HomeMy WebLinkAboutApplication for Landmark Designation HISTORIC PRESERVATION COMMISSION
SOUTHOLD TOWN
APPLICATION FOR LISTING ON THE
SO[ITHOLD TOWN RFGISTFR OF DESIGNATED LANDMARKS
BUILDING-STRUCTURE INVENTORY FORM
DATE:
OWNER'S/SPONSOR'S NAME:
ADDRESS:
CITY/STATE/ZIP: PHONE:
ORGANIZATION (If any):
IDENTIFICATION
1. Building Name (How commonly identified):
2. Address:
3. County: Town: Village:
4. County Tax Map Number: Section: Block Lot
( 5. Ownership: a. Public b. Private
6. Present Occupant:
7. Use: Original: Present:
8. -Accessibility to Public: Exterior visible from public road: _Yes _No Interior
accessible: (Explain, i.e. By appointment)
DESCRIPTION
1. Building Materials: a. —Shingles b. _Clapboards c. _Stone
d. _Bricks e._Stucco f._Board and Batten
2. Structural System: a.—Wood frame b. _Masonry load bearing walls
C. _Metal d. _Other
3. Condition: a._ Excellent b. _Good c. _Fair d. _Deteriorated
4. Integrity: a._On original site b. _Moved If so, when?
c. List major alterations and dates, if known: .
RELATED OUTBUILDINGS AND PROPERTY
a. _Barn b. —Carriage House c. _Garage d. _Privy e. _Shed
f. _ Greenhouse g. _Shop h. —Gardens i. _Fence
j. _Landscape Features k. _Other (Explain):
THREATS TO BUILDING
a. —None Known b. _Zoning c. _Roads d. _Developers
e. —Deterioration f. _Other (Explain)
. a✓ `
2
OTHER NOTABLE FEATURES OF BUILDING AND SITE(including interior features,
if known; indicate if building or structure is in an historic district):
SIGNIFICANCE
1. Date(s) of Initial Construction and Major Alterations, if any:
2. Architect:
3. Builder:
4. Historical and Architectural Importance, i.e. famous residents, special events
took place, etc.
5. Is structure, place or site presently on any historic register that you know of? If
so, which one(s) and on what date (s)?
MISCELLANEOUS DATA
In your estimation, why should this property be designated a Southold Town
Landmark?
SOURCES OF INFORMATION(Individuals other than owner/applicant, maps, etc.):
Attach photos of facades of building/structure/site visible from a public street as
well as of significant interior features, i.e. fireplaces, mantles, stairs, etc. as
appropriate.
Attach Survey Map or Sketch of Location.
AGREEMENT
It is understood that by the riling of this application,and following the inspection and
evaluation of the property recommended for landmark status, that you are requesting the services
of the Southold Town Historic Preservation Commission to help you conserve,protect and
preserve your historic property. Neither the Commission nor the Town has fiduciary
responsibilities for any recommendations it might make to you to accomplish these conservation
goals. The Commission's recommendations to you are not binding, but non-conformance with
these recommendations could result in denial or revocation of Southold Town landmark status.
Signature (s) of Applicant(s):
Date:
Forward completed application with required attachments to Southold Town
Historic Preservation Commission, Town Hall, P.O. Box 1179, Southold, NY 11971
APPLICATION FOR LISTING ON THE
SOUTHOLD TOWN REGISTER OF DESIGNATED LANDMARKS
TRANSMITTAL/ROUTING SHEET FOR
BUILDING-STRUCTURE IAIVENTORY FORM
(For Office Use Only)
1. Date Received:
2. Date Initially Reviewed by Commission:
3. Date Scheduled for Inspection:
4. Date Inspected:
5. Inspection Team:
6. Comments of Inspection Team:
7. Recommendation:
8. Date of Final Review by Commission:
9. Action: Approved Denied
Date Submitted to Town Clerk for Official Notice:
10. Date Applicant Notified:
11. Date Plaque Presented at Meeting of Town Board: