Revival
  • Beau Arts
  • Classical Revival
  • Tudor Revival
  • Late Gothic Revival
  • Mission
  • Italian Renaissance
  • French Renaissance
  • Prairie
  • Commercial Style
  • Chicago
  • Craftsman
  • Skyscraper
  • Moderne
  • Art Deco
  • International
  • Other

• If Other, Describe

Construction and Materials

• Exterior Materials

  Select Log (note dressing) Clapboard / Weatherboard Drop / Novelty Siding Flush Horizontal Board Vertical Board Board and Batten Wood Shingle Exposed Bousillage Stucco Brick (note bond) Stone (note dressing) Concrete Block Decorative Concrete Block Poured Concrete Wall Pigmented Glass Glass Block Terra Cotta Glazed Brick/Tile/Block Sheet Metal Enamelled Steel Asbestos Aluminum / Vinyl Siding Asphalt Reconstituted Wood Siding Permastone Other (see narrative) Unknown

  • Log (note dressing)
  • Clapboard / Weatherboard
  • Drop / Novelty Siding
  • Flush Horizontal Board
  • Vertical Board
  • Board and Batten
  • Wood Shingle
  • Exposed Bousillage
  • Stucco
  • Brick (note bond)
  • Stone (note dressing)
  • Concrete Block
  • Decorative Concrete Block
  • Poured Concrete Wall
  • Pigmented Glass
  • Glass Block
  • Terra Cotta
  • Glazed Brick/Tile/Block
  • Sheet Metal
  • Enamelled Steel
  • Asbestos
  • Aluminum / Vinyl Siding
  • Asphalt
  • Reconstituted Wood Siding
  • Permastone
  • Other (see narrative)
  • Unknown

• Roof Form

  Select Front Gable Side Gable Parapet Gable Stepped Gable Clipped Gable Cross Gable Gambrel Hip Double Pitch Hip Gable on Hip Pyramidal Mansard Complex Round Conical Flat Shed Other (see narrative) Unknown

  • Front Gable
  • Side Gable
  • Parapet Gable
  • Stepped Gable
  • Clipped Gable
  • Cross Gable
  • Gambrel
  • Hip
  • Double Pitch Hip
  • Gable on Hip
  • Pyramidal
  • Mansard
  • Complex
  • Round
  • Conical
  • Flat
  • Shed
  • Other (see narrative)
  • Unknown

• Roof Pitch

  Select Low Pitch Moderate Pitch Steep Pitch w/ Parapet Wall

  • Low Pitch
  • Moderate Pitch
  • Steep Pitch
  • w/ Parapet Wall

• Roof Materials

  Select Wood Shingles Slate Asphalt Shingle Asbestos Metal Ceramic / Terra Cotta Tile Built Up Other Unknown

  • Wood Shingles
  • Slate
  • Asphalt Shingle
  • Asbestos
  • Metal
  • Ceramic / Terra Cotta Tile
  • Built Up
  • Other
  • Unknown

• Yes

  No

  N/A

• Chimney(s)

  Select Gable End Exterior Gable End Interior/Flush Ridge Center Ridge Off-Center Slope Center Slope Off-Center Lateral Exterior Removed Other Unknown

  • Gable End Exterior
  • Gable End Interior/Flush
  • Ridge Center
  • Ridge Off-Center
  • Slope Center
  • Slope Off-Center
  • Lateral Exterior
  • Removed
  • Other
  • Unknown

• Doors & Surrounds

  Select Batten French Panel Flush Glazed Partially Glazed Fanlight Sidelights Transom Screened Replacement Unknown Federal Greek Revival Queen Anne Other

  • Batten
  • French
  • Panel
  • Flush
  • Glazed
  • Partially Glazed
  • Fanlight
  • Sidelights
  • Transom
  • Screened
  • Replacement
  • Unknown
  • Federal
  • Greek Revival
  • Queen Anne
  • Other

• Number of Doors

• Doors Comment

• Porch

  Select Stoop Verandah Gallery Portico Balcony Loggia Porte-Cochere Full Width Partial Width Attached Integrated Wrap Peripheral Screened Enclosed Unknown Other

  • Stoop
  • Verandah
  • Gallery
  • Portico
  • Balcony
  • Loggia
  • Porte-Cochere
  • Full Width
  • Partial Width
  • Attached
  • Integrated
  • Wrap
  • Peripheral
  • Screened
  • Enclosed
  • Unknown
  • Other

• Secondary Porch

  Select Stoop Verandah Gallery Portico Balcony Loggia Porte-Cochere Full Width Partial Width Attached Integrated Wrap Peripheral Screened Enclosed Unknown Other

  • Stoop
  • Verandah
  • Gallery
  • Portico
  • Balcony
  • Loggia
  • Porte-Cochere
  • Full Width
  • Partial Width
  • Attached
  • Integrated
  • Wrap
  • Peripheral
  • Screened
  • Enclosed
  • Unknown
  • Other

• Porch Comments

• Windows

  Select Batten Fixed Single Fixed Divided Single-Hung Double-Hung Triple-Hung Bay Oriel Palladian Casement Sliding Replacement Unknown Other

  • Batten
  • Fixed Single
  • Fixed Divided
  • Single-Hung
  • Double-Hung
  • Triple-Hung
  • Bay
  • Oriel
  • Palladian
  • Casement
  • Sliding
  • Replacement
  • Unknown
  • Other

• Window Panes

  Select 1/1 2/2 4/4 6/6 9/9 12/12 2/1 3/1 4/1 6/1 9/1 12/1 9/6 Stained Diamond Unknown Other

  • 1/1
  • 2/2
  • 4/4
  • 6/6
  • 9/9
  • 12/12
  • 2/1
  • 3/1
  • 4/1
  • 6/1
  • 9/1
  • 12/1
  • 9/6
  • Stained
  • Diamond
  • Unknown
  • Other

• Windows Comment

• Foundation

  Select Post in Ground Sill on Ground Wooden Pier Brick Pier Concrete Block Pier Concrete Pylon Pier Continuous Brick Continuous Concrete Block Concrete Slab Unknown

  • Post in Ground
  • Sill on Ground
  • Wooden Pier
  • Brick Pier
  • Concrete Block Pier
  • Concrete Pylon Pier
  • Continuous Brick
  • Continuous Concrete Block
  • Concrete Slab
  • Unknown

• Foundation Infill

  Select Stone Infill Brick Infill Concrete Block Infill

  • Stone Infill
  • Brick Infill
  • Concrete Block Infill

• Construction

  Select Post in Ground Post on Sill Log (note notch0 Hewn Log French Timber Frame Eastern Timber Frame Balloon Frame Unknown Wood Frame Load Bearing Brick Load Bearing Stone Load Bearing Concrete Block Reinforced Concrete Steel Frame/ Curtain Wall Unknown Construction

  • Post in Ground
  • Post on Sill
  • Log (note notch0
  • Hewn Log
  • French Timber Frame
  • Eastern Timber Frame
  • Balloon Frame
  • Unknown Wood Frame
  • Load Bearing Brick
  • Load Bearing Stone
  • Load Bearing Concrete Block
  • Reinforced Concrete
  • Steel Frame/ Curtain Wall
  • Unknown Construction

• Construction Infill

  Yes

  No

  N/A

Additions and Alterations

• Alteration Date and Description

• Alteration Impact

  Insignificant

  Moderate

  Severe

• Alteration Date and Description

• Alteration Impact

  Insignificant

  Moderate

  Severe

• Alteration Date and Description

• Alteration Impact

  Insignificant

  Moderate

  Severe

• Alteration Date and Description

• Alteration Impact

  Insignificant

  Moderate

  Severe

Photos

• Front View

  Media

• Oblique View

  Media

• Optional Photo 1

  Media

• Optional Photo 2

  Media

• Optional Photo 3

  Media

Narrative and History

• Narrative

• History

• Sources

Outbuildings

• Outbuilding #1 Type

  Select Single Crib Barn Double Crib Barn Transverse-Crib Barn Storage / Misc. Shed Smoke House Spring / Well House Corn Crib Coop Quarters Garcconier Piegeonnier Kitchen Office Machine Shed Garage Privy Stable Other

  • Single Crib Barn
  • Double Crib Barn
  • Transverse-Crib Barn
  • Storage / Misc. Shed
  • Smoke House
  • Spring / Well House
  • Corn Crib
  • Coop
  • Quarters
  • Garcconier
  • Piegeonnier
  • Kitchen
  • Office
  • Machine Shed
  • Garage
  • Privy
  • Stable
  • Other

• Date:

• Comment

• Outbuilding #1 Photo

  Media

• Outbuilding #2 Type

  Select Single Crib Barn Double Crib Barn Transverse-Crib Barn Storage / Misc. Shed Smoke House Spring / Well House Corn Crib Coop Quarters Garcconier Piegeonnier Kitchen Office Machine Shed Garage Privy Stable Other

  • Single Crib Barn
  • Double Crib Barn
  • Transverse-Crib Barn
  • Storage / Misc. Shed
  • Smoke House
  • Spring / Well House
  • Corn Crib
  • Coop
  • Quarters
  • Garcconier
  • Piegeonnier
  • Kitchen
  • Office
  • Machine Shed
  • Garage
  • Privy
  • Stable
  • Other

• Date:

• Comment

• Outbuilding #2 Photo

  Media

• Outbuilding #3 Type

  Select Single Crib Barn Double Crib Barn Transverse-Crib Barn Storage / Misc. Shed Smoke House Spring / Well House Corn Crib Coop Quarters Garcconier Piegeonnier Kitchen Office Machine Shed Garage Privy Stable Other

  • Single Crib Barn
  • Double Crib Barn
  • Transverse-Crib Barn
  • Storage / Misc. Shed
  • Smoke House
  • Spring / Well House
  • Corn Crib
  • Coop
  • Quarters
  • Garcconier
  • Piegeonnier
  • Kitchen
  • Office
  • Machine Shed
  • Garage
  • Privy
  • Stable
  • Other

• Date:

• Comment

• Outbuilding #3 Photo

  Media

• Outbuilding #4 Type

  Select Single Crib Barn Double Crib Barn Transverse-Crib Barn Storage / Misc. Shed Smoke House Spring / Well House Corn Crib Coop Quarters Garcconier Piegeonnier Kitchen Office Machine Shed Garage Privy Stable Other

  • Single Crib Barn
  • Double Crib Barn
  • Transverse-Crib Barn
  • Storage / Misc. Shed
  • Smoke House
  • Spring / Well House
  • Corn Crib
  • Coop
  • Quarters
  • Garcconier
  • Piegeonnier
  • Kitchen
  • Office
  • Machine Shed
  • Garage
  • Privy
  • Stable
  • Other

• Date:

• Comment

• Outbuilding #4 Photo

  Media

Site Plan

• Drawing of Site Plan

  Drawing

• JPG of GIS Site Plan

  Media